FORM 1099 S 1098T TUITION PAYMENTS STATEMENT 1098E

FORM 1099 S
If you are required to report a real estate transaction, you must file Form 1099S to report the sale or exchange of one-to-four-family real estate.
NOTE: The Energy Policy Act of 1992 amended section 6045(e)(4) to require filers of Form 1099-S to report any real estate transactions involving a residence.
TC-S4
3
4
5
6
7
8
CONTINUOUS FORM NUMBERS
Carbonless FORM TC-S4
4-PART
Available
Self Seal
DW19S
9
10
11
12
13
14
15
16
17
18
19
20
SW19
Use Envelope
DW19 or
SW19
DW19
2
3
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1098T TUITION PAYMENTS STATEMENT
19
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An eligible educational institution, such as a college or university that receives qualified tuition and expenses on a student must furnish this statement.
27
28
29
30
T18T-1
__
4
OMB No. 1545-1574
14
$
5
2 Amounts billed for
qualified tuition and
related expenses
6
7
$
8
FILER’S federal identification no.
9
10
Form
Copy B
4 Adjustments made for a
prior year
5 Scholarships or grants
$
$
6 Adjustments to
scholarships or grants
for a prior year
7 Checked if the amount
in box 1 or 2 includes
amounts for an
academic period
beginning January March 2014
12
13
14
15
__
16
$
17
4
VOID
CORRECTED
$
6
2 Amounts billed for
qualified tuition and
related expenses
8
9
4 Adjustments made for a
prior year
13
17
18
19
$
9 Check if a graduate
8 Check if at least
Service Provider/Acct. No. (see instr.)
student
half-time student
Form
1098-T
3
4
—
(keep for your records)
CORRECTED
8
10
$
FILER’S federal identification no.
Use Envelope
DW19 or
SW19
Department of the Treasury - Internal Revenue Service
15
4
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
5
$
6
2 Amounts billed for
qualified tuition and
related expenses
FILER’S federal identification no.
10
11
Form
13
Tuition
Statement
FORM PTM18T-2
9 Checked if a
20
Form
21
__
1098-T
10 Ins. contract reimb./refund
$
graduate student
(keep for your records)
Department of the Treasury - Internal Revenue Service
25
CORRECTED
8383
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
26
For
Internal Revenue
Service Center
27
$
28
File with Form 1096.
For Privacy Act and
Paperwork Reduction
Act Notice, see the
2014 General
Instructions for
Forms 1099, 1098,
10 Ins. contract reimb./refund
3921, 3922, 5498,
and W-2G.
$
30
2 Amounts billed for
qualified tuition and
related expenses
29
7 Check this box if the
amount in box 1 or 2
includes amounts for
an academic period
beginning January March 2014
OMB No. 1545-1574
14
$
FILER’S federal identification no.
__
2-PART PEEL-APART
Form
Tuition
Statement
1098-T
STUDENT’S social security number 3 If this box is checked, your educational institution
has changed its reporting method for 2009
Copy B
__
__
CORRECTED
8383
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
4
OMB No. 1545-1574
2014
$
5
2 Amounts billed for
qualified tuition and
related expenses
6
23
$
6 Adjustments to
scholarships or grants
for a prior year
MAILER FORM NUMBERS
PTM18T-2
3
For Student
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.
22
1098-T
5 Scholarships or grants
$
Street address (including apt. no.)
7 Checked if the amount
in box 1 or 2 includes
amounts for an
academic period
beginning January March 2014
Copy A
4 Adjustments made for a
prior year
STUDENT’S name
5 Scholarships or grants
$
6 Adjustments to
scholarships or grants
for a prior year
half-time student
24
STUDENT’S social security number 3 Check if you have changed your
reporting method for 2009
12
14
14
$
8
9
OMB No. 1545-1574
4 Adjustments made for a
prior year
$
8 Checked if at least
Service Provider/Acct. No. (see instr.)
