OMB No. 1545-0110 CORRECTED (if checked) PAYER'S name, street address, city or town, state or province, country, ZIP la Total ordinary dividends or foreign postal code, and telephone no. $1,131.00 Divide 2020 1b Qualified dividends Devona Corporation 33133 Hilltop Drive Alpine, CA 91901 Distributi $ 816.00 Form 1099-DIV 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain RECIPIENT'S TIN 2d Collectibles (28%) gain PAYER'S TIN 27-1234567 2c Section 1202 gain $ 313-13-1313 Cop RECIPIENT'S name 3 Nondividend distributions 4 Federal income tax withheld Sally Heck For R. $ 0.00 5 Section 199A dividends 6 Investment expenses This is impor Street address lincluding ant nn Street address (including apt. no.) 7 Foreign tax paid 1420 Pasadena Blvd. 8 Foreign country or U.S. possession City or town, state or province, country, and ZIP or foreign postal code This is import information and i furnished to the you are required return, a neg penalty sanction imposed on yo income is taxa the IRS determir it has n 9 Cash liquidation distributions 10 Noncash liquidation distributions Carrollton, TX 75007 FATCA filing 11 Exempt-interest requirement dividends 12 Specified private activity bond interest dividends re $ Account number (see instructions) 13 14 State identification no. 15 State tax withheld $ State $ Form 1099-DIV (keep for your records) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue The Hecks also received the following dividends and interest in 2020 (Forms 1099-DIV not shown): Sally Charles Jointly Qualifying dividends: General Motors $960 IBM $2,240 $3,590 Gene Corporation Interest: Dime Box Bank First National Bank 12 1,016 Assuming the Hecks file a joint tax return, complete Schedule B of Form 1040 for them for the 2020 tax year. If an amount box does not require an entry, enter "o". SCHEDULE B (Form 1040) Interest and Ordinary Dividends OMB No. 1545-0074 Department of the Treasury Internal Revenue Service (99) Go to www.irs.gov/Schedule for instructions and the latest information. Attach to Form 1040 or 1040-SR. 2020 Attachment Sequence No. 08 Your social security number 313-13-1313 Amount Name(s) shown on return Charles and Sally Heck Part I 1 Interest (See instructions and the instructions for Forms 1040 and 1040-SR, line 2b.) List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see the instructions and list this interest first. Also, show that buyer's social security number and address 1 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. 2 2 3 3 Add the amounts on line 1. Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815... Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b... 4 4 Amount Note: If line 4 is over $1,500, you must complete Part III. 5 List name of payer Part II 2 Add the amounts on line 1 2 99-INT, 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. 3 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815... 4 Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b ..... Note: If line 4 is over $1,500, you must complete Part III. 5 List name of payer 4 Amount Part II Ordinary Dividends (See instructions and the instructions for Forms 1040 and 1040-SR, line 3b.) 5 0000 Note: If you received a Form 1099-DIV or substitute statement from a brokerage firm lict the firm's ... Add the amounts on line 5 Enter the total hors and on Form 104n or inan_SR HRERERE 6 6 Yes No from a brokerage firm, list the firm's Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, name as the payer line 3b.. and enter the ordinary dividends shown on that form. Note: If line 6 is over $1,500, you must complete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account; or (C) received a distribution from, or were a grantor of, or a transferorto, a foreign trust. 7a At any time during 2020, 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 Part III country? Foreign See instructions Accounts and Trusts If "Yes," are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts Caution: If required, (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its failureto file FinCEN instructions for filing requirements and exceptions to those requirements ... Form 114 may result in substantial b If you are required to file FinCEN Form 114, enter the name of the foreign country where the penalties. See financial account is located instructions. During 2020, did you receive a distribution from, or were you the grantor of, or transferorto, a foreign trust? If "Yes," you may have to file Form 3520. See instructions For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Form 1040) 2020 8 OMB No. 1545-0110 CORRECTED (if