Statement for Form 1099-INT for Tax Year 2013
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
Shawn D Power RECIPIENT’S ID NO.
12813 Domingo Ct 567-89-0312
Parker, CO 80134
ACCOUNT NUMBER IRS DESCRIPTION IRS BOX # AMOUNT
33205782 2013 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $100.70
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
TAX-EXEMPT BOND CUSIP NO. 10
STATE 11-Top
STATE IDENTIFICATION NO. 12-Top
STATE TAX WITHHELD 13-Top
STATE 11-Bottom
STATE IDENTIFICATION NO. 12-Bottom
STATE TAX WITHHELD 13-Bottom
ADDITIONAL ACCOUNTS START ON NEXT PAGE
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
ACCOUNT NUMBER IRS DESCRIPTION IRS BOX # AMOUNT
TOTAL 1099-INT 2013 - 1099-INT, INTEREST INCOME
INTEREST INCOME NOT INCLUDED IN BOX 3 1 $100.70
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
TAX-EXEMPT BOND CUSIP NO. 10
STATE 11-Top
STATE IDENTIFICATION NO. 12-Top
STATE TAX WITHHELD 13-Top
STATE 11-Bottom
STATE IDENTIFICATION NO. 12-Bottom
STATE TAX WITHHELD 13-Bottom
CUSTOMER SERVICE: Capital One, National Association
1-888-464-0727
Instructions for Recipient
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), or adoption taxpayer identification number (ATIN). However, the issuer
has reported your complete identification number to the IRS and, where applicable, to state and/or local governments.
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, qualified forestry conservation 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 2013 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.
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.
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. possesession 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.
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.
Box 10. Shows CUSIP number(s) for tax-exempt bond(s) on which tax-exempt interest was paid to you during the calendar
year and reported in box 8. If blank, no CUSIP number was issued for the bond(s).
Boxes 11 - 13. 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 husband or wife
is not required to file a nominee return to show amounts owned by the other.
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