18
19
Use Envelope
DW19 or
SW19
Copy B
$
16
DW19
__
3
7
Tuition
Statement
DW19
1098-T
12
13
14
Do Not Cut or Separate Forms on This Page
CORRECTED
Form
STUDENT’S social security number 3 If this box is checked, your educational institution
has changed its reporting method for 2009
STUDENT’S name, address, city and ZIP code
11
14
2 Amounts billed for
qualified tuition and
related expenses
7
9
SW19
OMB No. 1545-1574
$
6
17
VOID
8383
2
Department of the Treasury - Internal Revenue Service
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
5
SW19
41-1628061
Do Not Cut or Separate Forms on This Page
1098-T
8383
2
Available
Self Seal
DW19S
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act and
7 Check this box if the
Paperwork Reduction
amount in box 1 or 2
Act Notice, see the
includes amounts for
an academic period
2014 General
beginning January Instructions for
March 2014
Forms 1099, 1098,
10 Ins. contract reimb./refund
3921, 3922, 5498,
and W-2G.
$
City, state, and ZIP code
20
Form
Electronic
Filing
$
graduate student
__
$
6 Adjustments to
scholarships or grants
for a prior year
Street address (including apt. no.)
20
Tuition
Statement
1098-T
5 Scholarships or grants
$
15
16
Form
STUDENT’S social security number 3 Check if you have changed your
reporting method for 2009
STUDENT’S name
12
14
14
$
FILER’S federal identification no.
10
11
OMB No. 1545-1574
10 Ins. contract reimb./refund
9 Checked if a
half-time student
19
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
5
__
__
3
7
8 Checked if at least
Service Provider/Acct. No. (see instr.)
18
8383
Available
Self Seal
DW19S
7
$
8
FILER’S federal identification no.
9
10
Form
4 Adjustments made for a
prior year
5 Scholarships or grants
$
$
6 Adjustments to
scholarships or grants
for a prior year
7 Checked if the amount
in box 1 or 2 includes
amounts for an
academic period
beginning January March 2014
12
13
14
15
16
$
17
8 Checked if at least
Service Provider/Acct. No. (see instr.)
18
Form
1098-T
Copy B
For Student
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.
10 Ins. contract reimb./refund
9 Checked if a
graduate student
half-time student
19
20
Tuition
Statement
1098-T
STUDENT’S social security number 3 If this box is checked, your educational institution
has changed its reporting method for 2014
STUDENT’S name, address, city and ZIP code
11
__
__
__
__
__
For Student
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.
DETACH BEFORE MAILING
TC18T-4
CONTINUOUS FORM NUMBERS
T18T-1 1-PART
TC18T-44-PART
Tuition
Statement
1098-T
STUDENT’S social security number 3 If this box is checked, your educational institution
has changed its reporting method for 2009
STUDENT’S name, address, city and ZIP code
11
__
__
__
__
__
CORRECTED
8383
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
3
(keep for your records)
$
Department of the Treasury - Internal Revenue Service
__
CORRECTED
8383
2
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
3
OMB No. 1545-1574
1098-T
41-1628061
26
27
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page
$
6 Adjustments to
scholarships or grants
for a prior year
7 Checked if the amount
in box 1 or 2 includes
amounts for an
academic period
beginning January March 2014
$
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.
4
Service Provider/Acct. No. (see instr.)
VOID
8383
CORRECTED
OMB No. 1545-1574
2 Amounts billed for
qualified tuition and
related expenses
30
$
FILER’S federal identification no.
Form
4 Adjustments made for a
prior year
2 Amounts billed for
qualified tuition and
related expenses
6
7
$
8
FILER’S federal identification no.
9
10
STUDENT’S name, address, city and ZIP code
11
Form
6 Adjustments to
scholarships or grants
for a prior year
$
9 Check if a graduate
8 Check if at least
student
half-time student
Form
1098-T
41-1628061
Do Not Cut or Separate Forms on This Page
—
For
Internal Revenue
Service Center
File with Form 1096.
$
For Privacy Act and
7 Check this box if the
Paperwork Reduction
amount in box 1 or 2
Act Notice, see the
includes amounts for
an academic period
2014 General
beginning January Instructions for
March 2014
Forms 1099, 1098,
10 Ins. contract reimb./refund
3921, 3922, 5498,
and W-2G.
$
City, state, and ZIP code
Service Provider/Acct. No. (see instr.)
$
graduate student
(keep for your records)
Department of the Treasury - Internal Revenue Service
4 Adjustments made for a
prior year
5 Scholarships or grants
$
$
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page
TC18E-4
OMB No. 1545-1576
14
5
6
7
8
9
Form
RECIPIENT’S federal identification no.
BORROWER’S social security number
1
1099 FORMS
Street address (including apt. no.)
