California Form 541-B - Charitable Remainder And Pooled Income Trusts - 2009 Page 5

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Schedule A – Distributions, Assets, and Donor Information
Part I Accumulation Schedule (IRC Section 664 trust only)
Accumulations
(a)
(b)
(c)
Ordinary income
Capital gains (losses)
Nontaxable income

Total distributable income .
Enter the amount from Side 2, Part III, line 29 . . . . . . . . . . .
2a Total distributions for 2009: _____________________
2b 2009 distributions from income . . . . . . . . . . . . . . . . . . . . . .
3
Undistributed income at end of tax year .
Subtract line 2b from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . .
Part II-A Current Distributions Schedule (IRC Section 664 trust only)
(a)
(b)
(c)
Name of recipient
Identifying number
Percentage of total unitrust amount payable (if applicable)
4a
%
4b
%
4c
%
(d)
(e)
(f)
(g)
(h)
Ordinary income
Capital gains
Nontaxable income
Corpus
Total . Add cols . (d) through (g)
4a
4b
4c
Total
If Part II-A Total, column (h) does not agree with line 61b for a CRAT or line 68 for a CRUT, check here and attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . .
Part II-B Current Distributions (charitable lead trust or pooled income funds only)
5
Enter the amount required to be paid to private beneficiaries for 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________________
Part III Assets and Donor Information
6
Is this the initial return or were additional assets contributed to the trust in 2009? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If “Yes,” complete the schedule below.
If “No,” complete only column (a) of the schedule below .
(a)
(b)
(c)
Name and address of donor
Description of each asset donated
FMV of each asset on date of donation
7a
7b
7c
Total. Add lines 7a through 7c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
7d
Form 541-B
2009 Side 5
7025093
C1

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