EFTA00595680.pdf

De Not show 6969 OMB No. 1545.0108 Form 1096 Annual Summary and Transmittal of Department of the Treasury Internal Remus Sent* U.S. Information Returns 20013 FILERS name BEB 2011 Trust Street address (ini:turfing room or suite number) 445 Park Ave., Suite 1401 City or town. province or state, country. and ZIP or foreign postal code New York f NY 10022 Name of person to contact Telephone number For Official Use Only R 646-589-0101 Email address Fax number 1 Employer Identification number 2 Social secunty number 3 Total number of forms 4 Federal income tax vAthheld 5 Total amount mooned with this Form 1096 45-6341048 1 $ $ 464294 6 Enter an "A" in only one box below to indicate the type of form being Ned. 7 II this is your final return. enter an IC here Pr1 W-20 1097-870 1098 1098.0 1098-E 1098.7 1099-A 1099.8 1099-C 1099.CAP1099.0Iv 10994 1099.1 10994NT 10994C 1099-LTC 1099- 1099-0ID 32 50 81 78 84 83 80 79 85 73 91 86 71 92 10 93 MSC 98 95 ❑ 00000 ❑ 0 II la 0 DETACH BEFORE MAILING 1099. 1099.0 1099-R 1099.5 1092.64 3921 3922 5498 5499-ESA 5498.5A PAIR 31 98 75 94 25 26 28 72 27 97 El ❑ 0 Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Under penalties of penury. I declare that I have examined this etum and accompanying documents, and, to the best of my knowledge and bekel, they are true. correct. and complete. Signaturee Title, Date I. Instructions When to file. File Form 1096 as follows. Future developments. For the latest information about developments • With Forms 1097, 1098, 1099. 3921. 3922. or W-26. file by related to Form 1096. such as legislation enacted after they were February 28, 2014. published. go to tinvw.irs.govItorm1098. • With Forms 5498, file by June 2, 2014. Reminder. The only acceptable method of filing information returns with Internal Revenue Servicennformation Returns Branch is Where To File electronically through the FIRE system. See Pub. 1220. Specifications Send all information returns filed on paper with Form 1096 to the for Filing Forms 1097. 1098. 1099, 3921. 3922, 5498, 8935. and W-20 following: Electronically. If your principal business, office Purpose of form. Use this form to transmit paper Forms 1097, 1098, Use the following 1099, 3921, 3922. 5498, and W-2G to the Internal Revenue Service. or agency, or legal residence in the case of an individual, Is three-line address Oo not use Form 1096 to transmit electronically. For electronic submissions. see Pub. 1220. located in Caution. If you are required to file 250 or more information returns of any one type, you must file electronically. If you are required to file Alabama. Ancona. Arkansas, electronically but tail to do so. and you do not have an approved Connemicut Delaware, Florida. Georgia. waiver. you may be subject to a penalty. For more information, see Kentucky. Louisiana. Maine. pan F in the 2013 General Instructions for Certain Information Returns. Massechusens, Mississippi. New Department °lino Treasury Hampshire, New Jersey. New Marko. Internal Rifuenue Service Censer Who must file. The name, address, and TIN of the filer on this form Austin. TX 73301 must be the same as those you enter in the upper left area ol Forms Now York. North Caroline. Ohio, 1097, 1098. 1099. 3921. 3922, 5498. or W-2G. A filer is any person or Pennsylvania. Rhode island. Texas. entity who files any of the forms shown in line 6 above. Vermont. Viry;inia. West Virginia Enter the filets name. address (including room, suite. or other unit number), and TIN in the spaces provided on the form. For more Information and the Privacy Act and Paperwork Reduction Act Notice. Form 1096 (2013) E see the 2013 General Instructions for Certain Information Returns. 38-20.99003 ; EFTA00595680  9292 n VOID Li CORRECTED PAYERS name. street address. city or town, province or state. country. ZIP Payers RTN (Optional) OMB No. 15450112 or foreign postal code, and telephone no. BEB 2011 Trust 1Interest income 2a13 Interest Income 445 Park Ave, Suite 1401 New York, NY 10022 $ 121870.03 Form 1099-INT 2 Early withdrawal penalty Copy A PAYER'S federal identification number RECIPIENT'S identification number $ 3 Interest on U.S. Savings Bonds and Treas. obligations For Internal Revenue Service Center 45-614104R 102-76-7664 $ RECIPIENT'S name 4 Federal income tax withheld S Investment expenses File with Form 1096. Yggdrasil Trust For Privacy Act Street address (Including apt. no.) 6 Foreign tax paid $ 7 Eceeign cony or U.S. pOSSentri and Paperwork Reduction Act 0 445 Park Ave. Suite 1401 Notice, see the City or town, province or state, country. and ZIP or foreign postal code 2013 General Instructions for New York, NY 10022 8 Tainexempt interest 9 Spewed private actmI bond Certain irnerest Information Returns. Account number (see instructions) $ 2nd TIN not. 10 Tax-exempt bond CUSIP no. 11 State 12 State identification ro. 13 State tax withheld 2 S Form 1099-INT 16-0331690 iwnv.irs.govilorrn1099int Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page $ Department of the Treasury' Internal Revenue Service cc 0 9292 0 VOID 0 CORRECTED PAYER'S name, street address, city or town, province or state, country, ZIP Payer's RTN (optional) OMB No. 1545-0112 W or foreign postal code, and telephone no. M BEB 2011 Trust 1 Interest income 2013 Interest Income 445 Park Ave, Suite 1401 $ 142424 76 Form 1099-INT New York, NY 10022 2 Early withdrawal penalty Copy A PAYERS federal identification number RECIPIENTS identification number $ 3 Interest on U.S. Savings Bonds and Treas. Obligations For Internal Revenue Service Center 45-6341048 102-76-7664 $ RECIPIENTS name 4 Federal income tax withheld 5 Investment expenses File with Form 1096. Benjamin Black 2010 Trust For Privacy Act Street address (including apt. no.) $ $ and Paperwork 6 Foreign lax paid 7 Foreign Many Cr U.S. onsessr5n Reduction Act 145 Park Ave, Suite 1401 Notice, see the Oily or to". province or elate. country, and ZIP or foreign postal aide 2013 General Instructions for New YnrIc NY 10022 8 Tax-exempt interest 9 Specified private activny bond Certain interest Information Returns. a w LL $ $ I— Account number (see Instructions) 2nd TIN not. 10 Tax•exempt bond CUSIP ne. 11 Stale 12 State identilcabon no 13 State tax withheld $ $ F01111 1099-INT 16-0331690 wwwirs.govrlomilOggint Department of the Treasury • Internal Revenue Service O EFTA00595681