City, state, and ZIP code
17
18
2
Account number (see instructions)
19
20
Form
1098-E
2
3
Check if box 1 does not include loan origination
fees and/or capitalized interest, and the loan was
made before September 1, 2014
VOID
—
14
6
Contributions of
Motor Vehicles,
Boats, and
Airplanes
14
1 Date of contribution
Form 1098-C
DONEE’S federal identification
number
13
14
16
3 Vehicle or other identification number
DONOR’S identification
number
4a
17
Street address (including apt. no.)
4b Date of sale
City, state, and ZIP code
4c Gross proceeds from sale (see instructions)
Copy A
$
For
Internal Revenue
Service Center
5a
Donee certifies that vehicle will not be transferred for money, other property, or services before completion of material
improvements or significant intervening use
5b
Donee certifies that vehicle is to be transferred to a needy individual for significantly below fair market value in furtherance of
donee’s charitable purpose
5c Donee certifies the following detailed description of material improvements or significant intervening use and duration of use
6a Did you provide goods or services in exchange for the vehicle?
Yes
2
Account number (see instructions)
1098-E
Form
21
Do Not Cut or Separate Forms on This Page
Check if box 1 does not include loan origination
fees and/or capitalized interest, and the loan was
made before September 1, 2014
23
25
26
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Forms 1099,
1098, 3921, 3922,
5498, and W-2G.
27
VOID
RECIPIENT’S/LENDER’S name, address, and telephone number
OMB No. 1545-1576
14
29
Form
RECIPIENT’S federal identification no.
BORROWER’S social security number
1
BORROWER’S name
6b Value of goods and services provided in exchange for the vehicle
Street address (including apt. no.)
City, state, and ZIP code
7
Under the law, the donor may not claim a deduction of more than $500 for this vehicle if this box is checked
Account number (see instructions)
Form
1098-C
41-0852411
Department of the Treasury - Internal Revenue Service
Form
1098-E
2
4 Adjustments made for a
prior year
5 Scholarships or grants
$
$
6 Adjustments to
scholarships or grants
for a prior year
7 Checked if the amount
in box 1 or 2 includes
amounts for an
academic period
beginning January March 2014
8 Checked if at least
1098-T
9 Checked if a
Copy B
For Student
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.
10 Ins. contract reimb./refund
graduate student
(keep for your records)
$
Department of the Treasury - Internal Revenue Service
5498 ESA
Copy A
File with Form 1096.
For Privacy Act and
Paperwork Reduction
Act Notice, see the
2014 General
Instructions for
Forms 1099, 1098,
3921, 3922,
5498, and W-2G.
Coverdell ESA Contribution Information.
Contributions (including rollover contributions) to a Coverdell ESA.
Check if box 1 does not include loan origination
fees and/or capitalized interest, and the loan was
made before September 1, 2014
41-1628061
TC58ESA-4
Student
Loan Interest
Statement
3
4
1098-E
Student loan interest received by lender
$
$
6c Describe the goods and services, if any, that were provided. If this box is checked, donee certifies that the goods and services
consisted solely of intangible religious benefits
STUDENT’S social security number 3 If this box is checked, your educational institution
has changed its reporting method for 2014
STUDENT’S name, address, city and ZIP code
Do Not Cut or Separate Forms on This Page
CORRECTED
28
30
Tuition
1098-T
Department of the Treasury - Internal Revenue Service
41-1628061
22
24
FILER’S federal identification no.
Form
$
For
Internal Revenue
Service Center
—
$
half-time student
Student
Loan Interest
Statement
14
2 Amounts billed for
qualified tuition and
related expenses
Service Provider/Acct. No. (see instr.)
Use Envelope
DW19 or
SW19
OMB No. 1545-1574
$
Form
1098-E
Student loan interest received by lender
City, state, and ZIP code
20
File with Form 1096.
No
1
$
Street address (including apt. no.)
19
Donee certifies that vehicle was sold in arm’s
length transaction to unrelated party
BORROWER’S social security number
This form is used for charitable
contributions of motor vehicles.
18
DONOR’S name
RECIPIENT’S federal identification no.
BORROWER’S name
12
15
2 Make, model, and year of vehicle
Form
1098 C
8
9
Available
Self Seal
DW19S
Copy A
File with Form 1096.
For Privacy Act and
Paperwork Reduction
Act Notice, see the
2014 General
Instructions for
Forms 1099, 1098,
3921, 3922,
5498, and W-2G.
