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Capital Gains and Loss						[Date]
[Name]

GAINS AND LOSSES REALIZED TO DATE			�	�	�	�	�
Number�		Price	Date	Amount	Date	Net	Gain or
of Units	Investment Type	Per Unit	Acquired	Invested	Sold	Proceeds	(Loss)
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						NET GAIN OR (LOSS)	�
						CAPITAL LOSS CARRYOVERS
						NET CAPITAL GAIN OR (LOSS)	�

UNREALIZED GAINS OR LOSSES IN CURRENT INVESTMENTS				�	�	�	�
Number�		Date	Cost per	Total Cost	Current�	Current�	Gain or
of Units	Investment Type	Acquired	Unit	or Basis	Market Price	Market Value	(Loss)
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						NET UNREALIZED CAPITAL GAIN OR� (LOSS)	�

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