Form Dr-601i - Florida Intangible Personal Property Tax Return For Individual And Joint Filers - 2005 Page 3

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DR-601IS
Include These Schedules With Your Tax Return
R. 01/05
Name: ________________________________________
Social Security Number
Spouse’s Social Security Number
(Complete only if filing a joint return)
Total Taxable Amount
Schedule B
Loans, Notes, and Accounts Receivable
January 1, 2005
Taxable Accounts Receivable
Notes Receivable
Loans and Advances Receivable
Other Receivables
12. Total of Schedule B (Enter on Schedule A, Line 1.)
12.
FEIN of Trust
Schedule C
Beneficial Interest in Any Trust
(Individual Receiving Income from Trust Property)
Beneficial Interest in Stocks, Mutuals, Money Market Funds, and Limited Partnership Interests
Class
Just Value
Total Just Value
C = Common
Name of Company Issuing Stocks
Number of Shares
Per Share
P = Preferred
January 1, 2005
(A)
(B)
(C)
(D)
C x D = (E)
a.
Total Value of Stocks in Trust
a.
Beneficial Interest in Bonds
Face Value
Number
Total Taxable Amount
Name of Issuer, Series
Per Bond
Interest Rate
Maturity Date
Owned
Per $100 Value
January 1, 2005
(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, 2005
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.
Schedule D
Bonds
Face Value
Number
Total Taxable Amount
Name of Issuer, Series
Per Bond
Interest Rate
Owned
Maturity Date
Per $100 Value
January 1, 2005
(A)
(B)
(C)
(E)
(D)
(F)
(G)
Example:
(B) X (E) ÷ 1 0 0 X (F) =
X,Y,Z Corporation
50
7%
2020
50
1 0 0.1 4 20
$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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