[4]RECORD NUMBER :
[6]RECORD SERIES :
[8]AGENCY FILE NUMBER :
[10]ORIGINATOR :
[11]FROM:
[12]TO:
[16]DATE:
[17]PAGES:
[19]SUBJECTS :
[21]DOCUMENT TYPE :
[22]CLASSIFICATION :
[23]RESTRICTIONS :
[24]CURRENT STATUS :
[25]DATE OF LAST REVIEW :
[27]OPENING CRITERIA :
[29]COMMENTS :
[31]JFK Assassination System . Date:
[33]Identification Form
[35]Agency Information
[37]HSCA .
[38]180-10073-10093
[40]NUMBERED FILES
[41]004876
[43]Document Information
[45]RUBY, SAMUEL
[46]RUBY, SAMUEL
[48]01/24/1978
[49]118
[51]RUBY, SAM
[52]RUBY, JACK, BACKGROUND, ASSOCIATES AND RELATIVES
[54]OTHER TEXTUAL
[55]Unclassified
[57]3
[59]Redact
[61]10/25/1995
[63]W/cover letter. Box #:102.
[65]NW 88326 Docid:32245535 Page 1
[67]10/1/201
[69]162L50 Burcher Ave TAn . AEG TE
[70]Wills, CR.
[71]Granada LMS,
[73]004876.
[75]af | ae, oD imal
[78]7 , be deb = we . . “F yb .
[79]"stan 5399 Return for Indiv’ ily 1978 «
[81], Form. J Retirement Savings Arrangement UIE
[83]- Bopertiont’ at tho Treasury (Under. Sections 408 or 409 of the Internal. Revenue Code) Only This Side of Form is
[85]")., Igtornal Revenuc Service
[86]r .
[88]> Attach to Form 1040. — Open to Public Inspection-
[90]-If you have established a retirement savings arrangement you must p Part | and Part Il and ‘attach this
[91]form to your individual income tax return, Form 1040. In addition: (1) if you claim a deduction on your Form 1040
[92]for contributions to your retirement savings arrangement, complete Part Ill; (2) if you have made contributions in
[93]excess of your allowable limitation for this year or prior years, complete Part IV; (3) if you are not yet age 5914
[94]when you receive a diStribution from your retirement savings arrangement which is not due to a disability,.a-rollover
[95]contribution to another plan or retirement savings arrangement, or the transfer of an amount to a former spot
[96]under a divorce decree, you must complete Part V; (4) if you are 701% or older on the last day of the year, : see: in-
[97]structions to determine if you are required to complete Part VI.
[99]t , i
[100]te . Name ol. . vA
[102]Address (Number ‘and street)
[104]et
[106]City or town, State and ZIP code
[107]G Cer
[109]If you are not required to file a Form 1040 check here
[111]MRar.ty lai Individual and Retirement Savings Information , ae
[113]1 Type of individual retirement savings arrangement:
[115](a) [J Individual retirement account
[116](b) [[] Individual retirement annuity
[117](c) [7] Individual retirement bonds
[119]2 Were you during any part of the year an active participant in a qualified pensi atk on sharing
[120]plan, including a qualified Keogh (HR 10) plan, or were you covered under a sactio' 403(b) annuity.
[121]account or under a government*retirement plan other than the Social Security ¥ Railroad Retin
[122](Volunteer firemen and military reservists see specific instructions for line 2) . Nw
[124]ial,
[126]If ““Yes,"’ you are not allowed a deduction for your 1976 contributions to your indivi
[128]Under penalties of perjury, | declare that | have examined this return, including accompanying- sche S22
[129]knowledge and belief it is true, correct, and complete. If prepared by a person other than the taxpayer, this this declay
[130]of which the preparer has any knowledge. : ‘
[132]_ ee IEAM MY T
[134]fe r i other than taxpayer: Preparer’s identification number. 5 : a
[135]. “Prepa er's signature ( J taxpayer) _(see General Instruction B) Rate “ i oe
[137].~ Preparer’s address‘and ZIP code
[140]Lehi Dig ence meneame eh ie te te eee Eh tet ME a id Pi oy eee
[142]filed by surviving spouse or - beneficiary ofa an individual who created this retirement savings arrangement check here > oO
[144]nd enter name arid social security number of individual for whom the arrangement was established b>
[146]di ste-your age as of the end of the year (If you checked item 3 do not complete this item):
[149]= (a) ci Under age-591%
[150]“(b) Age 5914 to 7044"
[151](ce) ©) Over age 7034 (if you check item: *(c) complete Part VI below)
[153]5 (a) if during the year, you received a distribution of your entire account from a qualified pension, profit
[154]sharing or stock bonus plan, because either (i) you terminated employment or (ii) your employer .
[155]terminated the plan, and you transferred (rolled over) such distribution to your arrangement, check here . . . e oO
[157](b) If you checked (a) did you transfer the entire amount of the distribution (less any amounts you con-
[158]tributed to the qualified plan—see instructions) to your arrangement within 60 days of receipt of such .
[159]distribution (or 12/31/76 if (a)(ii) applies and you received such distribution prior to 11/2/76)?. . . [J Yes [ No
[161](c) If (b) was “Yes,” complete lines (i) through ii) below: Month j Day | Year
[162](i) Date of transfer to arrangement . . . ee eee bk be ee ee ;
[164](ii) Date distribution was made to you from tre plan eee ee ew ew tt tt lke
[165]ii) Name of trustee or insurance compeny to which the transfer was made (If bonds were purchased state “Bonds”) b>...
[167](d)’ (i) ‘if within one taxable year, you received a distribution of your entire “account from your employer's qualified pension,
[168]“profit-sharing or stock bonus plan because the plan was terminated by your employer did you:
[169](A) receive such amount on or after July 4, 1974 but prior to January 1, 1976,
[170](B) transfer such amount, reduced Ly the amount of the income tax paid on the distribution on ©
[171]your 1974 or 1975 income tax return, to an arrangement and
[172](C) tite a claim for refund of such tax paid? (Check “Yes” only if (A), (B) and (C) ALL apply.) . (J Yes ( No
[175]? (ii) if (d)(i) is ‘‘Yes,"’ and you have received such refund or credit for such tax paid enter: Month: Day | Year
[176]4 (A) Date refund or credit received 2. 2. 1 1 1 ew we ew ee te kk oe 6
[178]“(B) Date refund or amount of credit was contributed to your retirement savings arrangement . .
[179]Note: See Definition C in the Instructions concerning rollover contributions,
[181]"6 If, during the year, you transferred any funds from one retirement savings arrangement to another retire-
[182]ment savings arrangement, enter the date of transfer here. . . . . . 2. es ws we tb we .
[183]Caution: Such a transfer may be a taxable distribution. a
[185]7 If, during the tax year covered by this form, you have entered into a prohibited transaction under section 4975 or borrowed any amount from
[186]your retirement savings arrangement or pledgéd any part of your arrangement as security for a loan, check here . . i |
[187]Note: See instructions for the tax consequences of such transactions.
[189]Abarth) Computation of Allowable Deduction.
[191](If you have entered into a prohibited transaction: under section 4975, do not complete Part [Il or Part
[192]W for the retirement savings arrangement with which you entered into such prohibited transaction.) _
[194]8 Wages, tips and other compensation from Form 1040 (if a joint returri do not include compensation of spouse) H
[195](See definition B in the instructions for the meaning of compensation.). . es Sen
[196]9 15% of line 8 or $1,500, whichever is lesser (if you are 701% or over or answered “Yes” to line 9 enter zero). .« 2 «© «© eo fo _—_ ee nnn
[197]10 Amount paid by you or on your behalf under all your retirement savings arrangements (do not include any
[198]amounts which were considered as “rollover contributions,” see lines 5 and 6, or the purchase price of any
[200]individual retirement bonds redeemed within 12 months of their date of purchase (see instructions) or life cS .
[201]insurance Portion of your endowment premium as reported on Form 5498 box6). 2. «2... . . Le
[203]Nentn| Day { Year
[205]11 Allowable deduction, lesser of line 9 or line 10 (enter here and on Form 1040, line 40a)... . - > So ’
[206].Getniiy..| Tax on Excess Contributions ee
[207]12 Tax on excess contributions (see Part IV of the Specific Instructions if Part lil, line 10 exceeds line 11). Enter
[209]tax from worksheet here and on Form 1040, line 61 7. oe . 5 - >
[210](Temy:.:] Tax on Premature Distributions
[212]13 Tax on premature distributions (see Part V of the Specific Instructions if you received a distribution from
[214]your retirement savings arrangement before you have attained age £9%A). Enter tax from worksheet here and
[215]on Form 1040, line 57. . . . . ee ee ee
[217]Fj Tax on Undistributed Retirement Accounts and Annuities
[218](See Instructions before completing this Part.)
[220]14 Tax based on current year distribution method, see worksheet in Instructions . . . . . ee ee
[221]15 Tax based.on aggregate distribution methods, see worksheet in Instructions . . . . oe eo we
[223]16 Tax due, lesser of line 14 or 15, enter here and on Form 1040, in your total for line 62. On the dotted line to
[224]the left of the line 62 entry space write ‘'4974 tax,” and show the amount oe ee le
[226]WW U.S, GOVERNMENT PRINTING OFFICE : 1976—O-218-176 ELI. 13.2687299
[228]4
[231]: Department of the Treasury— internal Revenue Service
[232]' 040 U.S. Individual Income Tax Return
[233]For thé year January” 1—December 31, 1976, ¢ or. other taxable year beginning _ _ "1976 ending —_ 19
[235]Name (If joint return, give first names and initials of both)
[239]| For Péivac
[240]| see page 5 of Instructions.
[242]5 Oceu- |_Yours
[243]a? tar, pation | Spouse's p>
[244]1 Single (Check only ONE box) 6a Regular (J Yourself [—] Spouse Enter Chee p> yy
[245]2 arried filing joint return (even if only one had income) b First names of your dependent children who Z Yy, :
[246]2 3 Married filing separately. If spouse is also filing give a lived with you eS td S &} _———____ 7
[247]= 1 i i i j = pn Eee Ent
[248]FE] spouses Social security number in designated space above s THor "Ky 5 Aumber > _
[249]. J name here p> =| ¢ Number of other dependents (from line 7) . > i_ Ui
[250]E | 0 Unmarried Head of Household. See page 7 of instructions Rs] d Total (add lines 6a, b, andc) . .
[251]este ty > e@ Age 65 or older. O Yourself [7] Spouse Enter ;
[252]5 [] Qualifying widow(er). with dependent child (Year Blind. . . . [] Yourself [] Spouse gf paxes b>
[253]spouse died > 19 ). See page 7 of Instructions. _f TOTAL (add lines 6d and e) woe . Bb :
[254]' . 7 Other dependents: (b) Relationship (c. Months lived in your (a) Did dependent (e) Amount furnished for dependent’s support ~
[255]an : (a) Name ; during year, write B or D. or more? of $75 By. You. It 100% ry Set eRS includ:
[256]$d
[257]. . ae Of . : “ ”
[258]8 Presidential Election Do you wish to designate $1 of your taxes for this fund? . . {__} Yes. 7 No _| fontes) it'will not increase our
[259]Campaign Fund . . If joint return, does your spouse wish to designate $1? Yes Y No _| tax or reduce your refund.
[260]9 Wages, salaries, tips, and other employee compensation ‘Attgch_ Forms W-2. If ungall en f:) -p ~ . :
[262]able, see page 6 of Instructions.) *
[264]7 10a Dividends Teo ee uations wecceeeeeeee cee a , 10b less exclusion. Balance f> | 10¢). . GQ —— —_——
[265](if gross dividends and other distributions are over $400, list ir rt lof Schedule B.) r : :
[266]11 + Interest income. {if Gver $400, enter total and Int ie Part ot Seheakle B cee faa SES
[267]£ ‘12 Income other than wages, dividends, and interest (from line 37) . . . . . .. 120 _—_——
[268]$| 13 Total (add lines 9, 10c, ll and 12)... . . cee ee LE ADAG fe)
[269]“| 14 ‘Adjustments to income (such as moving expense, ete. from line 42) se ee ee 4 ca - inal ——-
[271]b Disability income exclusion (sick pay) (attach Form 2440) toe eee 15b_ _ ae —t#
[272]c Adjusted gross income. Subtract line 15b from line 15a, then complete Part MI on back. , “:
[273](If less than $8,000, see page 2 of Instructions on ‘“‘Earned Income Credit.”) . . . . | 15¢| - 7 > \f }
[275]{| Tax Table Tax Rate Schedule X, Y or Z| | Schedule D| | ‘ . -
[276]Schedule G Form 2555 | TO Form 4726 |_16 oe
[278]16 Tax, check if from:
[280]Please attach Copy B of Forms W-2 here
[282]Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is
[283]true, correct, and complete. Declaration of preparer (other than taxpayer) is based’on all information of which Preparer has any knowledge.
[285]17a Multiply $35.00 by the number of exemptions on line 6d . 17a — 4 seo page 10 Of} sstpuetions)
[286]|B Enter 2% of line 47 but not more than $180 ($90 if box 3 is checked) vs | W¥o ofa! | 17c¢ — 2G
[287]3 18 Balance. Subtract line 17¢ from line 16 and enter difference (but not less than zero) :
[288]L- S| 19 Credits (from line 54) : .
[289]| 20 Balance. Subtract line 19 from line 18 and enter 1 difference (but not less than zero)
[290]z 21 ~~ Other taxes (from tine 62) ee :
[291]a 22 Total (add lines 20 and 21). . Soe ee ee ae (
[292]i s E 23a Total Federal income tax withheld. "{atagh, Forms frosts , | 43a. m0
[293]ra = b 1976 estimated tax payments . qe credit from, 1975 woken 23b_ 8 full ith this return. Write )
[294]z c Earned income credit. of ‘Instructions) Son ee 23c_ Y check or money order and Y
[295]° ‘d Amount paid with Form 4868 . . 2. 2. 1... «| 23d = Rover ee inert 7)
[296]2 e Other payments (from line 66) . . . . 3 0. ; [23e Yyjyyypyywyw@—
[298]'“s 24 TOTAL (add lines 23a through e) woes wos
[300]~ 8 (| 25 If line 22 is larger than line 24, enter BALANCE DUE IRS... - . > [25- a
[301]3 3 " (Check here [> ["], if Form 2210 or Form 2210F is attached. See page 10 of instructions.) .
[302]ra] ra 26 If line 24 is larger than line 22, enter amount OVERPAID: eee ee ee Bm IRB .
[304].3| 8] 27 . Amount of line 26 to be REFUNDED TO YOU . . ‘ wes) yb 7 27 ede Dn|
[305]= ©] 28° Amount of line 26 to be credited on 1977 estimated tax b> [ 28 |. —} | WHHE: YWVHE@V]V}@#Uyyi
[306]y
[307]8
[308]a
[310]our ‘signatira ° Date ID meer Preparer’s signature (and employer's name, if any) Sé@Date Signature {and employer's name, if any) . Date
[312]Span s signature (if filing “alas, BOTH must sign even if only one had income) _|> Tdentitying Number (see instructions) y Address (and ZIP code)
[314]~ Sign here
[316]NW 88326 Docld: 32245535 Page 5
[318]15a Subtract line 14 from line 13... . 1. PA A
[320]a 4 218-052-2
[323]NER deeria reuse ear a ek oF ema
[324]Emr. é : ee ire
[326]a
[328]Form 1040 4976) . wht page 2
[329]“7Tncome other than Wages, Dividends and Interest : ;
[331]+ 29 Business income or (loss) {attach Schedule C) . . . - oo ee ee [29
[332]. 30a Net gain or (loss) from sale or exchange of capital assets (attach Schedule b) woe ee . [30a 7) ’
[333]b 50% of capital gain distributions (not reported on Schedule D—see page 10 of Instructions). _30b" _
[334]. 31 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) . . . 31 __
[335]: 32a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) . 32a —_——
[336]b Fully taxable pensions and annuities (not reported on Schedule E—see page 10 of Instructions) _32b° _
[337]“33 Farm income or (loss) (attach Schedule F) re __.
[339]‘ does not apply if refund. is for year in which you took the
[340], 34 State income tax refunds ( standard deduction—others see page 10° of Instructions ) .
[342]q
[343]|
[345]35 Alimony received . . - - rr | 35 |
[346]36 Other (state. nature and source—see page rT of Instructions) >. ; . |
[348]Total add lines 39 through 36). Enter here and online 12
[349]Piet] Adjustments to Income
[351]38 Moving expense (attach Form 3903) soa
[352]39 Employee business expense (attach Form 2106) . . . cos
[353]-- 40a Payments to an individual retirement arrangement from attached Form 5329, Part i,
[354]b Payments to a Keogh (H.R. 10) retirement plan :
[356]. 41 Forfeited interest penalty for premature withdrawal (see page 12 of Instructions) oka
[357]' 42> Total (add lines 38 through 41). Enter here and on line 14 Coe ee
[359]PTE] Tax Computation
[361]43 Adjusted gross income (from line 15c). if you have unearned income and can be claimed as a
[362]. dependent on your parent's return, check here Pm Eja and see page 9 of Instructions
[363]i 44a If you itemize deductions, check here > C) and enter total from Schedule A, line 40, and attach Schedule A
[364]a b Standard deduction—If you do not itemize deductions, check here > [_], and:
[365]= ~ If you checked 2 or 5, enter the greater of $2, 100 OR 16% of line 43—but not more than $2, 800
[366]the box on 1 or 4, enter the greater of $1, 700 OR 16% of line 43—but not more than $2, 400
[367]line 3, enter the greater of $1,050 OR 16% of line 43—but not more than $1,400
[368]45. Subtract line 44 from line 43 and enter difference (but not less than zeroy 2. 6 1 we we
[369]‘46° Multiply total number of exemptions claimed on line 6f by $750 :
[370]‘ 47 Taxable income. Subtract line 46 from line 45 and enter difference (but not less than zero)
[372]- © If line 47 is $20,000 or less and you did not average your income on Schedule. G, or figure your tax on Form 2555, Exemption of Income Earned Abroad, find!
[373]your tax in Tax Table. Enter tax on line 16 and check appropriate box.
[375]© If line 47 is more than $20,000, figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, Z, or if applicable, the alternative tax from Schedule
[376]i ’D, income averaging from Schedule G, tax from Form 2955 or maximum tax from Form 4726. Enter tax on line 16 and check appropriate box.
[378]oa Credits
[380]Credit for the elderly (attach SchedulesR& RP). - 6 ep oe ee tt tts 48
[381]0 Credit for child care expenses (attach Form 2441)
[382]. 50 Investment credit (attach Form 3468)
[383]51 Foreign tax credit (attach Form 1116) .
[384]52 Contributions to candidates for public office credit (see pi page 212 of Instructions) .
[385]_ 53 Work Incentive (WIN) Credit (attach Form 4874) . : er
[387]2
[389]i
[391]}_Total add lines 48 through 53), Enter here and on line 19
[393]Wacsrves! f=4 Other Taxes
[395]55 Tax from recomputing prior-year investment credit (attach Form 4255)
[396]» 56 Minimum tax. - Check here [> [], and attach Form 4625 «.
[398]57 Tax on premature distributions from attached Form 5329, Part Vv.
[399]_ 58 Self émployment tax (attach Schedule SE) ‘ .
[400]59 Social:security tax on tip income not reported to employer (attach Form 4137) .
[401]60 Uncollected employee social security tax on tips (from Forms W-2)' sone
[402]61 Excess contribution tax from attached Form 5329, PartIV. 20. ee ee ee
[404]Total (add | lines 55 through 61). Enter here and on line 21 woe eee
[405]Sess Other Payments +
[406]” .: 63 . Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers—see page 13 of ‘lastructions)
[407]64 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) .
[409]' 65 Credit from a Regulated Investment Compdny (attach Form 2439) -
[410]-66 Total (add lines 63 through 65). Enter here and on line 23e
[412].NW 88326 Docid:32245535 Page 6
[414]SE US. GOVERNMENT PRINTING OFFICE : 1976—O-218-052 ve _ 218-0522
[416]OL Tapia deep aagpiceg erpeenemenerereriee rear
[418]RRS Py aia LT
[421]pe
[423]te
[424]in
[426]‘Sched és AsB—Itemized | Deductions AND
[427]‘(Form 1040) a Dividend and Imterest income.
[429]"Department of the, Treasu an > Attach to Form 1040. > See Instructions for Schedules A and B (Form 1040).
[430]1, Name(s) as shown on Form 1040 ;
[432]Schedule A—Itemized Deductions (Schedule B on back)
[434]Contributions (See page 15 of Instructions for examples.)
[436]Medical and Dental Expenses (not compensated by insurance
[437]. ‘or otherwise) (See page 13 of Instructions.)
[439]1 One half (but not more than $150) of in-
[440]surance premiums for medical care. (Be
[441]sure to include in line 10 below)
[443]. 2 Medicine and drugs
[444]3 Enter 1% of line 15c, Form 1040 .
[445]: “4 Subtract line 3 from line 2. Enter differ-
[446]ence (if less than zero, enter zero)
[447]; 5 Enter balance of insurance premiums for
[448]-- medical care not entered on line 1
[449]_ ‘ \i & Enter other medical and dental expenses:
[450]a Doctors, dentists, nurses, etc. ,
[451]_ db Hospitals . te ae
[452]4" -@ Other (itemize—include hearing aids,
[453]dentures, eyeglasses, transportation,
[455]21 a Cash contributions for which you have
[456]receipts, cancelled checks or other
[457]written evidence . . . ee
[458]b Other cash contributions. List donees : :
[459]and amounts. B ____.. 22. 2--2-- eee eee eee | ——
[461]22 Other than ‘cash (see page 15 of instruc:
[462]tions for-required statement) ' .
[464]23 Carryover from prior years . .
[465]24 Total contributions (add lines 21a through / >a
[466]23). Enter here and on line 37... >
[467]| Casualty or Theft Loss(es) (See page 15 of Instructions.)
[468]Note: If you had more than one loss, omit lines 25 through 28
[469]and see page 15 of Instructions for guidance.
[471]25 Loss before insurance reimbursement .
[472]26 Insurance reimbursement .
[474]27 Subtract line 26 from line 25. Enter dif-
[475]ference (if less than zero, enter zero)
[477]28 Enter $100 or amount on line 27, which-
[479]. 7 Total (add lines 4 through 6c)
[481]; 8 Enter 3% of line 15c, Form 1040. ever is smaller. . . - ee es _
[482]- §-Q Subtract line 8 from Sine 7 (if less than | 29 Casualty or theft loss (subtract line 28 @ ce .
[483]zero, enter zero) ]____from line 27). Enter here and ontine 38. | 7 |g
[485]-. 10 Total (add lines 1 and 9), Enter here and
[486]on line 34... > |
[487]., Taxes (See page” 13 of Instructions.) ;
[489]| Miscellaneous Deductions (See page 15 of Instructions.) a
[491]30 Alimony paid
[492]31 Union dues . woe ee Lo
[493]32 Other (itemize) P____.....-.-.-2-22------------ ee
[495]‘11 State and local income... + -
[496]12 Real estate. . - - oe
[497]+," 43 State and local gasoline (cee gas tax tables)
[498]". ; 14 General sates (see sales tax tables)
[499]fs 15 Personal property, . - + + +
[500]“+” 146 Other (itemize) > .
[502]33 Total (add lines 30 through 32). Enter
[503]here and on line 39
[505]34 Total medical and dental—line 10 .
[507]35 Total taxes—line 17 .
[509]36 Total interest—line 20...
[511]37 Total contributions—line 24 .
[513]38 Casualty or theft loss(es)—line 29
[515]39 Tota! miscellaneous—tine 33 .
[517]40 Total deductions (add lines 34 through
[518]39). Enter here and on Form 1040, line
[520]' 20 Total (add lines 18 and 19). Enter here
[521]and on line 36. wee ee we
[523]218-054-1
[525]> NW BB 326. Doctd:32245535 Page f
[527]INW.88326.
[529]Schedules A&B (Form 1040) 1976
[530]Name(s) as shown on Form 1040 (Do not_enter name and social security
[532]Schedule B—Dividend and Interest Income
[534]Page 2
[536]number if shown on other side) ‘Your social a sna 1G)
[538]Dividend Income
[540]+ ee I# gross dividends (including capital-gain distributions) and
[542]’ other distributions on stock are $400 or less, do not complete this
[543]part. But enter gross dividends less the sum of capital gain dls-
[544]tributions and non-taxable distributions, if any, on Form 1040,
[545]line 10a (see note below).
[547]"1 Gross dividends (including capital gain distributions) and other
[549]distributions on stock. (List payers and amounts—write (H),
[550](W), (J), for'stock held by husband, wife, or jointly)
[552]MELEE EE
[554]2 Total of line 1
[555]3 Capital gain distributions (see page $16 of
[556]Instructions. Enter here and on Schedule D,
[558]line 7). See note below
[559]4 Nontaxable distribu-
[561]tions (see page 16 of
[562]’ Instructions) .
[564]5 Total (add lines 3 and 4)
[566]6 Dividends before exclusion (subtract line
[567]5 from line 2). Enter here and on Form
[568]1040, line 10a
[570]Note: If you received capital @ain distributions and do not need Schedule D to report any other wins or josses or To compute -
[571]the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040,
[573]line 30b.
[574]Fru, |. Foreign Accounts and Foreign Trusts
[576]3224 iQ
[577]F Interest Income
[579]rest is $400 or Jess, do not complete this part. But
[580]nt of interest received on Form 1040, line 11.
[582]A 8t includes earnings from savings and loan aseaciations,
[583]mutial savings banks, cooperative banks, and credit unions
[584]‘ag wéll as interest on bank deposits, bonds, tax refunds, etc.
[585]Interest also includes original issue discount on bonds and
[586]other evidences of indebtedness (see page 16 of Instructions).
[587](List payers and amounts)
[589]More Do Oe EY {o
[592]IIT!
[594]LETT ET EP EPP EE
[600]t
[604]8 Total interest income. Enter here and on
[605]‘Form 1040, line 11
[607]2 Did you, ‘at any time during the taxable year, have any interest in or signature or other authority over a bank,
[609]securities, or other financial account in a foreign country (except in a U.S. military banking facility operated by a
[611]U.S. financial institution)? . . oe 4
[612]. If-“Yes,” attach Form 4683 (For « definitions, see @ Form 4683. )
[614]’ 2 Were you the.grantor of, or transferor to, a foreign trust during any taxable year, which foreign trust was in
[615]being during the current taxable year, whether or not you have any beneficial interest in such trust? .
[617]it.“Yes,” attach Form 4683 (For definitions, see Form 4683.)
[619]vx U.S. GOVERNMENT PRINT!
[621]am Yes/No
[622]Cc] Yes. <2No
[624]ING OFFICE: 1976-—-O-218-054 218-054-1
[628]a pre,
[632]’ Name of proprietor
[634]Income
[636]eS"
[638]Internal Revenue Service b> Attach to Form 1040. © See Instructions for Schedule C (Form 1040).
[640]A Principal business activity (see Schedule C Instryed ions) &.. Sb s ez
[641]B Business name>... LOODPLEy | freee a, ih PEE
[642]D Business address (number and street) B.. le é 2 BS. YES. Tylee 7 es eeseesseetentecees
[644]City, State and ZIP code >. ENCha cod CH 913!
[645]E Indicate method of accounting: (1) [7] Cash (2) Accrual (3) [_] Other >
[646]F Were you required to file Form W-3 or Form 1096 for 1976 (see Schedule C Instructions)? .
[648]If “Yes,” where filed B..
[650]‘G Was an Employer's Quarterly Federal Tax Return, Form 941, filed ‘for this business for any y quarter in 19767 :
[651]’ H Method of inventory valuation >
[653]Was there any substantial al change i in
[655]i
[659]- SCHEDULE. C Profi t or (Loss) From Business or Profession
[660]; 1040) (Sole Proprietorship)
[661](Form 10 70) wy Partnerships, Joint Ventures, etc., Must File Form 1065. — 1978
[663]the manner of determining quantities, costs, or valuations between the opening and. closing inventories? (If “Yes,” attach explanation) .
[665]1 Gross receipts or sales bare Less: returns and allowances $...............-cee- Balance >
[666]2 Less:.Cost of goods sold and/or operations (Schedule C-1, line 8)
[667]3 Gross profit .
[668]4 Other income (attach schedule) .
[669]5 Total income (add lines 3 and 4)
[670]6 Depreciation (explain in Schedule C3) . .
[671]7. Taxes on business and business property (explain in- Schedule C 2) .
[672]8 Rent on business property :
[673]9 Repairs (explain in Schedule C-2)
[674]10 Salaries and wages not included on line 3, Schedule c-1 (exclude a any ‘paid te to yourself) .
[675]11 Insurance. . . ee
[676]12 Legal and professional fees
[677]13 Commissions . 1
[678]14 Amortization (attach statement) . .
[679]15 (a). Pension and profit- sharing plans (see Schedule Cc instructions)
[680](b) Employee benefit programs ‘(see Schedule C Instructions)
[681]16. Interest on business indebtedness ‘ ; :
[682]17 Bad debts arising from sales or services
[683]Depletion .
[684]Other business expenses 5 (specify):
[686]Deductions.
[688]o
[690](k). Total other. business expenses (add lines 19(a) through 190)
[691]20 Total deductions (add lines 6 through 19(k)) ..
[693]21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on Form 1040, line 29. ALSO
[694]enter on. Schedule SE, line 5(a) . . . .
[696]1 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)
[698]2 Purchases $. ... Less: cost of items withdrawn for personal use $..............-.--....- Balance >
[699]3 Cost of labor (do not include salary paid to yourself)
[701]4 Materials :and supplies woe ee toe
[703]5 Other costs (attachschedule) . 2 2. 6 6 6 ee ee ew ee
[705]6 Total of lines through 5 . 6 6 6 ee ee ee ee
[707]7 Less: Inventory at end of year
[708]8 Cost of goods sold and/or operations. Enter here and on : line 2 above
[710]2 Lost of g00ds Sold and/or oper
[711]Did you claim a deduction for expenses of an office in yourhome?. - - - +e 2 2 + oe tot te (] Yes . [] No
[712]a
[714]218-055~1
[716]NW 88326 Docid:32245535 Page 10
[718]Schedule C (Form 1040) 1976 Page 2
[720]SCHEDULE C-—2,.—-Explanation of Lines 7 and 9
[722]Line No. ” Explanation Amount Line No. Explanation Amount
[724]SCHEDULE C-3.—Depreciation (See Schedule C Instructions for Line 6)
[725]If you need more space, use Form 4562.
[727]d. Depreciation e. Method of .
[728]rae b. Date c. Cost or . in f. Life g. Depreciation for
[729]_ @ Description of property acquired | «other basis alt wed allowable | see or rate . this year
[731]1 Total additional first-year depreciation (do not include in items below) ——$—$ $$$ $$$ $$
[732]42 Other depreciation:
[734]3 Totals... ee
[735]4 Less ‘arnount of depreciation claimed in Schedule C-1, page 1
[736]5 Balance—Enter here and on page 1, line 6
[738]SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4)
[740]Enter information with regard to yourself and your five Name Exerise account UMA
[741]highest paid- employees. In determining the five highest | Owner . . . . a. tok . Za
[743]paid employees, expense account allowances must be
[744]added to their salaries and wages. However, the informa-
[745]tion need not be submitted for any employee for whom
[746]the combined amount is less-than $25,000, or for your-
[747]self if your expense account allowance plus line 21, page
[748]1, is less than $25,000.
[750]Did you claim a deduction for expenses connected with: . . _. ;
[751](1) Entertainment facility (boat, resort, ranch, etc)? .. (Yes [J] No (3) Employees’ families at conventions or meetings? . . (J Yes [] No.
[752]; (2) Living acconimodations (except employees on busitiess)? O Yes (1 No (4) Employee or faniily vacations not reported on Form W-2? <C] Yes 1 No.
[754]* U.S. GOVERNMENT PRINTING OFFICE : 1916~0-218-088
[756]218-055~2 :.
[757]3 *
[759]“SCHEDULED | Capital Gains amd] LOSSe@S (Examples of property to be reported on this
[761](Form 1040) Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not
[762]‘Department of tho Treasury | losses) on personal assets such as a home or jewelry.)
[764]’ re, ‘intarnal Revenue Service p> Attach to Form 1040. © See Instructions for Schedule D (Form 1040).
[766]: *«: Name(s) as shown on Form 1040 Social security number
[767]\P h van tpi e°
[768]CVA MY 32242-1799 i_f
[770]osses—Assets Held Not More Thay 6 Months
[772]site co . : b. Date e Date @. Cost = ath basis, ¢ 4
[773]: “a. Kind of property and descrition : qui “sold dG f] i aS adjus! (seo f. Gain or (loss)
[774](Example, 100 shares of ‘'2Z'? Co.) (Mon day ye) (Mo., day, yt.) mas sass Poe instranee of ani (d less @)
[776]o . |. 2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries . . . « « 27
[777]3 Enter net gain or (loss), combine linesland2 . . . . . . (3.
[778]4 — Short-term capital loss carryover attributable to years begining after 1969 (see instruction ) . {4
[780]at . 5 _Net short-term gain or (loss), combine’ lines 3‘and 4 wo. ee ee
[782]7 Capital gain distributions . . . Loe res ee Ae .
[783]- 8 Enter gain, if applicable, from Form 4797, line 4(a)(1) ‘ee Instruction A) rs ie
[785]9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries . . . . . 9
[787]10 ‘Enter your share of net long-term gain from small business corporations (SubchapterS).. . . _10_
[788]‘21° Net gain or (loss), combine lines 6 through 10 © . . » |
[790]12. Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction 1 . 12
[791]‘13 Net long-term gain or (loss), combine lines 1l.and 12. . 13 |
[792]Ree] Summary of Parts | and Il (/f You Have Capital Loss Carryovers From Years Beginning ng
[794]Complete This Part. See Form 4798, Parts Ill, iV and V.)
[796]len
[798]14 Combine lines 5 and 13, and enter the net gain or (loss) here ©. 2 ee ee te 14
[799]15 If line 14 shows a gain— an ed
[800]a Enter 50% of line 13 or 50% of line 14, whichever is smaller (see P Part Vv for computation of
[801]alternative tax). Enter zero if there is a loss ornoentry online 13 . . . . |15a
[803]b Subtract line 15a from line 14, Enter here and on Form 1040, line30a . , . ww ws [5b
[804]- 16, If line 14 shows a loss—-~" i _
[805]rr a Enter one of the following amounts:
[806]: (i) If line 5 is zero or a net gain, enter 50% of Jine 14;
[807](ii) _ Hf line 13 is zero or a net gain, enter line 14; or,
[808](ii) Vf line 5 and line 13 are net losses, enter amount on line 5 added to 50% of amount on
[809]an " ; tine soe ee _ oo -
[810]“bp Enter here and enter as a (loss) on Form 1040, line '30a, the smallest of:
[811](? $1,000 ($500 tema fied’ d fili te ret n);
[812]{i if married and filing a separate re urn); or, .
[813](iit) Taxable income, as adjusted (see Instruction J). . SEE . VA.
[816]~ n . : é
[817]"+-Schedule D (Form 1040) 1976 - ; . . ” Page 2
[819]FeartlVae [| Computation of Alternative Tax (See Instruction S to See if the Alternative Tax will Benefit You)
[821]17 Enter amount from Form 1040, line47 2. 17) .
[822]. 18, Enter amount from line 15a (or Form 4798, Part Y, line 1)) 18 |
[823]“19 Subtract line 18 from line 17 Cif line 18 exceeds line 17, do not complete | the rest of this s part, The e Alter:
[824]native Tax will not benefit you) 2 6 we 19
[825]Note: If line 18 does not exceed $25, 000 ($12, 500 if married filing separately), omit lines 20 through
[826]23 and enter zero on line'24,
[827]\ .
[828]20 Enter $25,000 ($12,500 if married filing separately) . . . . 20 ___
[829]21 Add fines 19 and 20 2 1 ee ee | BR
[830]_, 22 Taxonamountonlinel7® 2 6 6 22 __
[831]: 23 Tax on amount on line 21*. 6 | 6 ee 23
[832]' 24 Subtract line 23 from line 22. . . . . . ee ee ee ee | 2
[833]’ 25 Taxon amount online 19%. 6. 25
[834]26 Enter 50% of line 18 but not more than $12,500 ($6,250 if married filing separately) . . . . 26 | : :
[836]. . 27 Alternative Tax—add lines 24, 25, and 26. If smaller than the tax figured on the. amount on Form 1040,
[837]tine 47, enter this alternative tax on Form, 1040, line 16. Also check the Schedule D box on Form 1040,
[838]line 16 ee ee we eee 27
[840]pa a ee oe
[842]/ > */f the amount.on which the tax is to be computed is $20,000 or less use the Tax Table; if more than $20,000 use Tax Rate Schedule X, Y, or 2.
[844]eT
[846]| Note: Enter your capital loss carryovers from 1976 to 1977: " \____Pre-1970
[848]Short-term (from Form 4798, Part Il or Part V) .
[850]Long-term (from Form 4798, Part Ii or Part V) .
[854]ORs ’ _ . ‘Sy US. GOVERNMENT PRINTING OFFICE : 1976—O-218-086 218-056-1
[856]Docid:32245535_Page.12..- -
[859]SCHEDULE SE
[860](Form 1040)
[862]“. + Department of the Treasury
[863]* Internal Revenue Service
[865]Computation of Social Security Self-Employment Tax:
[867]f> Each self-employed person must file a Schedule SE. ff Attach to Form 1040.
[868]> See Instructions for Schedule SE (Form 1040).
[870]. © If you had wages, including tips, of $15,300 or more that were subject to social security or railroad retirement taxes, do not fill in
[872]this schedule (unless you are eligible for the Earned Income Credit). See Instructions.
[873]; . © If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.
[875]Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.
[876]NAME OF SELF-EMPLOYED PERSON (AS_SHOWN ON SOCIAL SECURITY CARD)
[877]Sam Rw B
[879]* Business activities subject to self-employment ta (grocery store, restaurant, farm, etc.) >
[881]© If you have only farm income complete Parts | and Ill, © If you have only nonfarm income complete Parts Il and III.
[882]© If you have both farm and nonfarm income complete Parts |, II, and III. :
[884]- ERIE] Computation of Net Earnings from FARM Self-Employment
[886]Social security number of
[888]self-employed person p>» 22 an ? 4 q
[890]5
[892]You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line
[893]2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600.. However, lines 1 and
[895]2 must be completed even if you elect to use the FARM OPTIONAL METHOD.
[897]\ REGULAR METHOD a Schedule F, line 54 (cash method), or line 72 (accrual method) _la_
[898]1 Net profit or (loss) from: b Farm partnerships . Lo _ib_
[899]2 Net earnings from farm self-employment (add lines laandb). . . . 2 [2
[901]3 If gross profits a Not more than $2,400, enter two-thirds of the gross 5 profits .
[902]from farming * are: b More than $2,400 and the net farm profit is less than $1,600, Enter $1,600
[903]1Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 70 (accrual
[905]method), ‘plus the’ distributive share of gross profits from farm partnerships (Schedule K—1 (Form 1065), line 14)
[906]as explained in instructions for Schedule SE.
[908]4 Enter here and on line 12a, the amount on line 2, or line 3 if you elect the farm optional method .
[910]lelaul....) Computation of Net Earnings from NONFARM Seif-Employment
[912]FARM OPTIONAL METHOD |
[914]a ‘Schedule C, line 21. (Enter combined amount if more than one business.)
[916]Tan ese
[918]1978
[920]. b Partnerships, joint ventures, etc. (other than farming) . . _b_ —_
[921]a, c Service as a minister, member of a religious order, ora Christian Science ‘
[922]REGULAR METHOD | - © practitioner. (include rental value of parsonage or rental allowance fur-
[923]5 Net profit or . nished.) If you filed’ Form 4361, check here > C] and enter. zero on this
[924](loss) from:. - ‘fine . Soke ek Lo. Lone Lo... [Se
[925]d Service with a ‘foreign government or international organization : _5d_
[926](See Form 1040 “in- 5e
[928]@ Other’ structions for line 36.) SPECIFY Be ieee eee eeeeeee ce cceeeneec ene eneeenees peo:
[929](6 Total (add lines 5a through e) .
[930]7 Enter adjustments if any (attach statement)
[932]8 Adjusted net earnings or (loss) from nonfarm self- “employment (line 6, as adjusted by line 2.
[934]- H line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit dines 9
[936]through 11.and enter amount from line 8 on line 12b, Part III,
[938]Note: You may use the nonfarm optional method (line 9 through line 1D only if line 8 is tess than $1,600 and less
[939]than two-thirds of your grass nonfarm profits,= and you had actual net earnings from self-employment of
[940]$400 or more for at least 2 of the 3 following years: 1973, 1974, and 1975, The nonfarm optional method
[941]can only be used for 5 taxable years.
[943]NONFARM OPTIONAL METHOD
[945]9 a Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
[946]b Enter amount from line 3. (lf you did not elect to use the farm optional method, enter zero) .
[947]c Balance (subtract line 9b from line 9a) soe .
[949]10 Enter two-thirds of gross nonfarm profits * or $l, 600, whichever j is smaller .
[951]11 Enter here and on line 12b, the amount on line 9c or line 10, whichever is smalier .
[952]? Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the ‘distribu-
[953]tive share of gross profits from nonfarm partnerships (Schedule K—-1 (Form 1065), line 14) as explained in instruc-
[954]fions for Schedule SE. Also, include gross profits from services reported on line Sc, d, and e, as adjusted
[955]y fine
[957]Computation of Social Security Self-Employment Tax
[959]12 Net earnings or (loss): a From farming (from line 4) .
[960]b From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) .
[961]13 Tota! net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400,
[962]you are not subject to self-employment tax. Do not fill in rest of schedule.) . :
[963]14 The largest-amount of combined wages and self-employment earnings subject to social security or
[964]railroad retirement taxes for 1976 is . see ee
[965]15 a Total “FICA” wages and “RRTA” compensation wee ;
[966]b Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA .
[967]‘ ce Total of lines 15a andb .
[968]. 16 Balance (subtract line 15c from line 14). :
[969]17 Self-employment income—line 13 or 16, whichever is smaller .
[971]18 Self-employment tax. (If line 17 is $15,300.00, enter $1,208.70; if less, multioy the amount on line
[972]17 by 079.) Enter here and on Form 1040, line 58 . woe : wos
[977]-NW.88326 Docld:32245535 Page 13.
[985]Zz Zz
[987].
[989]218-060-1
[991](13 | 3SUh |
[992]00
[995].
[997]Capital Loss Carryover
[998](Computations of Capital Loss Carryovers and Summary of Capital
[999]Gains and Losses if Pre-1970 Capital Losses are Carried to 1976.)
[1001]Social ny Number
[1003]B Attach to Form 1040.
[1005]'*- Note: Complete Only =: 1 oH This Form to Cc pute Your Capital Loss Carryover if Your 1975 Schedule D Form 1040), lines
[1006]a : 4(a) and 12(a), DO NOT SHOW A LOSS.
[1008]7 Post-1969 Capital Loss Carryovers to 1976 (Complete this part if the amount on your 1975 Schedule D
[1009]Pd (Form 1040), line 16(a), is larger than the loss deducted on your 1975 Form 1040, tine 29a.)
[1012]. Department of the Treasury
[1013]Internal Revenua Service
[1015]. Name(s) as shown on eS —s
[1017]Section A.—Short-term Capital Loss Carryover
[1019]Enter loss shown on your 1975 Schedule D (Form 1040), line 5; if none, enter zero and ‘grove |
[1021]1
[1022]Le lines 2 through 6—then goto lne7 .. . . _i __
[1023]— 2 Enter gain shown on your 1975 Schedule D (Form 1040), line 13, i that line is ‘blank or shows
[1024]_aloss, entera zero... . Ce ee ee eg HB _
[1025]3 Reduce any loss on line 1 to the extent of any gain on line Pr a _
[1026]4 Enter amount shown on your 1975 Form 1040, line 29a. . 2 1... ee ee le 4 _
[1027]5 Enter smaller ofline30r4. 2. 1 1. 1 we, we ee ee ne tk ee _5_ _——_
[1028]6 Excess of amount on line 3 over amount on line 5 2. . ge 6 |
[1029]7 Note: The amount on line 6 is your short-term capital loss carryover from 1975 to 1976 that is attributable to years beginning
[1030]: after 1969. Enter this amount on-your 1976 Schedule D (Form 1040), line. 4. .
[1031]Section B.—Long-term Capital Loss Carryover
[1032]7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1975 Form 1040, line 292) . |__7 _ _
[1033]8 Enter loss from your 1975 Schedule D (Form 1040), line 13; if none, enter zero and ignore lines
[1034]Q9through 12. . , . . {8 __
[1035]-9 Enter gain shown on your 1975 Schedule D (Form 1040), line 5. If that line is blank or ‘shows .
[1036]“a loss, enter a zero re Bee ee _9 —_—
[1037]10 Reduce any loss on line 8 to the extent of any gain on line 9 Coe ee ee ee _10_ _
[1038]‘, 11 Multiply amount online 7by2..°.~«« er _—
[1039]' 12 Excess of amount on line 10 over amount on line m woh oa , rn 12
[1041]Note; The- amount on line 12 is your long-term capital loss carryover trom 1975 to ‘1976 that. is attributable to years beginning “
[1042]after 1969. Enter this amount on your 1976 Schedule D (Form 1040), line 12. .
[1044]AP artiligh Post-1969 Capital Loss Carryovers from 1976 to 1977 (Complete this part if the amount on your 1976 -
[1046]pe arie Schedule D (Form 1040), line 16a, is larger than the loss deducted on your 1976 Form 1040, line 30a.)
[1050]Section A. —Short- term Capital Loss Carryover
[1052]1 Enter loss shown on your 1976 Schedule D (Form 1040), line 5; if nane, enter zero and ignore lines
[1054]2 through 6—then gotoline7. . . . Fa Sa
[1055]2 Enter gain shown on your 1976 Schedule D (Form 1040), i line ‘1a! If that line is blank or shows a : 7
[1057]loss, entera zero. . . Bee te ee ee eee LB
[1059]Reduce any loss on Jine 1 to the extent of any gain on line a
[1061]Enter amount shown on your 1976 Form 1040, line 30a... ww ww ee ee LA
[1063]Enter smaller.ofline30r4 ... 0. 5. Ce ee ee ee BY
[1065]Excess of amount on line 3 over amount on line 5 rr , : 6
[1067]Note: The amount on line 6 is your short-term capital loss carryover from 1976 - to 1977 ¢ that is attributable to years | beginning ;
[1068]after 1969. Enter this amount in the space Provided on page 2 of your 1976 Schedule D (Form 1040). .
[1070]uv. Section B.—Long-term Capital Loss Carryover
[1072]Line 4 less line 5 (Note: If you ignored lines 2 through-6, enter amount from your 1976 Form 1040, line 30a)
[1073]Enter loss:from your 1976 Schedule D (Farm 1040), line 13; if none, enter zero and ignore lines
[1074]9 through’ 12 .
[1076]9 Enter gain ‘shown on your 1976 Schedule D (Form 1040), 1 dine 5. if that line is blank or shows @
[1077]a loss, enter’ a,zero . . .
[1078]‘| 40 Reduce aay loss on line 8 to the extent of any gain on line 9.
[1079]‘11° Multiply amount on line 7 by 2 . toe
[1080]"12 Excess of amount on line 10 over amount on line 11
[1082]; ” Note: The amount on line 12 is your long-term capital loss carryover + from 1976 to 1977 1 that is attributable to years beginning
[1083]after 1969. Enter this amount in the space provided on page 2 2 of your 1976 Schedule D (Form 1040).
[1085]Form 4798 (1976) ©
[1087]NW’88326 Docld:32245535 Page 14_
[1090]2
[1092]Form 4798 (1976)
[1094]Page 2
[1096]Do Not Complete the Rest of This Form if You Do Not Have a
[1098]Instructions oo
[1100]A. Who Should File.— : :
[1102]If your 1975 Schedule, D (Form. 1040), lines 4(a) and 12(a)
[1103]show a loss: (1) use Part’ dil, below, to determine your capital loss
[1104]carryover .to 1976; (2) coniplete your 1976 Schedule D (Form 1040),
[1105]lines 1 through 13 to report:capital gains and losses for the current year
[1106]and any post-1969 capitaltoss carryovers; and (3) complete Part IV
[1107]to figure your net capital gain, or (loss) for 1976 and the capital loss
[1108]limitation if necessary. Use , Part V to figure capital loss carryover from
[1109]1976 to 1977 for pre-1970 lossés or a combination of pre-1970 and post-
[1110]1969 losses.
[1112]B. Part.V, Line 19 or 33.—If there is a gain and a loss on the lines
[1113]mentioned in the instructions for Part IV, fine 19 or 33, enter the gain
[1114]reduced by the amount of the loss. If the loss exceeds the gain enter
[1115]a zero. If there is a gain and no loss, just enter the gain.
[1117]Pre-1970 Capital Loss Carryover to 1976 (See Instruction A).
[1119]t
[1121]C. Part IV, Line 22 or 36.—-{f there is a loss and a gain on the lines
[1122]mentioned in the instructions for Part IV, line 22 or 36, enter the loss
[1123]reduced by the amount of the gain. If the gain exceeds the loss enter
[1124]a zero. If there is a loss and no gain, just enter the loss. ~
[1126]D. Married Taxpayers Filing Separate Returns.—If you are married
[1127]and filing a separate return the limitation for Part iV, lines 9(b)(li)
[1128]and 27(b) is $500, increased by amounts attributable to pre-1970 short-
[1129]term capital loss components, but the combined total may not exceed
[1130]$1,000. If there is a loss in Part IV, line 2, complete Part IV, Section
[1131]E. If there is a loss in Part WV, line 5, complete Part IV, Section D,
[1132]lines 14 through 22 (assuming all the lines in Section D were not other:
[1134].wise required to be completed) ignoring the note under line 14.
[1136]E. Additional information—For information about capital assets,
[1137]investment interest expense deduction adjustment, aiternative tax, ete.,
[1138]see the Instructions for Schedule D (Form 1040).
[1140]Pre-1970 and Post-1969 Capital Loss Carryovers to 1976
[1141]Sem] 1975 Schedule D (Form 1040), line 16(a) or line 33,
[1143]Form 1040, line 29a.)
[1145]1 Enter loss shown on your 1975 Schedule D (Form 1040), iine i if none, enter zero and ignore
[1147]lines 2 through 20—then go to line 21 .
[1149]2 Enter gain shown on your 1975 Schedule D (Form 1040), line 3. If F that line is is blank or shows a loss enter a zero .
[1151]3 Reduce loss on line 1 to the extent of any gain on line 2.
[1153]Note: /f line 4(a) on your 1975 Schedule D (Form 1040) is blank, IGNORE lines. 4 through LL, enter
[1155]a zero on line 12—then go to line 13.
[1157]4 Combine lines 3 and 11 on your 1975 Schedule D (Form 1040).
[1159]Enter: the gain; if zero or a ‘loss, enter a zero.
[1161]Note: If line 4 is zero IGNORE lines 5 through i, enter on line. 13
[1162], the loss from your 1975 Schedule D (Form 1040), line 4(a)—
[1163]“then go to line 13.
[1165]$5, Enter any gain from your 1975 Schedule D (Form 1040), line3. .
[1167]‘6 Enter smaller of line 4or5.
[1168]7 Enter excess of gain on line 4 over line € 6
[1170]’ 8 Enter-loss from your 1975 Schedule ie) > (Form 1040), line 12(a):
[1172]otherwise, enter a zero... soe
[1173]9 Reduce any gain on line 7 to the extent of any loss on n line 8
[1174]10 Enter loss from your 1975, Schedule D (Form 1040), line 4(a); other-
[1175]wise enter.a zero. . . See ee NN
[1176]11 Add the gains on lines 6 and 9.
[1177]12 Reduce the loss on line 10 to the extent of any gain on n line ll.
[1179]‘13 Pre-1970 short-term capital loss (Enter smaller of line 3 or 12).
[1180]"14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over ‘tine 1:
[1182]15 Enter : ‘any loss from line 13, above .oG
[1183]16 Enter loss deducted on your 1975 Form 1040, jline 29a. oe
[1185]17 Pre-1970 short-term loss carrygver to 1976 (excess of line 15 over line 16—if line 15 does not
[1187]exceed line 16, enter zero). Enter here and in Part NV, ine 2.
[1189]18 Enter any loss from line 14, above
[1191]19 Enter excess of line 16 over line 15—if line 16 dots n not exceed line
[1192]15, enter zero .
[1194]20 Post-1969 short-term loss carryover to 1976 (excess of line 18 over line 19—if line 18 does not
[1195]exceed line 19, enter zero). Enter here and on your 1976 Schedule D (Form 1040), line 4
[1199]if you. were required to complete Part IV of your'1975 Schedule D
[1201](Form 1040), enter any*loss from your 1975 Schedule D (Form
[1203]1040), line 30; otherwise, enter %ero.. «
[1205]22 Enter excess of line-19 over line 18—if line 19 does not exceed line
[1206]18, enter zero. (Note: If you, ignored lines 2 through 20 above, enter
[1208]amount from your 1975 Form 1040, line 29a). .
[1210]23 Pre-1970 long-term loss carryover to 1976 (excess of line a1 over line 22—if line 21 does not
[1212]exceed line 22, enter zero). Enter here and in Part IV, line 5
[1214]24 If you wete required to complete Part IV of your 1975 Schedule D
[1216](Form 1040), enter any loss from your 1975 Schedule D (Form
[1217]1040), tine 31. However, if Part IV was not required, enter any loss
[1218]from your 1975 Schedule D (Form 1040), line 13. ~«
[1220]Enter excess of line 22 over line 21 ..
[1222]25 Enter excess of line 22 over line 21 .........!
[1223]does not.exceed line 21, enter zero.) ’.
[1225]a
[1227]26 Post-1969 long-term loss carryover to 1976 (excess | of line 24 over line 25—if line 24 does not
[1228]exceed line 25, enter zero). Enter here and on your 1976 Schedule D (Form 1040), line 12
[1230]w'W.88326 Docld:32245535 Page 15 _.
[1232]x 2 at line 22
[1234](Complete this part if-the amount on your
[1235]is larger than the loss deducted on your 1975
[1237]4/5105) _
[1239]ee GOO
[1241]—S_
[1243]7
[1245]9
[1246]10
[1249]15
[1250]16
[1252]So
[1254]a] &2I7)
[1255]22 A
[1257]2 | SEZF |
[1258]25 | o-,
[1261]Bory
[1262]and Losses
[1264]- te
[1266]Section A.—Short:term Capital Gains’
[1268]Amount from (1976. Schedule D (Form 1040),
[1269]Amount from Part Ill, tine 17. yee,
[1270]; Net short-term gain or (joss), combine ines 1 and 2.
[1272]ine 5,
[1274]Section B.—Long:term Capital Gains and Losses
[1276]| 1976 Schedule D (Form 1040), line 13.
[1277]. Artount from ‘Part Ml, tine 23. rn
[1278]‘6 Net long-term gain or (loss), combine lines 4 and 5
[1282]Section C.—Summary of Sections A and B
[1284]‘ .
[1286]“Combine tines 3 and 6 and enter the net ain or (loss) here.
[1288]8 If line 7 shows a gain—
[1290](a) Enter 50% ‘of line 6 or 50%
[1291]a
[1293]of line 7, whichever is smaller (see Schedule D
[1294]rnative tax), Enter zero if ther
[1295]jline 8(a) from tine 7. Enter h
[1297](Form 1040), Part
[1298]@ is a loss or no entry on line 6
[1299]€re and on Form 1040, line 30a
[1302]a) Enter one of the following amounts:
[1303]43,1) + tf line 3 is zerd oF a net gain, enter 50% of line 7;
[1304](ii) If line 6 is zero-or a net gain, enter amount from line
[1305](iii) If tine-3 and line 6 are net losses, enter amount
[1306]“on-line 6 2. Cr or Por,
[1307]“(b) Enter‘hére ‘and enter as a (loss) on Form 1040, line 30a; the smallest of:
[1308]-(i) The amount on line. 9(a); : . : tet .
[1309]hi) $1,000 (married taxpayers filing separate returns see Instruction D); or
[1310](iii) Taxable income, as adjusted (see Instruction J in ‘Instructions for Schedule D (Form
[1312]nd 6, omit lines 9(a) and (b) and go’ to Section D.
[1314]7; or
[1315]on line 3iadded to 50%
[1317]of amount
[1319]1040)). |,
[1321]9(a)
[1323]i)
[1325]o Section D.—Capital Loss Limitation—Where Losses Are Shown on Both Lines 5 AN
[1327]0 ‘Enter loss from line 3; if line 3 is zero ora
[1329]F loss from,tine 6
[1331]gain, enter a zero.
[1333]m if line 3 is zero or a Joss, enter a zero Loe
[1334]rf line! 11 to the extent of the gain, if any, on tine 12 .
[1336]biné amounts on 1976 Schedule D (Form 104 ih
[1337]‘if gain, enter gain, if zero or a loss, enter a zer at
[1339]0), lines 3 and
[1341]0 Lot 14
[1342]Note: if the entry on line 14 is zero, OMIT lines 15 through 21 and ia
[1343]i’. . enter on line 22 ihe loss shown on line 5. . , Bs
[1344]15,Enter gain,-if any; from 1976 Schedule D (Form 1040), line 11 15
[1345]Enter smailer. of amount on line 14 or line 15... , 16
[1346]; Enteréxcess of gain-on line 14 over amount on line 16 17
[1347]8 Enter loss from ‘tine.2: if line 2 is blank, enter a zero 18
[1349]on line 17 to the extent of loss, if. any, on line 18 {se
[1351]. 19
[1352]es... 20
[1353]1 Add the gain(s) dn line(s) 16 and 19: 21
[1355]‘on line 21 (see Instructio
[1357]24‘ Subtract amount on jine 23 from the loss on line 13.
[1359]25 ‘Enter 50% of the amount on line 24
[1361]26 “Add lines 10, 23, and 25 |
[1363]27. Ent
[1365]“here-and enter‘as'a (loss) on Form.1040;
[1366]‘Amount.on line 26;". ‘
[1368]$1,000 (Married t
[1369]¢) Taxable income, 2
[1371]line 30a, the smallest of: .
[1374]ax
[1376]Payers filing separate returns see Instruction D): or ‘
[1377]S adjusted (see Instruction J in Instructions for Schedu
[1379](Form 1040)) .
[1382]: MEDICAL.
[1384]ce
[1386]CALENDAR YEAR __ feo
[1388]SOC. SEC. NO. 322-12 7944
[1390]DEDUCTION SCHEDULE
[1392]FEDERAL
[1394]ZINCOME TAX PREPARATION _ |
[1396][State | FEDERAL CONTRIBUTIONS —¢ | —SSTATE
[1397]2 MEDICINE/DRUGS’_. | t...._ | [2tacasncontaisutions \J S| |
[1398]SLESSI% AGI (Line 18-104) | | | dE 2 tb PARTNERSHIP SHARE Ye ee)
[1399]““QNET MED/DRUGS {|_| [| Gaveoyscours RT
[1400]5H & A INS. (4 + EXCESS) |_| ¥Os. | [| veartrunoicancenruno{\ || FO
[1401]fa DR. | [TY] eocrossjunitenruno ff TT
[1402]OR. NL xwasvenstensears = 7 TT
[1403]DR. NE isc orcanizep cuaritiesf TT
[1404]“oR. | LD rotiticacconrarutions Jo TT
[1405]val DR. Jf. OTT crurcues
[1406]DR. | [fT pe
[1407]‘OR. SN es NY (OO GO
[1408]DR. ES RN NN NS ORNs (SN SU SS
[1409]an Y.-C otner tHancash TCO
[1410]Gb HOSPITAL Y. |... |__[24toratcontrsutions bE go | PO
[1411]PROSTHETIC APPLIANCES | [CASUALTY OR THEFT (LOSS(ES)
[1412]HEARING AID: |} “J toss meron asin
[1413]Gt AMBULANCE NS A £2 OO
[1414]“LABORATORIES TOSCO SSB isto Limitation rercas.) | |
[1415]TRAVELFORMED./ OED || dL SOL, [29 ror. cas. on tHertioss LS
[1416]: CUT CT MISCELLANEOUS DEDUCTIONS _ a _
[1417]~ MEDICARE INS. FMT TC 8D atimony
[1418]GLASSES TCM CC [3 unionsproressionat pues _|
[1419][3ZINCOME TAX PREPARATION _|
[1421]7 MEDICAL EXPENSES
[1422]LESS REIMBURSED BY INS.
[1424]8 LESS 3% ADJ. GROSS INC.
[1426]I+:% (TO $150) OF H & A INS.
[1427]40 TOTAL MEDICAL DED.
[1429]—ILSTATE & LOCAL INCOME .
[1430]“AZREALESTATE
[1432]13 STATE & LOCAL GASOLINE
[1434]14 GENERAL SALES TAX
[1436]18a PERSONAL PROPERTY
[1437]' {5b PERSONAL PROPERTY AUTO
[1438]~ 16 SALES TAX AUTO .
[1440]: 17 TOTAL TAXES
[1441]- INTEREST (TO WHOM PAID
[1442]18 MORTGAGE
[1444]co
[1446]49 INSTALLMENT
[1448]re
[1450]LOANS
[1452]we
[1454]90 TOTAL INTEREST ~:
[1456]' N88826.Bioeld:32245536~Rage.t t=
[1458]is
[1460]Ne
[1462]i (erie DEDUCTIBLE MEDICAL & DENTAL |
[1463]EXPENSES (FROM LINE
[1465]5 TOTAL TAXES (From Line 17)
[1466]6G TOTAL INTEREST (Line 20)
[1467]7 TOTAL CONTR. (Line 24)
[1469]138 CAS. & THEFT LOSS{ES) (Line 29
[1471]TOTAL MISCELLANEOUS
[1472]DEDUCTIONS (FROM LINE 33)
[1474]a
[1475]X
[1476]a
[1478]Ser
[1480]ls
[1481]id
[1482]| rs
[1483]ee LL] enironmsrprores. cuotuiné |_| |
[1484]tsa Toots ano surruies [| f=
[1485]PSF 7 taonory anocueannc | |.
[1486]TSO auto useioawince df
[1487]eT LLY PL _ | _nvest couse aruasisaeal |
[1488]| _ewpLovirent acency fees |_|
[1490][Tet Rea. eusiness fs
[1491]a SS
[1493]a NS
[1495]a
[1496]To arora is 0: a
[1497][|__| | feqanrany oF WeMzen oO ae]
[1498]ae 7
[1500]et)
[1501]8
[1505]ae)
[1507].
[1509]TOTAL ITEMIZED DEDUCTIONS T
[1510]ENTER ON FORM 1040 LINE 44
[1512]EMARKS
[1514]v
[1516]A
[1518]ay
[1519]a
[1523]D
[1525]PTT
[1526]TE:
[1527]3 YT | By
[1529]IIL
[1530]g
[1532]Kad
[1535]Q
[1536]3
[1538]o
[1541]F .
[1544]1.0. NO. . , CALENDAR YEAR 19 Th.
[1546]Soc. SEC. NO; deed 22 -I2.>F49Q
[1548]roe 34g
[1550]FISCAL YEAR ENDING _.
[1552]SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION
[1553]"PRINCIPAL BUSINESS ACTIVITY j j j
[1554]BUSINESS NAME . ; EMPLOYERS NO.
[1556]Se
[1558]|BUSINESS ADDRESS ‘ -
[1559]“TOTAL RECEIPTS
[1561]f TNVENTORY AT BEGINNING OF YEAR
[1562]“MERCHANDISE PURCHASED
[1563]LABOR '. :
[1565]TOTAL; a
[1566]“INVENTORY AT END OF YEAR
[1568]Vo" GROSS PROFIT:
[1570]“GROSS INCOME
[1575]an “ ce OTHER BUSINESS DEDUCTIONS
[1577]“AUTO AND TRUCK EXPENSE
[1579]BAD DEBTS
[1581]“ CASH SHORT . >
[1582]V1". COMMISS LONS
[1585]~ DEPRECIATION’ ( SCHEDULE ATTACHED }
[1586]DUES AND SUBSCRIPTIONS “wae
[1588]‘ENTERTAINMENT AND PROMOTIONAL
[1589]INSURANCE
[1591]. “INTEREST
[1593]pe JANITOR SERVICE
[1595]. LAUNDRY
[1596]**LEGAL AND ACCOUNTING
[1598]MAINTENANCE
[1602]OFFICE SUPPLIES: AND EXPENSE
[1604]. RENT
[1609]ror - SALARIES AND WAGES
[1611]SALARIES OFFICERS
[1613]ol, SUPPLIES +, ; ;
[1614]a a
[1616]a “TAXES AND LICENSES
[1618]1
[1620]TAXES - PAYROLL
[1622]“TELEPHONE
[1624]Y TRAVEL
[1626]‘ye CUTILITEES
[1629]4 : 3
[1631](NET, PROFIT:-OR( LOSS ) - FEDERAL RETURN
[1633]“NET PROFIT OR LOSS ) + STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF. )
[1635]Pye ’
[1637]| : sy .
[1638]“ PROFESSIONAL STATIONERS INC. FORM 104 .
[1639]wit LOS ANGELES, CALIF. SCHEDULE
[1641]"NW B8426 Docld:32245535 Page 18.
[1644]sd : 1.D._NO.. CALENDAR YEAR 19 LZke
[1646]| _ oR 0b 2242 IY Deis
[1648]‘ ADDRESS : . 2: soc. SEC. N DP FISCAL YEAR ENDING ;
[1649]: . 19
[1651]“ SCHEDULE .OF DEPRECIATION / AMORTIZATION
[1653]° SPEC 20% P RATE(®) | DEPRECIATION
[1654]KIND OF PROPERTY “pep } OR LIFE _ FOR
[1655]fF (YRS) THIS YEAR
[1658]m 7
[1660]2
[1661]m
[1662]5:
[1664]o
[1665]re
[1666]m
[1667]o
[1668]mn
[1669]72
[1672]ce
[1674]a
[1675]m
[1676]a
[1678]PoE | | |
[1679]le feria | pj dt tet Ort bint |.
[1681]i i
[1682]roo MWIeL nn re Ft
[1683]pF) TT UT TT | {| ot =
[1685]rt [ry Tt [yt ta wt pt Tt ft
[1688]. r { tyr Tt Ty tt Tt yp ey
[1689]- rt yt [yy tt tt yy fl |
[1690]Ce Oe ee Oe ee |
[1691]enn TEI : H Hl ‘ | i i
[1692]— SS es es Os Oe ee ee ||
[1694]| en yt] Tt | |
[1695]: ; | PF Tt Tt |
[1696]: i i ! i
[1699]en |
[1701]| tt
[1702]iW'88326 Bocld:32245535 Page 19
[1704]| ai
[1705]'
[1707]TOTALS i
[1708]i )
[1709]; . : Add 20% Additional Depreciation on Items Purchased THIS Year. [. |
[1710]ae oe oo, ~~ TOTAL DEPRECIATION Tuls YEAR | 7O4 |
[1711]PROFESS 1OWAL STATIONERS INC. hos. ANGELES 2 CALIF. FORM no torn Lo ee _ a = i - a 7 oo scneouce : an a ~ . = Ss
[1713]Re a a
[1716]19
[1718]vite 4 3 ku B Fai 47 “Calendar Ye
[1720]SOC. SEC, NO. 322 E/Y/E
[1722]GAINS ON INSTALLMENT SALES
[1724]Et oP _
[1725]‘a DATE solo Gf x7 a
[1727]CAPITAL “SEC. “eas
[1729]“NOTES oT YR
[1731]MORTGAGE TRANSFERRED
[1733]PRIOR TO 1—1-62
[1734]_ PRIOR’ TOA 1-64". -
[1736]EXCESS OVER S/L 1—64/12—-69
[1738], EXCESS OVER S/L AFTER 12-31-69
[1739]M4 ADJUSTED BASIS (6-7 THRU 13)
[1741]"45." EXPENSES OF SALE’
[1743]16. TOTAL ADJUSTED BASIS (14 + 15)
[1744]7.-TOTAL GROSS PROFIT (5 — 16)
[1746]8. TOTAL GROSS.PROFIT — ORDINARY
[1747]AQ. TOTAL GROSS: ‘PROFIT — OTHER
[1749]20. CONTRACT, PRICE. (b4+24+ 4)
[1751]“CASH (1)
[1752]+, PRINCIPAL’ COLLECTIONS
[1753]“EXCESS MORTGAGE.OVER BASIS
[1754]“OTHER (4) =:
[1756]““TOTAL: PAYMENTS (23 THRU 26)
[1757]‘RECOGNIZED GAIN Be RO eae eo a
[1759]29::, RECOGNIZED’ GAIN ~ ORDINARY 23/3 |
[1760]20. ‘RECOGNIZED GAIN — OTHER i 106) 2)
[1761]: ORDINARY INCOME - :
[1762]“TaKe "TOTAL LESS INT. SECTION 1245 _ 3ECTION 1250 CAPITAL GAIN
[1764]* (TO PT. 2
[1765]Ae PAYMENTS) | [[0.PT: 2-1 REPORTED BALANCE REPORTED BALANCE REPORTED |: . BALANCE
[1767]‘| 26 = ae Tie ; . | an
[1769]SO DSEIRLIUSASHSS “PraerDTy CAI ome SCHEDULE
[1772]INDIVIDUAL
[1774]CALIFORNIA
[1776]INCOME TAX
[1778]PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) "| Sheek Ag Calendar Year
[1779]. Enter social security number(s) only” if incorrect or not shown on label, One: Oo Fiscal Year Ending—______1977
[1781]"FOR "PRIVACY NOTIFICATION
[1782]SEE PAGE 2 OF INSTRUCTIONS
[1784]Your Social Security Number,
[1786]Spoyse’s Social Security Number A
[1788]; | f AYR ke
[1789]occu. | Yours
[1790]PATION Spouse's
[1792]6 Personal j If line Lo or 3 ‘checked, enter $25 t
[1793]If line 2, 4 or 5 checked, enter $50 §
[1794]1 7 Dependents —
[1796]Do not list the person who qualifies you as head of household
[1797][ae | home
[1799]CHorer s
[1801]4 © Head of Household—Enter name of qualifying
[1802]. individual
[1804]ik o Widowler) with dependent child (Year spouse died 197_.}
[1806]#8 Blind (see instructions) Number of blind exemptions —_______. X $8
[1807]19 Total exemption credits (add lines 6, 7 and 8) Enter here and on v line 20 f
[1808]"10 Wages, salaries, tips and other employee compensation attach copy 2 of for ms) W.2 to face of fis}
[1810]11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
[1811]12. Interest. Enter total (if over $400, complete and attach Schedule B(540) )
[1813]13 Income other than wages, dividends and interest (from line 48)
[1815]14 Total (add lines 10, 11, 12 and 13)
[1817]15 Adjustments to income (from line 55)
[1819]16 Adjusted gross income {subtract line 15 from line 1)
[1821]i
[1822]thong aaah LT SERRE Sa Ve a at
[1824]© ff you do NOT ‘itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on’ line 19.
[1825]© If you itemize deductions OR tine 16 is $15,000 or more, complete lines 17 and 18.
[1827]w “Deductions: . Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked)
[1828]“18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on line 19
[1830]<d ATTACH COPY 2 OF FORM W-2 HERE D>
[1832]“19 Tax from (check one) a Tax Table ax Rate Schedule C] Income Averaging Schedule (G or G-l) .
[1833]20 Total exemption credits (from line 9, above) .
[1835]21° Tax liability (subtract line 20. from line 19—if line 20 is greater ‘than line 19, enter ser)
[1837]22 Other credits (from line 68—\ncluding Special! Low Income Tax Credit) . .
[1839]23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter 2210) rn
[1840]“o4- Other taxes (from line 71). 0 ee Se ae
[1842]25 Total tax liability (add lines 23 and 24) . Fe
[1843]96 Total California income tax withheld (attach W-2 or W-2P to face of this return) . . . . . B26 1.
[1844]27 Renter's credit—if you lived in rented property on March 1, 1976, complete Part.1 on page 2 ...0927
[1845]28 1976 California estimated tax payments © 2 2 1 6 ee ee ee es . ) 28
[1846]29 Excess California SDI tax withheld (see instructions). 6 ef ee ee ee ee ee OY
[1847]30 TotalCredits.:......... See ke
[1848]31 If fine 25 is farger than line 30, enter BALANCE DUE. If it is equal to-line 30; enter zero. oda lao~ |
[1849]. Mail return to: : FRANCHISE TAX BOARD : PAY IN FULL — 31 | ao OG
[1850]. SACRAMENTO, CA 95867 . Do not write in p these spaces
[1851]32 If line 25 is smaller than line 30, enter amount OVERPAID rr 174 om P
[1852]-33 Amount of line 32 to be REFUNDED 10 You: anna at least six weeks. :
[1854]Mail return to: NCHISE TAX BOARD -_ [7 33
[1855]: a BOX 13-540.
[1856]SACRAMENTO, CA 95813
[1858]34 Amount of line ‘32 to be credited on your 1977 ESTIMATED TAX . i:
[1860]a you do NOT want State income tax forms and instructions mailed to you next year, check here Cc] Seé Instructions, Page 9°
[1862]o “Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to sbéSt of my knowledge
[1863]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.
