......
SCHEDULE B 
(Form 1040A or 1040) 
Department of the Treasury  
Internal Revenue Service (99) 
Interest and Ordinary Dividends
a
 
Attach to Form 1040A or 1040.
 
 
a
 
Information about Schedule B (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleb
.
 
OMB No. 1545-0074
20
13
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  
a
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
......................
a
4 
Note. 
If line 4 is over $1,500, you must complete Part III. 
Amount 
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
  
a
5 
6 
 
Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 
1040, line 9a 
......................
a
6 
Note.  
If line 6 is over $1,500, you must complete Part III. 
Part III  
Foreign  
Accounts  
and Trusts  
(See 
instructions on 
back.) 
Yes 
No
7a 
At any time during 2013, did you have a financial interest in or signature authority over a financial 
account (such as a bank account, securities account, or brokerage account) located in a foreign 
country? See instructions 
........................
If “Yes,” are you  required to file FinCEN Form 114, Report of Foreign Bank and Financial 
Accounts (FBAR), formerly TD F 90-22.1, to report that financial interest or signature authority? 
requirements 
............................
See FinCEN Form 114 and its instructions for filing requirements and exceptions to those 
b 
If you are required to file FinCEN Form 114, enter the name of the foreign country where the 
financial account is located  
a
8 
During 2013, 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 your tax return instructions. 
Cat. No. 17146N 
Schedule B (Form 1040A or 1040) 2013 
Enter more interest payers
Enter more dividend payers
foreign account; or  (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. 
You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends;  (b) had a 
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