Schedule BAdditional Dividends Statement2013

Part IIG Attach to return (after all IRS forms)Statement

Name(s) shown on returnYour social security number

List name of payer.Amount

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

----------------Page (0) Break----------------