Form Dr-601i - Florida Intangible Personal Property Tax Return Form For Individual And Joint Filers - 2002 Page 3

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DR-601IS
Include These Schedules With Your Tax Return
R. 01/02
Social Security Number
Spouse’s Social Security Number
Name: ____________________________________
(Complete only if filing a joint return)
Total Taxable Amount
B
Loans, Notes, and Accounts Receivable
Schedule
January 1, 2002
Accounts Receivable (see Instructions, Page 7)
Notes Receivable
Loans and Advances Receivable
Other Receivables
12.
Total of Schedule B (Enter on Schedule A, Line 1.)
12.
FEIN of Trust
C
Beneficial Interest in any Trust
(Individual Receiving Income from Trust Property)
Schedule
Beneficial Interest in Stocks, Mutuals, Money Market Funds, and Limited Partnership Interests
Class
Just Value
Name of Company Issuing Stocks
Number
Total Just Value
C = Common
January 1, 2002
Per Share
(List Alphabetically — Do Not Abbreviate)
of Shares
P = Preferred
(A)
(D)
(C)
C x D = (E)
(B)
a.
Total Value of Stocks in Trust
a.
Beneficial Interest in Bonds
Name of Issuer, Series
Face Value
Interest
Maturity
Number
Per $100
Total Taxable Amount
January 1, 2002
(List Alphabetically — One Bond Per Line)
Per Bond
Rate
Date
Owned
Value
(A)
(B)
(C)
(D)
(E)
(F)
(G)
b.
Total Value of Bonds in Trust
b.
Beneficial Interest in Other Intangible Assets
Total Taxable Amount
Type of Property
January 1, 2002
c.
Total Value of Other Intangible Assets in Trust
c.
13.
Total of Schedule C; Lines a + b + c (Enter on Schedule A, Line 2.)
13.
D
Bonds
Schedule
Name of Issuer, Series
Face Value
Interest
Maturity
Number
Per $100
Total Taxable Amount
January 1, 2002
(List Alphabetically — One Bond Per Line)
Per Bond
Rate
Date
Owned
Value
(A)
(B)
(C)
(D)
(E)
(F)
(G)
Example:
X,Y,Z Corporation
X,Y,Z Corporation
X,Y,Z Corporation
X,Y,Z Corporation
X,Y,Z Corporation
50 50 50 50 50
7% 7% 7% 7% 7%
2020
2020
2020
2020
2020
50 50 50 50 50
1 1 1 1 1 00
00
00
00
00. . . . . 1 1 1 1 1 420
420
420
420
420
÷
(B) X (E)
(B) X (E)
1 0 0 X (F)
1 0 0 X (F)
1 0 0 X (F) = = = = = $2,503.55
$2,503.55
$2,503.55
(B) X (E)
(B) X (E)
(B) X (E)
1 0 0 X (F)
1 0 0 X (F)
$2,503.55
$2,503.55
14.
Total of Schedule D (Enter on Schedule A, Line 3.)
14.
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).

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