Schedule B - SCHEDULE B (Form 1040A or 1040) Department of...

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(Form 1040A or 1040) 20 09 Interest and Ordinary Dividends Department of the Treasury Internal Revenue Service (99) ' Attach to Form 1040A or 1040. ' See instructions on back. OMB No. 1545-0074 Attachment Sequence No. 08 Name(s) shown on return Your social security number 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 ' 1 Amount 2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . 2 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 Note. If line 4 is over $1,500, you must complete Part III. 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. 5 List name of payer ' 5 Amount 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a . . . . . . . . . . . . . . . . . . . . . . ' 6 Note. If line 6 is over $1,500, you must complete Part III. Part III Foreign Accounts and Trusts (See instructions on back.) You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Yes No 7 a At any time during 2009, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See instructions on back for exceptions and filing requirements for Form TD F 90-22.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b If “Yes,” enter the name of the foreign country ' 8 During 2009, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If “Yes,” you may have to file Form 3520. See instructions on back . . . . . . For Paperwork Reduction Act Notice, see Form 1040A or 1040 instructions. Cat. No. 17146N
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Schedule B - SCHEDULE B (Form 1040A or 1040) Department of...

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