[1865]Write net eye check or money order. ATTACH HERE >
[1867]. . ann
[1868]SIGN ere signature ~ Date . . > iaaers sipnature (other, than saxpay a Date
[1870]HERE Roernsamaanae Page? return Date - Address’ (and Zip wae"
[1875]Paye 2 Form 540 (1976)
[1877]O Yes “yilo If no, you may not claim this credit
[1878]OD Yés No If yes, you may not claim this credit
[1879]O Yes ONo™ If yes, you may not claim this credit
[1881]a 38 Did you or your spouse claim the homeowners’ property ‘tax exemation or receive public assistance? O Yes GNo_ If yes, see page 3 of instructions
[1883]PART Il - Other Income
[1885]39 Business income (or. loss) (attach Schedule C(540)) . . De ee Cee
[1886]. 40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule D540). 2 ee SC ee
[1887]At Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-. 1(540))
[1889]42.Pensions and annuities . . Se eee ee ee ee
[1890]43 Rents and royalties .... cuenuie Le bo
[1892]; an SCHEDULE E
[1893]44 Partnerships ©. 2... Foam (640) [tcc pets
[1894]| 45 Estates and trusts’... . Co 0 | 45
[1895]:46-Farm income (or loss) (attach Schedule F(540)). 2. 2 ee ee ee see Se eee ee O
[1897]47 Miscellaneous income
[1898](a) Fully taxable pensions and annuities (not reported on Schedute E(540))
[1899](b) Alimony 2... ee ee ee
[1900]. (c) Other (state nature and source) — -
[1901]; os Enter total of lines 47(a), 47(b), and 47(c) . . See ee en
[1902]"48 Total (add lines 39 thru 47). Enter here and on line 13... ee ee ee ee bo ee ee
[1904]PART il ~ Adjustments to Income
[1906]"49° “Sick pay,” if ineluded in tine 10 (see instructions - attach Form FTB 3805T) .... 2... ee ee /. 8 ceeenteee. en
[1907]* §0 Moving expenses (see instructions - attach Form FTB 3805U) Le
[1908]“s 51 Employee business expenses, (See instructions - attach Form FTB 3805N) | :
[1909]52 Military exclusion (see instructions ) tee Po ee . Be Le
[1910]2 53(a) Payments to an individual retirement arrangement (attach FTB 3805P) ee eee : wee (988 ee pepe
[1911](b) Payments to a Keogh (H.R. 10) retirement plan rn i 2 2 eee ereeeeren Bee
[1912](c) Payments to.a self. -employed ‘‘Defined Benefit Plan’’
[1913]Enter total of lines.53(a), 53(b), and 53(c |
[1915]54 Forfeited interest penalty (see instructions). Le ee . Ce
[1917]"55 Total adjustments fadd lines 49 thru 54). Enterhereandonlinel5 ..... 2.0... ee bo ee
[1919]. PART IV ~ Itemized Deductions
[1921]. o. Attach Schedule A(540) and enter.sub-totals on lines 56 thru 62, below
[1922]. 56 Total deductible medical and dental expenses (from Schedule A(540), line 10)
[1923]57 Total taxes (from Schedule A(540), line 17)... ee be eee
[1924]. 58: Total interest expense (from Schedule A(540), line 20) -- ee ee ee ee
[1925]59 Total contributions (from Schedule A(540), line 24)... 0... 2... 2G Pe ee
[1926]: 60 Total casualty loss (from Schedule A(540), line 29). Bee eee
[1927]_61' Tota! miscellaneous deductions (from Schedule A(540), line 33)... 2 eee ar rn
[1928]62 ‘Total child care and adoption expenses (from Schedule A(540), line 37). 2... 0. ee eee :
[1929]‘ §3 Total itemized deductions (add lines 56 thru 62). Enter here and on line 17. . Dee be ee
[1931]PART V ~ Other Credits: - SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW
[1933]64 **Other State’’ net income tax credit (attach copy of other state return and Schedule S(540)). 2. ee ee O64 Joe. beegeecesteseedeceeeeee
[1934]_ 65° Retirement income credit (attach Schedule R(540)) 2 6. (©) 65 :
[1935]66 Special low income tax credit (see special instructions)... ..... rn rr @) 66 en nee
[1937]a Solar energy tax credit (see special instructions). ...........0.5 te ee @) 67 .
[1938]68 TOTAL (add lines 64 thru 67). Enter here and on tine 22 68 ;
[1940]4 an NS
[1942]“PART VI — Other Taxes
[1944]70 Tax on premature ‘distributions from attached Form FTB 3805P : .
[1945]"TL. Total (add lines 69 and 70) enter here and on tine 240 6 ee ee,
[1947]4
[1949]_NW 88326 Docld;32245535 Page 22, esas a ee a
[1952]FORM 340_
[1954]Name as shown on Form 540
[1956]- Medical and dental expenses (not compensated by Insurance or otherwise) for
[1957]medicine and drugs, doctors, dentists, nurses,
[1958]an hospital care, insurance premiums for medical
[1959]‘ * care, etc.
[1961]“1. One half (but not more than $150) of Insurance
[1962]premiums for medical care...................005
[1964]2. Medicine and drugs.................. Deve bene
[1965]"3. Enter 1% of line 16, Form 540.............0000 eee
[1967]‘4 Subtract line 3 from line 2. Enter difference (if less
[1968]" than zero, enter Zer0).. 0.0... eee ee eee
[1970]< §, Enter balance of insurance premiums for medical care
[1972]“+. mot entered on fine 1.................0. bees
[1973]“" @. Other medical and dental expenses: ;
[1975]* {a) Doctors, dentists,. nurses, So
[1977](b) Hospitals: ,
[1979] (c) Other (itemize)...
[1981] Total—tAdd lines 4, 5, 6a, b, and)...
[1983]. Enter 3% of line 16, Form 540..................
[1985]9. Subtract line 8 from line 7. Enter difference (if less
[1986]than zero, enter zero)... 0000... 62... eee eee
[1988]10. Total—{Add lines 1 and 9. Enter here and on Form
[1989]540, line 56)... .. Meee ceed eee e eee e ence es
[1993]’ Taxes -
[1994]11. Auto license—Excess cof registration and Weight fees
[1995](see instructions). “0°... 2.0.0)...
[1996]12. Real estate... ccc cece eee es
[1997]13, State and local gasoline........ lege cee e eee e en ens
[1998]14, General Sales... 22.00... 200 ccc e ee eee
[1999]15. Personal property (Boat and Aircraft)..............
[2000]16. Other (itemize)...
[2002]17. Total taxes—(Add lines 11 thru 16. Enter here and
[2003]on Form 540, line 57) .......0.... 00 cere eee
[2005]Tk
[2007]Interest Expense
[2009]18. Home mortgage... 2.0... bvee ee tetees
[2010]19. Other (itemize)... =:
[2012]26. Total—(Add lines 18 and 19. Enter here and on
[2013]Form 540, tine 58).............. 2000s eee es
[2016]ran
[2018]“NW 88326 Docld:32245535 Page 23
[2020]GALIFORWIA
[2022]ITEMIZED DEDUCTIONS
[2024]Attach to Form 540
[2026]USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION
[2028]Contributions
[2029]21(a). Cash contributions for which you have receipts,
[2030]canceled checks, etc.
[2031](b). Other cash contributions. List donees and
[2032]amounts --
[2034]22. Other than cash——See instructions for required state. .
[2037]23. Carryover from 1974 & subsequent years — See
[2038]instructions 6.00 nee es
[2040]24, Tota— (Add-lines 21a thru 23. Maximum de-
[2041]duction may not exceed 20% of adjusted gross
[2042]income. Enter here and on Form 540, line 59)..... .
[2044]Casualty or Theft Loss(es)
[2045]NOTE: If you had more than one loss, omit lines 25.
[2046]through 28—-See instructions for guidance
[2048]25. Loss before insurance reimbursement ..,...--- oe
[2049]26. Insurance reimbursement...........0......-0004 -
[2050]27. Subtract line 26 from line 25, Enter difference
[2051](If less than zero, enter zero) ... Docc enw teens
[2052]28. Enter $100 or amount on line 27, whichever is
[2054]29. Casualty or theft loss (subtract line 28 from
[2055]jine 27. Enter here and on Form 540, line 60)
[2057]Miscetlaneous Deductions .
[2059]30. Alimony paid to: ......--.ere cece eee eeeeegereee
[2060]31. Employment Education Expense.
[2061]32. Union dues
[2063]Other (itemize) ...
[2065]33. Total (Add tines 30 through 32. Enter here and _
[2066]on Form 540, line 61) . 5; A
[2068]Child Care and Adoption Expense 1,
[2069]34. Child care expenses ~- Attach Form 3805X. . . . ef.
[2071]35. Total adoption expense... - - [| we
[2073]Less 3% of line 16, Form 540. -
[2074]36. Net adoption expenses —See instructions
[2076]for maximum limitations... .....- anes
[2077]37. Total child care and adoption expenses
[2079](add liries 34 and 36. Enter here and on : 4
[2081]Form 540, line62).. 6... ee ee ee eee .
[2083]cenacaeee TT eal
[2085]‘" : t we
[2089]- DIVIDEND AND INTEREST INCOME
[2091]Attach to Form 540
[2093][FORM 840 _|
[2095]Name as shown on Form 540 - _ Social Security Numba
[2096]_ Rury | pe9e)
[2097]PART i-—BiVIDEND INCOME
[2098]. Line 1—Gross Dividends and Other Distributions on tions), less nontaxable portion, if any, on Form 540, page |.
[2099]Steck—if gross dividends and other distributions (including capital Do NOT deduct the $100 federal exclusion.
[2101]“Capital gain dividends” are treated as ordinary dividends for
[2102]State income tax purposes and not os capital gains as permitted
[2104]gain, dividends) on stock were $400 or fess, do not complete
[2105]‘this part; but enter gross dividends (including capital gain distribu- under the federal law.
[2107]2. Total dividends . .°. a
[2108]3. Nontaxable distributions -. Ce
[2109]‘4 Taxable dividends—Subtract line 3 from line 2. Enter here and on line 11, form 540 2. . 2) 1 we ee ee
[2110]PART li-—-INTEREST INCOME ;
[2111]Interest on bonds, -debentures, loans, notes, tax refunds and all (b) Bonds (but not other. obligations) of California and its polit-
[2112]types of savings accounts including banks, credit unions and postal ical subdivisions issued after November 4, ‘1902.
[2113]_ savings is taxable. : : (c) Interest on bonds of Alaska and Hawaii issued. prior to their
[2114]* “Interest on the following obligations is exempt from tax: ,achieving statehood. ‘
[2115]‘ (a) Bonds and other obligations (other than tax refunds) of the . -
[2116]|. + United States, the District of Columbia and territories of |. Note: If total taxable interest income was $400 or less, do
[2117]the United States. (Interest on Philippine Islands obligations not complete this part; but enter the total amount of interest
[2118]issued on or after March 24, 1934 is not exempt.) received on Form 540, page 1.
[2122]2. Total Interest Income. Enter here and on line 12, Form 540 . . _ Ce .
[2124]NW 88326 Docld:32245535. Page 24
[2127]~ PROFIT (OR Lass) FROM BUSINESS OR PROFESSION
[2129](Sole Proprictorships)
[2131]‘ Astach this schodule to your income tax retern, Form 340 or S540N2 — Partnorships, Joint ventures, ote, must filo on Form 368
[2133]Social PD: Number .
[2134]97)
[2136]Name as shown on Form 540 or S4NR lL
[2137]RA
[2139]A. Name and Address of Business ' oe . i . B. Federal mak No.
[2140]Dooplty BisTRo CoFr?s “HD? [0 Rrrnilgep Ip Aenedh, ZS = Ze 275"
[2142]C. Principal bus fness activity (ie., retail-hardware; wholesale-tobacco; services-legal; ete.)_ $2.2
[2144]D. Indicate method of accounting: CO cash; peacerual; O other
[2146]E. Were Forms 591, 592, 596 and 599, for ie year filed (if required)? YES. oO No
[2148]F. Method of inventory valuation > _.. Dace ceecceeeenaenesemeneneneene eee i aneopeg netesneneee eee peemestenrcccecsenmeecncapanagaeenename atta
[2150]_. Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
[2152]; DYES (NO If.“Yes,” attach ‘explanation. he
[2154]4 Gross receipts, sales, or fees $._____. Less returns and allowances $.. cece mannan encsenn j - Balance &
[2156]2 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) ne
[2158]3 Purchases $........._---------Less cost of items withdrawn for personal use $....
[2159]"4 Cost of labor (do ‘not include salary paid to yourself) a
[2160]§ Materials and supplies....0.......-20-002 0. 000ce cece teeter te retro es
[2162]6 Other costs (explain in Schedule C-2 or attach, Schedule)... ...... eee eee | CCCs
[2163](7 Total: of fines 2 thd 6... ET
[2165]8 Inventory at end of this year :
[2166]~ 9 Cost of goods sold (subtract line 8 ‘from line 1) wees vo geneveees _— cp eee centre ees bene cnn nee Lecce tenes
[2167]10 Gross profit (subtract line 9 from line ).
[2168]11 Other income (attach schedule)....... .. pee . :
[2169]1 "Total Income (add lines 10 and 1)... cece eg vee ee pee eter te re voveeee:
[2170]‘ OTHER BUSINESS DEDUCTIONS
[2171]1 Depreciation lexplain i in 7 Schedule C-1 or attach Schedule)... 0.00.02. 2 eee eee [ tC—C‘i‘Cstisizr :
[2172]14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule). eect ence eens
[2174]_ 15. Rent on business property...............-0--ge seers re Dope t eee e eterna n eee nnae [CY
[2176]- 16 Repairs (explain in Schedule C-2 or attach Schedule). beet e pe pee b ete e een ees eee 6?)
[2177]: 17 Salaries and wages not included on line 4 (exclude any paid to yourself). ..........-.. 0. e ee eer eee a
[2178]"$B Insurance 0.00 eee etree ers geese etter ices PT
[2179]* 19 Legal and profesional fees......... pepe e teense Levee ees cee, ee bee
[2181]20 Commissions ........ ll eeceeeeees vegeeies re re ccecceuncenvaes eee [ C—sdCY a
[2183]21 Amortization (attach statement)....0.......eeccee eee Meccan ees bees tee b tender eee e tenes Segue LCs
[2185]22. Retirement plans, etc. (other than your share, see instructions) cnet ey - Cv bev te eeveees Tr C—CS
[2186]/ 23 Interest on business indebtedness. . Lecce betes tee eerste tense e ee eee ecb e eee acces gee eens ‘ on ee
[2188]24 Bad debts arising from sales or services (Not applicable if reporting 0 on all, davis) vb env cctv ent eyvees TY
[2190]25 Depletion: (attach schedule) : TT _
[2192]28 Other business expenses (explain in Schedule C-2 or attach Schedule) ober beg pe eset eeeeee . °
[2194]27 Total of lines 13 thu 26.00.2222... ees etter ttt pages cree
[2196]2B Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or 540NR....... Le a ao a; ee | Scull
[2198]Group and guideline class Date Cost or Depreciation Method of Life or Depreciation
[2199]allowed (or allowable) computing ;
[2200]_ or description of property Acquired other basis in prior years depreciation Rate for this year
[2202]“Schedule C-1
[2203]Depreciation
[2204]Claimed on line 13.
[2206]WWE EXPLANATION ‘amount © HINE EXPLANATION _ | AMOUNT
[2208]14, 16, and 26
[2210]; Schedule c2 _
[2212]Explanation of Lines
[2214]NOPBSEZE Docid:32245535 Page 25 SCHEDULE F ON REVERSE
[2217]Led CAPITAL GAINS AND LOSSES
[2219]‘Name as shown on Form 540 or 540N8
[2221]PART I—Assets Held One Your or Lass
[2223]2. Enter gain (or loss), if applicable, from fine 17, Schedule D- 1 (540) (attach copy) . , —
[2224]3. Enter your share of net gain or loss from partnerships and fiduciaries .
[2225]. 4, Net gain or loss, combine lines 1, 2 and 3
[2227]“gt
[2229]Attach to Form 540 or 540NR
[2231]" Use this schedule to report gains and losses on stocks, bonds and similar investments,
[2232]ond gains (but not losses) on personal assets such os a home or jewelry.
[2234]we
[2236]2. Cost or other basis as
[2237]adjusted, cost of subse- .
[2238]quent improverents (If f. Gain or loss:
[2239]not purchased, attach (d. fess 2.)
[2240]exlanation) and a
[2242]penta of sao
[2244]¢. Date sotd
[2245](ms., day, yr.)
[2247]. d. Gress sales
[2248]price
[2250]b. Date acquired
[2251](mo, day, yr.)
[2253]a. Kind of property and description
[2254](Example, 100 shares of ‘‘Z" Co.)
[2256]6. Enter gain (or loss), if ‘applicable, from line 19, Schedule D-1 (540) (attach copy) .
[2257]7. Enter your share of net gain or loss from ‘partnerships and fiduciaries .
[2258]8. Net gain or loss, combine lines 5, 6 and 7 (if gain, see 540 instructions, line 24a “Preference tncome))
[2260]10.
[2261]V1.
[2262]12.
[2264]- PART fil—Assets Hold Mere Than Five Years
[2266]Enter ¢ gain (or joss), if applicable, from line 21, Schedule D-1 (540) (attach copy)
[2267]Enter your share of net gain or loss from partnerships and fiduciaries . an
[2268]Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a (Preference  Income))
[2270]. PART {¥—Summary of Capital Gains and Losses
[2272]13.
[2273]14,
[2274]oars
[2275]16.
[2276]17..,
[2277]18."
[2278]19.
[2280]- (b) the taxable income. for the toxable year. (computed without regard to gains or losses from sale or exchange
[2282]Enter amount from line 4
[2284]Enter 65% of the amount on line 8 coe
[2286]Enter 50% of the amount on line 12. . . F.
[2288]Enter unused capital loss carryover from preceding taxable. eld a ch computation)
[2289]Combine the amounts shown on lines 13, 14, 15 and 16
[2291]If line 17 shows q gain, enter here and on page 2, Part II of Form 540. or '540NR
[2293]If line 17 shows: a loss, enter here and on page 2, Part It of Form 540 or 540NR the smallest of:
[2294](a) amount on lines 17;
[2296]of capital assets; or
[2297](c) $1 000 ($500 in the case of a husband or wife filing a separate return)
[2299]Docld:3224553§. .Rage-26 —_ ra ener emer pe enn ae _ —— ai a oe :
[2301],
[2302]ed
[2304]4
[2305]i
[2307]“NW 88326 Docld:32245535 Page $7
[2309]. Please attach Copy B of Forms W-2 here ]|7
[2311]- Department of the Treasury—=IntéKe Revenue Service
[2312]US Individual Income Tax Return \
[2314]For the year January t-December 41, 1975, of other Gtx. ible year beginning > fou ce we TOFS, CHB oo ee
[2316]Your social security number | For Privacy Act Notification, a
[2318]7 Name (If joint —_ give first a. pe als of both) Last name
[2320]2 SJ AM nE é& l C.. Tk \ AB 322 Ju 29? ? see page 2 of Instructions. ek
[2321]: Present home addsess rate and ae ifeluding apaitment number, of rural sgute wn | Spouse's e security no. , For IRS use only ue
[2322]5 sO fi ReHER Io BF LE. Ro Ge: phd EET)
[2324]3 State and ZIP code : Occu- |_Yours _
[2326]* (ees. A pation |" cpouse’s B 5 : v
[2328]Requested by Ain what ay. town, village, | Bo Do you live within the legal | C tn’ what county and State do you live? | O In Tranatlownenin do
[2330]Census Bureau etc., do y Al . - + limits of the city, town, etc.? | County : State you live? (See page 4.)
[2331]for Revenue Pot} _ , po, . a
[2332]Sharing Lo. Ss ApoE Ares [7] No [_] Don’t know Fey Hi CA goo . ae
[2333]Ly Sine te 6a Regular re ea ME Spouse Lowes chewed | Del
[2334]a 2 it Married filing joint return (even if only one had income) b First names of Pay dependent . chiidren who ,
[2335]3 3 {2} Married ni separate Ul rst ue filing five g lived with vert Ext S _ .
[2336]spouse's social security number in designated ‘space above | 2 Ae Enter +
[2337]a and enter full : a Ht 077 - number > os
[2338]fev) name here > : E c Number of other dependents (from line 27) .. mm |_
[2339]& 4°([] Unmarried Head, of Household (See page 5 of Instructions) | @ d Total (add lines Ga, b, and c) a
[2340]= , a ’ woe ee
[2341]a . ; tte Age 65 or over. . [|] Yourself [1] Spouse. number .
[2342]5 [J] Qualifying widow(er). with dependent child (Year Blind . . ... [7] Yourself [7] Spouse Checked pe
[2343]spouse died ® 19 ). See paye 5 of Instructions. 7 Tota! (add lines 6d and e) err
[2344]8 Presidential Election Do you wish to designate $1 of your taxes for this fund? too __ Yes |Z Z No Note: If you check the "Yes"
[2345]Campaign Fund . Al joint return, does your spouse wish to designate $1? . ai FNo- to or teduee your relund.
[2347](Attach Forms Wed. If unavail-
[2348]able, see page 3 of Instructions.) *
[2352]9 Wages, salaries tbs, “and other employee compensation
[2354]10a Dividends Ge oes at) g weet t? cece es , 10b Less exclusion $.. . tf ? Balance >
[2356]e (if gross dividends and other distributions are over $400, list in Part 1 of Schedule B)
[2357]es . 1f $400 or less, enter total without listing in Schedule B
[2359]8 | al Interest ingame, [ Hoover $400, enter total and listia Part Hoof Schedule B
[2361]£ 120 Jncome other tha wages, dividends, aad interest (from Hine AG), :
[2363]“1 43. Total (add lines 9, 10c, 11, and 12)-. 6 6
[2365]14 > Adjustments to income (such as "sick pay,”” moving expenses, etc. from line 42).
[2366](if less than $8, 000, see paze 8 of In-
[2367]15 Subtractdine 14 from tine 13 (Adjusted Gross Income) Chasers on ‘‘Earned Income Credit."’)
[2369]@ If. you do not itemize deductions and line 15 is under $15,000, find tax in Tables and enter on line- 16a: : :
[2370]e If you itemize deductions or line 15 is $15,000 or more, go to line 43 to figure tax. Val a
[2371]@ CAUTION. if you-have unearned income and can be claimed as a dependent on your parent's return, check here B [|_| and see page 7 of insttuctions : -
[2373]Tax Tables
[2374]ScheduleD | +
[2376]Tax Rate Schedule X, Y, or Z
[2377]Schedule G | OR LI Form 4726
[2379]b Credit for personal exemptions (multiply line 6d by $30)
[2381]c¢ Balance (subtract line 16b from line 16a) .
[2382]17. «Credits (froni line 54) Loe
[2383]18 Balance (subtract line 17 from line 16c) . a
[2384]19 Other taxes (from line G3) , .
[2385]20 Total (add lines 18 and 19) . Thee Fe
[2386]21a Total Federal income tax. withheld a tae forms 2 "| 21a — 2?
[2388]16a Tax, check tf from:
[2390]|
[2392]Tax, Payments and Credits
[2394]"Please attach Check or Money Order here|
[2396]_20 | =O PP
[2397]Yee YL Ultithiyy Wy:
[2399]{include amount allowed as” yy Pay amount on line 23 in.
[2400]1975 estimated tax payments credit trom 1974 return) > —— y full_with this return. wit Z
[2401]YH social security number on
[2403]b
[2404]c Earned income credit
[2406]d Amount paid with Form 4868 .
[2407]e
[2409]Other payments (from line 67) .
[2410]22> Total (add lines 21a through e)
[2412]¢ “ wy check or money. order and
[2413]d|- : ‘ y make payable to Internal Ah,
[2414]e
[2418]2 23 If line 20 is larger than line 22, enter BALANCE DUE IRS . re 23 - .
[2419]ac _-(Check here > C] , if Form 2210, Form 221UF, or statement is attached. See p page 8 of Instructions.) . . -
[2420]2% 24 Mf line 22 is larger than line 20, enter amount OVERPAID. . . . 2. 1. 6 we 24 .
[2421]E@®! 25 Amount of line 24 to be REFUNDED TOYOU .. .. 6s 2 > | 25.
[2423]BB) 26 Avot of me 24 whe cise || Va OEE AEE PY
[2425]i] ited on 1976 estimated tax. >» 26 Ze retunded (line 2 25), make no entry on liste:2 %Z
[2428]Under penalties of perjury, | declare that i have examined this return, including accompanying schedules and statements, and te the best of my knowledge and aie it
[2429]is true, correct, aad complete, Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
[2431]Sign ; | 4
[2432]h : ‘ \ ‘ on . : : a 4
[2433]ere ee RN TTI .
[2435]. . ) . . Preparer’ s signature (other than taxpayer) - . Date
[2436]ml ye ‘ get a .
[2437]b—. a __| |. on 3O-3y_-£99.
[2439]"$ \gi i Ailin/jointly, BOTH must sign even if only one had income) Address (and ZIP Code) a
[2440]: 7 ae “oY ; oo, Soh Meares.
[2442]t, Form 1040 (1975) ; : Page 2
[2443]: tet (a) NAME (b)” Relationship {c) Months lived in your (ag) Did de- {e) Amount YOU (ft) Amount — fur-
[2444]2 * “ . ome. If born or died | pendent have | furnished for de- nished by OTHERS
[2445]ec ong year, write B or D. income of pendent’s sup- including .depend-
[2446]u - @ $750 or more? port. If 100% ent.
[2447]ts oy write ALL.
[2449]ro} 2 a en OD $
[2450]ra
[2451]27 Total number of dependents listed in column (a). Enter here and on line 6... ee
[2452]i MZUEMM !ncome other than Wages, Dividends, and Interest :
[2453]7m 28 Business income or (loss) (attach Schedule C). . . . . . . rs 28 7,
[2454]4 29a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) to. ee [298 4 ») .
[2455]29b 50% of capital gain distributions (not reported on Schedule D—see page 9 of Instructions) .-. 29b *
[2456]30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form ATS7). . 30 23) 3
[2457]: 3la Pensions, annuities, rents, royulties, partnerships, estates or trusts, etc. (attach Schedule E).  . _Sla_ —
[2458]31b Fully taxable pensions and annuities (not reported on Schedule E-—see page 9 of Instructions) . _31b_ ee
[2459]| 32) Farm income or (loss) (attach Schedule F) . 6. toe ee BRU
[2460]: ] pt apply if refund is f hich took th °
[2461]33. State income tox refunds (Sin sete voutaok tne) [aa
[2462]34 Alimony received : 34 |
[2464]: 35 Other (state nature and source—See pape ‘9 of Instructions) » |
[2468]|
[2470]nit
[2472]36 “Total (ada lines 28 throug h a5). Enter here and on line 12, — ee 7 : ; ad 3
[2474]EGS Adjustments to income
[2476]| e -37 “Sick pay.” (attach Form 2440 or other required statement). - oe, woe ee | BFE _
[2477]; 38 Moving expense (attach Form 3903) . . . . ee _
[2478]| 39 Employee business expense (attach Form 2106 or statement) Soe ee 39 _
[2480]40a Payments to a Keogh (H.R. 10) retirement plan... wee ew ee | 40a : : .
[2482]: 40b Payments to an individual retirement arrangement from attached Form 5329, Part Mu 2... | 40b_ 37 s ~~
[2483]4 41 Forfeited interest penalty for premature withdrawal-—-see page 10 of Instructions rn 2 oe _
[2485]42. Total (add lines 37 through 41). Enter here and online 14... re 42 3 2 o
[2487]a | Part (it BES Computation (Do not use this part if you use the Tax Tables to find your tax.)
[2489]A -43 Adjusted gross income (from line 15). . : soe. AB
[2490]. “44 (a) If you itemize deductions, check here > 7 and enter total trom Schedule A, line a
[2492]= and attach Schedule A es soe
[2494]y : (b) If you do-not itemize deductions and line 15 is ‘$15, 000 or more, check here >» cr] and:. 44
[2495]7 : (€ box on line 2 or 5 is checked, enter 16%, of line 15 but not more than $2,600: if box os
[2496]o ‘on line 1 or 4 is checked, enter $2,300; if box on line 3 is checked, enter $1,300 :
[2498]a . 45 Subtract line 44 from line 43... ee
[2499]7 46 Multiply total number of exemptions claimed on line 7, ‘by $750 . Coe ee eee | 46
[2501]AO 47 Taxable income. Subtract line 46 from line 45 2 6 ee ee we LAT
[2502], (Figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, or Z, or if applicable, the alternative .
[2504]57 Minimum tax. Check here m [7j, if Form 4625 is attached. . eee ee ee
[2506]58 Tax on premature distributions from attached
[2508]4 tax from Schedule D, income averaging fram Schedule G, or maximum tax from Form 4726.) Enter tax on line 16a.
[2509]a 2\ 48 Retirement income credit (attach Schedule R) . ee res a. :
[2510]: 2 49 Investment credit (attach Form 3468). 20 ee ee | AB
[2511]: ©! 50 Foreign tax credit (attach Form 1116) . . - 50
[2512]| 51 Contributions to candidates for public office credit—-see page 10 of Instructions . 51
[2513]' 52 Work Incentive (WIN) credit (attach Form 4874)... 27. et we we ee [82
[2514]53 Purchase of new principal residence credit (attach Form 5405). 2. . 2. ee 53
[2515]: - 54 Total (add lines 48 through 53). Enter here and on line 17... 54
[2516]i 3 55 Tax from recomputing prior-year investment credit (attach Form 4255) WeTRsE; 55 —oO =<
[2517]‘ pi 56 Tax from reconiputing prior-year Work lacentive (WIN) credit (attach Schedule) . 56
[2518]he
[2519]rT)
[2521]Cad
[2522]fe)
[2524]aie Ss
[2525]59 ‘Self-employment tax (attach Schedule SE) . ey eG): 19 0.
[2527]4 60 Social security tax on tip income not reported to employer (attach Form.4137) .
[2529]60
[2530]“ig 61 Uncollected employee social security tax on tips (from Forms W-2) 61
[2531]“es 62 Excess contribution tax from attached Form 5329, Part IV... 0. 6 ee 62 ,
[2533]i 63 Total (add line ob pb Hirguyh h os 2). F Enter here and on tine 19.0. 0. ke, oe pee 7 ‘od
[2535]. B2GAUM Other Payments
[2537]! 64 Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers—see page 10 of Instructions). :. . 2 1 64 .
[2538]A 65 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) | rn 65 : .
[2539]a 66 Credit from a Regulated Investment Company (attach Form 2439)). «6. ee ee ee 66 : ea
[2541]4 67 Total (add lines 64 through 66). Enter here and on line 2le re 67
[2543]ot te U.S. GOVERNMENT PRINTING OFFICE ; 1975-O-575-050 . , . , S 16-82510-1
[2545]NW 88326 Docld:32245535 Page 28
[2549]4
[2550]a
[2551]j
[2553]t
[2557]t
[2558]a
[2559]i
[2561]'
[2563]Schedules A&xB—ltemized Deductions AND:
[2564](Form 1040) Dividend and Interest Income
[2565]Department of the Treasury b> Attach to Form 1040. p> See Instructions for Schedules A and B (Form 1040).
[2567]Internal Revenue Service
[2568]AYCLIS k
[2570]meme shown -on Form 1040
[2571]Au € lL ZL
[2573]Schedule A—lItemized Deductions (Schedule B on back)
[2575]Your social security ey) 7.
[2577]Medical and Dental Expenses (not compensated by insurance | Contributions (See page 12 of Instructions for examples.)
[2579]or otherwise) (See page 11 of Instructions.)
[2581]1 One half (but not more than $150) of in- ;
[2582]surance premiums for medical care. (Be
[2583]sure to include in line 10 below) - Pe
[2585]2 Medicine and drugs . . . woe _—
[2586]3 Enter 1% of line 15, Form 1040 foe fe
[2588]2k a Cash contributions for which you have
[2590]receipts, cancelled checks or other
[2591]written evidence :
[2592]b Other cash contributions. List donees
[2593]_ and amounts. Bm |
[2595]4 Subtract line 3 from line 2. Enter differ-
[2596]ence (if less than zero, enter zero)... |_| _
[2598]5 Enter balance of insurance premiums for
[2599]medical care not entered on line 1 2. |
[2601]6 Enter other medical and dental expenses:
[2602]_ a Doctors, dentists, nurses, etc. 2... |-—_——] ——
[2603]>p Hospitals. . . - (i
[2604]ec Other (itemize—include hearing aids,
[2605]dentures, eyeglasses, ‘transportation,
[2606]etc.) >
[2608]22 Other than cash (see page 12 of instruc-
[2609]tions for required statement) . .
[2610]23 Carryover from prior years
[2612]24 Total contributions (add lines 2la through / f O
[2614]23). Enter here andonline38 . . . >»
[2615]Casualty or Theft Loss(es) (See page 13 of Instructions.) :
[2616]Note: /f you had more than one loss, omit lines 25 through 28
[2617]and see page 13 of Instructions for guidance,
[2619]25 Loss before insurance reimbursement .
[2620]26 Insurance reimbursement
[2622]|
[2624]27 Subtract line 26 from line 25. Enter dif-
[2625]ference (if less than zero, enter zero)
[2627]7 Total (add lines 4 through 6c) . .). J] ——
[2628]8 Enter 3% of line 15, Form 1040 . .  . |—___-__-|-_
[2630]9 Subtract line 8 from line 7 (if less than
[2631]- zero, enter zero) cee
[2633]10 Total (add fines 1 and 9). Enter here and /
[2634]on line 35 : Is2
[2636]28 Enter $100 or amount on line 27, which-
[2637]ever is smaller . .
[2638]29 Casualty or theft loss (subtract ti line 28
[2640]from line 27). Enter here and on line 39°
[2642]Miscellaneous Deductions (See page 13 of Instructions.)
[2644]30 Alimony paid
[2646]Taxes (See page il of Instructions.) 31 Union dues .
[2647]11 State and local income... - + |__| — 32 Expenses for child and dependent care
[2648]12 Real estate. . . .- . _ services (attach Form 2441)
[2649]13 State and local gasoline (see gas tax . tables) 33 Other (itemize) PM ooo
[2650]14 General sales (see sales tax tables) :
[2651]15 Personal property . . : .
[2652]16 Other (itemize) ® owe. | | =e oon e swe cee ceceueaneeeeeeseeetnn nee ceeees
[2653]a SCe
[2654]17 Total (add lines 11 through 16). Entor | 207, 34 Total (add lines 30 through 33). Enter
[2655]here and on line 36... here and online 40 ._. > :
[2656]E e Fy f I . . .
[2657]interest xpens (See page 12 oO asleuctions) Summary of Itemized Deductions A |
[2658]18 Home mortgage . : .
[2660]35 Total medical and dental—line 1
[2662]36 Total taxes—line 17 .
[2664]37 Total interest-—line 20 .
[2666]38 Total contributions—line 24
[2668]39 Casualty or theft loss(es)—line 29 .
[2669]40 Total miscellaneous—line 34 .
[2671]19 Other (itemize) P ...........2 eee
[2673]41 Total deductions (add lines 35 through
[2674]20 Total (add Jines 18 and 19). Enter here
[2675]and online 37... ee ad
[2677]oNW 88276 Dochd:32245535 Page 29
[2679]1975 Y
[2681]“SCHEDULE C Profit or (Loss) From Business or Profession
[2683]-Name(s) as shown
[2686]af
[2687]t
[2688]a
[2690]tye OH
[2692](Form 1040) (Sole Proprietorship) ; \ 7
[2693]Department of the Treasury > Partnerships, Joint Ventures, etc., Must File Form 1065. -
[2694]Internal Revenue Service » Attach to Form 1040. » See Instructions for Schedule C (Form 1040). :
[2696]on Form 104
[2697]we L LiL
[2698]A Principal business activity (see Schedule C ins! ctions) | ae
[2699]B Business name » [4/0.0 2 LEY
[2700]D Business address (number and street
[2701]City, State and ZIP code B........
[2702]E Indicate method of accounting: (1) im Cash (2) Mw Accrual @) go Other >»
[2703]F Were you required to file Form W-3 or Form 1096 for 1975? (see Schedule C Instructions) .
[2704]If “Yes,” where filed >
[2705]G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in 1975?
[2707]™ oa By eT ayy roduct Moa. fats ~ Gove lay nn
[2708]oC dag y 206 OR ver identification number >. 95-% Re. (SUP
[2710]H Method of inventory valuation Bo... wo cavevueceveseeeseseaerencseveecseee LL iuvceceeeeeeesstesceteneceess Was there any substantial change in
[2711]the manner of determining quantities, costs, or valuations belween the opening and closing inventories? (IC “Yes,” atlact explanation)
[2712]1 Gross receipts or sales $...0000 ee Less: returns and allowances $..........--- weesteeeeeees Balance > ch | lccceestececeeceneeeeeenee [eee
[2713]E Less: Cost of goods sold and/or operations (Schedule C-1, line 8) oe a
[2714]8 Gross profit en
[2715]= . Other income (atlach schedule) . A
[2717]Tota! income (add fines 3 and 4)
[2719]Taxes on business and business property (explain in Schedule c-2)
[2720]Rent on business property
[2721]_ Repairs (explain in Schedule C—2) tee .
[2722]10 Salaries and wages not inchided on line 3, Schedule c 1 (exclude 3 any ‘paid to yourself) :
[2723]11 Insurance . . .
[2724]- 12 Legal and professional fees
[2725]13 Commissions . Lee
[2726]14 Amortization (attach statement) . .
[2727]15 (a) Pension and profit- sharing plans (see Schedule Cc instructions)
[2728](b) Employee benefit programs (see Schedule C Instructions)
[2730]2
[2731]3
[2732]4
[2733]5
[2734]6 Depreciation (explain in Schedule C-3)
[2735]7
[2736]8
[2737]9
[2739]16 Interest on business indebtedness
[2741]17 Bad debts arising from sales or services
[2742]18 Depletion .
[2744]19 Other business expenses (specify):
[2746]Deductions
[2748](k) Total other business expenses (add lines 19(a) thrown 19(j)) .
[2749]Total deductions (add lines 6 through 19(k)) :
[2751]21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on | Form 1040, line 28. ALSO
[2753]enter on Schedule SE, line 5(a).  . . 21 ; |
[2754]SCHEDULE C-1.—Cost of Goods Sold and/or Operations (See “Schedule a instructions for Line 2)-
[2756]1 Inventory at beginning of year (it different from last year’s closing inventory, attach explanation) .
[2757]Purchases $......0.0....-....ee Less: cost of items withdrawn for personal use $............ cee Balarce >
[2758]Cost of labor (do not include salary paid to yourself)
[2760]Materials and supplies
[2762]Other costs (attach schedule)
[2764]Total of lines 1 through 5
[2766]Less: Inventory at end of year -
[2767]8 Cost of goods sold and/or operations. Enter here and on ‘tine 2 above
[2769]NOU &@ WD
[2771]WG—-B82517-1
[2773]NW 88326 Docid:32245535 Page 30
[2777]: “Schedule C (Form 1040) 1975 ; Page 2
[2778]. a nS NEUSE nS SEINS NUS UES
[2779]sos, SCHEDULE C-2.——-Explanation of Lines 7 and 9 ,
[2781]ho , Line No. Explanation ‘Amount Line No. Explanation + Amount
[2783]SCHEDU LE C-
[2785]eprec ition (Seu Schedule C Instructions for Line G) If you need more space, you inay use Form 4562.
[2787]Note: If depreciation s computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, o1 or the Guideline Class. .
[2789]. . Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline _
[2790]Class Life System), Except as otherwise expressly provided in income tax regulations sections 1,167(a)-11(b)(5)(vi) and 1.167(a)-12, the pro-
[2792]visions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970. (See Publication 534.) |
[2794]Check box if you ‘made an election this taxable year to use [_} Class Lite (ADR) System and/or [_] Guideline Class Life System.
[2796]ev, Method of . yo
[2797]"computing {. Life g. Depreciation for
[2798]depreciation or rate this year
[2800]d. Depreciation
[2801]allowed or allowable
[2802]in prior years
[2804]a, Group and guideline class b. Date c. Cost or
[2805]ot description of property acquired - . other basis
[2807]_ 1 Total additional first-year depreciation (do not include in items below) ———-———___.-_.____________—_»
[2808]“2 Depreciation trom Form 4832 . + see Note \ + |--------eeeeeeeeee eee eee a
[2809]3 Depreciation from Form 5006 . \ ®Peve cece eee eeeteeteeeeeeeeees Yj
[2810]4 Other depreciation:
[2812]Buildings oo
[2813]Furniture and fixtures. .
[2815]Transportation equipment .
[2816]Machinery and other equipment
[2817]7 Other (specify)
[2819]5 Totals... 1. 1 ew we ee ee
[2821]6 Less amount of depreciation claimed in Schedule C-1, page 1
[2823]7 Balance—Enter here and on page 1, line 6 . - :
[2824]. SCHEDULE C~4.—-Expense Account Information (See Schedule Cc Instructions Tor Schedule Cad)
[2826]Enter information with regard to yourself and your five highest paid Name Expense account | _Salaries TE DOE
[2827]employeeg. In determining the five highest paid employees, expense y
[2828]account allowances must be added to their salaries and wages. How-
[2829]ever, the information need not be submitted for any employee for
[2830]whom the combined amount is Jess than $25,000, or for yourself if
[2831]your expense account allowance plus line 21, page 1, is Jess than
[2833]$25,000.
[2834]. Did you claim a deduction for expenses connected with:
[2835](1) Entertainment facility (boat, resort, ranch, etc.)? . . [CT] Yes tyflo (3) Employees’ families at conventions or meetings? . . [) Ves
[2836]a (2) Living accommodations (except employees on business)? [7] Yes Thtve (4) Employee ot family vacations not reported on Form W-2? [7] -Yes
[2838]st U.S. GOVERNMENT PRINTING OFFICE + 19/5—(3 575-053 . Wi S2517-1
[2840]“NW 88326 Dochd:32245535 Page 31
[2842]ca on fa wlaSpaaeide
[2843]g .
[2845]“SCHEDULE D Capital Gains and LoSS@$& (Examples of property to be reported on this
[2847]“uy (Form 1040) Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not
[2848]soot Department of the Teasuy | 'SSeS) on personal assets such as a home or jewelry.)
[2849]intemal Revenue Service m Attach to Form 1040. ® See Instructions for Schedule D (Form 1040).
[2851]Social security number
[2855]Narne(s) as shown on Form 1040
[2857]JAmuge
[2858]EZUAMEE Short-term Capital Gains and Losses—Assets Held Not More Than 6 Months
[2860]320.
[2862]. . b. Date c. Date e, Cost or ant basis,
[2863]. Kind of property and description acquired “sold d. Gross sales price .8s adjusted (see f. Gain or (toss)
[2864]pos téxample, 100 shares of ‘'2”' Co.): (Mo., day, yr.) (Mo., day, yt.) instruction and (d less o
[2865]! 1 a,
[2866]nn | ae | | ee |
[2868]' a Oe
[2869]1 hn Ran OS I
[2870]i a rs
[2871]{ i es a | | | a Fe
[2873]‘ a | em | eee nee | a | nn | ae
[2874]~ 8 2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries . 2... |
[2875]we 3 Enter not gain or (loss), combine lines lund 2.0.0.) . a ee ee
[2877]7 4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction 1)
[2878]: (b) Short-term: capital loss carryover attributable to years beginning after 1969 (see Instruction 1).
[2880]‘ a) Net short-term gain or (loss), combine lines 3, 4(a) and (b) . . . so
[2881]j ESL Long-term Capital Gains and Losses——Assets Held More Than 6 Months a .
[2882]" 6 . + _ ”
[2883]a —
[2884]4 a —
[2885]Fl S(O a UF
[2886]4 —_— _
[2887]4 .
[2888]‘t
[2889]| 7 Capital gain distributions. . . . toe ee as ee ae a
[2890]H 8 Enter gain, if applicable, from Form 4797, line 4(a)(1) (see instruction A) woe eee ee 8 Sf OS :
[2891]9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries .. . _39_ .
[2892]10 Enter your share of net Jong-term gain from small business corporations (Subchapter S). . . 10
[2893]11 _—Net gain or (loss), combine lines 6 through 10... . ee ee ew ee ee | SOS ;
[2894]4 12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction |) . 12(a)|_¢ 3 |
[2895]i (b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction y. |)" _
[2896]° 13 Net long-term gain or (loss), combine lines 11, 12(a) and (b)_. we 13
[2897]{ [eam Summary of Parts | and Ab
[2898]14 Combine the amounts shown on lines 5 and 13, and enter the net gain or (loss) here. 2. .
[2900]4 15 \f line 14 shows a gain—
[2901](a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part VI for computation
[2903]\ . of alternative tax). Enter zero if there is a loss or no entry on line 13... ro -
[2905](b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29a. . 1.
[2907]: 16 If line 14 shows a loss—
[2908]4 a & If losses ure shown on BOTH lines 12(a) and 13, omit lines 16(a) and 1) and yo to Part iV
[2909]. : (see Instruction J).
[2910], » Othemise,
[2911]mo (a) Enter one of the following amounts:
[2912]oe . : (i) If amount on line 5 is zero or a net gain, enter 50% of amount on line 14;
[2914]. (ii) f amount on line 13 is zero or a net gain, enter amount on line 14; or
[2915]a : ’ (iii) If amounts on line 5 and line 13 are net losses, enter amount on line’ 5 added to
[2916]i 50% of amount on line 13... tone
[2918]: : (b) Enter here and enter as a (loss) on Form 1040, line 29a, the smallest oft
[2920]‘ : (i) The amount on line 16(a);
[2922]of . (ii) $1,000 ($500 if married and filing a separate return—if a loss is shown on line
[2923]. 4(a) or 12(a), see instruction N for a higher limit not to exceed q $1, 000); or,
[2925](iii) Taxable income, as adjusted (see Instruction M) . . - os
[2927]16-—82511-1
[2929]“NW 88326. Docld:32245535 Page 32 oe ae
[2931]Schedule D (Form 1040) 1975
[2933]17
[2934]18
[2936]20
[2938]22
[2939]23
[2940]24
[2941]25
[2942]26
[2943]27
[2944]28
[2945]29
[2947]31
[2949]33
[2950]34
[2952]Part IV Capita! Loss Limitation—Where Losses Are Shown on Both Lines 12(a) AND 13
[2954]Enter loss froni line 5; if line 5 is Zero or a gain, enter a zero .
[2955]Enter loss from line 13... 2 we
[2956]Enter gain; if any, from line 5; if line 5 is zero or a loss, enter a zero .
[2957]Reduce !oss on line 18 to the extent of the gain, if any, online 19 -
[2959]Combine lines 3 and 11 and if gain, enter gain; if zero ora loss, enter a zero
[2961]2 | 5/0 |
[2963]Note: if the entry on linc 21 is zero, OMIT lines 22 though 28, and enter on line 29 the
[2964]loss shown on line 12(a).
[2966]Enter gain, if any, from line 11 . .
[2968]Enter smaller of amount on line 21 or line 22 .
[2970]Enter excess of gain on line 21 over amount on line 23
[2971]Enter loss from line 4(a); if line 4(a) is blank, enter a zero .
[2972]Reduce gain, if any, on line 24 to the extent of loss, if any, on line 25 (see instruction K) 26
[2973]Enter loss from tine 12(a) .
[2977]Add the gain(s) on line(s) 23 and 26.0... ee ee 28 | Ss OS
[2978]Reduce the loss on line 27 to the extent of the gain, if any, on line 28 (see Instruction L) .
[2980]Enter smaller of amount on line 29 or line 20 (if line 29 is zero, enter a zero) .
[2982]Subtract amount on line 30 from the loss on line 20 .
[2983]Enter 50% of the amount on line 31.
[2985]Add lines 17, 30, and 32 so
[2987]Enter here and enter as a (loss) on Form 1040, line 29a, the ¢
[2988](a) Amount on line 33;
[2990]smallest of:
[2992](b) $1,000 ($500 if married and filing a separate return—see Instruction N for a higher limit not to exceed hae 000); or,
[2994](c) Taxable Income, as adjusted (see Instruction M) .
[2996]14 (See Instruction N)
[2998]35
[3000]j 36
[3001]37
[3002]7 38
[3003]_ 39
[3004]40
[3005]: 41
[3006]J 42
[3008]43
[3010]B28 Computation of Alternative Tax (See Instruction W to See if the Alternative Tax Will Benefit You)
[3012]: 44
[3013]a 45
[3014]a 46
[3015]_ 47
[3017]Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a Zero .
[3019]Note: if the entry on line 35 is zero, OMIT lines 36 through 42, and enter on line 43 the loss shown on
[3021]line 4(a).
[3023]Eriter gain, if any, from line 3 .
[3025]Enter smaller of amount on line 35 or line 36 .
[3027]Enter excess of gain on line 35 over amount on line 37 .
[3029]Enter loss from line 12(a); if line 12(a) is blank, enter a zero . .
[3031]Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 9 (see ‘Instruction K).
[3032]Enter loss from line 4(a) .
[3034]Add the gain(s) on line(s) 37 and 40. .
[3035]Reduce the loss on line 41 to the extent of the gain, if any, on line 42 (see Instruction Lb.
[3037]29
[3038]30
[3039]31
[3040]32
[3041]33,
[3043]|
[3045]|
[3049]Complete Part V if You are Married Filing a Separate ‘Return and Losses are Shown on Lines 4(a) and
[3051]35
[3053]Enter amount from Form 1040, line 47 .
[3055]Enter amount from tine 15(a) . ee
[3056]Subtract amount on line 45 from amount on line 44 (but not less than zero) .
[3057]Enter smaller of amount on line 13 or line 14 .
[3059]If line 47 does not exceed $50,000 ($25,000 if married filing separately), check here > q and omit
[3061]lines 48 through 54.
[3063]u 48
[3065]49
[3067]50
[3068]51
[3069]: 52
[3070]53
[3071]- 54
[3072]a 55
[3073]56
[3074]57
[3076]s vo
[3077]ONW 88226 Docld:32245535 Page 33
[3079]Enter your share of certain long-term gains from partnerships, fiduciaries, and small business cor-
[3081]porations referred to as “certain subsection (d) gains” (see Instruction W) .
[3083]Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger .
[3085]If line 49 is equal to or greater than line 47, check here > [] and omit lines 50 through 54.
[3086]Multiply amount on line 49 by 50% .
[3088]Add amounts on lines 46 and 50 . woe eee
[3090]Tax on line 44 or 45, whichever is greater (use Tax Rate - Schedule in instructions) ©
[3092]Tax on the amount on line 51 (use Tax Rate Schedule in instructions)
[3094]Subtract amount on line 53 from amount on line 52 . .
[3096]Tax on the amount on line 46 (use Tax Rate Schedule in instructions) . .
[3097]If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 259, of line 49
[3099]Alternative Tax—add amounts on lines 54 (if applicable), 55, and 56. If smaller than the tax figured
[3101]on the amount on Form 1040, line 47, enter this alternative tax on Form 1040, line 16a
[3103]ir U.S, GOVERNMENT PRINTING OFFICE ; 1975—O-575-054
[3105]57
[3107]‘ on the amount on Form Use ine a eee eee 00 ,
[3109]16-=B2511-1
[3111]4
[3112]H
[3113]|
[3116]NW 88326 Docld:32245535 Page 34
[3118]rr re ea arin nae ieee”
[3120]Oe 1040) _| Computation of Social Security Self- Employment Tax . 1975
[3122]Department of the Treasury p> Each self-employed person must file a Schedule SE. p> Attach to Form 1040.
[3123]Internal Revenue Service > See Earned Income Credit Instructions on page 8 and instructions for Schedule SE (Form 1040).
[3125]@ If you had wages, including tips, of $14,100 or more that were subject to social security or railroad retirement taxes, do not fill'in
[3126]this schedule unless you are eligible for the Earned Income Credit. See Instructions. . 6
[3128]@ \f you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.
[3130]Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits,
[3131]NAME OF SELF-EMPLOYED OF SHOWN ON SOCIAL SECURITY CARD) Social security number of
[3134]Business ae an to self- AB ent tax (grocery store, restaurant, farm, etc.) »» ¢
[3136]@ If you have only farm income complete Parts t and tll. @ If you have only nonfarm income complete Parts II and Ml.
[3137]@ If you have both farm and nonfarm income complete Parts |, fl, and Ul.
[3139]Giza Computation of Net Earnings from FARM Self-Employment
[3140]You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line
[3142]2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and -
[3143]2 must be completed even if you elect to use the FARM OPTIONAL METHOD.
[3145]‘2
[3147]REGULAR METHOD (a) Schedule F, line 54 (cash method), or line 74 (accrual method) .
[3148]1 Net profit or (loss) from: (b) Farm partnerships . . . . . . wee
[3149]2 Net earnings from farm self-employment (add lines 1(a) and (b)) . 2. see :
[3150]31 gross profits METHOD | (a) Not more than $2,400, enter two-thirds of the gross = profits rn Ie :
[3151]from farming ' are: (b)} More than $2,400 and the net farm profit is less than $1,600, enter $1, 600 .
[3153]1Gross profits trom farming are the total gross profits from Schedule F, line 28 (cash method), or tine 72 (acerual
[3154]method), plus the distributive share of gross profits from farm partnerships (Schedule K-I (Form 1065), tine 14) as Y
[3155]explained in instructions for Schedule SE. yy Le ee
[3157]4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method .
[3159]BENG Computation of Net Earnings from NONFARM Self-Employment
[3161](a) Schedule C, line 21. (Enter combined amount if more than one business.)
[3163]Wii
[3165]; (b) Partnerships, joint ventures, etc. (other than farming) . . . 2. . 1.20. 2.04
[3166]REGULAR METHOD | (c) Service as a minister, member of a religious order, or a Christian Science prac-
[3167]5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If you
[3169](loss) from: filed Form 4361, check here B® [] and enter zero on this tine
[3171](d) Service with a foreign g government or international organization
[3172]( 1
[3173](e) Other Structions for line 35.) Specify >
[3175]6 Total (add tines 5(a) through (e)) .
[3176]7 Enter adjustments if any (attach statement) . . . . to . . oo. -
[3177]8 Adjusted net earnings or (loss) from nonfarm self- employment (line 6 6, as adjusted. by | line ”». :
[3178]_ If line 8 is $1,600 or more OR if you do not-elect to use the Nonfarm Optional Method, omit-lines 9 through
[3179]11 and enter amount from line 8 on line 12(b), Part Il.
[3180]Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than. $1,600 and less
[3181]than two-thirds of your gross nonfarm profits,’ and you had actual net earnings from: self-employment of $400 or more
[3182]for at least 2 of the 3 following years: 1972, 1973, and 1974. The nonfarm optional method can only be used for 5
[3183]taxable years.
[3184]NONFARM OPTIONAL METHOD :
[3185]9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
[3187](b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.) . im
[3188](c) Balance (subtract line 9(b) from line 9(a)) . 2. . 1 ww oe ee
[3189]10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller ee ee ek ea
[3190]11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller. . . .
[3192]2Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3; plus the distributive
[3193]share of gross profits from nonfarm partnerships (Schedule K-1 (Form 1065), line 14) as explained in instructions
[3194]for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7.
[3196]eke Computation of Social Security Self-Employment Tax
[3197]12 Net earnings or (loss): (a) From farming (from line 4). 2. 7. 2 we ee toe eee ;
[3198](b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) . woe ee
[3200]13 Total net earnings or (joss) from self-employment reported on line 12. (If Line 13 is less than $400, you are not
[3201]subject to self-employment tax. Do not fill in rest of schedule.) .
[3203]14 The largest amount of combined wages and seif- employment earnings subject to social | security ¢ or railroad
[3205]retirement taxes for 1975 is . . . . $14,100. 100
[3206]15 (a) Total “FICA’ wages and "RRTA” compensation. . . . Ff =
[3207](b) Unreported tips subject to FICA tax from Form 4137, line 9 orto RRTA. . -
[3208](c) Total of lines 15(a) and (b) 2. we ew me - oe oe
[3209]16 Balance (subtract line 15(c) from line 14) 2.) ww “ee neon es
[3210]17 Self-employment income—line 13 or 16, whichever is smaller... . eg
[3211]18 Self-employment tax. (If line 17 is $14,100.00, enter $1,113.90; if less, muriply ¢ the amount on line 7 Yos
[3212]by .079.) Enter here and on Form 1040, line 59. . .
[3214]yr U.S, GOVERNMENT PRINTING OFFICE : 1975—O-575-058 . . , N-B2518-3
[3218]od
[3220]“4
[3221]ad
[3225]“SCHEDULE SE enn: , at tT:
[3226](Form 1040) Computation of Social Security Self-Employment Tax
[3227]Department of tho Treasury p> Each self-employed person must file a Schedule SE. p> Attach to Form 1040.
[3229]Internal Revenue Service B Sce Earned Income Credit Instructions on page 8 and Instructions for Schedule SE (Form 1040).
[3231]@ If you had more than one business, combine profits and lasses from all your businesses and farms on this Schedule SE.
[3235]@ if you had wages, including tips, of $14,100 or more that were subject to social security or railroad retirement taxes, do not fill in
[3236]this schedule unless you are eligible for the Earned Income Credit. See Instructions.
[3238]Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.
[3240]NAME OF ,SELF-EMPLOYED RAB SHOWN ON SOCIAL SECLIRITY CARD) Social security number >| 9
[3244]self-employed person »
[3245]Business activities subject to self- A.B tax (grocery store, restaurant, farm, etc.) >» Sf
[3247]@ If you have only farm income complete Parts | and lil. @ If you have only nonfarm income complete Parts II and Ht
[3249]@ If you have both farm and nonfarm income complete Parts |, H, and Ilt.
[3251]EZ ~ Computation of Net Earnings from FARM Self-Employment .
[3253]. You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line
[3255]2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1, 600. However, lines 1 and
[3257]2 must be completed even if you elect to use the FARM OPTIONAL METHOD.
[3259]REGULAR METHOD (a) Schedule F, line 54 (cash method), or line 74 (accrual method) .
[3260]1 Net profit or (loss) from: (b) Farm partnerships ee
[3261]2 Net earnings from farm self-employment (add lines 1(a) and (b)) . yee
[3262]FOR once otis METHOD | (a) Not more than $2,400, enter two-thirds of the gross s profits see
[3263]"from farming’ are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 .
[3264]1Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 (accrual —
[3266]method), plus the distributive share of gross profits from. farm partnerships (Schedule K-1 (Form 1065), line 14) as
[3267]explained in instructions for Schedule SE.
[3269]4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method
[3270]| Computation “of Net “Earninigs trom” NOI “NONFARM S “Self-Employment ~~
[3272](a) Schedule C, line 21. (Enter combined amount if more than one business.) Lone
[3274](b) Partnerships, joint ventures, etc. (other than farming) . . . . ee ee
[3276]REGULAR METHOD|.{c) Service as a minister, member of a religious order, or a Christian Science prac-
[3278]5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If you
[3279](loss) from: filed Form 4361, check here » [[] and enter zero on this line
[3280]: (d) Service with a foreign Bovernment or international organization
[3282](e) Other Crastions tor line. 35 35) Specify De eee cece eee cence ee npeecnvsenevaceaeeeraeee
[3284]6 Total (add lines 5(a) through (e)) . 2. 1. ww ee
[3285]7 Enter adjustments if any (attach statement)
[3287]8 Adjusted net earnings or (loss) from nonfarm self- employment ‘tine 6, as 5 adjusted: by line 2). .
[3288]If tine 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 9 through
[3289]11 and enter amount from line 8 on line 12(b), Part IIL.
[3290]Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than $1,600 and less
[3291]than two-thirds of your gross nonfarin profits,” and you had actual net earnings from self-employment of $400 or more
[3292]tor at least 2 of the 3 following years: 1972, 1973, and 1974. The nontarm. optional method can only be used for 5
[3293]taxable years.
[3294]NONFARM. OPTIONAL METHOD .
[3295]’ 9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
[3296](b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.) .
[3297](c) Balance (subtract line 9(b) from line 9(a)) . 7 2. ww we eee ke
[3298]10 Enter two-thirds of gross nonfarm profits? or $1,600, whichever is smatler .. oe ee ee
[3299]11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller .
[3300]2Gross profits from noantarm business are the total of the gross profits from Schedule C, line 3, plus the distributive
[3302]share of gross profits fram nonfarm partnerships (Schedule K-1 (Form 1065), tine 14) as explained in instructions
[3303]for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7.
[3305]BZ Computation of Social Security Self-Employment Tax
[3307]12 Net earnings or (loss): (a) From farming (from line 4). 2 2 1. . Cone ete
[3308](b) From nonfarm (from line 8, or tine 11 if you elect to use the Nonfarm ‘Optional Method)
[3310]13 Total net earnings or (loss) from self-employment reported on line 12. (Hf Line 13 is less than $400, you are not
[3311]subject to self-employment tax. Do not fiil in rest of schedule.) .
[3313]14 The largest amount of combined wages and self- employment earnings Subject to social | security ¢ or railroad
[3314]retirement taxes for 1975 is
[3316]15 (a) Total “FICA’ wages and “RRTA’’ compensation. . . . —— EZ
[3317]. (b) Unreported tips subject to FICA tax from Form 4137, tine 9 orto RRTA.. .
[3319](c) Total of lines 15(a) and (by) ©. 7, ee ee
[3320]16 Balance (subtract line 15(c) from line 14) . 2. 2 we one Ce ee ee nk ke
[3322]17 Self-employment income—line 13 or 16, whichever is smaller . . . . soe
[3324]18 Self-employment tax. (If tine 17 is $14,100.00, enter $1,113.90; if ess, mutual & the amount on line 17
[3325]by .079.) Enter here and on Form 1040, line 59 . : eee
[3326]yc U.S, GOVERNMENT PRINTING OFFICE : 1973—-O-575-058
[3328]NW 88326 Docld:32245535 Page 35
[3332]j 5G
[3333]Vee Leas %
[3335]es
[3339]]
[3340]4
[3342]. :
[3344]NW 88326 Docid:32245535 Page 36
[3346]. 47197 Supplemental Schedule of Gains and Losses
[3348]u
[3350]Department of the Treasury ‘ Sections 1231, 1245, 1250, 1251, and’ 1252
[3352]Internal Revenue Service
[3354]Sales, Exchanges and Involuntary Conversions under 1975 a
[3356]g. be filed with Form 1040, 1041, 1065, 1120, etc.—See Separate Instructions
[3358]Identifying qumber
[3360]KUL’ BrL-/L-2FIP
[3362]ft Property Used in Trade or Basiness, and Involuntary Conversions .
[3364]J
[3365]Part . (Section 1231)
[3367]SECTION A.—Involuntary Conversions Due to Casualty and Theft (See Instruction E)
[3369]f. Cost or other basis,
[3371]a. Kind of property (if necessary, . . - e. Depreciation al. | cost of subsequent im- .
[3372]attach additional descriptive b. Date acquired] c. Date sold d. Gross sales lowed (or allowable) | provements (if not pur- g. Gain or (loss)
[3373]details not shown below) (mo., day, yt.) | (mo., day, yr.) price since acquisition | chased, attach explana. (d plus e less f)
[3375]tion) and axpense of sale
[3377]2 Combine the amounts on line 1. Enter here, and on the appropriate line as follows . 9... ee ee es
[3379](a) For all except partnership returns:
[3380](1) If line 2 is zero or a gain, enter such amount in column g, line 3. ; : : ;
[3381](2) If line 2 is a loss, enter the loss on line 5, . : ; a
[3382](b) For partnership returns: Enter the amount shown on line 2 above, on Schedule K (Form 1065), line 6.
[3384]tion A) (See Instruction E) :
[3386]4 Combine the amounts on line 3. Enter here, and on the appropriate line as follows .
[3388](a) For all except partnership returns: . : .
[3390](1) If line 4 is a gain, enter such gain as a long-term capital gain on Schedule D (Form 1040, 1120, etc.) that is being filed. See
[3391]instruction E.s -
[3392](2) If line 4 is zero or a loss, enter such amount on line 6.
[3394](b) For partnership returns: Enter the amount shown on line 4 above, on Schedule K (Form 1065), line 7.
[3396]~ Part Il. - Ordinary Gains and Losses
[3398]f. Cost or other basis,
[3400]a. Kind of property (if necessary, + e. Depreciation al- } cost of subsequent im- .
[3401]attach additional descriptive b. Date scauired| ¢. Date sold | 4. Gross sales rowed” tor allowable) | provements Cit ant pur | & Gain oy Cow)
[3403]details not shown below) (mo., day, yr.) | (mo., day, yr.) price since acquisition | chased, attach explana-
[3404]. : tion) and expense of sale
[3406]5 Amount, if any, from line 2(a)X(2) . - ew ee
[3408]6 Amount, if any, from line 4(a)(2) 2 6 ee
[3409]7 Gain, if any, from page 2, line 21
[3411]8 .
[3413]9 Combine amounts on lines 5 through 8. Enter here, and on the appropriate line as follows Coe
[3414](a) For all except individual returns: Enter the gain or (toss) shown on line 9, on the line provided for on the
[3416]return (Form 1120, etc.) being filed. See instruction F for specific line reference.
[3418](b) For individual returns: ; :
[3420](1) If the gain or (loss) on line 9, includes losses which are to be treated as an itemized deduction on
[3421]Schedule A (Form 1040) (see instruction F), enter the total of such loss(es) here and include on
[3422]Schedule A (Form 1040), line 29—identify as ‘‘loss from Form 4797, line 9(b)(1)"" . ye,
[3423](2) Redetermine the gain or (loss) on tine 9, excluding the loss (if any) entered on line 9(b)(1). Enter here
[3424]and on Form 1040, line 30... ee ee
[3426]16—82504-1 mo, 7 _ uo : Form 4797 (1975) =.
[3429]Forms 4797 (1975) : . . Page 2
[3431]Gain From Disposition of Property Under Sections 1245, 1250, 1251,
[3432]1252—Assets Held More than Six Months (See Separate Instructions) os
[3433]Disregard lines 18 and 19 if there are no dispositions of farm property or farmland, or if this form is filed by a partnership. ¢
[3435]10 Description of sections 1245, 1250, 1251, and 1252 property: . pute acquired, ima 4s
[3437]ai l2¥|. Lfad. far |
[3439]Relate lines 10(A) through 10(E) to these
[3442]Property Property Prope rty Property
[3443]« ) ” (D) :
[3445]11 Gross sales price . .
[3446]12 Cost or other basis and expense of sale .
[3447]13 Depreciation allowed (or allowable)
[3449]14 Adjusted basis, tine 12 less tine 13.
[3451]15_Total gain, line 11 lnss ine 14
[3452]i6 if section 1245 property:
[3453](a) Depreciation allowed (or allowable) after ap
[3454]plicable date (see instructions) .
[3455]___(b) Enter smalier of line 15 or 16(a) .
[3456]17” If section 1250 property:
[3457](a) Enter additional depreciation atter 12/31/83
[3458]‘and before 1/1/70:
[3460](b) Enter additional depreciation after 12/31/69
[3461](c
[3462]id
[3464]~~.
[3466]‘Enter smaller of line 15 or 17(3)
[3470]Line 1/7(c) times applicable percentage (see
[3471]instruction G.4) ..
[3473](e) Enter any excess of line 15 over line 1706) .
[3474]{f) Enter smaller of line 17(a) or 17{e) .
[3476](g) Line 17(f) times applicable percentage. (see
[3477]instruction G.4)
[3478]4h) Add fines 174d) and 17)
[3479]18 Wf section 1251 property:
[3480](a) ‘lf farmland, enter soil, water, and land clear-
[3481]ing expenses for current year and the four
[3482]Preceding years . .
[3484](b) {f farm property other than land, subtract ‘ine : oo : ,
[3485]16(b) from line 15; OR, if farmland, enter
[3486]‘smaller of line 15 or 18(a) (see instruction
[3487]G5). ee
[3491](c) Excess deductions account {see instruction
[3492]=D)
[3494](d) Pier smaller of line 18(b) or “18(c)
[3496]19 If section 1252 property:
[3497](a) Enter soil, water, and land clearing expenses .
[3498]made after 12/31/89 rs Le nesececececasfenecececeeceeceeecncee peceteeceenneereeecece] ennneeenecececpeeenere| pee geenegenenereeenes
[3500](b) Enter amount from tine we F(a), if none enter a
[3501]zero .
[3503](c) Enter any excess of line 19(a) over line 19(b)
[3505](d) line 19(c) times applicable percentage (see :
[3506]instruction G.5) Fn nn Se oceeeseseeeececeeee | ccceeee en ee
[3507](e) Line 15 fess line 19(b) .
[3508](f) Enter smaller of tine 19(d) or 19{e) .
[3509]Summary of Part tll Gains (Complete Property columns 5 (A) through (E) through line 19(f) before going to line 20)
[3511]20 Total gains for all properties (add columns (A) through (E), line h-) - ye ee ee a ZY E-
[3513]“21 = Add columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter here and on line 7. . - soe 22/3-
[3515]fOS .
[3517]_ WULS, GOVERNMENT PRINTING OFFICE ; 199S—O-575-158 . _ . + . 16—-82.504-1
[3519]22 Subtract line 21 from line 20, Enter here and in appropriate Section in Part | (see instructions E and G.2) .
[3521]“NW 88226 Dochd:32245535 Page 37 i
[3523]rom 4798
[3525]Department of the Treasury
[3526]Internal Revenue Service
[3528]Name(g) as shown on Form 1040
[3530]A. Who Should File.—You wil! need to complete either
[3532]. Part i or Part Il of this form if you have a capital. loss to
[3534]carry over to 1975.
[3536]You will have a capital loss to carry to 1975 if the
[3537]amount on your 1974 Schedule D (Form 1040), line
[3538]16(a), or line 33, is LARGER THAN the loss deducted
[3539]on your 1974 Form 1040, line 29.
[3541]4
[3543]Capital Loss Carryover
[3544]> (From 1974 to 1975)
[3545]m» Attach to Form 1040.
[3547]Social Security Number
[3549]B. How to Compute Carryover.—lIf you have a capital
[3550]_ loss carryover, complete either Part | or Part li of this
[3551]form, but do not complete both.
[3553]1. Complete only Part-I if lines 4(a) and 12(a) on .
[3554]your 1974 Schedule D (Form 1040) DO NOT SHOW A
[3555]LOSS.
[3557]- 2. Complete only Part Il if either (or both) line 4(a) or
[3558]line 12(a) on your 1974 Schedule D (Form 1040) shows
[3559]a loss. ; —
[3561]MEZUAME Post-1969 Capital Loss Carryovers,
[3563]Section A,-—-Short-term Capital Loss Carryover
[3565]lines 2 through 6—then go to line 7
[3567]2 Enter gain shown on your 1974 Schedule D (Form 1040), line 13. i that line is blank or "shows
[3569]a loss, enter a zero
[3570]3 Reduce any loss on line 1 to the extent of any gain online 2 .
[3571]4 Enter amount shown on your 1974 Form 1040, line 29
[3572]5 Enter smaller of line 3 or 4 .
[3574]6 Excess of amount on line 3 over amount on fine 5
[3576]Enter loss shown on your 1974 Schedule D (Form 1040), line 5; if none, enter zero and ignore
[3578]Note: The amount on line 6 is your short-term capital loss carryover from 1974 to 1975 that is attributable to years beginning
[3579]after 1969. Enter this amount on your 1975 Schedule D (Form 1040), line 4(b). .
[3581]Section B.—Long-term Capital Loss Carryover
[3583]1040, line 29) .
[3585]8 Enter toss from your 1974 Schedule D (Form 1040), line 13: if none, enter zero and ignore lines
[3587]9 through 12
[3589]9 Enter gain shown on your 1974 Schedule D > (Ferm 1040), line 5. if that line is "blank or ‘shows
[3591]a loss, enter a zero
[3592]10 Reduce any !oss on line 8 to the extent of any gain on line 9
[3593]11 Multiply amount on line 7 by 2 .
[3595]12 Excess of amount on line 10 over amount on ‘line ll.
[3597]. 7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1974. Form
[3599]Note: The amount on line 12 is your long-term capital loss carryover + from 1974 ‘to ‘1975 that is attributable to years beginning
[3600]after 1969. Enter this amount on your 1975 Schedule D (Form 1040), fine 12(b). :
[3602]a
[3604]NW 88326 Docld:32245535 Page 38
[3606]Form 4798 (1975)
[3609]PO a beta, bb ret r E Ts
[3611]Form 4798 (1975)
[3613]a Pre-1970 and Post-1969 Capital Loss Carryovers
[3615]Section A.—Short-term Capital Losses Identified
[3617]1 Enter loss shown on your 1974 Schedule D (Form 1040), line 5; if none, enter zero and ignore
[3618]lines 2 through 20—then go to line 21
[3619]2 Enter gain shown on your 1974 Schedule D (Form 1040), | line 13, it that | line is ‘blank or "shows
[3620]a loss enter a zero tot thos
[3621]3 Reduce loss on line 1 to the extent of any gain on ‘ine 2.
[3622]i Note: /f line 4(a) on your 1974 Schedule D (Form 1040) is blank, IGNORE lines 4 through 11, enter
[3623]. a zero on line 12—then go to line 13.
[3624]4 Combine lines 3 and 11 on your 1974 Schedule D (Form 1040). -
[3626]Enter the gain; or if zero or a loss, enter a zero .
[3628]yo . Note: If line 4 is zero IGNORE lines 5 through 11, enter ¢ on line 12
[3629]the loss from your 1974 Schedule D (Form 1040), line 4(a)—
[3630]then go to line 13.
[3632]5 Enter any gain from your 1974 Schedule D (Form 1040), line 3.
[3634]6 Enter smalier of line 4 or 5 .
[3636]7 Enter excess of gain on line 4 over line 6. no.
[3638]; 8 Enter loss from your 1974 Schedule D (Form 1040), line 12(a):
[3639]to otherwise, enter a zero.. :
[3641], 9 Reduce any gain on line 7 to the extent of any y loss ¢ on line 3.
[3643]a 10 Enter loss from your 1974 Schedule D (Form 1040), line 4(a); other-
[3644]: wise enter a zero . rT
[3645]11 Add the gains on lines 6 and 9 toe : .
[3646]12 Reduce the loss on line 19 to the extent of any gain on ‘tine ul.
[3648]: 7 13 Pre-1970 short-term capita! loss (Enter smaller of line 3 or 12) . .
[3649]14 Short-term capital loss attributable to years beginning after.1969 (excess 5 of line 3 over line 13)
[3651]15 Enter any loss from line 13, above .
[3653]16 Enter loss deducted on your 1974 Form 1040, line 29.
[3654]17 Loss carryover to 1975 (excess of line 15 over line 16—if line 15 does not exceed line 16, enter
[3655]zero). Enter here and on your 1975 Schedule D (Form 1040), line 4(a) .
[3657]1
[3658]at
[3663]18 Enter any loss from line 14, above .
[3664]‘19 Enter excess of line 16 over tine 15—if line 16 does not exceed line
[3665]15, enter zero : :
[3666]20 Loss carryover to 1975 (excess of line 18 over fine 19—if line 18 does not exceed line 19, enter
[3667]zero), Enter here and on your 1975 Schedule D (Form 1040), line 4(b) . .
[3668]21 If you were required to complete Part IV of your 1974 Schedule D
[3669](Form 1040), enter any loss fram your 1974 Schedule D (Form
[3670]1040), line 30; otherwise, enter zero. . » ee {22
[3671]22 Enter excess of line 19 over line 18—if line 19 does not exceed line
[3672]18, enter zero. (Note: If you ignored lines 2 through 20 above, ¢ enter -
[3673]: 22 | —0-——
[3674]amount from your 1974 Form 1040, line 29.) tee eee
[3675]_ 23 Loss carryover to 1975 (excess of line 21 over line 22—if line 21 does not exceed line 22, enter
[3676], : zero). Enter here and on 1975 Schedule D (Form 1040), line 12(a). . ee Be)
[3677]“ : 24 If you were required to complete Part IV of your 1974 Schedule D
[3678](Form 1040), enter any loss from “your 1974 Schedule D (Form
[3679]1040), line 31. However, if Part IV was not required, enter any loss
[3680]from your 1974 Schedule D (Form 1040), line 13
[3682]25 Enter excess of line 22 over line 21 «........0. ee x2 Cif line 22 :
[3683]— O-—
[3684]does not exceed line 21, enterzero.). . . . . . 25 ;
[3685]26 Loss carryover to 1975 (excess of line 24 over line 25—it line 24 does not exceed line 25, enter Hl
[3687]zero). Enter here and on your 1975 Schedule D (Form 1040), line 12(b). . . . «| 26
[3689]W 88326 Docld:32245535 Page 39
[3691]gee a or
[3692]Vad ag tama ee OST ek leet
[3694]iA ad _ CALENDAR YEAR 19° PS
[3695]322—/2-7 SOC. SEC.-NO.
