2005 Interest & Dividend Income

Your Email address (required)        Taxpayer Social Security No.

Interest Income
Seller Financed Mortgage: Enter - Name, Address, Fed ID No. and Amount


Interest Income from Banks, S&L's, and other sources
Payor Savings Bonds & Treas. Obligations Early Withdrawal Penalty Other Interest Income Federal Income Tax Withheld Foreign Tax Paid Investment
Expenses 		Foreign Country or US Possession
   

Dividend Income

Payor Ordinary Dividends Qualified
Dividends		 Total Capital Gain Distr Collectibles
(28% rate gain) 		Unrecap. sec.1250 gain Section 1202 gain Non taxable Distr. Fed Income Tax WH Invest Exp. Foreign Tax Paid Foreign Country Cash liqidation distr. Noncash liquidation distr.
 

Did you have an interest in a Foreign Financial Account during 2005? No / Yes

Did you have an interest in a Foreign Trust during 2005? No / Yes


    
   
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