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87-t2-OG014 t,r,,, Form 2G `~~"
<br />Grantor's or Other Owner's Share of Income,
<br />Deductions, Credits, Etc. of a Grantor-type Trust
<br />To be reported on Massachusetts Individual I
<br />Name of entity
<br />Crowell Famil
<br />Tax
<br />mr„c~
<br />1995
<br />Massachusetts
<br />Department ot
<br />Revenue
<br />~ Grantor-type trust
<br />0 Pooled Income Fund
<br />~ Charitable RemainderAnnuity Trust
<br />~ Chantable Remainder Unitrust
<br />0 Other
<br />Grantor/Beneficiary's Identification Number Entity's Employer ldentification Number
<br />014-45-4952 04-6453020
<br />legal Domicile
<br />Massachusetts
<br />Grantor/Beneficiary's Name Address
<br />Samuel H. Crowell
<br />- i Fiduciary's Name Address
<br />Zip code
<br />44 Mashantum Rd, Dennis, MA 02638
<br />Zip code
<br />Joanne B. Crowell 44 Mashantum Rd, Dennis, N1A 02638
<br />(a) Allocable Share Item (h) Amount (c) Include' on Massachusetts form 1
<br />(or Form 1-NR/PY) the Cnlumn b
<br />__ _ Amounts as Inditated Below
<br />2 Dividends
<br />.................................................................. ...........
<br />3 Interest: (a) Corporate Bonds, Notes ..........................„_......,.....
<br />(b) Non-Mass. Municipal Bonds ...................................
<br />(c) Other Interest (including Mass. Bank Interest -
<br />see line 7 below) ..................................................
<br />(d) Total Interest ,,,,,,,,,,,,,,,,,,,,,,,
<br />...............................
<br />4 Exempt U.S. Interest ...............................................................
<br />5 Mass. Net Capital Gain or (Loss): (a) Short-term ........................
<br />(b) Long-term ......................~
<br />6 Capital Gain or (Loss) Differences: (a) Short-term .....................
<br />(b) Long-term .....................
<br />,
<br />
<br />,~ > 7 Mass. Bank Interest
<br />......................... ................
<br />>`~ ?'
<br />: o >: 8 Net Rental and Ro al Income or Loss ._...,......
<br />Y ~Y ( 1
<br />c>;:: 9 Profit or (Loss) from Business/Farm
<br />~:: : (attach Mass. and U.S. Sch. C or U.S. Sch. ~_._.
<br />...
<br />~ <::
<br />~'
<br />:
<br />:
<br />10 ..
<br />Partnership or S Corporation Income or (Loss)
<br />..
<br />
<br />~
<br />.
<br />.
<br />;
<br />
<br />11 ...
<br />.
<br />Other
<br />
<br />~ y'; 12 Carryover (Losses): a) Shori-term .....................
<br />°~ b) Long-term .....................
<br />~~j : 13 Other
<br />a;'<. 14
<br />o..
<br />1995 Mass. Estimated Tax Paid by TNSte.
<br />2
<br />3a
<br />3b Mass. Schedule 8,
<br />Iine 1 and / or 3
<br />3c 208
<br />3d
<br />4 Mass. Sch. 8, line 7
<br />5a Mass. Sch. D, line 1, Col. a
<br />56 Mass. Sch. D, line 1, Col. b
<br />6a Mass. Sch. D, line 2, Col. a
<br />6b Mass. Sch. 0, line 2, Col. b
<br />Form 1, line 5(or Form 1-NR/PY, Iine 13)
<br />~ 1, 4 9 4 and Mass. Sch. B, Iine 6
<br />8
<br />Mass. Sch. E, Part III
<br />9
<br />io 260
<br />11
<br />12a
<br />..•.. .~ .. ...... .. .. . ~2b Mass. Sch. D, line 11
<br />...... 13
<br />•• .................... 14 form 1, line 31 or t-NR/PY, line 51. Enter
<br />TrusYs I.D. No. to the right of line 31 or 51.
<br />' Some amounts ere induded automatlcally on the Massachusetts retum as a result of being camed over by you hom your U.S. Fortn 1040. Do not report any aiviaends or interest cn
<br />Mazs. Schetlule E. Also, see Form 1 instructions.
<br />'• Estimated tax payments are requiretl hom residmt grantors or other owners of a grantor-type hust Nonresitlents see page 2 of this fortn.
<br />Grantor/Beneficiary: Attach this form to page 2 of your Massachusetts Individual Income Tax retum.
<br />Under penalties of perjury, I declare that I have ezamined this return, including accompanying schedules and statements, and to the best of my
<br />o knowledge and 6eliet it is true, correct and complete. Declaration of preparer is based on all information o1 which helshe has any knowledge.
<br />~' Fiduciary's signature Date P i prep rers si nature & social rity number Date _
<br />d;:' ~ ~ C~~~ L 8- 4 2-5 6 61 ~~~~ '~ i
<br />~'. Firm name (or you~s, if self-employed) and address Empfoyer idenf i tion number 0 Check if self-empl d
<br />~' anders. Walsh & Eaton, CPAs '
<br />~ .O. Box 1427 04-3128198
<br />; est Chatham, MA 02669-1427
<br />~
<br />~ Warning: Willful tax evasion - induding underrepoRing income, overstating deductions or exemptions, or failing to file and othenvise e~.-a;.e taxes - is a 1:
<br />~az~ ComicUon can result in a jail term of up to five years and/or a fine of up to 5100,000
<br />~ 3 95
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