checked) PAYER'S name, street address, city or town, state or province, country, ZIP la Total ordinary dividends or foreign postal code, and telephone no. $1,131.00 Divide 2020 1b Qualified dividends Devona Corporation 33133 Hilltop Drive Alpine, CA 91901 Distributi $ 816.00 Form 1099-DIV 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain RECIPIENT'S TIN 2d Collectibles (28%) gain PAYER'S TIN 27-1234567 2c Section 1202 gain $ 313-13-1313 Cop RECIPIENT'S name 3 Nondividend distributions 4 Federal income tax withheld Sally Heck For R. $ 0.00 5 Section 199A dividends 6 Investment expenses This is impor Street address lincluding ant nn Street address (including apt. no.) 7 Foreign tax paid 1420 Pasadena Blvd. 8 Foreign country or U.S. possession City or town, state or province, country, and ZIP or foreign postal code This is import information and i furnished to the you are required return, a neg penalty sanction imposed on yo income is taxa the IRS determir it has n 9 Cash liquidation distributions 10 Noncash liquidation distributions Carrollton, TX 75007 FATCA filing 11 Exempt-interest requirement dividends 12 Specified private activity bond interest dividends re $ Account number (see instructions) 13 14 State identification no. 15 State tax withheld $ State $ Form 1099-DIV (keep for your records) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue The Hecks also received the following dividends and interest in 2020 (Forms 1099-DIV not shown): Sally Charles Jointly Qualifying dividends: General Motors $960 IBM $2,240 $3,590 Gene Corporation Interest: Dime Box Bank First National Bank 12 1,016 Assuming the Hecks file a joint tax return, complete Schedule B of Form 1040 for them for the 2020 tax year. If an amount box does not require an entry, enter "o". SCHEDULE B (Form 1040) Interest and Ordinary Dividends OMB No. 1545-0074 Department of the Treasury Internal Revenue Service (99) Go to www.irs.gov/Schedule for instructions and the latest information. Attach to Form 1040 or 1040-SR. 2020 Attachment Sequence No. 08 Your social security number 313-13-1313 Amount Name(s) shown on return Charles and Sally Heck Part I 1 Interest (See instructions and the instructions for Forms 1040 and 1040-SR, line 2b.) List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see the instructions and list this interest first. Also, show that buyer's social security number and address 1 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. 2 2 3 3 Add the amounts on line 1. Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815... Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b... 4 4 Amount Note: If line 4 is over $1,500, you must complete Part III. 5 List name of payer Part II 2 Add the amounts on line 1 2 99-INT, 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. 3 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815... 4 Subtract line 3 from line 2. Enter the result here and on Form 1040 or 1040-SR, line 2b ..... Note: If line 4 is over $1,500, you must complete Part III. 5 List name of payer 4 Amount Part II Ordinary Dividends (See instructions and the instructions for Forms 1040 and 1040-SR, line 3b.) 5 0000 Note: If you received a Form 1099-DIV or substitute statement from a brokerage firm lict the firm's ... Add the amounts on line 5 Enter the total hors and on Form 104n or inan_SR HRERERE 6 6 Yes No from a brokerage firm, list the firm's Add the amounts on line 5. Enter the total here and on Form 1040 or 1040-SR, name as the payer line 3b.. and enter the ordinary dividends shown on that form. Note: If line 6 is over $1,500, you must complete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account; or (C) received a distribution from, or were a grantor of, or a transferorto, a foreign trust. 7a At any time during 2020, 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 Part III country? Foreign See instructions Accounts and Trusts If "Yes," are you required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts Caution: If required, (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its failureto file FinCEN instructions for filing requirements and exceptions to those requirements ... Form 114 may result in substantial b If you are required to file FinCEN Form 114, enter the name of the foreign country where the penalties. See financial account is located instructions. During 2020, did you receive a distribution from, or were you the grantor of, or transferorto, a foreign trust? If "Yes," you may have to file Form 3520. See instructions For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Form 1040) 2020 8