Form Inc 250 Draft - Individual Income Tax Return - 2001 Page 2
ADVERTISEMENT
1
2If taxpayer is deceased,
Enter taxpayer's phone number in the boxes below
enter date of death in the
boxes at right
If taxpayer spouse is
deceased, enter date of
death in the boxes.
SCHEDULE A - TAXABLE DIVIDENDS AND INTEREST
SCHEDULE B - NON-TAXABLE DIVIDENDS AND INTEREST
List taxable dividends from all sources, including holding companies and mutual funds. List all
DIVIDENDS from national and Tennessee chartered bank stock, credit unions, building or
bonds, notes, mortgages and other taxable interest. (See instructions on separate sheet for
savings and loan companies, Tennessee licensed insurance companies, and cemetery
examples and explanations of taxable income.)
companies. INTEREST on bonds of the U.S. Government and its agencies, Tennessee
bonds, interest from credit unions, certificates of deposit, accounts not represented by a
_____________________________________________________
Please round to the nearest dollar
written instrument, passbook accounts, savings accounts, bank money market accounts,
Dividends:
0 0
_____________________________________________________
"NOW" accounts, and commercial paper maturing in 6 months or less. (See instructions on
separate sheet for examples and explanations of nontaxable income).
0 0
_____________________________________________________
0 0
__________________________________________________________________________________________________________
Please round to the nearest dollar
0 0
0 0
Dividends:
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
Interest:
Interest:
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
__________________________________________________________________________________________________________
0 0
0 0
GROSS
GROSS
TAXABLE
NON-TAXABLE
INCOME
00
00
Enter on Line 1
INCOME
on front also.
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief, it is true, correct and complete.
Date
Taxpayer's Signature
Spouse's Signature
(
)
Date
Tax Preparer's Signature
Telephone
Zip
State
Preparer's Address
City
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial