U.S. Real Estate Mortgage Investment Conduit OMB No. 1545-1014

(REMIC) Income Tax Return Form 1066

For calendar year 2004 or short tax year beginning , 20 , ending , 20 Department of the Treasury

Internal Revenue Service  See separate instructions.

Name A Employer identification number

Please

Type or

Print

Number, street, and room or suite no. (If a P.O. box, see page 4 of the instructions.) Date REMIC started B

City or town, state, and ZIP code C Enter total assets at end of tax year

$

D Check applicable boxes: (1) Final return (3) Address change (4) Amended return

Section I—Computation of Taxable Income or Net Loss

Income (excluding amounts from prohibited transactions)

1 Taxable interest 1

2 Accrued market discount under section 860C(b)(1)(B) 2

3 Capital gain or (loss) (Schedule D) 3

4 Ordinary gain or (loss) (attach Form 4797) 4

5 Other income (attach schedule—see page 4 of the instructions) 5

6 Total income (loss). Add lines 1 through 5 6

Deductions (excluding amounts allocable to prohibited transactions)

7 Salaries and wages 7

8 Rent 8

9 Amount accrued to regular interest holders in the REMIC that is deductible as interest 9

10 Other interest 10

11 Taxes 11

12 Depreciation (see page 5 of the instructions) 12

13 Other deductions (attach schedule) 13

14 Total deductions. Add lines 7 through 13 14

Taxable income (or net loss). Subtract line 14 from line 6. Enter here and on Schedule M,

column (c)

15

15

Section II—Tax and Payments

1 Total tax (Schedule J, line 12) 1

2 Tax paid with: Form 8736 Form 8800 2

3

Tax due. Enter excess of line 1 over line 2. (See Payment of Tax Due on page 3 of the

instructions.) 

3

4 Overpayment. Enter excess of line 2 over line 1 4

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge

and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign

Here  Signature  Date

Date Preparer’s SSN or PTIN Check if selfemployed

Preparer’s Paid signature

Preparer’s

Use Only



Firm’s name (or yours

if self-employed),

address, and ZIP code

EIN  Phone no. ( )

For Privacy Act and Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 64383U Form 1066 (2004)

(2) Name change

May the IRS discuss this return

with the preparer shown below

(see instructions)? Yes No

2004
Form 1066 (2004) Page 2

Capital Gains and Losses (Caution: Use Form 4797 instead of Schedule D if the startup day was

after November 11, 1991. See page 5 of the instructions.)

Part I—Short-Term Capital Gains and Losses—Assets Held One Year or Less

(f) Gain or (loss)

((d) minus (e))

(e) Cost or other basis

(see page 5 of the

instructions)

(d) Sales price

(see page 5 of the

instructions)

(c) Date sold

(mo., day, yr.)

(a) Description of property

(Example: 100 shares 7% preferred of Z Co.)

(b) Date acquired

(mo., day, yr.)

1

2 Short-term capital gain from installment sales from Form 6252 2

3 Short-term capital loss carryover 3

4 Net short-term capital gain or (loss). Combine lines 1 through 3 4

Part II—Long-Term Capital Gains and Losses—Assets Held More Than One Year

5

6 Long-term capital gain from installment sales from Form 6252 6

7 Capital gain distributions 7

8 Enter gain, if applicable, from Form 4797 8

9 Long-term capital loss carryover 9

10 Net long-term capital gain or (loss). Combine lines 5 through 9 10

Part III—Summary of Parts I and II

11 Combine lines 4 and 10 and enter the net gain or (loss) here 11

12 If line 11 is a gain, enter here and also on line 3, Section I (page 1) 12

13 If line 11 is a loss, enter here and as a loss on line 3, Section I (page 1), the smaller of:

a The loss on line 11; or

b ($3,000) 13 ( )

Part IV—Computation of Capital Loss Carryovers From 2004 to 2005 (Complete this part if the loss on line 11 is

more than the loss on line 13.)

14 Enter loss from line 4. If none, enter -0- and go to line 19 14

15 Enter gain from line 10. If line 10 is blank or shows a loss, enter -0- 15

16 Combine lines 14 and 15 16

17 Enter the smaller of (a) the loss on line 13 or (b) the loss on line 16 17

18 Subtract line 17 from line 16. This is your short-term capital loss carryover from 2004 to 2005 18

19 Enter loss from line 10. If none, enter -0- and skip lines 20 through 23 19

20 Enter gain from line 4. If line 4 is blank or shows a loss, enter -0- 20

21 Combine lines 19 and 20 21

22

Subtract line 17 from line 13. (Note: If lines 15 through 18 are blank, enter the amount from line

13.) 

