STATE OF WEST VIRGINIA
                                                                                                
          State Tax Department, Tax Account Administration Div
                                                                                                
          P.O. Box 2666 
                                                              Charleston, WV 25330-2666

                                                                                                _____________________________________________________________
                                                       NameTEST CORPORATION 1                                                                                                        Letter Id: L0544489472
                                                                                                1001_____________________________________________________________           LEE ST E Issued:    03/21/2019
                                                                     AddressCHARLESTON WV  25301-1725                                                                                Account #: 2270-3778
                                                                                                _____________________________________________________________                        Period:    06/30/2018
          City                                                                      State                        Zip
                                                                                                
                                          PRENEED CEMETERY COMPANY ANNUAL REPORT
WV/CEM-4 
REV02-19  
Account                 PERIOD                                                                       PERIOD                                                   FISCAL                            DUE DATE
#                       STARTING                                                                     ENDING                                                   YEAR END                          MMDDYYYY
                        MMDDYYYY                                                                     MMDDYYYY
  A separate report must be completed for each trust account.  Make a photocopy of this return for additional trust accounts.   
  If more space is needed for any items on this report, use mytaxes.wvtax.gov
1. TRUST ACCOUNT NAME

  ADDRESS                                                                                                      CITY                                                                               STATE   ZIP

2. COMPLIANCE AGENT NAME

  ADDRESS                                                                                                      CITY                                                                               STATE   ZIP

3. TRUSTEE NAME

  ADDRESS                                                                                                      CITY                                                                               STATE   ZIP

                                                                                       4. TOTAL AMOUNT OF
  TELEPHONE NUMBER                                                                     PRINCIPAL IN PRENEED
                                                                                       TRUST ACCOUNT
5. LIST SECURITIES IN WHICH TRUST ACCOUNT IS INVESTED:
                        SECURITY NAME                                                                                                                         AMOUNT INVESTED                     WHEN INVESTED MMDDYYYY

  MAIL TO:     WEST VIRGINIA STATE TAX DEPARTMENT  
               Tax Account Administration Div  
               P.O. Box 2666 
               Charleston, WV 25330-2666  
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297  
For more information visit our web site at: www.tax.wv.gov  
File online at https://mytaxes.wvtax.gov  
                                                                                                                                                                                     O     5     2     2     0     1     9     0     1     W

  WV/CEM-4                     PRENEED CEMETERY COMPANY ANNUAL REPORT                      ACCOUNT #
  CONTINUED

  6.  INCOME RECEIVED FROM TRUST DURING PRECEDING FISCAL YEAR:
       INCOME SOURCE                                                                                        AMOUNT

                                                                            Total income received  

                     COMPLETE THE FOLLOWING FOR PERIOD COVERED ON FRONT OF THE RETURN
7 TOTAL SALES OF CEMETERY MERCHANDISE AND PRENEED SERVICES SOLD DURING THE PERIOD INCLUDING BOTH          7
  MERCHANDISE SOLD UNDER CEMETERY PRENEED CONTRACTS AND NOT SOLD UNDER CEMETERY CONTRACTS
  BREAK DOWN AMOUNT SHOWN ON LINE 7 INTO THE FOLLOWING AMOUNTS
    7a.  AMOUNT SOLD UNDER PRENEED CEMETERY CONTRACTS FOR WHICH 40% OF THE FUNDS HAVE BEEN DEPOSITED      7a
           INTO A TRUST ACCOUNT

    7b.  AMOUNT SOLD AND PHYSICALLY DELIVERED WITHIN 120 DAYS                                             7b

    7c.  AMOUNT SOLD WHERE SELLER PURCHASES THE MERCHANDISE AND STORES IT AT THE CEMETERY WHERE IT IS     7c
           INTENDED TO BE USED

    7d.  AMOUNT SOLD WHERE THE SELLER HAS PAID THE SUPPLIER OF SUCH GOODS AND THE SUPPLIER HAS CAUSED     7d
           MERCHANDISE TO BE MANUFACTURED AND STORED, AND HAS CAUSED TITLE TO BE TRANSFERRED TO THE BUYER
           OR OTHER CONTRACT BENEFICIARY AND HAS AGREED TO SHIP SUCH MERCHANDISE UPON HIS OR HER REQUEST.
           ATTACH COPIES OF ALL PURCHASE ORDERS OF MERCHANDISE SOLE WHERE THE MERCHANDISE HAS NOT BEEN
           DELIVERED TO THE BUYER OR 40% OF THE FUNDS RECEIVED HAVE NOT BEEN DEPOSITED IN A TRUST ACCOUNT.

