EFTA02712022.pdf

OMB No 1545-0074 1 2013 SCHEDULE B Interest and Ordinary Dividends (Form 1040A or 1040) ► Attach to Form 1040A or 1040. Allactunent Dcpsurme a Vro Treauty Intornal Revenue 541,000 lei Information about Schedule B (Form 1040A or 1040) and Its Instructions is at Stcpanco No 08 kerneol shown on social sectray numtw BENJAMIN E. BLACK Part I I 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 Pr. BEB 2011 TRUST (YGGDRASIL TRUST) 121,870 JP}fORGAWCIFIIIIII= 3. BEB 2011 TRUST BENJAMIN BLACK 2010 TRUST) 82,266 FROM K-1 - FARMERSWEB LLC 21. Note. If you received a Form 1099-INT, Form 1099-010, 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 alter 1989. Attach Form 8815 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, My 8a 4 204,160 Note. If line 4 is over $1,500, you must complete Part 111. 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 1099-DIV 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, ens 9a 1,928. Note. If line 6 is over $1.500, you must complete Part III. You must complete this par1 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 7a 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 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 PO' 8 During 2013, did you receive a distribution tram, or were you the grantor of. or transferor to. a foreign trust? 327501 094043 If Wes • you may have to file Farm 3520. See instructions LHA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule B (Form 'IOWA or 1040) 2013 7 EFTA_R1_02128127 EFTA02712022