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efta-efta01116009DOJ Data Set 9Other

SCHEDULE B

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EFTA Disclosure
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SCHEDULE B (Form 1040A or 1040) Deportment of the Treasury internal Revenue &hence (991 Name(s) shown on return LEON & DEBRA BLACK Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see instructions on back and list Interest this interest first. Also, show that buyers social security number and address ► Interest and Ordinary Dividends ►Attach to Form 1040A or 1040. ► Information about Schedule B (Form 1040A or 1040) and its instructions is at rnswirs.govIscheduleb. plAB No. 1545.0074 2©13 Attachment Sequence No. 08 Your social security number (See instructions on back and the instructions for Form 1040A. or Form 1040. line Ba.) Note. If you received a Form 1099-INT. Form 1099-0ID, or substitute statement from a brokerage firm. list the firm's name as the payer and enter the total interest shown on that form. Part II Ordinary Dividends SEE RIDER ATTACHED - A SEE RIDER ATTACHED - B 2 Add the amounts on line 1 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 1040A, or Form 1040. line 8a 1 Amount 369,352 5 121 155 2 3 5,490507 4 5 490 507 Note. If line 4 is over $1.500. you must complete Part III. 5 List name of payer ► (See instructions on back and the instructions for Form 1040k or Form 1040. line 9a.) Note. If you received a Form 1099-DN or substitute statement from a brokerage firm. list the firm's name as the payer and enter the ordinary 6 Add the amounts on line 5. Enter the total here and on Form 1040A. or Form dividends shown on that form. 1040. line 9a Part III Foreign Accounts and Trusts (See instructions on back.) Note. If line 6 is over $1.500, you must complete Part Ill. 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 transferor to, a foreign trust. 5 Amount 6 7a At any time during 2013, 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 country? See instructions If "Yes." are you required to file FinCEN Form 114. Report of Foreign Bank and Financial Accounts (FBAR). formerly TD F 90-22.1, to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial account is located ► 8 During 2013, did you receive a distribution from, or were you the grantor of. or transferor to, a foreign trust? If "Yes," you may have to file Form 3520. See instructions on back Yes No For Paperwork Reduction Act Notice, see your tax return Instructions. Cat. No. 17146N Schedule B (Form 1040A or 1040) 2013 EFTA01116009 LEON & DEBRA BLACK ATTACHMENT TO 1040 FY 2013 SSN: RIDER A SCHEDULE B, PART I, INTEREST, LINE 1: NAME OF PAYER AMOUNT AMERICANS ELECT BANK OF AMERICA - CKING A/C# 0112-6296 BANK OF AMERICA - CKING A/C# 0624-6273 BANK OF AMERICA - CKING A/C# 0662-3840 BANK OF AMERICA - CKING A/C# 3940-0132-0945 BANK OF AMERICA - MMK SV A/Ctt 3940-0129-9982 BANK OF AMERICA - SAVNG A/Ctt 0688-6140 HSBC BANK - RENT SECURITY JPMORGAN A/Ctt 159-16357 JPMORGAN A/Ctt 159-17426 WELLS FARGO A/Ctt 297287T2 BANK OF AMERICA - CKING A/C# 4830-4482-0384 GOLDMAN SACHS A/Ctt 681-57975-1 GOLDMAN SACHS A/Clt 681-58333-2 GOLDMAN SACHS A/Clt 681-58348-0 GOLDMAN SACHS A/Ctt 681-58001-5 1,352 13 113 12,667 1,398 31,770 42,234 73 30,006 31 4,131 203 268 2,185 216,394 26,514 369,352 EFTA01116010 LEON & DEBRA BLACK ATTACHMENT TO 1040 FY 2013 SSN: SCHEDULE Et, PART I, INTEREST, LINE 1: RIDER 8 NAME OF PAYER AMOUNT AMOUNTS REPORTED 8Y PASS-THROUGH ENTITY: ENTITY EIN: ARTNER TO WHOM ISSUED TO RALLY LABS LLC 6,879 EON O. BLACK APOLLO ADVISORS LP 12,704 EON O. BLACK APOLLO INVESTMENT FUND 574 EON O. BLACK PEGASUS PARTNERS LP 7448 EON O. BLACK 976 MADISON RESTAURANT LLC 11409 EON O. BLACK AP CAPITAL PROP CO 531 EON 0. BLACK APOLLO INTL RE ADVISORS LP 9,336 EON 0. BLACK APOLLO POLAND RE ADVISORS LLC 9,659 EON 0. BLACK AREIF V CO-INVESTORS LLC 1,176 EON O. BLACK APOLLO INTL RE CO-INVESTORS U.0 9,247 EON O. BLACK APOLLO RE MEZZANINE ADVISORS 971 EON O. BLACK AP AR HOLDCO 3,045 EON O. BLACK AP TECHNOLOGY PARTNERS LLC 9,223 EON O. BLACK AP SILL INVESTORS LLC 4,007 EON 0. BLACK ANCHORAGE CAPITAL PARTNERS, LP 204059325 124 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) CANYON VALUE REALIZATION FUND, LP 95-4449342 55,461 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO VIF CO-INVESTORS, LLC 204216554 6,821 LACK FAMILY PARTNERS, I.P I DISREGARDED ENTITY) MN HOLDINGS LP 98-0641994 3,860,395 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) KNOWLEDGE UNIVERSE EDUCATION LP (LBF ICLOINGS LLC) 98-0498581 9,194 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS IV, LLC 13-4002661 68,155 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO