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					          9592              □ VOID           □ CORRECTED
PAYER”S name, street address, city, state, ZIP code, and telephone no.   Payer’s RTN (optional)       OMB No. 1545-
                                                                                                      0112
Wells Fargo                                                                                                                     Interest Income
1240 Franklin
Boise, ID 83706

                                                                                                      Form 1099-INT

PAYER’S Federal identification          RECIPIENT”S identification            1 Interest income not included in box 3                     Copy A
number                                  number                                $68.40                                                           For
  xxx-xxxxxxxxxx                           xxxx-xxxxxxxxxx                                                                                Internal
RECIPIENT’S name                                                              2 Early withdrawal           3 Interest on U.S Savings
                                                                              penalty                      Bonds and Treas.
                                                                                                                                         Revenue
                                                                                                           Obligation                     Service
                                                                                                                                           Center
                                                                              $                           $                                File with
Street address (including apt. no.)                                           4 Federal income tax withheld     5 Investment expense     Form 1096
                                                                                                                                         For Privacy
203 Lake Lowell Ave                                                           $                                 $                            Act and
                                                                                                                                          paperwork
City, state, and ZIP code                                                     6 Foreign tax paid              7 Foreign country or U.S     reduction
                                                                                                              possession                 Act Notice,
Nampa, ID 83686                                                                                                                              see the
                                                                                                                                                2004
                                                                                                                                            General
Account number (optional)                                                                                                                 instructio
                                                                              $                                                               ns for
98098-234                                                                                                                                     Forms
                                                                                                                                               1099,
                                                                                                                                         1098, 5498
                                                                                                                                          and W-2G

				
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