EFTA00595680.pdf

De Not show 6969 Form 1096 Department of the Treasury Internal Remus Sent* Annual Summary and Transmittal of U.S. Information Returns OMB No. 1545.0108 20013 FILERS name BEB 2011 Trust Street address (ini:turfing room or suite number) 445 Park Ave., Suite 1401 City or town. province or state, country. and ZIP or foreign postal code New Yorkf NY 10022 Name of person to contact Telephone number For Official Use Only R 646-589-0101 Email address Fax number 1 Employer Identification number 45-6341048 2 Social secunty number 3 Total number of forms 1 4 Federal income tax vAthheld $ 5 Total amount mooned with this Form 1096 $ 464294 6 Enter an "A" in only one box below to indicate the type of form being Ned. 7 II this is your final return. enter an IC here Pr1 W-20 32 K 1097-870 50 00000 1098 81 1098.0 78 1098-E 84 1098.7 83 1099-A 80 K 1099.8 79 0 1099-C 85 1099.CAP1099.0Iv 73 91 II 10994 86 1099.1 71 10994NT 92 la 10994C 10 1099-LTC 93 1099- MSC 95 1099-0ID 98 0 1099. PAIR 97 1099.0 31 1099-R 98 1099.5 75 1092.64 94 3921 25 3922 26 5498 28 El 5499-ESA 72 K 5498.5A 27 0 Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Under penalties of penury. I declare that I have examined this etum and accompanying documents, and, to the best of my knowledge and bekel, they are true. correct. and complete. Signaturee Instructions Future developments. For the latest information about developments related to Form 1096. such as legislation enacted after they were published. go to tinvw.irs.govItorm1098. Reminder. The only acceptable method of filing information returns with Internal Revenue Servicennformation Returns Branch is electronically through the FIRE system. See Pub. 1220. Specifications for Filing Forms 1097. 1098. 1099, 3921. 3922, 5498, 8935. and W-20 Electronically. Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922. 5498, and W-2G to the Internal Revenue Service. Oo not use Form 1096 to transmit electronically. For electronic submissions. see Pub. 1220. Caution. If you are required to file 250 or more information returns of any one type, you must file electronically. If you are required to file electronically but tail to do so. and you do not have an approved waiver. you may be subject to a penalty. For more information, see pan F in the 2013 General Instructions for Certain Information Returns. Who must file. The name, address, and TIN of the filer on this form must be the same as those you enter in the upper left area ol Forms 1097, 1098. 1099. 3921. 3922, 5498. or W-2G. A filer is any person or entity who files any of the forms shown in line 6 above. Enter the filets name. address (including room, suite. or other unit number), and TIN in the spaces provided on the form. Title, Date I. When to file. File Form 1096 as follows. • With Forms 1097, 1098, 1099. 3921. 3922. or W-26. file by February 28, 2014. • With Forms 5498, file by June 2, 2014. Where To File Send all information returns filed on paper with Form 1096 to the following: If your principal business, office or agency, or legal residence in the case of an individual, Is located in Use the following three-line address Alabama. Ancona. Arkansas, Connemicut Delaware, Florida. Georgia. Kentucky. Louisiana. Maine. Massechusens, Mississippi. New Hampshire, New Jersey. New Marko. Now York. North Caroline. Ohio, Pennsylvania. Rhode island. Texas. Vermont. Viry;inia. West Virginia Department °lino Treasury Internal Rifuenue Service Censer Austin. TX 73301 DETACH BEFORE MAILING For more Information and the Privacy Act and Paperwork Reduction Act Notice. Form 1096 (2013) E see the 2013 General Instructions for Certain Information Returns. 38-20.99003 ; EFTA00595680 9292 n VOID Li CORRECTED PAYERS name. street address. city or town, province or state. country. ZIP or foreign postal code, and telephone no. BEB 2011 Trust 445 Park Ave, Suite 1401 New York, NY 10022 Payers RTN (Optional) 1 Interest income $ 121870.03 OMB No. 15450112 2a1 3 Form 1099-INT Interest Income PAYER'S federal identification number 45-614104R RECIPIENT'S name Yggdrasil Trust RECIPIENT'S identification number 102-76-7664 2 Early withdrawal penalty $ Street address (Including apt. no.) 445 Park Ave. Suite 1401 City or town, province or state, country. and ZIP or foreign postal code New York, NY 10022 3 Interest on U.S. Savings Bonds and Treas. obligations $ 4 Federal income tax withheld S Investment expenses $ 7 Eceeign cony or U.S. pOSSentri 6 Foreign tax paid 8 Tainexempt interest $ 10 Tax-exempt bond CUSIP no. 9 Spewed private actmI bond irnerest Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2013 General Instructions for Certain Information Returns. Account number (see instructions) 2nd TIN not. 11 State 12 State identification ro. 13 State tax withheld S $ Form 1099-INT 16-0331690 iwnv.irs.govilorrn1099int Department of the Treasury' Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 9292 0 VOID 0 CORRECTED PAYER'S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no. BEB 2011 Trust 445 Park Ave, Suite 1401 New York, NY 10022 Payer's RTN (optional) PAYERS federal identification number RECIPIENTS identification number 102-76-7664 45-6341048 RECIPIENTS name Benjamin Black 2010 Trust 1 Interest income $ 142424 76 2 Early withdrawal penalty $ OMB No. 1545-0112 201 3 Form 1099-INT Interest Income Street address (including apt. no.) 145 Park Ave, Suite 1401 Oily or to". province or elate. country, and ZIP or foreign postal aide New YnrIc NY 10022 3 Interest on U.S. Savings Bonds and Treas. Obligations $ 4 Federal income tax withheld $ 5 Investment expenses $ 7 Foreign Many Cr U.S. onsessr5n 6 Foreign lax paid 8 Tax-exempt interest $ 10 Tax•exempt bond CUSIP ne. 9 Specified private activny bond interest $ 11 Stale Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2013 General Instructions for Certain Information Returns. Account number (see Instructions) 2nd TIN not. 12 State identilcabon no 13 State tax withheld $ $ F01111 1099-INT 16-0331690 wwwirs.govrlomilOggint Department of the Treasury • Internal Revenue Service 0 2 c c 0 MW a w LL I— O EFTA00595681