[3696]ne ; DEDUCTION SCHEDULE
[3697];- MEDICAL STATE | FEDERAL [CONTRIBUTIONS -
[3698]* ° 2 MEDICINE/DRUGS : 1a CASH CONTRIBUTIONS
[3699]. - 3 LESS 1% A.G.I. (Line 18 - 1040) 21b PARTNERSHIP SHARE
[3700]1 _@NET MED/DRUGS GIRL/BOY SCOUTS
[3702]5H & AINS. (% + EXCESS) HEART FUND/CANCER FUND
[3704]STATE FEDERAL
[3708]a
[3710]|
[3712]A
[3714]al
[3716]| _Gapr. RED CROSS/UNITED FUND f
[3717]: DR. XMAS & EASTER SEALS ‘
[3719]MISC. ORGANIZED CHARITI§
[3721]CHURCHES
[3723]|
[3739]|
[3743][| [22 0THER THAN CASH
[3744][at eanaroven tron moa vast
[3747]| |
[3749]|
[3751]|
[3757]oo
[3758]Dina
[3760]X
[3761]3
[3763]LS.
[3764]CASUALTY OR THEFT (LUSS(E
[3766]25 LOSS BEFORE ADJUSTMENT
[3768]26 INSURANCE REIMBURSEMENT
[3769]27
[3770]26 ($100 LIMITATION PER CAS.)
[3772]MISCELLANEOUS DEDUCTIONS
[3774]6b HOSPITAL
[3775]PROSTHETIC APPLIANCES
[3776]HEARING AID
[3778]n
[3780])
[3782]6c AMBULANCE
[3783]4, LABORATORIES
[3784]’ TRAVEL FOR MED.
[3786]eS
[3787]-
[3789]30 ALIMONY. - “
[3790]31 UNION/PROFESSIONAL DUES
[3792]32 CHILD & DEP. CARE (Form 2441)
[3793]33 INCOME TAX PREPARATION:
[3794]UNIFORMS/PROTEC. CLOTHING
[3796]11377 |_| sMALt TOOLS AND suPPLIES
[3797]| =} SO] | LauNnprRy AND CLEANING
[3798]| 1S 2) | | auto use/oamace
[3800]INVEST. COUNSEL & PUBS.(Sched
[3801]|__EMPLOYMENT AGENCY FEES
[3802]SAFE DEPOSIT BOX
[3804]POLITICAL CONTRIBUTIONS
[3806]MEDICARE INS.
[3807]GLASSES _
[3808]7] MEDICAL EXPENSES -
[3809]LESS REIMBURSED BY INS.
[3810]B LESS 3% ADJ. GROSS INC.
[3811]9
[3812]1+:% (TO $150)-OF H&AINS. >
[3813]+ (OTOTAL MEDICAL DED.
[3814]1 _TAXES
[3815]~  ALSTATE & LOCAL INCOME
[3816]AREAL ESTATE
[3817]1 T3STATE & LOCAL GASOLINE
[3818]1 14GENERAL SALES TAX
[3819]15a PERSONAL PROPERTY
[3821]I
[3823]2-T |
[3825]LOTT ' :
[3826]EUUTENOOUETREGEY UTE THVT ESS
[3828]| 1SbPERSONAL PROPERTY AUTO | -} 2
[3829]pf} 34 TOTAL MISC. DED.
[3830]es es Os
[3831]a —
[3833]TTTOTAL TAXES IN 22 Xo A Se
[3834]INTEREST (TO WHOM PAID : 36 TOTAL TAXES (From LINE 17)
[3835]37 TOTAL INTEREST (Line 20)
[3837]38 TOTAL CONTR. (Line 24)
[3839]39 CAS. & THEFT LOSS(ES) ({Line29)
[3841]40 TOTAL MISCELLANEOUS : .
[3842]DEDUCTIONS (FROM LINE 34}
[3844]Al TOTAL ITEMIZED DEDUCTIONS
[3845]ENTER ON FORM 1040 LINE 45
[3846]R .
[3848]EMARKS
[3850]WDINSTALLMENT LOANS MJ LSC
[3852]| TRANS ALOR ED
[3853]- SBR _
[3854]i 7 ¥edDea
[3856]20 TOTAL INTEREST ie? <ou
[3858]Professional Stationers, lnc_
[3859]7440 Laurel Canyors Boulevard Form 101
[3861]“NW 8326 Docid:32245535 Page 40. oo, © SCHEDULE 7
[3863]AMOR TGAGE =
[3864]| TSE
[3866]SANT
[3868]s nn
[3869]m
[3871]. i]
[3872]m
[3874]us >
[3875]-
[3877]SERGRnn0
[3879]Coo
[3883]s
[3885]- NAME 1.0. NO. S 7 CALENDAR YEAR 19 2s
[3886]- >. - GP SOC. SEC. NO. ; ee
[3887]ADDRESS 3B22- - 2 FISCAL YEAR ENDING
[3891]EDULE OF PROFIT OR LOSS FROM BUSINESS OR PRO S UON
[3892]PRINCIPAL BUSINESS ACTIVITY
[3893]BUSINESS NAME . : EMPLOYERS NO.
[3895]BUSINESS ADDRESS
[3897]TOTAL RECEIPTS es es 7 et
[3900]: . S
[3901]INVENTORY AT BEGINNING OF YEAR (i f) ()
[3903]MERCHANDISE PURCHASED : . : Gj
[3905]RL
[3906]a , | 7 “Bye —
[3907]t LESS INVENTORY AT END OF YEAR ot |
[3909]GROSS PROFIT
[3911]GROSS INCOME
[3912]{ : - OTHER BUSINESS DEDUCTIONS
[3914]t
[3916]ADVERTISING oy a" iz
[3918]7 AUTO ANO TRUCK EXPENSE | rea
[3920]BAD DEBTS ‘
[3921]COMMISSIONS
[3923]me
[3924]DELIVERY .
[3926]DEPRECIATION ( SCHEDULE BELOW }
[3928]DUES AND SUSSCRIPTIONS
[3930]} > ENTERTAINMENT AND PROMOTIONAL . . :
[3934]: _ INSURANCE : , : . Ke
[3935]Sa cE
[3937]Pt tO?
[3938]P|
[3940]an INTEREST
[3941]JANITOR ANO HAULENG
[3943]LEGAL AND ACCOUNTING
[3945]OFFICE SUPPLIES AND EXPENSE
[3946]i
[3949]i REPAIRS AND MAINTENANCE ,
[3950]{ SALARIES AND WAGES .
[3951]' SUPPLIES .
[3953]oo. TAXES AND LICENSES
[3955]TAXES PAYROLL
[3957]een ENE
[3958]TELEPHONE AND UTILITIES.
[3960]tae ee. [NE N : a
[3961]| TIE RAC LALO QT
[3963]NET PROFIT OR (LOSS }) FEDERAL RETURN J
[3965]NET PROFIT OR (LOSS ) STATE RETURN - SEE DEPREC, SCHEDULE FOR DIFF, Gabsra ACs 9x7 ma
[3966]. SCHEDULE OF DEPRECIATION
[3967]" DATE COST OR
[3968]4 ; ; OTHER BASIS
[3970]' PROFESSIONAL STATIONERS INC FORM JO4A . mo . . ; ! .
[3971]LOS ANGELES, CALIF. oe re SCHEDULE
[3973]“NW 88326 Docid:32245535 Page 41
[3976]or YL Co
[3977]“NAME Samuel tay SOC. SEC. NO.
[3979]" DESCRIPTION OF PROPERTY.
[3981]ps KuBy
[3983]GAINS ON INSTALLMENT SALES
[3985]war
[3987]DATE ACQUIRED
[3988]TYPE OF ASSET: __
[3990]1. SELLING PRICE: CASH
[3992]‘Calendar Yr:
[3993]_F/Y/E 19
[3994]pate soto FP f 2S 7S
[3995]CAPITAL | SEC. 1245 "| SEC. 1250
[3997]2 NOTES ,
[3999]3 MORTGAGE TRANSFERRED
[4000]4 . OTHER
[4001]5. GROSS SALES PRICE (1+2+3+4)
[4003]6. COST OR BASIS
[4005]7. LESS ACCUMULATED DEPRECIATION
[4007]8 PRIOR TO 1-162 __
[4009]9. PRIOR TO 1—1-64
[4010]AFTER 12-31-61
[4011]ST. LINE AFTER 12-31-63
[4013]EXCESS OVER S/L.1—64/12-—69
[4014]; EXCESS OVER S/L AFTER 12—31-69
[4015]._ ADJUSTED BASIS (6-7 THRU 13)
[4017]“NW 88326 Docld:32245535 Page 42
[4019]NOFLEG CALIE enna ag
[4021]. EXPENSES OF SALE
[4023]. TOTAL ADJUSTED BASIS (14 + 15)
[4024]. TOTAL GROSS PROFIT (5 — 16)
[4025]18. TOTAL GROSS PROFIT — ORDINARY
[4027]. TOTAL GROSS PROFIT — OTHER
[4028]. CONTRACT PRICE (1 +2 +4)
[4029]1. GROSS PROFIT % —
[4031]. PAYMENTS RECEIVED YEAR OF SALE
[4033]CASH (1}
[4035]PRINCIPAL COLLECTIONS -
[4036]EXCESS MORTGAGE OVER BASIS
[4037]26... ° OTHER (4)
[4039]27. TOTAL PAYMENTS (23 THRU 26)
[4041]28. RECOGNIZED GAIN
[4043]29. RECOGNIZED GAIN — ORDINARY
[4044]30. RECOGNIZED GAIN — OTHER
[4046]ORDINARY INCOME
[4048]SECTION 1245
[4050]REPORTED
[4052]- TAX- TOTAL LESS INT.
[4053]ABLE PAYMENTS = [20,7732
[4055]CAPITAL GAIN
[4057]REPORTED
[4059]a
[4060]|
[4062]|
[4068]m
[4070]- BALANC
[4072]- eruEnI Ee
[4075]29 Married filing joint return (even if only one had income)
[4077]. INDIVIDUAL
[4078]CALIFORNIA
[4080]“INCOME TAX
[4082]PLACE PREADDRESSED LABEL HERE, if avaiable (Correct name and address, if necessary) ‘| Check “SaeCalendar Year
[4083]Enter social security number(s) only if incorrect or _not shown on label. - One: (7) Fiscal Year Ending._____-_1976
[4084]NAME_J(If joint return, MEL first p: initials of both} Aas NAME . CATION SEE BAGE SAE INSTRUCT ONS
[4085]AM Lf Your Social Security Number
[4086]. : ct i”
[4088]PRESENT TE Ee he (Number Ps tre
[4090]~~ Spouse's Social Securily Number
[4092]: [LE SF 24
[4093]occu. | Yours :
[4094]PATION | Soouse's
[4096]FILING STATUS oneck mar One:
[4097]1 Single
[4099]EXEMPTION CREDITS. | If fine 1 or 3 checked, enter $25
[4100]‘G Personal If line 2, 4 of 5 checked, enter $50
[4102]7 Dependents — Do not list yourself, your spouse or the person who qualifies you
[4103]as head of household. Enter name and relationship. .
[4105]__ELItA
[4106]. __CHOMMIA-S .
[4107]4 © Head of Household—Enter name of qualifying
[4109]individual 8 Blind (refer to instructions) Number of blind exemptions x $8
[4110]5 [) Widow(er) with dependent child (Year spouse died 197.) 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20
[4112]3 (1) Separate return of married person—Enter spouse’s
[4113]social security number and full name here
[4115]{ Attach copy 2 of Form(s) W-2 to face of this ?
[4116]10 Wages, salaries, tips and other employee compensation, return. it unavailable, see instructions, Page 6 {
[4118]11 Dividends—before federal exclusion. Enter total {if over $400, complete and attach Schedule (540) )
[4119]12 Interest. Enter total (if over $400, complete and attach Schedule B(540))-
[4121]13 Income other than wages, dividends and interest (from fine 48)
[4123]14 Total (add lines 10, 11; 12 and 13)
[4125]15 Adjustments to income (from line 55) ;
[4127]16 Adjusted gross income (subtract line 15 from tine 14)
[4129]© If line 1 or 3 is checked and line 16 is $4,000 or less, enter zero tax on line 23, Do not complete {
[4130]© If tine 2, 4, or 5 is checked and tine 16 is $8,000 or less, enter zero tax on line 23, } lines .17 thru. 22
[4132]© If you do NOT itemize deductions AND tine 16 is under $15,000, find tax in Tax Table and enter on line 19.
[4133]© If you itemize deductions OR line 16 is $15,000 or More, complete lines 17 and 18.
[4135]17 Deductions: Itemized (from line 62) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 of 5 checked)
[4136]18 Taxable income (subtract line 17 {rom tine 16) Compute tax fyem Tax Rate Schedule—Enter tax on line 19
[4138]“4 ATTACH COPY 2 OF FORM W-2 HERE
[4140]19 Tax from (check one) Tax Table [ Tax Rate Schedtteg7 Income Averaging Schedule (G or 6-1) 0
[4141]20 Total exemption credits (from line 9, above) . ,
[4143]21. Tax liability (subtract tine 20 from tine 19—if line 20 is greater” than line 19, enter aero)
[4145]22 Other credits (from tine 65)
[4147]23° Net tax liability (subtract line 22 from tine ait line 22 is s greater than “tine “21, enter 2et0)
[4149]24 Tax on preference income (see instructions—attach Schedule P(540) )
[4151]25 Total tax liability (add lines 23 and 24)
[4153]26 Total California income tax withheld (attach W-2 or W-2P to face of this return) .
[4154]27 Renter's credit—if you lived in rented property on March 1, 1975, complete Part 1 on page 2
[4155]28 1975 California estimated tax payments . . . toe. OF 28.
[4156]29° Excess California SBI tax withheld (attach Form DE 1964 t to face of this return) . rn | o
[4157]30 Total prepayment credits (add lines 26 thru 29) a .
[4158]31 If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero.
[4159]Pay in full and mail with return to: FRANCHISE TAX BOARD mre PAY IN FULL ——> 3)
[4160]SACRAMENTO, CA 95867 : .
[4162]32 If line 25 is smailer than line 30, enter amount OVERPAID
[4164]‘33° Amount of line 32 to be REFUNDED TO YOU. Atlow at least six “weeks,
[4166]Mail return to: FRANCHISE TAX BOARD
[4167]P.O. BOX 13-540
[4169]SACRAMENTO, CA 95813 ri
[4171]34 Amount of line 32 10 be credited on your 1976 ESTIMATED TAX. Ee | <—— ESTIMATED TAX} R
[4173]Under penalties of perjury, | declare that | hove examined this return, including accompanying schedules and statements, and to the best of my knowledge ond
[4174]belief it is true, correct and complete. If prepared by a person other than taxpayer, his declaration is based on all information of which he has any knowledge.
[4176]z SIGN or signature . Date - 7 P Scary Signature (other than taxnayer) : Date .
[4177]7 HERE eT signature—if a4d Joint return Date : a Address (and Zip cole) "36 2: 3 v859
[4179]Do not write in these spaces
[4181]ATTACH FORM DE 1964 HERE
[4182]Write social security number on check or money order. ATTACH HERE »
[4184]nw 88326 Docid:32#745555 Page
[4186]+ Page 2 Form 540 (1975)
[4188]PART | — Renter's Credit — All questions must be answered
[4190]35 Did you, on March 1, 1975, live in rented property which was your principal residence? . . . . (© Yes Sh Wo If no, you may not claim this credit
[4191]36 Was the property you rented exempt from property tax? . . . . - oe oe wees 6D Yes O-No if yes, you may not claim this credit
[4192]37 “Did you tive with any other person who claimed you as a dependent for i income tax purposes? . . OG Yes “(No If yes, you may not claim this credit
[4194]38 Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance? (J Yes O No If yes, see page 6 of instructions
[4196]PART Ii — Other Income : . ; . J
[4198]39 Business income (or loss) (attach Schedule C(540}) ~
[4200]: 40 Net gain (or loss) from sale or exchange of capital assets fattach Schedule 01540) )
[4202]| 41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D- 115400)
[4203]: 42 Pensions and annuities
[4205]:; 43° Rents and royalties . curnuce el A
[4208]A 44 Partnerships . . 1. FORM (540) I Peete ec cn Pree n eee
[4209]4 45 Estates and trusts . . . yd [eee ereeeeeeeee Stree
[4211]46 farm income (or loss) (attach Schedule F(540) }
[4213]47 Miscellaneous income ~
[4215]~ (a) Fully taxable pensions and annuities (not reported on Schedule £(540) )
[4217](b) Alimony . Loe
[4219](c) Other (state nature and SOUICE) eee sevoeesenssoneenneesnceneeeneeeeauteeenesouseese
[4220]Enter total of lines 47(a), 47(b), and 47(c)
[4222]Total (add lines 39 thru 47).
[4224]Fr PART ‘ll — Adjustments to Income
[4226]49 “Sick pay,” if included in line 10 (see instructions — attach statement)
[4228]: 50 Moving expenses (see instructions —- attach statement)
[4230]4 51 Employee business expenses (see instructions — attach, statement)
[4232]z 52 Military exclusion (see instructions) . .
[4234]A §3 Payment as a self-employed person to a retirement plan, etc. (see instructions)
[4235]4 54 Forfeited interest penalty (see instructions) Lo
[4237], 55 Totat adjustments (add lines 49 thru 54). Enter here and on line 15
[4239]Enter here and on line 13°.
[4241]PART IV — Itemized Deductions —
[4243]@ Attach Schedule A(540) and enter sub-totals on lines 56 thru 61, below
[4244]_ 56 Total deductible medical and dental expenses (from Schedule A(540), line 10)
[4245]- _ 57 Total child adoption expenses (from Schedule A(540), tine 13)
[4246];| 58 Total taxes (from Schedule A(540), line 20)
[4247]4 59 Total interest expense (from Schedule A(540), line 23)
[4248]+ 60 Total contributions (from Schedule Al540), line 28)
[4249]61 Total miscellaneous deductions (from Schedule A(540), line 39)
[4250]62 Total itemized deductions (add lines 56 thru 61). Enter here and on line 17
[4252]i PART V — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW.
[4254]63 “Other State’ net income tax credit (attach copy of other state return and Schedule $(540)) toe ee ee ee y
[4255]64 Retirement income credit (attach Schedule RIS40)) . 2... ®
[4257]65 TOTAL (add lines 63 and 64).
[4259]Enter here and on line 22
[4261]NW 88326 Docld:32245535 Page 44
[4263]|
[4264]|
[4265]|
[4267]on Form 540
[4269]Name as show!
[4271]or $4,000 or less and your filing status is ‘‘Single,”
[4272]table box.
[4274]Medical and dental expenses (not compensated by insurance or otherwise) for
[4275]medicine and drugs, doctors, dentists, nurses,
[4276]hospital care, insurance premiums for medical
[4277]care, etc.
[4281]. One half (but not more than $150} of insurance
[4282]premiums for medical care................ Doce ee ee
[4284]. Medicine and drugs. 2.000... 0... ccc eee
[4285]. Enter 1% of line 16, Form 540......... ena L
[4287]. Subtract line 3 from line 2. Enter difference (if less
[4288]than zero, enter zero)... 6... .
[4290]Plow Nn
[4292]5. Enter balance of insurance premiums for medical care
[4293]not entered on line Loo... eee
[4295]6. Other medica! and dental expenses: ~
[4296]“ (a) Doctors, dentists, nurses, etc.......... rn
[4297](b} Hospitals
[4298](c) Other (itemize)... nee eeencseecceceseeceencersnesecneenscemeesnere
[4300]9. Subtract line 8 from line 7. Enter difference (if less
[4301]than -zero, @nter zero).....................00. .
[4303]10. Total—(Add lines 1 and 9. Enter here and Q
[4305]Form
[4306]540, line 56)......... :
[4308]Child Adoption Expense
[4310]11. Total expenses paid or incurred—Attach itemized list
[4311]12. Enter 3% of line 16, Form 540..................
[4312]13. Subtract line 12 from line 11—See instructions for
[4314]maximum limitations. (Enter here ‘and on Form 540,
[4315]line 57). eee eee
[4317]Taxes
[4318]14. Real estate.....00.0 0.0.2 eee
[4319]15, State and local gasoline
[4320]16. General Sales...... cece eevee eee .
[4321]17. Auto license—Excess of registration and weight fees
[4322](see instructions)...................0.0220 2000
[4323]18. Personal property (Boat and Aircraf)..............
[4324]19. Other (itemize)
[4326]20, Total taxes—(Add lines 14 thru 19. “Enter here and
[4327]on Form 540, line 58)............0..000.0c eee
[4329]NW 88326. Docld:32245535 Page 45
[4331]» CALIFORNIA
[4332]ITEMIZED DEDUCTIONS
[4334]Attach to Form 540
[4336]It your adjusted gross income is $8,000 or less and your ning status is “Married, Filing Taint.” “f 4d of Household,” or ‘“Widow(er) With Dependent Child,”
[4337]‘Married, Filing Separately,” do not itemize, enter zero on Form $40, line 23, and check the tax
[4339]USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEOUCTION
[4341]30. Insurance
[4343]31. Subtract line 30 from line 29. Enter difference (if line
[4345]Social Security N Number,
[4347]Interest Expense
[4349]21, Home mortgage... eee
[4350]22. Other (itemize)
[4352]23. Total—tAdd lines .21 and 22. Enter here and on
[4353]Form 540, line 59).
[4355]Contributions
[4357]24. Cash contributions for which you have receipts,
[4358]canceled checks, etc......... bec e ete tees
[4360]25. Other cash contributions. List donees and amounts
[4362]tet
[4364]26. Other than cash.—See instructions for required state-
[4365]ment ....... Tc cece teeter eens
[4367]27. Carryover from 1974—See instructions.......... ,
[4368]28. Total—{Add lines 24, 25, 26, and 27. Maximum de-
[4370]duction may not exceed 20% of adjusted gross
[4371]income. Enter here and on Form 540, fine 60)......
[4373]Miscellaneous Deductions
[4375]Casualty or Theft Loss(es)—See instructions _
[4377]NOTE: If you had more than -one loss, omit lines 29
[4378]through 33 and follow instructions for guidance.
[4380]29. Loss before insurance reimbursement.............. :
[4381]reimbursement.................-6. an
[4383]30 is greater than line 29, enter zeto)............
[4384]32. Enter $100 or amount on line 31, whichever is smaller
[4385]33. Casualty or theft loss (line 31 less fine 32)........
[4386]34. Alimony paid... eee
[4387]35. Child care—See instructions. wees
[4388]36. Union dues... coves tees
[4389]37. Employment education expense—See instructions... .
[4390]38. Other—litemize) cent nee a
[4392]39. Total—Add lines 33, 34, 35, 36, 37, and 38.
[4394]J (Enter
[4395]- here and on Form 540, line 61) :
[4399]_ PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION = |v
[4401](Sole Proprietorships)
[4403]po . . :
[4404]vt : Attach this schedule to your Income tax turn, Form 540 or S40NR — Partnerships, joint ventures, ete., most file on Form 565
[4405]i Name as shown on Form 540 or 540NR ff y ; y) : : Soclal Security Number
[4406], AMue Le PV¥eLts Aub | 322-/2-79797
[4407]1A. Name and Address of Business B. Federal Employer 1.0. No.
[4408]ivoprey BecrkoWerce Soe pega oe
[4409]: C. Principal business activity (i.e., retail-hardware; wholesale-tobacco; services-legal; etc.)_.--=>_1 aa
[4410]- D. Indicate method of accounting: O cash; oun: Ot cece ee ce cecnenenmnntrtenenenee
[4411]"£, Were Forms 591, 592, 596 and 599, for the cal -filed (if required)? ifyes 0 NO
[4412]F. Method of inventory valuation m__........ Ln LO...
[4413]Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
[4414]0 YES (NO If “Yes,” attach explanation. :
[4415]es 1 Gross receipts, sales, or fees $e Less returns and allowances §...............-. : a : Balance >
[4416]: 1 2 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)........... Ce
[4417]‘ 3 Purchases $.... cesta Less cost of items withdrawn for personal US $_ou. oe. eceees eeepc: sd
[4419]LS 4 Cost of labor (do ‘hot include salary paid to Fousoll nee ee eee teen eee reer e Cet arte nena T —SY
[4421]“2 & Materials and supplies... 0.0.2... ccc eee eect cette ees Me cev eee Lee | —SY
[4423]4 6 Other costs (explain in Schedule C-2 or attach Schedule)............0..0. 00... eee ween ee  —sSY
[4425]: 7 Total of lines 2 thru Bocce cee eee bebe bbb bbb bbb et ben b een n ees concen e ae Cid oo :
[4426]8 Inventory at end of this year... eee peeves eee es : aon ‘ :
[4428]- 9 Cost of goods sold (subtract line 8 from line 7)........ 00.0 0. cecevcceeceeeceeeeevee ect eee ceeecees nace ett eee ee
[4429]. 10 Gross profit (subtract line 9 from fine once eee eens beeen eee ue ees lobe e eens
[4430]“14 Other income “(attach schedule). 0.2. eee eens re bocce ees cet e betes ce enes
[4431]"1 12 Total Income (add linés 10 and 11) ; ;
[4432]: ; . OTHER BUSINESS DEDUCTIONS :
[4433]* ‘13 Depreciation {explain in Schedule C-1 or attach Schedule)............ ee ee bebe nee ne
[4434]14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule). bbe e cen eee an TY
[4435]“ 15 Rent on business property... 00000. e tne e renee SY .
[4436]+ 1B Repairs (explain in Schedule C-2 or attach Schedule), 6. ............. Do ece ee nuns p vewbeves |
[4437]“: 17 Salaries and wages not included on line 4 (exciude any paid to yourself eee eee tect e eee es ae sd .
[4438]1B Insurance eee eee Cid
[4439]* 49 Legal and professional fees......... Ene EE nnn tert e tue teres id
[4440]20 Commissions 20.0. e et ete ake nee ees Meee Tr t—S
[4441]21 Amortization (attach statement)..................... re bed bbe bbb veee ved ebeeeees Sd
[4442]22 Retirement plans, etc. (other than your share, see instructions)......2.00 2202 ee
[4443]23 Interest on business indebtedness................-...0.-....04- eect edt eect ey be cb eee eeeees id
[4444]24 Bad debts arising from sales or services (Not applicable if reporting on cash basis)...................... Tr —SY
[4445]25 Depletion (attach schedule)... 00.0... tenes TCS
[4446]" 96 Other business expenses (explain in Schedule C-2 or attach Schedule)...................... cceeeeeeee Ld
[4448]"97 Totat of Hines 139 thru 260000 TM pg eens
[4449]a 28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or S40NR.... an Ce cn Sane AG G
[4450]Group and guideline class Date Cost or Depreciation Method of Life or Depreciation
[4451]int + . allowed (or allowable) computing :
[4452]or description of property Acquired other basis in prior years depreciation Rate . _ for this year
[4454]Schedule C-1
[4455]Depreciation
[4456]Claimed on line 13.
[4458]IN
[4459]i
[4460]NE
[4462]. ase * . A
[4463]Pe ts ae ee
[4469]. ze
[4471]m
[4473]NW 88326 Docid:32245535 Page 46
[4475]TAXABLE:
[4477]S975:
[4479]CAPITAL GAINS AND LOSSES
[4481]a . Attach to Form 540 or S40NR
[4483]Use this schedule to report gains and losses on stocks, bonds and similar investments,
[4484]and gains (but not losses) on personal assets such as a home or jewelry.
[4486]Name an on Form 540 or S40NR (/ i)
[4487]ANMUEL ’ Va.
[4489]<a 7 it
[4491]Social Security Number -
[4493]AB pz) 2992
[4494]PART I—Assets Held One Year or Less _ , 1 )
[4496]e. Cost or other hasis as
[4497]adjusted, cost of subse-
[4498]quent improvements (if
[4499]not purchased, attach
[4500]explanation) and = ex-
[4502]pense of sale.
[4504]b. Date acquired
[4505](mo., day, yr.)
[4507]a. Kind of property and description
[4509]c. Date sold
[4510](Exampie, 100 shaves of ''Z" Co.)
[4512](mo., day, yr.)
[4514]é. Gross sales.
[4516]¢..Gain or loss
[4517]price
[4519]Ad fesse) 7.
[4521]2. Enter gain (or loss), if applicable, “from line 18, ‘Schedule D-1 (540) (attach copy) .
[4522]3. Enter your share of net gain or loss from partnerships and fiduciaries .
[4523]4, Net gain or loss, combine lines 1, 2 and 3
[4525]PART il—Assets Held More Than One Year But Not More Than Five Years
[4527]6. Enter gain (or loss), if applicable, from line 20, Schedule D-1 (540) (attach copy) .
[4528]7. Enter your share of net gain or loss from partnerships and fiduciaries .
[4529]8. Net gain or loss, combine lines 5, 6 and 7
[4531]10. Enter gain (or loss), if applicable, from ‘line 22, Schedule D-1 (540) (attach copy) .
[4532]11. Enter your share of net gain or loss from partnerships and fiduciaries .
[4533]12. Net gain or loss, combine lines 9, 10 and 11
[4535]. Enter amount from line 4
[4536]14, Enter 65% of the amount on line 8
[4537]15, Enter 50% of the amount on line 12.
[4538]16. Enter unused capital loss carryover from preceding taxable years "(attach compotion
[4539]; 17. Combine the amounts shown on lines 13, 14, 15 and 16
[4540]* % 18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540. or ‘540NR
[4542]19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of
[4543]-° (a) amount on lines 17;
[4545](b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
[4546]of capital assets; or
[4548]fgseagt a husband or wife filing a separate return)
[4550]*, 10. If Section 18219 property:
[4552]“INW.88326,.Docld:32245535 Page 48
[4554]of 12. Enter amounts from lines 7(b), ach), 9(d) ‘and 10(4)
[4556]eggs te
[4558]SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES |
[4560](Sales or Exchanges Including Involuntary Conversions)
[4561](Attach to Form 540, S40NR, 541 or 565)
[4563]Name as shown on Tax Return
[4564]MILE L-
[4565]PART | Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220
[4567]Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
[4568]1._Description of Sections 18211, 18212-18, 18219, and 18220 property. (mo tay 9)
[4570]JAN! WOOP LES. BISTRO... COFFE Kee wt MEOF. 2S.
[4572]Correlate lines 1(A) through 1(D) with these columns ——= > Property = Property 7
[4574]Gross sales price :
[4576]Cost or other basis and expense of sale
[4578]Depreciation allowed (or allowable) .
[4580]Adjusted basis, line 3 less line 4
[4582]Total gain, subtract line 5 from line 2
[4584]If Section 18211 property:
[4586](a) Depreciation allowed (or allowable) after applicable date.
[4587](See Instruction D-3)
[4589](b) Line 6 or line 7(a), whichever is smaller
[4591]8. If Section 18212-18 property:
[4593](a) Enter additional depreciation after 12-31-63 and before
[4594]1-1-71 .
[4596](b) Enter additional depreciation after 12. 31 70 :
[4598](c) Enter line 6 or line 8(b), whichever is smaller .
[4600](d) Line 8(c) times applicable percentage (Instruction D-4) .
[4602](e) Enter excess, if any, of line 6 over line 8(b)
[4604](f) Enter line 8(a) or line 8(e), whichever is smaller .
[4608](g) Line 8(f} times applicable percentage (Instruction D-4)
[4609](h) Add line 8(d) and line 8(g) toe ee
[4610]9. If Section 18220 property: .
[4611](a) If farm land, enter soil and, water conservation expenses
[4612]for current year and four preceding years .
[4613](b) If farm property, other than land, subtract line 7(b) from
[4614]- line 6; OR, if farm.tand, enter line 6 or fine 9(a), which-
[4615]ever is smaller (see Instruction D-5)
[4616](c) Excess deductions account (see Instruction D-5)
[4617](d) Enter line 9(b) or line 9(c), whichever is smaller .
[4619](a) Soil and water conservation expenses made after 12-31-69
[4621](b) Enter amount from line 9(d), if any; otherwise, enter a zero
[4623](c) Enter excess; if any, of line 10{a) over 10(b) _.
[4625](d) Line 10(c) times applicable percentage (Instruction D-5)
[4627](e) Line 6 less line 10(b) 2...
[4629](f) Enter smaller of line 10(d) or line 10(e) os - .
[4630]SUMMARY OF PART | (Complete Property Columns TA) through (D) up to Line 10(f) before going to Line 11) '
[4631]11. Enter amounts from line 6 . 5
[4633]13. - Subtract line 12 from line 11, enter here and in appropriate
[4634]Section in Part Il (see Instruction D-2) Coe eee
[4635]14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part til
[4638]7
[4640]' Schedule D-1(540)
[4642]“+ PART Il Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions
[4643]_ (Section 18181-82) see Instruction E
[4645]‘Section A— INVOLUNTARY CONVERSIONS DUE TO CASUALTY AND THEFT
[4647]f, Cast or other basis, cost of
[4648]subsequent improvements
[4649](if not purchased,
[4650]attach explanation) and
[4651]expense of sale
[4653]a. Kind of property (if necessary,
[4654]attach statement of descriptive
[4655]details not shown below)
[4657]e Depreciation al allowed
[4658](or aliowable)
[4659]since acquisition
[4661]g. Gain (or toss)
[4662](4, plus e. less f.)-
[4664]c. Date sold
[4665](mo., day. yr.)
[4667]b. Date acquired
[4669]d. Gross sates
[4670](mo., day, yr.) price .
[4672]16, Combine the amounts on line 15, enter here and also on the appropriate , line as follows
[4673](a) For all returns, except partnership returns: (1) {f line 16 is zero or a gain, enter amount of each gain or- loss, above, in. -
[4674]column (g) of applicable Section B-1, B-2 or B-3; (2) If line 16 is a loss, enter such amount on line 25 of Part Il,
[4675](b) For partnership returns: Enter gain(s) and loss(es) in Schedule K (Form 565). See Instruction E.
[4676]Section B-— SALES OR EXCHANGES OF PROPERTY USED IN TRADE OR BUSINESS AND CERTAIN INVOLUNTARY CONVERSIONS
[4677](Net Reportable in Section A)
[4679]Section B-1 Property Held One Year or Less
[4681]. Combine the amounts on line 21, enter here .
[4683]& ° -23. Combine the amounts on lines 18, 20 and 22; enter here and also on the ‘oppropriate line ds follows
[4684](a) For all returns, except partnership returns: (1) If line 23 is a gain, enter the amounts from lines 18, 20 and 22, on lines 2, 6
[4686]"and 10, respectively, of the Schedule D (Form 540), or if filing Form 541, enter amounts from lines 18, 20 and 22, on lines.
[4688]2, 7 and 11, respectively, of the Schedule D (Form 541). (2) If line 23 is a loss, enter such amount on line 26 of Part Wh
[4690](b) For partnership returns: Enter amounts on lines 18, 20 and 22, in Schedule K(565)—see Instruction. E. ;
[4691]PART 11 Ordinary Gains and Losses ,
[4693]a
[4695]a. Kind of property and how
[4696]' acquired (if necessary,
[4697]J attach statement of descriptive
[4698]details not shown below)
[4700]{. Cost or other basis, cost of
[4701]subsequent improvements
[4702]and expense of sale
[4704]e. Depreciation allowed
[4705](or allowable)
[4706]since acquisition
[4708]b. Date acquired
[4709](mo., day, yr.)
[4711]c. Date sold
[4713]d. Gross sales
[4714](mo., day, yr.) i
[4716]0: Gain (or loss) *
[4717]price
[4719](Cd, plus e. less f.)
[4721]. Gain, if any, from line 14
[4722]25. Loss, if any, from line 16
[4723]. Loss, if any, from line 23
[4725]28. Combine lines 24 through 27, enter here and also on the appropriate line as follows .
[4726]. (a) For fiduciary and partnership returns: Enter the gain (or loss) shown on fine 28 on the line provided for on ‘the
[4727]oe return being filed—see Instruction F for specific line reference.
[4728]: (b) For individual returns:
[4729]: (1) If the gain (or loss) on line 2B includes losses which are to be treated. as an itemized deduction on
[4730]. ; : Schedule A (Form 540 or 540NR) (see Instruction F), enter the total of such loss(es). here and on-
[4731]” Schedule A (Form 540 or 540NR)—Identify as loss from line 28(b)(1), Schedule D-1. (Form 540)
[4733]A (2) Redetermine the gain (or loss) on line 28, excluding the loss (if any) entered on line 28(b)(1). Enter here
[4734]q 2 f F 540 or F S40NR, under “Other | ie” oe ee .
[4735]“NW 88326~Bocld: Sab ReMs Sai of Form r Form under er Incom
[4737]NAME .. SS) AY LL? tA Bip
[4739]te ee pes TN ee ee le pe eee AE Ca ef
[4741]PROSTHETIC APPLIANCES
[4742]HEARING AID
[4744]Ge AMBULANCE
[4745]LABORATORIES
[4747]CASUALTY OR THEFT (LOSS(ES)
[4749]7 CSSC~*S
[4751]29 TOT.CAS.OR THEFTLOSS >
[4753]CALENDAR YEAR 19 2S”
[4754]"ADDRESS 22 — /2-? ____ soc. sec. No. .
[4755]-_ DEDUCTION SCHEDULE i
[4756], - MEDICAL. FEDERAL
[4758]3 LESS 1% A.G.1, {Line 18 - 1040) |  J2ib PARTNERSHIP SHARE __. 0 Sn Os
[4759]4NET MED/DRUGS a __GIRL/80Y SCOUTS Y | J
[4760]| “BH &AINS. (% + EXCESS) a — HEART FUND/CANCERFUND ||
[4761]. _baor, | spenossuamreo rune ft 115-0
[4763]OR. S| |_| MISC. ORGANIZED cHanimies| TT
[4764]DR. fd 77 a
[4766]| or: el i aan
[4767]1 OR. ; pT ns
[4768]: or, ae ns Cs Qs
[4769]. i [ [2orwentHancasy | CT CT
[4770]aa may Atel ae a Sl
[4771]‘ GbHOSPITAL 24 TOTAL CONTRIBUTIONS T FSa] [| (sn
[4772]5
[4773]SY
[4774]|
[4775]|
[4776]Td
[4777], .
[4779]TRAVEL FOR MED.
[4781]NI}
[4783]MISCELLANEOUS DEDUCTIONS
[4785]MEDICARE INS.
[4787]30 ALIMONY j
[4789]GLASSES
[4790]7 MEDICAL EXPENSES |
[4791]LESS REIMBURSED BY INS.
[4792]‘| “BLESS 3% ADJ, GROSS INC.
[4793]. 9
[4794]1 +:% (TO $150) OF H & A INS.
[4795]10 TOTAL MEDICAL DED.
[4796]TAXES
[4797]11 STATE & LOCAL INCOME
[4798]12 REAL ESTATE
[4799]13 STATE & LOCAL GASOLINE
[4800]14 GENERAL SALES TAX
[4802]31 UNION/PROF ESSIONAL. DUES
[4803]32 CHILD & DEP. CARE {Form 2441)
[4805]INVEST. COUNSEL & PUBS. (Sched
[4806]EMPLOYMENT AGENCY FEES
[4807]SAFE DEPOSIT BOX
[4809]TEL. REQ. IN BUSINESS ;
[4810]POLITICAL CONTRIBUTIONS
[4814]a
[4816]LE )
[4817]BS PAD
[4821]i
[4823]hm
[4826]y
[4828]6
[4830]15a PERSONAL PROPERTY
[4832]15b PERSONAL PROPERTY AUTO
[4833]16 SALES TAX AUTO
[4835]34 TOTAL MISC. DED.
[4837]| TOTAL TAXES
[4838]: INTEREST (TO WHOM PAID
[4839]“. “TBMORTGAGE
[4841]1
[4842]4
[4844].
[4846]STATE
[4848]SUMMARY OF ITEMIZED DED.
[4850]TOT. DEDUCTIBLE MEDICAL & DENTAL
[4851]XPENSES {FROM LINE $0)
[4853]36 TOTAL TAXES (From LINE 17)
[4854]37 TOTAL INTEREST (Line 20)
[4855]38 TOTAL CONTR, (Line 24)
[4857]He |
[4858]hes
[4859]SERRSUERREMEEE
[4861]19 INSTALLMENT LOANS ja tsa.
[4862]i lteer|
[4864]39 CAS. & THEFT LOSS(ES) {Line29)
[4866]QQ TOTAL MISCELLANEOUS
[4867]DEDUCTIONS (FROM LINE 34)
[4869]Pit Ly
[4870]|
[4874]T,
[4876]_ Fe PES
[4878]ai TOTAL ITEMIZED DEDUCTIONS
[4879]ENTER ON FORM 1040 LINE 45
[4881]Ly ;
[4882]m
[4883]m
[4884]2
[4886]4
[4888]REMARKS
[4890]20 TOTAL INTEREST
[4895]KJ
[4896].
[4897]4
[4903]Professional Stationers, 4
[4904]7180 bayiael ueytas
[4905]Neatly Hall geen, Gite
[4907]Inc.
[4909]. pg
[4911]sets
[4913]~NW 88326 Docld:32245535 Page 50
[4915]ah
[4917]2
[4918]5
[4919]3
[4920]an
[4921]S
[4923]SCHEDULE
[4925]- NW 88326 Docld:32245535 Page 51
[4927]© NAME,
[4933]a oe . et tee . wei ote
[4935]” rd a cr es
[4937]L S s huey “cavewoae year 19 Ze
[4939]. 50C. SEC. NO.
[4940]FF
[4942]FISCAL YEAR ENDING
[4943]7 7
[4945]19
[4947]a
[4949]EDULE OF PROFIT OR LOSS FROM BUSINESS OR PRO STON
[4950]PRINCIPAL BUSINESS ACTIVITY . ;
[4952]BUSINESS NAME EMPLOYERS NO,
[4954]BUSINESS ADDRESS . . i
[4956]INVENTORY AT BEGINNING OF YEAR
[4958]MERCHANDISE PURCHASED
[4960]I
[4962]TOTAL
[4963]LESS INVENTORY AT ENO OF YEAR
[4965]GROSS PROFIT
[4967]a
[4969]re
[4971]GROSS INCOME
[4973]en eee ert lt
[4975]OTHER BUSINESS DEDUCTIONS
[4977]“ADVERTISING
[4979]AUTO AND TRUCK EXPENSE
[4981]BAD DEBTS
[4983]COMMISSIONS
[4985]DELIVERY
[4987]a
[4989]DEPRECIATION ( SCHEDULE BELow )
[4991]DUES AND SURISCRIPTIONS
[4993]RR
[4997]ENTERTAINMENT AND PROMOTIONAL
[4999]INSURANCE,
[5001]nn I
[5003]INTEREST
[5004]JANITOR AND HAUL ENG
[5006]LEGAL AND ACCOUNTING
[5008]OFFICE SUPPLIES AND EXPENSE
[5010]RENT
[5012]REPAIRS AND MAINTENANCE
[5014]SALARIES ANO WAGES
[5016]SUPPLIES
[5018]TAXES AND LICENSES
[5020]TAXES PAYROLL
[5022]TELEPHONE AND YTILITIES
[5024]CoN TRAC LALO
[5026]A
[5028]NET PROFIT or (LOSS ) FEDERAL RETURN
[5030]| P rs a
[5031]NET PROFIT OR (LOSS ) STATE RETURN - SEE DEPREC. SCHEDULE FOR DIFF. TAY sie aw) Van
[5033]SCHED! LE OF DEPRECIATION
[5035]YEARS COST OR PRIOR | SEPRECIATION
[5036]KIND AND LOCATION OF PROPERTY ACQUIRED METH. | OR % } OTHER BASIS a, DEPREC. THIS YEAR
[5038]2. Py SL IR 10328) —- __| 394
[5040]Tbe ES 7, 1 el od
[5042]PROFESSIONAL STATIONERS Inc FORM 104A
[5043]LOS ANGELES, CALIF.
[5045]SCHEDULE
[5049]7 f p "i E EL ab fuses rts or 3 hu. ay * Calendar Yr. : ive
[5050]- SOC. SEC. NO. mee F/V/E 19__
[5052]_ GAINS ON INSTALLMENT SALES.
[5054]—) DESCRIPTION OF PROPERTY Ep (<a a ae SA OP |
[5055]3 DATE ACQUIRED : DATE SOLD Wel
[5057]TYPE OF ASSET: : CAPITAL | SEC. 1245 SEC. 1250 |
[5058]* 1, SELLING PRICE: CASH
[5059]2 NOTES
[5060]"3 MORTGAGE TRANSFERRED
[5061]C4 OTHER
[5062]Mtg. GROSS SALES PRICE (1+2+3+4)
[5063];  _6. COST OR BASIS
[5064]4 7, LESS ACCUMULATED DEPRECIATION
[5065]8 PRIOR TO 1~—1-62
[5066]9. PRIOR TO 1-164
[5067]10. AFTER 12-31-61
[5068]io ST. LINE AFTER 12-31-63
[5069]12. EXCESS OVER S/L 1~64/12—69
[5070]13, EXCESS OVER S/L AFTER 12-31-69
[5072]14. ADJUSTED BASIS (6-7 THRU 13)
[5073]15. EXPENSES OF SALE
[5074]16. TOTAL ADJUSTED BASIS (14 + 15)
[5075]17. TOTAL GROSS PROFIT: (5 — 16}
[5076]18. TOTAL GROSS PROFIT — ORDINARY
[5077]19. TOTAL GROSS PROFIT ~ OTHER
[5078]1 20. CONTRACT PRICE (1 +2 + 4)
[5079]"24, GROSS PROFIT %
[5080]22. PAYMENTS RECEIVED YEAR OF SALE
[5082]23. CASH (1)
[5084]24. PRINCIPAL COLLECTIONS
[5086]25. EXCESS MORTGAGE OVER BASIS
[5087]26. OTHER (4)
[5089]27. TOTAL PAYMENTS (23 THRU 26)
[5090]- 28. RECOGNIZED GAIN
[5092]29. RECOGNIZED GAIN — ORDINARY
[5094]30. RECOGNIZED GAIN — OTHER
[5096]ORDINARY INCOME
[5098]TAX- TOTAL Go te
[5099]ABLE "PAYMENTS REPORTED
[5100]pa e —
[5104]A
[5106]NW 88326 Docld:32245535 Page 52 we eee acerca
[5108]3
[5109]2K
[5112]ay i Acaaandbenisehiits, Shee
[5114]4040 . uUSs
[5116]the year January 1— December 31, 1974, or other taxable year ‘beginning . deeeeeeeeteceteseetaecaeeeteueeees
[5117]Name (If Joint return, os na
[5120]For
[5122]and initials of both) COUNTY. OF
[5124]tte bE
[5126]Last name ..
[5128]Please print or type
[5130]Filing | Status (check only one)
[5132]” Married filing separately. If spouse is ‘also filing give
[5134]spouse's social security number in designated space above
[5135]and enter full
[5137]2
[5138]3
[5139]name here > oy
[5141]4. CO Unmarried Head of Household (See instructions on page 5)
[5143]S
[5147]mo
[5148]5 CL] Widow(er) with dependent child (Year spouse died» 19 )
[5150]‘Departinent of the Treasury—Internal Revenue Service
[5152]‘Individual Income Tax Return.
[5154]L974, ending ol cee eee eceeeees
[5156]RESIDENCE...
[5158]Exemptions Regular / 65 or over rf Blind - :
[5159]| 1 EJ Single 6a Yourself . i . Oo. | o Q
[5160]Married filing joint return (even if only one had income) b Spouse . . Ol -* C1 Checked pe
[5162]c First names of your dependent children who lived with,
[5164]iS SESE ULE DERR SEE
[5166]Your social security number -
[5168]BID 12-777
[5170]* Spouse’ 8 social security no.
[5172]8 Presidential Election
[5174]Enter
[5176]d Number of other dependents (from line 027) « >
[5177]7 Total exemptions caine . oe ly
[5178]Do you wish to designate $1 of your taxes for this fund? . Noto: If you check the ‘*Ves"’
[5179]box(es). it -will not increase
[5180]It joint return, does your spouse wish to designate $1? : Tal Zi No'|
[5182]your: tax: or reduce your refund.
[5184]Campaign Fund. . >»
[5185]Attach Forms W-2. If unevail-
[5187]. 9 Wages, salaries, tips, and other employee compensation ane see instructions on page 3)
[5188]Seo Instructions
[5190]10a Dividends \on pages 6 and a) AZ... wees 10b ‘Less. exclusion $ BE. Balance >»
[5191](it gross dividends and other ‘distributions are over $400, list in ban | of Schedule B.)
[5193]I" $400 or less, enter total without listing in Schedule B
[5195]il ° Interest income.
[5197]12. Income other, than wages, dividends, and interest (from | line 38) .
[5198]13 Total (add lines 9, 10c, 11, and 12) woe . .
[5199]14 Adjustments to income (such as “sick pay," moving expenses, etc. = from line 43) .
[5201]15
[5203]Subtract line 14 from line 13 (adjusted gross income) .
[5205]@ if.you. itemize deductions or line 15 is $10,000 or more, go to line 44 to figure tax. -
[5207]Please attach Copy B ‘of Forms W-2 here |
[5209]' Tax Rate Schedule X, Y, or Z™
[5211]Schedule G Seteile clon [Eoms7as Form 4726 |
[5213]Tax, check if from: | Tax Tables 1-12 |
[5214]Schedule D
[5216]a |.
[5217]5 17 Total credits (from line 54).
[5218]6 18 - Income tax (subtract line 17 ‘from line 16) :
[5219]~ |.19 Other taxes (from line 61) ute a
[5220]& |. 20 Total (add lines 18 and19). . . 2 we woe ee
[5221]oe a 7) ~ 21a Total Federal income tax withheld (attach Forms _
[5222]- 5 <> W+2 or W-2P to front) . 21a _ |G
[5223]Ee b 1974 estimated tax payments (include emount .
[5224]& |: allowed as credit from 1973 return)... —b_ __
[5225]” ¢ Amount paid with Form 4868, Application for Automatic {oo . vot a
[5226]fa Extension of Time to File U.S. Individual Income Tax Return c __
[5227]“- d@ Other payments (from line 65) . . 2. . 1. d
[5229]Total (add lines 21a, by c, and d)
[5231]22 : 23 = If line 20 is larger than line 22, enter BALANCE DUE IRS . me 4 _ . : -
[5232]© R= “ - > (Check here > GB , if Form 2210, Form 2210F, ‘or statement is attached. , See instructions on page 7) “
[5233]2a] 24 Ifline 22 is larger than line-20, enter amount OVERPAID ..
[5235]© | (25 Amount of line 24 to be REFUNDED TO YOU .
[5237]a ° Amount of line 24 to be cred-,
[5239]26
[5241]‘Piease attach Check or Money Order here] ,
[5243]ited on 1975 estimated tax. > |
[5245]NW 88326 Docid:32245535 Page 53
[5247]f over $400, enter total and list in Part Il of Schedule B] *
[5249]@ If you do not itemize deductions and line 15 is under $10,000, find tax in Tables and enter on line 16.
[5251]CAUTION. lf you have’ unearned income and can be claimed as a dependent on your parent's return, check fiere >] and see » instructions on peg: a7.
[5253]ee |
[5255]Y
[5257]Ve y order and make
[5258]Mp
[5260]ypu Wyle OE LG LL KG We EA (ee “tilde Mitel itil
[5262]Y . refiinded: (line 25), :
[5263]CMLL ID EL Ly Z
[5265]. Under penalties of perjury, # declare that | have examined this return, including accompanying schedules and statements, and to the best-of m
[5266]~ itis true, correct, and complete. Declaration of preparer {other than taxpayer) ts based'o ‘on all Information | of which F he has any knowledge.
[5268]43717 V VANOWE N STREET.
[5269]MAN NUYS, CA. 91405
[5271]|}
[5277]41
[5280]Ny
[5282]1
[5285]15
[5287]w
[5289]Pay amount on line 23
[5290]in full with this return.
[5291]Write social security
[5292]number on, check or
[5293]payable to — Internal
[5295]eve: WH yy Yy : :
[5297]VL
[5300]i
[5302]WE
[5304]make, no entry 0 ‘ine 76.
[5306]7] Emp. Ident. or Soc. See. No. *
[5307]Ae BBRLOTE - :
[5310]NW 88326 Docld:32245535 Page 54
[5312]in.
[5314]Form 1040 (1974) . a + Page 2
[5315]tlt la Tn a SEINE nse
[5316](a) NAME. , (b) Relationship () Months lived in your | (d) Did de- {e) Amount YOU | (f} Amount ~fur-'
[5317]. . me. If born or died pendent have furnished for de- | nished by OTHERS
[5318]. oO gus year, write B or D. income of | pendent’s sup- including Gepend-
[5319]. : . $750 or more? port. if 100% ent.
[5320]* . . write ALL.
[5322]Me BL :
[5324]Other
[5325]Dependents
[5327]27 Total number of dependents listed in column (a). Enter here and on line 6d .
[5329]28
[5331]28 Business income or (loss) (attach ScheduleC) . . 2°. 1 ee 3 ee es
[5332]29 Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) . ee ee
[5333]30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) .
[5334]31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (aitach Schedule E) .
[5335]32 Farm income or (loss) (attach Schedule F) . . . . . . w . .
[5336]33 Fully taxable pensions and annuities (not reported on Schedule E—see i instructions on 1 page 8)
[5337]. 34 50% of capital gain distributions (not reported on Schedule D—see instructions on page 8) -
[5338]35 State income tax refunds (iat tt thae edt yon ‘page 8).
[5339]36 Alimony received . . . oboe ee tke ew ee
[5340]37 Other (state nature and s source—see instructions on page 8) > :
[5342]Eel
[5344]38
[5345]Adjustments to income
[5347]39 ‘Sick pay.’’ (From Forms W-2 and W-2P. If not shown on Forms W-2 or W-2P, attach Form 2440 or statement.) 39
[5349]40 Moving expense (attach Form 3903) . . . . . a
[5350]41 Employee business expense (attach Form 2106 or statement) tee a , | 4r
[5351]42 Payments as a self-employed person to a retirement plan, etc-—see instructions on page 9 . 42
[5352]43 Total adjustments (add lines 39, 40, 41, and 42). Enter here andon line 14...) 43
[5353]Tax Computation (Do not use this part if you use Tax Tables 1-12 to find your tax.)
[5354]44 Adjusted gross income (from line 15) . 9. . woe a | 44
[5355]45 (a) If you itemize deductions, check here & (J and enter ‘total from Schedule A, line 41 ) ©
[5356], and attach Schedule A. a se ee . | 45
[5357](b) - ff you do not itemize deductions, check here > c and enter 15% of line 44, but do an es
[5358]NOT enter more than $2,000. ($1,000 if tine 3 checked) wee .
[5359]46 Subtract line 45 from line 44. . . . eee . kee ee te | 46
[5360]47 Multiply total number of exemptions claimed on line z, by $750 eee ee ke ee 47
[5361]48 Taxable income. Subtract line 47 from line 46... rr 1)
[5363](Figure your tax on the amount on line 48 by using Tax Rate Schedule X, Y, or Z, or if applicable, th the alternative -
[5364]tax from Schedule D, income averaging from Schedule &, or maximum tax from Form 4726.) Enter tax on line 16. -
[5366]Genes Credits
[5368]49 Retirement income credit (attach ScheduleR) . 2. ee ee ee ee
[5369]50 Investment credit (attach Form 3468) . . . . . a woe eee
[5370]51 Foreign tax credit (attach Form 1116) . . . . . on ee ee ke 4
[5371]§2 Credit for contributions to candidates for public office—see instructions on page9 .
[5373]53-Work Incentive (WIN) credit (attach Form 4874) °°. . . woe oe
[5374]54 Total credits (add lines 49, 50, 51, 52, and 153). Enter here and on ‘line 17 .
[5376]Other Taxes
[5378]55 Self-employment tax (attach Schedule SE)
[5379]56 Tax from recomputing prior-year investment credit (attach Form 55) ak eae
[5380]57 Tax from recomputing prior-year Work Incentive (WIN) credit’ (attach schedule) . ae
[5381]58 Minimum tax. Check here & [], if Form 4625 is attached. 2. 6. - 1 ee ee
[5383]§9 Social security tax on tip income not reported to. employer (attach Form 4137): .
[5385]60 Uncollected employee’ social security tax on tips (from Forms W-2) . . -. soe
[5387]61 Total (add lines 85, 56, 57, 58, 59, and 60). Enter here and online 19 .
[5388]: Other “Payments ; il .
[5390]62 Excess FICA tax withheld (two or more employers—see instructions on page 9)
[5392]63 Credit for Federal tax on special fucts, nonhighway gasoline and lubricating oil (attach Form 4136) . -
[5394]64 Credit from a Regulated investment Company (attach Form 2439)... . . . .
[5395]65 Total (add lines 62, 63, and 64). Enter here and on line 2ld. . .
[5396]2 | Did you, at any time during the taxabie year, have any interest in or signature © or other authority over -
[5398]A>) © | a bank, securities, or other financial account in a foreign country (except | ina U. ‘Ss. military banking
[5399]& 8 facility operated by a U.S. financial institution)? ©... .-. 0. 4% .- —_ toe .
[5400]“ = | If “Yes,” attach Form 4683. (For definitions, see Form A683. } : : -
[5402]a : ue te U.S, GOVERNMENT PRINTING OFFICE ; 1974--O-548-047
[5404]“+-
[5407]AAP ia Terenas ae SRR Ta aa sitinid * RES ia PHD
[5409]Schedules AxB—Itemized Deductions AND
[5411](Form 1040) . Dividend and Interest Income
[5412]cee tevenen Serace” b> Attach to Form 1040. p> See Instructions for Schedules A and B (Form 1040).
[5414]Internal Revenue Service
[5416]Name(s). as shown on Form ‘104
[5417]SAMUEL £.
[5419]‘Medical and Dental Expenses (not compensated by insurance
[5420]or otherwise) (See instructions on page 10.)
[5422]1 One half (but not more than $150) of
[5423]insurance premiums for medical care.
[5424](Be sure to include in line 10 below)
[5426]2 Medicine and drugs
[5427]3 Enter. 1% of line 15, Form 1040
[5429]_ 21 a Cash contributions for which you |
[5430]have receipts, cancelled checks,. etc.
[5432]b Other cash contributions. List
[5433]donees and amounts. »_____
[5435]4 Subtract fine 3 from line 2. Enter dif--
[5436]ference (if less than zero, enter zero) .
[5438]5 Enter balance of insurance premiums
[5439]for medical care not entered on line 1’.
[5440]6 Enter other medical and dental expenses: ne A ean
[5442]a Doctors, dentists, nurses, etc. 22 Other than cash (see instructions on
[5443]b Hospitals . oe -. page 11 for required statement)
[5444]¢ Other (Itemize—include ‘hearing aids, 23 Carryover from prior years
[5445]dentures, eyeglasses, transportation, 24 Total contributions (add lines 21a, b , LIA
[5446]ete.) Pee eel Lo 22, and 23). Enter here and on line 38 . /
[5447]‘ ; ; Casualty or Theft Loss(es) (See instructions on page 12) ;
[5448]Note: If you had more than one loss, omit lines 25 through —__
[5449]28 and see instructions on page 12 for guidance.
[5451]Loss before insurance reimbursement .
[5453]26 Insurance reimbursement
[5455]27 Subtract line 26 from line ‘25. Enter
[5456]difference Cf less than _-20F0, enter
[5457]zero) . . -
[5459]28 Enter $100 or amount on line 27, :
[5460]whichever is smaller. . . _
[5462]29 Casuaity or theft loss (subtract line 28
[5463]_from line 27). Enter here and on line 39 Lani
[5465]7 Total (add fines 4, 5, 6a, b, and c)
[5466]8 Enter 3% of line 15, Form 1040.
[5468]9 Subtract line 8 from line 7 it less than
[5469]zero, enter zero)
[5471]10 Total (add lines 1 and d 9). Enter here {
[5472]and online 35... . >
[5474]Taxes (See instructions © on page 10)
[5476]30 Alimony paid
[5477]31 Union dues .
[5479]11 State and loca! income
[5481]12 Real. estate
[5483]13 State and local gasoline (see gas tax tables)
[5485]14 General sales (see sales tax tables)
[5487]15 Personal! property: . . . :
[5488]16 Other (itemize) P ooo
[5490]32 Expenses for child and dependent c care
[5491]services (attach Form 2441) .
[5493]17 Total (add lines 11, 12, 13, 14, 15, and 34 Total (add lines 30, 31, 32, and 33).
[5494]16). Enter here and online 36. Enterhereandonline40. . . . >
[5496]Interest Expense (See instructions on rage 11.) Summary of Itemized Deductions A
[5498]18 Home mortgage .
[5499]19 Other (Itemize) » 35 Total medical and dental—line 10.
[5501]: 36 Total taxes—line 17
[5503]37 Total interest-—line 20
[5505]38 Total contributions—line 24 ..
[5507]39 Casualty or theft loss(es)—line 29.
[5509]40 Total ‘miscellaneous—line 34
[5511]aL Total deductions (add lines 35, 36, 37,
[5512]. 38, 39, and 40). Enter here and on S90.
[5514]Form 1040, line 45
[5516]20 Total (add lines 18 and 19). Enter here 24 9
[5517]and online 37...
[5521]_ NW 88326 Dockd:32245535 Page 55
[5523]aE Uy hat Ta esr eS
[5525](ARAL EE SAAT RISER, FUL be
[5527]Profit or (Loss) From Business or Profession
[5528](Sole Proprietorship)
[5530]fot the Treasury Partnerships, Joint Ventures, etc., Must File Form 1065.
[5531]Revenue Service Pm Attach to Form 1040. p> See Instructions for Schedule C (Form 1040)._
[5533]y Name(s) as mS on Form “LP
[5534]A Principal business > a. (see oe C1n
[5535]B Business name Pm. Wo Ob Le
[5538]stryctions) b>. KNERVICE .... > product ef am
[5539]YY PIT s Co FFEES HOE Employer identification number
[5540]D Business address (number and street) B >. 60 OLS AB
[5542]GM TRG 7-1 Oy,
[5543]City, State and ZIP code m.. AICS (6. =.
[5545]_ E Indicate method of accounting: “Q (C] Cash (2) 5 Accrual (3) oO Other >
[5546]F Were you required to file Form W-3 or Form 1096 for 1974? (See Schedule C Instructions.) . . .
[5547]If “Yes,” where filed ce eee nee tne ete rence suena es coe eeee cee cee ee eeneedeeeneneceeeeumeaeeeneeeeeeee
[5548]G Was an Employer's Quarterly Federal Tax Return, Form om 8 for this business for any quarter in 1974? . a
[5550]H_ Method of inventory valuation Dr. cee ee secetessceseeseseevareneeceteetsnees . Was there any substantial change in
[5551]the manner of determining quantities, costs, or valuations between the ‘opening and closing inventories? (if “Yes,” attach explanation) .
[5553]1 Gross receipts or sales $ ) oo... Less: returns and allowances $....... eeueeaseesesitscereteneel : Balance >
[5554]" 2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8) : ¥
[5555].3 Gross profit . 7
[5556]4 Other income (attach ‘schedule
[5557]5 Total income (add lines 3 and 4)
[5558]6 Depreciation (explain in Schedule C-3) oo
[5559]Taxes on business and business property (explain in Schedule C-2) .
[5561]Income
[5563]Rent on business property)... 6. ee
[5565]Repairs (explain in Schedule C—2) . . oo
[5567]10 Salaries and wages not included on line 3, Schedule eC-l (exclude a any paid to yourself) a
[5569]Al Insurance © ee ye
[5571]12 Legal and professional fees. oe ee Peeceeencneeee : 7
[5573]13 Commissions . . * Ce .. weeceeseece ee
[5575]14 Amortization (attach statement) Soe bo . . —_
[5577]15 (a) Pension and profit- -sharing plans (see Schedule C instructions)
[5578](b) Employee benefit programs (see Schedule C Instructions) .
[5580]16 Interest on business indebtedness .
[5582]17 Bad debts arising from sales or services
[5583]Depletion . :
[5585]19 Other business expenses (specify):
[5589]Deductions
[5590]Lol
[5593](k) Total other business expenses (add lines 19(a) *hroveh 1
[5594]20 Total deductions (add lines 6 through 19) .
[5596]21 Net profit or (loss) (subtract line 20 from tine 5). Enter here and on Form 1040, line 28. ALSO | q BY
[5597]enter on Schedule SE, line 5(a) ._.. .
[5598]SCHEDULE C—1.—Cost of Goods Sold ‘and/or Operations See Schedule C Tastructions for Line 2)
[5600]1 Inventory at beginning of year (if different from last year's closing inventory, attach explanation) .
[5602]Purchases $..........------2:teseeses Less: cost of items withdrawn for personal use $.......--.--..--= ’ Balance >
[5603]Cost of labor (do not include salary paid to yourself) . ee ot
[5605]Materials and supplies .
[5607]Other costs (attach schedule)
[5609]Total of lines 1 through 5 ;
[5611]Less:. Inventory at end of year Pa won
[5612]Cost of goods solid and/or operations. Enter here and on line "2 above .
[5614]and
[5616]NOU hRWN
[5618]NW 88326 Docld:32245535 Page 56
[5621]oi
[5623]SNe STCIET SRNETER 20 AED BEA PRN
[5625]Schedule C (Form 1040) 1974
[5627]":.  * SCHEDULE C-2.—Explanation of Lines 7 and 9
[5628]ee Line No. ~
[5630]Explanation
[5632]Explanation
[5634]SCHEDULE C—3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, you may use Form 4562. . .
[5636], Note: if depreciation is computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, or the Guideline . ‘
[5638]. Ciass Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Lite (ADR) System) or Form 5006
[5639]yo . (Guideline Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)—11(b)(5)(vi) and 1.167
[5640](a)-12, the provisions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970. (See
[5642]Publication 534.) So
[5644]Check box if you made an election this taxable year to use ["] Class Life (ADR) System and/or ["] Guideline Class Life System.
[5646]. sors d. Depreciation e. Method of . . . oe a
[5647]a. Group and guideline class b. Date c. Cost or allowed me allowable * “computing f. Life or . g. Depreciation for...
[5648]or description of property acquired other basis in prior years depreciation rate this year: |”
[5650]Total additional first-year depreciation (do not include in items below) \_
[5652]Sepeaton rm romaooe C8).
[5654]ek WNP
[5656]Other depreciation:
[5657]7 Buildings. . 2 2
[5658]oo "Furniture and fixtures
[5659]Transportation equipment -_
[5660]Machinery and other equipment .
[5661]Other (specify)
[5663]5 Totals . . . . « « «
[5664]6 Less amount of depreciation claimed in Schedule C~1, page 1 °.
[5665]7 Balance—Enter here and on page l,line6. 2. 7 ww en
[5666]SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4)
[5668]Name =: . Expense account Salaries and Wages
[5670]‘Enter information with regard to yourself and your five highest paid
[5671]employees. In determining the five highest paid employees, expense
[5672]account allowances must be added to their salaries and wages. How-
[5673]ever, the information need not be submitted for any employee for
[5674]whom the combined amount is less than $25,000, or for yourself if
[5676]. your expense account allowance plus line 21, page 1, ‘jis less than
[5678]es,’ $25,000,- : 7
[5680]: Did you claim a deduction for expenses connected with: ~ .
[5682](1) Entertainment facility (boat, resort, ranch, ete.)?. . . (] Yes 19 (3) Employees’ families at conventions or meetings? .
[5684](2) Living accommodations (exeept employees on business)? [] Yes No (4) Employee or family vacations not reported on Form W-2? (] Yes
[5685]. w us. GOVERNMENT PRINTING OFFICE : 1974—-O-548-050 oe .
[5687]Age h,
[5689](988326 -Docld:32245535 Page 5T re
[5694]SCHEDULE D Capital Gains and Losses (Examples of property to be reported on
[5696]~ (Form 1040) this Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but ne EE
[5697]Department of the Treasury not losses) on personal assets such as a home or jewelry.) ay be
[5698]Internal Revenue Service » Attach to Form,1040. p> See instructions for Schedule D (Form 1040). e
[5700]Social security number
[5702]ee iy as hin py viata oe fee — Z . ‘ — oo ce aaah : 5 7 ;
[5704]mm Short- on Capital Gains and Losses—Assets Held Not More Than 6 Months
[5706]-@, Cost or other basis,
[5708]6. Date ¢t. Date
[5710]a. Kind of property and description Bs adjusted (see “f. Galn or (loss)
[5711](Example, 100 shares of '‘Z'’ Co. acquired - - sold d. Gross sales ‘price instruction D) and "
[5712]) (Mo. day, yr.) | (Mo. day, yr.) instruction Da (d less 8)
[5714]1
[5716]2. Enter your share of net short-term gain or (loss) from partnerships and fiduciaries: soe 22
[5717]3 Enter net gain or (loss), combine lines 1 and 2 . °.) . eee ee . 3
[5718]4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction G) . 4a) | ¢
[5720](b) Short-term capital loss carryover attributable to years beginning after 1969 (see | Instruction 9)
[5721]Net short-term gain or (loss), combine lines 3,.4(a) and (b) .. :
[5723]7 Capital gain distributions . . . | : re Soe se ne
[5724]8 Enter gain, if applicable, from Form 4797, line 4tay(a) (see Instruction A) ve ee - woe
[5726]9 . Enter your share of net long-term gain or (loss) from partnerships and fiduciaries. . ,
[5728]10 Enter your share of net long-term gain from small business corporations (Subchapter S) .
[5730]11 _Net gain or (loss), combine lines 6 through 10 _ , .
[5732]12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction 6) .
[5734](b) Long-term capital loss carryover attributable to years. beginning after 1969 (see Instruction G) .
[5735]bP 13 Net long-term gain or (loss), combine lines 11, 12(a) and 1 (b) ee oe
[5737]Fam Summary of Parts | and Il
[5739]t 14 Combine the amounts shown on lines 5 and 13, and enter the net gain or loss here ot
[5740]oreo) If line 14 shows a gain—
[5741]“ . (a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part V1 for computation | 154)
[5742]of alternative tax). Enter zero if there is a loss.or no entry on line 13. ~ 8 oe
[5744]. ' (b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29 | rs
[5745]16 If line 14 shows a loss— _-
[5746]_& if losses are shown on BOTH lines 12(a) and 13; omit lines 16(a) a and (b) and go to Part IV,
[5747]See Instruction H. .. : a
[5748]& Otherwise, ot *
[5749]toy (a) Enter one of the following amounts: ‘ ,
[5750]4 (i) If amount on line 5 is zero or a net gain, enter 50% of amount on line’ 14;
[5751]co . (ii) If amount on line 13 is zero or a net gain, enter amount on line 14; or,
[5752]4 (iii) If amounts on line 5 and line 13 are net losses, enter amount on line 5. added to
[5753]50% of amount on “ine WY... we . oe
[5755](b) Enter here and enter as a (loss) on Form 1040, line 29, the smallest of:
[5757]: (i) The amount on line 16(a); .
[5759](ii) $1,000 ($500 if married and filing a separate return—if a loss is shown on line
[5760]3 “ 4(a) or 12(a), see instruction L for a higher limit not to exceed ($1, 000);, or
[5761]oo ; (iii) Taxable income, as adjusted (see Instruction K) .
[5763]- AG AAZB2—T
[5765]NW 88326 Docld:32245535 Page 58
[5768]NW 88326 Dochd:32245535 Page 59
[5770]oe NSE SS eit RES CaN a ey Ea Sa
[5772]“15 (a) Total “FICA" wages as indicated on Forms W-2 . . «> —= = a
[5773](b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9. le Is
[5775]SCHEDULE SE | Computation of Social Security Self-Employment Tax
[5776](Form 1040) p> Each self-employed Person must file a Schedule SE. isi4
[5777]Department of the Treasury p> Attach to Form 1040. p> See instructions for Schedule SE (Form 1040).
[5779]Internat Revenue Service
[5781]@ If you had wages, including tips, of $13,200 or more that were subject to social security taxes, do not fill in this form.
[5782]@ if you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE."
[5784]Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.
[5785]NAME OF SELF-EMPLOYED PERSON (AS SHOWN (ON SOCIAL SECURITY CARD) Social security number of
[5787]Faye tts Kw Bo soltemployed person & | 3¥O | 1B: (YD o. ee
[5788]Business ‘Sctivities subject to self-e i= fe tax (grocery store, restaurant, farm, etc. ms A 2. a S -
[5790]@ If you have only farm income complete Parts | and I. @ If you have only nonfarm income complete Parts Il and Ul.
[5791]@ If you have both farm and nonfarm income coniplete Parts 1, Wl, and II.
[5793]SUIEER Computation of Net Earnings from FARM Self-Employment ws
[5794]A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, oe
[5795]yne 2, if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and :
[5796]2 must be completed even if you elect to use th vot
[5797]REGULAR METHOD (a) Schedule F, tine 54 (cash method), or line 74 (accrual method). .
[5798]1 Net profit or (loss) from: | (b) Farm partnerships . . ... . -
[5799]2 Net earnings from farm self-employment (add lines 1(a) and (b)) cee
[5800]FARM OPTIONAL | (a) Not more than $2,400, enter two-thirds of the gross 5 profits eee,
[5802]3 If gross profits
[5803]from farming ' are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 .
[5805]’ Gross ‘profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 ‘(accrual
[5807]Y
[5808]method), plus the distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line Yy Yj Y
[5810]15) as explained in instructions -for Schedule SE. LY Lila
[5812]4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method .
[5813]Computation of Net Earnings from NONFARM Self-Emptoyment
[5815](a) Schedule C, iine 21. (Enter combined amount if more than one business.) .
[5817]. (b) Partnerships, joint ventures, etc. (other than farming) : .
[5819]REGULAR METHOD (c) Service asa minister, member of a religious order, or a Christian Science prac-
[5823]5 Net profit or _ titioner. (Include rental value of parsonage or rental allowance. furnished.) If
[5824](loss) from: you filed Form 4361, check here [] and enter zero on this line . .
[5825]se {d) Service with a foreign government or international organization . . . . .
[5827](See Form 1040 in Sous
[5828](e} Other structions for line 37.) Specify Po. cee ee ane ee cee een eee nee
[5830]6 Total (add lines 5(a), (b), (c), (a), ana (@)) ee
[5831]7 Enter adjustments if any (attach statement) . . . . : : eee
[5833]8 Adjusted ‘net earnings or (loss) from nonfarm self- employment (line 6, as Js adjusted by line y.
