Include These Schedules With Your Tax Return
DR-601CS
R. 01/01
FEIN
Name: ___________________________________________________
Schedule
B
Total Taxable Amount
Loans and Notes Receivable
January 1, 2001
Loans Receivable
Notes Receivable
Other
17.
Total of Schedule B (Enter on Schedule A, Line 2.)
Schedule
C
Bonds
Name of Issuer, Series
(List Alphabetically — One Bond Per Line)
(A)
Example: X,Y,Z Corporation
18.
17.
Face Value
Per Bond
(B)
50
Interest
Rate
(C)
Maturity
Date
(D)
7%
2020
Total of Schedule C (Enter on Schedule A, Line 3.)
Number
Owned
(E)
50
Per $100.00
Value
(F)
Total Taxable Amount
January 1, 2001
(G)
1 00.
00.11 4 20 (B) X (E) ÷ 100 X (F) = $2,503.55
18.
Include additional schedules if necessary. Photocopies of all schedules are acceptable. You may use your broker's
statement if all required information is listed and the totals are transferred to the appropriate schedule(s).
DR-601CS
R. 01/01
Schedule
D
Stocks, Mutuals, Money Market Funds, Limited Partnership Interests, and Beneficial Interest in
any Trust The law provides for a specific penalty of 10% for omitted and/or undervalued stock.
Class
Name of Company Issuing Stocks
C
100
P = Preferred
(A)
Example: X,Y,Z Corporation
19.
(B)
Number
of Shares
(C)
C = Common
(List Alphabetically — Do not Abbreviate)
Just Value
Per Share
(D)
8.875
Total of Schedule D (Enter on Schedule A, Line 4.)
Schedule
Class of
Stock
E
Total Just Value
January 1, 2001
(E)
(C) X (D) = $887.50
19.
Corporations Only — Paying as Agent for Florida Stockholders
Total Number of Shares
Outstanding
(1)
No. of Taxable Shares
(All shares held by Florida residents)
(2)
Just Value
Per Share
(3)
Value of
Shares Outstanding
(4)
Total Taxable Amount
January 1, 2001
(5)
Common
Preferred
Other
LOANS and ADVANCES FROM FLORIDA STOCKHOLDERS
20.
Total of Schedule E (Enter on Schedule A, Line 5.)
20.
Include additional schedules if necessary. Photocopies of all schedules are acceptable. You may use your broker's
statement if all required information is listed and the totals are transferred to the appropriate schedule(s).