22

23 Subtract line 22 from line 21. This is your long-term capital loss carryover from 2004 to 2005 23

Schedule D

( )

( )

Form 1066 (2004)
Form 1066 (2004) Page 3

Tax Computation

Part I—Tax on Net Income From Prohibited Transactions

1 Income—See page 5 of the instructions.

a Gain from certain dispositions of qualified mortgages 1a

b Income from nonpermitted assets 1b

c Compensation for services 1c

d Gain from the disposition of cash flow investments (except from a qualified liquidation) 1d

2 Total income. Add lines 1a through 1d 2

Deductions directly connected with the production of income shown on line 2 (excluding

deductions attributable to prohibited transactions resulting in a loss)

3

3

4 Tax on net income from prohibited transactions. Subtract line 3 from line 2 4

Part II—Tax on Net Income From Foreclosure Property (as defined in section 860G(a)(8))

Net gain or (loss) from the sale or other disposition of foreclosure property described in section

1221(a)(1) (attach schedule)

5

5

6 Gross income from foreclosure property (attach schedule) 6

7 Total income from foreclosure property. Add lines 5 and 6 7

8 Deductions directly connected with the production of income shown on line 7 (attach schedule) 8

9 Net income from foreclosure property. Subtract line 8 from line 7 9

10 Tax on net income from foreclosure property. Enter 35% of line 9 10

Part III—Tax on Contributions After the Startup Day

(Do not complete this part if the startup day was before July 1, 1987. See page 6 of the instructions.)

Tax. Enter amount of taxable contributions received during the calendar year after the startup

day. See page 6 of the instructions (attach schedule)

11

11

Part IV—Total Tax

12 Total tax. Add lines 4, 10, and 11. Enter here and on page 1, Section II, line 1 12

Schedule J

(Caution: See page 6 of the instructions before completing this part.)

Form 1066 (2004)
Form 1066 (2004) Page 4

Designation of Tax Matters Person

Enter below the residual interest holder designated as the tax matters person (TMP) for the calendar year of this return.

Identifying

number of TMP

Name of

designated TMP  

Address of

designated TMP 

Additional Information (See page 6 of the instructions.)

Yes No

E

If you checked “Segregated Pool of Assets,” enter the name and type of entity that owns the assets:

Name Type

F Number of residual interest holders in this REMIC  

Check this box if this REMIC is subject to the consolidated entity-level audit procedures of sections 6221

through 6231 

G

H At any time during calendar year 2004, did the REMIC have an interest in or a signature or other authority over

a financial account in a foreign country (such as a bank account, securities account, or other financial account)?

If “Yes,” enter name of foreign country  

During the tax year, did the REMIC receive a distribution from, or was it the grantor of, or transferor to, a foreign

trust? If “Yes,” see page 6 of the instructions for other forms the REMIC may have to file

I

J Enter the amount of tax-exempt interest accrued during the year 

K Check this box if the REMIC had more than one class of regular interests 

If so, attach a schedule identifying the classes and principal amounts outstanding for each at the end of the year.

L Enter the sum of the daily accruals determined under section 860E(c) for the calendar year 

Balance Sheets per Books (a) Beginning of year (b) End of year

Assets

1 Permitted investments (see page 7 of the instructions):

a Cash flow investments

b Qualified reserve assets

c Foreclosure property

2 Qualified mortgages

3 Other assets (attach schedule)

4 Total assets

Liabilities and Capital

5 Current liabilities (attach schedule)

6 Other liabilities (attach schedule)

7 Regular interests in REMIC

8 Residual interest holders’ capital accounts

9 Total liabilities and capital

Reconciliation of Residual Interest Holders’ Capital Accounts (Show reconciliation of each

residual interest holder’s capital account quarterly on Schedule Q (Form 1066), Item F.)

(g) Residual interest

holders’ capital accounts

at end of year (combine

cols. (a) through (f))

(c) Taxable income

(or net loss) from

Section I, line 15

(b) Capital

contributed during

year

(a) Residual interest

holders’ capital

accounts at

beginning of year

(f) Withdrawals and

distributions

(e) Unallowable

deductions

(d) Nontaxable

income

( ) ( )

Schedule L

Schedule M

If “Yes,” the REMIC may have to file Form TD F 90-22.1. See page 6 of the instructions.

Form 1066 (2004)

What type of entity is this REMIC? Check box  Corporation Partnership Trust

Segregated Pool of Assets