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You can duplicate both of these statements if you need additional space.

The interest statement columns are:

 

Enter the payer and amount in the appropriate column.

+ or - and State adjustment: These columns should be used if the state taxes interest differently from the IRS. Enter a "+" and the amount of interest to add to the state, or enter a "-" and the amount of interest to subtract from the state return. For instance, if the interest is exempt from tax by the IRS (Federal), but the state taxes it, enter a "+" and that amount.

U.S. Exempt: Mark this box if the interest is nontaxable by the Federal government.

Withdrawal penalty: If there is a withdrawal penalty on the interest, enter the amount of the penalty here.

Federal Withholding: Enter the amount of any Federal withholding here.