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Page Number

SCHEDULE A

Income: type and amount. If "None (or less than $201)" is checked, no
other entry is needed in Block C for that item.

Туре

None (or less than $1,001)

$50,001 - $100,000

$1,001-$15,000

$100,001-$250,000 $250,001 - $500,000

$15,001-$50,000

$500,001-$1,000,000 Over $1,000,000

Rent and Royalties

Dividends

Excepted Investment Fund

Capital Gains

Excepted Trust

Qualified Trust

Interest

X

X

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[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

Page Number

SCHEDULE A

Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for that item.

Туре

None (or less than $1,001)

$1,001 - $15,000 $15,001-$50,000

$100,001 - $250,000

$50,001-$100,000

$500,001-$1,000,000

$250,001 - $500,000

Over $1,000,000

[blocks in formation]
[blocks in formation]

5

[blocks in formation]

1

Healthcare Financial

S

Management Association

Honoraria

$2,000 4-23-90

[blocks in formation]
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