Capital Gains and Loss
[Date]
[Name]
GAINS AND LOSSES REALIZED TO DATE Number Price of Units Investment Type Per Unit
Date Acquired
Amount Invested
Date Sold
Net Proceeds
Gain or (Loss)
NET GAIN OR (LOSS) CAPITAL LOSS CARRYOVERS NET CAPITAL GAIN OR (LOSS) UNREALIZED GAINS OR LOSSES IN CURRENT INVESTMENTS Number Date Cost per of Units Investment Type Acquired Unit
Total Cost or Basis
Current Market Price
Current Market Value
NET UNREALIZED CAPITAL GAIN OR (LOSS)
Gain or (Loss)