Statement for Form 1099-INT for Tax Year 2015
1099-INT - Copy B - For Recipient - OMB #1545-0112 CORRECTED (if checked)
DEPARTMENT OF THE TREASURY - INTERNAL REVENUE SERVICE
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.
Capital One, National Association PAYER’S FEDERAL ID NO.
P.O. Box 60 72-0210640
St. Cloud, MN 56302-0060
Marcella T Mcintosh RECIPIENT’S ID NO.
22 White Horse Ave XXX-XX-1472
Clementon, NJ 08021
ACCOUNT NUMBER IRS DESCRIPTION IRS BOX # AMOUNT
34791358 2015 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $11.28
EARLY WITHDRAWAL PENALTY 2 $0.00
INTEREST ON U.S. SAVINGS BONDS AND TREAS. OBLIGATIONS 3 $0.00
FEDERAL INCOME TAX WITHHELD 4 $0.00
INVESTMENT EXPENSES 5 $0.00
FOREIGN TAX PAID 6 $0.00
FOREIGN COUNTRY OR U.S. POSSESSION 7
TAX-EXEMPT INTEREST 8 $0.00
SPECIFIED PRIVATE ACTIVITY BOND INTEREST 9 $0.00
MARKET DISCOUNT 10
BOND PREMIUM 11
12
BOND PREMIUM ON TAX-EXEMPT BOND 13
TAX-EXEMPT AND TAX CREDIT BOND CUSIP NO. 14
STATE 15-Top
STATE IDENTIFICATION NO. 16-Top
STATE TAX WITHHELD 17-Top $0.00
STATE 15-Bottom
STATE IDENTIFICATION NO. 16-Bottom
STATE TAX WITHHELD 17-Bottom $0.00
FATCA FILING REQUIREMENT
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
ACCOUNT NUMBER IRS DESCRIPTION IRS BOX # AMOUNT
36928840 2015 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $3.47
EARLY WITHDRAWAL PENALTY 2 $0.00
INTEREST ON U.S. SAVINGS BONDS AND TREAS. OBLIGATIONS 3 $0.00
FEDERAL INCOME TAX WITHHELD 4 $0.00
INVESTMENT EXPENSES 5 $0.00
FOREIGN TAX PAID 6 $0.00
FOREIGN COUNTRY OR U.S. POSSESSION 7
TAX-EXEMPT INTEREST 8 $0.00
SPECIFIED PRIVATE ACTIVITY BOND INTEREST 9 $0.00
MARKET DISCOUNT 10
BOND PREMIUM 11
12
BOND PREMIUM ON TAX-EXEMPT BOND 13
TAX-EXEMPT AND TAX CREDIT BOND CUSIP NO. 14
STATE 15-Top
STATE IDENTIFICATION NO. 16-Top
STATE TAX WITHHELD 17-Top $0.00
STATE 15-Bottom
STATE IDENTIFICATION NO. 16-Bottom
STATE TAX WITHHELD 17-Bottom $0.00
FATCA FILING REQUIREMENT
36928895 2015 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $26.57
EARLY WITHDRAWAL PENALTY 2 $0.00
INTEREST ON U.S. SAVINGS BONDS AND TREAS. OBLIGATIONS 3 $0.00
FEDERAL INCOME TAX WITHHELD 4 $0.00
INVESTMENT EXPENSES 5 $0.00
FOREIGN TAX PAID 6 $0.00
FOREIGN COUNTRY OR U.S. POSSESSION 7
TAX-EXEMPT INTEREST 8 $0.00
SPECIFIED PRIVATE ACTIVITY BOND INTEREST 9 $0.00
MARKET DISCOUNT 10
BOND PREMIUM 11
12
BOND PREMIUM ON TAX-EXEMPT BOND 13
TAX-EXEMPT AND TAX CREDIT BOND CUSIP NO. 14
STATE 15-Top
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
STATE IDENTIFICATION NO. 16-Top
STATE TAX WITHHELD 17-Top $0.00
STATE 15-Bottom
STATE IDENTIFICATION NO. 16-Bottom
STATE TAX WITHHELD 17-Bottom $0.00
FATCA FILING REQUIREMENT
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
ACCOUNT NUMBER IRS DESCRIPTION IRS BOX # AMOUNT
78945089 2015 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $2.26
EARLY WITHDRAWAL PENALTY 2 $0.00
INTEREST ON U.S. SAVINGS BONDS AND TREAS. OBLIGATIONS 3 $0.00
FEDERAL INCOME TAX WITHHELD 4 $0.00
INVESTMENT EXPENSES 5 $0.00
FOREIGN TAX PAID 6 $0.00
FOREIGN COUNTRY OR U.S. POSSESSION 7
TAX-EXEMPT INTEREST 8 $0.00
SPECIFIED PRIVATE ACTIVITY BOND INTEREST 9 $0.00
MARKET DISCOUNT 10
BOND PREMIUM 11
12
BOND PREMIUM ON TAX-EXEMPT BOND 13
TAX-EXEMPT AND TAX CREDIT BOND CUSIP NO. 14
STATE 15-Top
