Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for that item. reporting period Туре None (or less than $1.001) $15,001-$50,000 $1,001-$15,000 000'001s 100'09S $100,001 - $250,000 $500,001 - $1,000,000 $250,001-$500,000 Over $1,200,000 Dividends Rent and Royalties Excepted Investment Pund Capital Gains Excepted Trust Qualified Trust Interest X X Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for that item. Type BLOCK C Amount None (or less than $1,001) $15,001-$50,000 $100,001 - $250,000 $50,001-$100,000 $1,001-$15,000 $500,001 - $1,000,000 $250,001 - $500,000 Over $1,000,000 Rant and Royalties Dividends Excepted Investment Fund Capital Gaine Excepted Trust Qualified Trust Interest X Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for that item. Type Nooe (or less than $1,001) $1,001-$15,000 $15,001-$50,000 $50,001 - $100,000 $100,001 - $250,000 $500,001 - $1,000,000 $250,001-$500,000 Over $1,000,000 Tab 4 (Page 9 of 14) Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for that item. Туре Nose (or less than 31,001) $15,001-$50,000 $1,001-$15.000 $50.00 . $100,000 $100,001-$250,000 $250,001-$500.000 $500,001 - $1,000,000 Over $1,000,000 Rent and Royalties Dividends Excepted Investment Pund Capital Gains Excepted Trust Qualified Trust Interest |