[5835]If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9
[5837]through 11 and enter amount from line 8 on line 12(b), Part Whe
[5839]Note: You may use the nonfarm optional method (line 9 through line 11) only if tine 8 is less than $1, 600 and
[5840]less than two-thirds of your gross nonfarm profits,? and you had actual net earnings from self-employment of
[5842]$400 or more for at least 2 of the 3 following years: 1971, 1972, and 1973. The nonfarm optional method can
[5844]only be used for 5 taxable years.
[5846]* Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu-
[5847]tive share of gross profits from nontarm partnerships (Schedule K-1 (Form 1065), line 15) as explained in
[5848]instructions for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (2), a as
[5849]adjusted by line 7.
[5851]NONFARM OPTIONAL METHOD
[5852]9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
[5853](b) Enter amount from line 3. (if you did not elect to use the farm optional method, enter zero.) .
[5854](c) Balance (subtract line 9(b) from line Ma)) 2. 2 ee . coe eee ee
[5855]10 Enter two-thirds of gross nonfarm profits 7 or $1,600, whichever is , smaller eo. : se ee
[5856]11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller .
[5857]Computation of Social Security Self-Employment Tax
[5859]12 Net earnings or (loss): (a) From farming (from line 4) 2. . 64. we . : . we
[5860](b) From nonfarm (from tine 8. or line 11, if you elect to use the Nonfarm Optional Method) . .
[5861]13 Total net earnings or (loss) from self-employment reported on line 12. ar line 13 is tess than $400,
[5862]you are not subject to self-employment tax. Do not fill in rest of form.) . woe : myo.
[5863]14 The largest amount of combined. wages and self-employment earnings subject to social secutty tax for 1974 is. ss tax for 1 : ___ $135,200 — 200 __06
[5865](c) Total of tines 215(a) and (b) : :
[5866]16 Balance (subtract line 15(c) fromline 14). ... 2°: ee
[5867]17 Self-employment income—line 13 or 16, whichever is smaller ee eat
[5868]18 if tine 17 is $13,200, enter $1, 042.80; if less, multiply the amount on line 17 ‘by. 079 Lo ns
[5870]19 Railroad employee's and railroad employee representative’s adjustment from Form 4469, line 10
[5871]20 Self-employment tax (subtract line 19 trom line 18). Enter here and on Form 1040, line 55 .
[5873]tte U.S. GOVERNMENT PRINTING OFFICE 1 1974—-0-548-085 . So 16852943
[5875]RR St bt Sa EEN RI COT LE lA OMT TT
[5877]* (Form 1040)
[5879]“NW 88326 Docld:32245535. Page 60
[5881]"hoe
[5883]SCHEDULE SE.
[5885]Department of the Treasury
[5886]Internal Revenue Service
[5888]Pp Attach to Form 1040.
[5890]AEDT EERE AAR OI AERE RIE NENT MT OUTS TB NOR NED ANI EDIE TEAS
[5892]wo
[5894]’ Computation of Social Security Self- Employment Tax.
[5896]& Each self-employed person must file a Schedule SE.
[5897]b> See Instructions for Schedule SE (Form 1040).
[5899]@ |f you had wages, including tips, of $13,200 or more that were subject to social security taxes, do not fill in this form.
[5900]@ If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.
[5902]Important.——The self-cmployment income reported below will be credited to your social security record and used in figuring social security benefits.
[5903]SELF-EMPLOYED PERSO ;
[5907]Social security number of
[5908]self-employed person >
[5910]‘AS SHOWN ON SOCIAL SECURITY CARD) -
[5912]Muek - Ma B Y .
[5913]Business activities subject to self- employmént tax (grocery store, restaurant, farm, etc.) DP» -
[5915]EIS TERRA HORNE DTT EN or
[5917]a
[5919]“ee
[5921]ikea
[5923]‘07 : |
[5925]he
[5927]Gat
[5929]@ If you have only farm income complete Parts | and IIH.
[5931]@ if a have both farm and nonfarm income complete Parts |, tl, and Ill.
[5932]Computation of Net Earnings from FARM Self-Employment
[5934]A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular “Method, =
[5935]line 2, if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines Land .
[5937]2 must be completed even if you elect to use the FARM OPTIONAL METHOD.
[5939]REGULAR METHOD
[5941]1 Net profit or (loss) from:
[5943]2 Net earnings from farm self-employment (add lines 1(a) and (b)) . . .
[5944]FARM OPTIONAL METHOD
[5946]3 if gross profits
[5947]from farming ' are:
[5949]' Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 ‘(accrual
[5950]method), plus the distributive share of gross profits from farm partnerships (Schedule K—1 (Form 1065), tine
[5951]15) as explained in instructions for Schedule SE.
[5953]4 Enter here and on line 12(a), the amount on line 2, or'line 3 if you elect the farm optional method . |
[5955]@ if you have only nonfarm income compiete Parts and WI.
[5957]| (a) Schedule F, “line 54 (cash method), or line 74 (accrual method). -
[5958](b) Farm partnerships’)... wee et
[5959](a) Not more than $2,400, enter two-thirds of the gross profits oe
[5961](b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 .
[5963]|
[5965]Sy,81e Computation of Net Earnings from NONFARM Self-Employment
[5967](a)
[5969](b)
[5971]REGULAR METHOD] (c)
[5972]5 Net profit or
[5973](loss) from:
[5975](d)
[5977](e)
[5979]Schedule C, iine 21. (Enter combined amount if more than one business.) .
[5980]Partnerships, joint ventures, etc. (other than farming)
[5982]Service as a minister, member of a religious order, or a Christian Science prac-
[5983]titioner. (Include rental value of parsonage or rental allowance furnished.) If
[5984]you filed Form 4361, check here [_] and enter zero on this line . ;
[5985]Service with a foreign. government or international organization woe ee , .
[5987](Sea Form 1040
[5988]Other structions tor line 31) Specify > _:
[5990]6 Total (add: lines 5(a), (b), (c), (d), ana (€)) 2 ee
[5991]7 Enter adjustments if any (attach statement) . . . . Ale oa tae
[5992]8 Adjusted ' net earnings or (loss) from nonfarm self- employment (line 6, as 1s adjusted by line 2). .
[5993]If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9
[5994]through 11 and enter amount from line 8 on line 12(b), Part tt.
[5995]Note: You may use the nonfarm optional method (tine 9 through line 11) only if line B is less than $1,600 and
[5996]less than two-thirds of your gross nonfarm profits," and you had actual net earnings from self-employment of
[5997]$400 or more for at least 2 of the 3 following years: 1971, 1972, and 1973. The nonfarm optional method can
[5998]only be used for 5 taxable years.
[5999]? Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu-
[6000]tive share of gross profits from nonfarm partnerships (Schedule K~1 (Form 1065), line 15) as explained in
[6001]instructions for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as
[6003]adjusted by line 7.
[6005]NONFARM OPTIONAL METHOD .
[6006]9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
[6008](b) Enter amount from‘tine 3. (If you did not elect to use the. farm Optional method, enter zero.) .
[6010](c) Balance (subtract line 9(b) from tine 9(a)) 26 ee
[6012]‘10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller... soe ee
[6013]11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller .
[6014]Computation of Social Security Self-Employment Tax
[6016]- 4
[6018]12 Net earnings or (loss): (a) From farming (from line 4) . * ee ee ee a
[6019]‘(b) From nonfarm (from line 8, or line’11 if you elect to use the Nonfarm Optional Method) . ,
[6021]-13° Total net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400, .
[6022]you are not subject to self-employment tax. Do not fill in rest of form.) .  .
[6024]14 The largest amount of combined wages and self-employment earnings subject to social security tax for 1974 is...
[6026]15 (a) Total “FICA” wages as indicated on Forms W-2 . . ce
[6027](b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9.
[6029](c) Total of fines 15(a) and (b) © 6 6 we ee
[6030]16 Balance (subtract line 15(c) from line 14)... «we : moa : , :
[6031]17 Self-employment income-—line 13 or 16, whichever is smaller woe eee ae
[6033]18 If line 17 is $13, 200, enter $1,042.80; if less, multiply the amount on line ‘V7 ‘by, 679 wie ve
[6034]19 Railroad employee’ s and railroad employee representative's adjustment from Form 4469, line 10°.
[6036]20 Self-employment tax (subtract line 19 trom line 18). Enter here and on Form 104
[6038]O, line 55...
[6040]_ Fv U.S. GOVERNMENT PRINTING OFFICE ; 1974—-O-548-055 . a
[6044]oe ls a
[6048]5 |
[6050]Eat 2
[6052]—w .
[6055]angeney
[6056]Be
[6058]Departmant: of the Treasury
[6059]Internal Revenue Service
[6061]| Computation of Investment Credit
[6063]b> Attach to your tax return,
[6065]Identifying number 88 shown on
[6066]Page 1 of your tax return
[6068]1 Qualified investment in new and use
[6069]NOTE: Include your share of investm
[6071]d property. (See instructions C a
[6073]for eligible property.)
[6074]ent in property made by a Partnership,
[6076]estate, trust, smail business corporation, or lessor.
[6078]Type of Cost P oasis Applivabie Qualified GR uestment
[6079]Property Line - (See instruction Gj percentage Column 2 x column 3)
[6080]—_—u | ° . , ; +
[6081]~ (a) 3314 : *
[6082]New : "(by
[6084](©)
[6086](d)
[6087]Used | a We tnteensereneeeneee
[6088]Property (0)
[6090](See Instructions for
[6091]dollar limitation)
[6093]: on
[6094]7 or more
[6096]' 2 Total qualified investment—Add lines J(a) through 1(#). Boe ee
[6097]3 Tentative investment credit—7% of line 2 (4% for public utility property) ,
[6098]4 Carryback and Carryover of unused credit
[6100]¢ (s). (See instruction F and instructicn for fine 4—attach computation.) ,
[6101]5_Total—Add lines 3 and 4 a 2. :
[6104]6 (a) Individuals—Enter amount from line 16, page 1,Form 1040 , , soe ee
[6105](b) Estates and trusts—Enter amount from line 24 or 25, page 1, Form 1041
[6106](c) Corporations—Enter amount from line 5, Schedule J 1 ye
[6108]+ Form 1120
[6109]7 Less: (a) Foreign tax credit hoe ee
[6110](b) Retirement income credit (individuals only) :
[6111](ce) Tax on lump-sum distributions. (See instruction 7.) 20. | .
[6112]8 Total—Add lines 7(a), (b), and,(c). 2. | |, Soe,
[6113]9 Line 6G less line 8 re
[6114]10 (a) Enter amount on line 9 or $25,000, whichever
[6116]is lesser, (Married persons filing separately,
[6117]trolled corporate groups, estates, and trusts,
[6120]see instruction for line 10.) .
[6122](b) If line 9.exceeds line 10(a), enter 50%
[6124]of the excess . °
[6126]"11 Total—Add lines 10(a) and (by
[6128]» whichever is lesser (enter here and on line 50,
[6129]© appropriate line on other returns) .
[6130]‘Schedule A
[6132]If any part of your investment in line 1. above was made by a Partnership,
[6134]estate, trust, small business Corporation, or lessor, complete the following: ° *
[6135]Name . / Property
[6136](Partnership, estate, trust, etc.) Address
[6138]- New - Used Life years. }
[6140]16—~83298-1
[6142]Form 3468 as
[6143]_ NW'88326 Docld:32245535 Page 61 Lo as _ a * Te
[6145]Se Ra Bic (te arcs bee ee aes
[6147]NW 88326 Docld:32245535 Page 62 . _ . . . a
[6149]AA a EERE PRISER RS TO OT BERS PETE
[6151]Bee eye
[6153]Capital Loss Carryover
[6155]Form 4798 » (From 1973 to 1974)
[6157]Department of the Treasury ‘ » Attach to Form 1040.
[6158]Internal Revenue Service
[6160]Name(s) as shown on Form 10. . Social Security Number
[6161]HYtlei s 3 rid i?
[6163]A. Who Should File.—You will need to complete B. How to Compute Carryover.—if you have a capi-
[6165]either Part | or Part || of this form if you have a capital tal loss carryover, complete either Part | or Part Il of
[6166]this form, but do not complete both. :
[6168]loss to carry over to 1974.
[6169]1. Complete only Part | if lines 4(a) and 12(a) on ~
[6170]your 1973 Schedule D (Form 1040} DO NOT SHOW A
[6172]You will have a capital loss to carry to 1974 if the LOSS. . ee
[6173]amount on your 1973 Schedule D (Form 1040), line 2. Complete only Part Il if either (or both) line ~~
[6174]16(a), or line 33, is LARGER THAN the {oss deduct- 4(a) or line 12(a) on your 1973 Schedule. D (Form
[6175]ed on your 1973 Form 1040, line 29. 1040) shows a loss.
[6177]GEZEER Post-1969 Capital Loss Carryovers
[6179]Section A.—-Short-term Capital Loss Carryover
[6181]Enter loss shown on your 1973 Schedule D (Form 1040), line 5; if none, enter zero ane ignore *
[6182]lines 2 through 6—then go to line 7... , 1 { 2? Y ! ;
[6184]2 Enter gain shown on your 1973 Schedule D (Form 1040), line 13. r that tine is blank or “shows
[6185]aloss, enter a zero. 0 8
[6187]_
[6189]3 Reduce any loss on line 1 to the extent of any gain on line 2 . Ce
[6191]4 Enter amount shown on your 1973 Form 1040, line 29). 2... ww ee ee 4 [58 »)
[6192]5 Enter smallerofline30r4. 0.0. 1 eee 5 mom?)
[6194]6 Excess of amount on line 3 over amount on line5 2 we 6 (GehaD)
[6196]Note: The amount on line 6 is your short-term capital loss carryover fram 1973 to 1974 that is attributable to years beginning .
[6197]after 1969. Enter this amount on your 1974 Schedule D (Form 1040), line 4(b).
[6201]i
[6202]N
[6205]rE a
[6207]POT I
[6209]Section B.—Long-term Capital Loss Carryover
[6211]7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1973 Form
[6213]1040, line 29) . . coe toe ee ;
[6214]8 Enter loss from your 1973 Schedule D > (Form 1040), tine 213; if none, enter zero and ignore lines Va oot -
[6215]Q9 through 12... «. Ne 84] e: *
[6216]9 Enter gain shown on your 1973 Schedule D (Form 1040), ‘line 5. If that line is ‘blank or ‘shows - : ‘.
[6217]a loss, enter a zero Ca 9 —_—o9
[6218]can :
[6219]10 Reduce any loss on line 8 to the extent of anygainonlineQ 2 2 1 1 ww we ew we | dO ———} = >
[6220]| —o—
[6222]11 Multiply amount online 7by2 20. 20. ee woe ey. | a x,
[6224]12 Excess of line 10 over amount on line LL. 1 7. - . . , a2 es 0= a"
[6226]Note: The amount on line 12 is your long-term capital loss carryover from 1973 to igvat that is “attributable to years beginning
[6227]after 1969. Enter this amount on your 1974 Schedule D (Form 1040), line 12(b). oo oh
[6229]|
[6231]Form 4798 11974)
[6233]|
[6235]Form 4798 (1974)
[6237]ayia Pre-1970 and Post-1969 Capital Loss Carryovers
[6239]Section A.—-Short- term. ‘Capital Losses Identified
[6241]Enter loss shown on your 1973 Schedule D (Form 1040), line 5; if none, enter zero > and ignore
[6242]lines 2 through 20—then go to tine 21 :
[6243]- 2 Enter gain shown on your 1973 Schedule D (Form 1040), line 13. iW that line is blank or "shows
[6245]_
[6247]a loss enter a zero eof ee
[6248]3 Reduce loss on line 1 to the extent of any gain on line 2. an -
[6249]Note: /f line 4(a) on your 1973 Schedule D (Form 1040) is biank, IGNORE lines 4 through 1 11, enter
[6250]a zero on line 12-—then go to line 13.
[6251]4 Combine lines 3 and 11 on your 1973 Schedule D (Form 1040). Enter
[6253]the gain; or if zero or a loss, enter a zero... . 4
[6254]Note: If line 4 is zero IGNORE lines 5 through 11, enter on n line 12 the
[6255]loss from your 1973 Schedule D (Form 1040), line 4(a)—then go
[6256]to line 13.
[6257]Enter any gain from your 1973 Schedule D (Form 1040), line 3
[6258]Enter smaller of line 4or5 .
[6260]5
[6261]. _6_
[6263]Enter excess of gain on line 4 over line 6 Lo, : 7
[6266]9
[6268]on oou
[6270]Enter loss from your 1973 Schedule D (Form 1040), i line 12a); other-
[6272]wise, enter a zero so Soe eee
[6274]9 Reduce any gain on line 7 to the extent of any loss o on line 8. oe
[6276]10 Enter loss from your 1973 Schedule D (Form 1040), line 4(a); other-
[6278]. wise enter a zero. . a
[6280]11 Add the gains on lines 6 and 9 Loe ne : .. . (2d _
[6281]12 Reduce the loss on line 10 to the extent of any gain on line 11 .
[6283]: “13 Pre-1970 short-term capita! loss (Enter smalier of line 3 or 12) . .
[6285]14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over line 13)
[6287]Section B.—Computation of Capital Loss Carryovers to 1974
[6289]15 Enter any loss from line 13,above 2 2... 1 ew “| as
[6291]16 Enter loss deducted on your 1973 Form 1040, line29. 2 2... {36 |
[6292]17 Loss carryover to 1974 (excess of line 15 over line 16—if line 15 does not exceed line 16, center
[6293]- zero). Enter here and on your 1974 Schedule D (Form 1040), .line “(a ;
[6295]18 Enter any loss from line 14, above . . ees me:
[6296]19 Enter excess of line 16 over line 15—if line 16 does. not t exceed line 15,
[6297]" entef zero 19
[6299]20 Loss carryover to 1974 (excess of line 18 0 over line 19-Lit line 18 does not exceed line 19, enter
[6300]’ zero). Enter here and on your 1974 Schedule D (Form 1040), line 4(b)
[6301]21 If you were required to complete Part IV of your 1973 Schedule D
[6302](Form 1040), enter any loss from your 1973 Schedule D (Form 1040),
[6303]line 30; otherwise, enter zero... 21
[6304]22 Enter excess of line 19 over tine 18—if line ‘19 does not t exceed line
[6305]18, enter zero. (Note: if you ignored lines 2 through 20 above, enter .
[6306]amount from your 1973 Form 1040, line 29.). . . . 22 | 7 6
[6307]- 23 Loss carryover to 1974 (excess of line 21 over line 22—-if line 2 21 does not exceed line 22, enter
[6308]zero). Enter here and on 1974 Schedule D (Form 1040), line 12(a) :
[6309]24 If you were required to complete Part !V of your 1973 Schedule D (Form
[6310]1040), enter any loss from your 1973 Schedule D (Form 1040), line 31.
[6311]. However, if Part IV was not required, enter any joss from your 1973
[6313]Schedule D (Form 1040), line 13. 2 2 2. an 24
[6314]25 Enter excess of line 22 over line 21 _W.--  x 2 (if line. 22 does not
[6315]exceed line 21, enter zero.) . . . . os -|_ 25 -
[6317]26 Loss carryover to 1974 (excess of line 24 0 over r line 25—if line 2 24 does not exceed line 25, enter
[6318]zero). Enter here and on your 1974 Schedule D (Form 1040), line 12(b)
[6320]ty US. GOVERNMENT PRINTING OFFICE : 1974—-O-548-157 52-0761621
[6322]NW 88326 Docld:32245535 Page 63
[6324]17
[6326]20
[6331]BPAY NWS A RN BERR AN, ACH Ha ES ID EA Rd RELA UR AN ER EBM SONNE RD LIVMT A DPA 2 A TRADE ER, 8 TDS SES OT Ae ARERR IG RPT BVT
[6333]“awe S, £ A ub ts huey NO. | - an 7 csucwon ey ae :
[6334] jooness BLD =P — PPD 06 566-1 = , eo
[6336]; : _ 19 _
[6338]FI SCAL” YEAR” ENDING". =
[6340]a
[6342]y
[6344]SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION
[6346]PRINCIPAL BUSINESS ACTIVITY . :
[6347]BUSINESS NAME EMPLOYERS NO.
[6349]BUSINESS ADDRESS
[6350]TOTAL RECEIPTS
[6354]INVENTORY AT BEGINNING OF YEAR peo -t
[6355]MERCHANDISE PURCHASED 1:46077\ | vot
[6357]es
[6359]TOTAL (Ah079\| |
[6360]INVENTORY AT-END OF YEAR ; ‘ | €Oop | |35279
[6362]——— 7 .
[6363]GROSS INCOME : : | 32KOS |
[6364]8 . : : . OTHER BUSINESS DEDUCTIONS , .
[6366]ADVERTISING :
[6367]. AUTO AND TRUCK EXPENSE } f A. ‘ is ¢ °
[6369]BAD DEBTS
[6371]CASH SHORT
[6372]COMMISSIONS
[6377]DELIVERY
[6379]Ez —
[6381]DEPRECIATION ( SCHEDULE ATTACHED } ,
[6382]DUES AND SUBSCRIPTIONS
[6386]ENTERTAINMENT AND. PROMOTIONAL
[6387]INSURANCE
[6389]INTEREST |
[6391]JANETOR SERVICE
[6393]LAUNDRY
[6395]LEGAL AND ACCOUNTING
[6399]OFFICE SUPPLIES AND EXPENSE
[6401]RENT
[6403]REPAIRS
[6405]SALARIES AND WAGES we,
[6406]SALARIES OFFICERS . Bo
[6408]SUPPLIES
[6409]TAXES AND LICENSES
[6411]TAXES - PAYROLL
[6413]TELEPHONE
[6414]TRAVEL
[6415]UTILITIES .
[6417]PARKING _
[6419]NET PROFIT OR( LOSS ) - FEDERAL RETURN
[6421]“NET PROFIT OR LOSS ) ~- STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF.
[6423]PROFESSIONAL STATIONERS INC. FORM 104
[6425]NW. 88826 “NBcid:33245535 Page 64.
[6428]PEER AB TAT SE
[6430]SEE OEE OD a REE OT EES As
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[6524]a
[6526]NW 88326. Docld:32245535 Page 65
[6528]PES ESTES I Ra ae EL
[6530]re RE ic LBS FAP SEES ERR FARIS SSE APNE SE Sa SEN BOSE TEE EE BA ST 2 SE DEER BES LEH SFE IS PERRET ay le ARETE EME Be EI EE IT ;
[6532]ce ESE as
[6534]2 INDIVIDUAL
[6536]CALIFORNIA
[6538]r RESIDENT
[6540]TAXABLE YEAR
[6543]Spouse's Social Security Number
[6545]era /¥20
[6547]occu. | Yours Jf eS
[6548]A PATION Spouse's, =
[6549]EXEMPTION CREDITS If line 1 or 3 checked, enter $25 .
[6551]6 Personal (f line 2, 4 or 5 checked, enter $50
[6553]7 Dependents —- Do not list yourself, your spouse, or the person whu qualifies you
[6554]aii head of household. Enter name and relationship.
[6556]Artigas
[6558]ba INCOME TAX . :
[6559]“PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) For calendar year or
[6560]Enter social security number(s) only if incorrect or not shown on label. Taxable year ending. _., 197
[6561]NAME ( int return, give wa and initials of both) yy Your Social Security Number
[6562]AMGaEL Pu LLL K p 12-2! i PPP
[6564]PRESENT HOME ADDRESS (Number andrei, including apartment number, o
[6566]. b 2 é
[6567]R POST OFFICE, STATE AND, ZIP CODE
[6569]city, TOW
[6570]on AW AP
[6572]“FILING STATUS—Check Only One:
[6573]-. 10 Single
[6574]2 Married filing joint return (even if only one had income)
[6576]3 C) Separate return of married person—Enter spouse’s
[6577]* social security number and full name here
[6579]: Total Number > _ 2. 1. x $8
[6580]8 Blind (refer to instructions) Number of blind exemptions = x $8
[6581]5 (J Widower) with dependent child (Year spouse died » 197)| 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20
[6583]4 Oo Head of Household—Enter name of qualifying
[6584]_ individual
[6586]. 10 Wages, salaries, tips and other employee compensation { Agia Gory 2 of hormOd 2 ta tare af this}
[6588]) return. (f unavailable, attach explanation.
[6590]_ 11 Dividends—before federal exctusion. Enter total (if over $400, complete and attach Schedule B(540))
[6591]12 Interest. Enter total (if over $400, complete and attach Schedule B(540))
[6593]13° Income other than wages, dividends and interest (from line 48)
[6595]14 Total (add lines 10, 11, 12 and 13)
[6597]15 Adjustments to income (from line 54)
[6599]16 “Adjusted gross income {subtract line 15 from line 14)
[6601]+ If you do NOT itemize deductions AND line 16 is under $10,000, find tax in Tax Table and enter on line 19.
[6602]+ If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18. ,
[6604]17 Deductions: itemized (from fine 61) OR Standard ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 of 5 checked)
[6605]18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on line 19
[6607]19 Tax fram (check one) Tax Table (] Tax Rate Schedule ‘s Income Averaging Schedule (G or G-1) 0
[6608]20 Total axemption credits (from line 9, above) ol .
[6610]21 Tax liability (subtract line 20 from line 19-—if line 20 is greater ‘than line 19, ‘enter - ser0)
[6612]22° Other credits (from line 65—Includes special low income tax credit) -
[6614]23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, “enter ze10)
[6615]24 Tax on preference income (see instructions—attach Schedule Pt540)) a
[6617]25 Total tax liability (add lines 23 and 24) a
[6619]<@ ATTACH COPY 2 OF FORM W-2 HERE >
[6621]26 Total California income tax withheld (attach Form(s) W-2 or W-2P to face of this return)
[6623]27 Renter's credit—if you lived in rented property on March 1, 1974, complete Part 1 on page 2 .
[6624]28 1974 California estimated tax payments .
[6626]29° «Excess California SD! tax withheld (attach Form DE 1964 to face of this cefurn)
[6628]30 Total prepayment credits (add lines 26 thru 29).
[6630]= 31 If line 25 is larger than tine 30, enter BALANCE DUE. If it is equal to line 30, enter zero.
[6632]b 4 ; Pay in full and mail with retura to: FRANCHISE TAX BOARD ° PAY IN FULL aad
[6634]2 SACRAMENTO, CA 95867 ” not write in these spaces ans -
[6635]ow 32 If line 25. is smaller than line 30, enter amount OVERPAID Bo oe : .
[6636]= Mail return to: ; - FRANCHISE TAX BOARD =. | we el P82] ee Freep a
[6637]= P.0. BOX 13-540 m, E _
[6639]i ‘ ; SACRAMENTO, CA 95813 a ; ra
[6641]3 33 Amount of line 32 to be REFUNDED. (Allow at least six weeks) — —— REFUND TO YOU —» 33 .
[6643]E & 34 Amount of line 32 to be credited on your 1975 ESTIMATED TAX . . . | 34: Pe
[6645]Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge ond
[6646]belief it is true, correct and complete. if # prepared by a persan other than taxpayer, his declaration is based on all information of which he has any knowledge. -
[6648]SIGN aT signature — : . Date do — sionatuve (other than taxpayer) Date
[6650]83717 VANOWEN STREE} 2
[6652]Write social security number on check or money order. ATTACH HERE
[6654]: v HERE rr signature—if filing a joint return : Date
[6655]NW 88226 Docid:32245535 Page 66 ,
[6657]Address (and Zip cod " . 94
[6658]re! an . ~ 967-34-8729
[6661]APSEDIESFRSSIR STEEL SRL UN RP PR RH FEE AEN LET ARENA TINA RSE REE BE SO ALTE SETS
[6663]et
[6665]Page 2 Form 540 (1974)
[6667]“PART | — Renter's Credit — All questions must be answered See Instructions, Page 3, for Allowable Credit. > |E.
[6669]-35 Did you, on March 1, 1974, live in rented property which was your principal residence? . . . . {) Yes MNo If mo, you may not claim this credit
[6670]35 Was the property you rented exempt from property tax? -. . te ee Yes CO No - If yes, you may not claim this credit
[6671]37 Did you live with any other person who claimed you as a dependent for income tax purposes? . . ([_) Yes (No -. If yes, you may not claim this credit .
[6673]38 Did you or your spouse claim the homeowners’ property tax ‘exemption or receive public assistance? (} Yes 1-1 No If yes, see page 3 of instructions _—
[6675]PART Il — Other Income
[6677]Busiriess income (or loss) (attach Schedule C(540))
[6678]40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule 1540))
[6680]41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540) )
[6681]Pensions and annuities
[6683]Rents and royalties . . | ATTACH
[6685]: ae SCHEDULE E
[6687]Partnerships . FORM (540)
[6689]Estates and trusts . t
[6691]Farm income (or toss) (attach Schedule F(540))
[6693]Miscellaneous income .
[6695](a) Fully taxable pensions and annuities (not reported « on Schedule £(540)) - oe — Cow eee PATad oe - weneeereeeefeeee
[6696](b) Atimony Le we
[6697](c) Other (state nature and source)... senses ten ecene eee eet ecceeeerennctnelenne
[6698]Enter total of tines 47(a), 47(b), and 47(c). =, ;
[6699]48 Total (add lines 39 thru 47). Enter here and on line 13
[6701]_ PART Hl — Adjustments to Income
[6703]“Sick pay,” if included in line 10 (see instructions — attach statement)
[6705]50 Moving expenses (see instructions — attach statement)
[6707]51 Employee business expenses (see instructions — attach statement)
[6708]“52 Military exclusion (see instructions). . . . . a)
[6709]53 Payment as a self-employed person to a retirement plan, etc. , ,
[6711]54 Total adjustments {add lines 49 thru 53). Enter here and on line 15
[6713]ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE ~ po ae.
[6714]DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION. : _
[6715]© Attach Schedule A(540) and enter sub-totals on lines 55 thru 60, below coe : -
[6716]55 Total deductible medical and dental expenses (from Schedule A(540), line 10). tae an
[6717]56 Total child adoption expenses (from Schedule A(540), line 13)
[6718]-- 57 Total taxes (from Schedule A(540), line 21) a
[6719]Total interest expense (from Schedule A(540), line 25) . . . . . cs
[6720]59 Total contributions (from Schedule A(540), line 29) :
[6721]60 Total miscellaneous deductions (from Schedule A(540), line 40)
[6722]Total itemized deductions (add tines 55 thru 60). Enter here and on line 17
[6724]“seaeee
[6726]_ PART IV — Itemized Deductions —
[6728]PART ¥ — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW.
[6730]62 “Other State’ net income tax credit (attach copy of other state return and Schedule $(540) )
[6731]"63 Retirement income credit (attach Schedule R(540)) :
[6733]64 .(a) Special Low Income Tax Credit — If Adjusted Gross Income does not include net capital gains from assets held 1 more than a one
[6734]year and is $8,000 or less (joint return of married couple, head of household or widowler) with dependent child) or $4,000 or
[6735]tess (single or separate return of married person) enter the amount from: line 2l. It Adjusted. Gross Income includes Capital
[6737]; Gains, complete Schedule B-1. See Page 3 of Instructions :
[6738]“(b) Enter total here from line 4, Schedule B-!. If zero or a joss, enter zero...
[6740]65 TOTAL (add lines. ,62 thru 64a. Enter here and on tine 22
[6742],
[6744]NW 88326 ‘Docid:32745535 Page 67
[6747]ee en eae ec a
[6749]e as shown on Form 540
[6751]ite Ll.
[6753]ATEMIZED DEDUCTIONS
[6755]Attach to Form 540
[6757]Use only it you do not use the Tax Table or take the standard deduction.
[6759]Medical and dental expenses (not comperisated by insurance or otherwise) for
[6760]medicine and drugs, doctors, dentists, nurses, hospi-
[6761]tal care, insurance premiums for medical care, etc.
[6763]10.
[6765]. Total—iAdd tines. 4 5, ‘6a, b, and c)
[6767]. Enter 3% ot adjusted Bross income shown on
[6768]Form 540 . toe
[6770]. One half (but not more than $150) of insurance
[6772]premiums for medical care
[6774]. Medicine and drugs
[6776]. Enter 1% | of adjusted gross income shown on Form
[6777]540. oh .
[6779]. Subtract line 3 from line 2. Enter difference (if tine
[6781]3 is greater than line 2, enter zero)
[6783]. Enter. balance of insurance premiums for medical
[6785]care not entered on line 1
[6787]. Other medical and dental expenses:
[6789](a) Doctors, dentists, nurses, etc.
[6790](b) Hospitals . ; : :
[6791](c) Other {itemize) .
[6793]CH
[6795]. Subtract line 8 from tine 7. Enter difference (if
[6797]line 8 is greater-than tine 7, enter zero).
[6799]Total—(Add lines 1 and 9. Enter here and on
[6800]Form 540, page 2, line 55)... . >
[6802]Child Adoption Expense
[6804]11. fatal axpenses paid or incurred—Attach itemized
[6805]12. Enter 3% of adjusted gross income shown on Form
[6806]13. Subtract line 12 from tine 11—See instructions -
[6807]for maximum limitations. (enter h here and on Form
[6808]. $40, page 2, line 56) . rn
[6809]Taxes :
[6810]. 1 R Real estate
[6811]_ 15. State and local gasoline
[6812]~ "16. General sales
[6813]17. Auto license—Excess of registration a and weight fees
[6814](see instructions) .
[6815]18. Personal property. .
[6816]19. State disability insurance (SOi—Employer private
[6817]. disability plans do not qualify ..
[6818]20. Other wo. rin a
[6819]21. Total taxes—{Add lines 14 through 20. Enter here
[6821]and on Form 540, page 2, line 57). . >
[6823](Rev. 1974) wo
[6824]NW88326 Docld:32245535 Page 68
[6826]. 23. Installment purchases
[6828]28.
[6830]_ 35. Alimony pald
[6832]Interest Expense i
[6834]22. Home mortgage .
[6836]24. Other (itemize) .
[6838]25. TotaliAdd ‘lines 2, "23 and. 8. ‘Enter here ad :
[6839]on Form 540, page 2, line 58).
[6841]Contributions . oso
[6843]26. Cash contributions for which you have recelpts, can- m
[6844]celed checks, etc. .
[6846]27. Other cash contributions. List donees and amounts ,
[6848]Other than cash. —-See instructions for required :
[6849]. ‘statement : . .
[6851]29. TotaliAdd lines 26, 27 and 28. Maximum deduction ~
[6852]may not exceed 20% of adjusted gross income. —
[6853]Enter here and on Form 540, page 2, line 59) . >
[6855]Miscellaneous Deductions
[6857]Casualty or Theft Loss(es)—See instructions
[6859]NOTE: If you had more than one loss, omit lines. 30
[6860]through 34 and follow instructions for guidance. "
[6862]30. Loss before insurance reimbursement
[6863]31. Insurance reimbursement
[6865]32. Subtract line 31 from tine 30. Enter difference ‘it :
[6866]- fine 31 is greater than line 30, enter zero) :
[6868]33. Enter $100 or amount on tine 32, whichever is
[6871]34. Casualty or theft loss (line 32 less line ‘wi
[6873]36. Child care—See instructions.
[6875]“37. Union dues - a
[6876]38. Employment education expense—See instructions ae]
[6877]39. Other—See instructions (itemize) . :
[6879]40. Total—Add fines 34, 35, 36, 37, 38 and 39. (Enter
[6880]here and on Form 540, page 2, ‘line 60) nl od
[6882]EMT SABRI ABP ETHERS ARTE PD MERI AA bP LRP HATRED S AT AUN EL ESET A SLR RS RRS TT NSA SES OTE IE RTE TRS URNS 7
[6885]PROFIT (OR 108s) FROM BUSINESS OR PROFESSION
[6887]- . (Sole Proprietorships)
[6889]Attach this schedule to your Income tax return, Form 540.or S40NR —_— Partnerships, joint ventures, etc., must file on Form 365 -
[6890]Social Security Number
[6892]/ wv _ oe 22/279
[6893]A. Principal business activity... pa RB. Ve Cc. Ee. cote sacastnee sscuceneaeeseeateesesnnneeanece ; product... all CEBAR.
[6895](See Instructioris for ‘Item A.'’) (For example; retail—hardware; pees sarvices—legal; manvufacturing—furniture; etc.)
[6896].. B. Business name... e Woo oe y B (STR.O Cor FEES eee
[6897]D. Business address.. Mors V NTA RA BL OD ve cetaecleecesetoeeeseseeun
[6898]E. Indicate method of accounting: [(} cash; i accrual; i Fe J MP coda)
[6899]F. Were Forms 591, 592, 596 and 599, maw, calendar year filed a required)? oo ' EJ No io
[6900]G. Method of inventory valuation P.. ST eeeeeee SY:
[6901]Was there any substantial change in the manner of determining quantities, costs, 0 or valuations between the o opening g and closing inventories? ;
[6902]If “Yes,” attach explanation.
[6904]Name as shown on Form 540 or A40NR
[6906]{MPORTANT—A!! applicable lines and schedules must be filled in.
[6908]- 1 Gross receipts or sales $__ Less returns and allowances $..-
[6909]S| 2 Less: Cast of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) .
[6910]9 3 Gross profit ,
[6911]Z) 4 Other income (attach schedule)
[6912]5 “TOTAL income (add lines 3 and 4)
[6913]6 Depreciation (explain in Schedule C-3)
[6914]7 Taxes on business and business property (explain in ‘Schedule C. 2)
[6915]8 Rent on business property ry rn sone
[6916]9 Repairs (explain in Schedule C-2) . . . . a : i an vee :
[6917]10 Salaries and wages not included on line 24, Schedule C 1 {exclude any ‘paid 1 to yourself). :
[6918]WL Insurance |. a
[6919]12 Lega! and professional fees . . : 7 a
[6920]13 Commissions. . . eS OO
[6921]14 Amortization (attach statement) rn es [ee .
[6922]w|15 (a) Pension and profit-sharing plans (see Instructions for line 15(a)) . , , .
[6923]3 (b) Employee benefit programs (see Instructions for line 15(b)) oo 7 an oy 4
[6924]5 16 Interest on business indebtedness ©. 2. 2 6 2 2 we me Se
[6925]5|17 Bad debts arising from sales or services a
[6926]18 Depletion . . we ee ee Le
[6928]19 Other business expenses (specify):
[6930](h) Total other business expenses s (add lines 1916) through 19%(g)) . ee ge
[6931]20 Total deductions (add lines 6 through 19) . Co ee ee ee ee ‘Cy rt
[6933]21 Net profit (or loss) (subtract line 20 from fine 5). Enter here. and on page 2, Form 540 or Form S540NR ©
[6935]- SCHEDULE c-1. COST OF GOODS SOLD (See Schedule C Instructions for line 2)
[6937]22 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) .
[6938]23 Purchases $000 Less cost of items withdrawn for personal use $....... vevseeee vente _ “Balance >
[6939]: 24. Cost of labor (do not include salary paid to yourself) vee ee fa rs - an eee
[6940]- 25. Materials and supplies a ee oe ; ° : a sessed _
[6942]26. Other costs (attach schedule) 2. 60 ke ee ee
[6944]_ 27 Total of lines 22 through 26 °. a . noe ne
[6945]28 Less: Inventory at end-of year. . . _ Re
[6946]29 Cost of goods sold. Enter here and on line 2, ‘above. Le - .
[6948]: NWW88978 Docld:32245535 Page 69
[6951]SALE Re CREPES AR SPCR AIS AEE DSRS STATA MR j
[6953]L
[6955]Schedule C’ (Form 540) (Rev. 1974) De SE. Page 2
[6957]. SCHEDULE C-2. Explanation of Lines 7 and 9 ;
[6959]Line No, Explanation
[6961]Amount
[6963]Amount
[6965]’ SCHEDULE C-3. DEPRECIATION (See Schedule C Instructions for line 6). NOTE: Depreciation may be computed by
[6966]using the Asset Guideline Classes Specified in Federal Revenue Procedure 72-10, regardless of when assets were:
[6967]placed in service. If this method is used, do NOT use the Lower Limit or the Upper Limit (ADR) Ranges. Attach .
[6968]detailed statement of depreciation computation.
[6970]a, Group and guideline class b. Date c. Cost or d. Depreclation e. Method of f. Life or |g. Depreciation for
[6971]: fl 7 allowed or allowable computing
[6972]or description of property acquired other basis in prior years depraciation rate this year
[6974]1 Total additional first-year depreciation (do not include in items below)
[6975]2 Asset Guideline Class System (See Note above)
[6976]3 Other depreciation
[6977]Buildings .
[6978]Furniture and fixtures . .
[6979]Transportation equipment. . 2. fo. en nn Corn
[6980]Machinery and other equipment.» fo. a veeeelecscae|ooeee
[6981]_ Other (specify)
[6983]4 Totals
[6984]_ 3 Less: Amount of depreciation claimed “elsewhere in n Schedule C1
[6985]6 Balance—Enter here and on page 1, line 6 .
[6987]SCHEDULE C-4. Expense Account Information (See Schedule C Instructions for Schedule C-4)
[6989]Enter information with regard to yourself and your five
[6990]’ highest paid employees. In determining the five highest
[6991]paid employees, expense account allowances must be
[6992]added to their salaries and wages. However, the infor- : ;
[6993]mation need not be submitted for any employee for L[ AB crrttrrererceregrey sees rene nun ennnnennencernes
[6994]’ whom the combined amount is less than $10,000, or .
[6995]for yourself if your expense account allowance plus. _ it On BO nena en .
[6996]tine 21, page 1 is less than $10,000. ns es en ie i
[6998]Did you claim a deduction for expenses connected with:
[7000](1) Entertainment ility (boat, resort, ranch, ete)? . ‘(3) Employees’ families at conventions or meetings? ne
[7001]C7 Yes No so 0 Yes © No ;
[7002](2) Living eccommosictions (except employees on business)? (4) Employee or family vacations not reported on Form W: 22
[7004]No
[7006]Y ae
[7009]A RAP EAR BET ASRS Bat RTE E EEE SAR REPL ATT OE EFI EF AAP ie EE a vr TTR
[7010]a . yee st a i or a pe
[7012]CALIFORNIA
[7013]CAPITAL GAINS AND LOSSES
[7015]Attach to Form 540 or 540NR
[7017]TAXABLE
[7019]sat.
[7021]" FORM 540.
[7022]Use this schedule to report gains and losses on stocks, bonds and similar investments,
[7023]and gains (but not losses) on personal assets such as a home or jewelry.
[7024]Name as shown on Form 54 "¥ 4ONR /) — _ : ; joel f -
[7025]ta Eb. Me burs u_ fs _—_ 2.2/2. 779?
[7026]PART I—Assets Held One Year or Less ; . - :
[7028]e. Cost or other basis as
[7029]: adjusted, cost of subse- .
[7030]a. Kind of property and description b. Date acquired ¢. Date sold d. Gross sates quent improvements (if f. Gain or loss”
[7031](Example, 100 shares of ‘‘2” Co.) . (mo.. day, yr.) (mo., day, yr.) price ‘not pprehased, attach Lo (d. fesse.)
[7032]. : explanation) and = ex- vate
[7033]: pense of sale ;
[7035]SE CAN Ta Su MMiTTE AELE
[7037]joo CHIEFTAIN DEXEL 3 |6/70/
[7040]“2 E Enter gain or loss), ‘if “Gpplicabie, “from Tine 18, ‘Schedule D- 1 (540) {attach copy) .
[7041]3. Enter your share of net gain or loss from partnerships and fiduciaries .
[7042]4, Net gain or loss, combine lines 1, 2 and 3
[7044]PART I!l—Assets Held More Than One Year But Not More Than Five Years
[7046]7. Enter your share of net gain or loss from partnerships and fiduciaries :
[7047]8. Net gain or loss, combine lines 5, 6 and 7
[7049]10. Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)
[7050]11. Enter your share of net gain or loss from partnerships and fiduciaries . .
[7051]12. Net gain or loss, combine lines 9, 10 and 13 .
[7053]PART 1V—Summary of Capital Gains and Losses
[7054]13. Enter amount from line 4 2 6 1 6 ee 4 2. Fp i
[7055]14. Enter 65% of the amount on line 8 ee ee eee. JQ pOY sud -
[7057]' 15. Enter 50% of the amount on line 12 . oP e ,
[7058]16, Enter unused capital loss carryover from preceding taxable years "(attach computation ek 509
[7059]17. Combine the amounts shown on lines 13, 14, 15 and 16 , .
[7061]. 18, If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or ‘540NR
[7062]19. If line 17 shows a loss, enter here and on page 2, Part wy of Form 540 or S540NR the smallest, oft
[7063](a) amount on lines 17; . : .
[7064]. (b) the taxable income for the taxable year (computed without: regard to gains or losses from sale or exchange
[7065]of capital assets; or ; :
[7066](c) $1,000 ($500 in the case of a husband or wife filing a separate return) |
[7068]NW 88326 Docld:32245535 Page 71 - .
[7070]y
[7072]wane _ Simuar L faye Lts Kuby CALENDAR VAR
[7074]_ ADDRESS 322-12-7? : SOC. SEC. NO, —____
[7076]ES ER PETE SEGRE TARA ERR PUSS Bee EEO EU ee OY A PSS Re EE RON
[7078]DEDUCTION SCHEDULE o
[7080]“WEDICAL___ [STATE FEDERAL CONTRIBUTIONS STATE FEDERAL
[7081]2 MEDICINE/ORUGS | {| f2teartNersniesnane ew |
[7083]3 LESS 1% A.G.L. (Line 18 - 1040) GIRL/BOY SCOUTS
[7084]HEART FUND/CANCER FUNJ
[7086]4 NET MED/DRUGS
[7087]5H & A INS, (4 + EXCESS)
[7089]P|
[7090]P|
[7091]fia DR. ‘ \f Jt at [oT
[7092]OR i po
[7093]DR. Ko |_| Pourrica contrisutions/” | pe
[7094]OR. cHuRcHeS | ff _ aE
[7096]DR.
[7097]J pe
[7098]|. sds carry over FROM PRIOR YRS Ts
[7099]6b HOSPITAL pat | 24 TOTAL CONTRIBUTIONS 3 A T ISO |
[7100]PROSTHETIC. APPLIANCES CASUALTY OR THEFT LOSS(ES): j
[7101]26 INSURANCE REIMBURSEMENT [ff
[7102]6c AMBULANCE — 27 Difference (not less than zero) [ {||
[7103]LABORATORIES Po fa stoo citation Per cas.) | i
[7104]TRAveLFoRMeD. (yD | —s| | DO |. 29 ror.casontHerttoss PY | |__|
[7105]: — MISCELLANEOUS DEDUCTIONS
[7106]MEDICARE INS. 30 ALIMONY a
[7107]GLASSES | | |31unionproressionacoues [| | of
[7108]7 MEDICAL EXPENSES . pa =| 32 CHILD & DEP, CARE (Form 2441)
[7109]LESS REIMBURSED BY INS. ; 33 INCOME TAX PREPARATION Pf
[7110]8 LESS 3% ADJ. GROSS INC. | =f UNIFORMS/PROTEC. CLOTHING a
[7111]9 FL ae GIT smatc toousanosuppuies [OT
[7112]1__+:% (TO $150) OF H & A INS. Po SOT TT caunory ano CLEANING __- a eee
[7113]10 TOTAL MEDICAL DED. 1386 1 PT web tT Auto Use Mi ————E
[7114]TAXES LINVEST,COUNSEL&PUBS.Schedf |
[7115]11 STATE & LOCAL INCOME Fr | | emecovmentacencyfeces | - - .[ JY. |
[7116]12 REAL ESTATE a 2-7 | | sareverosirsox TT
[7117]13 STATE & LOCAL GASOLINE el | re.reaineusiness [| of
[7118]14 GENERAL SALES TAX + | ff —_________}- ____|___J
[7119]184 PERSONAL PROPERTY os re ee ee
[7120]15b PERSONAL PROPERTY AUTO ee See
[7121]IG STATE DIS.INS.H WW ——————————
[7122]SALES TAX AUTO — 34 TOTAL MISC. DED. a
[7124]| || —— | any oF re OE a FEDERAL
[7125]rota Taxes S779 0) SS
[7126]INTEREST (TO WHOM PAID) BETOTAL TAXES (FromLiNEi7) J. | Of
[7127]18 MORTGAGE il #3 | | 37 TOTAL INTEREST (Line 20) a ee
[7128]a [—aerorac conta. tinwan |__| J
[7129]fr TB cas. & THEFT LOSS(ES) (Linea) FT
[7130]“IQINSTALLMENT LOANS ee es Crack e pT
[7132]TRAC 6, | ee ee eee
[7133]BEL C | PAT RIES on PokMe tao Line as STA NS sFO |
[7134]po Fras
[7136]20 TOTAL INTEREST 3992+ 192992 | z= ae
[7138]| NWAGSES6 oDecle2245505, Rage?anaeles, Calif. Form 101 . _ . . fot
[7140]SPEARS OT ARG AB BERG TY
[7142]SE AALS IERIE RARE Cae EPS A ORR oe PSSST NEN TPE SR
[7144]wwe Sauer L bay
[7146]_ ADDRESS 322 -~/i-? ? : __ $06. SEC. NO.
[7148]~ MEDICAL
[7149]2 MEDICINE/ORUGS
[7151]STATE
[7153]wows kuby
[7155]; FEDERAL
[7157]DEDUCTION SCHEDULE
[7159]CONTRIBUTIONS ;
[7161]21 PARTNERSHIP SHARE
[7163]STATE FEDERAL
[7165]J LESS 1% A.G.I. (Line 18 - 1040)
[7166]4NET MED/DRUGS
[7168]5H & AINS. (% + EXCESS)
[7170]6a DR.
[7172]1
[7174]“DR.
[7175]DR.
[7176]DR.
[7177]OR.
[7178]DR.
[7179]DR.
[7180]DR.
[7182]6b HOSPITAL
[7184]GIRL/BOY SCOUTS
[7186]HEART FUND/CANCER FUNY
[7187]RED CROSS/UNITED FUND
[7188]XMAS & EASTER SEALS
[7189]MISC. ORGANIZED CHARITIE
[7191]FO Y |
[7193]s
[7195]POLITICAL CONTRIBUTIONS/ |
[7196]CHURCHES ;
[7198]22 OTHER THAN CASH
[7200]23 CARRY OVER FROM PRIOR YRS
[7202]24 TOTAL CONTRIBUTIONS
[7204]PROSTHETIC APPLIANCES
[7206]CASUALTY OR THEFT LOSS(ES)
[7208]HEARING AID
[7212]LABORATORIES
[7214]25 |.OSS BEFORE ADJUSTMENT
[7215]26 INSUMANCE REIMBURSEMENT
[7216]27 Difference (not less than zero}
[7218]eT
[7219]UB
[7221]_TRAVEL FORMED. | () U™D
[7223]MEDICARE INS..
[7224]GLASSES
[7225]7 MEDICAL EXPENSES
[7226]LESS REIMBURSED BY INS.
[7228]8 LESS 3% ADJ. GROSS INC.
[7229]9
[7230]1 +:% (TO $150) OF H & A INS.
[7231]10 TOTAL MEDICAL DED.
[7232]TAXES
[7233]11STATE & LOCAL INCOME
[7237]12 REAL ESTATE
[7238]13 STATE & LOCAL GASOLINE
[7240]14 GENERAL SALES TAX
[7242]15a PERSONAL PROPERTY
[7243]15b PERSONAL PROPERTY AUTO
[7245]16 STATE DIS. INS. H w
[7246]SALES TAX AUTO
[7248]17 TOTAL TAXES
[7250]INTEREST (TO WHOM PAID)
[7251]18 MORTGAGE
[7253]= SUMMARY OF ITEMIZED DED.| State
[7254]AYO TORE TL [3 ee ess Fron tine io 6 ONT*
[7256]xe)
[7257]N
[7259]i
[7261]—s 28 ($100 LIMITATION PER CAS.)
[7262](-)
[7264]| [29 ror.cas oR THEFTLOSS >
[7267]2c)
[7268]i)
[7269]m
[7271]-
[7273]2
[7274]m
[7275]i=]
[7277]77)
[7278]o
[7279]m
[7281]c
[7283]a
[7284]i=)
[7285]2
[7286]|
[7288]| [30auimony
[7290]| [31 union/PRoressionat DUES _|
[7292]PIS OY | [32 cHiLo & DEP. CARE (Form 2441)
[7294]YS 83 INCOME TAX PREPARATION
[7296]| 2698 | UNIFORMS/PROTEC. CLOTHING
[7297]2S
[7299]igs, LAUNDRY AND CLEANING
[7300]£ Auto Use Mi
[7306]EMPLOYMENT AGENCY FEES
[7307]SAFE DEPOSIT BOX
[7308]TEL. REQ. IN BUSINESS
[7310]34 TOTAL MISC. DED
[7315]INVEST. COUNSEL & PUBS.(Sched
[7317]3G TOTAL TAXES (From LINE 17)
[7319]37 TOTAL INTEREST (Line 20)
[7321]19 INSTALLMENT LOANS
[7323]38 TOTAL CONTR. (Line 24)
[7324]139 CAS. & THEFT LOSS(ES) (Line29)
[7326]MERRILL AW
[7327][RAL AID
[7329]LE fal h
[7332]m
[7333]o
[7334]mi
[7335]a
[7339]BLT...
[7340]CBD a
[7342]20 TOTAL INTEREST
[7344]w
[7346]NVRBSE2G CDOT RAIS STIS. Pago ya nceles. Calif. Form 101
[7348]\)
[7349]5
[7351]I
[7353]. 40 TOTAL MISCELLANEOUS
[7354]DEDUCTIONS [FROM LINE 34)
[7355]26 . :
[7356][7 TOTAL LTEMIZED DEDUCTIONS : ™ ro
[7357]41 INTER ON FORM 1040 LINE 45 my £4 ¥ ow £Y
[7359]REMARKS
[7361](2.9
[7364]a
[7367]ea TE a BRN PED TT TRE ID ee JME ITS ST SR DEE RASS MS BRE I PEND EN NLT TER BOP ERIS CH OE RARE TRE ELT OIA
[7369]4
[7371]Moe LLIs RB - : a
[7373]“ADDRESS __ 222 -/ —?97 SOC. SEC. xo.
[7375]SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION
[7377]PRINCIPAL BUSINESS ACTIVITY :
[7378]BUSINESS NAME . mo : EMPLOYERS NO.
[7380]BUSINESS ADDRESS
[7382]TOTAL RECEIPTS fi
[7383]INVENTORY AT BEGINNING OF YEAR .
[7385]MERCHANDISE PURCHASED
[7387]LABOR
[7389]TOTAL
[7390]INVENTORY AT END OF YEAR
[7392]GROSS PROFIT
[7394]GROSS [NCOME
[7396]OTHER’ BUSINESS DEDUCTIONS
[7398]a
[7400]Xe!
[7402]ADVERTISING
[7404]4
[7406]S|
[7408]Uy
[7410]2
[7412][Ps
[7414]AUTO AND TRUCK EXPENSE laAre-?P
[7415]BAD DEBTS
[7417]CASH SHORT
[7418]COMMISSIONS
[7420]DELIVERY
[7423]x
[7426]DEPRECIATION ( SCHEDULE ATTACHED } _ '
[7427]DUES AND SUBSCRIPTIONS .
[7429]ENTERTAINMENT AND PROMOTIONAL
[7431]INSURANCE ©
[7436]INTEREST
[7438]JANETOR SERVICE
[7439]LAUNDRY
[7441]J
[7442]Lon
[7443]|
[7445]LEGAL AND ACCOUNTING
[7449]MAINTENANCE
[7450]OFFICE SUPPLIES ANO EXPENSE
[7452]RENT
[7454]REPAIRS
[7456]SALARIES AND WAGES
[7457]SALARIES OFFICERS
[7459]SUPPLIES ©
[7460]TAXES AND LICENSES ‘ a , ,
[7461]TAXES + PAYROLL ~ : = . | Ses |
[7462]TELEPHONE ‘ - ;
[7463]TRAVEL
[7464]UTILITIES °
[7466]_ FARK? NG
[7471]. hol
[7472].
[7474]“CNET PROFIT OR LOSS ) - FEDERAL RETURN
[7476]i RRA A
[7478]Et
[7480]NET PROFIT OR LOSS ) ~ STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF. 1 aj)’
[7482]PROFESSIONAL STATIONERS INC, FORM 104
[7484]mS : SCHEDULE |
[7485]NW 88396 “ASG sddnb595 Page 74 a ne SCHED
[7487]TERE HE eT Sr ra tig, rcaess BANOS SBR SLE CES PRE SEARS ENROL UATE SEEN APR BEAST :
[7488]e a Fa
[7489]re o ve ~ £ Bry
[7490]z < « > a
[7491]2a 2 gee
[7492]. ae Ww uo ‘
[7493]a
[7494]< a
[7495]yo
[7496]; val cana
[7497]ta > moe
[7498]5 2 Cares
[7499]z Pa ao
[7501]2 2
[7502]Su g
[7503]z
[7504]G
[7505]a
[7507]z
[7508]Zo q
[7509]<8 _
[7510]a
[7511]o a
[7513]awn
[7515]. eS
[7517]° ga
[7519]z 47
[7521]<a
[7523]. 1°
[7525]- oO. =
[7527]gy BE
[7529]a
[7531]*O-
[7532]a VU
[7533]7 Oo
[7534]-— YY.
[7536]DEPRECIABLE
[7538]SPEC 20%
[7539]DEP
[7541]SCHEDULE OF DEPRECIATION / AMORTIZATION: -
[7543]a n ||
[7545]- ° RB
[7546]a Pe
[7548]u &
[7549]oO
[7551]Ww >
[7554]<3 RS +E
[7557]<z | +
[7559]KIND OF PROPERTY
[7561]ADDRESS
[7562]TOTALS
[7564]NW 68326 Docld:32245535 Page 75
[7566]“SCHEDULE. ————___———.
[7568]. CALIF. FORM NO TO2ZA
[7570]LOS ANGELES
[7572]“ING.
[7574]PROFESSIONAL STATIONERS
[7577]4
[7579](Ss Ley ohinaunt-of thie Treooury / Iegornal Rovonue Sorvica eo” crt 9 ONG
[7580]LSS (nclhviciced Income Fax Rotarn => * FO) IQTL
[7582]Q
[7583]74, or othor CnObla yoor BOGIAIAG 1. eee
[7585]4
[7589]Lost nome Gaur celal rca 7
[7590]Reihcad’o, Moi Ce ae
[7591]RUBY cas any
[7592]ei a
[7593]3 Gumbce, €7 merch seuto) . | Citoto curctca, 8 fein’ acm, :
[7595]89S [349 436 13420
[7598], BOM Lay Sokicus a es Tints HOSUowlvO™ 7
[7600]: Exemptions | Rogular / 6S orever / Olind Enter
[7602]: | Gyoursof. . . . . & , O f° Gano
[7603]iaing ko r kun (oven if erty eno hed ineoma) =| 7 Wifo (husband)... oO
[7604]are ociy. 1 vic (iuchsnd) ts atco | O First names of your dopondont chitdron who Htved with
[7606]: 3 isk eounty humiber ond fos you _Frad, Brinn, Elion, Thoman. =
[7608]. “. “
[7609]| : . : ; . oy cote me ee rename oe ans crrmenre eer camer rine f Ns
[7611]a first nemco Cad gilddla Initista ef bate)
[7612]YANG
[7614]i, ineludiag cr :
[7618]4
[7620]he meh anily one:
[7622]. bee ' . ee naa pales ane tite Hier oe ebm aint” aie “4
[7623]Ye bat a a . wee ae bilcate| f°.
[7624]2 cr hac’: magne child (kat wysuvet cath | 9 Number of other dopandents (from line 32) 6. Et
[7625]: oad CW > 8 ys . 10 Yotai oxemptions claimed . . . . . + . Fl &
[7627]21 08, C5el03, tiga, rid choy ciiployca eomponcation. yy ynovariclio, uttcen ononation) *
[7629]an a camin
[7633](Attach Ferm Vie? to front.
[7635]wee tee |e nme tee eee | ere
[7637])
[7639]a | tuba’ OSs Ook) g F000 321 Logs oxelusion § 70.00 atone . [>
[7640]— cf vet, ¢hddonds and ethe7 elatrigutions Cro over $200, Nat in Part | of Sehcdute B.)
[7641]qo | 7 : I? CZI9 or.t2vs, entcr otal without listing in Schcdulo B
[7642]|
[7643]|
[7647]aff eves. CE°9, onter toccl and list ja Port I of Schcdulo BJ * °
[7648]DA WEECS, Guicouds, and interest (from ling 45)... ew kes
[7649]BRD, We, Wace WY ee ee ee ee
[7650]18 ineorna (Cc 73 “ciek oy,” moving orponses, ete. from tino 50). Jee nix meer eee few
[7651]20 rom Nia. flacomo) . ) ee ee ee | _ andy &
[7652]& you do not Romize deductions § © 1 yeu itemizo dodust
[7653]ond Ino 27 Is under $20,000, liao 37 Is $10,039 ev 6.
[7654]ies { # ia YiuSleo ond ontor on $0 Hird BE Fo HOUFO (Ot, h
[7655]ue HO). So, - :
[7656]okie, | [uf You Roto Scheculo % Vor 2
[7657]x} | J Schedule | or Form 4726_ _
[7658]{vor ling GL)‘.
[7660]vavact no 29 {vom lino 18)...
[7661]ty (rom lina GF) wee ae be ee
[7662]1 38°20 and 28) rr
[7663]wa’ § Income tox withheld (attesh Ferms W-2
[7664]BPW HOM .
[7666]Ui, ow tan poymonts {include emount allowed
[7667]ACTA roturm) . 4. Se ,
[7668]“ity Foon 4868, frplleation for Lutomatic Extension
[7669]"1 44.8, Mndividual tnyonta Tax Return «
[7671]yeatty Grom ling 7B).
[7673]nde Mase 23, 24, 25, and 26). .
[7675]. pe ‘ Pey ta full with rotum. Cloto
[7676]“jan line 27, onter BALANCE DUE IRS eticat or monsy ordcr payuslo b P28}
[7678]Ling 22 Cla
[7680]tcmnal Rowwaua Ecruizo
[7682]wilhso 67 E
[7684]Shan lind 22, onter omount OVERPAID. . . . . .'. 2D |
[7686]— te te Leo |
[7687]imatcauies [8 | | | GUMMY
[7689]4 ¢anable yoas, have any intorest in or signotura or othor autherity Leas
[7690]‘" re financial account in a forcign country (Oxcept ia a U.S. _ :
[7691]by a U.S. Anancial institution? . 2 2... wwe & oo Ey.
[7693]|. (ior definitions, see Form 4683.) . as
[7694]a i nplete Rovenue Sharing (lines 33 and 34) on next page. = ae
[7695]_ “Wiel. ponds fb dcsbura thet | kovg caamained to rotuca, including ceeampenying schodulon ond ctatomonto, and ta th baat of ray knezicigo ond balict
[7696]a : it ts tres, geriec?, cht femiptety, Doclaration ¢f aruparer (effin tisn taxpayers is booed ca ofl information of which he hos ony inewiedgo.
[7697]3) Sere, vs ! ED D ARAREF ie 1
[7698], Py en le il fe guetta tes Le Lge eee vate p> aN | : 22 | ee :
[7699]w Lore Vour Aw tue . Dato Properor'o 6 an Pe le bla . Dovo a
[7700]@ a a oe 17835 VENTURA BLVD., SUITE_106. ; .
[7701]te “ Wifa's (hugbund’s) signature (if filing jointly, BOTH must sign ovon if only one hod income) | Address (ind CW der AL Tpsesg q's lige. Idcat. G7 Lea, { :
[7702]a _ we . . TEL. (213) 881-7350 dy
[7704]: , . oe toe S.5. 568-40-9527
[7705]| NW'88326 Docld!32245535. Page-76-.
[7710]x
[7711]Pogo 2
[7712]selonchip YOu Amount fumiohad
[7713]® Rolatlanohip fe) Benana lod In Mod @ ert haw 1 Ae or do- i) SINERS includ:
[7714]duging yoor, writo 8 or incoma ondont’a support. ing dopendant
[7715]oD. $750 or morcl # 100% writo ALL.
[7716]5. ——— g
[7717]¢3 Mets ba column, (0). Enter hora ond on tino 9 . : |
[7718]‘ your pices ef revise:29 at cad of yoar (not nocosscrliy 7) cama a pour post wiles Paice). 2S
[7719]becky, Wt yes Need ingido tho boundorica et on Incorga- (a) Towsosbla Ae icrction ¢ ¢ ,
[7720]ed a tia, c2., catcr its noma; Hf ast, ehosh fore [> 18) a.
[7721]hog HET?! may "
[7722]z oT
[7723]rent 730n0 ineieccd on Hag “ ys GEA TAL TEE Lilegrm We me
[7724]| 0 rauen of tkolr own; ov, (2) | g y 13 ite . j 4 y
[7725]aod wipal plc|eg of residence % J : \ H H Z..
[7726]; aD GMO, Libel Mlle ET, Mle Ze
[7727]ws say CHI titorost .
[7728]: “y Csole sp tetra Gene an Cee ee ee Lee
[7729]: SR Eta he ea. ob cy onehoncd ef capital cesta (attach Sehcdulo D) . toe
[7730]: SY Ng 8 eg) trom Sepalomontal Coke dul of Golno ond Loscos (attach Form 4797)...
[7731]: Ps oto canuiticg, ronks and royatiics, partnorchias, cotetes or trusts, otc. (attach Schcdula E}
[7732]No8Q (ee toca) fattosh Schadulo Ff). . 1 es - . o
[7733]i C4 rely f2 mabto (odions ond annulilos (net roportcd on eshodulo E200 Instructions on page 8) .
[7734]pO 495% of eat gala eoselputlens (nee rcgertcd ea Cchcdulo DY). 6 ee ee
[7735]em ota income Cort pafesne. 3 (coutten-—oc9 inotresctt ‘one CA AGI B) . woe ees
[7737]? £9 \Cuaar nth pure awd GOURD) vo we ee
[7738]_. 66 Titel (end Bios 85 Sarcugh 44 herg_ond on Mra M4. ee
[7739]: yu. “
[7740]ae  tneeang (ottngh Vorm 2040 oF ethor roquircd ctatemonty. » . . «| ES |
[7741]uv eNOS) lee tee ee La —.
[7742]( «2% Ausit Pet 8803 €7 €OX ce oeazcmont) 1 + + 6 ee es i i "oul ieee
[7743]: ( a jroo C9 11 2odlroiion | 19a, Ces, (voo Forma 4840). . 6. £2 wales *
[7744]Hy a GAS OA LVS ner, 9 oad.en! Nao 3G . . le —
[7746]ve, Eyucese “aia Tifa M7). .
[7747]6 (ey aes ‘amor totnl trom Scincsluta A, ‘tina 40 and attach Schodulo A|
[7748]os @) Kt Jc cuctions, gator 15% o7 lina 51, but do NOT enter more .
[7749]: 6s) Set ea Nora tie BE rr ran Loe
[7750]‘ . CO pguitioty teeck aumbds cl oxomptions cloinied on lina 40, by $750 .
[7751]{> Veneto ke oe Subtest ting $4 from tina 53.0. 2 ee ee ee .
[7752] (Vigurc: itn GIO AMOUR On line 5S by using Tox Rate Schedulo X, Y or Z, or if applicable, the alternative tax from Sched-
[7753]n2 DB, 2 earache srom § Schedulu G, of maximum tax from Form 4726.) Enter tox on line 18.
[7754]ve 1 a see ea, ST SS SS EN IEEE a — ae
[7756]othe nae eth “eh Sehuduto ) _ ES oO
[7757]Wena DAC8) ee en re toe ee a 1 OF a
[7758]; x omen
[7759]‘natn 146) « a 2S en ee
[7760]ati:tidatoa (ev public efflec—ooa inoiructions on pogo® . . - . 60 | et
[7761]_ nt {nttoch Fora £074) soo C3 :
[7762]lines 63, 7,58, 59, ond €0). Enter horo and on lino 19
[7764]C2 Solt-er.aleyincnt tan (civ ch Schedulo OF)... .
[7766]C3 ‘lan fron: coconputiag pvler-yoar investmont credit (cttach Form 4255) .
[7768]CS Cliniraus: Cox (era inctarettgno on paga 86). Chock hero O), If Form 4625 is attached . . . . 63
[7769]e P83 Cselel 9 7 tax ea Sip tweome not Fayortad to omployor (attach Form 4137) . 6B |
[7770]‘ ret i sanity ton ea ‘ips (ror Forms w-2) . . 66) at 2
[7771]ce | G67 52470
[7773]C3 Excoo ne We oy, vega A (f 46° ‘67 More ChiBloyoro—ccd Inatructions on page 10) . .
[7774]CD Brodit (ar ¢ceforul ton 64 ) Gpoel, | fuals, nonhiihway gacatine and lubricating oil (attach Form 4136)
[7775]79 Grodie vera O Kogulutcd Invougmont Corapuny (attach Port 2439)... 6 6. ees
[7776]"2 PA Fetal (udd tive G8, G9, arid 79), Entor hor ond on Wag 26
[7777]; - . : , tous CoaVE RAMIENT PIPING Wn Wi 0 4 068 A GPO T44 601 ras
[7779]NW 88326 Docid:32245535-Page77-.
[7781]nie ne eR PR Oe enema
[7784]7 | ;
[7786]Q,
[7788]Chace talos Aol s—tomlzod Waductlons AND ay.
[7789]Gera WO) is.” Divtele J ed VD
[7790]Cerca Me) ke Yiviconel and Iuverest Income ©
[7792]Invernal-Roven Ravens Sorvica m, a Attach to Form 3 2049.
[7794]Name(o) as shawn en Form 1040 1 v Vour ceelal ccounty CyeCc7,
[7795]rn ac “Man Baby oe 22:32 1 :
[7797]wg f: . Somat eG 2) :
[7800]oo cy “Tnotraneo Contributions. —Cash—including ehceks, monoy ardc7s, Cte, «!
[7801]3, Gacioi, ddntists, nurdes, | (Itomize—see instructions on page 11 for exampioa.)
[7802]} “top medle: PENPO, CVE. ie .
[7806]i no he 9) CF ae POS
[7807]ay OW a ‘On (LO,
[7808]° ; saptans Gee meee oe
[7809]So tA hy Wed Us 40 Total cash contributions woe |
[7810], . ; eee Ge 19 Othor than cash (860 instructions on »
[7811]rere for @lvor |, a page 12 for required statement). Entor ;
[7812]x OO shat OVO) oo |e | total for such iterns haro. . nena
[7813]“.‘Gntgr bolan, Pras jeuraite prerilums for’ 20 Carryover from prior yOars «© 6 + | menenn—necmemnne
[7814]‘ .. gardleei ear .ae: ontoercd en ling 1... |---| 21 Total contributions (Add lines 18, 19, and
[7815]: G Momize echorhacdiet ond dantal ox. : 20. Enter hera and on line 35, bolow.) [> 200.
[7816]ey * ponecs. So Aourlac, aids, denturas, - ae a :
[7817]—ayogli: 3c, SSbLosors glut, ote, y: Intoroot oxpense.
[7818]‘ £ : peg tee Sameera, Lennon mee —nettanenenen | 8% Homo mortgogo . s+ + + + +
[7819]. 2} Inotollmont purchacod. . et | oe ees
[7820]_ 2A Othor (itemize) ee eee
[7821]1 23 Terol intorest oxpoaco (Add linca 22,
[7822]: 23 and 24. Entor hero and on hina 36,
[7823]: bolow.) woe oe.
[7824]: Casualty or thon Isao {ca) :
[7825]Soe instructions on page 12. NOTE: ‘if
[7826]you had more than one casualty or
[7827]thoft loss occurrence, OMIT lines 26
[7828]through 29 and sce page 12 of the
[7829]e) instructions for guidanco. :
[7830]: 23 Loos before odjustments. . . +» +
[7831]a . 27 Inouronce rolimburcomont . ..
[7832]7 , AA, Boia 1040, oe eee sit | 28 $100 imitation. 2 6. 6 ee
[7833]® os Sabatrn ss « tij.. fern Hie ys Envor distor | . 29 Add lines 27 and 28 .
[7834]: Jo aes o 2070; Bier he a 30 Casualty or thaft loss. (Excess ‘of lina
[7835]a” al ns GONE arse’ | =| el 26 ovor line 29. Enter here and oa line ;
[7836]ad 5 Toe Enter fiora |. ef 37, below.) ale
[7837]nMOS se be 15
[7838]‘ pia acannon ie 3) 00, 31 Child and dopondont care oxponces
[7839]eo, oo, ; ; from Form 2441, (Entor hero and on
[7840]01) gue a ee P . _. _ling 38, below.) . . b> :
[7841]ie stniaine fowl casollnc (ava gay ton tables) J _ “Miseollancous doduetlona for ain,
[7842]. ne : t st n
[7843]i @Coneres sok 3 (Gud sale, fax tablos) . : es ee Mo ge 13). etc. (seg Instructions on
[7844]3G State ti loest incomd , : rs ‘ de. | __
[7845]ny Parson ORY te Se ns _|___| -
[7846]Te 6 Oger, . Lee neces a as ee a an ee eee poe een eee we Pee _—_-
[7847]i AD Total fae 0 (ad ines AE thyough 16.. 861 HEL 32 Yetal miscellancguo Coductiono (Entor oe
[7848]Rater novo esr? on lag 24 below.) a oe hore and on line 39, Below.) - aot _
[7849]4
[7851]s : "otal tomy tr i VW) don. a a
[7852]oy otal eosutons (fe ine 23) a ,
[7854], 2 suc, 86 Total Intorose axpense | (irum lino 1) ee ee ee
[7855]: eo 37 Casualty, and theft losis) (from line BO). fe a,
[7856]s 23 Child and dopendent cure expenses (from line 31). 6. 2 6 se ee Ce ee ee ee Fe L
[7858]m 39 Total miscellaneous deductions (from line 32). Coe ee
[7859]~ 40 TOTAL ITEMIZED DEDUCTIONS. (Add lines 33 through 39. Enter here and on Form: 1040, ‘line 52 fh/A b> 4 abe
[7861]_ NW 88326: Docld:32249535;Pagé-78 : .. eet
[7863]“Pie Kg _. IDENTIFICA. no SY TLE TD
[7865]. 7 ear)
[7866]MALE _ a pe dthe
[7868]ABDRELS
[7870]v
[7872]CMEDULE OF DEDUCTIONS _ YEAR_ENDEO.
[7873]“STATE || CONYRIBUTIONS FEOEMAL & STATE
[7875]CHURCHES | 160 |
[7877]_Gorimuntry cHest/uniren crusace | |
[7879]SALVATION ARMY/GOOOWILL INDUSTRIES fT
[7881]RED CROSS aoe
[7882]KMAS & I EASTER sé ALS
[7883]HEART | FUND/CANCER FUND”
[7885]PARTNERSHIP RETURN
[7886]__paynounpeouction
[7887]City OF HOPI 81 —
[7889][ [|__ ower oncanizco CHARITIES: | /00 fy |
[7891]l| “YOTAL CONTRIBUTIONS | ang (0.