SOMA CO-INVESTORS, LLC 20.8472391 1,066 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS VI (EN-A). LLC 98-0511923 4,739 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS VI A I, LLC 20.3396939 145 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS V. LLC 13-4125399 1,937 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) AP ALTERNATIVE ASSETS 98-0495844 94,220 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) ATHENE HOLDING LIMITED 713 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) FO CO-INVESTORS II (Al 62,493 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) KING STREET CAPITAL, LP 13-3812174 898 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) SUSTAINABLE WOODLANDS FUND II, LP 20-5192952 994 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) WOLFENSOIIN CAPITAL PARTNERS LP 98-0553759 33,733 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) WCP AIV, LP 27-5271800 2,353 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) AP SILL INVESTORS LLC 5,187 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) AP TECHNOLOGY PARTNERS LLC 20,772 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) CRETE LLC 590 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) TENFORE HOLDINGS FUND I LP 89,880 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) MILLENNIUM USA LP 13-3976200 867 BF HOLDINGS LLC (DISREGARDED ENTRY] IIAO CAPITAL FUND II, LP 98/114326 3,676 BF HOLDINGS LLC (DISREGARDED ENTRY] CRETE LLC 37-/528994 19,432 BF HOLDINGS LLC (DISREGARDED ENTRY] LONE CASCADE LP 20/330917 909 BF HOLDINGS LLC (DISREGARDED ENTRY] APOLLO -TO CO-INVESTORS I (A) 322 DB 2011 LLC (DISREGARDED ENTITY APOLLO APOLLO INVESTMENT FUND 95,569 DB 2011 LLC (DISREGARDED ENTITY SEARCHLIGHT CAPITAL LP 599 DB 2011 LLC (DISREGARDED ENTITY SEARCHLIGHT CAPITAL AN I LP 4,626 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE CAPITAL PARTNERS 26,203 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE (OFFSHORE) CAPITAL PARTNERS 289 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE (ACCESS) CAPITAL PARTNERS 5,466 DB 2011 LLC (DISREGARDED ENTITY TENFORE HOLDINGS FUND I LP 49,994 DB 2011 LLC (DISREGARDED ENTITY BHM INVESTORS 9,368 DB 2011 LLC (DISREGARDED ENTITY MICROBES INVESTORS LLC 14,381 DB 2011 LLC (DISREGARDED ENTITY AP TECHNOLOGY PARTNERS LLC 722 DB 2011 LLC (DISREGARDED ENTITY AP SILL INVESTORS LLC 84,039 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE (OFFSHORE) CAPITAL PARTNERS II 49,421 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR QUADRANGLE CAPITAL PARTNERS II 812 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR QUADRANGLE OM CAPITAL PARTNERS II 459 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR QUADRANGLE (AR12) CAP PARTNERS II 2,123 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR DUNE REAL ESTATE FUND LP 208 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR MARKSTONE CAPITAL PARTNERS 899 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR AREIF IV CO-INVESTORS 5,878 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR BUCKINGHAM RAF PARTNERS LP 94,939 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR BLUE STAR I LLC 211 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR GIFTHORSE PARTNERS, LLC 8,252 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR APOLLO CREDIT OPP. I LP 235,812 APO 1 AGREEMENT GRANTOR TRUST: LEON BLACK GRANTOR 5,121,155 EFTA01116011 Schedule B (Form 1040A or 1040) 2013 Page 2 General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future Developments For the latest information about developments related to Schedule 8 (Form 1040A or 1040) and its nstructions. such as legislation enacted after they were published, go to vnvw.irs.govischedufeb. Purpose of Form Use Schedule B if any of the following applies. • You had over $1.500 of taxable interest or ordriary dividends. • You received interest from a seller-financed mortgage and the buyer used the property as a personal residence. • You have accrued interest from a bond. • You are reporting original issue discount (OID) in an amount less than the amount shown on Form 1099-0ID. • You are reducng your interest income on a bond by the amount of amortizable bond premium. • You are claiming the exclusion of Merest from series EE or I U.S. savings bonds issued after 1989. • You received interest or ordinary dividends as a nominee. • You had a financial interest n. or signature authority over. a financial account in a foreign country or you received a distributico from, or wore a grantor of. or transferor to. a foreign trust. Part III of the schedule has questions about foreign accounts and trusts. Specific Instructions You can Nsf more than