Form 1098 Mortgage Interest Statement

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
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Page 1 of 6 of Form 1098 (Page 2 is Blank)

4

The type and rule above prints on all proofs including departmental
reproduction proofs. MUST be removed before printing.

INK: Red, J-6983 Separation for Form 1098, page 1
INK: Black Separation for Form 1098, page 1

VOID

Revised proofs
requested

OMB No. 1545-0901

2008
PAYER’S social security number

1

Mortgage interest received from payer(s)/borrower(s)

$
2

Points paid on purchase of principal residence

$

Street address (including apt. no.)

3

Refund of overpaid interest

$

City, state, and ZIP code

Account number (see instructions)

Form

1098

4

5

Cat. No. 14402K

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Mortgage
Interest
Statement

1098

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Form

PAYER’S/BORROWER’S name

Signature

CORRECTED

RECIPIENT’S/LENDER’S name, address, and telephone number

RECIPIENT’S federal identification no.

Date

O.K. to print
T:FP:F
O.K. to print
Responsible
scan organization

Date

8181

Action

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2008 General
Instructions for
Forms 1099, 1098,
5498, and W-2G.

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page