CORRECTED (if checked) PAYER'S name. street address, city or town. state or province. country. ZIP or foreign postal code, and telephone no. Payees RTN (optional) OMB No. 1545-0112 2017 Form 1099-INT 1 Interest income $ 2 Early withdrawal penalty PAYER'S federal identification number RECIPIENT'S identification number $ 3 Interest on U.S. Savings Bands and Treas. obligations $ RECIPIENT'S name Street address (including apt. no.) City or town. state or prcntnce. county, and ZIP or foreign postal code 4 Federal income tax withheld $ 5 Investment expenses $ 6 Foreign tax paid $ 7 Foreign country or U.S. possesson 8 Tax-exempt interest $ 9 Speerlied paves, activry bond interest $ 10 Market discount $ 11 Bond premeurn $ FATCA filing requirement O 12 Bcnd prentrn en Treats/ ctignors $ 13 Bond premium on tax-exempt bond $ Account number (see instructions) 14 Tax-exempt and tax credit bond CUSIP no. 15 Slate 18 State itentificaton no. Form 1099-INT (keep for your records) www.irs.goy/form1099int Interest Income Copy B For Recipient This is important tax information and is being fumished 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. 17 State tax withheld $ $ Department of the Treasury - Internal Revenue Service EFTA01222597