Form 41 - Fiduciary Income Tax Return - 2001 Page 2
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1
2FORM 41 – 2001
PAGE 2
PART I – Income
DIVIDEND INCOME (List Payers and Amounts)
1 Total Income from Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
INTEREST INCOME (List Payers and Amounts)
EXEMPT
TAXABLE
2 Total Taxable Income from Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
PROFIT FROM SALE OF REAL ESTATE, STOCKS, BONDS, ETC.
Depreciation
3
4
5
6
7
8
Date
Amount
Cost or
Subsequent
Kind of Property
Allowable Since
Acquired
Received
Other Basis
Improvements
Acquisition
9 Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Net Profit or (Loss) (Sum of columns 5 and 6, less columns 7 and 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
INCOME FROM RENTS AND ROYALTIES
11
12
13
Depreciation
14
15
Other
Amount of
Repairs
Kind and Location of Property
or Depletion
Expenses
Rent or Royalty
(Attach Itemized List)
(Explain in Part II)
(Attach Itemized List)
16 Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Net Profit or (Loss) (Column 12 less sum of columns 13, 14, and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
18 Income from Partnerships (Name and Address)
18
19 Income from Other Fiduciaries (Name and Address)
19
20 Business Income (Attach copy of Federal Schedule C) (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
21 Farm Income (Attach copy of Federal Schedule F) (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
22 Income from Other Sources (State nature) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
23 TOTAL INCOME OR (LOSS) (Add lines 1, 2, 10, 17, 18, 19, 20, 21, and 22)
Enter here and on page 1, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
PART II – Explanation of Deduction For Depreciation Claimed In Part I, Column 13
1
2
3
4
5
6
7
Depreciation
Kind of Property (if buildings, material
Method of
Date
Cost or
Allowed (or
Rate (%)
Depreciation
of which constructed). Exclude land and
Computing
Acquired
Other Basis
Allowable) in
or Life (Years)
for This Year
other nondepreciable property.
Depreciation
Prior Years
PART III – Deductions
Describe deductions and state to whom paid. If more space is needed, list deductions on separate sheet of paper and attach to this return.
INTEREST PAID
CASUALTY AND THEFT LOSSES (Attach Federal Form 4684)
3a Enter the amount from Form 4684 . . . . . . . .
3b Less exclusion: Enter 10% of Form 41, line 1
3c Allowable Loss (Subtract line 3b from 3a)
If zero or less, enter zero . . . . . . . . . . . . . .
OTHER DEDUCTIONS (See instructions) (Attach list)
4a Deductions subject to 2% limitation. . . . . . . .
4b Enter 2% of Form 41, line 1. . . . . . . . . . . . . .
1 Total Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4c Balance (Subtract line 4b from 4a)
TAXES (See instructions)
If zero or less, enter zero. . . . . . . . . . . . . . . .
4d Deductions NOT subject to 2% limitation . . .
4e Total Other Deductions
(Add lines 4c and 4d) . . . . . . . . . . . . . . . . .
5 TOTAL (Add lines 1, 2, 3c, and 4e)
2 Total Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter here and on page 1, line 2 . . . . . . . .
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