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Rev . Feb 19 13

Schedule D Individual - Page 2

Part IV

Total Distributions from Qualified Pension Plans

(A)

(B)

(C)

Description

Fill in if you Prepaid

Distribution Date

Total Distribution

Taxable Amount

Basis

(Day/Month/Year)

(41)

(45)

23.

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

(42)

(46)

24.

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

(43)

(47)

25.

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

(44)

(48)

26.

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

Total distributions from qualified pension plans (Total of Column C. Transfer this amount to Part 1, line 2A of the return or to line 3A, Columns B

27.

and C of Schedule CO Individual, as applicable) .............................................................................................................................

(50)

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)

28.

Enter the gains determined on lines 10, 21 and 22 in the corresponding Column .........

(02)

(03)

(05)

29.

Enter the losses determined on lines 10, 21 and 22 in the corresponding Column ...........

30.

If any of Columns B and C reflect a loss on line 29, apply the total to the gain in the

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

31.

Subtract line 30 from line 28. If any Column reflected a loss on line 29, enter zero here

32.

Apply the loss from line 29, Column A proportionally to the gains in Columns B and C

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

(04)

(06)

33.

Subtract line 32 from line 31 ...........................................................................

34.

Add the total of Columns B and C, line 33. However, if line 28 does not reflect any gain

(07)

in Columns B and C, you must enter the total amount of line 29, Columns A, B and C ...

35.

Net capital gain (or loss) (Add line 28, Column A and line 34) ..................…….............................................................................................……

(08)

36.

If line 35 is more than zero, enter here and in Part 1, line 2B of the return or on line 3B of Schedule CO Individual, as applicable. If line 35 includes

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

(09)

37.

If line 35 is a net loss, enter here and in Part 1, line 2B of the return or on line 3B of Schedule CO Individual, as applicable, the smaller of the

following amounts:

a) The net loss on line 35,

b) (1,000), or

c) (5,000) if the loss was generated in the sale of qualified property between January 1 and December 31, 2012. (See instructions) ................

(10)

Retention Period: Ten (10) years