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

Type

X

X

X

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None (or less than $1.001)

$15.001 - $50.000

$1.001 $15.000

$50,001 - $100.000

$100,001 - $250,000

$250.001 $500.000

$500,001 - $1,000,000

Over $1.000.000

Rent and Royalties

Dividends

Interest

Excepted Investment Fund

Capital Gains

Excented Trust

Qualified Trust

X

X

X

X

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

Type

None (or less than $1.001)

S: 001 $:5.000

$15.001 $50,000

$50 001 $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 Fund

Capital Gains

Excented Trust

Interest

X

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X

X

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

Type

None (or less than $1.001)

$15.001-$50.000

$50,001 - $100.000
$100,001 - $250,000
$250.001-$500,000

$1.001 - $15.000

$500,001 - $1,000,000

Over $1.000.000

Rent and Royalties

Dividends

Excepted Investment Fund

Capital Gains

Interest

Excented Trust

Qualified Trust

X

X

и

X

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X

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None (or less than $201)

$201-$1.000

$1.001-$2.500

$15.001 - $30,000

$2.501-$5.000

$5.00 - $15.000

$100,001 - $1,000,000

$30,001 - $100.000

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

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Identify ench asset held for the produc
tion of income which had a fair market
value exceeding $1,000 at the close of
the reporting period.

Identify each asset or source of
income which generated over $200
in income during the reporting
period.

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Ex στηλ.

None☐

Central Airlines Common

Dhe Jones & Smith, Hometown, USA

Kempstone Equity Fund

Doe Jones & Smith pension plan

Compucom Communications Corp. (Common Stock)

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X

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X

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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

$50.001 $100.000 $100,001 - $250,000 $250.001-$500,000 $500,001 - $1,000,000

Over $1.000 000

Rent and Royalties

Dividends

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MACK C

Amount

None (or less than $201)

$201-$1.000

$1,001-$2.500

$15.001-$50,000

$2.501-$3.000

$5.001-$15.000

$100,001 - $1,000,000

$50,001-$100,000

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