one payer on each entry space for fines 7 and 5. but be sure to clearly show Me amount paid next to the payer's name. Add the separate amounts paid by the payers listed on an entry space and enter the totals the "Amount" column. If you still need more space. attach separate statements that are the same sae as the printed schedule. Use the same format as lines 7 and 5, but show your totals on Schedule a Be sure to put your name and social security number (SSN) on the statements end attach them at the end of your return. Part I. Interest Line 1. Renal on Imo 1 all of your taxable retest. Taxable interest should be shown on your Forms I099-INT. Forms 1099-0ID. or substitute statements. Include interest from aeries EE. H. HH. and I U.S. savings bards. List each payer's name and show the amount. Do not report on this line any tax-exempt interest from box 8 a box 9 of Form 1099-INT. Instead. report the amount from box 8 on sne 8b of For 1040A a 1040.1f an amount is shown in box 9 of Form 1099-INT. you generally must report eon line 12 of Form 6251. See the Instructions for Form 6251 for more details. Seller-financed mortgages. If you sold your home or other peoperly and the buyer used the property as a personal residence, list first any Merest the buyer paid you on a mortgage or other form of seller financing. Be are to show the buyer's name. address. and SSN. You must also let the buyer know your SSN. If you do not show the buyer's name. address. and SSN. or let the buyer know your SSN. you may have to pay a $50 penally. Nominees. If you received a Form 1099-INT that =rides interest you received as a nominee (that is. in your name. but the interest actually belongs to someone else). report the total on line I. Do this even it you later distributed some or all of this income to others. Under your last entry an line I. put a subtotal of all interest listed on line 1. Below this subtotal, enter 'Nominee Distribution* and show the total interest you received as a nominee. Subtract this amount from the subtotal and enter the result on line 2. N you received interest as a nominee. feu must give the actual owner a Form 1099-1NT unless the owner is your spouse. You must also Ole a Form 1096 and a Form 1099-1NT with the IRS. For more cletads. see the General Instructions for Certain Information Returns and the Instructions for Forms 1099-INT and 1099-0ID. Accrued interest. When you buy bonds between interest payment dates and pay accrued interest to the seller. this Merest is taxable to the seller. If you received a Form 1099 for interest as a purchaser of a bond with accrued interest. follow the rules earlier under Nominees to see how to report the accrued interest. But identify the amount to be subtracted as "Accrued Interest.' Original issue discount (OW). If you are reporting OID in an amount less than the amount shown on Form 1099.0ID, follow the rules earlier under Nominees to see how to report the OID. But identify the amount to be subtracted as "OID Adjustment." Amortizable bond premium. If you are reducing your interest income on a bond by the amount amatizable bond premium. follow the rues earlier under Nominees to see how to report the interest But identity the amount to be subtracted as 'ABP Adjustment." Line 3. If, during 2013. you cashed series EE or I U.S. savings bonds issued after 1989 and you paid qualified higher education expenses for yourself. your spouse. or your dependents. you may be able to exclude part or al of the interest on those bonds. See Form 8815 to details. Part II. Ordinary Dividends O You may have to file Form 5471 X. in 2013. you were an officer or director of a foreign corporation. You may also have to fife Form 5471 if, in 2013, you owned 70% or more of the total (e) value of a foreign corporation's stock, or fib) combined voting power of all classes of a foreign corporation's stock with voting rights. For defogs, see Form 5471 and its instructions. Line S. Report on line 5 all of your ordinary dividends. This amount should be shown kr box to of your Forms 1099-DIV or substitute statements. List each payees name and show the amount. Nominees. If you received a Form 1099-DIV that includes ordinary dividends you received as a nominee (that is. kr your name, but the ordinary dividends actually belong to someone else), report the total on line 5. Do this even if you later distributed some or all of this income to others. Under your last entry on line 5. put a subtotal of all ordinary dividends listed on line 5. Below this subtotal. enter "Nominee Distribution' and show the total ordinary dividends you received as a nominee. Subtract this amount from the subtotal and enter the result on line 6. f you received dvidends as a nominee, you must give the actual owner a Form 1099-DfY unless the Owner is your spouse. You must also Me a For WAS and a Form 1099-0W with the IRS. For more details. see the General Instructions for Certain Information Returns and the Instructions for Far 1099-DN. Part III. Foreign Accounts and Trusts Regardless of whether you are required !o file FinCEN Form 114 (FEAR). you may be required to fife Form 8938. Statement of Specified Foreign Financial Assets. with your income tax return. Failure to file Form 8938 may result in penalties and extension of the statute of limitations. See www.irs.gov/form8938 for more information. Line la-Question 1. Check the "Yes" box if at any time dung 2013 you had a financial interest in a signature authority over a financial account located in a foreign country. See the defnitions that follow. Check the "Yes" box even if you we not required to file FinCEN Form 114, Report of Foreign Bank and Fnancial Accounts (FBAR). Financial account. A financial account includes. but is not tinted to. a securities, brokerage. savngs. demand. checking. deposit. time deposit. or other account maintained with a financial institution (or other person performing the services of a financial institution). A financial account also includes a commodity futures or options account an insurance policy with a cash value (such as a whole life insurance policy). an annuity policy with a cash value. and shares kr a mutual fund or similar pooled fund (that is. a fund that is available to the general public with a regular net asset value determnabon and regular redemptions). Financial account located in a foreign country. A financial account is located yr a foreign country if the account is physically located outside of the United States. For example. an account maintained with a branch of a United States bank that is physically located outside of the United States is a foreign financial account. An account maintained with a branch of a foreign bank that is physically located in the United States is not a foreign financial account. Signature authority. Signature authority is the authority of an individual (alone or in conjunction with another individual) to control the disposition of assets held in a foreign financial account by direct communication (whether in writing or otherwise) to the bank or other financial institution that maintains the financial account. See the FinCEN Form 114 instructions for exceptions. Do not consider the exceptions relating to signabse authority yr answering Question 1 on line 7a. Other definitions. For definitions of `Mandel interest." 'United States." and other relevant terms. see the instructions for FinCEN Form 114. Line la-Question 2. See FirCEN Form 114 and its instructions to determine whether you must file the form. Check the "Yes" box if you are required to file the form: check the "No" box if you are not required to file the form. If you checked the 'Yes" box to Question 2 on line 7a. FriCEN Form 114 must be electronically feed with the Financial Crimes Enforcement Network (FiCEN) at the following website: httpilbseeNing. finoen.treas.govImain.html. Do not attach FnCEN Form 114 to your tax retum. To be considered timely. FinCEN Form 114 must be received by June 30. 2014. A CAUTION If you are required to Ole FinCEN Form 114 but do not properly do so. you may have to pay a civil penalty up to 810,000. A person who willfully fails to report an account or provide account identifying information may be subject to a civil penalty equal to the greater of 3100,000 or 50 percent of the balance in the account at the time of the violation. Wilful violations may also be subject to criminal penalties. Line 7b. If you are required to file FirCEN Form 114. enter the name of the foreign country or countries in the space provided on line lb. Attach a separate statement if you need more space. Line 8. If you received a distribution from a foreign trust. you must provide additional information. For this purpose. a loan of cash or marketable securities generally is considered to be a distribution. See Form 3520 for details. If you were the grantor of. or transferor to. a foreign trust that existed during 2013. you may have to file Form 3520. Do not attach Form 3520 to Form 1040. Instead. fee it at the address shown in its ratrucbons. If you were treated as the owner of a foreign trust under the grantor trust rules, you are also responsible for ensuring that the foreign trust files Form 3520-A. Form 3520-A is due on March 17. 2014. for a calendar year twat. See the nstructions for Form 3520-A for more details. EFTA01116012

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