Form 5227 - Split-Interest Trust Information Return - 2017
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75227
Split-Interest Trust Information Return
OMB No. 1545-0196
2017
Form
See separate instructions.
▶
Open to Public
Go to for instructions and the latest information.
Department of the Treasury
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Do not enter social security numbers on this form (except on Schedule A) as it may be made public.
Internal Revenue Service
Inspection
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A Employer identification number
Full name of trust
Name of trustee
B Type of Entity
(1)
Charitable lead trust
Number, street, and room or suite no. (If a P.O. box, see the instructions.)
(2)
Charitable remainder annuity trust
described in section 664(d)(1)
(3)
Charitable remainder unitrust
described in section 664(d)(2)
City or town, state or province, country, and ZIP or foreign postal code
(4)
Pooled income fund described in
section 642(c)(5)
C
Fair market value (FMV) of assets at end of tax year
D Gross Income
(5)
Other—Attach explanation
E
Check applicable
F Date the trust was created
Initial return
Final return
Amended return
boxes (see the
instructions)
Change in trustee’s
Name
Address
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G
If the trust is a section 664 trust, did it have unrelated business taxable income? If “Yes,” file Form 4720
Yes
No
Part I
Income and Deductions (All trusts complete Sections A through D)
Section A—Ordinary Income
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Interest income .
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2a Ordinary dividends (including qualified dividends)
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2a
b Qualified dividends (see the instructions)
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2b
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Business income or (loss). Attach Schedule C or C-EZ (Form 1040) .
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Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040)
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Farm income or (loss). Attach Schedule F (Form 1040) .
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Ordinary gain or (loss). Attach Form 4797
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Other income. List type and amount
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Total ordinary income. Combine lines 1, 2a, and 3 through 7
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Section B—Capital Gains (Losses)
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Total short-term capital gain or (loss). Attach Schedule D, Part I (Form 1041)
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Total long-term capital gain or (loss). Attach Schedule D, Part II (Form 1041) .
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Unrecaptured section 1250 gain
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28% gain .
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Total capital gains (losses). Combine lines 9 and 10 .
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Section C—Nontaxable Income
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Tax-exempt interest
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Other nontaxable income. List type and amount
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Total nontaxable income. Add lines 14 and 15 .
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Section D—Deductions
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Interest
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Taxes (see the instructions) .
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Trustee fees .
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Attorney, accountant, and return preparer fees
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Other allowable deductions. Attach statement (see the instructions)
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Total. Add lines 17 through 21 .
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Charitable deduction .
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Section E—Deductions Allocable to Income Categories (Section 664 trust only)
24a Enter the amount from line 22 allocable to ordinary income
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24a
b Subtract line 24a from line 8
24b
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25 a Enter the amount from line 22 allocable to capital gains (losses) .
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25a
b Subtract line 25a from line 13 .
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25b
26 a Enter the amount from line 22 allocable to nontaxable income
26a
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b Subtract line 26a from line 16 .
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26b
5227
For Paperwork Reduction Act Notice, see the instructions.
Form
(2017)
Cat. No. 13227T
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