5 XVFPSVK
5 XVFPSVK
5 XVFPSVK
PAYER'S name, street address, city, state, ZIP code and telephone number Payer's RTN (optional) OMB No. 1545-0112
2011
Form 1099-INT
Interest Income
Copy B For Recipient
06-0634736
136-80-2656
141.75
3 Interest on U.S. Savings Bonds and Treas. obligations
RECIPIENT'S name, address (including apt. no.), city, state and ZIP code
$
4 Federal income tax withheld
0.00 $
0.00
5 Investment expenses
$
6 Foreign tax paid
0.00 $
0.00
$
8 Tax-exempt interest Account number (see instructions) 9 Specified private activity bond interest
0.00
10 Tax-exempt bond CUSIP no. (see instructions)
312480172-00 Form
$
Substitute Form
0.00 $
0.00
This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
1099-INT