Ownership Certificate: Information About Form 1000 Is at WWW - Irs.gov/uac/about-Form-1000

Form 1000
(Rev. September 2016)

Ownership Certificate
OMB No. 1545-0054
Department of the Treasury
Internal Revenue Service ▶ Information about Form 1000 is at www.irs.gov/uac/about-form-1000.
To be used by a U.S. citizen, resident individual, fiduciary, partnership, or nonresident partnership all of whose members are citizens or residents, in connection with
interest on bonds of a corporation containing a tax-free covenant and issued before January 1, 1934.
Owner of bonds U.S. identifying number Name of withholding agent Employer identification number
Address of owner (number and street, city or town, state or province, country, ZIP or U.S. address of withholding agent (number and street, city or town, state, and
foreign postal code) ZIP code)
I CERTIFY that to the best of my knowledge and belief, the Name of bond and date of issue Date interest due Date interest paid
information entered on this form is correct.
Signature of owner, fiduciary, trustee, or agent
Gross Amount Tax

Classes of Bond Owners of Interest Paid Assumed
Address of fiduciary, trustee, or agent (number and street, city or (2%)
town, state or province, ZIP or foreign postal code)
1 (a) Individual, estate, or trust, whose taxable income

exceeds the deductions for exemptions; or (b)
partnership . . . . . . . . . . . $ $
If an estate or trust, enter name No tax paid
2 Individual, estate, or trust, whose taxable income
by corporation
does not exceed the deduction for exemptions . . $
For Paperwork Reduction Act Notice, see instructions. Cat. No. 17097D Form 1000 (Rev. 9-2016)
Form 1000 (Rev. 9-2016) Page 2
Instructions for Owner, Fiduciary, Trustee, or States. You are required to give us the information. We need it to
ensure that you are complying with these laws and to allow us to
Agent figure and collect the right amount of tax.
Use a separate Form 1000 for each issue of bonds. If amended You are not required to provide the information requested on a
certificates are necessary, forward them to the withholding agent by form that is subject to the Paperwork Reduction Act unless the form
February 1 of the following year. displays a valid OMB control number. Books or records relating to a
Where to file. File this form with the withholding agent for interest form or its instructions must be retained as long as their contents
payments on bonds that have a tax-free covenant and that were may become material in the administration of any Internal Revenue
issued before 1934 by a domestic corporation or a resident or law. Generally, tax returns and return information are confidential,
as required by Internal Revenue Code section 6103.
nonresident foreign corporation.
The time needed to complete and file this form will vary
Instructions for Withholding Agents depending on individual circumstances. The estimated average
time is: Recordkeeping, 3 hr., 6 min.; Learning about the law or
Use Form 1042 to summarize Forms 1000. Do not send Form 1000 the form, 6 min.; Preparing the form, 9 min.
to the IRS. Keep Form 1000 for at least 4 years after the end of the If you have comments concerning the accuracy of this time
last calendar year in which the income the form applies to is paid. estimate or suggestions for making this form simpler, we would be
If a nonresident foreign corporation with a fiscal or paying agent happy to hear from you. You can send us comments from
in the United States issues the obligation, modify Form 1000 to www.irs.gov/formspubs. Click on “More Information” and then on
show the name and address of the nonresident debtor corporation “Give us feedback.” You can write to the Internal Revenue Service,
in addition to the name and address of the U.S. fiscal or paying Tax Forms and Publications, 1111 Constitution Ave. NW, IR-6526,
agent. Washington, DC 20224. Do not send this form to this address.
Instead, see Where to file, earlier.
Paperwork Reduction Act Notice. We ask for the information on
this form to carry out the Internal Revenue laws of the United

Ownership Certificate: Information About Form 1000 Is at WWW - Irs.gov/uac/about-Form-1000

Uploaded by

Ownership Certificate: Information About Form 1000 Is at WWW - Irs.gov/uac/about-Form-1000

Uploaded by

Form 1000

(Rev. September 2016)

Gross Amount Tax

1 (a) Individual, estate, or trust, whose taxable income

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