[7893]Poe INTEREST (To wyoy Pain) | FEBERAL & STAVE
[7894]MORTGAGE LOAN Q) OAL _ mney wea
[7896]INSTALLMEN NT LOAN
[7898]lay Aiea fis |
[7899]. ile INE. FM
[7900]Ire See
[7902]________TOTAL INTEREST |_
[7903]| _- || CUISEELLANEOUS ODEOUCTIONS
[7905][|] atiaony exPLainy |_|
[7906]| _||__ sare cerosiy Box Fee a
[7907][|| union pues PT
[7909]SMALL TOOLS (GOOD 1 YEAR)
[7910]TOOLS DEPRECIATION |
[7911]SAFETY EQUIPMENT _ |
[7912]UNIFORMS {NOT GEN. _ WEAR) ee.
[7913]LAUNOAY a ol EATING _ J | ]
[7914]_ AUTO . MIL EAGE. o. _
[7915]| FHLePMONG expense ‘mor AciMa) | Ll.
[7916]@ oly {0 be __EMPLOYRIENT AGINGY PEO
[7917]Bogus, 1 grail | ougs 6 guoserierions
[7918]7 INCOME YAN PREPARATION
[7919]Tomocare
[7920]OTHERS:
[7922]YOVAL RISE. DEDUCTIONS |
[7924]I[GASUALTY LOSSES texptainy
[7926]LICE ef
[7927]tt. Hey Geth ui
[7929]ame ca et ne
[7933]FEDERAL & STATE
[7935]tARgW CC
[7937]"sua | TOTAL,
[7938]iFss $100 06 ron FACH CASUALTY |
[7940]TOTAL CAL UALTY LOSSES |
[7942]~—FeERAL | gYATE_|
[7943]‘y Gy |
[7945]ee IN te nbn gat eee
[7947]ae Gur7 Ov, Siva | YOTAL DEDUGTIONS “Wf
[7948]IB WWAR ‘ Bel 17835 VENTURA BOULLVARL, SUITE 166
[7949]nw.ndiie CARR Adobe gp Nee ; ENCINO, CALIFORNIA 91316
[7953]AN ORD!
[7956]Seth Eater ee
[7960]NW 88226--Diseld:39245535'-Page"bo.~
[7962]De Mew ile
[7963]nde Wea a ait Crmigdeyor'u- Quagcrl ‘cry Fodoral tax Roturn, Form 244, tiiod for thio husincos for ony quartor In 1972? [7] YES {9} NO. ;
[7964]STAN Al exalleablo ‘hada and Schedules must be fillod tn.
[7966]SV
[7968]Tr ae
[7970]a am
[7972]enue Profit (or Loss) From Business or Profession
[7973]orn 0) (Sole Proprietorship) 1/2
[7975]Dopartinont of tho Troasury > Attach to Form 1640.
[7976]intornat Rovanue Sonics > Partnerships, Joint ventures, ote., must file Ferm 1065.
[7977]) ec TG ae | Secial sccurity numiscr
[7981]Feao(s) e9 as shesat on Fora 3 neo
[7983]; product -.
[7985]C Employor tdantiflcation Number... cceeerecrcsceceeernenacaencanens wentenreccees
[7989]ey tn ua aN) avin ond ctr a) ee “contgawng a”
[7990]hy, Le con wd ane ¢ eada eden eneetdncntevanscettens csctognaetae o ets veceeee detcececensetesspenaauneeteewennceseresaee
[7992]a tndlecter i aed Ww coset lag: qa) a ‘cooky “Q) Cy “pecrual; @) Oo “other.
[7993]roquieod fo alo form. A096 for 1972 (See Schedula C Instructions) [] YES _ CENT It “Yes,”’ where filed? [> ....
[7995]1G soecia'ln 107% did yay own thio buotnose? . DA...
[7997]a ‘3 Grego" 0" roca or aolca 6. saeteeesssesesecesestsence LODD POUND ONG allowancOD $F... cece Balance en een rrr ees eee
[7999]12 Es 28: 268 of goede oold and/or oporiona (Schedule C-1, fine 8). 2. 2. ee ee
[8001]7 (or wena (arr tho) '
[8002]‘ 130, Invannn tos 34 Iinag 8 ond 4)
[8004]Wyeth J
[8005]JOT 0 ee aga pre, Jong eae
[8006]Rowit. (oiotan in tla ‘e-3) oe i _
[8007]40 Eelarica cel 1 yogeg fey i lieluded on ing a, Schedula C-3 (oxclude any paid to yourself) . . . . |
[8008]8 2 mae ae ee : Fr
[8010]a) (c), ‘Ponciea: and prot sharing plans “hoa Schadula ¢ inotructions) rrr
[8012], &) “Eigatex benatiz Rrograms (sea Geledule C Instructions) . - . . ee
[8013]a6 Wier ‘on iano Indgbtodnosa . we
[8014]V7 Gigde’ a ert ing trea gales ¢ or corvicop » poten ee
[8018]hoe ee
[8020]he ry
[8022]percep n
[8023]tS we
[8025]wdpestecsansencneeeeedensensenrsec-ceenemeeners .
[8027]nh ewnagee, AUN nen pean ne eens mao ere emee nae nensmewenaee | ce iswnnsemeawnsecemmmens | weenie
[8029]won mg nonenenesusaeenencuaneowan
[8031]een naemmagunnnneenenerwnm AE ADE Ren eden nee enememene re ter rT y Serna
[8032]1
[8035](py "Total oghar businioss oxponses (add fines 19a) through 19(0)) 2 6 ee eee
[8036]20 _Tatal deductions (add linos 6 through 19)... ee ew
[8037]en =P
[8039]; aa Net profit (or loss) (subtract line 20 from line 5). Enter hare and on line 35, Form 1040, ALSO enter on
[8040]Schedulo SE, line 1. we . Coe eS 6.969 140
[8043]ee ee fe eee ape
[8047]Ce, pat
[8049]‘“Lenpehold Imps:
[8051]Sonwol dud Phyllsa Ruby
[8053](1972:
[8055]- he,o9 Halos 3 Bont"
[8057]Bo
[8060]rede
[8064]VR otarage
[8065]ovophouu
[8066]OAL AB
[8068]ea AG Woy
[8070]. Boudpuc
[8071]Porno fide
[8072]Honilevy.
[8073]Auta “ : 7
[8074]: Lagat
[8075]~Bonat ono’
[8076]FNewupoyore
[8078]ca aot con
[8080](Balance of Lease)
[8082]NW, 88328 Docld:32245535,Page 84. ee
[8085]WO 70 Nee Bath
[8087]tt oF
[8090]bey
[8091]pane
[8093]NET icucoMe
[8094]Loags Deprecdagion
[8096]‘Ner TNCOMP.
[8100]': 5,000.00
[8102]3,000.00
[8104]SUPPLEMENT_TO_SCHEDULE_C
[8106]DEPRECIATION
[8108]$4 ,000,,00
[8109]2,000.00
[8111]957,00
[8113]5 Yr, SL
[8115]2 Yr. SL
[8117]7 Yr. SL
[8121]383.47
[8125]4,491.98
[8126]16,463.08
[8127]2,923.29
[8128]3,102.44
[8131]800.00
[8135]26,980.79
[8138]100,00
[8139]3,877.93
[8140]323.62
[8141]190,00
[8142]12745
[8144]254,15
[8145]382,25
[8146]214,51
[8148]425,29
[8149]=Qo
[8154]- 1,000.00
[8156]1B
[8160]7737 056
[8162]' -3,428,50
[8163]5 6969.40
[8165]2
[8170]4
[8172]428,50
[8176]y
[8178]NKDULE SE! Computation of Soctal Security Self-Employment Tax 1972
[8180]Oral
[8181]ier hoe oe [> Each sel7-omnloycd persen muct fila a Schedule SE.
[8182]fntorl Rovenuo Servicy [> Aitach te Form 4C40. -
[8184]b Hf you had wei, including tips, of $9, 000 or moro D thee wora subjoct to social security taxes, do not fill in this pago.
[8185]bl 0? you ha Red k PHOTO | shan 6s 6n0 Qualngss, comiblag profita and loscos from all your businesses and farms on this Schedule SE. _
[8187]wv will be crodited | to your social sceurity record and used in figuring f social securliy honefits. -
[8189]ves u] 1 SSA L Ceeunry EARS) Csefal cocurity nurnbor
[8190]af celf-employcd parcen
[8192]| 322] 12} 7997
[8194]F- omploymoat gan (grecory | Store, rostaurant, , farm, atc.) [>
[8196]| JOR: wwiction of Not Ez wnings from BUSINESS Self-Employment (other than farming) .
[8198]: oo LA, 1 Net pr aii for cas) shown in S¢ehedulo c (Form 1040), line 21. (Entor combinsd amount H more then one 6.969140
[8199]' . : beaiesea) er er tee we ee Ce ne fA OF BY
[8200]7 ; Pot Inieont " Ge foao) ‘i oneludod coniéos or cauréion Included on tino bs. ee ee beeen |
[8201]© Ppowlyy ote g OCTUC LLP DOMED _ahogesseersscseseneneensnnnten raereees pecececses seveueseventcnseeveeneeraneoae .
[8202]1 Be Hot canilti 30 ted looay fog buolness colt. rcraployemont (Subtract lino 2 from tine 1, and onter hore and 6..969/ 40
[8204]on, “at ick Forts 13 tein & Alin Soll. Employmont
[8206], A givmer fi may: “alcae to ‘ecorisute hot farm Carnings yaing tha OPTIONAL METHOD (lino 6, below) INSTEAD OF THE F HEOULAR
[8207]SEvtiOD fhiaa G, chow) 7 Ria grocs profits ara: (1) $2,409 or loss, or (2) more than $2, 400 and net profits are less than $1,G00.
[8208]LO your pres provcs {rom forming are not mero ee $2,460 and you glact to use the optional method, you need not complate lines
[8211]Sr aaton ae pe
[8212]7 * Commutation undor Rogular Motes
[8213]ra) Roo teen ‘promt (or !o38) from:
[8214]2 be Scheie F Bi lina 54 (cooh method), o7 line 74 (accrual method)
[8216]pote,
[8218]“satan uncar Opt
[8220]tonal “haces aed
[8224]powka Wei “nrinling aro $ha totol 0? tho greso profita from Schodulo F, lino 28 (each
[8225]of Had 22 (cseruul motied), plua tho dlsCributlvo ohare of gress profit trom varm
[8226]43 c3 onplalncd | in Instru6stovs for Schcdulo SZ.
[8228]oe 7. Ent a’ hore one: ‘on haa 800), below, tho amount on line 5 (or line 6, if you use the optional
[8229]* ve“ wothed) . . oe
[8230]a “ | pf sie sputetion! ‘ors Social Sceurity Sail. Enploymont Tan
[8231]a -_ 8 Wet ea imine ‘(or loss) from selt- -employment—
[8232]Po ‘@ From business (othoy than farming) § from line 3, above
[8233]3 (0) From ‘farming (from iino 7, above) *. woes Co
[8235]-e From ‘Lay iniorships,, joint vanturas, ote, (other than forming) . . .
[8236]td) Prom, Bois 0 a8 a nilnioter,” membor of a religious ordor, or a Christian Science practitioner. If you
[8238]beg Oo Aled b Pye 4361, cline hava [ | and ontor zero onthistine . . Lok eee ee
[8240]a oo _ G0) Res onske with 4) vercign Bovorniign’ or ingornational organization Ck ek
[8241]1G) Obi. CAlrcstor's tooc,/ote.). Spoclly clea bec ceevy weaeaeave ces ceutesaee
[8243]BO 29 Votal wot Curtlitga (or feno) trem solf araployinont raported on lina 8. . ‘
[8245](U9 Heco © fy Koco Shon C409, you ore not cubjoe to colv-om@loymant ton. Bo not ail In root ‘of pogo. y
[8246]"10 The laryaot amount of combined waroo and salf-employmont oarnings Gubject
[8247]‘to social. sucurity tax for 1972 is . ; . foe.
[8248]43 (a) Total “PICA wages a5 ‘indicated on Form w-2,
[8249](b) Unrcaored tips, if any, Subject to FICA tax from
[8250]"Forma 4137, lino 9-. . re ee tt _
[8252]89,000 | 00
[8254](c) Total of lines 10) and 1b) se ;
[8255]42 Balanco (subtract tino 14(c¢) from line 10) . a
[8256]ly” AB’ Self. -emplnymont incomo—ing 9 or 12, whichever is smalier .
[8257]a: an 14 If line 23 16 $8,000, ontor 2675.00: if leso, multiply the amount on line 13 by 075. . :
[8258]‘a. 4, AB Railroad € fuiploye Q's and rallragd employoo represontative’s adjw.tment for hospital insurance henofits
[8259]: fox from Funia 4409. Lone
[8260]A 3G Golf. Solf-empluytnunt faa (oubtract line 15 iron lina 14), Entor horas and on h Form 1040, lino 62 . os yes So
[8262][NW-88326 Docld:37245535, Page
[8265]‘ SCHEDULE D
[8266](Forna 1040)
[8268]Departinent of the Treasury
[8269]internal Revenua Service
[8271]Name(s) aa shown on Form 1040
[8273]on on shyt Ruby
[8275]Capital Gains and Losses —
[8277][> Attach te Ferm 1049. [> Examplics of property to be reported on this Schedule are 19) 7/2
[8278]gains and losses on stocks, bonds, and similar investments, and gains (but not losses)
[8280]On personal assets such as a home or jewelry. :
[8282]Social security number ;
[8284]322 | 12) 7997 *
[8289]Oequirc
[8290]Fator tostor
[8291]oytabol (cco
[8292]inctructton
[8294]0, Cost of athor bosis, |
[8295]os odjustod (soo
[8297]oxpence of solo H
[8299]te
[8300]a. ‘to. doy, yr.
[8301](Put dato sot’ ab6vo
[8302]dotted tino ond dato
[8303]ocquircd below
[8304]dotted Hoo)
[8306]§. Goin (or joa)
[8308]d Gioso onloo price (d foes o}.
[8310]uy, ihe ey roporty ond corse ion
[8311]PEG, i oharcs ae fan )
[8315]is
[8316]0 30
[8317]ah
[8319]*18
[8321]_ AS
[8323]. NW.88326~Docld:32245435: Page 830°. 2
[8325]“ey.
[8326]MQ),
[8330]7 VE(0) Long-tarm eapital lons component carryover from yoars beginning before 1970 (soe Instruction H)
[8331]“12(b) Long-term capital locs carryover attributable to years baginning after 1969 (sea Instruction H) .
[8333]“ Ont linog 46(0) wad #1 0(b) and co to Part IV if locoes are shown on BOTH lines 12(a) and 13,
[8335]a " Entor your cliaro of ‘not chars: ‘term colin ‘(or lens) fram partnarships ‘and fiduciaries .
[8336]oF “Entoe, Ai Cala (or. foo), eembing linos 1 and 2.
[8337]. SHOCK
[8339]2 Nag host
[8341]Ye Bhtor (2 ‘lia af opplleatato'yronn | fino 4¢0)(39, Gorm 4797 (c00 Instuction A)
[8343]a enpltal 1930. component corryovor from yoar baginning, botoro 1970 {000 Inatructlon H)
[8344]Sherr: Cr eu: otal lacs" Gorryover att? sutobla ta yooro Boginning after 1969 (cod Instruction H) a
[8346]eg
[8348]oped. Lpaly” for foes), combl19 lines nag 2, 4{o) and Alb)...
[8350]‘orm G Gopial Gains ond “Lescos—13 ‘seats bald More Than 6 Months
[8354]et, 9 ta dioteude
[8356]» Emtor your chara of nog long-term gain (or loss) from partnerships and fiduciavion . . Cs
[8357]2 Entor your, ghare of HER ‘Tons term gain from small business corporations (Subchapter 8). .
[8358]Not gain (cr (coo), combina lines 6 through 10. . .
[8360]Net long-term gain (or loss), combine lines 11, 12(a) and 12(t)
[8362]jy) j Summary of Paris | and __ . oe
[8363]Combine the amounts shown on lines 5 and 13, and enter the net gain or “loss here . a4 es _ 0) , .
[8364]Ii lite 34 chews a patie= a ;
[8365](a) Etizor 50% of lino 13 or 50% of ling 14, whichever is smaltar (see Part VI for computation §5(a) .
[8367]of altornative tax). Enter zero if tncra is a loss or no entry on tina 13.
[8369]a Subtract line 15{a) from line 14. Entor here and on line 36, Form 1040.
[8370]f Rae 34 chews o baton
[8372]15(b) oo
[8374]Coe dackruesion hs
[8375]c& Gehorwlsy,: “y
[8376]da) Entar eno oft 10 following ameurto: boas
[8377](i) Wf ameurt on line 5 is 2070 oF a net goin, onter 50% of amount on tino 14; nee fh ae
[8378]aR if amount on line 13 io zore or a net gain, enter amount on line 14; or, ; , we
[8379]© (ii), 4 amounts on line 5 and Jina 13 aro net losses, enter amount on line 5 added to 1G gt
[8380]50% of amount on line 13. . , 26@))_ pm
[8381](by Entcr here and enter as a (oss) on line 36, Form 1040, the e smalier. of: |
[8382](i) The amount on fine 16(a); Lo
[8383]7 (ti) $1,000 ($500 if m: arried and filing a separate return—if a ‘oss is shown on line | : |
[8384]. 4(a) or 12(a), see instruction M for a higher limit not toa exceed 131 000); or, i, 000 n0
[8385]: (iii) Taxable income, as adjusted (see Instruction |) 46 b) | Ic )
[8386]Carrvover (13,322.00)
[8389]Yoo
[8391]| SURuGe D. D. on Pryeecs Ry by
[8393]at WEEKLY WORK PLANSEIME REPORT
[8397]cnr ls ruta: va GB, las numnen £7 ~ Wi RK ENDING
[8399]oe tf M 5
[8400]t are COMME ANI
[8402]oe le = : mr coe
[8405]5 wee OES
[8409]spills ‘Wet a _
[8411]; be g Be 08 $4 8 nan
[8412]th } Oy 2.2 Chiat.
[8414]a. OTF fn aie Bal =F a2
[8416]a on aioe _ pa
[8417]IS 5 | Re ! it i fas 2 Uk | ageh 33 _
[8418]oan i ca .
[8421]2.
[8423]<7
[8426]STN IAL
[8428]_ NW 88326, Docld:32245535. Page 84.) *
[8431]OS Giracasts BeEt Layenis
[8435]Ry By
[8437]WEEKLY WORK PLAN/‘TIME REPOICT
[8439]saasions| A 1S, ication Qu. Tale. NUMBER WEEK ENDING SAGE EK
[8441]“CUSTOMER
[8443]v0) NAMES
[8444]coe te TUES.
[8445]; a a wef ot
[8447]“esd Eee g
[8449]4 MOR nl ap
[8450]Hican BOOKED COMMENTS At
[8452]i ee
[8453]HR] + Wesvo™ ©
[8454]M4,
[8456]cai Men? 5 , Ia. a
[8457]— ane if
[8459]2
[8461]oh “i tM eiceat (_
[8463]NW, 88326. Docld:3 32245535 Page 85% ~- Saal
[8465]feo se q-Wy. 7K | ,
[8467]ott ? se. ia 10. me ih ie a2
[8470]ttrteh aterenne Ketan unenentnenrintne eeni armament
[8472]SAMVEL ay. ft. Phyecis £ uBy
[8474]WEEKLY WORK PLAN/’ yy RFEPOR I
[8476]ADF
[8478]“nusteen ( CLE. IES
[8480]7 _saLesMat Beete nad Ch.
[8482]QUSTOMER, =. Jak
[8483]| ' NAMB. -{esy
[8484]if he. Oh DEF, iM We
[8486]€ m
[8488]ee EN V4 a 2%
[8489]a Mf fl hy wh !
[8490]ONY Gee:
[8491]: ‘a Loon: ah 1 Git
[8493]TL 2 P24| aso! ll
[8494]Z| Pepa Saale Th
[8496]ce ley yO PP
[8497]ay . We i i ah
[8500]ran “nt MOS
[8502]a4 Al
[8504]| 7951
[8505]oo sot-Z Bie | Ate
[8507]aye let? [ele | Bare |
[8508]Wendie Fe Ee _ mae ial oe ERD)
[8512]: oo) “A Ay fs
[8513]. Pos er 20. La Si
[8515]» TOTALS
[8517]oN DOV EIEL Tanne WORE]
[8519]CALIFORNIA | AGE
[8521]INCOME TAR
[8523]boginaing . , 1972, onding
[8524]‘ LAST NAKA
[8527]Your soelal soeugity nuabor 7
[8529]322 | 12] 7997)"
[8531]Wito's nurabcr, bY folnt eeicro
[8532]9 | te! 16207
[8533]eocu- as Sel Emap lo y Oe
[8535]paTIOn Wiifora Howpawh lo” * % _
[8537]8. B= Sedoa=-05 60 fice yeurcolf, your spouse or parson who Gualiiica you as is head of fisusoheld
[8538], AIAOU Cecleds test cxica crd/er c4¢rcca IP dierent frac yours) — RELATIONSHIO |
[8540]LPead,. BeE ARs. BM A.3 TROMAG. : levees G4 ao
[8541]- meme tay
[8543]ZIP CODE
[8545]nprteremermmcersrce cane “nomen ee—cacweree
[8546]peepee apecnnecnennet sete dessunecceceaneesante so sarcueeeueenees soneneee ... Number > 5
[8547]6. Oiled (refer to instructions) “umber ‘of ‘blind exemptions claimed C> 6
[8549]» Jot Gopondont ond Ellnd onoragilans (add lines 5 and 6)
[8551]; ‘Atgoch Copy 2 of Form(s) wW-2 to
[8552]WO, cet es, clot rev omployoa ecnccsatica. een eaavallento, cltcsd expleacticn) 6 6. 6 ee
[8554]oan om We ro a evor F300, comztoto ond attech Schcdule 8(540)) .
[8556]ong ARO ee are i cedor S1GC23, @ad ton lo Yea Teblo ocd ontar oa Hao 17.
[8557]C2 Mca 14 Bs GIO,CCI or sore ecmpise tsa 19 cad 16. ;
[8558]‘gtoudond dedeettod Grom page 2, Wino 56) 0. 2... ; . we
[8560]2 Aout ‘ing’ 15 from Hag 24), Figure your tex on » thle cmaunt by ‘ng a corn Tos rato
[8561]Ni itor ton of ag u er La
[8563]‘at Tabla, ° - ‘B Tox. Ricvo Cencdule @ Oo Schiodulo "C1500)
[8564]f a . : Z
[8566]. oi sou $05, Married couple or “heed of houschold £50
[8567]o—Total on ting’ 7 above, A xB... a
[8569]ied (869 is 03 18 and 19)
[8571]: ate ‘ , ts 4 ;
[8572]oe Uae 2 file Te! a ee (rtbtract 4e9 0 from tino a re
[8573]SoA OAD BB, CF eae Ne Hrom page 2 Wine BY. ee
[8574]a «8, Rok tun Meltty (subtenet line 22 from lino 2)...
[8576]9 (see instructions—attach Schedule pIS.40)) .
[8577](2 fino 23 and 24)
[8579], AB Tan 6 ions
[8580]~~ 2B. Tete] ter Ce
[8582]; a8. etc). ce cy 29 teera “so clot (attcen Formls) W-2 ¢7 BE-2P to front)
[8584]. 27. 1002 Seimtuiota osttc.ck.d tat peynonts ,
[8586]ae 23, Gxeccs Gultiivata, Sul ton wfGhold (wttach Farm DE 1964 09 fea of rotutn)
[8587], Tete) 0G 003 (utd "noo a, a7 and 2)... ee ee
[8589]1 lo opr Go 2, er CEE Py poet ib sg
[8591]" - ‘Molt raturn to P.O. Box 13-540,
[8592]She Te 29 Io lage finan “tna 8, enter Gi Sone, Gseramento, CA 95913.
[8594]. . hy
[8595]Les 7 8, ao i) to ib ‘a RPC, (Allow at loc “ot cht woots (er your refund)
[8596], _() Credited on ‘1973 estimated tax... .
[8598]Pa “dear. that. t het ci cxbwainod this voters, Izates sdiag cecomeanying schedutes and ctatements, ond to tia Last of Gy beawiccca cod ]
[8599]at eonciote, HW ezeptrcd by o poreon otic thtn Roxpayer, hic deelcration ts bascd ea olf Information of tle ho hos ony teocitadge.
[8601]toy
[8603]hits wees
[8607]Unser corstits of 27,
[8608]Calle? hb ts frwo, corres.
[8613]4
[8614]id
[8616]3 s _ EDWARD L. LAMBERT
[8618]2 Ua Di "folatiy, BOTA anal tow Bute ee Gearon wala ee ye ee
[8620]La !
[8622]¥ ner Las ee alg NS earn “isis — ota .
[8624]S.d. bt 40-9527
[8626]NW:88326' Docd:22245895-Page8# ee ce
[8629]_.,
[8631]_ hye? Fora Scu (1972) F
[8633]besa [ofc of Gouschel¢—I claimed, answer | “the following questions —_ (See _Inciructions) Lo ie a
[8635]a Choely .£] Nover mareled (J Leget soparation (intorlecutory deroo doos not quelify) Dore
[8637]ORO Oo Widow(ar) Bato, a —_—,, [) Finel diverco/dinselution Date__________.. _ =
[8639]wacdvicl ea whe, quel yee, 2) hoad ef household @o no? Ile? this individual as @ dopondont on gago 1, line 5): Sate
[8641]. ina Cs es Rolationship__.... Age Did this person qualify as your dosiandloné tor
[8642]panes br ths & Forcen | scatsla in your hema for the entire tarable year? a not, ‘explain elreumnstone—3
[8644]code
[8645]: a ~ ott .
[8647]oe wale ta (ci loss) fon Cx ‘tomental Cohedule of Gains aad tosses tattech Sehadule . 1540) .
[8649]Joe 08 goin (or, tore! wand fines 34 ta) od le, we
[8650]we, cat gaauitiaa Phe . aan .
[8651]ral Fully taba posion eng ‘onnuitles (nat icaartod on 1 Schaduta Q. Lok ee
[8653]qD Alimony :.
[8654]L * 2) Othar ising
[8655]ao for vet
[8657]san too talhomontp plan, cM . . 2 rr rrr
[8658]Gieeue’s oa it af foro anc'éa pogo W, Hea BO
[8660]Diao £ 90 soparata rote7e3 C} crcyricd tanpoyera bath must Homlze dodesticas er both aust take the otondard deduction |
[8662]Sean) Cm seat ME 0), TE a
[8664]fier Sohytulo” AAO, Hina 4). Ce eg
[8666]uiieas (eos 8 “Hd ACG, Bh 28) a
[8668]wri opens? Gresa Souodula AGM HIng 29).
[8670]“yous Cue, iam Setodule A (540), ting 3 Ce ee ke ate
[8672]all, fad? tines GQ Grough $3) tee
[8674]YRS sete ) Pace ontcy .o atcaded dedueticn cf -
[8676]ay Wi shighe or marric:} gorsaa filing separate return Ce ee ee
[8678]j bed of bowed 7 OF migiri(3 Cosipto filing joing roturn a
[8679]wis sat on ap Acduction fiing 55). Entor taro and oa pego I, line 13.
[8681]thin a of. vee
[8682]9 4 tina 1).
[8686]' a . ‘
[8687]boro cd a pago 1 Ning a. .
[8689]a4a00- 400 9-72 12.c0001 @ A ear
[8693]7
[8694]Se y
[8696]GALIFORWG IA
[8698]WER Ue eUEvlOns
[8700]Bieccd fo Pena 849
[8702]TAXA DEE :
[8704]Coal Coy ensa
[8706]322 | 2a] 7997,
[8708]aoe Ruby
[8710]79 Ucéustten
[8711]cofuctica
[8712]1 Red end wha,
[8714]if one ssouse itemizos doducttons, the othor may cot use the Tox Tcble o7 eck
[8715]tha ctcadard ésduction. If you choose to itemize your asuctlons, complcto fit:
[8716]agzpropriata ttems blot. wos _ wih
[8718]vd bg Iesurcaed tet chomised for
[8719]13, Cet ate » RESTS
[8720].
[8722]me a cues oe
[8726]ewe,
[8727]wot wits |
[8729]+ es a f at 2 a Eat dlaronga
[8731]ale
[8733]29 eb na atl prc
[8734]wrod 0) Fs 2%
[8736]. mer C: Catt) “thea 44 iat 20, Gator -
[8737]4 ho cud 6H FCM LA). pero a toe abe
[8739]Goutidutions
[8741]22. Coahmelaciuding chet, rnonoy ot, ete.
[8742]@tomlza) 2... —
[8744]23. Total cash contributions 23 | oe eee veeeneceet
[8745]26, Other than cash (see instructions). Entor total °
[8747]Ree . 6 we if 8 a
[8748]99. Votri—(idd lines 23 and 24. Maximum daduction
[8750]08s Incorte.
[8752]may not exceed 2995 of cdjusted
[8753]p>
[8755]Enicr here and on Form 540, page 2
[8757]= es
[8761]fo, Uomo mortqago . 6 eee te
[8762]G9. Anotaiimant purehacoo 4 + we ee et
[8763]BO. Biron Wtommbea) . . eeceecaecesescseaseessnawenannscuemsseee -
[8765]@. Tot lines %, 7 ond 2 28. Enter ‘hora and
[8767]on Form 5 540, page 2). 29
[8769]Meacollecsona Bodeaticas i
[8771]Ccsucky or Thott Loss(cs}—Sa0 lostrueticas
[8773]NOTE: If you hed mora then one casualty or theft
[8774]loa, occurrence, omit lines 20 through 33 and follow
[8775]inotrueticas for ‘quidanca,
[8777]£0, loos boforo odjusimonig... 6 ek
[8778]BY. Incyrcago rolmaurcomont , se ky ge
[8779]38, $1@9 Wenltation 2 6. ee ee te
[8780]99, Add Minos 31 ond 320. 7
[8781]34, Casualty or theft loss. (Line 30 fess lino 33
[8783]38,
[8784]30.
[8786]Ght™) Erro—Seo instructions .
[8788]Otor-—For education, alimony, unton cus, etc.
[8789]—S20 Instructions
[8792]baa geenoneemmenmenesowes
[8796]C sn 2 we Leo me er sete a
[8798]' luv. 1972)
[8802]37. Totcl mlscoltancous ¢aductlonc~-Add tlnas 94, 35 so?
[8803]and 06, (Enter here ond on Form 520, payo ar | 37 ; ee
[8804]Solsodial D ex rovorso °
[8808]CALIFORNIA
[8810](Bene Ea . PROFIT (02 LOSS) FROM) CUS! INESS OR PROFESSION
[8812]Lalo Prcprtoterchips) i ~
[8813]a —— . — = _ _
[8814]: vecnedita to yer? cco aly Posts OCD ov DGENQ _ DovacoraNtoa, folce SOunurody Ooty Chey EI) 5 cote ar
[8816]Secla Tocurtiy fukcor
[8818]ae — 322 32i 7907
[8820]pes EE
[8822]AS rorvdeg ae PPODUER aero. seceseveernee cneneeeeon ccanecsennesonumenee
[8824](Por onorieios rotell-horceroro, ‘wholosalo—tobacto; sorvicos ~logaly Taanufaciuring—-furnituros ated
[8826]seenceees  G
[8828]en cr eth wid for: “fal at o, eae
[8829]ne Lise ee csece saaea Go Podorol omployor icontifleation mumbar......c.-ssee eve enneecersenten snes
[8831]Wau ‘Nuya Ba Tvd. Von Nuys, Califormha ow je Leneencas soeeeececcesenateccemenanerenes
[8833]i ; : ere uatinge on ab eech; C) czerval; (] other. : irae
[8834]ia SOM Fe and £ fij< 400 (ne catchy year Sled Vit coqyired)? (] Yeo ff] No tN. a ofbe
[8836]tien of (iso eliy, town, ote. indicated? =. 6 1 1 ee Jy » EB Yos ‘(7 No
[8837]“6 Uh tans § joor? ve ee ee ee ee ee + GQ Ves (Bo
[8839]ales sauct b9.0% QMsd fa.
[8841]_—. borg roturns and ollowaneos &
[8843]: _ lino €) and/or operations (etiach sehodulo) .
[8844]fi wo! Ma see propariy (oxpiain’ in Sched c 3) . toe ee ee
[8845]30 rok bavi [rcpevly tee Ns ve re
[8846]2 beadulo’ 8) rer foe
[8850]nel clo 6 ‘on line 3, Schedule C-} Conclude any paid ta yourself) .
[8852]“ed aa-
[8854]CN RR Le
[8856]pane ‘ton’ (ie 73H Bh etonioa)
[8857]Otay aa end syomtesharlng’ plang (o00 Inotruetions for Wiad IS(a)). 6 ee ke
[8858]6“ arloyeo Man wp pregren? (ona Instructions ( for ling OY). we
[8859]190. GE oe én buetacn., tdobicda se ee
[8860]Feo dchis evitlag ion nalts \.t"egevleos a ee
[8861]! mie Jal “ea oO avra oe. a
[8863]ae (aie bavhiecs ci
[8865]‘ { to cacenenptetnane ssa ed ntammmeme genres smee 3 fey
[8866]| RS
[8868](0) ai angen et pe
[8870]fp) Total bihor business expenses (add lines 19(a) through 19{0)) wee ee ke tk ek ke i
[8872]Total deductions (add lines 6 through 19) toe es Se ee ke ee ee an ho
[8873]a au, Net profit (or loss) (subtract fine 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR 6,969 40 .
[8874]{GQuv. 1678) . . . Pago q
[8881]ac (Sina
[8883]CALIFORNIA ~
[8885]- —— ERAVAL QRS Lia LOSSES
[8887]Astash Co Vorca £3 of C4ENN om n,
[8889]4 :
[8890]5 tert fa ropart entan and tc2990 en stacks, bonds and dmiler “lavootacito
[8893]ei ea) ui no eee) on For rca ¢ acesia oye @9 @ heino eo Iewolry.
[8895]rae Clas lag
[8897]Ealustct, cont C} Giict
[8898]quent taproveacs (i
[8899]not purchaccd, cries
[8900]qupfonation), tad ot
[8903]b. Bato esacized &. Gress sales
[8904]price
[8906](od (yd
[8908]oe Sa sone Depa ).- + seaman ee
[8910]‘ 5 »f SCHEDULE, Ar’ ACHED
[8911]ten! eet eT
[8913]o
[8915]Jeraprancas: p
[8916]H poms gy ,
[8920]Ace si
[8922]pee enen es Abe sae cmemmannen eb
[8923]'
[8925]. . 1
[8926]ae abtutn, ad
[8927]eee ONS
[8929]Ae poveneusee new omen bedaenwenab
[8931]staceaubheaeeeahe
[8933]at CALL Wea a saiecthiga and &
[8934]“) CSIYOVEr feat proceding: tanable yeara (attach slatomom) . 2.4. -
[8936](B20) me oh CC ay) r
[8937]ahha end Aductorieg 2 ee ke ye
[8939]3 ae i) rar! ;
[8941]eee tit ho ie eee Pee
[8943]Cobndulo DoT (840) (attach copy)
[8945]ci reyencr, trey) procoding fanetle yoaro (oitaeh sraiornont soe ees
[8950]“SKE 192. 0m.
[8952]bee
[8954]Toaty
[8956]oF Fea C tinea’ 15 an!) too. te
[8958]an karo and en page 2, Part I of te Ora 520 or S4ONR 2 ww ee
[8960]at lina’ 4 47 shows o' loco, cover hicro Gad on page 2; Part It of Form 540 or SZONR the smallest of:
[8962]fe) on, syat on ling: VW... : ;
[8964](bd) lic faxable ingore for’ ‘the toxablo your (computod without rogard to gins or lossos from tale or exchange
[8965]of capital asco)
[8967]( y gn 009 ($500 ba the ouey of a hyoband or wito filing @ Copsrata roturn) won . . .
[8969]SES Ta SGT “Ci, 322, 00). ;
[8971]Lo ae eR a ee eee AD ee eee ee ee tnt eee TE oe eens ane
[8973]ate
[8974]hoe
[8976]UNW 88326. Docld:32245535 Page 91
[8979]: Please print or type f
[8981]Write soc. sec. no. on Check or Money Order. Attach here 7]
[8983]la
[8985]Please attach Copy B of Form W-2 to back
[8991]7040 yy Department of the Treasury / - Internal Reventtie’Service ~~ et. (07
[8992]y . / é }
[8993]Individual income Tax Return } i
[8994]For the year January 1-Dacembar 31, 1971, or other taxable year beginning —...... oceans cessor, igrh ending .
[8995]First name and initial (I? joint rata, ute first names and middie initials of both: Last nama... wo Your sociat security. number
[8996]“SAMUEL AND, MYL [s : : - | RU . Se . 322 £12: 7997
[8997]“Present homa adcress (Humber and strea an cluding apartment number, or rural route) : . , , : : ‘ Fo : . : “Spouse” Ss social security number. .
[8998]16259 Bircher Street 00° ; Bh9
[8999]City, town of port office, Stain and 11? cote ‘ : { - Self Employed, ~
[9000]. : aa : on
[9001]— Graneda Wills, Californts ae : pation _Spouie's Housevite.
[9002]|. Fill ing Status—check only ane: Solos : - Exemptions oo 7 Regu jar 765 of over / ‘Blind Enter v oe
[9003]| 2 [] Single ce 7 Yourself Lo, BE) Oh tyme
[9004]“2 Gy Married filing jointly (even if only ‘one had incom) @ Spouse (yes “ii ten ir] mon Cc os | checked i
[9005]: ‘ .. . py h as Checked . Pi
[9006]3 (J Married filing separately and spouse is also filing. 9 First numes of your: dependent children who lived with
[9007]Give sp: use’s social secusity aumber in .
[9008]Space aiove and enter first name here ee “you ry ed, Brian, 2d isa a
[9009]4 [7] Unmarried Head of Household 7 —: *hends: ; .
[9010]50 Surviving widow(er) with dependent child 10 Number of cther dependents (from line 33)
[9011]& [] Married filing se arately 2 and t spouse | is tfiling “AL ‘Total exemptions claimed
[9013]120 Wages, salaries, tips, etc. (Attach Forms W~2 to back. it unSvailable, attach explanation) ae
[9014]13a Dividends (8 pte )$.42, 50 wane 13b Less exclusion $... “hy 50. ct - Belance . Di. 13 wees
[9015]w - (ff gross dividends and other distributions are over $100, list in Part 1 of Schedule 8. » : .
[9016]& 14 interest. it $100 or less, enter total without listing in Schedule B ok ee | 14
[9017]o if over $100, enter total and lst in Part ti of Schedule B , . ob,
[9019]is income other than wages, dividends, and interest (from line: 40).
[9021]16 Total (add lines 12, 12.13 14 and 15) - Le
[9023]a7 Adjustments to income (such as “sick pay,” moving expense, ‘ete. ftom line 45) .
[9025]i a) 18. Adjusted gross income (subtract {i fine 17 from line 16). . :. " oe
[9026]See page 3 of instructions for rules under which the {RS will figure your tax, :
[9027]If you do not itemize deductions and line 18 is under $10,000, find tax in Tables and enter on line 19.
[9028]If you itemize deductions or line 18 is $10,000 or more, go to line 46 to figure tax.
[9030]19 Tax (Check if from:.(] Tax Tables 1-13, [1] Tax Rate Sch. X, ¥, or 2, se Sch. D, [] Sch. G or Form 4726) | 39 |
[9032]20 5 Tota credits (from line 54) 2... - .
[9034]‘24 Income tax (subtract lina 20 frora line 19) 2. ie woe
[9035]22 Other taxes (from line 60) eee
[9037]23 Total (add tines 21 and 22) Lae ey
[9038]24 Total Federal income tax withheld (attach Forms W-2 or W-2P to. back) : = 2
[9040]}.25 1971 Estimated tax payments (include 1 1970 overpayment allowed as a credit)
[9041]26. Other payments (fromline 64) .
[9043]| Tax, Payments and Credits
[9045]___.| 27 Total (add lines. 24, 25, and 26). oe cote ; :
[9046]og 1 tine 99 ie tare ee tee Ba = yy yi Pay in duit with return, Make check aa
[9047]8 z 28 If line 23 is larger than line 27, enter BALANCE DUE pen a ea site seek
[9048]me 29 If line 27 is larger than fine 23, enter OVERPAYMENT 6
[9049]GB | 30 Line 29 to be: (a) REFUNDED int mince = BP
[9050]! (b) Credited 09-1972 estimated tax. 0. -
[9052]31 Did you, at any time during the taxable year, have any interest im or signature or other author-
[9053]. ity over a bank, securities, or other financial account In a foreign country fexcept inaU.S. oo»
[9054]military banking facility operated by a U.S. financial institution)? . 7 . Yas No
[9056]if “Yes,"’ attach Form 4683. (For definitions, see Form 4633.) . Trt ee b ol ark
[9058]Foreign
[9059]Accounts
[9061]Under penalties of perjury, 1 dectare that } have examined this return, including accompany ng ‘ehedules and statements, and to the best of my knowledge and beet
[9063]t
[9064]- 7 iis trus, correct, and complete. ;
[9065]sien > __ es “EDWARD L, LAMBERT
[9066]ISM Your signature , _ Date spew ai preparer: SL eee J Tae Cate
[9067]ere ) : : : a . a alt information of hha jkionle :
[9069]88326 Docld:32245535 Page920
[9071]Pane 2 Form 1040 (1971) ~ Attach Copy 8 of Form W-2 here. Bb.
[9073]to - Ce een
[9074]-* “PART 1.—Additionai Exemptions (Coniplete only for other’ dependents claimed on line 10).
[9075]. CAME . “ (b) Relationship fe 3 tived in your hom (a} -Aniount Yeo ure; (fF) Amount furnished”
[9076]° 32 @ NAME Beene ni or deg dur wee a eee dep: : by OTHERS includ.
[9077]ae Sor D “. support. ff 109 g atite ing dependent. -
[9078]ALL.
[9082]al
[9085]i
[9086]mi
[9088]33. Total number of dependents disted above. Enter here and on tine 100. SO te mI
[9090]PART il.—Income other than Wages, Dividends, and Interest
[9092]34 Business income or (loss) (attach Sched ule C).
[9093]35 Net-gain or (loss) from. sale or exchange of capital assets (attach Sel rdule ‘Dy
[9094]36 Net gain or (loss) from Supplemental Sctredu! e of Gains and Losses tat tach, Form 4797)
[9095]37 Pensions anc annuities, rents and royalties, partner Ships, estates or trus ts, ‘etc. (attach Schedule E).
[9096]38 Farm income or (loss) (attach Schedule - FY, ee F
[9097]39 Miscel- ( (a, Fully taxable pensions and: annuities nnn ee : ie
[9098], laneous (b) 50% of capital gain distributions (not re; vorted on Sehes tule 0)
[9099]. “ income | (cj State income tax refunds (caution—see instructions on page 7)
[9100](d) Alimony . ee ; oad
[9101](e) Other (state nature and source)... 3+. 0. 0s, ee
[9103]RSS
[9104]EWS :
[9106]SSS
[9108]nO Total miscellaneous income (add lines ¢ :9fa), (b), (©, (a). and )
[9109]40 Total’ (add fines 34, 35, 36, 37, 28, and 39). Enter here and aniline tS 2°.
[9110]PART lil.—Adjustments to income ~ :
[9112]41 "Sick. pay’ if included in line 12 (attach Form 2440. or other requted stateinent) om
[9113].. 42 Moving expense (attach Form 3903) ... Be ee i a
[9114]43 Employee business expense (attach Form 2106-or other ¢ statement) .
[9116]44 Payments as a self- cemployed person to a retirement plan, etc. (altach Form 2950SE).
[9117]45 Total adjustments (add lines 41, 42, 43, and 44). Enter here and on line 17
[9119], PART IV.—Tax Computation (Do not use this part if you use Tax Tables 1-13 to find your, tax.)
[9121]46 Adjusted gross income (from line 18) 3 wy 5 46 {6,529
[9122]47 (a) If you iternize deductions, enter total from Schedule A, line 32 and attach Schedule A a boa. |
[9123](b) If you do not itemize deductions, and line 46 is: ce, . a [a7
[9124](1) $10,000 or more but less than $11,538.43, enter 13% of line 46 rs ee —
[9125](2) $11,538.43 or more, enter $1,500. ee nes ;
[9126]. Note: deduction under (1) or (2) is limited to $750 if married and fibng separately. :
[9127]- . 48 Subtract line 47 from line 46, : wy 48.
[9128]49 Multiply total number of exeniptions claimed..on | line 1), by $675. be ne oe 49
[9129]50. Taxable income. Subtract line 49 from line 48.00. 2 50
[9131](Figure your tax on the amount on line 50 by usins: Tax Rate Schecdule x, Y or Z, or ‘if applicahbie, the “alternative-
[9132]tax from: Schedule D, income averaging from Schedule G, or maximum tax from Form’ 4726.) Enter tax on tine 19.
[9133]a RAH
[9135]PART V.—Credits _
[9137]51. Retirement: income credit (attach Schedule Ry
[9138]52 dnvestment credit (attach Form 3468)
[9140]53 Foreign tax credit (attach Form1116) ." ot oy
[9141]54 Total credits (add lines 51, 52, and 53). Enter here and on ‘line. 20
[9143]PART Vie —Other Taxes
[9145]55 Self- -employment tax (attach ‘Schedule St) - .
[9146]56 Tax from recomputing prior-year investment credit (attach Form 4255)" Loe
[9147]-57 Minimum tax (see instructions on page 8). Check here (i, if Form 4625 is attached
[9148]58 Social security tax on unreported tip income (attach Form 4137)
[9150]59 Uncollected employee social security tax on tips (from Forms W-2) we Loa
[9151]60 Total (add lines 55, 56, 57, 58, and 59). Enter here andon line 22 . 2 Ws tw
[9155]61 Excess FICA tax withheld (two or more employers—s fe instructions on page 8). ee ey
[9156]62 Credit for Federal tax on § special fuels, nonhizhway gasohne and lubricating foil {attach Form 4136) .
[9158]53 Regulated investment Company Credit (attach Form 2439)
[9160]64 Total {add lines 61, 62, and 63). Enter. here and on line 26 .
[9162]SE ORE De Ta a Ga” : : OA 14GG24
[9164]NW 88326 Docld:32245535 Page 93
[9166]Schedules AzB—It emized Deductions AND
[9168]"+ (Form 1040)
[9170]° Department of the Treasury: :
[9171]“Internal Revenua Service > Attach to Form 1040.
[9172]. Name(s} as shown on Form 1040
[9174]Samuel and Phyllis Ruby
[9176]- Medical z and dental ¢ expenses ; (not compensated by insurance
[9177]or otherwise) for medicine and drugs, doctors, dentists, nurses,
[9178]hospital care, insurance premiums. for medical care, etc.
[9180]“1 One half (but not more than $150) of in-
[9182]surance premiums for medicai care. (Be |
[9184]2 Medicine and drugs
[9186]Enter 1% of line 18, Form 1040
[9188]Subtract line 3 from tine 2. Enter differ
[9190]ence (if less than zero, enter zero)
[9192]5 Enter balance of insurance premiums for
[9193]medical care not entered on line 1
[9195]6 Itemize other .medical and dental ex
[9196]penses. Include hearing aids, dentures
[9197]eyeglasses, transportation, etc
[9199]i
[9200]sure to include in lina 10 below)... |
[9204]7 Total (add lines 4, 5, and 6)
[9206]8 Enter 3% of line 18, Form 1040
[9208]9 Subtract line 8 from line 7. Enter differ-. ee
[9209]ence (if less than zero, enter zero)
[9211]_ 10 Total deductible medical and dentai ex
[9212]penses (Add lines 1 and 9. Enter here
[9213]and on tine 27, below.) >
[9215]Taxes. . : . |
[9216]11 Real estate !
[9217]12 State and !ocai gasoline (see gas tax - tables)
[9218]13 General sales (see sales tax tables) .
[9220]14 State and local income.
[9222]Dividend and interest Income
[9224]Schedule A—Itemized Deductions (Schedu e B on ack) -
[9226]4
[9227]- Your sacial security number
[9229]le s22 422 | 7997 |
[9231]i
[9233]Contributions. —Cash—inctuding ‘checks. money orders, ete,
[9234](Itemize—see instructions on page 10 for |
[9236]examples) _ . ot a -
[9238]18 Total cash contributions... 9. 7. 0. |
[9240]19 Other than cash (see instructions on
[9241]page. 10 for required statement). Enter’
[9242]total for such items here.
[9244]20 Carryover from prior years
[9246]21 Total ‘contributions: (Add lines. 18,°
[9248]19, and 20. Enter here and on line 23,
[9249]beiow.)”
[9251]Interest expense.
[9253]22 Home mortgage.
[9254]23 Instaliment purchases
[9255]24 Other (itemize)_
[9257]25 Total interest expense {Add lines 22,
[9258]23, and 24. Enter here and on line 30,
[9259]below.) >
[9261]Miscellaneous deductions for child care,
[9262]alimony, union dues, - casualty losses, etc. .
[9263](see i instructions. on page 10).
[9265]15 Personal property
[9267]16 Other
[9269]17 Total taxes (Add. lines 11 through 16.
[9270]Enter here and on line 28, below.) >
[9272]28 Total taxes (from line 17)
[9274]29 Total contributions (from line 21) .
[9276]30 Total interest expense (from line 25) .
[9278]31 Total miscellaneous deductions (from line 26):
[9280]iW: 88376 Docld:32245535 Page 94
[9282]Summary of. Itemized Deductions
[9284]27 Total deductible medical and ‘dental expenses (from line 10).
[9286]32 TOTAL ITEMIZED DEDUCTIONS. (Add lines 27 through 31. Enter here # ace on Form ‘104 4, line 47. ae
[9288]“26 Total miscellaneous deductions (Enter
[9289]here and on line 31, below.) « >
[9291]“80
[9293]ELS) 3h
[9295]“1 F617 | 68
[9296]500 lan-
[9297]ST aT
[9300]. A} or . _
[9301]NAME, eV CH Koes WA IDENTIFICATION pro Le PHD
[9303]" SCHEDULE NO. : —._.__ SCHEDULE OF DEDUCTIONS. ——vear ENDED.
[9304]MEDICAL FEDERAL | STATE | CONTRIBUTIONS FEDERAL & STATE
[9305]1. ONE HALF OF MEDICAL INSURANCE ; CHURCHES oe - _
[9306]{NOT OVER $130.00) hs Q iva | to
[9307]‘2, DRUGS AND MEDICINES ee ee ee COMMUNITY CHEST/UNITED CRUSADE =: co,
[9308][3 LESS: 1% OF ADJ.GROSS INCOME || SALVATION ARMY/GOODWILL INDUSTRIES
[9309]fenetonvesanm wees TY aes -
[9310]§. DOCTORS/ DENTISTS | XMAS & EASTER SEALS ae
[9311]DR. . HEART FUND/CANCER FUND _ an
[9312]OR PARTNERSHIP RETURN ee
[9313]DR. [oT PAYROLL DEDUCTION a
[9314]pR. OTHER ORGANIZED CHARITIES: a
[9315]DR. ~ woe
[9316]oR. Po,
[9317]oR. _
[9318]OR. -———
[9319]| _oR.
[9320]a INSTALLMENT LOAN —
[9322]“HOSPITAL ~ ——
[9323]“| LaBoraToRY +— ; ,
[9324]"BALANCE OF MEDICAL INSURANCE
[9325]NOT DEDUCTIBLE ON TOP LINE’
[9327]FEDERAL & STATE|
[9329]TRAVEL FOR MEDICAL a MISCELLANEOUS DEDUCTIONS
[9330]AMBULANCE. PT atimony (EXPLAIN)
[9332]SAFE DEPOSIT BOX FEE
[9334]__SLASSES
[9336]| tT
[9337]HEARING AID | ff | __UNION QUES
[9338]+ PT sw
[9339]j
[9341]; SMALI. TOOLS. (e000 1 1 YEAR)
[9342], LESS: REIMBURSED BY INSURANCE | | sarery equipment
[9343]. [6 TOTAL _ |_| UNIFORMS (NOT GEN. WEAR)
[9344]EAE sees mamas LAUNDRY & CLEANING
[9346]8. BALANCE (NOT LESS THAN ZERO) ; AUTO "MILEAGE @
[9347]9. TOTAL MEDICAL DEDUCTIONS. TELEPHONE EXPENSE (NOT REIM
[9348]EMPLOYMENT AGENCY FEES
[9350](LINE 1 PLUS LINE 8) — j ATO Je a e
[9351]LTAXES a ; FEDERAL STATE DUES & SUBSCRIPTIONS
[9353]AUTO LICENSE (LESS REG. FEE) : INCOME TAX PREPARATION
[9354]SALES TAX 00 | || orners
[9356]SALES TAX AUTO
[9357]REAL ESTATE TAX C77
[9359]PERSONAL PROPERTY TAX
[9361]| {STATE INCOME TAX
[9363]GAS TAX /O) cat.@ s{)) ¢Gal.
[9365]i
[9367]SUB TOTAL
[9368]_ DISABILITY INSURANCE LESS REIMBURSED BY INS.
[9369]MISC, TAX -xx [x x [ | = - SUBTOTAL | Zr Ip
[9371]LOTHERS: | Paes stn Fon cach casey | eo I
[9372]|__| || TOTAL CASUALTY LOSSES | a @ |
[9374]_FEDERAL STATE _
[9376]| TOTAL TAXES! Jd gil aYpir) ___ TOTAL DEDUCTIONS | G/OO9) Gry, nee
[9378]NWEES3 267 Hogi; 372455235, Page, 16622 VFNTHRA RONIEVARN cIIITE RIN FNPINA CALIFARNIA 012148
[9381]me
[9385]Profit {or Loss) From Business or Profession |
[9386]{Sole Proprietorship) ; : VOR.
[9388]BP eoartinent of tha Treasury > Partrierships, joint ventures, etc., must file on Form 1065.
[9390]Internal Revanue Service & Attech to Form 1040. .
[9392]Name(s) as stiown on Forin 1040 .. . . Coe, . i
[9393]Samiel and Phyl ts Buby oo ee |
[9395]Social 1 number
[9397]322 22 E 2997.
[9399]A Principal business activity .. Food | Service : eee Product 0 2 eee ee eee ae Sl eledeldeecede ete
[9400](See separate instructions) , (For exainple: retait— hardware: wholasala—tobaces: services——legat: “Jnanutacturing——farniture; ete. )
[9402]B Business name Snack Rar ce leceeeeeeeeeee c Employer identification Number leeeeee Loe celacnececceceenececces ence _
[9404]Van “avs, California 91401 :
[9406]D Business address - pee deeee ce see hte oes .
[9407]E indicate method of accounting: Ox cash; “(2) fa acerua!; (3) Tj other, re : {ZIP code).
[9409]F Was there any substantial changa in the manner of determining quantities, costs, or, valuations between the opening and clesing inventories?
[9411]CU YES [§ NO. If “Yes,” attach explanation. ” :
[9412]- G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 19712 (See “lem Gr in separate instructions for Se hedule co)
[9414]C] YES | NO. If “Yes,"’ where. were they filed? D>
[9419]1 Gross receipts or gross sales $. 0. Less: Returns and allowances Bonet et steeecee cere
[9421]2 Inventory at beginning of yaar (if different from dast years closing inventery - . .
[9422]attach axplanation) ,
[9424]3 Merchandise purchased $.
[9426], less cost of any items | : Coa . 1.
[9428]Ro. a
[9430]withdrawn from business for personal use $.
[9431]4 Cost of labor (do not include salary paid to yourself) . . . SCHED
[9432]5 Material and supplies . . . . 2 ee 7 ATTACHED
[9433]6& Other costs (explain in Schedule C-1) . . 1. ee ee ee a
[9434]"27 otal of lines 2 through 6 2.
[9435]8 ‘Inventory at end of this year ©. 6 te ee :
[9436]9 -Cost of goods sold and/or operations (subtract line 8 from line 7) .~*. oy 7
[9437]- 10 Gross profit (subtract ine 9 from line 1)... me
[9439]OTHER BUSINESS DEDUCTIONS
[9440]11 Depreciation (explain in Schedule C~2)
[9442]12 Taxes on business and business property (explain in Schedule C-1). _ .
[9444]13 Rent on business property 2. 6 ee ce
[9446]14 Repairs (explain In Schedule C-1) . . ae
[9447]' 15 Salaries and wages not included on-line 4 (exclude any paid to yourselt) - rs oe ans Dealt
[9448]WG-Insurance . 0. ek ek ee we ee ee _ lace veeeepeteecesaeterefeccead
[9449]_17- Legal and professional fees ©. 2. ee eee : Lo oo! :
[9450]18-Commissions .°. . 2. . es - - a 7 ; ,
[9452]19 Amortization (attach-Statement) 2. 0-2 ke ee te et Peete soeeceeceedncened °
[9454]20 (a) Pension and profit-sharing plans (See instructions). eo
[9456](b) Employee benefit programs (See Instructions)... . a
[9457]21 interest on business indebtedness . 6-00 eee ee ke ee
[9458]22 Bad debts arising from sales or services . a
[9460]23 Depletion «> a SG
[9462]24 Other. business expenses (explain in Schedule C-1) ye - a
[9464]25 : " Total of lines 11 through 24 . 2. 1... Soe ee te ee weve
[9466]26 Net profit (or Jose} (subtract line 25 from line 19). Enter hare and on line 4 Form 1040. ALSO enter on | .
[9467]Schedule SE, Part |, lina boo. 1. . re 350 7
[9469]Amount’
[9471]_ SCHEDULE Ci. EXPLANATION OF LINES 6, 12, 14, AND 2a ot J
[9473]“Explanation
[9476]. Samuel and Phyllis Ruby
[9477]SUPPLEMENT TO SCHEDULE C:
[9478]a
[9480]Income. _ Bee _ vs 7 rea 343,479.18.
[9481]Less: Sales Tax SO we ‘1746.63
[9482]. . . a 843,394.55 =
[9484]Cost of foods Sold . ; oo,
[9485]Ber innine Inveatory Lo. ; ; Te, oe So 800.0
[9486]Purchases oo ws ans
[9487]Reverage/milk Co ; , Se 4,980.70
[9488]Groceries, § - oe 5, 169,50 |
[9489]_ Meat. . ; oo, an _ 2,570.35 -
[9490]| Bakerv/hread _ So os 8815402
[9491]Total Avatlable . ; ne . $26,336.17
[9492]"Less: Ending inventory =... a 800.09 (25 516, 17
[9494]Saran
[9496]Adjusted Gross Profit, | “su, 768,38
[9498]‘Expenses . a a, . a :
[9499]Casual labor 2 ee See
[9500]“Rent re - nee 1,459.87 =
[9501]Payroll a 077
[9503]. Telephone Lae. OO 0
[9504]Insurance ‘190.50
[9505]Accounting =~ ee oO es gg age
[9507]. Miscellaneous ‘ te Se ee 27,04 oo
[9509]Maintenance/repairs: - 136,19 —
[9510]‘Taxes/Licenses. oe . Lo. LE 556,06 07
[9511]Hostery— . : po fe Be 130.04
[9512]Auto ee oo ae oo. TA
[9513]Linen. ee e783
[9515]Donations 9. et a ao By 9 55°
[9517]Se oe - re Ssh 778832
[9518]- Less: Peprectat ton 7 ; _ io 7 - arenas , 3, 428550)
[9519]MET PROFTT © a re Sg a 5033"
[9520]DEPRECIATION
[9522]Equipment 4/70 © $19,990.09. $2,90N,n0 2 5 HE, st $2,900.00
[9523]’ Covenant not SO St a ee Se Cee
[9524]to Compete 5, 000,00 1,000,900. S¥r. SL... 1 an0.00°
[9525]Leasehold Imp, 3,900,009 A28,50° 2 Pel so yg 50
[9526](Ral, of Lease) So . Se ae oe :
[9530]W 88326 Docid:32245535 Page 9f
[9533]> [hibast Revenue serves,” | B Attach to Form 1040.
[9535]SCHEDULE SE Computation of Social Security Self. Empi oyment Tax |
[9536]{Form 1040) oe
[9538]> Each self-employed person must file a Schedule Sh.
[9540]internal Revenue Service
[9542]> If you had wages, including: tips, of $7.600 or more that were Subject to social. Secunty taxes, do not fill in “this page.
[9543]> If you had more than one business, combine profits and losses froin ail your businesses and far ms on this Schedule 2 SE. _
[9545]Importar . ne self. employment income reported below will be credited to your social security, recoid and used in figuring | social ‘sec :
[9546]Name of self. -empioyed person {as Shownon social security card) - . : en - 7 Social = security - number
[9547]: , : . | of self-employed person
[9549]o we - Mo, , 39 t [2.1796
[9550]Samuel Ruby : i : ; ae . 322 £2. i 7997
[9552]Business activities subject to self-employment tax (grocery store, restaurant, farm, etc.) Db |
[9554]“EE Computation of Net Earnings from BUSINESS Self-Employment (other than farming)
[9556]Net profit (or loss) shown in Schedule C (Form -1046), hae 26. (Enter combined amount if more than’ one 7,3: 50} 33
[9557]husiness.) 2 rr pb :
[9559]2 Not income (or loss) fron exciided senaces of sources included on. lee 1 Lo — TET
[9560]Specify excluded. services: or SOUurceS . neo. Leetede , 2ole. seet recente!
[9562]3 Net earnings (or loss) from business self. employment (Sub btract tline 2 2 from tine 1. and Wt here and a oT 3 50) 33°
[9564]on line 8(a). Part Ul below.)
[9565]i Computation of Net Earnings from FARM Sell. Employment . a
[9566]A farmer may elect to compute net farm earnings using the OPTIONAL METHOD (line- 6, below) ‘INSTEAD OF THE REGULAR
[9567]METHOD (line 5, below) if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600."
[9569]If your gross profits from farming are not more than $2,400 and you elect to use the aptional method, you need rot complete : eo
[9570]. lines 4 and 5. . . . : . 7
[9572]Computation under Regular Method | So ; | ae :
[9573]4 Net farm profit (or loss) from: : ; :
[9574](a) Schedule F, line 52 (cash method), orline 71 (accrual method) .
[9575](b) Farm: partnérships. ‘ : . :
[9576]"5 Net-earnings from self- employment from farming. Add, tines Alay and Hib)
[9577]a - Computation under Optional Method - ; c: a
[9578]6 AV gross profits from farming are: ° ; : rn harran 7
[9579]* (a) Nat more than $2,400, enter two-thirds of the gross’ profits ee re
[9580](b) More than $2,400 and the net farm profit is less than $1,600, enter $1, 600
[9582]*Note. —Gross profits from farming are the total of the gross profits from ‘Schedule F, line 28 (cash.
[9583]: method), or line 69 (accrual method), pius the distributive share of Bross: profit from farm
[9584]Partnerships as explained in instructions tor Schedule SE. L,
[9586]7 Enter here and on lite. Cb), Part Ill, below, the amount on line 5 5 (or line 6. if you use. the optional po
[9587]method) - eee :
[9589]Computation of Social Security Seif. ‘Employment Tax .
[9590]Net earnings (or loss) from self-employment— — i
[9591](a) From business (other than farming) from line-3, Part |, above ~
[9592](b) From farming (from line 7, Part ll, above) ; .
[9593]“(c) From partnerships, joint ventures, etc. (other than farming) wee: - woe.
[9594](d) From service as a minister, meniber of a religious order, ora Christian Science pre actitioner If you : Q
[9595]. filed Form 4361; check here {j and enter zero on this line’ Se Load
[9599](e) From service with a foreign government ¢ or international organization |
[9600](f) Other. (director's fees, etc.). Specify
[9601]-9 Total net earnings (or Inss) from self- employment reported online 8 . |.
[9603]t
[9604](If line 9 is fess than-$400, you are not subject to self- -employment. tax. Do not fa in rest of page)
[9606].10 The largest amount of combined wages and self. employment earnings S subject aa a | ,
[9607]. tosocialsecuritytaxis . . .. : a rs i |
[9609]11 (a) Total “FICA”’ wages as indicated on 1 Form w-2 i
[9610](b) Unreported tips, if. any, subject to FICA tax from
[9612]Form 4137, line 9 .). cr
[9614]. (c) Total of lines 11(a) and 11(b) . a
[9616]12 Baiance (subtract tine 11(c). from line 10). ; — a oe
[9618]13 Self-employment income—line 9 or 12, whichever. is. smaller to.
[9620]14 If line 13 is $7,800, enter $585.00; if fess, multiply the amount on line 13 by. 075 . . woe,
[9622]- 15 Railroad employee's and. railroad employee repres sentative’s adjustuient for hospitaki insurance © benetits hoe
[9624]tax from Form 4469 . ow. Sy ote ae _
[9626]16 Self-employment tax (subtract line 15 ‘trom line 14). Enter he “en anion 1 For J
[9628]ais lis
[9630]W 88326 Docid:32245535 Page 98°
[9633]r.
[9634]g
[9635]bi
[9637]a (Form 1040) mm Attach to.Form 1060. Examples of property to’ ‘be reported on this Schedule are
[9638]’ : gains and losses on stocks, bonds, and similar investments, and gains (but nat losses)
[9639]on personal assets such as a home or jewelry.
[9641]SCHEDULE D Capital Gains and Losses pee pow |
[9642]|
[9644]Internal Ravenua
[9646]Nama(s) as shown an Farrn 1040
[9647]Samuel and Phy liis Ruby
[9649]Short. term Capital Gains and Losses—Asseis Held Not More Than 6 Months
[9651]boH ¢. Mo., day, yr. 7 a : ~ H ‘a. Gost or “other sasis, |
[9652]sat ey {Pat cate sob aboea — | seeuout impraverents | Gain or
[9653]a bind of Bop an nee oO j anes fatter j- dotted ling and cata” Gross sates Be eee ichaer attach : ofa or floss)
[9654]: symbol (see | free Gel om | explanation) and ex- : : :
[9655]| Instructions) | dottad linny
[9657]SCHEDULE: ATTACHED
[9658]1
[9659]2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries . 2 ;
[9660]‘3. Enter net gain or (loss), combine lines land2. . ... . - soe {3
[9661]4(a) Short-term capital loss component Carryover from years béginni ng + before 1970 (see Instruction 4 | Ala):
[9662]4(b) “Short-term capital loss carryover attributable to years beginning after 1969" (see Instruction H) ~. f 4(b)_
[9663]5 “Net short-term pain or r (loss), combine | lines 3, 4(a) and 4 ACD) es _— cel 5 _
[9664]ale Long'te term Capital Gains and Losses—Assets Heid More Than an 6 ‘Months .
[9666]7 Capital gain. distributions ee ele
[9668]a _ Enter-gain if applicable from tine A(ay(1), Form ‘4797 (see lristruction A).
[9669]9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries oe
[9670]10 Enter your share of net long-term gain from small business s corporations (Subchapter $)..
[9671]11 ‘Net gain or (loss), combine lines 6throughio. ... . : . : ’
[9672]12(a) Long-term capital loss component carryover from years beginning t before 1970 (sée Instruction Hy. tava)
[9674]5
[9678]12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) :, - | 12(b) oe _
[9679]13 Net Jong term gain or (loss), combine lines 11, 12(a) and 12(0) we ee kt 131 ¢
[9681]Summary of Parts | and ii |
[9683]15 If line 14 shows a gain-—..
[9684](a) Enter 50% of line 13 or 50%, of line 14, “whichever i is smaller (see Part vi for F computation of
[9685]alternative. tax). Enter zero if there is a loss or no entry online 13. . : 15(a)
[9687]. = (b) Subtract line 15(a) from line 14. Enter ‘here and on 1 line 25, Form 1040 . a o - _ _ | 15(b)
[9688]16 ~ If line 14 shows a loss—See Instruction 1.
[9689]; b> Omit lines 16(a) and 16(b) and go to Part IV if losses. are shown on lines $ 12(0) and 13.
[9691]> Otherwise, ; of
[9692]@) Enter ona of the following amounts; - a ; 2d
[9693](i) If amount on line 5 is zero or a net gain, enter 50% of amount. on nine 1 14; a ef
[9694]|
[9696]140 : . Combine the amounts shown on lines 5 and 13, and enter the net gain. (loss) here coe ay | 14 “ia as, 8a i
[9698]ia
[9700]‘(i)- df amount on line 13 is zerd or a net gain, enter amotunt on tine 14: or,
[9701]* (ily if amounts on line 5 and line 13 are net losses, enter amount on ‘Tine § added: to
[9702]50% of amount on line 13. . . rer . .
[9704]“(b) Enter here and on line 35, Form 1040, the smatier of:
[9705](i) The amount on line 16(a); , .
[9707](i) $l, 000 ($500 if married and ‘filing a separate return—if losses are shown on Tines
[9708]4(a) and 5, see Instruction K for a higher limit not to exceed $1, 000); or, :
[9710](iii) Taxable income, as adjusted (see instruction J) wo. : :
[9713]16(a)| fe
[9714]fe
[9716]a :
[9718]: . Cavewe ver ny SLA, 522.09) i
[9720]W 88326 Docld:32245535 Page 99
[9722]. ag oo oe ra
[9723]TERA LER LAP te, iberecl varef
[9724]VEEKLY WORK PLAN/TIME REPORT ye a
[9725]j PEI ON pm :
[9726]LE SNUMBER ZF OT coc Sic ex
[9727]REVENUE
[9729]“BOOKED _
[9731]1 shy
[9735]. wed fe
[9736]REZ pep FG |
[9737]"CALL _
[9738]HRs | COMMENTS ayo
[9739]EXPENSE
[9740]NOTES |
[9742]= =F
[9744]CUSTOMER
[9745]NAME
[9749]Veer ei pPiey, eeaSil dl [TT EE ge Peep op
[9750]y, eA oy
[9751]ELI PN OX, a
[9754]| ff
[9755]a
[9758]Co 5 id
[9759]Bisel ioli
[9760]map WEEKLY WORK F
[9762]Des py
[9763]ny Rae YD dys
[9765]TIME REPORT. |
[9767]Eft
[9769]CONTRACT | 7%, REVENUE "1 ALi
[9771]& “0 /WEEK ek DING!
[9774]- SALESMAN”
[9776]' CUSTOMER 3 i ne "+ BOOKED ERS COMMENTS AND
[9777]_ : : "EXPENSE -
[9779]- NAME nee
[9780]NOTES
[9782]BO
[9784]. 2 vo
[9785]bt cn fh Oe
[9789]Reene
[9791]5
[9793]prere D OPEL
[9795]TOTALS |.
[9797]W 88326 Docld:32245535 Page 101
[9799]War Leaepci b De
[9800]WEEKLY WORK Pi. ne TIME REPORT
[9802]SALESMAN AS CC Ce psaigg of, Noynnze:,
[9803]— be REVENUE. a oe
[9804]CUSTOMER. . ; “  Rookep:) ) | -COMMENTS AND
[9805]NAME af oo . ob EXPENSE .
[9806]8 MONTHLY | HB] +- NOTES
[9808]~ j ; one vey os a . , oi I. . ° re? . . m,
[9809]wane: Rid i vel - Lo rity Weiser aps
[9811]ed |
[9812]Phewcehs \yieo| | | TT ben
[9814]W.88326 Docld:32245535 Page 102
[9816]SLA LA se . MOY ETP PR ey.
[9818]VAJFEK ENDING Lo
[9819]REVENUE
[9820]BOOKED
[9822]COMMENTS ANE!
[9823]; EXPENSE -
[9824]“NOTES °
[9826]CUSTOMER
[9827]NAME
[9829]Se (ee=)
[9831]PT —
[9832]po tT TT —
[9834]5 Vergy Co dsac | :
[9836]“NW.88326 Docld:32245535 Page 103
[9838]er.
[9840]TAXA | TAXABLE
[9842]a lr OTT,
[9843]CAPITAL GAINS AND LOSSES. ee ee eee
[9845]Attach to Form 540 or S4GHR o
[9848]SCHEDULE |
[9850]Use this schedule to report gains and losses ‘on stocks, bonds ‘and. ‘Similar investments,
[9851]_ and gains (but not losses) on personal assets such as a home or iewelry.
[9853]Name as shown on Form 540 or 540NR T ~ Secial Security Humber
[9855]Samuel and Phyllis Rubv . 7 - . | 322 i429 2997 "
[9857]SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS
[9859]- . . - . — .@. Cast or other basis, as oo
[9860]. , a adjusted. cast of ' . :
[9861]fa. Kind of prooerty and description , b. Dale acquired c. Date sold : - ep Sept ” subsequent improvements | f. Gain cr loss*.*
[9862] (Examale, 100 shares af “Z"" Co.) : (mo. day, yr.) | ¢mo., day, yr.) [4% Grass sales price
[9864]attach explanation) °
[9866]Cif not purchased, | (a tess e)
[9867]- and expense of sale :
[9871]“SCHEDUL Fe At TAG nen
[9873]i 7 2. ‘Enter your ‘share, of net short- term ‘gain 1 (oF ‘loss) ‘from partnerships “and fiduciaries
[9874]"3. Enter net gain (or loss), combine lines } and 2... . . ; woe 7 Fe ee
[9875]4. Enter unused short-term capital loss carryover from preceding ‘taxable \ years {ottoch stotement) : :
[9876]5. Net short-term gain (or loss), combine lines 3 and 4 :
[9878]LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS
[9880]Enter gain if applicable from ‘line 4 “Schedule ‘D- 1 {Form 540) ‘(attach copy).
[9881]8. Enter your share of net long-term gain (or. loss) from partnerships and fiduciaries o rs :
[9882]9. Net gain (or loss), combine lines 6 through 8... st te a ee
[9884]10, Enter unused long-term capital loss carryover from preceding taxable years (ottach stotement) Cae ek 14 s als GIs
[9886]11, Net long-term gain (or loss), combine lines 9 and 10 .
[9887]Se Sac
[9888]_ £15,522.09)
[9890]30
[9892]12, Combine the amounts shown on lines 5 and W and enter the net gain (or loss) here. ..-. . an Ta.
[9893]-13. If line 12 shows a gain— ; ao. ae .
[9894](a) Enter 50% of line 11 or 50% of line 12, whichever is smaller. ‘Enter zero if there i is a loss or no entry on n tine YW
[9895](b) Subtract line 13(a) from line 12. Enter here ond on line 32, Form 540 (line 33, Form 540NR) ‘
[9896]_ 14. Mf lina 12 shows a loss-—-
[9898](a} Add tines 4 and. 10 (if lines 4 Hand 10 are blonk, enter a zero here and on lines + 1b) and 14(c) ond go to
[9899]line 14(d)). vo ee ee a
[9901](b) Combine lines 3 ‘ond 9—if gain, enter gain; if loss, enter zero. . ; . a , .
