U.S. TREAS Form treas-irs-5227-2003
Form
5227
OMB No. 1545-0196
Split-Interest Trust Information Return
Department of the Treasury
Internal Revenue Service
䊳
2003
See separate instructions.
Full name of trust
A
Employer identification number
Name of trustee
B
Type of Entity
Number, street, and room or suite no. (If a P.O. box, see page 2 of the instructions.)
City, state, and ZIP code
C
Fair market value (FMV) of assets at end of tax year
E
Check applicable
Initial return
boxes (see
Change in trustee’s
instructions)
䊳
D
Date the trust was created
Final return
Name
Amended return
Address
Did the split-interest trust have any unrelated business taxable income (section 664 trusts
only)? If “Yes,” file Form 1041
F
Part I
1
2a
b
3
4
5
6
7
8
Yes
(1)
Charitable lead trust
(2)
Charitable remainder annuity trust
described in section 664(d)(1)
(3)
Charitable remainder unitrust
described in section 664(d)(2)
(4)
Pooled income fund described in
section 642(c)(5)
(5)
Other
No
Ordinary Income (Section 664 trust only)
Interest income
2a
Qualified dividends (see instructions)
Ordinary dividends (including qualified dividends)
Business income or (loss) (attach Schedule C or C-EZ (Form 1040))
Rents, royalties, partnerships, other estates and trusts, etc. (attach Schedule E (Form 1040))
Farm income or (loss) (attach Schedule F (Form 1040))
Ordinary gain or (loss) (attach Form 4797)
Other income (state nature of income)
Total ordinary income (combine lines 1, 2b, and 3 through 7)
1
2b
3
4
5
6
7
8
Deductions Allocable to Ordinary Income
Interest
Taxes
Other deductions (attach a separate sheet listing deductions)
Total deductions (add lines 9 through 11)
Ordinary income less deductions (subtract line 12 from line 8). Enter here and on line 21, column (a)
9
10
11
12
13
9
10
11
12
13
Capital Gains (Losses) and Allocable Deductions
14
15
16
17a
b
c
d
18
19
Total short-term capital gain or (loss) for tax year (attach Schedule D
14
(Form 1041))
15
Deductions allocable to short-term capital gains
Balance (subtract line 15 from line 14). Enter here and on line 21, column (b)
Total long-term capital gain or (loss) for tax year (attach Schedule D
17a
(Form 1041))
17b
28% rate gain or (loss)
17c
Qualified 5-year gain
17d
Unrecaptured section 1250 gain
18
Deductions allocable to long-term capital gains
Balance (subtract line 18 from line 17a). Enter here and on line 21, column (c)
Part II
19
Accumulation Schedule (Section 664 trust only)
(a) Ordinary
income
Accumulations
20
21
22
23
16
Capital gains and (losses)
(b) Net short-term
(c) Net long-term
(d) Nontaxable
income
Undistributed from prior tax years
Current tax year (before distributions)
Total (add lines 20 and 21)
Undistributed at end of tax year
Part III
Current Distributions Schedule (Section 664 trust only)
Name of recipient
Identifying
number
(a) Ordinary
income
Capital gains
(b) Short-term
(c) Long-term
(d) Nontaxable
income
(e) Corpus
24a
b
c
For Paperwork Reduction Act Notice, see page 11 of the instructions.
Cat. No. 13227T
Form
5227
(2003)