Schedule D Individual - Capital Assets Gains And Losses Form

Rev. 01.10

Schedule D Individual - Page 2

Part IV

Lump-Sum Distributions from Qualified Pension Plans and from Variable Annuity Contracts

(A)

(B)

(C)

Description

Fill in if you Prepaid

Distribution Date

Total Distribution

Taxable Amount

Basis

(30)

(34)

Taxable at 20% - Taxpayer ...............

22.

(31)

(35)

23.

Taxable at 20% - Spouse ..................

(32)

(36)

24.

Taxable at 10% - Taxpayer ................

(33)

(37)

25.

Taxable at 10% - Spouse ...................

26.

Total lump-sum distributions from qualified pension plans (Total of Column C) ..........................................................................................................

(38)

Lump-sum distributions from variable annuity contracts - Taxpayer (See instructions) .......................................................................................

27.

(39)

28.

Lump-sum distributions from variable annuity contracts - Spouse (See instructions) .....................................................................................

(40)

29.

Total lump-sum distributions from qualified pension plans and from variable annuity contracts (Add lines 26 through 28. Transfer this amount to

Part 2, line 2R of the return or to line 3R, Columns B and C of Schedule CO Individual, as applicable) .................................................................

(41)

Part V

Net Capital Gains or Losses for Determination of the Adjusted Gross Income

Column A

Column B

Column C

Gains or Losses

Short-Term

Long-Term

Under Special Legislation

(01)

30.

Enter the gains determined on lines 11, 20 and 21 in the corresponding Column .........

(02)

(03)

(05)

31.

Enter the losses determined on lines 11, 20 and 21 in the corresponding Column ...........

32.

If any of Columns B and C reflect a loss on line 31, apply the total to the gain in the

other Column (See instructions) ......................................................................

33.

Subtract line 32 from line 30. If any Column reflected a loss on line 31, enter zero here

34.

Apply the loss from line 31, Column A proportionally to the gains in Columns B and C

(See instructions) .......................................................................................

(04)

(06)

35.

Subtract line 34 from line 33 ...........................................................................

36.

Add the total of Columns B and C, line 35. However, if line 30 does not reflect any gain

(07)

in Columns B and C, you must enter the total amount of line 31, Columns A, B and C ...

37.

Net capital gain (or loss) (Add line 30, Column A and line 36) ..................…….............................................................................................……

(08)

38.

If line 37 is more than zero, enter here and in Part 2, line 2 Q of the return or on line 3Q of Schedule CO Individual, as applicable. If line 37 includes

long-term capital gains, see instructions .......…....................................................................................................................................

(09)

39.

If line 37 is a net loss, enter here and in Part 2, line 2 Q of the return or on line 3Q of Schedule CO Individual, as applicable, the smaller of the

following amounts:

a) The net loss on line 37, or

b) (1,000) ..……………..........................................……………............…........................................................................................…………..

(10)

Retention Period: Ten (10) years

Schedule D Individual - Capital Assets Gains And Losses Form - 2009 Page 2

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