8 TOTAL RECEIPTS REQUIRED TO BE DEPOSITED IN TRUST ACCOUNT (40% OF LINE 7A)                               8

9 TOTAL RECEIPTS DEPOSITED IN TRUST ACCOUNT (ATTACH PROOF OF TRUST ACCOUNT BALANCE WITHIN LAST WEEK)      9

10 TOTAL REQUIRED PRENEED CEMETERY COMPANY CONTRACTS EXPENSES PAID                                        10

11 TOTAL EXPENSES PAID FROM PRENEED TRUST ACCOUNT                                                         11
12 IS THE TRUSTEE OTHER THAN A BANK SAVINGS AND LOAN OR OTHER FEDERALLY INSURED BANKING INSTITUTION?

  NO       YES       If yes, you must provide proof that a fidelity bond from a corporate surety licensed to do business in West Virginia and payable 
                     to this trust has been issued in the greater of the following amounts:
                              $100,000
                              OR
                              NOT LESS THAN 100% OF THE VALUE OF THE TRUST ESTATE PRINCIPAL AT THE BEGINNING OF THE CALENDAR YEAR

                                                                                                    O     5     2     2     0     1     9     0     2     W

   WV/CEM-4 PRENEED CEMETERY COMPANY ANNUAL REPORT                                 ACCOUNT #
   CONTINUED
13                                          CERTIFICATION OF COMPLIANCE AGENT
  I certify that for the specified reporting period this trust account is in compliance with all applicable provisions of Article 5B, Chapter 35 of the Code of West Virginia of 1931,
  as amended, and of Series 36, Title 110 of the West Virginia Code of State Rules.

   SIGNATURE OF COMPLIANCE AGENT
   TAKEN; SUBSCRIBED, ACKNOWLEDGED AND
            SWORN TO BEFORE ME ON THIS DATE:

            MY COMMISSION EXPIRES ON:

                                      NOTARY PUBLIC                                                  (NOTARY SEAL)
14                                          CERTIFICATION OF CERTIFIED PUBLIC ACCOUNTANT
I have audited this trust account and certify that according to all information provided to me in the course of completing the audit, at least 40% of the cash receipts from the
sales of preneed property, goods and services which was not anticipated to be delivered or performed with 120 days after receipts of the initial payment on account has
been deposited in the account within 30 days after the close of the month in which such payments were received, all as required by West Virginia Code 35-5B-10.

   SIGNATURE OF CERTIFIED PUBLIC ACCOUNTANT                                        TYPED/PRINTED NAME

   CERTIFIED PUBLIC ACCOUNTANT ADDRESS
   TAKEN; SUBSCRIBED, ACKNOWLEDGED AND
            SWORN TO BEFORE ME ON THIS DATE:

            MY COMMISSION EXPIRES ON:

                                      NOTARY PUBLIC                                                  (NOTARY SEAL)
15                              AFFIRMATION FOR CORPORATION, SOLE PROPRIETORSHIP, OR PARTNERSHIP
I (we) do hereby certify that this Annual Report contains a true and accurate accounting and that all information requested has been provided in complete and accurate detail, all as required by Article
5B, Chapter 35 of the Code of West Virginia of 1931, as amended, and the regulations promulgated pursuant to such Act and the terms of this reporting form.  
   Corporate Seal, if applicable
                                            SIGNATURE                              TITLE

                                            SIGNATURE                              TITLE
   TAKEN; SUBSCRIBED, ACKNOWLEDGED AND
            SWORN TO BEFORE ME ON THIS DATE:

            MY COMMISSION EXPIRES ON:

                                      NOTARY PUBLIC                                                  (NOTARY SEAL)