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Schedules A&B (Form 1040) 2001

OMB No. 1545-0074

Page

Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side.

Your social security number

Attachment

Schedule B—Interest and Ordinary Dividends

Sequence No.

Amount

List name of payer. If any interest is from a seller-financed mortgage and the

Part I

buyer used the property as a personal residence, see page B-1 and list this

Interest

interest first. Also, show that buyer’s social security number and address

(See page B-1

and the

instructions for

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

Add the amounts on line 1

form.

Excludable interest on series EE and I U.S. savings bonds issued after 1989

from Form 8815, line 14. You must attach Form 8815

Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a

Note. If line 4 is over $400, you must complete Part III.

Amount

List name of payer. Include only ordinary dividends. If you received any capital

Part II

gain distributions, see the instructions for Form 1040, line 13

Ordinary

Dividends

(See page B-1

and the

instructions for

Form 1040,

line 9.)

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 5. Enter the total here and on Form 1040, line 9

Note. If line 6 is over $400, you must complete Part III.

You must complete this part if you (a) had over $400 of taxable interest or ordinary dividends; (b) had a

Yes

Part III

foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.

Foreign

At any time during 2001, did you have an interest in or a signature or other authority over a financial

Accounts

account in a foreign country, such as a bank account, securities account, or other financial

and Trusts

account? See page B-2 for exceptions and filing requirements for Form TD F 90-22.1

b If “Yes,” enter the name of the foreign country

(See

During 2001, did you receive a distribution from, or were you the grantor of, or transferor to, a

page B-2.)

foreign trust? If “Yes,” you may have to file Form 3520. See page B-2

For Paperwork Reduction Act Notice, see Form 1040 instructions.

Schedule B (Form 1040) 2001

Schedules A&b (Form 1040) - Itemized Deductions, Interest And Ordinary Dividends - 2001 Page 2

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