[9903](c) Enter smallest of- (i) ‘fine 14(a) less line 14(b); (ii) the amount of toxoble income on Form ‘540 or 540NR, :
[9904]computed without capital gains and or losses—determine this figure via a side computation; or. (iii) $1,000:
[9906](d) Combine lines 3 and 9—if loss, enter loss; if gain, enter zero here and on line 14(e) and go to line 14(f)
[9908](e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital cyains
[9909]and or losses, tess line 14(c)—-determine this figure via a side computation; (ii) $1,000 ($500 if married and
[9910]filing separately); (iii) if line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows o .
[9911]gain, amount on line 14(d); or (v) if lines 3 and 9 show losses, line 3 added to 50% of line 9 .
[9913](f) Enter here, and on line 32, Form 540 (line 33, Form 540NR}, the sum of lines 14(c) and Mee not |
[9915]enter.an amount greater than $1,000) .
[9917]€ 1,990,090).
[9923], oo carr: O° ver 4). (14,5
[9925], are
[9926]: Sen tnstructions on Back | Loe a - o . oe
[9928]W 88326 Docid:32245535 Page 104
[9930]DWIDUAL COME TAX eTURR .
[9932]WD
[9934]For Calendar Year 1971
[9935]or Fiscal Year Begun
[9937]1971 and Ended
[9939]ce
[9940]each
[9941]es
[9942]: end
[9945]FIRST NAME(S) AND tNITIAL(S) LAST NAME Snause’s social security number :
[9946]pease SAMUEL AND PHYLLTS RUBY | 329°: 12/7997 | 349 4 18) 1429
[9947]Type PRESENT HOME ADDRESS (Number and street,-or rural route} Your oe | “Spause’s oceusation
[9949]16250 Bircher Street
[9950]CITY, TOWN OR POST OFFICE
[9951]“Granada Hillis
[9952]NAME AND ADDRESS OF EMPLOYER AT TIME OF FING
[9953]Selif Employed ;
[9954]FILING STATUS—Check Only One:
[9955]1. (J Single
[9956]2. CE Married, filing joint return
[9958]“4. OO Married, filing separate relun-—If this item shecked, enter spouse's
[9959]social “security number in space above and enter first name
[9961]“or
[9962]Print
[9964]“Self Emploved
[9965]| COUNTY ae
[9966]‘| Leas Anceles’”
[9968]ZIP CODE
[9970]STATE
[9971]California
[9973]| BLIND and/or QEPENDENT EXEMPTIONS: a ;
[9974]i 5. Blind Lf Yourself (Your spouse -Enter nunibar of boxes checked
[9976]6. Dependents—- Us not ist yourself, your : spouse, or person who qualities you
[9977]as head of household NAME ¢and adiress if diferent from yours) RELATIONSHIP -
[9979]RBretan FE ‘lisa,
[9981]Claim your appropiate
[9982]eyemption on line 16
[9984]Thomas". : .
[9985]! Slip leeeeheetee Eta
[9987]number
[9989]‘Fred,.
[9991]here > | - Sees | Cecceee crete ne ce dee gen een ee one TeneeeTbeadhesesanyesete seneneectanee ote
[9992]4.0 Unmartied head of ‘household’ “Complete P Part thy page 2. "| 7. Total-blind and dependent exemptions (add lines 5 and 6)
[9994]Do not » write:
[9996]. Tax on preference income (see instructions) check here (), if Schedule: P (540) is attached -.
[9997]. Tota! tax liability (add lines 23 and 24) : .
[9999]. 1971 California estimated, tax payment (include 1970, overpayment allowed as a credit) - oe, .
[10000]PAY IN FULL WITH RETURN
[10002]Balance: ‘27. Balance due—if any (subtract line 26 from line 75)
[10003]en 28. Overpayment—if any (subtract line 25 from line 26) - OVERPAYMENT
[10004]29. Portion of line 28 you wish to apply on 1972 estimated tax . Oo
[10006]. Refund—if any (subtract line 29 from line 28). . ...
[10008]. REFUND
[10010]Ys
[10011]in peyaities of perjury, 1 declare that I have examined this return, including accompanying schedules and stalements. and to the best of my knowledge and
[10012]vel it ts true, correet and complete. If prepared by a persea other than taxpayer, Ais declaration is based on all information of which he has an Knowledge.
[10014](8. Wages, salaries, tips, ete, (before payroll deductions) ite mote than two, employers, attach list S in: this. coliss -
[10015]Income . Emoloyer's name fi - Wheee employed: (city, and " state)
[10016]i 9 Dividends. _ Enter total here (complete and attach Schedule B (540), if, total is over $100) .~ :
[10017]. 10. Interest. Enter total here (complete and attach Schedule B (540), it total is over 3100)”
[10018]& 11. Other incoma (from. page 2, linn’ 40) sed
[10019]ud 12. Total (add tines #, 9, 10 and 11) ;
[10020]7 = 13. Adjustmonts to Incoma (fram paye-?, linn 46)
[10021]Pr 14. Adjustad gross Income (subtract line 13 from line 12) . woe .
[10022]= © If you do not itemize deductions AND line 14 is under $10,090, find your tax in Tax Table in instructions. Enter tax” on tine 15. -
[10023]=. © {f you itemize deductions OR line 14 is $10,000 or more, go to Part IV on page 2 to figure tax. Enter tax on line 15. .
[10024]3 15. Tax from (check one): (j Tax. Table, [y Tax Computation (page 2, Part 1V) or (] Schedule G (540), line 21 25 .60
[10025]rE 16. Personal Exemption. Single—$25. Married couple or head of household--$50 “TI fe Lg
[10026]= Your iM. Multiply total number. of exemptions on line 7 above, by 38
[10027]Tax, 18. Total exemptions (add lines 16 and 17)
[10028]and _--‘19, Tax liability {subtract line 18 from line 15—not less than zero) weseeeeeele ee
[10029]Credits 20. Other credits (from page 2, tine 62)
[10030]21. Net tax (subtract line 20 from fine 19) . oar
[10031]22. Tax torgiveness—20% % of line 21 (use Part V on page 2: it reporting i income on 4 Schedule 0 640 a 22
[10032]a NOTE: You must file your return and pay any tax due (line 27) by the due date to be entitled ta this: forgivenass
[10033]23. Net tax ability (subtract line 22 from Jine 21—if $1.00 ar less, enter wo 0 a FOB  Ee
[10034]24
[10036]Do not write tn these spaces
[10038]Sign >
[10039]here D>.
[10041]aan Your Social Sacurity No..on Your Chock or Monay Order. Make Remittance Payable to
[10042]ANCHISE TA Mail to FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95867
[10043]W 68326 Bold s22888 Pax Page 105 ;
[10045]Your signairecit filing jini, BOTH must sign
[10047]Address
[10049]Spouse’ . ‘Signature annie |
[10052]: 2) a, Form 540 1971 Page 2
[10054]PART. t—Head af Household—If claimed, answer the foitowing questions (See Instructions)
[10056][Check .[} Never married -_ ; "7 Legal separation (interlocutory decree does not t qualify) Daten
[10057]“one: [7 Widower) Date, ° . So... AC} Final divorce/dissolution ‘Date : : . .
[10058]. , Individual who qualified you as head of household: oo,
[10059]: Name. 00 voeeeaeees Relationship ; _ Age... . Gross income $... cee
[10060]i _ ds this person married? 0. IF yes, di d he « or + she file a joint return with spouse? _. a “Did this person, 4 qualify as your dependent for.
[10062]the calendar year 1971?.... :.Did this person reside in your home for the entire ‘taxable. year?
[10064]lf not, explain circumstances. _
[10066]“Tote! amount. necessary tc maintain household $0... 0. mo “How much did you > contribute? $...
[10068]PART I—Other Inceme -
[10070]31. Business income (ar loss) (attach Schedule C (540)) . 2 2. Foe ee Te
[10071]32. Nat gain for ioss) from sale or exchange of capital assets {attach Schedule D (6409) :
[10072]33. Net gain (or loss) from Supplemental Schedule of Cains and Losses (attach Schedule 0-1 (540))
[10073]. Pensions and annuities . : oe ee
[10074]. Rents and royalties o [ Attach |
[10076]: : Schedule £ .
[10077]. Partnerships ; (Form 540)
[10078]a7. Estates and trusts . .
[10079]. Farm income (or toss) (attach Schedule F (540))
[10080](a) Fully taxable pensicns and annuities (not reported on ‘Schedule
[10081]| Miscel- (b) Alimony. .
[10083]langous (c) Other ‘state nature and source)
[10084]income
[10086]: ' (d) Total miscellaneous income add lines 39(a), (b) ‘and (c)
[10087]’ 40. Total (add lines 31 through 39). Enter here and on page 1, line 11 =
[10089]‘PART IH—~Adjustments to Income.
[10091], AL “Sick pay” if included in line 8 (see instructions—attach -statement)
[10092]. 42, Moving expenses (see instructions—attach statement)
[10094]a 43. Employee business expense (see instructions—attach statement)
[10096]44. Military exclusion (see instructions for line 8) .
[10097]. Payments as a self-employed person to a retirement plan, etc., ‘attach Federal Form 295086) i
[10098]45. Total adjustments {add lines 41- through 45), Enter here and on page 1, line 13
[10100]PART \V—Tax Computation—Do not use this part if you use the Tax Table to find your tax
[10102]“47. Adjusted gross income (from page 1, line 14)
[10104]48. (at If you itemize deductions, enter total fram Schedule A (540), line 32, and attach Schedule A j
[10105] {b} if you do not itemize deductions, and line 14 is $10,000 or more, enter :
[10106](1) $1,000, if single, or married person filing separate return’ .
[10107](2) $2,000, if head of household, or married couple filing joint return -
[10109]13, Taxable income (subtract line 48 from line 47). Figure your tax on this amount by using”
[10110]- appropriate Tax Rate Schedule in instructions. Enter tax on page 1, line 15 .
[10112]. Complete all fines belaw. However, if you used ihe income averaging method to compute your tax on- tine 15. emit tines 50.
[10113]PART V—Tax Forgiveness §1 and 52, enter on fine 53 the amount shown on. line 41 of Schedule G (540), and complete. lines.54. 55 and 56. \-
[10115]50. Tazzble income from line 49 above, or page 1, line 14 if Tax Table used
[10117]3. Amcunt (if any) entered on Schedule D (540), line 13a)
[10119]52. Adjusted taxable income Asubtract tine 51 from line 50)
[10121]33. Adjusted tax (use same method. as used for determining tax on page 1, line 15)
[10122]- Adé lines 18 and 20, page 1; and enter total here
[10124]. Adjusted net tax (subtract line 54 from Jine 53).
[10126]: 20% of tine 55. Enter here ‘and on page 1, line 22
[10128]57. Inczme derived from sources within State Of ee ceneg tng and also taxable by California.
[10130]$8. Cati foraia adjusted gross income (from page 1, “line 14) Dake ae
[10132]$3. Catifarnia. tax: liability (from page 1, Tine 19) a
[10133]2 Credit limitation—line 57 = line 58 2.2 % (100% maximum) x fine 59 (cannot exceed tax paid ather state) -
[10135]34 Retirement incame eredit (attach, Schedule R (540) © co ,
[10137]ot. Totet (add tines 60 and 61). Enter here and on page , line 20
[10139]ART AT Vil—Reconciliation to Federat Return—If adjusted pross income on Federal Return is “different trom ‘ine. 14, 14paps 1, explain be below
[10141]a -
[10142]si72a.ann a.71 12 ocem () A o8P i
[10144]«TBE voenicientse95-Page-t06
[10146]SCHEBULE
[10148]©) CALIFORNIA
[10150]ITEMIZED DEDUCTIONS =
[10152]Attach to Form 540
[10154]Secial | Sesurity Number
[10155]32242! 79
[10157]Itemized 45. stondard Deduction—You have a choice between two deduction if one spouse itemizes deductions, the other may not use the Tax Table or cia;
[10159]metheds. You can either itemize your deductions or take a standard deduction as ~ the standurd deduction. if you. choose to itemize your deductions; complete tr
[10160]explained in the 54Q Instructions. Qn separate-returns of a husband and wite, appropriate items below. . .
[10162]edical and dental expenses (not compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hasta care, insurance ©
[10163]— premiums for medical care, etc. . . : :
[10165]1. One half (but not more » than $150) of insurance premiums for medical care, 7 Lee a wo [1 |
[10166]2. Medicine and drugs ; , ;
[10167]3. Enter 1% of adjusted gross income “shown on a Form 540 .
[10168]4. Subtract line 3 from line 2. Enter difference (if less than zero, enter zero)
[10169]§. Enter balance of insurance premiums for medical care not entered on line |
[10170]6
[10171]1
[10172]8
[10173]8
[10175]. Other medical and dental expenses (attach itemized list)
[10176]1. Total—(Add fines 4, 5 and 6)
[10177]. Enter 3% of adjusted gross income shown on Form 510 .
[10178]. Subtract line 8 from line 7, Enter difference (it les: sh than zero, enter zeta}
[10179]» 10, Total--(Add lines 1 and 9) .
[10181]Child Adoption Expense
[10182]11. Total expenses paid or incurred—Attach itemized fist
[10184]12. Enter 3% of adjusted gross income shown on Form 540 .
[10185]13. Subtract’ line 12 from fine 11—See instructions for maximum limitations .
[10187]Taxes ~
[10189]"14, Real estate .
[10191]15. State and local gasoline
[10192]18. General sales . : .
[10193]17. Auto license—Excess of registration 9 and weight tees (see instruction) an
[10194]18. Personal property . .
[10196]19. State disability insurance (SD) Employer private disability sla do not quatity
[10197]20. Other (specify) _ .
[10199]“21. Total taxes—(Add lines 14 through 20)
[10201]Contributions con oe, _
[10202]22. Cash—Includirig checks, money orders, ‘etc. (itemize)
[10204]23. Total. “cash “contributions.
[10205]- 24, Other than cash (see instructions). Enter total here on : ‘ : wo.
[10206]25. Total—Add lines 23 and 24—Maximum deduction may not exceed "20% at adjusted. Bross incre wo
[10208](ntarast Expansa
[10210]28. Home ‘mortgage :
[10211]27, Installment purchases. a
[10212]28. Other (itemize) .
[10214]29. TotsltAdd lines 26, 27 and 28)
[10216]Mistollaneous Deductions
[10218]30. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize) nano ener een nce
[10220]MW Total miscellaneous. deductions: Ld 7
[10222]2. Total detuctions tng lines 10, 13, 21, 25,29 and 31). Enter total here and on form 440, paye 2: in spice provided” . S/o. EER
[10224]po Mey 1974)
[10225]W 86326 Docld: 32245535 Page 107
[10227]Schedule A on raverse
[10229]TAXABLE i
[10231]CALIFORNIA a.
[10233]TFORM,540 | ‘ . “PROFIT (GR LOSS) FROM BUSINESS OR PROFESSION = ; - - Sey
[10234]a (Sole Proprietorships) wo
[10236]SCHEDULE
[10238]9
[10240]Artoch this schedule.to your income tax raturn, Form 540 or 540NR — Portnerships, joint ventures, ete., must file on Form 345
[10242]Sssial Security Number
[10244]Name as shown on Form 540 or 540NR Y
[10245]322. 512. ! 7997
[10247]Samuel and Phyllis Ruby
[10249]wo. : - Foc s .
[10250]A. Principal business activity. FO08..* ervice ; product... .. a
[10251]. : : {For axample: “reteil— “hordware; wholesale— “tobacco; servicas — ~legal; manufacturing—fursiture; ete) a
[10253]“B. Business name... “Snack Rar Ce gente Soe ey ig ye Cc. Federal math identification number.” Doce,
[10254]DB, Business location... 5418 Van : woe ee . an IS Cal is Forny a _ 14601 Lesbbsnenitieseconeaten eeeneeee
[10255]. . (Number and street or ¢ rural route)” : “(City=post ‘office) 7 ce . Siete), so . tai code! .o
[10257]E. Indicate: method of accounting: - Cat cash; Oo accrual; [] other (describe) eomeneesnete
[10258]-f, Was theré any-substantial change in the manner of determining quantities, ‘costs ‘or ‘valuations between the opening and clasing
[10260]inventories? [1] Yes .[q No. If “yes,” attach explanation. ae re
[10261]G. Were Forms 591, 592, 596 and 599, for the calender year filed {if required)? (“Yes re No:
[10263]a Grois receipts or gross ‘sales $0. Le. Less: Returns ond allowances $ —
[10264]2. Inventory at beginning of year (Hf different than last year’s closing inventory at tach. . . vs
[10265]explanation)... Soe Soe foe Ce ke ef.) SCHEDULE’
[10266]Merchandise purchased $ . we a less cost of any items with. op Coe . ATTACHED
[10267]drawn from business for personal use $ : oa , rs on em,
[10268]Cost of labor (do not include salary paid to yourself)
[10269]. Material and supplies : ‘
[10270]Other costs (explain in Schedute C. 1).
[10271]Total of lines 2 through 6 ~
[10272]Inventory at end of this year. : : : .
[10273]Cost of goods sald and/or operations (subtract line 8 from line n.
[10274]. Gross profit (subtract line 9 from line 1) Lo ;
[10275], . “OTRER BUSINESS | DEDUCTIONS |
[10276], Depreciation (explain i in Schedule C-2) . .
[10277]Taxes on business and business property (explain in 1 Schedule C. 1)
[10279]Rent on business property
[10281]|. Repairs. (explain in Schedule C- 1). , .
[10282]- Salaries and wages not included on ‘Tine 4. (exclude | any: y paid to -yoursell)
[10283]« Insurance . . Soe
[10285]+ Legal and professional fees .
[10287]Commissions . . :
[10288]. Amortization (attach statement)
[10290](a): Pension and profit-sharing plans (see instructions)
[10292](b) Employee benefit programs (see instructions) woke
[10294]+ Interest on business indebtedness .° . ;
[10296]Bad debts arising from sales or services te -
[10298]Depletion of mines, oil. and gas wells, timber, ete. . (attach ‘schedule)
[10300]Other business expenses (explain in Schedule C-l) .
[10302]Total of lines 11 through 24 . . wo:
[10303]» Net profit (or loss) (subtract line 25 from line 10). ‘Enter here and on page 2 Form 540 < or S40NR
[10305]SCHEDULE an EXPLANATION OF LINES 6, 12, 14, AND 24
[10307]Explanation - : . [terre my wo 2 Explanation Ameunt «=
[10309]Rev, 1971)
[10311]W 88326 Docld:32245935 Page 108
[10314]Department of. the Treasury—Internal Revenue Service
[10315]Sk individual income Tax Return
[10317]wee ce ence geseceneesneesteseeenneee , 1973, ending
[10319]: vw) | COUNTY OF
[10320]pe ¥: d
[10321]Present home address ‘umber and ane po se bak namber, or + rural routs)
[10322](6250 By & CHE Ke Re 7
[10324]RESIDENCE
[10325]City, town or Post oftica, State and ZIP code
[10327]Your social security number
[10329]322! 29992
[10331]Spouse's s social Sec: rity no
[10335]Ausere
[10337]4
[10339]: Filing creme only one:
[10341]. “Exemptions ° Regular / 65 or over / Blind oa,
[10342]1 Single : 6a Yourself... MM Cy Ester nN
[10343]2 A raried filing joint return (even if only one had income) b Spouse. . . FL - ian oO oF ennes > 2".
[10344]3 [] Married filing separately. If spouse is also filing give c First names,of your dependent children’ who lived with .
[10346]spouse’s social security number in designated space above
[10348]and enter full name here > __ Ek 1S = ERE number D>
[10350]4 [] Unmarried Head of Household d Number of other dependents (from line 27) . _
[10351]5 Cc Widow(er) with dependent child (Year spouse died > 19 )| 7 Total exemptions claimed . . . ._ op
[10353]. check [7] if spouse wishes to designate $1. Note: This will not increase your tax or reduce your refund. See note below.
[10355](Attach Forms W~2. If
[10356]9 Wages, salaries, tips, and other employee compensation. unavailable, attach explanation) 9 ee _—_—
[10358]10a Dividends (see,ntucons)g OP Jonee 10b Less exclusion $°7. 4:
[10359]Aid (Gross amount received, if different from line 10a 211. Siete tects ccna ctee, )
[10360]11 Interest income . . . :
[10361]12 Income other than wages, dividends, and interest (from line © 38) .
[10362]"43 Total (add lines 9, 10c, 11, and 12)
[10363]14_' Adjustments to income (such as “sick pay,”” moving expenses, “ete. > from line 43) .
[10364].15 Subtract line 14 from line 13 (adjusted gross income) . :
[10366]@ If you do not itemize deductions and line 15 is under $10,000, find tax in Tables and enter on line 16.
[10367]© if you. itemize deductions or line 15 is $10,000 or more, go to line 44 to figure tax.
[10372]16 Tax, check if from:: Tax Tables 1-12 Tax Rate Schedule X, Y, or Z _ . ;
[10374]_ [Schedule D ] Rl Seats 6 Schedule G Yl Form 4726 form a726 lon|_]Fonm 972 Form 4972 } P| a6 109°
[10375]“17 Total credits (from line 54) _17_ a
[10376]18 Income tax (subtract line 17 from line 16) . se
[10378]‘19. Other taxes (from line 61) :
[10380]+ 20 Total (add lines 18 and 19)
[10381]ala Total Federal income tax withheld (attach Forms
[10383]W-2 or W-2P to front). . . . . . . | 21a
[10384]b 1973 estimated tax payments (include amount
[10386]- Please attach Copy B of Forms W-2 here |
[10388]Tax, omen and Credits
[10390]1972 return, but now wish to do so. If joint return, check Oi if spouse did not designate on 1972 return but now wishes to do so.
[10392]Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, , and to the best of my knowledge and belief
[10393]“It is true, correct, and complete. Declaration of preparer (other than taxpayer) i is based on all information of which he has any knowledge. a
[10395]~ Write. soc.-see. no. on ‘Check or Money Order. Attach herel  -
[10397]{3717 VANGWEN. STREET
[10398]WAM NUYS, CA. 91403
[10401]A
[10403]8 Presidential Election Campaign Fund.—Check [_] if you wish to designate $1 of your taxes for this fund. if joint return, ;
[10405]CAUTION. If you have unearned income and can be claimed as a dependent on your parent's return, check here B> [] and see instructions on n page 7.
[10407]‘ allowed as credit from 1972 return) a __
[10409]c¢ Amount paid with Form 4868, Application for Automatic |
[10411]: Extension of Time to File U.S, Individual Income Tax Return c _
[10413]_-d Other payments (from line 1) d
[10415]22 Total (add | lines 2la, b, c, and d) Lo. ere
[10416]Ct) ; : Cee ot monee secer payable 7 . f : “ °
[10417]Bz 23° If line 20 is larger than line 22, enter BALANCE DUE IRS ‘to internal Revenue Service B> 23 | Y ae i ee
[10418]o = (Check here > Ol. if Form 2210, Form’ 2210F, or statement is attached. See instructions on page 8.) oe . — :
[10419]2 e 24 If line 22 is larger than line 20; enter amount OVERPAID. . ... . . . oa —_—:
[10420]3 ae 2 ‘ Amount of line 24 to.be REFUNDED TO YOU . , be .
[10421]fos) 26 Amount of line 24 to be credited on 1974 esti | 7
[10422]mated tax... woe “26
[10424]Note: i972 Presidential Election Campaign Fund Becignation, —Check | if you did not designate $1 of your taxes on your’,
[10426]Sign . —— _ ;
[10428]: Your signature . : Date VY” Preparer’s signature (other than taxpayer) , ~ , |; Date
[10429]lye: . 7,
[10430]D Bb PBY-KI29
[10431]. Spouse's signature (if filing jointly, BOTH must sign even if only one had income). Address (and ZIP Gade) Papas Emp. Ident. or Soc. Sec. No. ©
[10432].. . va .:16-—82337-2
[10437]TAAL. | Adjustments to Income
[10439]a NW 88326 Docld:32245535 Page 110
[10441]= Total {add lines 28, 29,-30, 31,-32, 33, 34, 35, 36, and 37). Enter here and online 12 .
[10443]39 “Sick pay.’” (From Forms W-2 and W-2P, if not shown on Forms W-2 or W-2P, attach Form 2440 or statement.) _39 :
[10444]' 40 Moving expense (attach Form 3903) oo. . 40
[10446]41 Employee business expense (attach Form 2106 or statement) rn tee ee | AL
[10448]42 Payments as a self-employed person to a retirement plan, etc. (see Form 4848) : . | 420
[10450]43 Total adjustments (add lines 39, 40, 41, and 42). Enter here andon line 14... : . . B® 43
[10452]J
[10453]4 . a
[10454]* Form 1040 (1973) ~ ~". Page Z
[10455]3 b) ionship” Mi d) oD a A t YOU f) Amount fur-
[10456]| NAME tO) Relationship | rel bora or Wied | Sendent’ have | furnished Yor de: | hished by. OTHERS
[10457]= during year, write B or D. income Loft. pendent’ Ss sUuD- ingluding depen-
[10458]~5 aan " : $750 or more? port, ‘If 100% dent.
[10459]vo write ALL. .
[10460]£5 .
[10463]a - - -
[10464]27 Total number of dependents listed in columin (a). Enter here and on line 6d _. b>
[10465]PGE a Income other than Wages, Dividends, and Interest _
[10466]28 Business income or (loss) (attach Schedule C) Loe 28 *
[10467]29 Net-gain or (loss) from sale or exchange of capital assets (attach Schedule b) tone 29 : )
[10468]_30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) . 30 {wey & 4 ,
[10469]31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule Ew 31 :
[10470]’ 32 Farm income or (loss) (attach Schedule F) woe ee . _ 32
[10471]33 Fully taxable pensions and annuities (not reported on Schedule E—see instfuctions on page 8). 33}. +
[10472]34 50% of capital. gain distributions (not reported on Schedule D). ; 34
[10473](¢ oes not.apply if refund tis for year in which you took 8). 35
[10474]35 State income tax refunds (standard deduction—others see instructions on page 8 —_—
[10475]36 Alimony received mo, _36_
[10476]' 37 Other (state nature and source) > 37
[10478]PTE. Tax Computation (Do not use this part if you use Tax Tables 1-12 to find your tax.)
[10480]44 Adjusted. gross income (from line 15) - oe
[10481]45 (a) If you itemize deductions, enter total from Schedule A, line 41 and attach Schedule A | .
[10482](b) If you do not itemize deductions, enter 15% of line. 44, but do NOT enter more than .
[10483]$2,000. ($1,000 if'line 3 checked) J
[10484]46 Subtract line 45 from line 44 . tones
[10485]47 Multiply, total number of exemptions claimed on line 7, by $750 Boe
[10487]48 Taxable income. Subtract line 47 from line 46 . . .
[10489]“a5 5% wT
[10491]46 .
[10492]47 | BAP OQ |
[10493]CSA
[10495]376
[10497](Figure your tax on ‘the amount on line 48 by using Tax Rate Schedule X, Y, or Z, or if
[10498]applicable, the alternative tax from Schedule D, income averaging from Schedule G, max-
[10500]imum tax from Form 4726, or special averaging ftom Form 4972.) Enter tax on line 16.
[10502]Ezmdne | Credits
[10504]49 Retirement income credit (attach Schedule R)
[10505]50 Investment credit (attach Form 3468)
[10506]51 Foreign tax credit (attach Form 1116)
[10508]53 Work Incentive (WIN) credit (attach Form 4874)
[10510]55 Self- ae tax (attach Schedule SE)
[10512]49
[10514]50 _
[10516]. . . . . 51 _
[10518]52 Credit for contributions to candidates for public office—see instructions onpage9. 52 __
[10520]an woe. | BBE
[10522]se Total credits (add lines 49, 50, 51, 52, and 53). Enter here andonlinely. . . . .m | 54, _
[10525]_ ob. [88 2G
[10527]56 Tax from.recomputing prior-year investment credit (attach Form: 4255) _56_ __
[10529]57 Tax from recomputing prior-year Work Incentive (WIN) credit (attach schedule) : 57 _
[10530]58 Minimum tax. Check here Bb [], if Form 4625 is attached : _58 _
[10531]59 Social security tax on tip income not reported to employer (attach Form 4137).. 59 __
[10532]60
[10534]60 Uncollected employee social security tax on tips (from Forms’ W-2)
[10535]61 Total (add lines 55, 56, 57, 58, 59, and 60). Enter here and on line 19.
[10537]FGF -4| Other Payments
[10539]62 Excess FICA tax withheld (two or more employers—see instructions on page 9)
[10540]63 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form
[10542]4136). . .
[10543]64 Credit from a Regulated Investment Company (attach F Form 7 2439) . foe ees
[10544]65 Total (add lines 62, 63, and 64). Enter here and on line*21d woes >
[10546]e 2 | Did you, at any time during the taxable year, have’ any interest in or T signature © or other authority over
[10548]64
[10549]65
[10553]» 20S] a bank, securities, ‘or other financial account in a foreign country (except | ina US, military banking :
[10554]= 8 facility operated by a U.S. financial institution)? .. ° > Ep Yes. [] No
[10555]= =| if ‘Yes, " attach Form 4683. (For definitions, see Form 4683. ) NS
[10556]3k U.S. GOVERNMENT PRINTING OFFICE : 1973—-O- 500-047 16—89937-1
[10558]-* .
[10560]ane pected
[10563]ce . . : toner . fee fT Am gaMaEe ie
[10567]‘, “ ae . -
[10568]'.SGHEDULE A . : . foe
[10569]"(Form 1040) Itemized Deductions 11 1973
[10571]4 +... Department of the Treastity : . > Attach to Form 1040.
[10573]Internal Revenue Service
[10575]shown on Form 1040
[10577]Name(s) Your social seountty number
[10579]Medical and | Dental Expenses (not compensated by insurance
[10580]or otherwise) for medicine and drugs, doctors, dentists, |
[10581]‘ nurses, hospital care, insurance premiums for medical care,
[10583]21 a Cash contributions for which you
[10584]have receipts, cancelled checks, etc. Sq’) .
[10586]etc.
[10587]. b Other cash contributions. List :
[10588]1 One half (but not more than $150) of ! . oo
[10589]insurance premiums for medical care. | / i 5 | donees and amounts. Dr..........-..-.- -|———————
[10590](Be sure to include in line 10 below)
[10592]2 Medicine and drugs ;
[10593]- 3 Enter 1% of line 15, Form 1040
[10595]. 4 Subtract line 3 from line 2. Enter dif-
[10596]ference (if less than zero, enter zero) .
[10598]-5 Enter balance of insurance premiums |} y rad
[10599]for medical care not entered on line 1.
[10601]6 Enter other medical and dental expenses: 7 : :
[10602]a Doctors, dentists, etc... . 9. . 7.3 0
[10603]: . b Hospitals . . . , __ a |
[10604]° a c Other (itemize—-include ‘hearing aids, .
[10605]ae f 23 Carryover from prior years
[10607]dentures, eyeglasses, transportation, . .
[10608]. Yee p 6 oO ! 24 Total contributions (add lines 21a, b,
[10609]Teoeanonconmasacscommamannnc esc oe pevnces Pe | 22, and 23). Enter here and on line
[10613]eeeeeeen
[10615]22 Other ‘than cash (see instructions on
[10616]page 12 for required statement)
[10618]| |
[10620]i
[10622]— J 38.
[10624]| Casualty or Theft Loss(es) (See instructions on page 12.)
[10625]Note: /f you had more than one loss, omit lines 25 through
[10626]28 and see instructions on page 12 for guidance.
[10628]Loss before insurance reimbursement .
[10630]Insurance reimbursement.
[10631]Subtract liné 26 from line 25. Enter
[10632]difference (it less than zero, enter
[10633]zero) .
[10635]Enter $100 or amount on tine ‘27,
[10636]whichever is smaller. . . : \
[10637]Casualty or theft loss (subtract line 28 from :
[10638]line 27). Enter here and on line 39. & :
[10639]Miscellaneous Deductions (See instructions on page S12)
[10642]-
[10644]7 Total (add lines 4, 5, 6a, b, and ¢) toe het __|
[10645]8 Enter 3% of line 15, Form 1040. . . a |
[10646]9 Subtract line 8 from line 7 (if less than ; ‘
[10647]zero, enter zero) woe 769 _
[10648]10 Total (add lines 1 and 9). Enter here
[10649]andonline35 . . . . . 719.
[10651]rs... Taxes
[10653]30 Alimony paid
[10655]31 Union dues . woes
[10657]32 Expenses for child and dependent care
[10658]services (attach Form 2441)
[10660]| 33 Other (ltemize) Bee... ecceccceeeeenetees
[10662]11 State and local income
[10664]12 Real estate
[10666]13 State and local gasoline (see gas ss tax tables)
[10667]14 General sales (see sales tax tables)
[10669]15 Personal property . Son.
[10670]16 Other (itemize) Bonet eee te
[10672]34 Total (add lines 30, 31, 32, and 33).
[10673]Enterhereandonline40. . . . &
[10675]Vv Total (add lines 11, 12, 13, 14, 15, and 4 |
[10676]16). Enter here and on line 36 La , & _|| 35 Total medical and dental—line 10 .
[10677]Interest Expense : : | 36 Total taxes—line17. . . . .
[10678]37 Total interest—line 20. . . . . >) [4 g ‘|
[10680]} 38 Total contributions—line 24. . . . )Ss [2] _
[10681]'39 Casualty or thett loss(es)—line 29. . __
[10683]40 Total miscellaneous—line 34 :
[10685]41 Total deductions (add lines 35, 36, 37,
[10687]38, 39, and 40). Enter here and on SI aa
[10689]Form 1040, line 45... >
[10691]Wy U.S. GOVERNMENT PRINTING OFFICE : 1973—-0-500-049 , ” ye—b2349-3
[10693]Summary of Itemized Deductions
[10695]18 Home mortgage . Soe ete
[10696]19 Other (Itemize) B..........2.---.y eee
[10698]and on line 37.
[10700]» NW 88326 Docld:32245535 Page 111
[10703]i
[10707]7 SCHEDULE” ¢ | Profit or r (Loss) From & Business or Profession |
[10708]- Form 1040) | (Sole Proprietorship) : 197s
[10710]. Internal Revenue Service > Attach to Form 1040. ® Partnerships, joint ventures, etc., must file Form 1065.
[10712]2 AF a > product b........ = ~ ey,
[10714]er identificati
[10715]Bib. te
[10717]A Principal business activi
[10720]WS cK. BAR
[10722]B Business name >.......% £07. Seer Ee...
[10723]-D Business address (number and str
[10724]Oo City, State and ZIP code B......2.. a -
[10726]- we E Indicate method of accounting: (1) fac ‘Gash (2) [] Accrual (3) [7] Other B
[10728]F Were you required to file Form W-3 or Form 1096 for 1973? (See Schedule C Instructions.) .
[10729]_o., tf “Yes,” where filed _____. _ FR . E'S £fV¥.0 eee ne CF
[10730]. G Was an Employer's Quarterly Federal Tax Return, Form sis | for this business for any quarter in 1973?
[10732]H Method of inventory valuation £8. _ .-Was there any substantial change in
[10733]the manner of determining quantities, costs, or valuations ane the opening and closing inventories? (If. "Yes," attach explanation) . i-
[10735]1 Gross receipts or sales $. Less: returns and allowances $
[10736]‘2 Less: Cost of goods sold and/or operations (Schedule C~1, line 8)
[10738]3 Gross profit .
[10740]- 4 Other income. (attach schedule)
[10742]. 5 Total income (add lines 3 and 4)
[10743]’ 6 Depreciation (explain in Schedule C-3) .
[10745]7 Taxes on business and business property (explain in Schedule C2) .
[10747]8 Rent on business property
[10749]9 Repairs (explain in Schedule C-2) .
[10751]10 Salaries and wages not included on line 3, Schedule cel (exclude ¢ any ‘paid to yourself) .
[10752]11 insurance .
[10754]12, Legal and professional “fees .
[10756]13 Commissions
[10757]14 Amortization (attach statement)
[10758]15 (a) Pension and profit- sharing plans (see Schedule c instructions)
[10760](b) Employee benefit programs (see Schedule C Instructions) .
[10762]16 Interest on business indebtedness .
[10763]17 Bad ‘debts arising from sales or services
[10764]18 Depletion . .
[10765]Other business expenses (specity):
[10767]Income 1
[10769]Deductions
[10771](kK) Total other business expenses (add lines 19@) through 190)
[10772]20 Total deductions (add lines 6 through 19)
[10774]21 Net profit or (loss) (subtract line 20 from line 5). Enter here an
[10775]- enter on Schedule SE, line 5(a) ._.
[10776]SCHEDULE C-1.—Cost of Goods Sold ‘and/or Operations. Ses Schedule Cc Instructions for Line 2)
[10778]; 1 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) .
[10779]tee.) D Purchases $......2--ee:eeeeeee- .... Less: cost of items withdrawn for personal use Qooceeceeceegeeeceeeeeeeeeeeeee. Balance >
[10780]‘. "3 Cost of labor (do not include salary paid to yourself) .
[10781]4 Materials and supplies .
[10782]5 Other costs (attach schedule)
[10783]6 Total of fines 1 through 5 .
[10785]7 Less:. Inventory at end of year . . : .
[10786]8 Cost. of goods sold and/or operations. Enter here and on line 2 above .
[10788]16—82344-1
[10791]r Page 2
[10793]SCHEDULE C-2.—Explanation of Lines 7 and 9
[10795]Line No. 7 Explanation Amount “Line No. 7 Explanation 7 Amount
[10797]‘SCHEDULE C—3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, you may use Form 4562.
[10799]Note: if depreciation is computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, or the Guideline
[10800]Class Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life (ADR) System) or Form 5006
[10801](Guideline Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)—11(b)(5)(vi) and 1.167
[10802](a)-12, the provisions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970.
[10804]Check box if you made an election this taxable year to use [7] Class Life (ADR) System and/or [—] Guideline Class Life System.
[10806]a. Group and guideline class b. Date c. Cost or . atte relation penal mel f. Life or g- Depreciation for
[10807]or description of property acquired other basis in prior years depreciation rate this year
[10809]“1 Total additional first-year depreciation (do not include in items
[10810]2 Depreciation from Form 4832 .+ see note \-
[10811]3 Depreciation from Form 5006 .* bove )
[10812]_. 4 Other depreciation:
[10813]"Buildings.
[10814]‘ Furniture. and fixtures
[10815]oe _. Transportation, equipment
[10816]Machinery and other equipment .
[10817]; Other (specify)
[10819]~ §& Totals 2. 2. 1 1 we we ee
[10820]*. 6 Less amount of depreciation claimed in Schedule C-1, pagel ©. 1 1 we ee : —|——
[10821]"+ 7 Balance—Enter here and on pagel, line6 . . . ww ee ee :
[10822]' ' SUMMARY. OF DEPRECIATION (Other Than Additional First-Year. Depreciation)
[10824]. i i ini . Sum of the: Units of : - j :
[10825]Straight line Declining balance years-digits production Other (specify) . Total
[10827]1 Depreciation from
[10830]_ 2 Depreciation from
[10831]Form 5! Sa nnn EE LLL CLL LL LLL LLL LLL PREY OE
[10832]3 Other - -:- aed
[10833]; _ . SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4)
[10834]ae _ Enter information with regard to yourself and your five highest paid Name Expense account poalaries and Weaes _
[10835]. ‘7%. employees. In determining the five highest paid employees, expense | Qwner .-. . . . . YWWWTTIIWYT™
[10837]account allowances must be added to their salaries and wages. How-
[10839]“ever, the information need not be submitted for any employee for :
[10840]whom the combined amount is less than $10,000, or for yourself if
[10841]. your expense account allowance plus line 21, page 1, is less than :
[10844]Did you claim a deduction for expenses connected with: 5 : :
[10845]i ¢)) Entertainment facility (boat, resort, ranch, etc.)?. . . (] Yes WY No (3) Employees’ families at conventions or meetings? . . . (] Yes i No
[10846](2). Living accommodations (except employees on business)? [1] Yes No (4) Employee or family vacations not reported on Form W-2? (] Yes -[}f No
[10851]ne
[10853]“SCHEDULE-D- | Capital Gains and Losses
[10855](Form 1040) _ | » attach to Form 1040. p> Examples of property to be reported on this Schedule are 1973
[10856]“ "+ Department of the Treasury | | gains and losses on stocks, bonds, and similar investments, and gains (but not losses)
[10858]Internal Revenue Service on ‘personal assets such as a home or jewelry.
[10859]- Name(s) as shown on Form 1040
[10861]SAMUEL ‘Paty Ltt f hue a4.
[10862]N
[10864]~ PRA =] Short-term Capital Gains x Losses—Assets H
[10866]| Social security number
[10867]32-2! /2-' DFP P
[10868]ot More Than 6 Months ;
[10870]' : acaus red. c. Mo., day, yr. e Cost or other basis. .
[10871]. . Kind of property and description Enter letter (et date sold above d. Gross sales price _as adjusted “(see . f. Gain or (loss)
[10872]mo : “eamor, 100 shares of “‘2'' Co.) symbol (see acquired below a p instruction £) and (d less e)
[10873]: instiuction dotted Hine) expense of sale
[10878]ton rer Isr
[10879]joo Esse lyre
[10881]Br) 8
[10882]_1/2@1 2797.
[10883]20h | BPS
[10885]: 2 Enter your share of net short- term gain or (loss), from partnerships and fiduciaries oko _27
[10886], 3. Enter net gain or (loss), combine lines 1 and 2 “3
[10887]. 4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction ) 4a)
[10888]ae 2) Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) 4(b)
[10890]“a short-term gain or (loss), combine lines 3, 4(a) and 4(b) . 5
[10892]7 Capital gain distributions . re 7}
[10893]8 Enter gain, if applicable, from line 4(a)(1), Form 4797 (see instruction a). Se _8 _ —_
[10894]9 *. Enter your share of net long: -term gain or (loss) from partnerships and fiduciaries . . 9 :
[10896]_ 10 Enter your share of net long: -term gain from small business corporations (Subchapter S). . . _10_ _.
[10898]oa 12(b) Long- -term capital loss carryover attributable to’ years beginning after 1969 (see Instruction H) . . 12(b)
[10899]oo 13 Net long-term gain or (loss), combine lines 11, 12(a) and 12(b) . ww we 13
[10901]mo PERIL 4 Summary of Parts | and Il
[10902]a 14 Combine the amounts shown on lines 5 and 13, and enter the net gain orloss here. . . . “a UB OE3]_D
[10903]“ . . ~ a
[10905]15 If lirie-14 shows a gain—
[10906]: (a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part VI for r computation . .
[10907]of alternative tax). Enter zero if there is a loss or no entry on line 13.
[10909]4 : (b) Subtract line 15(a) from line 14. Enter here and on line 29,Form1040. . . . . . . 15(b) —_
[10910]. ~ 16 If line 14 shows a loss— .
[10912]B& Omit lines 16(a) and 16(b) and go to Part IV if losses are shown on BOTH lines 12(a) and 13.
[10913]ee See Instruction |.
[10915]” > Otherwise,
[10917](a) Enter one of the following amounts: :
[10919]: ..- (i) lf amount on line 5 is zero or a net gain, enter 50% of amount on line 14;
[10921]a _ ++ .(ii) If amount on line 13 is zero or a net gain, enter amount on line 14; or,
[10923]oe Loy did lf amounts on line 5 and line 13 are net losses, enter amount on line 5 added to 6
[10924]os 50% of amount on line 13... . a 16(a)
[10926](b) Enter here and enter as a (loss) on line 29, Form ‘1040, ‘the smallest of:
[10927]- (i) The amount on line 16(a);
[10929]di) $1,000 ($500 if married and filing a separate return—-if a loss is shown on line
[10931]4(a) or 12(a), see instruction M for a higher limit not to exceed 1 $1, 000); or, :
[10933]‘ (iii) Taxable income, as adjusted (see Instruction L) .. . » .. | 16(b)
[10935]per las? |Gba )
[10936]7
[10938]OR ad Net gain or (loss), combine lines 6 through 10 . . oy . ;
[10939]i 12(a) Long-term capital loss component carryover from years beginning before 1970 (see instruction Hy 12(a) Le ) ,
[10942]Tran a
[10944]Enter loss from line 5; if tine 5 is zero or a gain, enter a zero. 6 ee ee eh et
[10945]3 Enter loss from line 13... 1. . a
[10946]Enter gain, if any, from line 5; if line 5 is zero or a loss, enter a "zero :
[10947]Reduce loss on line 18 to the extent of the gain, if any, on line 19 .
[10949]Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero | 21 nen >
[10950]NOTE: If the entry on line 21 is zero, OMIT lines 22 through 28, and enteronfine29the; =)
[10951]an loss shown on line 12(a).
[10952]22 Enter gain, if any, from line 11 . Lo. 22
[10953]“ - 23 Enter smaller of amount on line 21 or line 22 rs a
[10954]‘4! 24 Enter excess of gain on line 21 over amount on linme23. 0. we eA -
[10955]f 25 Enter loss from line 4(a); if line 4(a) is blank, enter azero.. . a! _25 —_—
[10956]26 Reduce gain, if any, on line 24 to the extent of loss, if any, on ‘fine 25 (see | Instruction ). 26
[10957]27 Enter loss from tine 12(a) . ee is
[10959]_.."ux, 28 Add the gain(s) on line(s) 23 and 26 . .
[10960]vy 29 Reduce the loss on line 27 to the extent of the gain, i if any, on n line 28 3 (sea ‘Instruction K).
[10962]“30 Enter smaller of amount on line 29 or jine 20 (if tine 29 is‘zero, enterazero). 2. 6 ee ww
[10964]31 Subtract amount on line 30 from the loss online 20. 6 6 Ye ee et
[10966]32 Enter 50% ofthe amountonline 31. 0... eee ee eh
[10968]33 Add lines 17, 30, and 32. . . .
[10970]‘34 Enter here and enter as a (loss) on line ‘29, | Form 1040, ‘the , smallest of:
[10972](a) Amount on line 33;
[10974](b) $1,000 ($500 if married and filing a separate return—see Instruction M for a higher limit not to.exceed $1,000); or,
[10976]— Taxable Income, as adjusted (see Instruction L) . . . . .
[10978]Complete Part V if You are Married Filing a Separate Return and Losses are Sh
[10980]14. (See Instruction M).
[10982]own on. Lines A(a) and
[10984]oe 35 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero . _35_
[10985]NOTE: If the entry on line 35 is zero, OMIT lines 36 through 42, and enter on line 43 the loss shown on tine hee).
[10986];: 36 Enter gain, ‘if any, froomline3 . . . . a _36_
[10987]‘ 37 Enter smaller of amount on line 35 or line 36 . re er _37_
[10988]. 38° Enter excess of gain on line 35 over amount on line BF token vo. | 38 _
[10989]* 39 Enter joss from line 12(a); if line 12(a) is blank, enter a zero... see - _39_ - ;
[10990]a 40 Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 (see Instruction J). _40_ eas { ? i
[10991]"41 Enter loss from line 4(a) . . + a ’
[10992]42 Add the gain(s) on line(s) 37 and 40 toes 2. | 42
[10993]43 Reduce the loss on line 41 to the extent of the gain, if any, on n line 42 (see Instruction kK). woe 43 |. . oo
[10995]- ee] Computation of Alternative Tax (See Instruction V to See if the Alternative Tax Will Benefit You) -
[10997]., 44, Enter amount from fine 48, Form 1040 . 44
[10998]45 Enter amount from line 15(a) . . . Coc ee ee | 48
[10999]46 Subtract amount on line 45 from amount on 1 line 44 (but not less ‘than zero) . woe ee ee | AE at :
[11000]47 Enter smaller of amount on line 13 orline 14... . ee ee . | 47_
[11002]If line 47 does not exceed $50,000 ($25, 000 if married fling ‘separately), “check here > [] and
[11003]omit lines 48 through 54.
[11004]48 Enter long-term gains from certain contracts and installment sales referred to as “certain subsec-
[11005]tion (d) gains”! (see Instruction V) . . | 48.
[11006]49 Enter amount from line 48 or $50,000 ($25, 000 if married ‘filing separately), whichever i is larger . |_49
[11009]“ ~ -- If line 49 is equal to or greater than line 47, check here > Cl) and omit lines 50 through 54.
[11010]50 Multiply amount on line 49 by 50%
[11012]“+ SI Add amounts on'lines 46 and 50... . oy rr a2
[11013]52 Tax on line 44 or 45, whichever is greater (use Tax Rate Schedule in n instructions) . soe _ 52 |
[11014]‘ §3 Tax on the amount on line 51 (use Tax Rate Schedule in instructions) . _53_
[11015]Po 54 Subtract amount on line 53 from amount on line 52... ry _ 54
[11016]' ', 55 Tax on the- -amount on line 46 (use Tax Rate Schedule in instructions) . _55 |
[11017]' 86 If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 259; of line 49. 56 :
[11018]57 Alternative Tax—add amounts on lines 54 (if applicable), 55, and 56. If smaller than the tax figured
[11019]on the amount on line 48, Form 1040, enter this alternative tax on line 16, Form 1040 57
[11021], . +& U.S, GOVERNMENT PRINTING OFFICE: 1973—-O-500-051 ; 16—82930-1
[11023]NW 88326 Docid:32245535 Page 115.
[11026]noe . ’
[11028](Form 1040)
[11030]- | Department of the Treasury...
[11031]:-Internal Revenue Service
[11033]> See instructions on
[11035]wed ae ; a
[11036]» SCHEDULE G . income omen peet
[11037]p> Attach to Form 1040.
[11039]ges 3 and 4. | , | . 1973
[11040]. . Your social ‘security number
[11041]aise 2e7 7,
[11043](a) - (b) . . {c)" - : (d) ° eC)
[11045]«.. Name(s) as shown on Form 1040
[11047]Taxable Income and Adjustments’
[11049]Computation year Ist preceding -base 2d preceding base 3d preceding base 4th preceding base
[11050]° Sot period year ~ period “year , period year period year ~*~
[11051]1973 1972 1971 . 1970 1969 -
[11052]1 Taxable income (see instruction D oo ? 6 6 Oa 0 . = ? aa O “
[11054]oS Bees om ene anne . LL _
[11055]~ tbe pny rr section 72) _
[11057]: 4 Accumulatioh distributions subject to sec-
[11059]A en | | a | TS |
[11061]5 Adjusted taxable income or base period
[11063]income. (Line 1 plus line 2, less lines 3 VS ~~
[11064]> and 4.) If less than zero, enter zero... 76 24 QO : om
[11066]: “Computation of Averagable Income
[11068]6 Adjusted taxable’ income from line 5, column (a)... ee ee ee 6 | 7@26—
[11070]2 : _ . _ 7 em oO emer,
[11071]| 7 30% of the sum of line 5, columns (b), (¢), (d), and (@)- 2 ee Pe
[11072]8 Averagable income (line6lessline7) . 9... 1 ee ee ee | 8 26 LG a
[11073]og . ‘Complete the remaining parts of this form only if line 8 is more than $3,000. If $3,000 or .
[11074]oe Be ; less, you do not qualify for income averaging. Do not fillin rest of form. L. 4
[11076]-_,'+ Computation of Tax
[11078]le
[11080]- 9 Amount from line 7. 6 eee ;
[11081]yo 20% oftne Se ee eto) ISDS ‘?
[11082]"4 Total (add lines 9 and 10) 2 ee ee | IS2-£ _
[11084]12 Amount from line 3, column (a), less any income subject to a penalty under section 72(m)(5)
[11085]'. which was: included-in line 3 : eo Cone ee wo ee ke
[11087]ISL
[11088]2/F : -
[11090]Y
[11092]| Ee Land
[11094]|. 43 Total (add lines 11 and 12) .
[11095]* 44 Tax on amount on fine 130. 6 eee ee ee ke
[11096]15 Tax on amount on line 120. we ee ee ee 15 Zz! f
[11100]\\G
[11104]“4° 16 Taxon amount on line 9 . a rs oe
[11106]“!. 497 Difference (line 15 less fine 16). . 2. 1 ee ee ee tal RIG We
[11108]18 Multiply the amount on line 17 by 4 . a &
[11110]19 Total (add lines 14 and 18). 6 0 ee ee
[11112]20 Tax on income subject to the penalty under section 72(m)(5) which was included in line 3 .- . 20 a
[11114]21 Tax (add lines 19 and 20). Enter here and on Form 1040, line 16. Also check Schedule G box on 10 rad
[11115]Form 1040, line 16.0. ee ee f ‘
[11117]. 16—82358-1
[11119]ser gyri tt ena meneame, somes tomcoeegg snare ermemeen gS OTE RITE
[11122]SCHEDULE’ SE “| Computation of Social Security Self-Employment
[11123](Form 1040) p> Each self-employed person must file a Schedule SE. :
[11125]Department ofthe Treasury "| p> Attach to Form 1040.
[11127]If you had wages, including tips, of $10,800 or more that were subject to social security taxes, do not fill in this form. .
[11128]. @. If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.
[11129]Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.
[11131]- ” NAME OF SELF-EMPLOYED PERSON {AS SHOWN_,ON SOCIAL SECURITY CARD) : Social security number
[11132]os 7 ff ; . of self-employed person
[11133]; A ; i 4
[11137]ay. 4-'@ if you have only farm income complete Parts | and Ill.
[11138]- * @ Ifyou have only nonfarm income complete Parts Il and Il.
[11139]met ©. If you have both farm and nonfarm income complete Parts |, Il, and Wh.
[11141][AR | Computation of Net Earnings from FARM Self-Employment . i
[11143]A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method,
[11144]line 2, if. his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines
[11145]1 and 2 must be completed even if you elect to use the FARM OPTIONAL METHOD.
[11147]1 REGULAR METHOD—Net profit or (loss) from: oo . WY Y
[11148]ae (a) Schedule F, line 54 (cash methoe, °r line 74 (accrual method). . = 6h.
[11153]‘ore,
[11155]a - (b) Farm partnerships. . 2-8 8 8 ef ee oF ht ts
[11156]gle 2 Net earnings. from farm self-employment (add lines 1(a) and 1(b)) . . ae ee
[11157]3 FARM OPTIONAL METHOD— If gross profits from farming are: a :
[11159]" @)y Not more than $2,400, enter two-thirds of the gross profits , . . viens -
[11161].. (b) More than $2,400 and the het farm profit is less than $1,600, enter gi600. .... _— WY a
[11162]1 Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method),
[11163]' or line 72 (accrual method), plus the distributive share of gross profits from farm partnerships
[11165]- ; (Schedule K~-1 (Form 1065), line 15) as explained in instructions for Schedule SE. YY, Yyy .
[11167]4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method .
[11169]Sparkie - Computation of Net Earnings from NONFARM Self-Employment
[11171]_ 5°. REGULAR METHOD—Net profit or (loss) from: .
[11172]: -_ _ (a) Schedule C, line 21. (Enter combined amount if more than one business.) . ; } 9 ¥,
[11173]_ (b) Partnerships, joint ventures, ete. (other than farming) , er
[11174]— 4 @ Servicé as a minister, member of a religious order, or a Christian Science practitioner. (Include
[11175], rental value of parsonage or rental allowance furnished.) If. you filed Form 4361, check here [7]
[11177]~~ and enter zero on this line Loe ee
[11179](a) Service with a foreign government or international organization rr
[11181]‘ (e) Other (director's fees, etc.). Specify Br... «nenaectecesesues Lecleseeanenecees pees esteseneeeceeenanen Pale
[11182]" °" 6 Total. (add-lines 5(a), 5(b), 5(c), 5(d), and 5(@)) 6 ee Loe
[11184]7 Enter other adjustments (attach statement) . Co nes bo ee
[11186]|
[11188]“8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line7). . » 7 V8
[11189]~ If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 through 11 and enter
[11191]"_. amount from line 8 on line 12(b), Part 111. — ;
[11192]* Note:, You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than /)
[11193]. $1,600 and less than two-thirds of your gross nonfarm profits,” and you had actual net earn- Z
[11194]. .. ," ings from self-employment of $400 or more for at least 2 of the 3 following years: 1970, 1971, Y a
[11195]whe and 1972. The nonfarm optional method can only be used for 5 taxable years. /
[11196]“oe -* Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, Y /
[11198]plus the distributive share of gross profits from nonfarm partnerships (Schedule K-1 (Form
[11199]1065), line 15) as explained in instructions for Schedule SE. Also, include gross profits from
[11200]‘services reported on lines 5(c), 5(d), and 5(e), as adjusted by line 7.
[11202]_ 9 NONFARM. OPTIONAL METHOD:
[11204]’* (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) . $1,600" 09
[11206]“ * (b) Enter.amount from line 3. (If you did not elect to use the farm optional method, enter zero.) . 2:
[11207]: es (c) Balance (subtract, line 9(b) from line 9(a)) . ‘ _
[11208], 10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller . rr —_—————_— —
[11210]-11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller. .
[11215]Schedule SE “(Form 1040) 1973 . a Page 2
[11217]Patt] Computation of Social Security Self-Employment Tax _
[11219]ct 12 Net earnings or (loss): :
[11220]ae (a) From farming (from line 4). 06 6 1 ee
[11222]; . (b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) .
[11223]an . 43 Total net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400,
[11224]you are not subject to self-employment tax. Do not fill in rest of form.) .
[11225]-. 14 The largest amount of combined wages and self-employment earnings sub-
[11226]; ject to social security tax for 1973 is .
[11227]Y
[11228]-15 (a) Total “‘FICA’’ wages as indicated on Forms W-2
[11229](b) Unreported tips, if any, subject to FICA tax from
[11230]Form 4137, line 9 . .
[11232]_ (€) Total of lines 15(a) and 15(b) .
[11234]‘16 Balance (subtract line 15(c) from line 14).
[11236]17 Self-employment income—line 13 or 16, whichever is smaller .
[11238]18 If line 17 is $10,800, enter $864.00; if less, multiply the amount on line 17 by .08 . .
[11239], ‘19 Railroad employee's and railroad employee representative's adjustment for hospital insurance bene-
[11240]ae fits tax from Form 4469 . :
[11242]20 Self-employment tax (subtract line 19 from line 18). Enter here and on Form 1040, fine 55.
[11244]You may use this space to make any needed computations
[11246]3x U.S. GOVERNMENT PRINTING OFFICE: W979—-0-500-055 ~ 16-—-82342-1
[11249]sg ET “TT
[11251]" AT9T- Supplemental Schedule of Gains and Losses
[11252]Form Sales, Exchanges and Involuntary Conversions under Sections 1231, 1245, 1250, etc. 1973
[11253]To be filed with Form 1040, 1041, 1065, 1120, etc.—See Instruction A :
[11255]Identifying number as shown on page 1
[11256]of your return Bg =
[11258]Department of the Treasury
[11259]Internal Revenue Service
[11261]Sales or Exchanges of Préperty Used in Trade or B dsiness and/or Involuntary Conversions
[11262](Section 1231)
[11264]SECTION A.—Iinvoluntary Conversions Due to Casualty and Theft (See Instruction D)
[11266]‘ation al f. Gost or other basis, .
[11267]b. Date acquired | c. Date sold d. Gross, sales ee tee aitoorable) cost of subsaguient an u Sain oF {toss}
[11268]plus @ less
[11270]. 8, Kind of property (if necessary,
[11271]attach statement of descriptive
[11272]details not shown below) (mo., day, yr.) | (mo., day, yr.) price since acquisition chased, attach explana-
[11274]° tion) and expense of sale
[11276]2 Combine the amounts on line ‘L enter here and also on the appropriate line as follows .
[11277](a) For all returns, except partnership returns:
[11278](1) If line 2 is zero or a gain, enter such “amount in column g, line 3.
[11279](2) Ifline 2 is a loss, enter the loss on line 5.
[11280]" (b) For partnership returns: Enter the amount shown on fine 2, on line 6, Schedule K (Form 1065).
[11282]__(b) For partnership returns: Enter the amount Shown oe ee
[11283]SECTION B.—Sales or Exchanges of Property Used in Trade or Business and Certain Involuntary Conversions (Not Reportable
[11285]-in Section A) (See Instruction D)
[11287]4 ‘Combine the amounts on line 3, enter here and also on the appropriate line as follows .
[11288](a) For all returns, except partnership returns:
[11289](1) If line 4 is a gain, enter such gain as a long- ‘term capital gain on the Schedule D (Form 1040, 1120, ete.), that is
[11290], being filed—-see instruction D. "
[11291](2) If line 4 is zero or a loss, enter such amount on line 6. : iP.
[11292](b) For partnership returns: Enter the amount shown on line 4, on tine 7, Schedule K (Form 1065). 7 .
[11294]EB
[11296]Tac.) Ordinary Gains and Losses
[11298]f. Cost or other basis, le
[11299]cost of subsequent g. Gain or (loss)
[11300]improvements and (d plus e less f)
[11302]expense of sale
[11305]lowed (or allowable)
[11306]since acquisition
[11308]Kind of property and how acquired
[11309]it necessary,- attach statement of de-
[11310]scriptive details not shown below)
[11312]c. Date sold
[11314]b. Date acquired
[11315](mo., day, yr.)
[11317]d, Gross sales
[11318]| (mo., day, yr.) i!
[11320]price .
[11322]5 Amount, ‘if. any, from: line 2(a)(2)
[11323]6 Amount, if any, from line 4(a)(2)
[11324]7 Gain, if any, from line 21 .
[11326]9 Combine: ‘tines 5 through 8, enter here and also on the appropriate line as follows .
[11328](a) For all returns, except individual returns: Enter the gain or (loss) shown on line 9, on the line provided |
[11329]for on the return (Form 1120, etc.) being filed—see instruction E, for specific line reference.
[11331](b) For individual returns:
[11335](1) If the gain or (loss) on line 9, includes losses which are to be treated as an itemized deduction on
[11336]Schedule A (Form 1040) (see instruction E), enter the total of such loss(es) here and include on
[11337]line 29, Schedule A (Form 1040)—-identify as loss from line '9(b)(1), Form 4797 .
[11339](2). " Redetermine the gain or (loss) on line 9, excluding the loss (if any) entered on line 9(b)(1). Enter / 2248
[11340]..here and on line 30, Form 1040 . Loe, Coe ; ,
[11345]Pe oe BS NRT TO TT OEE TT
[11347]oe ¢
[11349]"Form 4797 (1973) ; ” BR Page 2
[11350]Gain From Disposition of Property Under Sections 1245, 1250,
[11351]: 1251, 1252——-Assets Held More than Six Months (See instruction F)
[11353]Lines 18 and 19 sould be omitted if there are no dispositions of farm ' property or farmland; or, if this form i is filed by a partnership.
[11355]. 10 Description of sections 1245, 1250, 1251, and 1252 property: . (ros acauired (me 4
[11357]Correlate lines 10(A) through 10(E) Property Property Property Property Property
[11358](D) - (E)
[11360]with these columns > > P— P (A) (B) (Cc)
[11362]' 11 Gross sales price
[11363]12 Cost or other basis and expense o of s sale .
[11364]13 Depreciation allowed (or allowable) .
[11365]14 Adjusted basis, line 12 less line 13 .
[11367]oe 15 2—
[11369]15 Total gain, subtract line 14 from line i . (2-24 £ .
[11370]16 If section 12a6 prop erty: ble) it
[11372](a) Depreciation allowed (or allowable) after
[11373]applicable date (see instructions) . . 12D & b ; _
[11374], (b) Line 15 or line 16(a), whichever is smaller | 22. -Y & : Af . =
[11375]17 If section 1250 property: TOO Ss
[11376](a) Enter additional depreciation after
[11377]12/31/63 and before 1/1/70 .
[11379](b) Enter additional depreciation after ; . : . ; :
[11380]V2/30/69 ne Penn nenne cece eens nee ce eenne nce geennn ee) neceee enn e cee genceen | caeceecereneceeeeeeme| <ooceneenceeeeeeececes
[11382](c) Enter line 15 or line 70), whichever i is
[11383]smaller . .
[11385]a
[11389]Line FO) times applicable percentage |
[11390](see: ‘instruction F.4) .
[11392]-
[11396]Enter excess, if any, of line 15 over
[11397]line 17(b) . . wo.
[11399](f) Enter. line 17(a) or line 17(e), wi whichever '
[11400]is smaller. . see ee ene ene en ence eens | pence mene ee enencccens | cence ce receencenneen:|seeeeemecenece rene cece | noeeceeeeeeeeneceeane
[11402](g) Line 17(f) times applicable percentage , : . ¢
[11403](see instruction’ F.4) . . :
[11405](h) Add line 17(d) and line 17(2) soe
[11406]18 If section 1251 property:
[11407](a) If farmland, enter soil, water, and Jand
[11408]clearing expenses for current year and ,
[11409]the four preceding years . . . seen emnenen nen nenennne | mnngennennecennnnn ener] onmenee a a
[11411](b) if farm property, other than land, sub.
[11412]tract line 16(b) from line 15; OR, if farm-
[11414]~ Jand,:enter line 15 or line 18(a), which- .
[11415]ever is smaller (see instruction F.5) . |.------------neeenneee | enee cece eee ene ene ene| enn e eee e ence nees | amen gene n er een enced] cneeeeecnepeceneneres :
[11417]- (ce) Excess deductions account (see instruc-
[11418]tion F.5) _
[11420](d) Enter-line 18(0) or line 18(c), wi whichever
[11421]is smaller .
[11422]19 If section 1252 property:
[11423](a) Enter‘soil, water, and land clearing ex-
[11426](b) Enter amount from line 18(0), if any; :
[11427]~ otherwise, enterazero. . seen neneeceeenn nnn nne | on lane ne enn nenn nnn nnnes| ncn enn nnn nnee ne nenne | ga gee ene nn een e eres | eeee ence pemeetercen
[11428](c) Enter excess, if any, of line & 19(2) | over
[11429]line 19(b) .
[11430]_ (d) Line 19(c) times applicable percentage |
[11433](e) Line 15 less line 19(b) .
[11434](f) Enter smaller of tine 19(d) or line 19(e)
[11435]_ Summary of Part Ill Gains (Complete Property columns (A) Through (E) up to line 19(f), before goi g to line 20)
[11437]20 Total of Property columns (A) through (E), line 15 . Lak
[11439]- 21 Total of Property columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter h here , anid’ on line 7. tS V2
[11440]22 Subtract line 21 from line 20. Enter here and in appropriate Section in Part | (see instructions D and F.2) . gO
[11441]$e US, GOVERNMENT PRINTING OFFICE :1973—-0-500-154 Og s2348-1
[11446]Department of the Treasury > Attach to Form 1040.
[11447]Internal Revenue Service
[11449]Form A798 . : aps a coe ao eal | 1978
[11451]Social Security Number
[11453]Ruby N32 JEP PP 7
[11455]A. Who Should File.—You will need to complete B. How to Compute Carryover.—lf you have a cap-
[11456]either Part | or Part Il of this form if you have a capital ital loss carryover, complete either Part | or Part II, but
[11458]- Joss to carryover to 1973. do not complete both.
[11460]You will have a capital loss carryover to 1973 if the A LOSS.
[11462]1. Complete only Part | if lines 4(a) and 12(a),
[11463]Schedule D (Form 1040) for 1972, DO NOT SHOW
[11465]-.. amount on line 16(a), or on line 33, of Schedule D 2. Complete only Part Il if either (or both) line 4(a)
[11466]- (Form 1040) for 1972 is LARGER THAN the loss de- or 12(a), Schedule D (Form 1040) for 1972,
[11467]ducted on line 36, Form 1040 for 1972. ‘ shows a loss. ,
[11469].-3]. Post-1969 Capital Loss. Carryovers
[11471]Section A.—-Short-term Capital Loss Carryover
[11473]1 Enter loss from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
[11474]a gain, check this block [7], and QMIT lines 1 through 6 (because no short-term capital loss carry-
[11475]over exists) and enter the amount from line 36, Form 1040 for 1972 on line 7—then goto lineS .
[11477]2 Enter gain from tine 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
[11478]a loss, enter a zero .
[11480]3 Reduce loss, if any, on line 1 to extent of gain, if any, on line 2.
[11481]4 Enter amount from line 36, Form 1040 for 1972 .
[11482]"5 Enter smaller of amount on line 3 or line 4 .
[11484]6 Excess of amount on line 3 over amount on line 5.
[11485]beginning after 1969. Enter this amount on line 4(b), Schedule D (Form 1040) for 1973.
[11487]Section B.—Long-term Capital Loss Carryover
[11489]7 Line 4 less line 5 (unless you checked the block on line 1, and followed the tine 1 instruction) -
[11491]8 Enter loss from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
[11492]a gain, check this block (], and OMIT lines 8 through 12, because no long-term capital loss carry-
[11493]over existS.. 6 ee
[11495]9 Enter gain. from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
[11496]a loss, enter a zero
[11498]10 Reduce loss on line 8 to extent of gain, if any, on line9 .
[11500]11 Multiply the amount on line. 7 by 2. . + - toe a bone
[11502]12 Excess of amount on line 10 over amountonlinell . . , .
[11504]Note: The amount on line 12 is your fong-term capital loss carryover from 1972 ta, 1973°that is attrib
[11505]after 1969. Enter this amount on line 12(b), Schedule D (Form 1040) tor 1923, x
[11509]NW 88326 Docld:32245535 Page 121
[11511]eS
[11513]Note: The amount on line 6 is your short-term capital loss carryover from 1972 to 1973 that is attributable to years
[11515]7
[11517]10
[11519]11
[11521]12
[11523]AS
[11527]a
[11529]utable to years beginning
[11531]3
[11534]zero). Enter here and on line 4(b), Schedule D (Form 1040) for 1973 .
[11535]21 If you ‘were required to complete Part IV, Schedule D (Form 1040) for
[11536]"1972, enter loss, if any, from line 30, Schedule D (Form 1040) for 1972.
[11537]Otherwise, enter zero
[11538]22 Enter excess of line 19 over line 18—if line ‘19 ‘does not exceed line 18,
[11539]enter zero (unless you checked the block on line 1, and followed the
[11540]line 1 instructions) 22 el lorD~
[11541]23 Loss carryover to 1973 (excess of line 21 over line 22—if line 21 does not exceed line 22, enter
[11542]zero). Enter here and on ‘line 12(a), Schedule D (Form .1040) for 1973 .
[11543]24 If you were required to complete Part IV, Schedule D (Form 1040) for
[11544]‘ 1972, enter loss, if any, from line 31, Schedule D (Form 1040) for 1972. :
[11545]Otherwise, enter Iss, if any, from line 13, Schedule D (Form 1040) for 1972 |_24_ l
[11546]25 Enter excess of line 22 over line 21 Be... -cseeecccceceeeeetees’ X 2 (if line
[11547]22 does not exceed line-21, enter zero.) .
[11549]26 Loss carryover to 1973 (excess of line 24 over line 25—if line 24 does not exceed line 25, enter
[11550]zero). Enter here and on line 12(b), Schedule D (Form 1040) for 1973 . soe
[11552]Yr U.S. GOVERNMENT PRINTING OFFICE : 1973—O-500-156 36-2603-697
[11554]21
[11556]2} 6 —
[11560]26 [tie
[11562]I cE TE teri terre carne a nied ~ ne ne 7
[11563]. . +
[11564]Form 4798 a Page 2
[11565],,Pre-1970 and Post-1969 Capital Loss Carryovers
[11566]Section A.—Short-term “Capital Losses Identified -
[11567]1 Enter loss from line 5, Schedule D (Form 1040) for 1972; however, it such line is blank or shows
[11568]a gain, check this block JR], and OMIT lines 1 through 20 (because no short: term capital loss carry-
[11569]- over exists), complete line 41, enter loss from line 36, Form 1040 for 1972 on line 22—then go to
[11570]line 23 . 1
[11571]2 Enter gain from line 13, Schedule D (Form 1040) for 1972; however, if such line is : blank or “shows ‘
[11572]a loss enter a zero | . . 2
[11573]3 Reduce the loss on line 1 to the extent t of the gain, if any, on line 2 . 3.
[11574]Note: If line 4(a), Schedule D (Form 1040) for 1972 is blank, OMIT lines
[11575]‘4 through 11, enter a zero on line 12—then go to line 13.
[11576]4 Combine lines 3 and 11, Schedule D (Form 1040) for 1972 and if gain,
[11577]enter gain; if zero or a loss, enterazero. . . _4
[11578]Note: /f line 4 is zero, OMIT lines 5 through 11, enter on ‘line 12 the loss
[11579]from line 4(a), Schedule D (Form 1040) for 1972—then go to line
[11580]5 ‘Enter gain, if any, from line 3, Schedule D (Form 1040) for 1972 . _5_
[11581]6 Enter smaller of amount on line 4 or line 5 . a
[11582]7 Enter excess of gain on line 4 over amount on line6 . . ' 7
[11583]8 Enter loss from line 12), Schedule D (Form 1040) for 1972; otherwise,
[11584]enter a ‘zero _8
[11585]9 Reduce the gain, if any, on line 7 to the extent of the loss, if any, on line 8 9
[11586]10 Enter loss from line 4(a), Schedule D (Form 1040) for’ 1972; otherwise,
[11587]enterazero. . . ne re
[11588]11 Add the gain(s) on line(s) 6 and 9 . . ii
[11589]12 Reduce the loss on line 10 to the‘extent of the gain, i if any, on » line nl. 12
[11590]13 Pre:1970 short-term capital loss (enter smaller of amount on tine 3 or on line 12) . . . {13
[11591]14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over line 13) . 14
[11592]Section B.—Computation of Capital Loss Carryovers to 1973
[11593]i?
[11594]15 Enter loss, if any, from line 13 above . 15 f
[11595]16. Enter loss deducted on line 36, Form 1040 for 1972... . |_16
[11596]17 Loss carryover to 1973 (excess of line 15 over line 16-—lf line 15 does not exceed line 16, enter
[11597]zero). Enter here and on line 4(a), Schedule D (Form 1040) for 1973 . _17_
[11598]18 Enter loss, if any, from line 14 above . . _18
[11599]19 Enter excess of tine 16 over line 15—if line 16 does not t exceed line 15, ;
[11600]enter zero . . 19
[11601]20 Loss carryover to 1973 (excess of line 18 0 over line 19—lf line 18 does not exceed line 19, enter
[11602]20
[11605]Rp or fee entre memcrnrrermnnns gan meen oe
[11607]vue 58 mueEL Z Payer Lo: huey
[11609]CALENDAR YEAR p73
[11611]ADDRESS Be w~hle ~ 2997 s0C, SEC, NO. __
[11612]. \ .