OMB No. 1545-1576
7
10
Department of the Treasury - Internal Revenue Service
CONTINUOUS FORM NUMBERS Statement
CarbonlessTC18E-4
4-PART
30
DW19
CORRECTED
RECIPIENT’S/LENDER’S name, address, and telephone number
5
11
$
CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
29
Do Not Cut or Separate Forms on This Page
4
__
graduate student
(keep for your records)
8383
28
Department of the Treasury - SW19
Internal Revenue Service
41-1628061
Do Not Cut or Separate Forms on This Page
OMB No. 1545-1959
1098-T
27
For
Internal Revenue
Service Center
BORROWER’S name
26
Student
Loan Interest
Statement
1098-E
Student loan interest received by lender
$
10
15
__
__
25
CORRECTED
RECIPIENT’S/LENDER’S name, address, and telephone number
4
16
CORRECTED
Form
7 Checked if the amount
in box 1 or 2 includes
amounts for an
academic period
beginning January March 2014
10 Ins. contract reimb./refund
23
VOID
3
9 Checked if a
half-time student
20
21
24
14
7878
$
8 Checked if at least
Service Provider/Acct. No. (see instr.)
Copy B
For Student
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.
22
__
13
DONEE’S name, street address, city, state, ZIP code, and telephone no.
15
17
12
__ __
6 Adjustments to
scholarships or grants
for a prior year
14
16
11
__
12
13
18
Tuition
Statement
1098-T
STUDENT’S social security number 3 If this box is checked, your educational institution
has changed its reporting method for 2014
19
Copy A
5 Scholarships or grants
$
Street address (including apt. no.)
1098-T
10 Ins. contract reimb./refund
1098-T
STUDENT’S social security number 3 Check if you have changed your
reporting method for 2009
STUDENT’S name
Form
9 Checked if a
Tuition
Statement
$
29
8 Checked if at least
half-time student
FILER’S name, street address, city, state, ZIP code, and telephone number 1 Payments received for
qualified tuition and
related expenses
28
5
Copy A
6
For
Internal Revenue
Service Center
7
File with Form 1096.
For Privacy Act and
Paperwork Reduction
Act Notice, see the
2014 General
Instructions for
Forms 1099, 1098,
3921, 3922,
5498, and W-2G.
Department of the Treasury - Internal Revenue Service
Available
Self Seal
DW19S
8
9
10
11
12
13
14
15
16
17
18
SW19
19
CONTINUOUS FORM NUMBERS
CarbonlessTC18C-4
4-PART
20
DW19
2
3
4
CONTINUOUS FORM NUMBERS
Carbonless FORM TC58ESA-4
4-PART
5
6
7
8
30
14
$
5
A financial institution, governmental unit or educational institution that is in the cause of trade or business, received interest of $600 or
more on a student loan in the calendar year must furnish this statement.
14
23
24
25
—
$
For Student
9
10
11
12
13
14
15
16
17
18
DETACH BEFORE MAILING
Form
Do Not Cut or Separate Forms on This Page
5 Scholarships or grants
•
22
student
half-time student
4 Adjustments made for a
prior year
Use Envelope
DW19 or
SW19
2009 FORM L18TB
21
9 Check if a graduate
8 Check if at least
Service Provider/Acct. No. (see instr.)
20
STUDENT’S name, address, city and ZIP code
2010 FORM L18TB
$
__
19
City, state, and ZIP code
__
17
18
•
1098E STUDENT LOAN INTEREST STATEMENT
15
16
FORM 1098
MORTGAGE INTEREST STATEMENT
If in the course of your trade or business, you receive at least $600 of mortgage interest from an individual for the calendar year,
you must file Form 1098 and furnish a statement to the individual.
1098 NON-MAILERS
T18-1
1098 MAILERS
PTM18-2
__
1 Mortgage interest received from payer(s)/borrower(s)*
PAYER'S social security number
$
2 Points paid on purchase of principal residence
PAYER’S/BORROWER’S name, address, city, and ZIP code
12
FORM 7168-1 1PT
14
15
4
16
RECIPIENT’S/LENDER'S name, address,
and telephone number
4
Form
7
1098
9
10
11
RECIPIENT’S federal identification no.