STATE IDENTIFICATION NO. 16-Top
STATE TAX WITHHELD 17-Top $0.00
STATE 15-Bottom
STATE IDENTIFICATION NO. 16-Bottom
STATE TAX WITHHELD 17-Bottom $0.00
FATCA FILING REQUIREMENT
TOTAL 1099-INT 2015 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $43.58
EARLY WITHDRAWAL PENALTY 2 $0.00
INTEREST ON U.S. SAVINGS BONDS AND TREAS. OBLIGATIONS 3 $0.00
FEDERAL INCOME TAX WITHHELD 4 $0.00
INVESTMENT EXPENSES 5 $0.00
FOREIGN TAX PAID 6 $0.00
FOREIGN COUNTRY OR U.S. POSSESSION 7
TAX-EXEMPT INTEREST 8 $0.00
SPECIFIED PRIVATE ACTIVITY BOND INTEREST 9 $0.00
MARKET DISCOUNT 10
BOND PREMIUM 11
12
BOND PREMIUM ON TAX-EXEMPT BOND 13
TAX-EXEMPT AND TAX CREDIT BOND CUSIP NO. 14
STATE 15-Top
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
STATE IDENTIFICATION NO. 16-Top
STATE TAX WITHHELD 17-Top $0.00
STATE 15-Bottom
STATE IDENTIFICATION NO. 16-Bottom
STATE TAX WITHHELD 17-Bottom $0.00
FATCA FILING REQUIREMENT
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
Instructions for Recipient
The information provided may be different for covered and noncovered securities. For a description of covered securities, see
the Instructions for Form 8949. For a taxable covered security acquired at a premium, unless you notified the payer in writing in
accordance with Regulations section 1.6045-1(n)(5) that you did not want to amortize the premium under section 171, or for a
tax-exempt covered security acquired at a premium, your payer may report either (1) a net amount of interest that reflects the
offset of the amount of interest paid to you by the amount of premium amortization allocable to the payment(s), or (2) a gross
amount for both the interest paid to you and the premium amortization allocable to the payment(s). If you did notify your payer
that you did not want to amortize the premium on a taxable covered security, then your payer will only report the gross amount
of interest paid to you. For a noncovered security acquired at a premium, your payer is only required to report the gross amount
of interest paid to you.
Recipient’s identification number. For your protection, this form may show only the last four digits of your social security number
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN). However, the issuer has reported your complete identification number to the IRS.
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 to satisfy its
chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions to Form 8938.
Account number. May show an account or other unique number the payer assigned to distinguish your account.
Box 1. Shows taxable interest paid to you during the calendar year by the payer. This does not include interest shown in box 3.
May also show the total amount of the credits from clean renewable energy bonds, new clean renewable energy bonds,
qualified energy conservation bonds, qualified zone academy bonds, qualified school construction bonds, and build America
bonds that must be included in your interest income. These amounts were treated as paid to you during 2015 on the credit
allowance dates (March 15, June 15, September 15, and December 15). For more information, see Form 8912, Credit to
Holders of Tax Credit Bonds. See the instructions above for a taxable covered security acquired at a premium.
