Form A - Financial Disclosure Statement - 2016 Page 6
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12SCHEDULE B – TRANSACTIONS
Name:
Page______ of _______
Report any purchase, sale, or exchange transactions that exceeded $1,000 in the
Type of Transaction
Date
Amount of Transaction
reporting period of any security or real property held by you, your spouse, or your
dependent child for investment or the production of income. Include transactions that
A
B
C
D
E
F
G
H
I
J
K
resulted in a capital loss. Provide a brief description of an exchange transaction.
Exclude transactions between you, your spouse, or dependent children, or the
(MO/DA/YR)
purchase or sale of your personal residence, unless it generated rental income. If
or
only a portion of an asset is sold, please choose “partial sale” as the type of
Quarterly,
transaction.
Monthly, or Bi-
weekly, if
Capital Gains: If a sales transaction resulted in a capital gain in excess of $200,
applicable
check the “capital gains” box, unless it was an asset in a tax-deferred account, and
disclose the capital gain income on Schedule A.
* Column K is for assets solely held by your spouse or dependent child.
SP, DC, JT
Asset
Mega Corp. Stock
Example
SP
X
X
3/9/16
X
Use additional sheets if more space is required.
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