5050                                    VOID               CORRECTED
FORM 1097-BTC ISSUER'S name, street address, city or town, state or      1    Total                   OMB No. 1545-2197
province, country, ZIP or foreign postal code, and telephone no.
                                                                         $
                                                                         2a  Code                     2019             Bond 
                                                                                                                       Tax 
                                                                                                      Form 1097-BTC    Credit
                                                                         2b  Unique identifier

FORM 1097-BTC ISSUER'S TIN            RECIPIENT'S TIN
                                                                         3    Bond type          4

RECIPIENT'S name                                                                                                       Copy A
                                                                         5a  January             5b  February          For 
                                                                         $                       $                     Internal Revenue 
Street address (including apt. no.)                                      5c  March               5d  April             Service Center
                                                                         $                       $                     File with Form 1096.
                                                                         5e  May                 5f   June
City or town, state or province, country, and ZIP or foreign postal code $                       $ 
                                                                         5g  July                5h  August            For Privacy Act 
                                                                         $                       $                     and Paperwork 
 Form 1097-BTC issuer is (check one):                                    5i   September          5j   October          Reduction Act 
                                                                                                                       Notice, see the 
                                                                         $                       $                     2019 General 
     Issuer of bond or its agent filing 2019                             5k  November            5l   December         Instructions for 
     Form 1097-BTC for credit being reported                                                                           Certain Information 
                                                                         $                       $ 
     An entity or a person that received or should have received         6    Comments                                 Returns.
     a 2019 Form 1097-BTC and is distributing part or all of that 
     credit to others

Form 1097-BTC                         Cat. No. 54293T                    www.irs.gov/Form1097BTC  Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

                                                                CORRECTED (if checked)
FORM 1097-BTC ISSUER'S name, street address, city or town, state or      1    Total                   OMB No. 1545-2197
province, country, ZIP or foreign postal code, and telephone no.
                                                                         $
                                                                         2a  Code                     2019             Bond 
                                                                                                                       Tax 
                                                                                                      Form 1097-BTC    Credit
                                                                         2b  Unique identifier

FORM 1097-BTC ISSUER'S TIN          RECIPIENT'S TIN
                                                                         3    Bond type          4

RECIPIENT'S name                                                                                                       Copy B
                                                                         5a  January             5b  February          For Recipient
                                                                         $                       $ 
Street address (including apt. no.)                                      5c  March               5d  April
                                                                         $                       $                     This is important tax 
                                                                         5e  May                 5f   June             information and is 
City or town, state or province, country, and ZIP or foreign postal code $                       $                     being furnished to the 
                                                                                                                       IRS. If you are required 
                                                                         5g  July                5h  August            to file a return, a 
                                                                         $                       $                     negligence penalty or 
                                                                                                                       other sanction may be 
 Form 1097-BTC issuer is:                                                5i   September          5j   October          imposed on you if an 
                                                                         $                       $                     amount of tax credit 
                                                                                                                       exceeding the amount 
     Issuer of bond or its agent filing 2019                             5k  November            5l   December         reported on this form is 
     Form 1097-BTC for credit being reported                                                                           claimed on your 
                                                                         $                       $                     income tax return. 
     An entity or a person that received or should have received         6    Comments
     a 2019 Form 1097-BTC and is distributing part or all of that 
     credit to others

Form 1097-BTC                       (keep for your records)              www.irs.gov/Form1097BTC  Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Issuers of certain tax credit bonds or their agents, and recipients of    hyphen and then an account number or other unique identifying 
Form 1097-BTC from the bond issuer or agent who are further               number.
distributing the credit, such as brokers, nominees, mutual funds, or      If no CUSIP number is available, the account number, or other 
partnerships, must report to you on at least a quarterly basis, and file  unique identifying number by which the bond transaction is tracked by 
with the IRS annually on a separate Form 1097-BTC, the amount of          the issuer, is shown in box 2b.
tax credit you are allowed for each month of the calendar year (see       C—CUSIP number
instructions).
Recipient's taxpayer identification number (TIN). For your                A—Account number
protection, this form may show only the last four digits of your TIN      O—Any other identifier 
(social security number (SSN), individual taxpayer identification         Box 2b. Shows the unique identifier assigned by the Form 1097-BTC 
number (ITIN), adoption taxpayer identification number (ATIN), or         issuer, limited to 39 alphanumeric characters. 
employer identification number (EIN)). However, the issuer has                    Shows the codes for tax credit bonds that are reported on 
reported your complete TIN to the IRS.                                    Box 3. 
                                                                          separate Forms 1097-BTC:
        You will not receive a separate fourth quarter report. The        101—Clean renewable energy bond
        credits for the fourth quarter will be reported together with 
▲!      the annual aggregate total amount of allowable credits            199—Other
CAUTION provided to you by February 18, 2020.                             Boxes 5a–5l. These boxes show the amount of the credit you are 
Note: The first three quarters reported on the annual report are          allowed for the month during the calendar year.
duplicative amounts previously reported. You are allowed to take the      You may be entitled to claim a credit against your income tax 
credit amount from each quarter only once.                                liabilities, subject to certain limitations under section 54A(c).
The checkbox shows if the filer is the issuer of the bond or its agent,   Additionally, clean renewable energy bond credits received from a 
or is an entity or a person that received or should have received this    pass-through entity are limited to the income received from the pass-
form and is making a further distribution of the credit.                  through entity. New clean renewable energy bond and qualified 
                                                                          energy conservation bond credits are limited to 70% of the credit 
Box 1. Shows the aggregate total of credits allowed for the calendar      amounts determined under section 54A(b); the credit reported on 
year.                                                                     Form 1097-BTC is the credit amount after the 70% limit has been 
Box 2a. Indicates if the unique identification number is your account     applied. For more information, see Form 8912.
number, the CUSIP number of the bond, or another identifier. For          Box 6. May show any additional information provided by the form 
filings of Form 1097-BTC by the issuer of the bond or its agent (as       issuer. 
indicated by the first checkbox being checked), the first nine            Future developments. For the latest information about  
characters of the unique identifier in box 2b must be the CUSIP           developments related to Form 1097-BTC and its instructions, such as 
number, if available. For further identification, if necessary or desired legislation enacted after they were published, go to 
by the issuer, the CUSIP number can be followed by an optional            www.irs.gov/Form1097BTC.

