AL-1041, page 3
SCHEDULE B - NAMES AND ADDRESSES OF RESIDENT BENEFICIARIES. Complete if any income is distributed.
1. Name
2. Address. If mailing address differs from home
3. Social Security Number
address, give both.
a.
b.
c.
d.
e.
f.
SCHEDULE C - RESIDENT BENEFICIARIES' SHARES OF EXCLUSIONS
4. Exclusion for Dividends
5. Exclusion for Capital
6. Exclusion for Interest
7. Exclusion for Rentals
8. Exclusion of Business
9. Total Misc. Estate
from National and State
Gains and Losses for the
from Government
Income
and Trust Income
Bank Stock
Period Prior to Jan. 1, 1972
Obligations
Exclusion (Add
Columns 6, 7 and 8)
a.
b.
c.
d.
e.
f.