[11613]oe . DEDUCTION SCHEDULE
[11614]MEDICAL [FEDERAL] STATE [CONTRIBUTIONS | FEDERAL [P__ STATE
[11615]MEDIGING DRUGS PARTNERSHIP SHARE es
[11616]LESS 1% A.G.I. (Line 18 - 1040) | GiRL/BOY SCOUTS Li. [| {|
[11617]NET MED /DRUGS HEART FUND/CANCERFuND |} | |
[11618]1S. A INS. (4 + EXCESS) RED CROSS/UNITED FUND 7{ {| {|
[11619]DR. XMAS & EASTER SEALS | jso| jf
[11620]DR.  - Misc. ORGANIZED CHARITIES \ | | |
[11621]DR. po z CHURCHES ns ee ee ee
[11622]DR. an Se
[11623]DR. (
[11624]‘DR. yo
[11625]LDR. Af
[11626]| [otnertHancase S| SCT CT
[11627]PROSTHETIC APPLIANCES ToT ___| Pee torat contrieurions bY ESOT TAF a |
[11628]"HEARING AID [  [ [  [ [CASUALTY OR THEFT LOSS(ES) _
[11629]HOSPITAL [-| [ | [ross serore absustMENT es ee
[11630]AMBULANCE POTEET Fstcourationercasuattyy | TT
[11631]LABORATORIES : rhe —CSTCC |
[11632]TRAVEL FOR MED. / QOD. [fo ror cas. on tert toss pf
[11633]ff J WISCELLANEOUS DEDUCTIONS ee
[11634]MEDICARE INS. = [COT TT income Tax PREPARATION ee ee eee
[11635]GLASSES. LT |  uion/pRoFessionAaL DUES -—_ —}-}+--_
[11636]“MEDICAL EXPENSES | (265 | | /g.e| | unirorws/ProTec. CLOTHING TE
[11637]LESS REIMBURSED BY INS. rTP smatetoous ano suppues [TP
[11638]LESS 3% ADJ.GROSS INC. | Yoel | F797 PLAUNDRY AND CLEANING | | S|
[11639][_ 747. | 2726] | Tauro usegoamace | TC:
[11640]+: (TO $150) OF H & AINS. | IspLt iF | [armonyiscneous, | |
[11641]10 TOTAL MEDICAL DED. rar PF LULL LAL | vest.counsecaruasyscuen) | | OP
[11642]TAXES _ [empLovment acencyrees | Ss | |
[11643]Sy REAL ESTATE EOTL LT | sareverosirsox |] CP
[11644]“STATE & LOCAL GASOLINE (ripe tT Prec reqineusmess |
[11645]GENERAL SALES TAX | Ate TP cnipaer. care (Fom aay) [|
[11646]STATE & LOCAL INCOME ee ee
[11647]‘PERSONAL PROPERTY "_ rT OCS CC(‘(SYP
[11648]/PERSONAL PROPERTY AUTO Se es
[11649]STATE DISABILITY INS.” ee YO) (KN (EO
[11650]_ SALES TAX AUTO ee :44 TOTAL MISC. DED. >| fT
[11651]: es ee eee _ Se ee
[11652]JL TOTAL TAXES TS OO Be ig DA a te EO
[11653]INTEREST (TO WHOM PAID) FSG, TOTAL TAXES (FROMLINE 17) | | of
[11654]MORTGAGE l2s760| [| S3ifoTa interest (Line 20) rT té<C~Ssté‘i*C
[11655]Oo | 2 [ | [38itotat contr. (Line 29 ee ee ee
[11656]a a EN NN KES TT
[11657]INSTALLMENT LOANS |
[11658]wets Verein | of [| [Remarks SS _
[11659]es Oe Ne
[11661]20 TOTAL INTEREST. _- Db 3769.1 | 37671 1
[11663]"HAW 88376, Rosld22A5h35, Pagealddes, Calif. Form 101
[11665]ADDRESS
[11667]FROM BUSINESS OR PROFESSION
[11669]BUSINESS NAME
[11671]BUSINESS ADDRESS
[11673]TOTAL RECEIPTS
[11675]INVENTORY AT BEGINNING OF YEAR
[11676]MERCHANDISE PURCHASED
[11678]LABOR
[11680]TOTAL
[11682]INVENTORY AT END OF YEAR
[11684]GROSS PROFIT
[11686]“GROSS 1NCOME
[11688]“ADVERTISING
[11689]AUTO AND TRUCK EXPENSE
[11690]BAD DEBTS
[11692]CASH SHORT
[11694], COMMISSIONS
[11696]ENTERTAINMENT AND PROMOTIONAL
[11698]DELIVERY
[11700]DEPRECIATION
[11701]. DUES AND SUBSCRIPTIONS
[11703]INSURANCE
[11705]~ INTEREST
[11707]JANITOR SERVICE
[11709]* LAUNDRY
[11711]LEGAL AND ACCOUNTING
[11713]MAINTENANCE
[11715]OFFICE SUPPLIES: AND EXPENSE
[11717]RENT
[11719]-
[11721]REPAIRS
[11723]SALARIES AND WAGES
[11724]SALARIES OFFICERS
[11725]‘SUPPLIES
[11727]TAXES AND LICENSES
[11728]TAXES + PAYROLL”
[11730]TELEPHONE
[11732]TRAVEL
[11734]UTILETIES
[11736]aw Fi F 7 1
[11737]yet pA i . i fP
[11738]a ae a ered —— o
[11742]N
[11744]SCHEDULE OF PROFIT (OR LOSS )
[11745]PRINCIPAL BUSINESS ACTIVITY
[11747]{ SCHEDULE ATTACHED }
[11749]Les Ku BY
[11751]OR
[11752]soc. SEC, NO.
[11754]OTHER BUSINESS DEDUCTIONS
[11756]i
[11758]“NW:88
[11760]‘ PROFESS | ONAL STATIONERS INC,
[11762]LOS ANGELES,, CALIF.
[11764]FORM 104
[11766]326 Docld:32245535 Page 124
[11768]ET PROFIT:-OR( LOSS ) - FEDERAL RETURN
[11770]NET PROFIT OR Loss ) + STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF. }
[11772]CALENDAR YEAR
[11774]19
[11776]EMPLOYERS NO.
[11780]i
[11782]| £OD
[11783]|
[11786]PI@Go | |
[11794]ty
[11795]S
[11797]M
[11798]oh
[11799], ~
[11801]SCHEDULE
[11803]19 ZF
[11805]FISCAL YEAR ENDING
[11808]KIND OF PROPERTY
[11810]roo PAs( ll
[11814]Guth me WT
[11818]OMPETE
[11820]Les
[11822]Hoel IMP.
[11824]j
[11825]B
[11826]1
[11828]PROFESSIONAL STATIONERS INC. LOS ANGELES . CALIF.
[11830]CoVENENT N at tO
[11832]1.B. NO.
[11834]CALENDAR YEAR’ 19.
[11835]OR -
[11836]_ $0C. SEC, NO.
[11838]FISCAL YEAR ENDING
[11840]SCHEDULE OF
[11842]|
[11843][
[11844]|
[11846]: Rg
[11848]DATE SPEC 20%
[11850]ACQUIRED
[11851]YR i
[11853]RATE(%)
[11855]OR LIFE - FOR
[11856](yrs)
[11858]METHOD
[11860]9
[11861]m
[11862]v
[11864]a
[11865]>| BI
[11866]e| 8
[11870]c
[11874]NJ
[11875]Rs
[11877]Pt tt
[11878]|
[11879]LIF
[11881]t
[11884]y)
[11886]4
[11888]_ NW 88326 Docld
[11890]Add 20% non Items Purchased THIS Year.
[11891]Le 7 . TOTAL DEPRECIATION THIS YEAR | derorp |
[11892]FORM NO 102A 0 . : oo ; SCHEDULE - : i
[11894]OEPRECIATION
[11896]THIS YEAR
[11898]37245535 ' Page 125
[11900]7Z
[11903]INDIVIDUAL
[11905]CALIFORNIA
[11907]INCOME TAX
[11908]For the year January 1-December 31, 1973, or other taxable year beginning
[11910]Please vA Lb PHYS Rusby _ [B22 2 ' 2992
[11912]Type PRESENT HOME ADDRESS (Number apf street, including apartment number, or r Zal route) Spouse’s Social Security Number
[11914]or oP UY2®
[11916]me occu- | Yours iV /=s
[11917]/ f f ( f PATION ) spouse's Hi fue
[11918]fing Status Check ony “One : Exemption Credits If line 1 or 3 checked, enter $25
[11919]2.60 Single ts 6. Personal Exemption: | If line 2, 4 or 5 checked, enter $50
[11920]“2. S94 Married filing joint: return 7. Dependents - Do not list person who qualifies you as head of household.
[11921]3 Oo Married filing separate return—-Enter spouse’ s full Name (include last name and/or address if different from_ygur e ig hin
[11922]: AM genet * O10 PS oe. oR P
[11923]4: El: Head of Household—Enter name of qualifying ELISA ——
[11924]Mee) individual pene eneneenne
[11925]: =] - Widowler) with dependent child. Enter year spouse 8. Blind (refer to instiuctions) Number of blind exemptions
[11926]: ° died 19_ a “* 9. Total ‘exemption credits (add lines 6, 7 and 8) Enter here and on line 20 below.
[11927]7 ». Income Attach copy 2 of Form(s) We to front,
[11929]10. Wages, salaries, tips and other employee compensation \if unavailable, attach explanation
[11930]11. Dividends—before federal exclusion. Capital gain dividends must be included at 100%
[11931]12. Interest. (See instructions for taxability of federal, state and municipal bonds) .
[11932]13.. Income other than wages, dividends and interest (from line 50)
[11934]14. ‘Total add lines 10, 11, 12 and 13)
[11936]“Adjustments to income (from line 56) :
[11938]16. Adjusted gross income (subtract line 15 from line 14)
[11940]_
[11941]a
[11943]© if, you do NOT “itemize deductions AND line 16 is under 10,000, find tax in Tax Table and enter on line 19.
[11944]° If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.
[11946]17... Deductions: Itemized (from line 63) OR Standard ($1,000 if line” 1 or 3 checked—$2,000 if line 2, 4 or. 5 checked):
[11947]me 18 Taxable income (subtract line 17 from tine 16) Compute tax from Tax Rate Schedule—Enter tax on tine 19.
[11949]ac
[11952]A
[11954]~ os
[11955]bey
[11957]Lhd
[11959]. Bt
[11960]2.
[11961]en
[11962]3,
[11963]Nt |
[11965]“Ss
[11966]3:
[11968]o
[11969]E
[11970]oe
[11971]WV
[11974]i
[11976]19.. Tax—It an averaging method is used, check appropriate box O Schedule G, o ~~ .
[11977]20. Total exemption credits (from line 9, above) .
[11978]fs Cer 10 Tax - Jiability (subtract line 20 from line 19—if line 20 Ae breater than line 19, enter pa
[11979]Your - 99. Other credits (from line 66)... . Ce ae
[11980]: Tax 23. Net tax (subtract line 22 from line 21—if line 22 is greater ‘than ‘line 2 iter zero). soe : a
[11981]. Credits “ 24. Speciat tax credit—from line 75 (see Instructions, page 2, for. ae Suit)
[11982].-« 25, ° Net:Tax liability (subtract line 24 from line 28—if line 24 is greater than Hitub3, enter zero)
[11983]26. Tax-on preference income (see instructions—attach Schedule POA)
[11984]a7: Total tax liability (add lines 25 and 26) . 2. 2. 1 we 2 ‘
[11987]2
[11988]s
[11993]Renter's credit_if you lived in rented property on March L 1973, Zimplete Part | on page 2
[11994]Your . 29, Total ‘California income tax withheld (attach Form(s) W-2 or W2P to face of return).
[11996]~ AVVACH FORM DE1964 HERE
[11997]rity number: am cheek or ‘money ord; ATTACH HERE D>
[11999]te 30. 1973 California estimated tax payments (include amount allowable as a credit from 1972 return)
[12000]5. bredits 31. Excess California SD! tax withheld (attach Form*DE 1964 :to face of return) .
[12001]32. Total prepayment credits (add lines 28 through 31) :
[12002]. 33. If ‘ine 27 is equal to or larger ‘than line 32, enter amount of BALANCE DUE .. : .
[12003]‘Balance : Pay: in full and mail with return to: Franchise Tax Board, Sacramento, CA 95867 —_ “ be not write in these spaces
[12004]Due 34. If line 32 is larger than line 27, enter amount OVERPAID : re OR :
[12005]‘OF : Mail return to: Franchise Tax Board, P.0. Box "13-540, Sacramento, CA 95813 : Lk
[12006]Refund — 35.» Amount of line 34-to be REFUNDED. (allow at least ah weeks for your refund) . . . :
[12007]36.‘ Amount of line 34 to be credited on your 1974 stiles tax. sont eas ja} Mo
[12009]Under "penalties of perjury, 1 declare ‘that 1 have examined this veturn, ineluding accompanying schedules and statements, “and to the best of my knowledge and A?
[12010]belief it is true, correct and ‘complete. If prepared by a person other tl ae ayer, his declaration is based on all information of which he has any knowledge. F ooo
[12012]: ; . 13717 VANOWEN STREET
[12013]Ww. 88376 Docid: 32245535 Page 126 . - me - ; . 7 (MAN NUYS, CA. 91403
[12015]2 ABT B4RT Oe cine
[12018]sae oe nae
[12020]Page: 2 Form 549 (1973)
[12022]“PART i - Renter's Credit - All questions must be answered
[12024]emery
[12026]“ae ‘ v .
[12027]See Instructions, Page 2, for Allowable Credit
[12029]37. -Did you, on March I, 2973, live in rented property which was your principal residence? O Yes P&No lf no, you may not claim this credit
[12031]38. -Was the property you rented exempt from property. tax? . CO Yes OC No : If yes, you may not claim this credit
[12033]* 39: “Did you live with any other person who claimed you as a dependent for j income tax ‘purposes? . Yes 1 No If yes, you may not claim this credit
[12034]tf) Yes [] No If yes, see page 2 of instructions
[12036]40. Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance? .
[12038]Other Income
[12040]PART Il -
[12042]’ Business income (or loss) (attach Schedule C(540)) .
[12043].. Net gain (or. loss) from sale or exchange of capital assets (attach Schedule 01540)
[12045]42.
[12046]43. Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D- 1(540))
[12047]44, Pensions and annuities :
[12048]"45. Rents and royalties . Attach
[12049]. : Schedule E
[12050]46. Partnerships Form (540)
[12051].4], Estates and trusts ©
[12052]_ 48. Farm income (or loss) (attach Schedule F(540))
[12053](a) Fully taxable pensions and annuities (not reported 0 on Schedule “E(640)
[12054]49 Miscel -} (0) Alimiony . tak
[12055]"" jncome } (c) Other (state nature and a soneceeeceeoneganepeeeaneeeesonee
[12057]Enter total of lines 49(a), (b) and (c)
[12058]Total (add lines 41 through 49). Enter here and on line 13 .
[12060]’ PART Ill - Adjustments to Income
[12062]51. “Sick pay”, if included in line 10 (see instructions—attach statement)
[12063]"52. Moving expenses (see instructions—attach statement)
[12064] §3. Employee business expenses (see instructions—attach satemet
[12065]54. Military exclusion (see instructions)
[12066]55....Payment as a’ self-employed person to a retirement pla, etc,
[12067]- §6. Total adjustments {add lines 51 through 55). Enter here and on line 15
[12069]PART IV - Itemized Deductions -
[12071]© Attach Schedule A(540) and enter sub-totals on lines 57 through 62, below
[12073]‘S37. “Total deductible medical and dental expenses (from Schedule A(540), line 10)
[12074]58. Total: child. adoption expenses (from Schedule A(540), line 13)
[12075]59. Total taxes (from Schedule A(540), line 21)
[12076]"60. Total interest expense (from Schedule A(540), line 25) :
[12077]"61." Total contributions. (from Schedule A(540), line 29)
[12078]. 62. Totals miscellaneous deductions (from Schedule A(540), line 40)
[12080]Total itemized deductions (add lines 57 through 62). Enter here and on line 7.
[12082]_ PART. ¥ - Other Credits - SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW
[12084]he 64. “Other State” net. income tax credit (attach copy of other. state return and Schedule $1540)
[12085]“65. rement income credit (attach Schedule R(540)) :
[12087]66. Total (add lines 64 ‘and 65). Enter here and om line 22
[12089]PART vl
[12091]. Special Tax cradi
[12093]G7. Taxable income from fine 18 (or line 16 if Tax Table used)
[12095]~ 68. Amount of gain or loss {if any) entered on Schedule D(540), line 14 .
[12097]_ 69., Amount of gain or loss (if any) entered on Schedule D(540), tine 15
[12098]70. :, Combine lines 68 and 69 and enter total here. If zero or a loss, enter zero
[12099]71." Adjusted taxable income (subtract line 70 from line 67)
[12101]- 72, Adjusted tax (use same methed as used for determining tax on line 19)
[12102]"73. Add lines 20 and’ 22, and enter total here
[12104]‘Adjusted net tax (subtract line 73 from line 72)
[12105]. Special tax credit—Determine allowable credit using Table on page 2 of i instructions.
[12107]ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE
[12108]DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION.
[12110]"Enter here and
[12112]49
[12114]If you report net gains from capital assets held more than one year on Schedule D(540), complete all lines below.
[12115]All other taxpayers enter ‘Net Tax” from line 23 on line 74 and complete line 75. :
[12117]on line 24
[12122]ITEMIZED DEDUCTIONS -
[12124]Attach to Form 540
[12126]the standard deduction. If you. choose to itemize your deductions, complete the
[12127]appropriate items below.
[12129]methods. You can either itemize your deductions or take a standard deduction as
[12130]explained in the 540 Instructions. On separate returns of a husband and wife,
[12132]Itemized ¥S. Standard Beduction—You have a choice between two deduction | if one spouse itemizes deductions, the other may not use the Tax ‘Table or claim
[12134]Medical. and dental expenses (not compensated by insurance or otherwise) for
[12135]c, medicine and-drugs, doctors, dentists, nurses, hospi- : :
[12136]vitae ot . tal care, insurance premiums for medical care, etc. 22. Home mortgage .
[12138]ne , cane —— 23. Installment purchases
[12140]1. One half (but not more than $150) of insurance oo po st
[12141]“premiums for medical. cares. / 5 oO " 24. Other (itemize). 2 6 we ey
[12143]. 2. Medicine and drugs. ee Lee eeeeeeeetee dienes.
[12145]Interest Expense
[12147]“13, Enter 1% of af adjusted gross income shown 0 on Form
[12149]540.
[12150]4. “Subtract line 3 from ‘line 2. Enter difference (if line. :
[12151]3. is Breater "than line 2, ‘enter zero) . . : 25." Total—(Add lines 22, 23, and ‘2 Enter ‘here and ;
[12153]| ee in on Form 540,-page 2)
[12154]5. Enter ‘balance of insurance premiums for medical ° U yay
[12155]care not entered on line 1 . . . :
[12157]Contributions
[12159]6. Other medical and dental expenses; a [ ; oO 26. Cash contributions for which h , en ay
[12161]uy . : . . Cash contributions for whic! you ave rect, can- ;
[12162](a) Doctors, dentists, etc... Lone 73 7) wpe celed checks, atc, 7, } sO | _
[12163]{b) Hospitals . 7
[12165]Other cash contributions, List donees and amounts - Ne ceeecceeereneee Jones
[12167]*Total—iadd lines 4, 5, 6a, b, ade)... , LA ee S|
[12169]. Enter 3% of adjusted ross income shown on : : ; . co
[12171]‘ 28. Other than cash. — See instructions for required :
[12173]4. Subtract line 8 from-line 7. Enter difference (if 966 statement 2 2 woes —_—. ;
[12174]7 “ti i i » . . ‘ . - ot 5
[12175]"7, fine 8 is greater than fine 7, enter zero} == 1 — | 25, totai—iadd lines 26, 27 and 28. Maximum deduction 7
[12176]40. Total—Add- lines 1 and 9, Enter here and on 9 /¢ may not exceed 20% of adjusted gross income. : wey 0
[12177]“Form 540, page 2)... ; iP f Enter here and on Form 540, page 2)...
[12178]child Adoption Expense ~ ; . : Miscellaneous Detluctions
[12179]Casualty or Theft Loss(es)—See tnstructions . -
[12180]Wt Total expenses. aid or incurred—Attach itemized . NOTE: If you had more than one loss, omit fines 30 .
[12181]list : : So Lleeeceeeegereeepeee ‘| through 34 and follow instructions for guidance. 5 ;
[12182]12. Enter 3% of adjusted gross income shown on \ Form . 30: Loss before insurance reimbursement... ©. | oluteeteeeeeeeee fone
[12183]‘n 540 . FE enn 31. Insurance reimbursement . :
[12184]: 13. Subtract fine 12 from line 11—See instructions . 32. Subtract line 31 from tine 30. Enter difference ‘it
[12185]for maximum limitations. (enter here and on Form ~——f} <r line 31 is greater than line 30, enter zero)
[12186]540, page 2) chs on . Ad 33. Enter $100 or amount on line 32, whichever is 7
[12187]' : smaller .
[12188]“Taxes (See tables on reverse) : 34, Casualty or theft loss (ine 2 | less 5 line 33)-
[12189]“14, Realestate 2 0 0 Leeder: 35. Alimony paid ~
[12190], 15. State ‘and local gasoline ee 36. Child care—See instructions
[12191]16. General sales ‘ a * 37. Union dues on
[12192]38. Employment educati —
[12193]17. Auto license—Excess of registration @ and weight f fees ployment education expense se instructions os eneeeenenneenes Genel
[12194](see instructions) _ 39. Other—See instructions itemize). © 6 6. ee eee eben
[12195]18. Personal property Loe ae ;
[12196]19. “State disability insurance (SDI) Employer. private
[12198]disability plans do not qualify
[12199]20. Other
[12201]| 21. Total ‘tares—iAdd tines 4 tough 20. Enter here
[12202]and on Form 540, page 2) Nod
[12204]40. Total—Add lines 34, 35, 36, 37, 38 and 39. (Enter
[12205]"here and on Form 540, page 2) . . ,
[12207]- (Rev. 1973)
[12208]_ NW Baste Docld: 32245535 Page 128
[12210]PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
[12212](Sole Proprietorships) ”
[12214]-* Amach this schedulo te your Income tax em Form 540 or SCONR — Partnerships, joint. yontures, ete., must filo om Form 363
[12216]: A | Princigal business activity... “Say a = i B & = ene ceseceneneepeeeeeeeeee j tla Aas ceneeeeeeee 7
[12218]: (See Instructions for “Item A.”) “(For example: retail-hardware; wholesale—tobacco; services—legal; monufacturing—furniture; etc.)
[12220]. B. Business name_.. SNA. LE. AR... coh ee cone eee C. Federal employer ry, ification number.........-.cg¢-------20-eeeceece
[12221].. Business address. .... a. Y1é | CWA Vays Bev ke lf. Uo.- van ¥ Le A. Days vee CA ELE...
[12223]~ “(ZIP code) ~
[12225]E. Indicate method of accounting: cash; [[] accrual; [J other.
[12226]“Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? PRL Yes (] No !
[12227]G. Method of inventory valuation B.__............-- COST ae nent ceccececchensaeegeeees
[12229]*. Was there any substantial change in the manner of determining quantities, costs, or valuations between the apening and closing inventories?
[12230]“DYES: [J NO.. Jf “Yes,” attach explanation.
[12232]- IMPORTANT—All opplicable lines and schedules must be filled in.
[12234]1 Gross receipts or sales $_____________ Less returns and allowances $2, Balance > paren .
[12236]2 Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) . Loe ee,
[12238]3 Gross profit . a
[12240]4 Other income (attach scheduie)
[12242]5 TOTAL income (add lines 3 and 4)
[12244]& Depreciation (explain in Schedule C- 3)
[12246]"J Taxes on business and business property (expla | ths Schedule C. 2)
[12248]& Rent ‘on business property :
[12250]| 9 Repairs (explain in Schedule C-2) . .
[12252]‘JI Salaries and. wages not included on line 24, Schedule c 1 (exclude o any ‘paid t to yourself) .
[12254]:[11 Insurance : sone
[12256]12 Legal and professional fees
[12258]13 Commissions ..
[12260]14 Amortization ‘(attach statement)
[12262]15 (a) Pension and profit-sharifig:
[12263](b) Employee benefit progi
[12265]|1G Interest on business indebiSdr .
[12267]17 Bad debts arising from sales or - services
[12269]18 Depletion
[12271]19 Other business expenses (specify): |
[12274]9
[12275]y
[12276]8
[12278]My
[12280]my a
[12282](see Instructions for line 15(a)) .
[12283]tructions for line 15(b))
[12285]DEDUCTIONS
[12287]. (@)
[12288](h) Total other business expenses (add lines 19(a) through Wg). 2. 2 ee ee
[12289]20 Total deductions (add lines 6through 19). 2... tee ee OO Cp Re Per
[12291]21, Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form S40NR
[12293]“SCHEDULE C-1. CcOsY OF GOODS SOLD (See Schedule € Instructions for line 2)
[12295]* 29 inventory at beginning of year (if different, from last year’s closing inventory, attach explanation)
[12297]_ 23 Purchases $.... Less cost of itémhs withdrawn for personal use $200 ee Balance >
[12298]24 Cost of labor (do not include salary paid to yourself) ,
[12300]25. Materials and supplies
[12302]26 Other costs (attach schedule) cee
[12304]27 Total of lines 22 through 26 2 © 6 ms
[12306]i 2B Less: Inventory at end of year .
[12307]| 29 Cost of ee sold. Enter here and on line 2, ‘above
[12309]1232245535 Page 129
[12312]ort a en ae al
[12313]chedule C (Forin 540) (Rev. 1973) . Page 2
[12315]“SCHEDULE C-2. Explanation of Lines 7 and 9
[12317]Explanation mo Amount
[12319]SCHEDULE C-3. DEPRECIATION (See Schedule C Instructions for line 6). NOTE: Depreciation may be computed by
[12320]_using the Asset Guideline Classes specified in Federal Revenue Procedure 72-10, regardless of when assets were
[12322]. placed in service. If this methed is used, do NOT use the Lower Limit or the Upper Limit (ADR) Ranges. Attach
[12323]- detailed statement of depreciation computation.
[12325]tao
[12327]mu, a. Group and guideline class b. Date ¢. Cost or d. Depreciation e. Method of f, Lifeor |g. Depreciation for
[12328]; or description of property acquired other basis a OWE ree come rate this year
[12330]» 1 Total additional first-year depreciation (do not include in items below) >
[12332]® Asset Guideline Class System ‘(See Note above)
[12333]3 Other depreciation
[12334]Buildings ae
[12335]Furniture and fixtures .
[12336], Transportation equipment .
[12337]‘ Machinery and other equipment .
[12338]" Other (specify)
[12340]4 .
[12341].5 Less: Amount of depreciation claimed ‘elsewhere i in n Schedule Clos
[12342]& Boalance—Enter here and on page 1, line 6 .
[12344]Summary Straight fine ‘Declining balance aah ae Other (specify) . Totat
[12346]7 Line 2, above
[12348]& Other. . ZOOM mi: =——s
[12350]SCHEDULE C-4. Expense Account Information (See Schedule C Instructions for Schedule C-4)
[12352]Expense Account Salaries and Wages
[12354]. Enter information with regard to yourself and your five
[12355]highest paid employees. In determining the five highest
[12356]. paid employees, expense account allowances must be
[12357]added to their salaries and wages. However, the infor-
[12358]mation ‘need not be. submitted for any employee for - wees
[12359]whom the combined amount is less than $10,000, or - nn ene
[12361]’ for yourself if your expense account allowance plus
[12362]line 21, page 1 is less than $10,000.
[12364]” Did you claim a deduction for expenses connected with:
[12366]‘ (1) Entertainment facility (boat, resort, ranch, etc.)? (3) Employees’ families at conventions or meetings?
[12367]CO Yes No (] Yes No
[12369]_ 2) living accommodations (except employees on business)? (4) Employee or family vacations not reported on Form W-2?
[12370]] Yes - No Yes No
[12372]NW 88326, Docid:32245535 Page 130 00 - _ mo ar19-400 #273 2,000 @ A ose
[12374]mn
[12376]CALIFORNIA
[12378]CAPITAL GAINS AND LOSSES
[12380]Attach to Form 540 or 540NR
[12382]Use this schedule to report gains and losses on stocks, bonds and similar investments,
[12383]and gains (but not losses) on personal assets such as a home or jewelry.
[12385]2. Enter gain (or loss), if applicable, from line 18, Sched ule D 1 (540) “(attach | copy)
[12386]3. Enter your share of net gain or loss from partnerships and fiduciaries .
[12387]4, Net gain or loss, combine lines 1, 2 and 3 =
[12389]PART il—Assets Held More Than One Year But Not More Than Five Years
[12391]‘6. Enter gain (or loss), if applicable, from ling 20, Schedule D-1 (540) ‘aivach copy) |
[12393]JF,
[12394]8.
[12396]adjusted, cost of subse-
[12398]a. Kind of property and description b. Date acquired c. Date sold d. Gross sales quent improvements (if
[12399](Example, 100 shares of ‘‘Z’ Co.) (mo., day, yr.) (mo., day, yr.) price not purchased, attach
[12400]a ue explanation) and ex-
[12402]pense of sale
[12404]e. Cost or other basis as
[12406]f. Gain or loss
[12407](d. Jess €.)
[12409]Enter your share of net gain or loss from partnerships and fiduciaries
[12410]Net gain or loss, combine lines 5, 6 and 7
[12412]“PART Ill—Assets Held More Than Five Years
[12414]10.
[12415]1.
[12417]12.
[12419]Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach * copy)
[12420]Enter your share of gain or loss from partnerships and fiduciaries
[12421]Net gain or loss, combine lines 9, TO and 11
[12423]PART {¥—Summary of Capital Gains and Losses
[12424]13. oe
[12425]14."
[12426]15.
[12428]16.
[12429]7.
[12431]18,
[12433]19.
[12435]‘* (a) amount on line 17;
[12437]* .*(b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
[12439]~(c) $1,000 ($500. in the case of a husband or wife filing a separate return).
[12440]“nw 88326. Docid:32245535 Page ii. . .
[12442]Enter amount from line 4
[12444]Enter 65% of the amount on line 8 .
[12446]Enter 50% of the amount on line 12 197e tos-3- py Baz. - 4
[12448]Enter unused capital loss carryover from preceding taxable years (attach foe
[12449]Combine the amounts shown on lines 13, 14, 15 and 16 .
[12451]If line 17 shows a gain, enter here and on page 2, Part If of Form 540 « or 540NR .
[12452]If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of.
[12454]of capital assets; or
[12456]Screeners agree ecespstnnee nga presen enenepecnttnennensite seen te
[12458]SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
[12460](Sales or Exchanges including tnvoluntary Conversions)
[12461](Attach to Form 540, 540NR, 541 or 565)
[12463]PART 1° Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220
[12465]‘ Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
[12466]“1... Description of Sections 18211, 18212- 18, 18219, and 18220 property. ’ (me aan ye.)
[12467]f i _¥/ 20. | BBs 22
[12469]Correlate lines 1(A) through 1(D) with these columns a << Pow Property Property
[12471]Gross sales price .
[12472]Cost or other basis and expense of sale
[12473]Depreciation allowed (or allowable) .
[12474]Adjusted basis, line 3 less line 4
[12475]Total gain, subtract line 5 from line 2
[12476]1f Section 18211 property: .
[12477], (a) Depreciation allowed (or allowable) after applicable date.
[12478](See- Instruction D-3) woe
[12479]. (b) Line 6 or line 7(a), whichever is smaller
[12480]8. If Section 18212-18 property:
[12481]- (a). Enter additional depreciation after 12-31-63 and before
[12482]1-1-71 . Lo
[12483]. (b) Enter additional depreciation after 12- 31-70 .
[12484]’ (c) Enter line 6 or line 8(b), whichever is smaller .
[12485](d) Line 8(c) times applicable percentage (Instruction D-4) :
[12486]» (e) Enter excess, if any, of line 6 over line 8(b)
[12487](f) Enter fine 8(a) or line 8(e), whichever is smaller .
[12488]_'(g) Line 8(f) times applicable percentage (nstruction D. 4) .
[12489](h) Add line 8(d) and line 8(g) | . woe
[12490]'.. 9 Hf Section 18220 property:
[12491].. (a) If farm land, enter soil and water conservation expenses
[12492]for current year and four preceding years . .
[12493](b) If farm property, other than land, subtract line 7(b) from
[12494]line 6; OR, if farm land, enter line 6 or line 9{a), which-
[12495]_ ever is smaller (see Instruction D-5)
[12496]» (ec) Excess deductions account (see Instruction D-5)
[12497]- (d) Enter line. 9(b) or line 9(c), whichever is smaller .
[12498]10. If Section 18219 property:
[12499](a) Soil and water conservation expenses made after 12-31-69
[12500](b) Enter amount from line 9(d), if any; otherwise, enter a zero
[12501](c) Enter excess, if any, of line 10(a) over 10(b)
[12502](d) Line 10(c) times applicable percentage (Instruction D-5)
[12503]* (e) Line 6 less line 10(b) .
[12504]’. (f) Enter smailer of line 10(d) or line 10(e) .
[12505]SUMMARY OF PART | (Complete Property Columns A) through (D) up to Line 10(f) before going to Line 11).
[12506]_ 11. Enter amounts.from line 6 .
[12507]| 12. Enter amounts from lines 7(b), 8h), 9(d) ‘and 10(4)
[12508]- 13. Subtract line 12 from line 11, enter here and in appropriate
[12509]_Section in Part Il (see Instruction D-2) . 2.
[12510]. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part tl oo. 122.4 & —_
[12512]N[o oe Od
[12514]. (REV. 1973)
[12516]WW 88326 Docld: 32245535 Page 132 _
[12519]aS - eae a a . - we et map re ee
[12520]7 a : . ss :
[12522]“Schedule D-1(840) ¢ va Page 2
[12524]PART Bf Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions
[12525](Section 18181-82) see Instruction E
[12527]’ Section A— INVOLUNTARY CONVERSIONS DUE TO CASUALTY AND THEFT
[12529]f. Cost or other basis, cost of
[12530]subsequent improvements
[12531]- (if not purchased,
[12532]attach explanation) and
[12533]expense of sale
[12535]8 Depreciation allowed
[12536]{or allowable) .
[12537]since acquisition
[12539]9. Gain (or loss)
[12540](d. plus e. tess f.)
[12542]a. Kind of property (if necessary,
[12543]attach statement of descriptive
[12544]details not shown betow)
[12546]c. Date sold
[12548]bh. Date acquired '
[12549](mo., day,- Wt )
[12551](mo., day, yr.)
[12553]d. Gross sales
[12554]price
[12556]16. Combine the amounts on line 15, enter here and also on the appropriate line as “follows
[12557]_ (a) For all returns, except partnership returns: (1) If line 16 is zero or a gain, enter amount of each” gain or ‘oss, above, in
[12558]; - column (g) of applicable Section: B-1, B-2 or B-3; (2) ‘If line 16 is a loss, enter such amount on line 25 of Part It.
[12559]' (b) For partnership returns: Enter gain(s) and loss(es) in Schedule K (Form 565). See Instruction E.
[12560]' Section B— SALES OR EXCHANGES OF PROPERTY USED IN TRADE OR BUSINESS: AND CERTAIN INVOLUNTARY CONVERSIONS
[12561](Not Ht Reportable in Section A) .
[12563]5 "Section 8-1 Property Held One Year or Less
[12565]ai mm ocr he ene A IR eee me
[12567]* Section B-3 Property Held More Than Five- Years
[12569]22. Combine the amounts on line 21, enter here . .
[12570]23. Combine the amounts on lines 18, 20 and 22; enter here and also on the ‘appropriate ling as follows
[12572](a) For all returns, except partnership returns: (1) If tine 23 is a “gain, enter the amounts from lines 18, 20 and 22, on lines 2, 6
[12573]and 10, respectively, of the Schedule D (Form 540 or 541) that is being filed. (2) if line 23 is a loss, enter such | amount on
[12574]line 26 of Part Hil.
[12576]” (b) For partnership returns: Enter amounts on fines 18, 20° and 22, in Schedule K(565)—see Instruction E. .
[12577]PART Ii Ordinary Gains and Losses : so
[12581]a. Kind of property and how
[12582]acquired (if necessary,
[12583]attach statement of descriptive
[12584]details not shown below)
[12586]f. Cost or other basis, cost of
[12587]subsequent improvements
[12588]and expensé of sale
[12590]e. Depreciation allowed
[12591](or allowable)
[12592]since acquisition
[12594]g. ‘Gain (or loss)
[12596]d. Gross sales
[12597]neue (d. plus e. less f.)
[12599]+ price
[12601]c. Date sold
[12603]b, Date acquired
[12604](mo., day, yr.)
[12606](mo., day, yr.)
[12608]4. Gain, if any, from line 14
[12609]25. Loss, if any,.from line 16
[12610]. Loss, if any, from line 23
[12612]28. Combine lines-24 through 27, enter here and also on the appropriate line as follows
[12613](a) For fiduciary and partnership returns: Enter the gain (or loss) shown on line 28 on the line provided for on the
[12614]return being filed—see Instruction F for specific line reference.
[12615](b) For individual returns:
[12616](1) If the gain (or loss) on line 28 includes losses which are to be treated as an itemized deduction on
[12617]Schedule A (Form 540 or 540NR) (see Instruction F), enter the total of such loss(es) here and on
[12619]Schedule A (Form 540 or 540NR)—Identify as loss from line 28(b)(1), Schedule D-1 (Form540).
[12621](2) Redetermine the gain (or loss)-on line 28, excluding the loss (if any) entered on line 2B(6)(1). Enter here
[12622]7 and on page 2 of Form 540 or Form 540NR, under “Other Income” toe, ae Lee re 48
[12625]For the year January 1-December 31, 1970, or othor taxable year beginning
[12627]- US
[12629]Department of the Treasury /
[12630]individual income Tax Return
[12632]Internal Revenue Service
[12634], 1970, ending -__.
[12636]r
[12637]cF g Firat name end initial (If Joint return, use first names ond middle initials of both) Last name
[12638]~2  - SAMUEL AND PHYLLIS 2. RUBY 3221, 14 7997
[12639]2 “Present home address (Number and street or rural route) Spouse's soclal security number
[12640]B 16250 Bircher ee . 349: 148 1420
[12641]o . @ City, town or post office, State and ZIP code : ' occu. Yours Se@ lf- -Empe
[12643]* & Granada Hills, California sd Panto | Suse's Housewife
[12644]. Filing Status—check only one: Exemptions Regular / 65 or over / Blind enter
[12645]* “1 Single; 2 20 Married filing jointly (Ra j%ouy one 7 Yourself . .. Ki 0 C] BP eokes|
[12646]* 3 (J Married filing separately and spouse is also filing. 8B Spouse (2>Plies anly tf item Kj ] (7 shecked 2 _
[12647]yey x. “s pace ahve ardent spouse's social security number in | 9 First names of your dependent children who lived with |
[12648]> B| firstname here _ you Pred, Brians Elisa, eae 4
[12649]2 4 ( Unmarried Head of Household nn ‘Thomas _ _ number >|
[12650]VI, 5a Surviving widow(er) with dependent chiid 10 Number of other dependents (from line 34). >,
[12652]: | _6 [i Married filing separately and spouse is not filing |_11, Total exemptions claimed — >| 6
[12653]£ 12 Wages, salaries, tips, etc. (Attach Forms W~2 to back..If unavailable, attach explanation) . | d2- a
[12654]3S :
[12655]fs) ; .
[12657]2 13a Dividends (,*2°°* 3.) $.. 20-60 13b Less exclusion g 20. 60. Balance . pe _13¢ -
[12659]ha 8 ® * {Also list in Part | of Schedule B, if gross dividends and other distributions are over $100)
[12660]; E E 14 Interest. Enter total here (also list in Part Il of Schedule B, if total is over $100). . . _24 |
[12661]4 fo)
[12662]3
[12663]Ly c + +
[12664]9; ™ 15 income other than wages, dividends, and interest (from line 40) . ~ 15 2 1284 22
[12665]: a 16 Total (add lines 12,4 16) 7,284 97
[12666]17 Adjustments to '' moving expense, etc. from line 45) 7 -
[12667]‘ 1.18 Adjusted gross incti ) ae : 18 7,284 97
[12668]@ See page nage 2 of instructions for rules Gr tax and surcharge. 7 7
[12669]@ ‘If you do not itemize deductions and liné in Tables. Enter tax on line 19.
[12670]@ Ifyou itemize deductions or line 18 is $10,0 tax.
[12671]oe Py Pedule D(C], or Schedule G [}) |-22. |... 11? | 53
[12673]_ 2 a gu claim retire!
[12677]o © Se }-
[12679]é we OP le. _
[12681](7 re ty
[12682]At 2¥ ‘Total (add lines 19 and 20) . _____ 117/53
[12684]e |. , a
[12685]3 oy 22 Total credits (from line 55)... A
[12686]: 5 Ki 23 Income tax (subtract line 22 from line 21) . :
[12687]§ BZ | 24 Other taxes (from line 61) 2. 1. a 24° 338. 20
[12690]= e 25 Total (add lines 23.and 24). Lo made
[12692]3 £ |°26 Total Federai income tax withheld (attach Forms w-2 to back) . | 26 | . VE check or money Z
[12693]. 2 & 27 1970 Estimated tax payments (include 1969 overpayment allowed as a credit) | 27 | : | _ Zoster payable f inter. Y)
[12694]8 . - 28. Other payments ‘(from line 65). - 2 ee ee 128 | - _ NT
[12695]a
[12696]© Bi "| 29 Totat edd i lines 26; 27, and and 28) . a oe 8
[12697]a a ee re a ——
[12698]a} 2)
[12699]aa 30 If line 25 i is larger than line 29, enter BALANCE DUE. Pay in full with return . . b> 73
[12700], qo |: 231 If line 29°is iarger than line 25, enter OVERPAYMENT . o 2 oem | Sa
[12701]_ | & | 32, Line 31 to be: (a) Credited on 1971 estimated tax b> $ 3} (b) Refunded >
[12702]. _ : Fee eeeeg et parla, core that | have oxamined this roturn, including accompanying schedules and statements, and to the best of my knowledge and belief
[12703]ee 52> an _ _ »
[12704]Sg bo Your signat “Date Signature of p
[12705]2 ap BIC Iar serie “ dima rte aia
[12706]LAMBERT-M KEI
[12707]— "a signature (if filing jointly, BOTH must sign oven if only one had income) : “Radress 16633 -RE-MARKELL
[12709]; ENCINO, CALIF. 91316
[12710]NW 88326 Docid:32245535 Page 134
[12712]Page’ @ Form 1049 (1970) oe a Por Attach Copy B of Form W-2 here. >
[12713]Foreign Accounts Did you; at any time during the taxable year, have any interest in or signature or other authority over
[12714](check. a bank: securities, or other financial account in a foreign country (except | in a U.S. military banking
[12715]facility operated by a U.S. financial institution)? . . Yes [1 Na.
[12717]appropriate, box) _V__f ""Yes,"" attach Form 4683. (For definitions, see Form 4683.)
[12719]PART I.—Additional Exemptions (Complete only for other dependents claimed on line 10)
[12721]—— rs ve ne en —
[12723]a3 @) NAME , ‘ : jb) ‘Relation. “| {) Months lived in your (d) Did “depend (e) “Amount YOU furnished { ry Amount furnished
[12724]f rst . + ship home, if born or died ent have incoms | for dependent’: 5 support, if | by OTHERS includ-
[12725]a Js . during, year write ‘B'' | of $625 or more? 100% write ‘ a ing dependent.
[12727]ct
[12729]aa Total number of dependents listed above. Enter here and on line 10. oe _ Doe
[12730]t
[12732]PART ti. —income other than Wages, Dividends, and Interest
[12734]r toss) (at een ‘F720 2
[12736]35 Business income (or loss) (attach Schedule Che we aan _ S
[12738]36 Sale or exchange of property (attach Schedule D). 2... . . (36| (1,000!00)
[12739]37 Pensions and annuities, rents and royalties, partnerships, estates or trusts, etc. 2. (attach Schedule 5). 37° cent fo
[12740]38 Farm income (or toss) (attach Schedule F) . 6... 2 ne a
[12741]39 Miscellaneous income (state nature and source) colaccesenceseecentereneennenetenenees canecneec contest ttecececesenenectnaatens i
[12743]40 Total (add tines 35, 36, 37, 38, and 39). Enter here and on line 15
[12745]PART Ili.—Adjustments to Income
[12747]cnn erage engines stam ates eka naman, | ammeter
[12749]-41 “Sick pay" if included in line 12 (attach Form 2440 « or other required statement) .
[12750]42, Moving, expense (attach Form 3903) . Loe
[12751]43 ‘Employee business expense (attach Form 2106 or other statement) .
[12753]i 44 Payments as a self-employed person to a retirement plan, etc. (attach Form 2950SE) re i _
[12755]45 Total adjustments (add lines 41, 42, 43, and 44). Enter here and online 17...
[12757]PART 4V;—Tax Computation . ; “
[12758]46 Adjusted gross income (from line '28) : Loe tot _ Do 46) 7,284 19?
[12760]47 (a) lf you itemize deductions, enter total from Schedule A, line 222 : | i
[12761](b) ‘If you do not itemize deductions, and line 46 is $10,000 or more, enter toe ee ee LAA 2,745 (44
[12762]S $1,000 ($500 if.married and filing separately) | ;
[12763]- 48 Subtract line 47 from line 46... Coe ee et [4B fe 539) 53
[12764]49 Multiply total number of exemptions claimed on line ul, ‘by $625 . Lo . (49) 3,790) 00
[12765]50 Taxable income. Subtract line 49 from line 48. (Figure your tax on this amount t by using Tax Rate i
[12766]Schedule X, Y, or Z-unless the alternative tax or income averaging is applicable.) Enter tax on line 51 50. ee") (33
[12768]51 Tax. Enterhere and online 19. . . . ee
[12770]PART Y. —tredits
[12772]52 Retirement income credit (attach Schedule R) . ee PIE
[12773]53 investment credit (attach Form 3468)... 2. 2. 0 2 ee ee ee ee BB
[12774]54 Foreign tax credit (attach Form 1116). . Ce eee ee | BAL _:
[12775]55 Total credits {add lines 52, 53, and 54). Enter here ‘and on n line 22. So eee mm 5B
[12777]PART Vi Other Taxes
[12779]56 Seif- employment tax (attach Schedule SE) . .
[12781]57 Tax from recomputing prior- year investment credit (attach Form 4255) .
[12783]58 Minimum tax. See instructions on page 7. Check here (1), if Form 4625 is attached .
[12784]59 Social security taxon unreported tip income (attach Form 4137).
[12786]60 Uncollected employee social security tax on tips (from Forms W-2) .
[12787]61 Total (add lines 56, 57, 58, 59, and 60). Enter here and on line 24
[12788]PART ART _VII.—O' —Other Payments
[12790]area nett nna nts ape aap ees oe die menbaeti eine oo tte
[12792]62 Excess F.1.C.A. tax withheld (two or more employers—see instructions on page 7) . . . . 62 _
[12793]63 Credit for Federal tax on gasoline, special fuels, and tubricating oil (attach Form 4136). . . . 63 eee ee
[12794]64 Regulated Investment Company Credit (attach Form 2439). . 2. 2. we ee ee | 64 a i
[12795]65 Total (add lines.62, 63, and 4. Enter here and online 28 .. ee eS |
[12797]Srivty vy U.S, GOVERNMENT PRINTING OFFICE :1970—\.>-370-040 94.1149624 : 1G—-SUTON-1
[12799]NW 88326 Docld:32245535 Page 135
[12801]Schedules AaB—Itemized Deductions AND |
[12802]- {1970
[12804](Form 1040) == 8 Dividend and Interest Income
[12805]. . Department of the Treasury
[12806]' . Internal Revenue Service => Attach to Form 1040. .
[12807]Name(s) as shown on Form 1040 r Your Social Security Number
[12809]Samuel and Phyllis Ruby | 322) 12).7997
[12811]Schedule A—lItemized Deductions (Schedule B on back)
[12813]| Contributions. —Cash— including checks, money orders, etc.
[12814](itemize—see instructions on page 8 for |
[12815]examples) | _ - —
[12817]a Medical and dental expenses (not compensated by insurance
[12818]Lk vos or otherwise) for medicine and drugs, doctors, dentists, nurses,
[12819], - hospital care, insurance premiums for medical care, etc.
[12821]‘1 One half (but not more than $150) of In-
[12823]surance premiums for medical care. . |
[12825]me 2 Medicine and drugs. . . i a a [nn
[12826]Z 3 Enter 1% of line 18, Form 1040... | _|.
[12828]—_ 4 Subtract line 3 from line 2. Enter differ: | i
[12830]ence (if less than zero, enter zero). .{_. jd.
[12832]5 Itemize other . medical and dental ex- . ae
[12834]-‘penses. Include hearing aids, dentures, ,
[12836]eyeglasses, transportation, balance of in-
[12838]surance premiums for medical care not |
[12840]entered on line 1, etc.
[12842]11 Total cash contributions a
[12843]-12 Other than cash (see instructions on
[12844]page 8 for required statement). Enter
[12845]total for such items here. ©. 2 6 io
[12846]13 Carryover from prior years (see in-
[12847]structions on page 8) . - oe
[12848]14 Total contributions (Add lines 11,
[12849]12, and 13. Enter here and on line
[12850]19, below. See instructions on page 8
[12852]EL tor timitation) > 280) 00
[12853]| |__| Interest expense—Home mortgage . ae
[12854]_ __._| installment purchases . jo
[12855]__ _ 7 |__| Other (Itemize) ee !
[12856]6 Total (add lines4.and5).°.°. 0. 3 ej a .
[12857]"+7 Enter 39% ' of line 18, Form 1040. 2 |
[12858]~ *"-. 8 Subtract line 7 from line 6. Enter differ- ae __
[12859]fue : ence (if less than zero, enter zero). . (|____ a i
[12860].9 Total deductible medical and dental ex- | 15 Total interest e expense (Enter here and
[12861]‘” penses (Add lines 1 and 8. Enter here and on tine 20, below.) . . ss 1, 552 18
[12862]“on line 17, below.):. 150 00 Miscellaneous deductions for child care, |
[12863]Taxes.—Real estate. . . . so ee : _..|___] alimony, union dues, casualty losses, etc. |
[12865]State and local gasoline (see gas tax tables)
[12867]General saies (see sales tax tables) .
[12868]State and local income .
[12870]Personal property .
[12872](see instructions on page 8).
[12874]ty
[12876]10 Total taxes (Enter here and on tine 18,
[12877]below.) . .
[12879]16 Total miscellaneous deductions | (Enter i
[12880]here and on line 21, below.) . b>!
[12882]Summary of Itemized Deductions
[12884]17 Total deductible medical and dental expenses (from line 9). Cee ee kk ee . wal
[12886]: 18 Total taxes (from line 10) |
[12887]_ 19 Total contributions (from line 14).
[12889]20 Total interest expense (from line’ 15). .
[12891]21 Total miscellaneous deductions (from line 16) . . é Ce a . . . |
[12893]i
[12895]i 22 TOTAL ITEMIZED DEDUCTIONS. (Add lines 17 through 21. Enter here and on Form 1040, line 47)S/A " 2474 2,745 4d 4u
[12897]16--81169- i
[12899]NW'68326 Docld:322745535 Page 136
[12901]_: NAME Samuel and Phyllis Ruby . __ IDENTIFICATION NO. 322=12-799?
[12902]ADDRESS. 16250 Bircher a. Granada Hills, California
[12903]SCHEDULE NO. A SCHEDULE OF DEDUCTIONS _ YEAR ENDED....-97.9.
[12905]| FEDERAL & STATE |
[12907]MEDICAL [ FeoeRa, | state || CONTRIBUTIONS
[12908]"4. ONE HALF OF MEDICAL INSURANCE |__ CHURCHES | 150 00}
[12909](NOT OVER A 1 (6) fore) 1 0/00 . :
[12910]2, DRUGS AND MEDICINES ee 7 a _ _COMMUNITY CHEST/Un i
[12911]3. LESS: 1% OF ADJ. GROSS INCOME __ SALVATION. ARMY /GOODWILL INDUSTRIES _ /
[12912]4. NET DRUGS AND MEDICINES _t on ro __REDCROSS ee | _
[12913]5. DOCTORS/ DENTISTS an ‘|| _XMAS & EASTER SEALS _ |
[12914]OR. [| HEART FUND/CANCER FUND |
[12915]OR: { || PARTNERSHIP RETURN ; |
[12916]DR. 2 L _ i|_ PAYROLL DEDUCTION | i i |
[12917]oR. - ; _ OTHER ORGANIZED CHARITIES: | 100/00, —
[12918]OR. [| |/Boy Scouts 15 |00
[12919]DR. [| fT yieirl scouts 1500
[12920]OR al 7 2 i
[12921]OR, __ a ee |
[12922]OR. — TOTAL CONTRIBUTIONS! 280 100
[12924]a
[12926]TINTEREST (70 « (TO WHOM PAID) _
[12928]+ FEDERAL & STATE
[12930]MORTGAGE LOAN
[12932]* BALANCE OF MEDICAL INSURANCE
[12933]© NOT DEDUCTIBLE ON TOP LINE ~.
[12935]Too — -
[12936]TOTAL | INTEREST |
[12938]+ — a rane | panes | nceceneten neff men = Seen ce - 7 Sanne
[12939]ed oe | + Colonial Mtg. Coe 11,133 [10
[12940]oe — a ma a. _ —— +
[12941]ee ttn . i Lo INSTALLMENT LOAN : _ Z . .
[12942]a TF Ieeodbody cow 3.
[12943]_ __. a che Co. 119/12.
[12944]“MEDICARE | _ To TFirat thei Ft [89 |10
[12945]HOSPITAL 4 _! ifransworld. _§1 144 |.
[12946]: _ | evolving. Shareea(EA| 39 110.
[12947]. LABORATORY | _ . LL LL J
[12949]L 552 /18 |
[12951]TRAVEL FOR MEDICAL
[12952]S_AMBULANCE _
[12954]| | FEDERAL & STATE |
[12956]| ___-ALIMONY (EXPLAIN) |
[12958]GLASSES “oo |
[12960]“SAFE DEPOSIT BOX FEE
[12962]2, HEARING AID
[12964]UNION DUES
[12966]: PROSTHETIC APPLIANCES
[12967]- MEDICAL EXPENSES
[12969]__SMALL TOOLS (GOOD 1 YEAR)
[12971]TOOLS DEPRECIATION
[12973]LESS: REIMBURSED BY INSURANCE __ SAFETY EQUIPMENT |
[12974]Lee Ll JL UUNIFORMS (NOT cEN.weaRy |
[12975]| JELESS: 3% OF ADJ. GROSS INCOME ° VL tAUNORY & CLEANING
[12976]8 BALANCE (NOT LESS THAN ZERO) | AUTO MILEAGE en seven
[12977]9. TOTAL MEDICAL DEDUCTIONS| “TELEPHONE EXPUNSE (NOT REIMA.) fe
[12978]WINE 1 PLUS LINE 8) _ _EMPLOYMENT AGENCY FEES _ 7
[12979]‘TAXES . dot R DUES & SUBSCRIPTIONS _ /
[12980]“AUTO LICENSE (LESS REG. FEE) 42 | $2 INCOME TAX PREPARATION —__ | $0 |00
[12981]SALESTAX + Large Items) 170! 00; 170/00) orners Financial Publ. 4. 50 00
[12982]SALES TAX AUTO . ; TE ; . _ !
[12983]“REAL ESTATE TAX _ | 311/26) 311 26 | TOTAL MISC, DEDUCTIONS |
[12984]CASUALTY LOSSES (&xPLain)
[12986]|__PERSONAL PROPERTY TAX
[12988]STATE INCOME TAX
[12990]“007 cGAL. |
[12992]140
[12994]gas TAX 200QcaL. @ -
[12996]& _ o_o __ SUB TOTAL |
[12997]| DISABILITY INSURANCE | a ween LESS REIMBURSED BY INS. | | as
[12998]‘MISC. TAX aS EOE 22 | _ sup roan; |
[13000]"_ornens: _ CT “LESS $100.00 FOR EACH CASUALTY | _ i
[13001]vi | TOTAL CASUALTY LOSSES se
[13002]a ae og eg ee setae eevee ceevehene ee wet En FEDERAL
[13003]TDI. Seieowetios ome TOTAL TAXES) 95) dee Bireranl comentooctooad ned shes bbe TOTAL DEDUCTIONS | tL
[13005]| NW 88326 Docid:32245535 Page 137 ~
[13007]LAMBERT-MARKELL + 16633 VENTURA
[13009]ELVD,
[13011]25785 1 ayes sae
[13013]+ ENCINO, CALIF. 98140
[13018]i
[13020]NW! 88326 Docld:32245535 Page 138
[13022]_18 Commissions tone Ce
[13023]. 19 Amortization (attach clatement) :
[13024]“20 Retirement plans, etc. (other than contributions made on your behalf—see separate
[13026]2
[13028]SCHEDULE C
[13029](Form’. 1040)
[13030]Department of the Treasury
[13032]internat Revonuo Service .
[13034]» (Sole Proprietorship)
[13036]> Partnerships, Joint ventures, etc., must file on Form 1065.
[13037]& Attach to Form 1 :
[13039]‘Profit (or Loss) From Business or Profession 197 0
[13041]Name as shown on Form 1040 Social security number
[13043]. amuel-and Phyllis Ruby _ 322 112 17997
[13044]A Principat business activity ..FOQQ oc cc cccsssseeennceeeeene product cece “eapeseesessenneseneesneuepeetennuneenensevaeuvnneveenuneeneersteees
[13045](For exomple: retaii—hardware; wholesale—tobacco; services—legal; manufacturing—furniture; etc.)
[13047](See:separate instructions)
[13048]B Business name ... oNaCK Bar.
[13050]we C Employer Identification Number . 95 572 6 51 578
[13051]Bo Van_N Ca
[13053]Ly. :
[13054]ash; (2) [-] accrual; (3) [] other, ; (ZIP code) .
[13056]D Business address ..
[13057]E Indicate method of acce
[13059]F Was thare any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
[13060]Yes: 8 NO. If “Yes,” attach explanation. .
[13061]G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 1970? (See “Item G" in separate instructions for Schedule C.)
[13063]() YES # NO. If "Yes," where were they filed? oo... cece ccc cccee sees cen soe sees teeter cette toesues eee ense tees neussetantuseteatente cue eeareraeestecissesseteesenteneesetecs
[13065].Gross receipts or gross sales $0.00... eee . . seeneeee Less: Returns and allowances $.......-----.----------------. bn wee ene ee
[13067]2 Inventory at beginning of year ;(if different from last year's closing inventory
[13068]attach explanation) «6. 6. 6 ee ee Be veneee
[13070]3 Merchandise purchased $.. : , less cost of any items
[13071]withdrawn from business for personal t use 3 tassessceecarenseeeaeceesenaeeaeseceseeaeseenere Penn n Dee
[13073]4 Cost of labor (do not include salary paid to yourself) ee ee ee ee pee
[13074]5 Material -and supplies so woe. :
[13076]6 Other costs (explain in Schedule €-1) a
[13078]7 Total .of lines 2 through 6 0. ee eceneeetteeneteeeten sede SCHEDU E
[13079]8 Inventory atendotthis year 2. 2 1. 1 we ee ee bee ee . : ATTAC D
[13080]9 Cost of goods sold and/or operations (subtract tine Bfrom line 7) © | ee ee
[13082]10 Gross profit (subtract line 9 from line 1) a
[13083]OTHER BUSINESS DEDUCTIONS me
[13085]11 Depreciation (explain in Schedule C-2) . woe ee a On
[13087]12 Taxes on business and business property (explain in Schedule 2 1) enn Sere
[13089]13 Rent on business property Sr ic See
[13091]14 Repairs (explain in Schedule C-1) . . . 20... to, ee
[13093]15 Salaries and wages not Included on line 4 {exclude any paid to yourset Fe ae Sn
[13095]16 Insurance . . .... se ee 5
[13097]17 Legal and professional ¢ fess . 2. 2.
[13099]instructions) ° on
[13100]1 Interest on business indebtedness
[13101]"22 Bed debts arising from sales or services... tk wk eo
[13102]23 Depletion. ... Oop te ee ee . _ oe ee }
[13103]24 Other business expenses (explain in Schedule C1) rn
[13104]25° "Total of lines 14 through 24... . a _—_—
[13105]26 Net profit (or loss) (subtract tine 25 from tine 10). Enter here and on line 35, Form 1040. ALso enter on . ,
[13106]~ Schedule SE, Part i, fine 1. 9,284
[13107]; . SCHEDULE c-1. EXPLANATION ¢ OF LINES 6, 12, 14, AND 24
[13108]Line Na. Explanation Amount _tine No. “Explanation TY Amount - 3
[13110]186—8NI71-1
[13112]1 Net earnings {or loss) from self-employment— ~
[13114]on anu
[13116]SCHEDULE SE | Computation of Social Security Self-Employment Tax
[13118](Form. 1040). & Each self-employed person must file a separate Schedule SE
[13120]Department of the treasuy | pe attach ta Form 1040.
[13122]> Hf you had wages, Including ‘tips, of $7, 800 or more that were subject to social security taxes, do not fill in this page.
[13123]&> If you had more than one business, combine profits (or losses) from all of your businesses and farms on this Schedule SE.
[13125]Important.—The self-employment income. reported below “will be “credited to ‘your “social “security record and used in figuring social ‘Security benefits.
[13127]Name of self-employed aby (as shown on social security card) Social security number Check applicable block
[13128]Samuel Rub y os | 322 112: 7997. |1 i Male 2 [) Female
[13130]Business activities subject to self- “employment tax (grocery store, sStaurant farm, etc.
[13131]| Computation of Net Earnings from BUSINESS Self-Employment (other than farming) -
[13134]1: Net profit (or loss) shown in Schedule C (Form 1040), tine 26. (Enter combined amount if more than one business.) .
[13135]2 ‘Net’ income (or loss) from excluded services or sources. included on line 1 wo
[13137]Specify. excluded Services OF SOUPCES.......:c. cc ccecceesseseeeserieeteerstsneeuttnenestentcnatenss Ceassesesinteeeeeneets secedesteecenevenseeesseseees
[13138]3° Net learnings (or lost) from business self-employment (Subtract line 2 from line 1, and enter here and on line 1(a),
[13139]Part tl, below.) : -
[13141]uPart Wie! "Computation | of Net “Earnings from FARM Self Employment
[13142]A farmer may elect to compute net far. n earnings using the OPTIONAL METHOD (line 3, below) INSTEAD. OF THE REGULAR ME HOD (line 2, below)
[13143]if his gross profits are: (1) $2,400 oF less, or (2) more than $2,400 and net profits are less than $1,600. If your gross profits from farming are
[13144]not more than $2, 400 and you elect to usa the optional mathod, you need not complete lines 1 and 2.
[13146]Boo - Computation under Regular Method - |
[13148]1 Net farm profit (or loss) from: — \
[13150](a) Schedule F, line 52 (cash method), or line 69 (accrual method)... . 1. ee ween eee eee ; woneee
[13152](b) Farm partnerships « Fc sleek a ee er
[13154]2 Net earnings from selt- “employment from farming. Add tines 1(a) and (b) .
[13155]‘Computation under Optional Methad
[13157]3 if gross profi its from farming are:* .. :
[13158](a) Not more than $2,400, enter two- thirds of the gross profits . . . . ek a ee
[13160](b) More than $2, 400 and the net farm profit is less than $1,600, enter $1,600 :
[13161]°Note. —Gross profits trom farming are the: total of the gross profits from Schedule F, line 28 (cash method), or line
[13162]67 (accrual method), plus the distributive share of gross prafit trom farm Partnerships as explained. in instruc
[13164]~ tions for Schedule SE.
[13165]4 Enter here and on line 10), Part Hi, below. the amount on line 2 (or line 3, if you use the optional method)
[13167]* (a) From business (other than farming—from line 3, Part 1, above) .
[13168]_ (b) From farming (from line 4, Part Il, above)... one
[13169]9. From: ‘partnerships, joint ventures, etc. (other than farming) Co ee aS . .
[13170]: Ad) From: service’ asa minister, member of a religious order, or a Christian Science practitioner. If you’ filed Form
[13171]4361, check here a and enter zero on this line « os .
[13172](e) From service with a ‘foreign government or international organization Co ee eee ee
[13173]“(f) Other (director’ 5 feas, etc.). Specify... wee nt enn ceneo ene newenee Leneeca cea tecneetentees sntewscnmevecneneus iueensuececescaedae A
[13174]2 Total net earnings (or loss) fram self- “employment reported online il . |. - . , toe
[13175](ifline 2 is less than $400, you are not subject to self-employment tax. Do not fill in rest of page. ) ,
[13176]3 The largest amount ‘ot combined wages and self-employment earnings subject to social
[13177]security taxis... cr
[13178]4 (a) Total “FICA” wages as indicated on Form W-2 :
[13179]“*(b) Unreported tips, if- any, subject to FICA tax: from Form 4137,
[13182](c) Total of tines Ala): and 400): . ee ee
[13183]Balance “(ubtract line 4(c) from tine 3) eek ew ke
[13184]Self-employment income—tline 2 or 5, whichever’ is smaller : coe te, ;
[13185]If line 6 is. $7,800, enter $538. 20; if less, multiply the amount on lirie 6by.069 ...... hoe ee
[13186]Railroad employee’s and railroad employee representative's adjustment for hospital insurance benefits tax from
[13189]Seitemployment tax (subtract line 8 from tine 7). ‘enter here and on Form 1040, line 56 538 120 20
[13191]16—81171-1 ope
[13193]NW 88326 Dochd:32245535 Page 139
[13195]Samuel and Phyllis Ruby
[13197]SUPPLEMENT TO SCHEDULE C
[13199]Income: , $32, Onn. 34,
[13200]Less: Sales Tax 153-39: » $32,503.95
[13201]"Beginning inventory |
[13202]Purchases - Beverages/milk  . $ 1,988.55
[13203]Groceries 8,761.69
[13204]Meat ee , 1,893.83
[13205]Bakery/bread . a 2,412.82
[13206]: $15, 15,056.89 :
[13207]Lessi Ending inventory - 7 "890.00 00 14,256.8
[13208]Adjusted Gross Profit $18,247.20
[13209]- Expenses. .
[13210]Rent ©. Lo . $ 1,172.16
[13211]Payroll. . 2,046.30
[13212]Payroll taxes . 202.92
[13213]Travel to employees 215-00
[13214]Miscellaneous expense , ; ' 219-40
[13215]Interest. an - 419.10
[13216]Accounting. — 225.200
[13217]Telephone .. . _ ; FBS
[13218]Repairs. a ~121.40
[13219]Insurance 150.00.
[13220]“Linen - 21.00
[13221]; ; Auto - 3, 000 Me © . ; 360.00 |
[13222]. Office « - — - 360.00.
[13224]Depreciation | ; ee 32321-36 -( _8,962.09)
[13225]“Net Profit. ; ae . $ 9,284.97
[13226]DEPRECIATION
[13227]Equipment . 4/70 $10,000.00 7 § Yre. $2,000.00
[13228]-Covenant Not To . ;
[13229]. Compete ; ; : 5,000.00 - ; 5 Yre 1,000.00
[13230]Leasehold Imp. : 3,000.00 7 Yre 428.50
[13231](7? Yre Balance Lease ) mo . ; _
[13232]- ; : April-December, 1970. | $4, 428750
[13234]_ NW.88326. Docid:32245535 Page 140
[13236]NW 88326
[13238]SCHEDULE D.
[13239](Form 1040) .
[13241]Department of the Treasury
[13242]internal Revenue Service
[13244]- Sales or Exchanges of Property
[13246]® Attach to Form 1040.
[13248]Name(s) as shown on Form 1040
[13250]samuee and Phyllis Ruby
[13252]322
[13253][Capital Assets—Short-term capital gains and losses—assets held not more e than, 6 months
[13255]Social Security Number
[13257]12! 7997
[13259]. . . c. How h. Cost or other
[13260]a, Kind of prop- b. Description _ tage basis, cost of
[13261]i : quired. g. Depreciation ; .
[13262]ory incicae SExgmiptes; 100 ah. of || Enter Kcqured | 2 Date sold | f. Gross sales | allowed (or subsequent improve
[13263]estate, or other |: z" Co., ‘te mye brick, set (mo., day, yr.) |(™- day. ¥F-) price a oi purchased, attach
[13264](specify) . explanation) and
[13265](seo : expense of sale
[13267]i. Gain (or loss)
[13268](f plus
[13269]g less h}
[13271]. Enter your share’ of, net ‘short- term gain ‘(or Joss) from partnerships and fiduciaries |
[13272]Enter net gain (or loss) from tines 1 and 2 :
[13274]Enter unused short-term capital loss carryover from preceding taxable years ‘(attach statement
[13275]Net short-term gain (or loss) from lines 3 and 4
[13277]Long-term capital gains | and | losses—assets eld more than 6 mo onths
[13279]mine wp
[13281], Capital gain distributions.
[13283]. Enter gain. from. Part VII, line 47 or line 51(a), whichever applicable
[13285]Enter your. share of ‘net lang-term gain (or loss) from partnerships and fiduciaries
[13286]Enter.your share of net.long-term gain from small-business corporations (Subchapter 8).
[13287]Net gain (or loss) from lines 6 through -10
[13289]Enter unused long-term capital loss carryover from n preceding taxable years attach statement)
[13290]Net! Jong: -term gain (or! loss) from lines 11 and 12.
[13292]Combine the amounts shown on lines 5 and 13, and enter the net gain (or loss) here —
[13294]If line 14 shows a gain— :
[13296](a) Enter 50% of line 13 or 50% of line 14, whichever i is smaller (see Part IV for computation of alternative
[13298]. tax). Enter zero,if there is a toss or no entry on line 13
[13300](b) Subtract ‘line 15(a) from line 14, Enter here and’on line 17, Part i!
[13302]If line 14 shows a loss—
[13304](a) Add tines 4 and. 12 (if lines 4 and 12 are blank, enter a zero here and on lines 1600) -and 16(c) and go
[13305]‘to line 16(d)). : ok woe ke
[13307](b) Combine lines-3 and L1—it 5 gain, enter gain; it loss, enter zero
[13309](c) Enter smallest of (i) line 16(a) less line 16(b); (ii) line 48, Form 1040 (line ‘18, Form 1040 if. tax
[13310]table used) disregarding capital gains and/or losses—determine this figure via a side computation;
[13311]or -(iii) $1,000
[13313]“(d) Combine lines'3 and 11—if loss, enter loss; if gain, enter zero 5 here and on line 16(e),
[13314]and go to line 16(f) . /
[13316]- (e) Enter smallest ‘of i) line. 48, Form 1040 (line 18, Form 1040 if tax table used) disregarding capital
[13318]fins and/or losses, less line 16(c)—determine this figure via a side computation, (ii) $1,000 ($500
[13320]if married and filing separately); (Iii) if line 3 ig zero or shows a gain, 50% of line 16(d); (iv) if line
[13321]‘1 is zero or shows a gain, amount on line 16(0); or, w if lines 3 and 11 show losses, line 3 added
[13323]to 50% of line 11.
[13326](f) Enter here, and on tne 17, Part r the sum of lines 5 16(0) ang,
[13328]16
[13330]than $1,000) . .
[13331]Summary of Schedule D Gains and Losses
[13333]( 1,000.00)
[13335]17 Net gain (or loss) from line 15(b) or 16(f), Part |
[13336]18. Net gain (or loss) from tine 22, Partlll .
[13337]19 Total net gain (or loss), combine lines 17 and 18. ‘Enter here and: on ‘ine 36, Form 1040
[13339]070 kA
[13341]Docld:32745535 Page 141
[13343]—-] 470-046
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[13536]732745535 Page 142
[13538]NW 88326 Docld
[13540]TAXABLE
[13542]CALIFORNIA
[13544]INDIVIDUAL INCOME TAX RETURN
[13546]® So Fe of
[13548]For Calendar Year 1970 or Fiscal Year Begun 1970 and Ended 1971
[13549]FIRST NAME(S) AND INITIAL(S)- LAST NAME Your sotial security number
[13551]~, SAMUEL AND PHYLLIS _ RUBY 322 | 1217997
[13552]TY, TOWN OR POST OFFICE Sate : ZiP CODE — Your occupation
[13553]California 9134s
[13554]Self-Employed | Housewife
[13555]11346 Montgomery Avenue © Granada Hills, Calif. _||f sitterent tom tig tan
[13557]Typo. r. PRESENT HOME ADDRESS (Number and street, or rural route) \
[13558]=- s+ 16250 Bircher oo Los Angeles} 349! 18; 1420
[13559]Granada Hills. Self-Employed
[13560]- NAME AND ADDRESS OF EMPLOYER AT TIME OF FILING Spouse's occupation
[13562]‘NAME AND AODRESS ON 1969 CALIFORNIA RETURN. IF SAME AS ABOVE, WRITE “SAME”. IF NONE FILEO, Adjusted gross income on 1970 Federal
[13563]GIVE REASON. ‘ Return §.-.- 39204297...
[13564]Filing Status 1. |__| Single 3. |__| Married, filing separate return-—spouse’s Mame: eens
[13565](check one) — 2. | X | Married, filing joint return 4. || Unmarried “head of household’"—Complete Part I, page 2
[13566]5. Wages, salaries, tips, etc. (before payroll deductions) if more than two employers, attach schedule
[13568]If different from line 11, below, explain
[13569]Employer's name Where emptoyed (city and state)
[13571]COUNTY Spouse's social security number
[13573]Hf Joint return,
[13574]‘Include all ©
[13576]income of .
[13577]both husband . oe 7 oo :
[13578]‘and wife " 8. Dividends. Enter total here (also list. in Schedule B (540), Part |, if total is over $100)... . . 22. LM LOM.
[13579]74 oe J. Interest. Enter total here (also list in Schedule B (540), Part ll, if total is over $100) . 2. 2. ee Gere :
[13580]BST 7
[13581]ag Ek a ; .
[13582]2 on 8. Other. income (from page 2, line 30) 2 6 2. ee 8
[13583]“—E G, Total (add lines 5, 6,7 and) 91...32305 [52
[13584]Cae | + 10, Adjustments to Income (from page 2, line 39). ee | TO
[13585]iS : a _—
[13586]=. 11. Adjusted gross income (subtract line 10 from fine 9) 2 2 2 2. 2 ee ee ee fd
[13588]if you do not itemize deductions AND Jine 11 is under $10,000, find your tax in Tax Table in instructions. Enter tax on line 12.
[13590]‘Your © If. you itemize deductions OR line 11 is $10,000 or more, g0 to Part IV on page 2 to figure tax. .
