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- 1 4281TPART I. INTEREST INCOME
- 1 6 40T1a Interest from seller-financed mortage [10]. 1a ==>
- 1 8 40T1b Name of payer ==>
- 110 40T2. Other interest income (list) [19]. 2 ==>
- 111 40T3. Add amounts on lines 1 and 2 [19]. 3 ==>C
- 113281TPART II. DIVIDEND INCOME
- 115 40T4. Dividend income (list) [25]. 4 ==>
- 116 40T6. Capital gain distributions [21]. 6 ==>
- 117 40T7. Nontaxable distributions [23]. 7 ==>
- 118 40T8. Exclusions from public utility dividends [07]. 8 ==>
- 119 40T9. Add amounts on line 6, 7, and 8 [16]. 9 ==>C
- 120 30T10. Subtract line 9 from total dividends [11]. 10 ==>C
- 1 6670$N10141a
- 1 8270AN25
- 110670$N10142
- 111670$Y10
- 115670$N10144
- 116670$N10146
- 117670$N10147
- 118670$N10148
- 119670$Y10
- 120670$Y10
- 2 4221TPART III. FOREIGN ACCOUNTS AND TRUSTS
- 2 6 30T11. Did you have an interest in or a signature or other
- 2 7 30T authority over a bank account, securities account,
- 2 8 30T or other financial account in a foreign country? (Y/N) ==>
- 210 30T If yes, name the country ==>
- 212 30T12. Were you the grantor of or transferor to a foreign
- 213 30T trust which existed during the current tax year whether
- 214 30T or not you have any beneficial interest in it? (Y/N) ====>
- 2 8680YN 1
- 210380AN20
- 214680YN 1