RECIPIENT’S/LENDER'S name, 12
address, and telephone number
6
7
8
14
TC18-3
TC18-4
FORM 7168-3 3PT
5
15
16
17
RECIPIENT’S federal identification no.
18
19
9
20
10
2 Points paid on purchase of principal residence
FORM 7168-1 1PT
$
12
13
2
Form
17
1098
8181
VOID
4
RECIPIENT’S/LENDER'S name, address, and telephone number
CORRECTED
8
21
22
RECIPIENT’S federal identification no.
FORM 7168-3 3PT
26
RECIPIENT’S federal identification15no.
27
28
30
16
18
19
20
$
Account number (see instructions)
2 Points paid on purchase of principal residence
8181
4
VOID
CORRECTED
RECIPIENT’S/LENDER'S name, address, and telephone number
Copy B
For Payer/Borrower
Department of the Treasury - Internal Revenue Service
26
27
Form 1098
28
29
30
RECIPIENT’S federal identification no.
2 Points paid on purchase of principal residence
FORM 7168-3 3PT
5
6
8
9
15
16
17
MAILER FORM NUMBERS
18
19
20
21
Electronic Filing
FORM PTM18-2
22
23
25
26
27
28
29
30
FORM 5498
$
4
Account number (see instructions)
Form
1098
2-PART PEEL-APART
24
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.
3 Refund of overpaid interest
City, state, and ZIP code
8403000585
4
File with Form 1096.
$
Street address (including apt. no.)
Department of the Treasury - Internal Revenue Service
For
Internal Revenue
Service Center
$
PAYER'S/BORROWER'S name
www.irs.gov/form1098
Copy A
1 Mortgage interest received from payer(s)/borrower(s)
PAYER'S social security number
5
1098
Mortgage
Interest
Statement
2014
(keep for your records)
25
Form
10
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.
sanction may be imposed on
you if the IRS determines
that an underpayment of tax
results because you
overstated a deduction for
this mortgage interest or for
these pointsOMB
or because
you
No. 1545-0901
did not report this refund of
interest on your return.
24
1098
19
11
File with Form 1096.
The information in boxes 1,
2, and 3 is important tax
information and is being
$
22
23
Account number (see instructions)
20
1098
furnishedDepartment
to the Internalof the Treasury - Internal Revenue Service
41-0852411
$
Revenue Service. If you are
required
file
a return, a
Do Not Cut or Separate
This Page — Do Not negligence
Cut
ortopenalty
Separate
Forms on This Page
3 RefundForms
of overpaidon
interest
or other
Form
21
Form
DW19
1-PART
3-PART
4-PART
Mortgage
Interest
Statement
4
1 Mortgage interest received from payer(s)/borrower(s)*
City, state, and ZIP code
PAYER'S social security number
Account number (see instructions)
18
3
For
Internal Revenue
Service Center
Carbonless FORM T18-1
2014
FORM TC18-3
FORM TC18-4
PAYER’S/BORROWER’S name,
17 address, city, and ZIP code
29
4
17
19
7
Copy A
1 Mortgage interest received from payer(s)/borrower(s)
$
$
3 Refund of overpaid interest
16
18
Use Envelope
DW19 or
SW19
CONTINUOUS FORM NUMBERS PAYER'S social security number
CORRECTED (if checked)
2 Points paid on purchase of principal residence
$
13
Form 1098
$
23
25
15
1A
440
14
9
RECIPIENT’S/LENDER'S name, address, and telephone
number
OMB No. 1545-0901
PAYER'S/BORROWER'S
name * Caution: The amount shown
2 Points paid on purchase of principal residence
10
may not be fully deductible by you.
Limits based on the loan amount
11
and the cost and value of the
secured property may apply. Also,
12
Street address (including apt. no.)you may only deduct interest to
3 Refund of overpaid interest
the extent it was incurred by you,
13
actually paid by you, and not
14
reimbursed by another person.
Form 1098
24
16
$
20
Mortgage
Interest
Statement
Department of the Treasury - Internal Revenue Service
6
19
13
14
Copy C
For
Recipient/Lender
or State Copy
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.
12
2014
(keep for your records)
5
7
20
For Payer/Borrower
required to file a return, a
negligence penalty or other
sanction may be imposed on
you if the IRS determines
that an underpayment of tax
results because you
overstated
a deduction
for
OMB
No. 1545-0901
this mortgage interest or for
these points or because you
did not report this refund of
interest on your return.
