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R * Provide information on improvements, prior sales of home, and cost of a new residence. Also see Section 17 (Job-Related Moving). 4. Interest Income 8. I.R.A. (Individual Retirement Acct.) Attach 1099-INT, Form 1097-BTC & broker statements Payer Amount Contributions for tax year income U for Amount Roth Date Taxpayer Spouse Tax Exempt Amounts withdrawn. Attach 1099-R & 5498 Plan Trustee Reason for Withdrawal Reinvested? Yes Yes Yes Yes 5. Dividend Income From Mutual Funds & Stock.

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