EXHIBIT B: GAINS AND LOSSES (1) Accounting Period Opening Date: (2) GAINS: Asset Gain Description Gain Amount $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Loss Amount $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Closing Date: Total Gains: (3) LOSSES: Asset Loss Description Total Losses: Revised September 2004 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.USCourtForms.com