                                             VOID               CORRECTED
FORM 1097-BTC ISSUER'S name, street address, city or town, state or      1    Total                OMB No. 1545-2197
province, country, ZIP or foreign postal code, and telephone no.
                                                                         $
                                                                         2a  Code                  2019             Bond 
                                                                                                                    Tax 
                                                                                                   Form 1097-BTC    Credit
                                                                         2b  Unique identifier

FORM 1097-BTC ISSUER'S TIN            RECIPIENT'S TIN
                                                                         3    Bond type       4

RECIPIENT'S name                                                                                                    Copy C
                                                                         5a  January          5b  February          For Payer
                                                                         $                    $                     For Privacy Act 
Street address (including apt. no.)                                      5c  March            5d  April             and Paperwork 
                                                                         $                    $                     Reduction Act 
                                                                                                                    Notice, see the 
                                                                         5e  May              5f   June             2019 General 
City or town, state or province, country, and ZIP or foreign postal code $                    $                     Instructions for 
                                                                         5g  July             5h  August            Certain Information 
                                                                         $                    $                     Returns.
 Form 1097-BTC issuer is (check one):                                    5i   September       5j   October
                                                                         $                    $ 
     Issuer of bond or its agent filing 2019                             5k  November         5l   December
     Form 1097-BTC for credit being reported
                                                                         $                    $ 
     An entity or a person that received or should have received         6    Comments
     a 2019 Form 1097-BTC and is distributing part or all of that 
     credit to others

Form 1097-BTC                                www.irs.gov/Form1097BTC                           Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form 1097-BTC, use:                              For the report furnished to the recipient (quarterly or 
• The 2019 General Instructions for Certain Information     annual), you may use Copy B or your own substitute 
Returns, and                                                statement reporting all the same applicable information 
                                                            (the reporting for the first three quarters may be furnished 
• The 2019 Instructions for Form 1097-BTC.                  electronically). 
To order these instructions and additional forms, go to     The IRS encourages Form 1097-BTC issuers to provide 
www.irs.gov/Form1097BTC.                                    the credit information to the recipient monthly if applicable, 
Due dates. Furnish the information shown on Copy B of       and as soon after the end of the month in which a credit 
this form to the recipient on or before the 15th day of the arises as possible.
second calendar month after the close of the calendar       Furnish the information shown on Copy B of this form 
quarter in which the credit is allowed.                     with the aggregate total amount of allowable credits for the 
For the first three quarters, report to the recipient only  2019 calendar year to the recipient by February 18, 2020. 
the amounts for the months of the applicable quarter. Box   File Copy A of this form with the IRS by February 28, 
1 should not be completed and box 6 is optional.            2020. If you file electronically, the due date is March 31, 
You are not required to furnish a separate report solely    2020. To file electronically, you must have software that 
for the fourth quarter because the fourth quarter amounts   generates a file according to the specifications in Pub. 
are reported with the annual filing. For the annual filing, 1220.
report the credits for each month in boxes 5a–5l; the total Need help? If you have questions about reporting onForm 
of those amounts in box 1; and complete the rest of the     1097-BTC, call the information reportingcustomer service 
form as applicable. If any amounts previously furnished for site toll free at 866-455-7438 or304-263-8700 (not toll 
the first three quarters need to be corrected, report the   free). Persons with a hearing or speech disability with 
correct amounts for the annual reporting and explain the    access to TTY/TDD equipment can call 304-579-4827 (not 
correction to the recipient; no explanation is required for toll free). 
the IRS filing.