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Get Prudential FORM 1099-INT

D. NO. CUSTOMER NAME ADDRESS AND ZIP CODE Prudential John Doe PAYER S FEDERAL I. D. NO. RECIPIENT S NAME I. D. NO. 123-45-6789 22-2222222 ACCOUNT/ CONTRACT NUMBER TAX ST CLAIM PLAN EOS999999 TOTAL DATE 1/25/02 2001 1099-INT INTEREST INCOME BOX 1 BOX 4 INTEREST FEDERAL INCOME TAX INCOME WITHHELD OMB 1545-0112 STATE TAX 222. Department of the Treasury - Internal Revenue Service TAX STATEMENT COPY B FOR RECIPIENT/PARTICIPANT PAYER S NAME ADDRESS ZIP CODE AND FEDERAL I. D. NO. CUSTOMER NAME ADDRESS AND ZIP CODE Prudential John Doe PAYER S FEDERAL I. D. NO. RECIPIENT S NAME I. D. NO. 123-45-6789 22-2222222 ACCOUNT/ CONTRACT NUMBER TAX ST CLAIM PLAN EOS999999 TOTAL DATE 1/25/02 2001 1099-INT INTEREST INCOME BOX 1 BOX 4 INTEREST FEDERAL INCOME TAX INCOME WITHHELD OMB 1545-0112 STATE TAX 222. 39 A B F ORM 1099-INT Interest Income Why you may receive this form If you received interest because of a delayed annuity payment or if you are credited interest on dividend accumulations and the amount of interest exceeds the reporting threshold. You would also receive this form for interest earned on bank accounts CDs etc* When the interest is being paid as a result of delayed disbursement and you had not previously provided us with a Form W-9 we will also withhold taxes at the backup withholding rate if that withholding is at least 1. This is the amount of interest subject to tax. You would include this amount on Part I Schedule B Form 1040 if you are required to complete this form* Totals from Schedule B or total interest if you are not required to complete Schedule B will be entered on Form 1040 line 8a* B Federal Income Tax Withheld An amount reported here represents backup withholding. Mandatory backup withholding may be imposed when rules regarding taxpayer identification numbers usually a Social Security number are not met by the individual or if you have been notified by the IRS that you are subject to you if the IRS instructs us to withhold on our payments to you. The rate for backup withholding was reduced to 30. 5 in August 2001. This rate is scheduled to be reduced slightly over the next few years. You can include this amount on Form 1040 line 59 to reduce your income tax due. If you received Form 1099-INT for any other type of interest payment please consult the Instructions for Recipient that accompanied the form and consult your tax adviser. Department of the Treasury - Internal Revenue Service TAX STATEMENT COPY B FOR RECIPIENT/PARTICIPANT PAYER S NAME ADDRESS ZIP CODE AND FEDERAL I. D. NO. CUSTOMER NAME ADDRESS AND ZIP CODE Prudential John Doe PAYER S FEDERAL I. D. NO. RECIPIENT S NAME I. D. NO. 123-45-6789 22-2222222 ACCOUNT/ CONTRACT NUMBER TAX ST CLAIM PLAN EOS999999 TOTAL DATE 1/25/02 2001 1099-INT INTEREST INCOME BOX 1 BOX 4 INTEREST FEDERAL INCOME TAX INCOME WITHHELD OMB 1545-0112 STATE TAX 222. 39 A B F ORM 1099-INT Interest Income Why you may receive this form If you received interest because of a delayed annuity payment or if you are credited interest on dividend accumulations and the amount of interest exceeds the reporting threshold. .

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