4
18
Copy B
PAYER’S/BORROWER’S name, street address (including apt. no), city or town, state or province, country, and ZIP or foreign postal code
12
15
17
1 Mortgage interest received from payer(s)/borrower(s)
PAYER’S social security number
2
For Privacy Act
and Paperwork
SW19
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.
The information in boxes 1,
3
Account number (see instructions)
15
Mortgage
Interest
Statement
1098
$
11
14
1098
2, and 3 isDepartment
important taxof the Treasury - Internal Revenue Service
41-0852411
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furnished
the Internal
Do Not Cut or Separate
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Revenue Service. If you are
Form
3 Refund of overpaid interest
14
FORM 7168-1 1PT
1098
$
11
16
Form
1 Mortgage interest received from payer(s)/borrower(s)*
Account number (see instructions)
13
File with Form 1096.
Mortgage
Interest
Statement
4
12
RECIPIENT’S federal identification no.
10
11
For
Internal Revenue
Service Center
3 Refund of overpaid interest
PAYER'S social security number
PAYER’S/BORROWER’S name, address, city, and ZIP code
Copy A
1 Mortgage interest received from payer(s)/borrower(s)
$
you may only deduct interest to
the extent it was incurred by you,
actually paid by you, and not
reimbursed by another person.
City, state, and ZIP code
Form 1098
2014
$
Street address (including apt. no.)secured property may apply. Also,
Available
Self Seal
DW19S
Mortgage
Interest
Statement
2 Points paid on purchase of principal residence
OMB No. 1545-0901
* Caution: The amount shown
may not be fully deductible by you.
Limits based on the loan amount
and the cost and value of the
13
2
Copy B
For Payer/Borrower
$
(if checked)
9
10
Department of the Treasury - Internal Revenue Service
PAYER'S social security number
CORRECTED
PAYER'S/BORROWER'S
name
14
Form
8
9
2014
(keep for your records)
8
20
4
CORRECTED
Account number (see instructions)
6
18
3
VOID
$
5
17
19
8181
3
3 Refund of overpaid interest
OMB No. 1545-0901
7
8
The information in boxes 1,
2, and 3 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 the IRS determines
that an underpayment
of tax
OMB No. 1545-0901
results because you
overstated a deduction for
this mortgage interest or for
these points or because you
did not report this refund of
interest on your return.
$
13
CORRECTED
6
7
2098-2 8298P
RECIPIENT’S federal identification no.
9
10
11
VOID
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country, ZIP or foreign postal code, and telephone number
5
6
PTM18-2
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7
5
Mortgage
Interest
Statement
2014
6
REMOVE THIS PLY BEFORE MAILING.
5
4
4
* Caution: The amount shown
OMB No. 1545-0901
may not be fully deductible by you.
Limits based on the loan amount
and the cost and value of the
secured property may apply. Also,
you may only deduct interest to
the extent it was incurred by you,
actually paid by you, and not
reimbursed by another person.
Form 1098
RECIPIENT’S/LENDER'S name, address, and telephone number
4
3
3
CORRECTED (if checked)
3
41-0852411
Department of the Treasury - Internal Revenue Service
The 5498 is used to report your individual retirement arrangement (IRA), simplified employee pension (SEP), or savings incentive match plan for employees
(SIMPLE) to report contributions and the fair market value of the account.
FORM 5498 MAILERS
PTM58-3
4
VOID
VOID
2828
CORRECTED
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1 IRA contributions (other
2828
TRUSTEE’S or ISSUER'S
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5
6
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9
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10
11
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TRUSTEE’S or ISSUER’S federal
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12
13
5 Fair market value of account
PARTICIPANT’S social security
number
$
14
7 IRA
SEP
8 SEP contributions
PARTICIPANT’S name, address, city, and ZIP code
15
16
4 Recharacterized
contributions
10 Roth IRA contributions
$
11 If checked, required minimum
distribution for 2013
12a RMD date
12b RMD amount
$
13a Postponed contribution
23
$
14a Repayments
13b Year
13c Code
DWMR
$
27
12
12
13
13
16
Account number (see instructions)
Use Envelope
DWMR or
SWMR
Department of the Treasury - Internal Revenue Service
CORRECTED (if checked)
TRUSTEE’S or ISSUER'S name, street address, city, state, and ZIP code
1 IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, and 14a)
OMB No. 1545-0747
2014
$
2 Rollover contributions
Form 5498
$
3 Roth IRA conversion
amount
$
TRUSTEE’S or ISSUER’S federal
identification no.
