Form 1097-BTC
2011
Cat. No. 54293T
Bond
Tax
Credit
Copy A
For
Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-2197
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.
5050
VOID CORRECTED
FORM 1097-BTC ISSUER'S name, street address, city, state, and ZIP code,
and telephone no.
FORM 1097-BTC ISSUER'S federal
identification number
RECIPIENT'S federal identification
number
RECIPIENT'S name
Street address (including apt. no.)
City, state, and ZIP code
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing initial 2011
Form 1097-BTC for credit being reported
An entity or a person that received a 2011 Form 1097-BTC
for credit being reported
1a March 15, 2011,
allowance date credit
$
1b March 15, 2011,
allowance date credit
identification no.
2a June 15, 2011,
allowance date credit
$
2b June 15, 2011,
allowance date credit
identification no.
3a September 15, 2011,
allowance date credit
$
3b September 15, 2011,
allowance date credit
identification no.
4a December 15, 2011,
allowance date credit
$
4b December 15, 2011,
allowance date credit
identification no.
5 Other allowance date
5a Other allowance date
credit
$
5b Other allowance date
credit identification no.
Form 1097-BTC
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1097-BTC
2011
Bond
Tax
Credit
Copy B
For Recipient
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 an
amount of tax credit
exceeding the amount
reported on this form is
claimed on your
income tax return.
OMB No. 1545-2197
CORRECTED (if checked)
FORM 1097-BTC ISSUER'S name, street address, city, state, and ZIP code,
and telephone no.
FORM 1097-BTC ISSUER'S federal
identification number
RECIPIENT'S federal identification
number
RECIPIENT'S name
Street address (including apt. no.)
City, state, and ZIP code
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing initial 2011
Form 1097-BTC for credit being reported
An entity or a person that received a 2011 Form 1097-BTC
for credit being reported
1a March 15, 2011,
allowance date credit
$
1b March 15, 2011,
allowance date credit
identification no.
2a June 15, 2011,
allowance date credit
$
2b June 15, 2011,
allowance date credit
identification no.
3a September 15, 2011,
allowance date credit
$
3b September 15, 2011,
allowance date credit
identification no.
4a December 15, 2011,
allowance date credit
$
4b December 15, 2011,
allowance date credit
identification no.
5 Other allowance date
5a Other allowance date
credit
$
5b Other allowance date
credit identification no.
Form 1097-BTC
(keep for your records)
Instructions for Recipient
Issuers of certain tax credit bonds (or their agents) and
nominees/intermediaries (such as a broker, a
partnership, a trust, an estate, a regulated investment
company, or a real estate investment trust) must report
to you quarterly and file with the IRS annually a separate
Form 1097-BTC for each tax credit distributed to you.
The checked box shows if the filer or its agent is the
original filer of this form, or is an entity or a person that
received this form.
Boxes 1a–5a. Shows the amount of the credit
distributed to you with respect to this allowance date.
You may be entitled to claim a credit against your
income tax liabilities, subject to certain limitations under
section 54A(c). For more information, see Form 8912,
Credit to Holders of Tax Credit Bonds.
Boxes 1b-5b. Shows the unique identification number
assigned to the credit you received with respect to this
credit allowance date. This information will help the IRS
track distribution of tax credits from tax credit bonds.
Form 1097-BTC
2011
Bond
Tax
Credit
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2197
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.
VOID CORRECTED
FORM 1097-BTC ISSUER'S name, street address, city, state, and ZIP code,
and telephone no.
FORM 1097-BTC ISSUER'S federal
identification number
RECIPIENT'S federal identification
number
RECIPIENT'S name
Street address (including apt. no.)
City, state, and ZIP code
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing initial 2011
Form 1097-BTC for credit being reported
An entity or a person that received a 2011 Form 1097-BTC
for credit being reported
1a March 15, 2011,
allowance date credit
$
1b March 15, 2011,
allowance date credit
identification no.
2a June 15, 2011,
allowance date credit
$
2b June 15, 2011,
allowance date credit
identification no.
3a September 15, 2011,
allowance date credit
$
3b September 15, 2011,
allowance date credit
identification no.
4a December 15, 2011,
allowance date credit
$
4b December 15, 2011,
allowance date credit
identification no.
5 Other allowance date
5a Other allowance date
credit
$
5b Other allowance date
credit identification no.
Form 1097-BTC
Instructions for Payer
▲
!
CAUTION
Filing Form 1097-BTC is voluntary for 2011.
General and specific form instructions are provided as
separate products. The products you should use are the
General Instructions for Certain Information Returns and
the Instructions for Form 1097-BTC. A chart in the
general instructions gives a quick guide to which form
must be filed to report a particular payment. To order
these instructions and additional forms, visit IRS.gov or
call 1-800-TAX-FORM (1-800-829-3676).
▲
!
CAUTION
Because paper forms are scanned during
processing, you cannot file with the IRS Forms
1096, 1097, 1098, 1099, 3921, 3922, or 5498
that you print from the IRS website.
Due dates. Furnish Copy B of this form to the recipient
quarterly and separately for each credit amount
allowable to the recipient on or before the 15th day of
the second calendar month after the close of the
calendar quarter in which the credit is issued.
File Copy A of this form with the IRS by February 28,
2012. If you file electronically, the due date is April 2,
2012. To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220, Specifications for Filing Forms 1097, 1098, 1099,
3921, 3922, 5498, 8935, and W-2G Electronically. The
IRS does not provide a fill-in form option.
Need help? If you have questions about reporting on
Form 1097-BTC, call the information reporting customer
service site toll free at 1-866-455-7438 or 304-263-8700
(not toll free). For TTY/TDD equipment, call
304-579-4827 (not toll free). The hours of operation are
Monday through Friday from 8:30 a.m. to 4:30 p.m.,
Eastern time.
