California Form 541-B - Charitable Remainder And Pooled Income Trusts - 2010 Page 5

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Schedule A – Distributions, Assets, and Donor Information

Part I Accumulation Schedule (IRC Section 664 trust only)

Accumulations

(a)

(b)

(c)

Ordinary income

Capital gains (losses)

Nontaxable income

Total distributable income .

Enter the amount from Side 2, Part III, line 29 . . . . . . . . . . .

2a Total distributions for 2010: _____________________

2b 2010 distributions from income . . . . . . . . . . . . . . . . . . . . . .

Undistributed income at end of tax year .

Subtract line 2b from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II-A Current Distributions Schedule (IRC Section 664 trust only)

(a)

(b)

(c)

Name of recipient

Identifying number

Percentage of total unitrust amount payable (if applicable)



(d)

(e)

(f)

(g)

(h)

Ordinary income

Capital gains

Nontaxable income

Corpus

Total . Add cols . (d) through (g)



Total



If Part II-A Total, column (h) does not agree with line 61b for a CRAT or line 68 for a CRUT, check here and attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II-B Current Distributions (charitable lead trust or pooled income funds only)

Enter the amount required to be paid to private beneficiaries for 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________________

Part III Assets and Donor Information



Is this the initial return or were additional assets contributed to the trust in 2010? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If “Yes,” complete the schedule below.

If “No,” complete only column (a) of the schedule below .

(a)

(b)

(c)

(d)

Name and address of donor

Description of each asset donated

FMV of each asset on date of donation

Date of donation

7d Total. Add lines 7a through 7c . . . . . . . . . . . . . . . . . . . . . . . . . . . . 