| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| Transamerica Principium III Variable Annuity | 0 | 64,622 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Licenses/fees | 25 | 25 |
| Description | Amount |
|---|---|
| Capital gain net income | 35,000 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Investment income tax | 409 | 0 | 0 | 0 |