Charities Form 004 - Annual Report Of Charitable Trust

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Charities Form 004
Page 1 of 5
STATE OF NEW YORK
OFFICE OF THE ATTORNEY GENERAL
120 BROADWAY, NEW YORK, NY 10271
CHARITIES BUREAU
ANNUAL REPORT OF CHARITABLE TRUST
CHAR004
For the period beginning _________________ and ending __________________.
Name
State of New York
Address (number, street, city,
Office of the Attorney General
or town, postal zone, and state)
and
Charities Bureau
Telephone number at which
120 Broadway
Trustee can be reached during
New York, NY 12071
normal business hours
See
(a)
(b)
(c)
Instruction
#
Principal
Income
Total
CHARGES
1. Principal received
1
______
______
______
2. Income collected
2,4,5
______
_____
_____
3. Realized increases
3
______
_____
_____
4. Total charges (lines 1 thru 3)
______
_____
_____
CREDITS
5. Realized decreases
3
______
_____
_____
6. Administration expenses (sched. A)
______
_____
_____
7. Distributions to charity (sched. B)
______
_____
_____
8. Distributions to others (sched. B)
______
_____
_____
9. Total credits (lines 5 thru 8)
______
_____
_____
FUND BALANCES
10. Fund increase (line 4 less 9)
______
_____
_____
11. Beginning fund balances
______
_____
_____
12. Ending fund balances (lines 10 and 11)
______
_____
_____
See
(a)
(b)
(c)
(d)
Book or
Instruction
Total @
Acquisition Value
#
Principal
Total
Market
Income
ASSETS
13. Cash-checking account
______
_____
_____
_____
14. Cash-saving accounts
______
_____
_____
_____
15. Securities - publicly traded
2
______
_____
_____
_____
16. Securities - not publicly traded
2
______
_____
_____
_____
17. Real estate
4
______
_____
_____
_____
18. Other assets
5
______
_____
_____
_____
3/3/00

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