Form 1120-Sf - U.s. Income Tax Return For Settlement Funds (Under Section 468b) Page 2
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Form 1120-SF (Rev. 12-2011)
Page
Schedule L
Balance Sheets
(a) Beginning of year
(b) End of year
Assets
1
Cash
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1
2
U.S. Government obligations
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2
3
3
State and local government obligations .
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4
Other investments (attach schedule) .
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4
5
Other assets (attach schedule) .
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5
6
6
Total assets. Add lines 1 through 5
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Liabilities and Fund Balance
7
Liabilities .
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7
8
8
Fund balance
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9
Total. Add lines 7 and 8 .
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9
Additional Information
Yes No
1a Enter the amount of cash and the fair market value of property, valued at the date of the transfer,
transferred to the fund during the tax year .
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b For transfers of property included on line 1a, attach a copy of each qualified appraisal and the statements received
from a transferor under Regulations sections 1.468B-3(b) and 1.468B-3(e).
c Were amounts transferred to the fund during the tax year by a person other than a transferor? .
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2
Enter the amount of tax-exempt interest received or accrued during the tax year
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3a Were direct and indirect distributions made to claimants during the tax year?
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b If “Yes,” enter the amount of the total distributions
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4a Did the fund make any distributions (including deemed distributions) to a transferor or related party during the tax
year? .
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b If “Yes,” enter the amount of the total distributions and attach a statement showing the name,
identifying number, and the amount of distributions to each transferor or related party
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5a Check the type of liability (or liabilities) for which the fund was established.
Tort
Breach of Contract
Violation of Law
CERCLA
Other
b If “Other” is checked, enter the percent (by value) of the assets of the fund that are allocated to the
“Other” liability .
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%
Attach a statement describing the type of liability (or liabilities).
6
If the fund was established by a court order, enter the Court Order Number under which the fund
was established .
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1120-SF
Form
(Rev. 12-2011)
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