Form Dr-601cs - Schedules B,c,d,e

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DR-601CS
R. 01/01
Include These Schedules With Your Tax Return
FEIN
Name: ___________________________________________________
B
Total Taxable Amount
Schedule
Loans and Notes Receivable
January 1, 2001
Loans Receivable
Notes Receivable
Other
17.
Total of Schedule B (Enter on Schedule A, Line 2.)
17.
C
Bonds
Schedule
Total Taxable Amount
Face Value
Interest
Maturity
Number
Per $100.00
Name of Issuer, Series
January 1, 2001
Per Bond
Rate
Date
Owned
Value
(List Alphabetically — One Bond Per Line)
(A)
(G)
(B)
(C)
(D)
(E)
(F)
÷
X,Y,Z Corporation
X,Y,Z Corporation
50 50 50 50 50
7% 7% 7% 7% 7%
2020
2020
50 50 50 50 50
1 1 1 1 1 00.
00.
00.
00.1 1 1 1 1 4 4 4 4 4 20
20
20
Example:
X,Y,Z Corporation
X,Y,Z Corporation
X,Y,Z Corporation
2020
2020
2020
00.
20
20
(B) X (E)
(B) X (E)
(B) X (E)
(B) X (E)
(B) X (E)
1 0 0 X (F)
1 0 0 X (F)
1 0 0 X (F)
1 0 0 X (F)
1 0 0 X (F) = = = = = $2,503.55
$2,503.55
$2,503.55
$2,503.55
$2,503.55
18.
Total of Schedule C (Enter on Schedule A, Line 3.)
18.
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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