EFTA01195153.pdf

OMB No I ra45•O074 SCHEDULE B Interest and Ordinary Dividends (Form 1040A or 1040) Owattrimfldthermeury ► Attach to Form 1040A or 1040. 2013 /tOoVonert Interrkal ROVONJO StvAC0 (99) Ill• Information about Schedule B (Form 1040A or 1040) and its instructions is at „„,„„, °nuk e 4, Sationroa No Name town on naturn WA1 a.Gn:v BENJAMIN E. BLACK Part I 1 List name of payer. If any interest is from a seller•financed mortgage and the buyer used the Amount Interest property as a personal residence, see instructions and list this interest first. Also, show that buyer's social security number and address BB. BEB 2011 TRUST YGGDRASIL TRUST) 121,870 JPMORGAN A/C# 3 BEB 2011 TRUST (BENJAMIN BLACK 2010 TRUST) 82,266 FROM K-1 - FARMERSWEB LLC 21 Note. If you received a Form 1093INT. Form 10990ID, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total interest shown on that 2 Add the amounts on line 1 204,160 form. 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a 4 204,160 Note. If line 4 is over 51.500. you must complete Part III Amount Part II 5 List name of payer ► Ordinary JPMORGAN A/C# 1,915. Dividends THE WALT DISNEY COMPANY 13 Note. If you received a Form 1099DIV or substitute statement from a brokerage firm. list the firm's name as the payer and enter the ordinary dividends shown on that form. 6 Add the amounts on line 5. Enter the total here and on Form 1040A. or Form 1040. line 9a Ie. 6 1,928. Note. If line 6 is over $1,500. you must complete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends: (b) had a foreign Yes No Part III account: or (c) received a distribution from. or were a grantor of. or a transferor to. a foreign trust. Foreign la At any time during 2013, did you have a financial interest in or signature authority over a financial account (such Accounts as a bank account, securities account, or brokerage account) located in a foreign country? See instructions X and If "Yes,' are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), Trusts formerly TD F 90.22.1 to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements b If you are required to file FinCen Form 114, enter the name of the foreign country where the financial account is located ► 8 During 2013, did you receive a distribution from, or were you the grantor of. or transferor to. a foreign trust? 321501 09-30-13 If "Yes,' you may have to file Form 3520. See instructions X LHA For Paperwork Reduction Act Notice, see your tax return Instructions. Schedule B (Form 1040A or 1040) 2013 7 EFTA01195153