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.
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8181

VOID

CORRECTED

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

OMB No. 1545-0901

2011

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Form

RECIPIENT’S federal identification no.

PAYER’S social security number

1

1098

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

$

PAYER’S/BORROWER’S name

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

Cat. No. 14402K

Do Not Cut or Separate Forms on This Page

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

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain
Information
Returns.

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page