Attention:
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similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
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forms.
Form 1097-BTC
2016
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
2016 General
Instructions for
Certain Information
Returns.
5050
VOID CORRECTED
FORM 1097-BTC ISSUER'S name, street address, city or town, state or
province, country, ZIP or foreign postal 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 or town, state or province, country, and ZIP or foreign postal code
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing 2016
Form 1097-BTC for credit being reported
An entity or a person that received or should have received
a 2016 Form 1097-BTC and is distributing part or all of that
credit to others
1 Total
$
2a Code
2b Unique Identifier
3 Bond type
4
5a January
$
5b February
$
5c March
$
5d April
$
5e May
$
5f June
$
5g July
$
5h August
$
5i September
$
5j October
$
5k November
$
5l December
$
6 Comments
Form
1097-BTC
www.irs.gov/form1097btc
Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page
Form 1097-BTC
2016
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 or town, state or
province, country, ZIP or foreign postal 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 or town, state or province, country, and ZIP or foreign postal code
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing 2016
Form 1097-BTC for credit being reported
An entity or a person that received or should have received
a 2016 Form 1097-BTC and is distributing part or all of that
credit to others
1 Total
$
2a Code
2b Unique Identifier
3 Bond type 4
5a January
$
5b February
$
5c March
$
5d April
$
5e May
$
5f June
$
5g July
$
5h August
$
5i September
$
5j October
$
5k November
$
5l December
$
6 Comments
Form
1097-BTC
(keep for your records)
www.irs.gov/form1097btc
Instructions for Recipient
Issuers of certain tax credit bonds or their agents, and recipients of
Form 1097-BTC from the bond issuer or agent who are further
distributing the credit, such as brokers, nominees, mutual funds, or
partnerships must report to you on at least a quarterly basis, and file
with the IRS annually on a separate Form 1097-BTC, the amount of
tax credit you are allowed for each month of the calendar year (see
instructions).
Recipient's identification number. For your protection, this form may
show only the last four digits of your social security number (SSN),
individual taxpayer identification number (ITIN), adoption taxpayer
identification number (ATIN), or employer identification number (EIN).
However, the issuer has reported your complete identification number
to the IRS.
!
CAUTION
You will not receive a separate fourth quarter report. The
credits for the fourth quarter will be reported together with
the annual aggregate total amount of allowable credits
provided to you by February 15, 2017.
Note: The first three quarters reported on the annual report are
duplicative amounts previously reported. You are allowed to take the
credit amount from each quarter only once.
The check box shows if the filer is the issuer of the bond or its
agent, or is an entity or a person that received or should have received
this form and is making a further distribution of the credit.
Box 1. Shows the aggregate total of credits allowed for the calendar
year.
Box 2a. Indicates if the unique identification number is your account
number, the CUSIP number of the bond, or another identifier. For
filings of Form 1097-BTC by the issuer of the bond or its agent (as
indicated by the first checkbox being checked), the first nine
characters of the unique identifier in box 2b must be the CUSIP
number, if available. For further identification, if necessary or desired
by the issuer, the CUSIP number can be followed by an optional
hyphen and then an account number or other unique identifying
number.
If no CUSIP number is available, the account number, or other
unique identifying number by which the bond transaction is tracked by
the issuer, is shown in box 2b.
C—CUSIP number
A—account number
O—any other identifier
Box 2b. Shows the unique identifier assigned by the Form 1097-BTC
issuer, limited to 39 alphanumeric characters.
Box 3. Shows the codes for tax credit bonds that are reported on
separate Forms 1097-BTC:
101 - Clean renewable energy bond
199 - Other
Boxes 5a–5l. Shows the amount of the credit you are allowed for the
month during the calendar year.
You may be entitled to claim a credit against your income tax
liabilities, subject to certain limitations under section 54A(c).
Additionally, clean renewable energy bond credits received from a
pass-through entity are limited to the income received from the pass-
through entity. New clean renewable energy bond and qualified
energy conservation bond credits are limited to 70% of the credit
amounts determined under section 54A(b); the credit reported on
Form 1097-BTC is the credit amount after the 70% limit has been
applied. For more information, see Form 8912.
Box 6. May show any additional information provided by the form
issuer.
Future developments. For the latest information about
developments related to Form 1097-BTC and its instructions, such as
legislation enacted after they were published, go to www.irs.gov/
form1097btc.
Form 1097-BTC
2016
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
2016 General
Instructions for
Certain Information
Returns.
VOID CORRECTED
FORM 1097-BTC ISSUER'S name, street address, city or town, state or
province, country, ZIP or foreign postal 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 or town, state or province, country, and ZIP or foreign postal code
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing 2016
Form 1097-BTC for credit being reported
An entity or a person that received or should have received
a 2016 Form 1097-BTC and is distributing part or all of that
credit to others
1 Total
$
2a Code
2b Unique Identifier
3 Bond type
4
5a January
$
5b February
$
5c March
$
5d April
$
5e May
$
5f June
$
5g July
$
5h August
$
5i September
$
5j October
$
5k November
$
5l December
$
6 Comments
Form
1097-BTC
www.irs.gov/form1097btc
Instructions for Payer
To complete Form 1097-BTC, use:
• the 2016 General Instructions for Certain Information
Returns, and
• the 2016 Instructions for Form 1097-BTC.
To order these instructions and additional forms, go to
www.irs.gov/form1097btc.
!
CAUTION
Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097,
1098, 1099, 3921, 3922, or 5498 that you print
from the IRS website.
Due dates. Furnish the information shown on Copy B of
this form 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 allowed.
For the first three quarters, report to the recipient only
the amounts for the months of the applicable quarter. Box
1 should not be completed and box 6 is optional.
You are not required to furnish a report solely for the
fourth quarter because the fourth quarter amounts are
reported with the annual filing. For the annual filing, report
the credits for each month in boxes 5a–5l; the total of
those amounts in box 1; and complete the rest of the form
as applicable. If any amounts previously furnished for the
first three quarters need to be corrected, report the correct
amounts for the annual reporting and explain the correction
to the recipient; no explanation is required for the IRS filing.
For the report furnished to the recipient (quarterly or
annual), you may use Copy B or your own substitute
statement reporting all the same applicable information
(the reporting for the first three quarters may be furnished
electronically).
The IRS encourages Form 1097-BTC issuers to provide
the credit information to the recipient monthly if applicable,
and as soon after the end of the month in which a credit
arises as possible.
Furnish the information shown on Copy B of this form
with the aggregate total amount of allowable credits for the
2016 calendar year to the recipient by February 15, 2017.
File Copy A of this form with the IRS by February 28,
2017. If you file electronically, the due date is March 31,
2017. To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220.
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). Persons with a hearing or speech disability with
access to TTY/TDD equipment can call 304-579-4827 (not
toll free).