Account

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SCHEDULE B
(Form 1040A or 1040)

Interest and Ordinary Dividends


OMB No. 1545-0074

Attach to Form 1040A or 1040. Department of the Treasury Internal Revenue Service (99) ▶ Information about Schedule B (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleb.
Name(s) shown on return

Attachment Sequence No. 08 Your social security number

2013
Amount

Part I Interest
(See instructions on back and the instructions for Form 1040A, or Form 1040, line 8a.) Note. If you received a Form 1099-INT, Form 1099-OID, or substitute statement from a brokerage firm, list the firm’s name as the payer and enter the total interest shown on that form.

1

List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see instructions on back and list this interest first. Also, show that buyer’s social security number and address ▶
Interest on certificate of deposits

3300

1

Part II Ordinary Dividends
(See instructions on back and the instructions for Form 1040A, or Form 1040, line 9a.) 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.

Add the amounts on line 1 . . . . . . . . . . Excludable interest on series EE and I U.S. savings Attach Form 8815 . . . . . . . . . . . . . 4 Subtract line 3 from line 2. Enter the result here and 1040, line 8a . . . . . . . . . . . . . . Note. If line 4 is over $1,500, you must complete Part III. List name of payer ▶ 5

2 3

. . . . . . . . bonds issued after 1989. . . . . . . . . on Form 1040A, or Form . . . . . . . . ▶

2 3 4 Amount

5

Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 6 1040, line 9a . . . . . . . . . . . . . . . . . . . . . . ▶ Note. If line 6 is over $1,500, you…...

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