5 Fair market value of account
PARTICIPANT’S social security
number
$
7 IRA
SEP
8 SEP contributions
PARTICIPANT’S name, address, city, and ZIP code
4 Recharacterized
contributions
$
6 Life insurance cost included in
box 1
21
$
10 Roth IRA contributions
11 If checked, required minimum
distribution for 2013
12a RMD date
For
Participant
12b RMD amount
This information
is being
furnished to
the Internal
Revenue
Service.
$
13a Postponed contribution
14a Repayments
$
13b Year
13c Code
Account number (see instructions)
Form 5498
(keep for your records)
www.irs.gov/form5498
14b Code
Life insurance cost included in
box 1
SIMPLE
Roth IRA
9 SIMPLE contributions
23
VOID
VOID
24
CORRECTED
CORRECTED
25
26
27
28
28
29
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IRA amounts
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5498
PARTICIPANT’Ssocial
socialsecurity
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PARTICIPANT’S
number
number
55 Fair
Fair market
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PTM58-2
7 IRA
7 IRA
8 SEP
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10 Roth IRA contributions
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66 Life
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included
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box 11
$
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$13a Postponed contribution
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14a Repayments
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13c Code
14b
Copy A
A
Copy
1A
469
CONTINUOUS FORM NUMBERS
Carbonless FORM T58-1
1-PART
FORM TC58-3 3-PART
MAILER FORM NUMBERS
FORM PTM58-3 3-PART PEEL-APART
Electronic
Filing
FORM PTM58-2 2-PART PEEL-APART
For
Internal
Internal Revenue
Revenue
Service
Service Center
Center
File with Form 1096.
File with Form 1096.
SIMPLE
Roth IRA
SIMPLE
Roth IRA
9 SIMPLE contributions
9 SIMPLE contributions
$
$
11
Check if RMD for 2013
11 Check if RMD for 2014
12b RMD amount
12b RMD amount
13a Postponed contribution
City, state, and ZIP code
City, state, and ZIP code
14
13b Year
Code
IRA
IRA
Contribution
Contribution
Information
Information
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.
15a FMV of certain specified assets 15b Code(s)
Form 5498
Form 5498
4 Recharacterized
$
4 contributions
Recharacterized contributions
www.irs.gov/form5498
$
$
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PARTICIPANT’S name
PARTICIPANT’S name
$
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13b Year
13b Year
13c Code
13c Code
14b Code
14b Code
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For Privacy
Act
and
Paperwork
and
Paperwork
Reduction
Act
Reduction
Notice,
see Act
the
Notice,
see the
2014 General
2013 General
Instructions
for
Instructions for
Forms 1099,
Certain
1098, 3921,
Information
3922, 5498,
and
Returns.
W-2G.
$
$
Account number (see instructions)
Account number (see instructions)
Form 5498
Form 5498
2013
$
22 Rollover
Rollovercontributions
contributions
Account number (see instructions)
29
TRUSTEE’SororISSUER’S
ISSUER’Sfederal
federal
TRUSTEE’S
identificationno.
no.
identification
OMB No. 1545-0747
$
OMB No. 1545-0747
14a Repayments
$$
27
12b RMD amount
$
22
2828
23
Copy B
$
FORM 6097-1 1PT
12a RMD date
22
15a Other contributions
$
SIMPLE
Roth IRA
9 SIMPLE contributions
$
$
IRA
Contribution
Information
6
Department
of the Treasury - Internal
$
$ Revenue Service
Department of the Treasury - Internal Revenue Service
21
26
Available
Self Seal
DW19S
FORM 6098-3 / TC58-3
www.irs.gov/form5498
14
$
$$
FORM 6097-1 1PT
T58-1
www.irs.gov/form5498
41-1628061
No. 1545-0747
ForOMB
Privacy
Act
For Privacy
Act
and
Paperwork
IRA
and
Paperwork
Reduction
Act
Contribution
Reduction
Notice,
see Act
the
Information
Notice,
see the
2014 General
2013
Form General
5498
Instructions for
Instructions for
Forms
1099,
Certain
4 Recharacterized
contributions
Copy C
1098, 3921,
Information
For
3922, 5498,
and
Returns.
