PRINT IN BLACK INK                                                                        FOR PRIVACY ACT NOTICE, 
                                                                                                                                                                       SEE INSTRUCTIONS.
Calendar year filers enter 01-01-2009 and 12-31-2009 below. Fiscal year filers enter appropriate dates.
Tax year beginning (month–day–year) 3                                        Tax year ending (month–day–year) 3

Form 2G            Grantor’s/Owner’s Share of a Grantor-Type Trust                                                                                                                                   2009
NAME OF GRANTOR/BENEFICIARY                                                                                                                                            GRANTOR/OWNER’S IDENTIFICATION NUMBER

LEGAL DOMICILE

MAILING ADDRESS OF GRANTOR/BENEFICIARY                                      CITY/TOWN/POST OFFICE                                                                          STATEZIP + 4

NAME OF FIDUCIARY                                                                                                                                                      ENTITY’S IDENTIFICATION NUMBER

TITLE OF FIDUCIARY

NAME OF ENTITY

C/O

MAILING ADDRESS OF FIDUCIARY                                                CITY/TOWN/POST OFFICE                                                                          STATEZIP + 4

         Ovals must be filled in completely. Example:
         Fill in applicable ovals:3   Grantor-type trust        3           Pooled income fund   3   Charitable remainder annuity trust
         3        Charitable remainder unitrust         3    Amended
              Other                                                                                                                                                  5 If showing a loss, mark an X in box at left
   1     Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31                              00

   2     Interest from corporate bonds or notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                 2                              00

   3     Non-Massachusetts state and municipal bond interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                            3                              00

   4     Other interest income (including Massachusetts bank interest-see line 15) . . . . . . . . . . . . . . . . . . . . . . 3                                      4                              00

   5     Interest from U.S. obligations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3          5                              00

   6     Short-term capital gains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3       6                              00

   7     Short-term capital losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37                                            00

   8     Gain on the sale, exchange or involuntary conversion of property used in a trade or business
         and held for one year or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3          8                              00

   9     Loss on the sale, exchange or involuntary conversion of property used in a trade or business
         and held for one year or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3  9                                            00

10       Long-term capital gains or losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3       10                                            00

         SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
         Signature of fiduciary                          Date       Print paid preparer’s name       Preparer’s SSN
                                                             //                                      or PTIN
         Title                                                      Paid preparer’s phone            Paid preparer’s
                                                                    (       )                        EIN
         May DOR discuss this return with the preparer?3     Yes    Paid preparer’s signature                                                                          Date             Fill in if self-employed
                                                                                                                                                                           //
Mail to: Massachusetts Department of Revenue, PO Box 7017, Boston, MA 02204.

                           2009 FORM 2G, PAGE 2
NAME OF GRANTOR/BENEFICIARY                                                                                                                                  GRANTOR/OWNER’S IDENTIFICATION NUMBER

11Massachusetts long-term capital gain or loss included in U.S. Form 4797, Part II (not included 
  in line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311  00

12Long-term gains on collectibles and pre-1996 installment sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                             1200

13Short-term capital gain or loss differences. Enclose statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                                13  00

14Long-term capital gain or loss differences. Enclose statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                                14  00

15Massachusetts bank interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3         1500

16Net rental and royalty income or loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                 16  00

17Business/profession or farm income or loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                        17  00

18Partnership or S corporation income or loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                       18  00

19Other income. Enclose statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3             1900

20Short-term carryover losses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3             20  00

21Other adjustments. Enclose statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3                    21  00

22Massachusetts income tax paid by trustee. Grantor or beneficiary enter this amount on Form 1,
  line 36 or Form 1-NR/PY, line 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3           2200