| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| Transamerica Principium III Variable Annuity | 0 | 48,667 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Licenses/fees | 25 | 25 | ||
| Supplies | 35 | 35 |
| Description | Amount |
|---|---|
| Capital gain net income | 25,000 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| Investment income tax | 487 | 0 | 0 | 0 |