Trustee or Issuer
$
W-2G.
$
SEP
8 SEP contributions
$
41-0852411
19
Form
(keep for your records)
3 Roth IRA conversion
13c Code
13b Year
amount
Copy A
Copy A
For
Internal Revenue
Service Center
File with Form 1096.
File with Form 1096.
19
10 Roth IRA contributions
11 Check if RMD for 2015
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Form 5498
12b RMD amount
2 Rollover contributions
$12b RMD amount
$
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15a Other contributions
15b Code
PARTICIPANT’S name, street address (including apt. no.), city or town, state or province, country, and Zip or foreign postal code 7 IRA
17
18
$
$
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17
18
11 Check if RMD for 2013
11 Check if RMD for 2014
14b Code
PARTICIPANT’S
social security 14b Code
$
14a Repayments
number
5 Fair market value of account
TRUSTEE’S or ISSUER’S federal
identification no.
14
14
16
Form 5498
Form 5498
28
30
13a Postponed contribution
$13a Postponed contribution
$ Repayments
14a
11
2828
TRUSTEE’S or ISSUER'S
24 name, street address, city, state, and ZIP code
25 name, street address, city, state, and ZIP code
TRUSTEE’S or ISSUER’S
SWMR
14b Code
25
26
12a RMD date
99
Account number (see instructions)
15
Account number (see 15
instructions)
66 Life
insurancecost
cost
included
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included
in in
box
box 11
1099 FORMS
22
88
11
30
18
21
29
This information
is being
furnished to
the Internal
Revenue
Service.
10 Roth IRA contributions
$10 Roth IRA contributions
$ RMD date
12a
City, state, and ZIP code10
10
City, state, and ZIP code
27
28
7
8
$
$
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SEP
SIMPLE
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IRA
VOID
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IRA
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9 SIMPLE contributions
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TRUSTEE’S or ISSUER’S name, street 8address,
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2-4, 8-10, 13a, and 14a)
$
$
77
26
$
SIMPLE
Roth IRA
9 SIMPLE contributions
19
20
55
25
Copy B
6 Life insurance cost included in
box 1
$
24
23
For
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$
2
44
Street address (including apt. no.)
1A
66
469
Street address (including
apt. no.)
21
24
$
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PARTICIPANT’S name
PARTICIPANT’S name3 3
22
Form 5498
$
17
17
18
19
20
55 Fair
Fair market
market value
value of
of account
account
PARTICIPANT’S
PARTICIPANT’Ssocial
socialsecurity
security
number
number
Form 5498
4 Recharacterized
4 contributions
Recharacterized contributions
REMOVE THIS PLY BEFORE MAILING.
3 Roth IRA conversion
amount
9
10
11
16
5498P
2 Rollover contributions
$
8
IRA
Contribution
Information
2014
$
6
7
FORM 6097-1 1PT
OMB No. 1545-0747
2298-2
5
1 IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, and 14a)
2 PT 5498 MAILER PTM58-2
4
TRUSTEE’S
TRUSTEE’SororISSUER’S
ISSUER’Sfederal
federal
identification
identificationno.
no.
15
8403001857
TRUSTEE’S or ISSUER'S name, street address, city, state, and ZIP code
3
FORM 6098-3 / TC58-3
CORRECTED (if checked)
2
$$
12
13
14
IRA
Contribution
Information
2013
14
2 Rollover contributions
2 Rollover contributions
8
5498 NON-MAILERS
OMB No. 1545-0747
in boxes
IRA amounts
contributions
(other
1 than
than8-10,
amounts
in boxes
2-4,
13a, and
14a)
2-4, 8-10, 13a, 14a, and
15a)
$$
7
8403001857
__
3
__
__
2
$
41-0852411
www.irs.gov/form5498
41-1628061
Do Not Cut or Separate Forms on This Page
—
15b Code
Department of the Treasury - Internal Revenue Service
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page
5498 SA
HSA, Archer MSA, or Medicare+Choice MSA Information.
Department of the Treasury - Internal Revenue Service
TC58SA-4
Available
Self Seal
DW19S
3
4
5
6
7
8
9
10
11
12
CONTINUOUS FORM NUMBERS
Carbonless FORM TC58SA-4
4-PART
13
14
15
16
17
18
19
SW19
20
DW19
2
3
4
5
6
7
Use Envelope
DW19 or
SW19
31