Box 2. Shows interest or principal forfeited because of early withdrawal of time savings. You may deduct this amount to figure
your adjusted gross income on your income tax return. See the instructions for Form 1040 to see where to take the deduction.
Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Treasury bonds, and Treasury notes. This may or may not all be
taxable. See Pub. 550. This interest is exempt from state and local income taxes. This interest is not included in box 1. See the
instructions above for a taxable covered security acquired at a premium.
Box 4. Shows backup withholding. Generally, a payer must backup withhold if you did not furnish your taxpayer identification
number (TIN) or you did not furnish the correct TIN to the payer. See Form W-9. Include this amount on your income tax return
as tax withheld.
Box 5. Any amount shown is your share of investment expenses of a single-class REMIC. If you file Form 1040, you may
deduct these expenses on the “Other expenses” line of Schedule A (Form 1040) subject to the 2% limit. This amount is
included in box 1.
Box 6. Shows foreign tax paid. You may be able to claim this tax as a deduction or a credit on your Form 1040. See your Form
1040 instructions.
Box 7. Shows the country or U.S. possession to which the foreign tax was paid.
Box 8. Shows tax-exempt interest paid to you during the calendar year by the payer. Report this amount on line 8b of Form
1040 or Form 1040A. This amount may be subject to backup withholding. See box 4. See the instructions above for a tax-
exempt covered security acquired at a premium.
Box 9. Shows tax-exempt interest subject to the alternative minimum tax. This amount is included in box 8. See the Instructions
for Form 6251. See the instructions above for a tax-exempt covered security acquired at a premium.
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
Box 10. For a taxable or tax-exempt covered security, if you made an election under section 1278(b) to include market discount
in income as it accrues and you notified your payer of the election, shows the market discount that accrued on the debt
instrument during the year while held by you. Report this amount on your income tax return as directed in the instructions for
Form 1040 or 1040A. Market discount on a tax-exempt security is includible in taxable income as interest income.
Box 11. For a taxable covered security, shows the amount of premium amortization allocable to the interest payment(s), unless
you notified the payer in writing in accordance with Regulations section 1.6045-1(n)(5) that you did not want to amortize bond
premium under section 171. If an amount is reported in this box, see the instructions for Form 1040 (Schedule B). If an amount
is not reported in this box for a taxable covered security acquired at a premium, the payer has reported a net amount of interest
in box 1 or 3, whichever is applicable. If the amount in this box is greater than the amount of interest paid on the covered
security, see Regulations section 1.171-2(a)(4).
Box 13. For a tax-exempt covered security, shows the amount of premium amortization allocable to the interest payment(s). If
an amount is not reported in this box for a tax-exempt covered security acquired at a premium, the payer has reported a net
amount of interest in box 8 or 9, whichever is applicable. If the amount in this box is greater than the amount of interest paid on
the tax-exempt covered security, the excess is a nondeductible loss. See Regulations section 1.171-2(a)(4)(ii).
Box 14. Shows CUSIP number(s) for tax-exempt bond(s) on which tax-exempt interest was paid, or tax credit bond(s) on which
taxable interest was paid or tax credit was allowed, to you during the calendar year. If blank, no CUSIP number was issued for
the bond(s).
Boxes 15 - 17. State tax withheld reporting boxes.
Nominees. If this form includes amounts belonging to another person(s), you are considered a nominee recipient. Complete a
Form 1099-INT for each of the other owners showing the income allocable to each. File Copy A of the form with the IRS.
Furnish Copy B to each owner. List yourself as the “payer” and the other owner(s) as the “recipient.” File Form(s) 1099-INT with
Form 1096 with the Internal Revenue Service Center for your area. On Form 1096 list yourself as the “filer.” A spouse is not
required to file a nominee return to show amounts owned by the other spouse.
Future developments. For the latest information about developments related to Form 1099-INT and its instructions, such as
legislation enacted after they were published, go to www.irs.gov/form1099int.
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
