Form 1041-A - U.s. Information Return Trust Accumulation Of Charitable Amounts Page 2
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42
Form 1041-A (Rev. 2-2012)
Page
Balance Sheets (see instructions). If line 9, page 1, is $25,000 or less, complete only lines 38, 42,
Part IV
and 45 (see instructions).
(a) Beginning-of-
(b) End-of-Year
Assets
Year Book Value
Book Value
25
25
Cash—non-interest bearing .
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26
Savings and temporary cash investments .
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26
27a Accounts receivable
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27a
b Less: allowance for doubtful accounts
27b
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28a Notes and loans receivable .
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28a
b Less: allowance for doubtful accounts
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28b
29
29
Inventories for sale or use
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30
Prepaid expenses and deferred charges
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30
31
Investments—U.S. and state government obligations (attach schedule)
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31
32
32
Investments—corporate stock (attach schedule) .
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33
33
Investments—corporate bonds (attach schedule) .
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34 a Investments—land, buildings, and equipment: basis .
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34a
b Less: accumulated depreciation
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34b
35
35
Investments—other (attach schedule)
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36a Land, buildings, and equipment: basis
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36a
b Less: accumulated depreciation
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36b
37
37
Other assets (describe
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38
Total assets (add lines 25 through 37)
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38
Liabilities
39
39
Accounts payable and accrued expenses .
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40
40
Mortgages and other notes payable (attach schedule) .
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41
Other liabilities (describe
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41
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42
Total liabilities (add lines 39 through 41) .
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42
Net Assets
43
Trust principal or corpus .
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43
44
Undistributed income and profits .
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44
45
45
Total net assets (add lines 43 and 44)
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46
Total liabilities and net assets (add lines 42 and 45) .
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46
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than trustee) is based on all information of which preparer has any knowledge.
Sign
Here
Signature of trustee or officer representing trustee
Date
Print/Type preparer’s name
PTIN
Preparer’s signature
Date
Paid
Check
if
self- employed
Preparer
Firm’s name
Firm's EIN
Use Only
▶
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Firm’s address
Phone no.
▶
1041-A
Form
(Rev. 2-2012)
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