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efta-efta01116009DOJ Data Set 9OtherSCHEDULE B
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DOJ Data Set 9
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efta-efta01116009
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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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