[13591]Tax, 12. Tax from (check one): Tax Table [7], Tax Computation (page 2, Part IV) Qg, or Schedule G.(540) on 12 fovecerenes
[13592]and 13: Exemption credits (from page 2, Sine 43) ; rn 13
[13593]Credits 14. Tax Hability (subtract line 13 from fine 12). ee Pa RE
[13594]: : 15. Total other eredits {from page 2, fine 49) 2 2. 2 2 ee ee ee ES
[13595]16. Net tax. lability (subtract line 15 from line 14—If $1.00 or less, enter “zero”) . 2 2... . | 16
[13597]an 17: 1970 California estimated tax payment or credit from 1969 (if any). If none, enter 1) ae 1 © A or .
[13599]Balance 18. Batance due—if any (subtract line 17 from fine 16) . . . . . . . . . “PAY IN FULL WITH RETURN 8 :
[13600]Bue or 18:’ Overpayment—if any (subtract lIne"16 from line 17)... 2 1. ee. OVERPAYMENT | 19
[13602]* Rofund 20, Portion of line 19 you wish to apply on 1971 estimated tax re 20 [>
[13604]fou 21. Rofund—if any (subtract line 20 from tine 19) 2 2 2. 2 eee ee ee. REFUND
[13605]|
[13606]T
[13612]" ‘Under penalties of perjury, | declare that 1 have examined this return, Inetuding accompanying schedules and statements, and to the best of my knowledge and
[13613]. ‘ .,, belief it is true, correct and.ecmplete. If prepared by a person other than taxpayer, his declaration is based on alt information of which he has any knowledge.
[13615]here > sscaai signatare, . * eaten 1 | Sainhel [i nrinnannr Adare AMBERT-MARKEL aig
[13616]16633 VENTURA BLVD.
[13618]© Make Remittance Payable to FRANCHISE TAX BOARD—Mall fo pi iio, CALIF: . 91316
[13619]FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814. © — :
[13621]- NW. 88326 .Docld:32245535 Page 143
[13623]. ?
[13625]* _ Form 540 1970 Page 2
[13627]“PART |—Head of Household—If claimed, answer the following questions (See Instructions)
[13628]Check -O Nevér married (] Final divorce/dissolution QO Separate maintenance = [_] Widow(er) ”
[13630]Date... eee eeee Date.
[13632]Is this person married?........ -....If yes, did he or she file a joint return with spouse? ..... ... Did this person qualify as your dependent for
[13633]the calendar year 1970?:.......... Did this person reside in your home for the entire ‘taxable year?..........If not, explain circumstances
[13635]cane ncnnne nan aameten: peene hammer erent
[13637]Total amount necessary to maintain in household $.
[13639]PART. i—Other Income’
[13641]. 22. Business income (or :toss) (attach Schedule C (540)) Loe, : :
[13642]23. Sale “or exchange of property (attach Schedule D (540). ©.) ee PRBS
[13644]24, Pensions and annuities’, \ ot. %e toe ee Te ee eT Cn ye 24
[13646]25. Rents and royalties > Attach
[13647]: Schedule E
[13648]. c (Form 540)
[13650]26. Partnerships
[13652]27. Estates or trusts
[13654]28. Farm income (or loss) (attach ‘schedule p 640))
[13655]29. Miscellaneous income (state nature and source).......:
[13659]30. Total edd fines 2 ‘through 23). ‘Enter ‘here ‘and ¢ on page 1, ‘Tine 8.
[13661]PART Ill—Adjustments to Income
[13662]81. “Sick pay” if included on page ‘1, fine 5 (attach statement)... ee) ore
[13663]32. Moving expenses (attach statement) 2 0 ee ee ee BR fe
[13664]33. Employee business expense (attach statement) .
[13666]34. Military exclusion (maximum $1,000—-$500 if separate return of husband or r wife)
[13667]35. Tota! adjustments (add lines 31 through 34). Enter here and on page 1, line 10
[13669]PART V—Tax Computation—It you do not use Tax Table or Income Averaging (Schedule G (540))
[13671]36. Adjusted gross. income (from page 1, line 11) . . os
[13672]37, if you itemize dedictions, enter total from Schedule A (540), line 31
[13673]If you do not itemize deductions, and line 36 is $10,000 or more, enter
[13674](a) $1, 000, if singfe, or married person filing separate return
[13675]__ (b) $2,000, if head of household, or married couple filing joint return
[13676]38. Taxable income {subtract line 37 from line 36) . .
[13677]-39.. Tax from Tax Rate Schedule in Instructions. Enter here and on page 1 line 12
[13679]PART V—Exemption Credits ee
[13681]40. Single—$25. Married couple or head of household—$50~. 2 2. eo 501 00.
[13682]41. Blind =) Yourself Your spouse—$8 for each box checked Lot ek Of /
[13683]42. Dependents—Do not list yourself, your spouse, or person who qualifies you as head of household ; .
[13685]NAME (and address if different from yours)- . . RELATIONSHIP
[13687]Thomas » ; . .children
[13689]Fred, Brian, Elisa,
[13691]Number of  dopondents listed...
[13692]43. Total exemption credits (add lines 40, al and 42). Enter hare and on page 1 Tne 13
[13694]PART Vi—Credit for Net Income Tax Paid to Another State—Attach copy of “other state” return—and Retirement Income Credit
[13696]44. Income derived from sources within State of .. ‘and also taxable by California 2. 2. 2 Le we eeenlenlacecceceuedfeseee
[13697]45. California adjusted gross income (from page 1, fine 11) 2 2 1. we eee | AS ;
[13698]46. California tax liability (from page 1, line 14) 2 2. ome . eo | 46 J: es hee :
[13699]47. Credit limitation—line 44 fine 45 oe. % (100%: inaximum) x "tine 16 (cannot ‘exceed tax ‘paid other state) we | A
[13700]48. Retirement income credit (attach Schedule R (540) 2 2... ee | AB
[13702]49. Total (add lines 47 and 48). Enter here and on page 1, fine 15
[13704]oc 45149-4090 7-70 13,000m@ A osp
[13707]CALIFORNIA
[13709]ITEMIZED DEDUCTIONS
[13711]Attach to Form 540
[13713]SCHEDULE
[13715]A al ,
[13716]. FORM 540
[13717]Social Security Number
[13719]Name as shown on Form 540 :
[13721]Samuel and Phyllis Rub 322 112 | 7997
[13722]{temized vs. Standard Deduction—You have a choice between two deduction if one spouse itemizes deductions, the other may not use the Tax Table or claim
[13723]methods. You can either itemize your deductions or take a standard deduction as the standard deduction. If you choose to itemize your deductions, complete the
[13724]explained in the 540 instructions. On separate returns of a husband and wife, appropriaie items below.
[13726]Medica and dental expenses (not compensated by insusance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospital care, insurance
[13727]premiums for medical care, etc.
[13729]. One haif (but not more than $150¥'0 of insurance premiums for medical care
[13731]1 woe
[13732]2. Medicine and drugs . 2°
[13734]"3. Enter 1% of adjusted gross ‘income “shown on Form 540° 3
[13736]_ 4; Subtract line 3 from line 2 (if less than zero, enter zero) 4
[13737]§. Other medical and dental expenses. Include balance of insurance premiums fot medical care not -
[13739]_ deducted on line 1 (attach schedule) 5
[13740]6. Total—(Add lines 4 and 5) «© © wu. 6
[13741]7. Enter 3% of adjusted gross income shown on Form 540 7
[13742]8: Subtract line. 7. from fine 6 {if less than zero, enter zero)
[13744]9. Total—(Add lines 1 and 8)
[13746]Child Adoption Expense
[13747]10.- Total expenses paid or incurred—Attach itemized list :
[13749]11. Enter 3% of adjusted. gross income shown on Form 540
[13751]12. Subtract line 11 from line 10—See instructions for maximum limitations
[13753]Taxes” wo . . .
[13755]"43. Real estate. 0 who
[13756]14. State and local gasoline en ee Pe db. i
[13757]15, General sales... . : ee PTB pe
[13758]16. Auto license—-Excess of registration and weight fees tee instructions) . ae Oe |< ee
[13759]17. Personal property. . . 1 es cee
[13760]18. State disability insurance (S01) —Employer private disability bias éo not st quality Wyo.
[13761]519. Other (specify) . - cescueeseeendsteeeeeetnntnee ned coeneacennune daceetetchaantis dageeeniene sats getnans san secteennceene . ow 719
[13762]20. Total taxes——(Add lines 13 through 19) 0 | 20 663] 26
[13763]Contributions oe , °
[13764]21. Cash—Including checks,: money orders, etc. (itemize) cesciig ecepnteee tee te seteced ce cages eeeeeadenige vce tegamats tenets ceenmecrtmesianememee s POL Lice enfin
[13765]22. Total’ cash contributions : an a ;
[13766]23. Other than cash (see instructions). Enter total here : Ce :
[13767]24. Total—Add lines 22 and 23—Maximum deduction may not exceed 20%. of adivsted gross income . . ww. 00
[13769]Interest Expense . : _ .
[13770]25. Home mortgage . 2... ee
[13771]26. Installment purchases —
[13773]27. Other (itemize) .
[13775]28. Total—tAdd lines 25, 26 and 27). rs 1,552118
[13777]Miscellaneous Deductions . ;
[13778]29. For child care, alimony, union dues, casualty losses, etc—See instructions (itemize). 2... cc. ccccce cucsececsseeceeescesevnssesteweeeeeeccessevtecreeneeees | 29
[13780]30. Tota miscellaneous deductions ren > | 30 100} 00
[13781]a a
[13782]_ 31, Total deductions—Add lines 9, 12, 20, 24, 28 and 30). Enter total here and on Form 540, page 2, in space provided S/A. 3) 25745] |
[13784]Schedule B on reverse
[13786]NW'88336 Docid:32245535 Page 145
[13788]TAXABLE
[13790]CALIFORNIA
[13792]PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
[13794](Sole Proprietorships)
[13796]FORM 540
[13798]Partnerships, joint ventures, etc., must file on Form 565
[13799]Social Security Number
[13801]322 j2
[13803]Attach this schedule to your Income tax return, Form 340 or 540NR
[13805]Name as shown on Form 540 or 540NR
[13806]Samuel and Phyllis Ruby
[13808]A. Principal business activity...... Lo X Fa 2). | EEE
[13809], (For example: rotall~hardwaro; wholosale—tobacco; services—legal; manufacturing—furniture; ete.)
[13810]B. Business name _Snack Bar. cee ce anne tectnamecens __.. €, Federal employer identification ns 25 51. 578.
[13811]D. Business location.. 5418 Van Nuys | Boulevard “Van Nuys, California 91401
[13812]ae {Number and stroet or rural route) ; L : (City—post office) (State) (zip “code)
[13814]Indicate method of accounting: RK) cash; C] accrual; oO other (describe)
[13816]F. Was there any substantial “henge. in the manner of determining “quantities, costs or valuations between the opening and closing
[13817]inventories? [1] Yes No. if “yes,” attach explanation.
[13819]G. Were Forms 591, 592, 596 “and 599, for the calendar year filed (if required)? []Yes K] No
[13821]1.: Gross receipts or gross sales $__.........--...- ecssneeenussens Less: Returns and allowances $........------------- ne ee] Gee ep
[13822]2. Inventory at beginning of year (if different than last year’s closing inventory attach .
[13823]- explanation). . Ca
[13825], less ‘cost of « any items $ with-
[13827]3. Merchandise purchased $
[13828]“.. . drawn from business for personal use $....-.. sneennnesoseees
[13829]4. Cost of labor (do not include salary paid to yourself)
[13830]5. Material and supplies _ soe ee
[13831]' 6. Other costs (explain in Schedule C. 1) re
[13832]7. . Total of lines 2 through Bn Lene dieeerecee tec enne tence:
[13833]8. Inventory at end of this year . cone
[13834]9. Cost of goods sold and/or operations (subtract line 8 from line 7).
[13835]‘10. Gross profit (subtract.line 9 from line 1). .
[13836]‘OTHER BUSINESS DEDUCTIONS |
[13837]11. Depreciation (explain in Schedule C-2) . oo
[13838]12. Taxes on business and business Property (explain i in Schedule C. 1 a ee ;
[13839]13. Rent on business property ... fe eee ate ates _
[13840]14, Repairs (explain in Schedule c 1) re : rs .
[13841]15. Salaries and wages not included on line 4 (exclude any y paid to - yourself) rr ae
[13842]16. Insurance .. soe ;
[13843]17. Legal and professional ‘fees | ceteeeenee cecteneecee tues
[13844]18. Commissions . : |
[13845]19. Amortization (attach statement)
[13846]20. Retirement plans, etc. (other than your share) .
[13847]21. Interest on business indebtedness .
[13848]22. Bad debts arising from sales or service; .
[13849]23. Losses of business property (attach statement) -. :
[13850]24. Depletion of mines, oil and gas wells, timber, ete. (attach schedule) .
[13851]25. Other business expenses (explain in Schedule C-1)
[13852]26. Total of lines 11 through 25. 2.
[13854]. Net profit (or loss) (subtract line 26 from line 10). Enter here ‘and on page 22, Part IL Form 540 or '540NR
[13856]” (Rev. 1970) . Page 1
[13857]: NW 88326 Dochd:32245535 Page 146 _
[13859]., L SCHEDULE
[13861]CALIFORNIA | ae :
[13863]~ SALES OR EXCHANGES OF PROPERTY
[13865]* co. * Attach to Form 540 or S40NR
[13867]Social Security Number,
[13869]322 | 12! 7997
[13871]Name as: — Form 540 or S40NR i
[13872]«-. Samuel and Phy? i's Ruby
[13874]Part I-CAPITAL ASSETS
[13875]SHORT-TERM--ASSETS HELD NOT MORE THAN 6 MONTHS
[13877]f. Cost or other basis,
[13879]att one, . oe . oti
[13880]mm e. Depreciation allowed cost of subsequent
[13881]a _ attach of prot it weeny, vi Date, aeauired Pa Date sald d. Gross sales price (or allowable) improvements Ai not & Gain or a
[13882]. oa . mo., day, yr. ‘mo., day, yr. * since acquisition purchased, attac! Pp jus ¢ fess
[13883]detaits not shown below) 7 (attach schedule) explanation) and
[13885]expense of sale
[13887]“2. Enter your share of net short-term gain (or loss): from partnerships and fiduciaries
[13888]: 3. +Enter unused short-term capital loss carryover from preceding taxable years (attach statement)
[13889]4. ‘Net short-term gain (or loss) from lines 1, 2 and’ 3
[13891]LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS
[13892]3. “Enter goin (if any) from line 16, Part it. OR ee ee fo
[13894]6. “Enter your. ‘share of net Tong. term gain n (or loss) from partnerships and fiduciaries
[13895]‘7. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)
[13896]8. ‘Net long-term gain’ (or loss) from lines 5, 6 and 7
[13898](15,274.00)
[13900]sO -Céibine the aiviounts shown ¢ on lines’4 and 8 and enter the net gain (or loss) here
[13901]10. ‘if line 9 shows a GAIN, enter 50% of line 8 « or 50% of fine 9, whichever is smaller. (Enter ; zero ‘if there i is a
[13902].. loss.or'no entry on line 8)". . . Ce ee ee fe :
[13903]“PH. Subtract line 10 from line 9, Entor here and on ‘line 17, Part il . :
[13904]12. If line 9 shows a LOSS, enter here and on line 17, Part II the smallest of the following:
[13905](a) the amount on line 9; (b) the amount of taxable income on Form 540 or 540NR, computed without capital
[13907]gains and” fosses;‘'or (c) $1,000 Carryover Loss (14,274.00)-
[13909]Part N-SALE OR EXCHANGE ‘OF PROPERTY UNDER SECTIONS 18181-82
[13911]13. Enter gain (if any) from line 22, Part IV
[13912]14. Enter gain (if any) from line25, Part IV
[13916]15. Enter your share of gain (or loss) of Section’ 18181-82 items, from partnerships and fiduciaries
[13917]16. ‘Net gain (or loss). If GAIN, enter on line 5, Part |; if LOSS, enter on line 29, Part V
[13919]' PART 1l-TOTAL NET GAIN OR LOSS FROM SALES OR EXCHANGES OF PROPERTY
[13920]17. Net gain (or loss) from line 10 or 11, Part | vt ;
[13921]‘18. Net gain (or loss) from line 31, Part IV ,
[13923]19. Total net gain (or loss)—Combine lines 17 and 18. Enter here and: on . Form 540 « or Form 540NR, poge 2, Part
[13924]H, fine 23 . soe ee : roe .
[13926](Rev. 1970) (Schedule continued on reverse) : Page 1
[13927]NW 6326 Docid:32245535 Page 14f
[13929]PERS worzepiiete | a3a-agod.
[13931]3H!
[13933]U) S Department of the Treasury / Internal Revenue Service ~ 960
[13934]Individual imcome Tax Return @ 19
[13936].. 1969, endin
[13938]For neler ‘January 1-December 31, 1969, or other taxable year beiNNiNg ............. .-eceereseereeeretecs
[13940]First namo-ond initial (If joint return, use first names and middle initials of both) Last nome . Your si security a
[13941]5 |
[13942]E . LL
[13943]'E Homo address (Number, and street or rural route) 7
[13944]g
[13945]F City, in or post office, State and iP co code * - ‘ Spouso's soial security number
[13947]'
[13948]1 '
[13950]Fa
[13951]Enter below name and address used on your return for 1968 (if same as above write Same’). If none filed, give
[13953]reason...If changing from separate to joint or joint to separate returns, enter 1968 names and addresses. Spouse s occupation
[13955]‘Your present employer and address
[13957]Your: | 2 (] Single to Ss j 4 (J Unmarried Head of Household
[13958]aie ~~}.2 [1] Married filing joint return (even if only one had income) - ; 5 (J Surviving widow(er) with dependent child .
[13959]US— | Married filing separate return and spouse is also filing a return. 6 M. fil
[13960]- (Check | 30 If this item checked give spouse's social security number in ‘space provided - is sot equineaee file return ane spouse
[13961]" only. one)!. above and enter first name here
[13963]Pour 65 or over Blind '
[13965]The Check boxes for exemptions which ‘apply
[13966]‘on | 7a Yourself. . . . Loe a QO C7 | Enter
[13967]va : 5. -7b. Spouse (only if her (his) income is included in this return or, she (he) had no income) O . oO , oO oF oeKeS
[13968]“os. ] @ap 8 First names of your dependent children who lived with you ~~ j a
[13969]e| Eu. 7 ; Enter number >
[13970]: , E—Enter figure 1 i ° Ts _, | WoMonths lived 00 Su S
[13971]ELE fo omen | SiMe san, teus Line met Tw naan | MeMont | $500 | Supe s,| © oe
[13972]sf aw DEPENDENTS (if more space is needed, use other side) a page ‘2 of instr, income? | write ““ALL.’ others
[13973]-&£ 3. tf [ae a Se SETS
[13974]Ss 10 ;Total exemptions from lines 7, 8, and Sabewe. ee ne OD L :
[13975]5 my os , , = a 7 — a
[13976], 8 a + Wages, salaries, tips, etc. Attach Forms W-2. If unavailable, explain on back. . le ee
[13977]F & | 12a Dividends “Belasion 3 ta = Hae sen 8) & Less 12b Exclusion $.... 2.0) Bi Banya 12c)_ 0 —
[13979]H =] 13 Interest (If over $100, list in Schedule B, Part ll)... ee ee 3) 465 7|—
[13980]zx 3. : . . . : . sy .
[13981]re ane 14 Other income from Schedule C (1, Schedule D (1, Schedule EO, ScheduleF OQ . . 14 —_
[13982]ag {Add lines 11 thru 14) (see back) os
[13983]os 15a Total, $ L b 4 7 — Less 15b Adjustments $ f_% ¢ ? , Adjusted Gross Income p>
[13984]x L oo A If line f5c is $5,000 or more, go to Schedule T, to figure tax and surcharge. (Omit lines 16a and 16b.)
[13985]_ flB 7 _B Also go to Schedule T, to figure tax and surcharge if you itemize deductions; or claim retirement income credit, foreign tax credit, or
[13986]yl ry 5 % investment credit; or if you owe self: -employment tax or. tax from recomputing prior year investment credit. (Omit lines 16a and 16b.)
[13987]. 8\x ¢ If neither A nor B applies use Tax Tables instead of Schedule T. Complete lines 16a, 16b, and 16c. See paragraph Do on back for
[13988]. & iS 2 rules under which the IRS will figure your tax and surcharge.
[13989]§ 5 16a: Tax from Tax Table: AO, BO, or C a “(check one) 16a ‘a =
[13990]m=) Ba) 16b Tax surcharge on amount on line 16a (see’ Page 10 of instr) 16b hm Vy YY i
[13991]: 4 : 16c Total add lines 16a and: 16b OR enter amount ‘from Schedule T (Form 1040), line 11. a
[13992]; = £. +17. Total Federal income tax withheld (attach Forms W-2) . . iz. ViKa“‘“é
[13993]wo 2 a) 18 © Excess F.I.C.A. tax withheld (two or more employers—see page 5 of instr.) . o : — ig money ordér pay- Z
[13994]‘O | 19 [ Nonhighway Federal gasoline tax—form 4136, [1] Reg. lnv.—Form 2439 | 29 | —— % able to Internal Z
[13995]met GAS Revenue Service. Z
[13996]2 20° 1969 Estimated tax payments (include 1968 overpayment allowed as a credit) - . 7 fT LLL
[13997]F >= Total (add lines 17, 18, 19, and 20) wee a i
[13999]afsd). -' . toe
[14000] &. as 22 Mf line 16c is larger than line 21, ———————-————_-> enter BALANCE DUE / 22 |
[14003]Ez s& 23 s/f line a1 is larger than line 16c, ————————----—-—-P enter OVERPAYMENT
[14004]a <. 24. Line 23 to be: (a) Credited on 1970 estimated tax > $ ; (b) Refunded p> $
[14006]"Under penalties of perjury, | deciare that 1 have examined this return, including accompanying schedules and statements, ond to tho best of my know! ge and belief it
[14007]is true, correct, and complote. 1 .
[14009]a D sam signature : . _ Date’ * p> Signature of preparer ather than taxpayer, based on : Date
[14010]be . - all information of which he has any knowledge. ‘
[14012]Addross
[14014]vv) SCHEDULE. D’ Gains and Losses From Sales or Exchanges —
[14015]vo (Form 1040) |. € p ee ° a ‘ ; 1968
[14016]‘YAS. Treasury Department @ reper y
[14018]. Internal Revenue Service - Attach this schedule te your income tax retucn, Form 1040
[14020]' +’ Name as shown on page 1 of Form 1040 : : . Social Security. Number
[14021]et Part I-—-CAPITAL ASSETS—Short-term: capital gains arid josses—assets held not more than 6 months
[14022]rs a How ann { . rr H :
[14024]h, Cost or other |
[14025]basis, cast of
[14027]a a. Kind af prop. b. Description i quired. |
[14029]. i ‘ a.
[14030]. Ory, Indicate d. Date " 7 . zg. Gepreciation | subsequent improve-
[14031]security, real acquired the Date sold, ft Gross gales 1 altewed (or i ments (if nat i deli
[14032]estaie, or other. | ina. day, yr.) | Os. GBY, Yr. Pr { allowable) since | purchased, attech ~ | a
[14033]toe {
[14035]Specify) explanation) and
[14037]expense of sale
[14039]acquisition
[14041]2 Enter your ‘share at net short:teriy gain (or toss) from pz snershipg ahd fiduc’ _ . .
[14042]3. Enter unused’ short- -term capital lose” carryover from preceding taxable years {attach : statement). . 2. ee
[14044]4 Net short-term gain (cr loss) from tines 1, 2, and 3 Coe . re)
[14047]Long-term capital gains and losses-—assets heid more than 6 months hs (12 months or more for certain livestock)
[14049]5 Enter gain from Part 1, fines... Oe ae ee ee i
[14051]et ae ea
[14053]Cia Total long: term gross sales price _ _ |” I
[14055]'
[14056]'
[14058]" 6a Enter your Share of net long-term gain (or toss) from partnerships and fiduciaries, 2 2, 5 6 ee aw : aos
[14059]vt 6b Enter your. share of net long-term gain from small business corporations (Subchapter 8}. 0. 2. toe eee
[14060]- 7 Enter. unused. long: -term capital loss carryover from preceding taxabl2 years (attach stalementy 2. 6 8 we ne
[14061]S Capital gain dividends (see Form 1040 Instructions, page). 2 Le Se woe
[14062].3 Net long-term gain for ‘foss) from tines 5,6a,6b,7,and8. 2. 6. we ky ee ee ee ee bk
[14064]“40 Combine ‘the.: ‘amounts shown on fines 4 and 9, and enter, the net gain (or oss) Here - ey ee ae
[14065]‘11 iffine 10 shows a GAII~-Enter 50% of line 9 or 50% af line 16, whichever is smaller. (Ener zero if there is a loss ar no}
[14067]entry on line B.) (See reverse side tar computation of alternative tay ee hin ai
[14068]&2 Subtract. tine, 11 from fine 10.° Entor here and in Part IV, line 1, on reverse sidé. . 2... : ; =f
[14069]Loy en
[14071]A3 if line 10 shows. a LOSS-—Enter here and in Part IV, lina 1, the smallest of the following: (a) the amount on line 10: (by
[14073]the amount on Form 1040, page 1, geal 1b, computed without regard to capital gains or lcsses; or (c) $1, 000 Lteq 3 |
[14076]Part il--GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245
[14077]assets held more than 6 months (see instructions far definitions)
[14078]Binera doudlts ‘neddings appear, use the first heating for section 1245 and the second heading for section 1250.
[14080]a. Kind of property and how acquired (if necessary, attach statement | @. Cost or other basis, cost of
[14082]fh bel t b. Date acquired Date sold L Gre f in subsequent improveriants (it
[14083]of descriptive “fo indiesto pe preent 8 1245 or 1250 imo., day yr) (nio., day. ye) d. Gross sales price not purchased. attach opie
[14084]nation) and expense of s3io
[14086](oar neers een LLL CCE Ses “mm
[14087]~ £. Depraciation altowed (or allowable) since acquisition | : :
[14089]‘, _ : 1 Ordinary gain :
[14091]a fh Priat ‘1 fanuaty 1, 1962 | 4-2. After December 31, 1961 | g. Adjusted basis he Tota! gain closer or hz oh) 1. other gains >
[14093]as GR | 40 loss suri of £1 and t-23 id fess gy | reine pevtathieaiaden + (less ip
[14094]4a "After December 31, 1953 (see ‘astinetions)
[14096]'2 Total ordinary gain. Enter tere and In Part IV, line 2, on reverse side . i _
[14098]+8 Yotal other gain. Enter here and In Part I, line 5; however, if the gains do not exceed the losses when this amount is
[14100]gombined with other gains and losses from section 1231 property enter the tn tal at colunnt
[14103]i
[14104]i
[14106]i
[14109]SCHEDULE T
[14110](Form 1040)
[14112]Department of the Treasury
[14113]internal Revenue Service
[14115]Tax Computation
[14117]Attach this schedule to your income tax return, Form 1040
[14119]Social Security Numbsr
[14121]Name (as shown on Form 1040)
[14123]Tax Computation
[14125]1 Your adjusted gross income (from line 15c, Form 1040) .
[14127]Note.-—If your adjusted gross income is less than $5,000 and you choose to take the ‘standard ‘deduction
[14128]instead of itemizing your deductions, omit lines 2, 3, 4, and 5. Find your tax.in the tables on pages 10-12
[14129]in the instructions and enter it in line 6a instead of making a percentage rate computation.
[14131]Enter on the line at the right the amount of your deduction figured under one of oo |
[14133]methods: Lob
[14134]—lIf you itemize deductions, enter the total from Schedule A (Form 1040), line 14
[14135]‘OR
[14137]—Figure your standard deduction as follows:
[14139](a) Enter 10 ‘percent of tine 1. ‘put’?
[14140]>not more than $1, 000 ($500 if
[14141]married and filing separately) .
[14143]ter the larger of (a) or (b) on the
[14145]Enter the sum of: $200 ($100 if
[14146]""cmarried and filing separately)
[14147]’ * plus $100 for each exemption
[14149]- claimed in line.10 of Form 1040,
[14151]line at the right. If your spouse files
[14152]a separate return, determine your
[14153]deduction in the same manner that
[14155]she (he) has.
[14157]but do not’ enter more than
[14158]: + $1,000 ($500 if married an
[14159]filing separately) fs
[14161]Subtract the amount on line 2 Q, the amount on line 1 and enter the balance here .
[14163]‘ Enter number of exemptions claimed on fine 10, Form 1040, - o Multiply this number by $600, and
[14164]enter the amount on this line .
[14166]Subtract the amount on line 4 from the amount on 1 line 3 and. enter ‘the balance here. “This i is your
[14167]taxable income .
[14169]a Tax: Use the appropriate Tax Rate Schedule on page 9 of instructions to figure y your tax on the amount on
[14171]fine a Le Ye oo
[14173](Check if tax is from: Tax Table c. Tax Rate Schedule ‘oOo. Schedule D oO. or Schedule G Oo) “| 4 :
[14175]Tax ‘surcharge. \f line Ga is less than $730, find surcharge from tables on page 10 of instructions. If line 6a :
[14177]is $730 or. more, multiply amount on line 6a by .05 and enter result. (If you claim retirement income -
[14179]credit. use Schedule R (Form 1040) to figure surcharge.) . : an es a Dene
[14180]6c Total (add lines 6a and 6b) . Pap | iene
[14182]Special credits l
[14183]7a Retirement income credit . . 7
[14184]3 , i
[14186]; Th Investment credit
[14187]7c Foreign tax credit .
[14189]. 7d Total (add lines 7a, 7b, and 7c)...
[14191]8 Income ta tax (subtract line 7d from line 6c) .
[14193]9 Selt- ‘employment tax (from Schedule SE - (Form 1040), line 13).
[14195]10 Tax from recomputing prior-year investment credit (attach statement) .
[14197]nu Total tax (add lines 8, 9, and 10). Enter here and on line 16c, Form 1040 (make no entries on line 162 _
[14198]or 16b, Form 1040) ranean nr woe, 8
[14200]te U.S. GOVERNMENT PRINTING OFFICE 1969—-O-337-051
[14203]SCHEDULE B
[14204](Form 1040)
[14206]Department of the Treasusy
[14207]internal Revenue Servics
[14209]. Dividends and imterest os
[14210]Income Schedule
[14211]Attach this schedule to your income tax return, Form 1040
[14213]Social Security Number
[14215]. Name (as shown on page 1 of Form 1040)
[14217]PART !|—Dividends income
[14219]_ 1 Gross dividends and other distributions on stock (list payers and amounts—write (H), Ww), (J), for stock
[14220]- held by husband, wife, or jointly)
[14222]Total line 1
[14224]er . eee b 7 ‘
[14225]2 Capital gain distributions (see Y ;
[14226]page 5 of instructions) . . | .
[14227]3 Nontaxable distributions (see | LL
[14228]/.
[14230]Page 5 of instructions)
[14232]4 Total (add lines 2and3). 2. 2 1.) ef _
[14233]5 Dividends before exclusion (line 1 less 4—not a
[14235]less than zero). Enter here and on Form 1040,
[14236]line 12, inspace provided. . . . . 1 2.
[14238]PART’ ll—Interest Income (list payers and amounts below)
[14240]_ Earnings.from savings and loan associations and credit unions
[14242]Enter here and on line 13.
[14245]- SCHEDULE A
[14246]‘(Form 1040)
[14248]Department of the Trossury
[14249]Internal Revenuo Service
[14251]_ . Name (as shown on Form 1040)
[14253]itemized Deductions
[14255]Attach this schedule to your income tax return, Form 1040
[14257]an:>)
[14258]| 1969
[14259]Sociol Security Numbor
[14261]itemized Deductions—You have a choice between two —
[14263].. deduction ‘methods. You can either itemize your actual
[14264]a _ deductions or take a standard deduction. Deductions may be
[14266].. itemized for charitable and other contributions, interest ex-
[14267]“pense, medical expense, certain taxes, casualty losses, child
[14268], care, and other items described in the instructions on
[14269]’ back. If you take the standard deduction, you will get an
[14271]"hospital care, medical insurance premiums, etc.
[14272]“. 1 One half ef insurance premiums for medi-
[14273](cal care (but not more than $150) .
[14275]. 2 Medicine and drugs .
[14277]_ or otherwise) for medicine and drugs, doctors, dentists, nurses,
[14279]“amount equal ta 10 percent of the income you report on fine
[14280]15c of Form 1040, but not less than $200 plus $100 for.
[14281]each exemption claimed on line 10 of Form 1040 (subtract
[14282]$100 if married and filing separately). The maximum
[14283]standard deduction is $1,000 ($500 if married and filing
[14284]separately). If you choose to itemize your deductions, fill
[14285]‘ in the appropriate spaces below. ‘
[14287]' 3 Enter 1% of tine 15¢, Form 1040 . .
[14288]4 Subtract. line 3 from line 2 (not less than
[14289]- zere) .
[14291]. § ttemize other medical, dental expenses
[14292](Include balance of insurance premiums
[14293]_ Not deducted on fine 1) .
[14295]required statement). Enter total of
[14296]such items here. «6 6) ee |_|
[14298]11d Total contributions (add lines Lia,
[14299]1lb, and 11c—see instructions for
[14300]limitation) . 9... . 0. 0.
[14302]Interest expense—Home mortgage .
[14303]Instaliment purchases
[14304]Other (itemize) -.
[14306]. 6 Total (add lines 4 and 5) .
[14308]7 Enter 3% of line 15¢, Form 1040: .
[14310]8 Subtract fine 7 from line6.0. =. ~=.~«w
[14311]9 Total (line 1 plus line 8)... o>
[14312]Taxes.—Real estate .
[14314]State and local gasoline . .
[14315]’ General sales (See page 15 of instructions)
[14317]12 Total _interest expense... sO
[14319]alimony, union dues, casualty losses, etc.
[14320]tL rack
[14321]See instructions. - vd g:
[14323].*, State and local income
[14325]: Personal property .
[14327]"10 Total ‘taxes
[14329]structions on back). . . . jf
[14331]Ri:
[14332]3
[14334]q
[14335]ed
[14339]a
[14342]ek NGI
[14344]er
[14345]R
[14347]h
[14349]y Suk eeticd “98 RY
[14351]™ a “All Swoc vel
[14352]) een
[14356]: ef Inpus Tees.
[14357]ray MY: Slendde. —
[14358]ft aM AMeL Pe
[14360]AMAWMGS fe
[14362]Uh b..
[14363]ob €.
[14365]h ffs
[14366]Zz)
[14367]forts.
[14369]WO.
[14371]j
[14372]ty
[14373]i
[14374]“yr
[14375]3
[14377]i
[14378]ye:
[14380]i
[14381]af
[14382]ia
[14383]8
[14385]f ne eeenerneernee ten
[14387]Ff
[14388]a
[14390]Abe,
[14391]AOR.
[14392]BMAF |
[14396]i al: ane
[14397]Lo LF.
[14399]2a | 4.67)
[14401]LAGF.|
[14403]a. ra
[14405]3269.
[14407]tab) | Aare 479th.
[14409]LE 1 bes. Levie
[14411]OF |. be LK A
[14413]. L2.:6F i i.
[14414]&. em |
[14415]69, Me 9N
[14417]“yap
[14420]“1279
[14422]B76 IK
[14423]2: C9 WL HCG. te (G6b3
[14424]24. | SMS
[14425]s- om: iq 5235
[14427]245 | W/oro=
[14429]gal “FES Fon
[14431]er |
[14433]A re ;
[14436]2 és 23 apes .
[14437]“fo: 67h : od, Mes
[14438]fe: SPR BIS: von
[14439]eth D, Cla) =
[14441]Me G4 3S, 320-4
[14443](67 bh.
[14444]See |
[14448]A Gah wear
[14450]“pts AL Peers |
[14452]ee Ht 207) 97h
[14455]AAT VE. Oma aay
[14457]prem Ng
[14459]“43 46 Mauree dbey
[14460]GEANADA Hite S, Cae: c
[14462]@ part of | U.S:
[14464]sponses ate n-t fon pnectien.—t
[14468]HCO. w. Ag TS
[14470]Se ee a
[14472]= Wheres. - AeviTr— ee
[14474]wed eee a.
[14477]Combined "Department of the Treasury / Internal Revenue Service r
[14478]Yoo us individual income Tax x Return a
[14480]“For the year January. 1-Devembor 31, L, 1963, or « or other taxable year beginning.
[14481]Ce S22 ane 7 PTF
[14482]Sawvel ¥ PAVLLLS Raby
[14484]i a iG ™ 4a NT & (4) Ee ay. A ves Pv rales
[14486]| FRA. wa DA H Lind, cf 4 At eo qi Aft. Your occupation
[14487]a | . a if- &y if, ;
[14488]“oe . . Spowie! 8 social security umber
[14490]_ B99 J iid | thd Jo
[14492]Spouse’ $ occupation
[14494]ter below. name and address used on your. return for 1968 (if same as above write “Sam”): If none filed, ‘ive | Spouse's
[14495]reason. If changing from separate to jgint or joi ‘to, separate’ returns, enter 1963 names and ad resses.,
[14497]34n7 VEY ~ G43 AS Ap YE Obi age Hi
[14498]Name and address of employer at time cf filing 5 _ :
[14500]1] Singie . 41] Unmarried Head pfHousehold
[14501]2 EX Married fi filing joint return (even if only one had income) . 6 Surviving widow(er) with dependent child
[14503]3 O Married tiling separate return and spouse is ajso filing 2 retura.. 6 (] Married filing ‘separate return and spouse
[14504]If this item checked give spouse's sociat secirity number in space provic ad ig not filing a return
[14505]above and enter first name hére b>
[14509]Check boxes for exemiptions which apply , “Reger ~ '65 or over *. Blind |
[14510]. Enter .
[14511]ae re number _
[14512]cer “Tb Spouse. (applies only if line 2 or line 6 ischeckedy . 5, . | checked > a ‘.
[14513]. Hl .§ First names of your dependent children who lived with you~ wo, on le
[14514]“g |: FRED -. Berad— Eli sé - Thootas . _! \ Y
[14515]RE ee Pam | Ger | le | ame
[14516]iv gh DEPENDENTS | (f more space fs neded, wispother side) instructions, 3-2. | income? | write VAL. oo
[14517]. Be : : _ ils
[14518]" oe : _ i |
[14521]a
[14523]"Please attach Ca:
[14525]“Va Dividends a Cabs befors a 7” sail 12b Less Exclusion nem b
[14527]exclusion
[14529]13 snterest t (Enter total here and if over $100, also list in Schedule B, Part ll)» ce ee
[14531]re Other. income: Total from attached schedules (check schedules used—C [1], D ay EO, F DD Sted?
[14534](Gross
[14535]“5b Less Adjustments [rca] $
[14536]G8, 20 Scheauie. 7, to figure tax and surénarge. (0 if
[14538]Fadd Unes 11, if
[14540]15a Tota 12e,.13 & 14.
[14542]i as Te ana 17,)
[14544]‘ as a | @ Go to Sch. T to: figure ta and surcharge if you itemize ‘deductions; or Glaim ratiremént income Credit, jareign i tax create, or invents
[14545]we 5 gi .' ment credit; or if you owe self-employment ‘tax or tax trom recomputing prior year investment credit, Yp gn 3 hy
[14546]B: x I- © It neither of above two items applies, go to Tax Tables instead of Sch. T..Complete lines 16, 17,&18. Vee dda
[14547]} woe, _ : u
[14548]25-5] 16° Tax ‘from Tax Table (see tables on T-2 and T=3). 5 6 a Sp : -Y na LY
[14549]' # 5g 17 Tax surcharge on line 16 (see T-1 for tax surcharge tables) . {a 17 .
[14550]. > °|.18. Enter total of lines 16 and 17 OR amount trom Schedule T, line
[14552]if from Tax Table AC, BE] C (; Tax Rate Sch, (, Sch. D
[14553]Total Federal income tax withheld (attach Forms W-2 to back)
[14554]“20 -Excess..F.1.C.A. tax withheld (two or more employers—see R-2) ee L
[14555]21 ‘gO Nonhighway Federal gasoline tax, Form 4136; [] Reg. Inv., Form 2439
[14557]722 ‘ 1969 Estimated tax payments (include 1968 overpayment allawed asa credit) L.
[14558]{23 Total odd lines 19, 20, 21, and i, and 22) Soli ees
[14560]or Money
[14562]st
[14563]3
[14564]rf S| 24 it ine 1B.is larger than line 23, enter BALANCE DUE. Pay in full with tun —————<p 24
[14565]wn |. 4
[14567]f Sal: a
[14568]; = 5 28 If line 23 | is larger than line 18, enter + OVE RPAYMENT - —_ ; oe Ge -
[14569]" "| 26. Line 25.to be: (a) Credited on 1970 estimated tax b> $ ; 3 (b) Refunded > $ ; :
[14571]e: (a) Grediter po A .
[14572]Under penalties of perjury, | dectare that I have examined this reluro,. including accompanying § sehedles and statements, and to" tha ‘best af my wate a it
[14573]_ § true, correct, and complete. : oo
[14575]4 a e o > Your signature ° _ . Date p> Signature of preparer other than taxpayer, based on Date
[14576]4 OD : . all information of which he has any knowledge.
[14578]t m=
[14580]Ds Spouse's Signature a filing jointly, 80TH list sign ¢ even if f only one had Income) Address hm
[14583]' SCHEDULE A
[14585]oe 3 Enter 1% of line 15¢, Form 1040, . .
[14587]2 line ee
[14589]_ 10 Total taxes 2... se 730= | here and on Schedule T, line 2). im] Spon
[14591]LOCUS Erno SRR
[14595]. i a
[14596]‘(Form 1040) |  Remized Deductions
[14597]"Department of the Treasury > See instructions on A~l and AW,
[14598]internal Revonua Service ; D> tf you use this seheiute, attach f to Ferm 1049,
[14599]Name as shown on Form 1 a ” . O) . vo ve Social Beciaty Number .
[14600]rans) | we Ss f } iM _ ce : 32a} Jatt | fp mk, j 7 797
[14601]Medical and dental expenses (not compensated by insurance Contributions. —Gash—tneluding checks, money orders, etc,
[14602], or otherwise) for medicine and drugs, doctors, dentists, nurses, (Iternize).__
[14603]. hospital « Care, insurance premiums for medical care, etc,
[14604]2 One halt of insurance premums fer mec:
[14605]cal ‘care: (but not more than $150). .
[14606]2 Medicine and drugs. . 2's 0 co
[14608]4. Subtract line 3 from line 2. Enter differ-
[14610]” ence: Cif less than zero, enter zero) .
[14612]5 itemize “other medical and dental ax-
[14613]", penses (include balance’ of insurance
[14614]premiums for medical care not déduicted
[14616]Total cash contributions . oo. 4.
[14617]12 Gther than cash (see, instructions on
[14618]A-1 for required statement). Enter
[14619]total for such items here. 2 2.
[14620]‘12 «Carryover from prior years (see In- | Lo
[14621]structions on A-2) rc . arinlanetsans frome
[14622]14 Total contributions | (add lines 1], te _ .
[14623]12, and 13—see instructions on A-2. :
[14624]for fimitation) . . oe : Hole
[14626]Interest expense—Home mortgage toe
[14628], Ty ~~ 4,
[14629]installment purchases © 6 6 we oe po -
[14631]Other (itemize)
[14634]15 tt otal interest expense 6 =
[14635]i, — ads een al
[14637]6 ‘Total (add fines 4 and 5).
[14639]7 Enter 3% of line 15c, Form 2040 ,
[14641]8 Subtract line 7 from fine 6. Enter differ:
[14642]ence (if less ‘than zero, enter zero)
[14644]9 Total ‘deductible medicat and ‘dental ex-
[14646]Naneous “edurtions for child care,
[14647]alimony, union dues, casualty losses, etc.
[14648](sze instructions on A+2)__.
[14650]1965 jf byioté TAK betekival ted eo
[14652]penses (add lines Land 8). 2). Bm im
[14653]rrr en nn a i
[14654]Taxes,+—Real ‘estate . . ene nn nen ne en
[14655]State and focai gasoline. . . . a Lae _ _-
[14657]: General: ‘sales (see sales tax tabes) a oe seed cenetarent sneer —~ ef
[14658]met neeme 18 Total rile Shaan deductions . =| , as
[14660]lines "9, 10, 14, 15, and 16— enter
[14662]| Docld:32245535 Page 156 __
[14665]SCHEDULE B ‘Dividend amd imterest income §~ “|.”
[14666]: . oo BAY
[14667](Form 1040) . f See instructions on B-1 19 6
[14668]Titeanl Revenue Service ; D. if you use this schedule, attach it to Form 4040 oe
[14669]Name as shown on Form 0 7” ee enn an eee ok Security. Humber
[14670]— Samyen Flyenss. Kogyo BRIA 797.
[14671]i - PART I-—Dividen d frcome | | ; PART Nae Ankerest Income .
[14672]i. Gross dividends and other distributions on stock (ist payers | sociations vadit
[14674]i Earnings from savings ard loan associations and credit
[14675]and amounts—write (H), (W), Gi). for stock held by fius- unions list payers and armounts) .
[14677]band, wife, or jointly)
[14679]— Sr tae . x, stu. eo
[14681]pee Se ee ee ee a eens enamine ore para st : on :
[14682]i
[14683]t
[14685]4 _ .
[14686]da. ; _
[14687]: = _ eh » Other interast on tank deposits, bands, LEGS
[14688]4 3 i tax i refunds, ete, (ist payers and amounts) yf,
[14689]" ~ ere an rn a einen nates me ste Lies
[14690]a Lo ‘ ~~ — en
[14691]}. a acne
[14693]ay 7 nec ane cesem ene
[14694]Boo:
[14695]a
[14696]ne ent ft a If A RR RR A A IT PP
[14697]i . : ae
[14698]Hd 1
[14699]of wet ~
[14700]” _ — oe
[14701]th a _ _ _— pene ence een Lae. a a . _.
[14702]Vea po OS a
[14703]ines i = — a — oe — ee meen fence fers gene tnt se re —
[14705]Booed . es ee oe a ae
[14706]", ht 2 Total of line 1-. 1... 2 we
[14707]at ty 3 Capital gain distri- |
[14708]Boot, butions (see instruc- |
[14709]mo fee tions on B~1) . ee
[14710]4 , t 4 Nontaxable distribu- |
[14711]% was tions .(see instruc-
[14712]hy tionsonB-1). . . | en tmnnner nn pene
[14713]. gt Total 1 ted lines 3 and 4)...
[14714]. 6 ‘Dividends before exclusion (sulstract | 7 - ans ns hi
[14715]: . "fine 5 from line 2). Enter here and on | 3 Total interest Income. Enter here and
[14716]ioe not . . 4 ak | é —_
[14717]| form 1040, tine 108 __o8 Form 2040, Hine Uh : a MOST. Lee
[14719]7
[14722]SCHEDULE D Sales or Exchanges of Property
[14723](Form 1040) pb See instructions on D-2 and O—2. ,
[14725]Department of the Treasury | B+ Sf you use this schedule, attach it to Form 1940.
[14726]_dnternal Revenue Service
[14728]h Fi aoc. | fi “Tt ee , Social Security Sap
[14729]Name as shown on Form SAMUEL + fyeers Key Bad JZ 7
[14733]Part I-—CAPITAL ASSETS—Short- tert capital gains and losse rete heid net more than 6 months
[14734]need een women _ canes: maleate
[14736]{ c. How r ee ne
[14738]Kind of 1 ac: . ne Cost or other
[14740]a, Kind of prop- -b, Description Quired, asis, cost :
[14742]erty. indicate (Examples: ‘90 she a “Enter & Rate e. Bate sald | f. Grosg sales | * peered cigtion sabsoqusnt,mpiove i. Gain or loss
[14743], “we acquired ore Be a sani @
[14745]estate,’ or other a Ca "dep " symntat | (ra9., day, (yr) fma., say, 91.) purchased, attich (F plas g‘less h)
[14746](Specify) . explanation) and
[14748]+ &xpense of sale
[14750]anne ge a bee eee eek
[14752]2 Enter-your share of net short-term gain (or joss) frern part ’nerships and fiduciaries
[14754]3 Enter unused short-term capital loss carryover from. preceding $ taxabie years {attach statement)
[14755]4 Net short-term gain (or loss) frorn lines 1, 2 2, ar and 3
[14757]Se
[14759]. 5 Enter gain from Part th line 3
[14761]. Ga Enter your share of net long-term gain (or loss) from partnerships and fiduciaries. =... .
[14763]6b Enter: your Share of net long-term gain from smail business corporations (Subchapter S) .
[14765]7 Enter unused long-term, capita! loss carryover from preceding taxable years (attach statement)
[14766]8 Capital gain ‘dividends veo Se ee ee
[14767]9 Net long-term gain (or loss) from lines 5, 6a, 6b, 7, and 8. ee
[14768]10 Combine the amounts shown ori lines 4 and 9, and enter the net gain. (cr ios) here . ee
[14769]11 IF LINE 10 SHOWS A GAIN—Enter 50% of line 9 or 50% of line 10, whichever is smailer. (Enter zero if thera is a loss |.
[14771]or ne entry on line 9.) (See reverse side for computation of. alternative tan). 2 ew we eh ,
[14772]12° “Subtract: line 11 from line 10. Enter here and in Part IV, line 1, on reverse side .
[14774]13 IF LINE 10 SHOWS A LOSS—Enter here anc in Part IV, fine 1, the smallest of: (a) line 10;
[14776]Forni 1040, if tax table used) computed without capital gains or losses; or (c) $1,000... al . 8
[14777]es ttre
[14779]‘Part I—GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SEC MONS 1245 AND 1250—
[14780]assets held more than 6 months (see instructions on D~1 for definitions)
[14781]‘Where ‘double headings appear, use the first heading jor sectlon 1245 and the second heading for section 1250.
[14783]nation) and expanse of sale
[14785]! oe
[14787]. Kind, of property and how acquired (if necessary, attach statement . . . e. Cost or othey basis, cost of
[14788]of descriptive deisils not shown balow—write 1245 or 1250 b. Date acquired m. Date sold d, Gross sales price “subsequent improvomants (if
[14789]to indicate type of asset) (mo., day, yz). Gags, day, yn) fot purchased,’ dtiach 2xpla-
[14791]i. Ordinary gain a
[14793]f-L, Prior to January 1, “1962 iva ‘Alter December a1 136! 1 8. Adjusted basis h, Total vain (lesser of f-2 or bh)
[14794]~~ = OR == [2:2 Alte Os OR--—=-——=-4 (a tess sum of fl and f-2) |. dese UR emem wm nee “i iteasn
[14795]Priaz to January 1, 1964 | Afler December 31, 1963 : ae instructions) 1
[14797]2 Total ordinary gain. Enter here and in Part lV, tine 2, on reverse side .
[14799]7 a : . . we 1 .
[14800]3 Total other gain, Enter here and in Part |, tine 5; however, if tha gains do not exceed the josses when this emount is
[14802]combined’ with other gains and fosses from section 123) property enter the total of column j in Part Ul, line 1. 2°
[14805]“NWW-88326 Docld:32245535 Page 158 - a
[14808]OR Ds ac al blk AO
[14810]ORE awe
[14811]poo no . . , : _ }
[14812]ULE TS PO , Pent : , Che oe
[14813]1040) oe Tax Computation 1969 =
[14814]ofthe Treasuy | Bb If ao entry is made on line 14, line 16, or line 17, keep this for your records : YW) Nosy ey, \ded h
[14815]‘enue Service “4g . : . : . . : ded by the
[14816]b> If entry is made on line 14, line 16, or fine 17, attach to form 1040 ons. This is
[14817]- - “s ; 12 opm ene ce - as arT ean enna tule T. Also
[14818]shown on Form 1040 ° WA so Social Security Number : :
[14820]SAMUEL PuYeLis vu BY 222} / Al 777 \
[14821]adjusted gross income (from line 15c, Form 1040). -° + 8 ee et ge ee bee rm
[14822]iif your adjusted gross income is less than $5,000 and you cheose to take the standard deduction ee
[14823]fad of itemizing your deductions, omit lines 2, 3, 4, and 5. Find your tax in the appropriate table 7
[14824]r.B on 1-2 or C on T-3), Enter tax on line 6 below. ‘ ie ormare.
[14825]onthe. line. at the right the amount of your deduction figured: under one of the following + [there isnotax,
[14826]j , RT ns . : “Wini-
[14827]you itemize deductions, enter the total from Schedule A, line 17 —
[14828]OR. oO i =
[14829]gure your standard deduction as follows: , ; 5 6)
[14830](1). Enter 10 percent of fing 1 but do not ) o
[14831]-" ‘enter. more than $1,000 ($500 if - . ) - 0
[14832]«married and filing separately): .- $ Enter th larger of bat) 2 9
[14833](2) Enter the sum. of: $200 ($100 if j right. If your spouse files 3 O.
[14834]_ married and filing separately) plus . a separate return, deter- 5 3
[14835]$100 for each exemption claimed in . mine your deduction in ) 0
[14836]line 10 of Form'1040, but do not __— : the. sama manner that 3 Oo -
[14837]eriter, more than $1,000 ($500 if : , she (he) has. . i») i 9 .
[14838]married and filing: separately) 8 $ : 7 9
[14839]rn me aa a : 3 oO
[14840]tract the amount on line 2 from the amount cn line 1 and enter the balance here, 5 8 6 eo emer entme se) 0 :
[14841]ér number of exemptions claimed on line 10, Form 1040, ....u.. ... Multiply this number by $600, and g 9 \
[14842]er the amount here a eon ee 9 8
[14843]stract’ the amount on'line 4 from the amount on line 3 and enter the balance here. This is your 3 5
[14844]able. income. Figure tax on this amount by using the appropriate Tex Rate Schedule (1, H, or HA on Q 9
[14845]- Enter ‘tax an ine 6 below. . - + + + ee i) o ,
[14847]‘ou-claim the retirement income credit, enter amount from Schedule R, line 12,here s 6 6 8 0 6 be ; of g ‘
[14848]tract line 7 fromline6 2 pe ee 2 ee eh et ce ee pe ee eee :
[14849]phen 7 Co _ : ‘of Qf 8 :
[14850]¢ surcharge. If line 8 is less than $735, find surcharge from tax surcharge tables on T—1. If line 8 Is 8 g 5 : “
[14851]35 or. more, multiply amount on line 8 by .10 and enter result here 2 6 6 ee De of oo OO \
[14852]cette | 7 po ag) 8 |
[14853]eg - oo . . of of. 0 4
[14854]tal (Add lines 6 and 9) eo 8 © © 7% 6 ® © © © 8 F 8 F -e@' 8 08 8 Oo 8 | 8 8 ( °
[14855]it 7 . . oo i en eee i
[14856]. siek, mo, . : . : vel ay 0
[14857]irement income credit from Schedule R, line 17 (attach Schedule RY. 6 2 6 + og
[14858]: - 0
[14860]vestment credit (attach Form B48). . ee ee
[14861]reign tax credit (attach Form 1116). + + + + * ss 6 * rr
[14863]o900)] O00
[14864]LOL aa
[14865]sbeoloo
[14866]|
[14869], oe os oa S| ee .
[14870]| eiaits (add lines 11,12, and 13)'6e 2 ee ee ee ee ee bet
[14871]- re . : Oo og 8
[14872]come tax (subtract line 14 from line 10). 2 2 0 © 2 ee oo ee wwe ee | eects unewene en |= 7 !
[14873]i: . eo Sd namecere i
[14874]wh : . of Oo) . 2 :
[14875]ai . ; . gt | ron fv) a ee) o
[14876]alf-employment tax (attach ScheduleSE) - 2 2 + se sf es Fe 8 2 2 0 oe oe poe 9 9 Q
[14877]vee ye  tnvae . : QO |— af of 9
[14878]ax from recomputing .prior-year-investment credit (attach Form 703) orca an 3 Qh. 9
[14879]otal taxr(add lines 15, 16, and 17). Enter here and on line 18, Form 1040 (make no entry on line 16 ey Nee 3 oe
[14880]17, Form 1040). Attach Sch. T to Form 1040 only if you made an entry on line 14,16, or 1/7 abova. . © |r : tg
[14881]eee ae Ee eee ae een mn ene a 6
[14882]te ‘Averaging.—-If your income has ° (b) a joint return, or as a surviving fus- To claim tax-free covenant bonds credit, go 6
[14883]ased substantially this year, it may .band or wife, with taxable mcome @x- enter: the amount of credit above line od
[14884]‘your advantage to figure your tax ceeding $52,000, or (c) as a head of 14, and write “covenant bonds’’ to left Go 60
[14885]@ surcharge under the “averaging household with taxable income exceeding of the entry. : . 9 0
[14886]od.”, Obtain Schedule G from an $38,000, ; : a) 4
[14887]aal Revenue Service office for full |. . Line 16-~Self-Employment Tax.—Enter ape
[14888]IS bs — a Line 9—-Tax Surcharge.—The rate for amount shown on fine 9, Part tll, Schedule sa te
[14889]Pe eB . the calendar year 1969 is 10 percent, SE. S61 25
[14890]natives Tax.—It will “usually be to The tax surcharge is an addition to the a3| 32 ,
[14891]advantage to use the alternative tax reguiar income tax. See the Tax Sure. Line 17--Tax From Recomputing Prior ° in 39
[14892]in-net long-term capital -gain exceeds charge Tables on T~1. . Year Investment Credit.—Enter the '
[14893]net short-term. capital oss, .or if you arnount by which the credit taken in a ee i
[14894]a net long-term capital gain‘only, and = Credit for Foreign Yaxes and Tax-Free = prior year or years exceeds the credit as . T-3 of
[14896]are filing (a) a separate return with Covenant Bonds.—You may claim these recomputed due to early disposition of |
[14897]ale .income exceeding '$26,000, or credits only if you itemize deductions. property. Attach Form 4255. : v4
[14899]nn | _ |
[14900]WW. 88326. Docid32245535 Page 159
[14904]a
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[14923]'. ‘SoURMSUF Aenaesip pus ‘sroarams ‘3Be-pro 203 46'¢ syateg souemsny ey,
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[14952]896! IASHELES YL OH HE
[14955]ea STE SE ee SER MEME TRATES ° PORTER a
[14957]Ua 3 ® K RA iG ti as barre Ss. es Internal Revenue Service SiN t: 0)
[14958]. LY,
[14960]i Q Cc ® m e. Ta. x R e t u r i for the year January 1~December 31, 1968,
[14962]aeesevesee seneaseeeentenceraneee , 1968, ONGING ....ceeveseeesscensesoronsees LO cesceee
[14963]First namo ond tnitiol (If joint return, use first names and middie initiats of both) Last name Your social security number
[14965]Rube |
[14967]3221 2| 7% 97
[14969]Your wre
[14973]Spouse! 3 social wa numb
[14975]Shoup’ 3 conupation
[14976]/ CUS Gt f
[14978]"ZIP. coda
[14980]Enter below namé and address used on your return for 1967 (if same as above, write “Same”'). If none filed, give
[14981]reason. If changing from separate to joint or foint to separate returns, enter 1967 names and addresses.
[14983]c
[14985]Your Filing Status—check only one: Your Exemptions Regular 65orover Blind
[14987]Ja Single - 2a Yourself. . . Of O °° QO jrumber
[14988]‘1b (Q. Married filing Joint return (even ifenly ane had income) | 2b Spouse ... a7) oO Cf checked 2.
[14989]4c O Married- filing separately. If spouse is also filing a return, | 3a First names, of your dependent children who lived’ with: _
[14991]7 enter her (his) social security number in space provided above you Fr oo . ;
[14992]2 and give first name hera__ a esis thor > AF .
[14993]\ ‘ld O Unmarried. Head of Household 3b Number of ‘ther dependents (from page 2, Part |, line 3) '
[14994]“le oO Surviving widow(er) with dependent child 4 Total exemptions claimed . . . . . OLB CG
[14995]: Income | 5 Wages, salaries, tips, etc. _If not shown on attached Forms W-2 attach explanation |5 & 250) 20
[14996]a Uf Joint re 6 __ Other income (from page 2, Part li, line 8) 6 | OGIO
[14997]’ * & allincoma 7 Total (add lines 5 and 6) ; Z| OS //9 “Oo
[14998]ay of both EE Adjustments to income (from page 2, Part Ill, line 5) 8 ‘ on bs 2s
[14999]a : and wife 9 __-Total income (‘‘adjusted gross income’) (subtract line 8 from line 7) 9 } 3
[15000]a 4B Find tax. 10° If you do not itemize deductions and line 9 is under $5,000, find tax in tables on oD
[15001]: uw from table pages 12~14 of instructions. Omit lines 11a, b, c, or d. Enter tax on line 12a, |20 oo
[15002]5 —OR— eh hills
[15004]lla- If you itemize deductions, enter total from page 2, Part lV, line 17
[15005]“If you do not itemize deductions, and line 9 is $5, 000 or more enter the larger of: jiu 7
[15006](1) 10 percent of line9; OR (2) $200 ($100 if married and filing separate return) lla a
[15008]"plus $100 for each exemption claimed on fine 4, above. _
[15009]‘Deduction under (2) or (2) limited to $1, 000 ($500 if married and filing separately).
[15011]25 Subtract line 24 from 23. Apply to: (1) U.S. Savings Bonds, with excess refunded or [1] Refund only |25 ~
[15013]“Under penalties of perjury, 1 doclaro that | hava examined this return, Including accompanying schedules and statements, and to the best of my knowledge ond beliof it le
[15014]trus, corroct, and completo. If proposed by o porson othor than taxpayor, his declaration is bared on ali Information af which he hos any knowledga,
[15016]1b’ Subtract line 11a from lire 9. Enter balance on this line wp] 6 -663/37 my
[15017]lic: Multiply total number of exemptions on line 4, above, by $600 7 ‘Ve 2 ans ‘f
[15018]ad lid Subtract line 11¢ from line 11b. Enter balance on this line. igure your tax on this |43g
[15019]7 , . : ‘., amount by using tax rate schedule on page 11 of instructions.) Enter tax on line 12a. 2 Ob: 2 BL
[15020]gto 12a Tax (Check if from: Tax Table (J, Tax Rate Schedule i, ‘Sch. D 4, or Sch. G (1) ‘Tal ao OZ.
[15021], 42b Tax surcharge. tf line 12a is less than $734, find surcharge from tables on page 10 of instruc- :
[15022]: tions. if line 12a is $734 or more, multiply amount on line 12a by .075 and enter result. (If |12b - .
[15023], you claim retirement income credit, use Schedule B (Form 1040) to figure surcharge.) . 2. af Ci)
[15024]tL. 12c Total (add lines 12a and 12b) __(t2e T&elSY
[15025]me 13-. Total credits (from page 2, Part V, line 4) . 13 | // oy
[15026]= ee 14a Income tax (subtract tine 13 from line 12c) : 14a Sf? oy
[15027]E tax 14b Tax from recomputing prior year investment credit (attach statement) . 4b _
[15028]7 = Credits 15 Self-employment tax (Schedule C3 or F-1) 15 _ .
[15029]“B and |26__Total tax (add lines 14a, 14b, and 15) 16 “A DANOG
[15030]7 ° Pay-. 17. Total Federal income tax withheld (attach Forms W-2) 17 LST OO Mane “cneew on Y
[15031]' g ments 18 __ Excess F.1.C.A, tax withheld (two or more employers—see page 5 of instr.) 13) Z money order pay- Z
[15032]= : 19 E] Nonhighway Federal gasoline tax—Form 4136, [] Reg. Inv.—Form 2439/19] CS Z ante ate ginternal y
[15033]5 20 © 1968 Estimated tax payments (include 1967 overpayment allawed a asa credit) 20| Cy memmmnnmnnnannnids
[15034]8 21.. Total (add lines 17, 18,19, and 20) oe ; : 21 | 3h BI OO
[15035]6S 22 if payments (line 21) ara less than tax (line 16), enter Balance Due. Pay in full with this return 22 "4 Ve,
[15036]i s Balance 23 __If payments (line 21) are larger than tax (line 16), enter Overpayment ; 23 | __
[15037]_& Refund |24 Amount of line 23 you wish credited to 1969 Estimated Tax [24 tT
[15039]Your lature . . Dato Ds Signature of proparer othor than taxpayor
[15040]ae at Fling felntly, wort mueat igi oven if TT ‘oho hed Incomo) Address 089-1680. 1898
[15043]Dee ieee oat ead ee
[15045]4 Exemptions
[15046]aL
[15047](a) NAME (if more space is needed attach schedule)
[15049]on
[15051]1
[15052]2
[15054]la Gross dividends and other distributions on stock (list payers
[15055]and amaunts—write (H), (W), (J), for stock held by husband, wife, or
[15056]pintly)
[15058]Total Jine ‘da
[15060]: ib Exclusion (see instructions).
[15062]+e Capita! gain distributions
[15064](see page 5 of instructions).
[15066]- Ad Nontaxable distributions
[15067]' (see page 5 of instructions).
[15069][ £C0l6Q
[15071]le Total (addtines1b,1c,andid). . « «
[15072]Taxable dividends (ine b la less line le—
[15073]: _ not less than. zero) oor ee
[15074]Re -
[15076]> *_ Interest (list payers and amounts below)
[15077]'"- Earnings from savings and loan assoc. and credit unions.
[15079]if
[15081]Completa sniy for dependenis claimedon line 3, page i
[15082](b) Relationship (c) W Months tived Pe
[15084]bor od
[15085]my oar write “B" or "D"
[15087]“poe ~ alse 2
[15089]_ | Other interestfon ban
[15090]yo Lew.On) k
[15092]2 Total interest income
[15094]oe ne
[15095]3: Pensions and. annuities, rents and royalties, part-
[15096]. nerships, astates or trusts, etc. (attach Sch. B) .
[15098]. 4 Business income or loss (attach Schedule C) .
[15099]5 Sale or exchangé of property (attach Schedula D) .
[15100]" .6 Farm income or loss (attach Schedule F).
[15102]'*” Miscellaneous income (state nature and source) ..:
[15103]* pith At C88... OUI
[15104]Ola. Cane WEAN Ona l
[15106]: 9 Total miscellaneous inéome .
[15108]“8 TOTAL (add lines 1f, 2, 3, 4, 5, 6, and.7).
[15109]* Enterhere and onpagel,line6. . . >
[15111]artalit® Adjustments to income . ob
[15113]“4 "Sick pay"’ if included in line 5, page 1 (at:
[15114]tach Form 2440 or other required statement) .
[15116]° 2 Meving ¢ expenses (attach,Form 3903). .
[15118]: 3 E Eniplosee-buamess SxfenseGttecr-Form |
[15119], 2106-or other statetient) . toe
[15121]6 Payments by self-amployed persons to re-
[15122]tlrament plans, ‘ete. (attach Form 2950SE) »
[15124]a 4
[15126]13 Totai contributions (add lines 10, 11, ,
[15127]-— and i2—see instructions for limitation) >
[15129]Bl 7st cS)
[15130]|
[15131]S869 YO)
[15133]* B TOTAL ADJUSTMENTS (lines 1 through 4),
[15134]Enter here and on 1 page | 1, line: 8 a
[15136]Uo
[15138]irre ty U.S. GOVERNMENT PRINTING OFFICE 1 1e80—--290-001
[15140]i
[15142]Form 1010—1968--Paga &
[15144](a) Amount YOU furnished
[15145]for dependent’s Aiport
[15146]100% write “ALL!
[15148](d) Did depena-
[15149]ant have income
[15150]of $600 oF more?
[15152](f) Amount furnished ©
[15153]by OTHERS includ- ~
[15154]_ ing dependent. -
[15156]id dur-
[15160]wi Itemized deductionscuse only if you do notuse
[15161]tax table or standard deduction.
[15163]Medical and dental expense (not compensated by insurance or
[15165]otherwise)—Attach itemized list.
[15167]1 One-half of insurance premiums for medi-
[15168]cal care (but not more than $150) .
[15170]-|2 Total cost of medicine and drugs . . .
[15172]3 Enter 1% of line 9, pagel . . . . . ——
[15174]4 Subtract line 3 from line 2 (not fess than zero) ;
[15176]5 Other medical, dental expenses (include :
[15177]balance of insurance premiums for medi- .
[15178]cal care not deductible. on line1) . . . —
[15180]6 Total (add lines 4 and 5) re ie —
[15182]7 Enter 3% of line 9, page ; :
[15184]8 Subtract line 7 from line 6 (not less than- zero) ;
[15186]9 Total (add lines 1 and 8).
[15187]0 checks,
[15190]money . orders, ete.
[15192]10 Total cash contributions . . 1 »
[15194]11 Other than cash (sea instructions for required
[15195]statement). Enter total of such items here.
[15197]12 Carryover from prior years (seo page 7 of instr.)
[15199]Taxes.—Real estate... _ coe eh
[15200]State and locai gasoline . toe : ' :
[15201]General sales (see page 15 of instructions) .
[15202]State and local income. « . » « «
[15205]14 Total taxes . oe ee ee
[15206]Interest expense.—Home Mortgage. « .
[15208]Instaliment purchases . . . « « 2 4
[15209]Other (itemize)
[15211]16‘Total miscellaneous... . . .
[15213]17 TOTAL DEDUCTIONS (add lines 9, 13, 14,
[15214]_ 15, and 16). Enter here and on page 1, line lla.
[15216]az Wd Credits | |
[15217]1 Retirement income credit (Schedule B) .
[15218]p* TZ 7 (ok
[15220]2 Investment credit (Form 3468). .
[15221]Wisy
[15223]3 Foreign tax credit (Form 1116); . . .
[15225]44 TOTAL CREDITS (for page 1, line 13) .
[15227]EXPENSE ACCOUNTS—if you had an expense a anes or Charge
[15228]‘expanses to your employer, check here [) and aga 6 of Instruction
[15230]oh 16—8O1d09] *
[15234]-
[15237]Gy ue/ aol fh Ms Va
[15238]Cun AOL S |
[15241]Ch ig.teG.0. -O-.
[15243]4 1
[15245]' .
[15247]“Tie ~ be Thea lawl on made ina
[15248]. Heacowe lod Facto tole [i6h
[15249]Pa aie)
[15251]. | !
[15252]7 feta, 4 |
[15254]‘ca WS Tedirdeal 7
[15257]t
[15258]{.
[15259]| |
[15260]i
[15261]1
[15262]H
[15263]i
[15265]connection
[15266]ee oe
[15268]-
[15269]| §
[15272]i
[15274]1 i ,
[15275]| | ae
[15276]poet
[15278]|
[15279]PoP ob |
[15282]1
[15284]i ,
[15285][i
[15286]hoo.
[15287]fl {
[15289]ab ;
[15291]The pele fistes
[15293]Tate veoh b pad bls sae
[15296]RR j
[15298]ith .
[15300]t t i a
[15301]: i
[15302], | : | po 7 po nn ,
[15303]‘al maryin accoun | oe Po | i poo fo
[15305]DoW y
[15308])
[15309]fr
[15310]} dog
[15311]i
[15313]LRT
[15315]7 _ oo |
[15316]fi lee Fave lech , G00 | oid.
[15317]; | 7 bess Pevsonaf’ § 5.) ene pop ws
[15319]et tod " a re oe 15%
[15320]. Felephie. | ate re 700.
[15321]2 fe ot: Use ao. Me me eee ee 2
[15322]| | phe |
[15323]fo]
[15325]A cade i
[15326]oalp tes LedeoseL Sf As
[15328]j
[15329]j
[15330]i i j
[15331]. i :
[15332]: i
[15336]A
[15338]PREPARED BY. ccsccesconsus, : : oO ~
[15340]“
[15342]“Sitter «Sap egen/ pf Mis Rby
[15344]EXTENSIONS BY.........
[15346]‘. SENIOR 7 Zz fer Vi
[15347]SPICE ee Seeger ipraene—srtcx rca ae ye Li HO. f5 SS tem Socorscrt Sys
[15349]me i of “(cpus 7
[15350]__| I
[15352]and mm na ~ a pi
[15353]plot, [i
[15354]_ fot
[15356]i
[15358]Facone ad Foe For
[15359]| 7
[15360]1
[15362]7 The, belts listed |
[15364]n oe et
[15366]SS SS
[15367]i
[15369]é t
[15373]7
[15374]i$ |
[15375]pop
[15377]i
[15379]| Reta |
[15382]|
[15383]|.
[15384]|
[15385]i
[15387]for Feb
[15388]i connection i
[15390]Tote ect pe
[15391]Te.
[15393]i
[15394]i
[15395]if
[15396]be
[15398]ae or ce ete
[15399]| 7 |
[15401]|
[15403]if
[15405]it .  F Eco
[15408]fo poe
[15409]ee ; 4 _ | { -
[15410]i oh i i i
[15411]Loy. |
[15412]Og
[15414]_ oe | _ ESD)
[15416],: : i a —— - -
[15417]fal E enses') | Lane |
[15418]! ieee i veuisy AN ard £2)
[15421]Pe
[15423]a
[15425]|
[15427]- Long-term capital gains and losses—assets held more than 6 months (12 months or more for certain livestock)
[15429]. 13 If line 10 shows a LOSS—Enter here and in Part iV, line 1, the smallest of the following: (a) the amount on line 10; (b)
[15431]Sigmar = . II LT TO EG TE
[15433]'
[15435]Gains and Losses From Sales ¢ or r Exchanges
[15436]of Property
[15438]Attach this schedule to your income tax return, Form 1040
[15440]' SCHEDULE D
[15441](Form 1040)
[15443]U.S, Treasury Department
[15444]Internal Revenue Service
[15446]Name as shown on page 1 of Form 1040
[15448]Biro |
[15450]‘zdins and losses—assets héld not more than ‘6 months
[15452]Social ais Numiber
[15454]72 | 2LG2
[15456]a. Kind of : . = Hom : he Cost or other
[15457]. Kind of prop: b. Description quired : asis, cost o
[15458]Sreiege vest | Sgummplet, 100 sof | Ener’ | $Date ato sold | f. Gros ant | © ,poprritin | subsoqunt imorove-
[15459]os ae fe 7 ON | sig [mon eer aea rom) wees ae nee | pacha ac
[15460]. : : et
[15461]. . woes instr.) |: expense of sale
[15462]_—_—_——— -
[15463]i
[15465]<a ss CAs
[15467]Lah 2
[15469]2 Enter your ‘share of net short-term gain (or loss) from partnerships and fiduciaries ». 1 6. ate ew ek et
[15470]3 Enter unused short-term capital loss carryover from preceding taxable years (attach statement). .. | .:
[15471]‘4 Net short-term gain (or loss) from lines 1,2, and 3... 2. a a)
[15473]5 Enter gain from Part Ii, line 3. a
[15475]6a Enter your share of net long-term gain (or loss) from partnerships and fiduciaries... . 1 tte : ee © ew
[15476]6b Enter your share of net long-term gain from small business corporations (Subchapter S$). . ; ee ee soe od
[15477]7 Enter unused long-term capital loss carryover from preceding taxable years (attach statement) . :
[15478]8 Capital gain dividends (see Form 1040 Instructions, page 5). 2. 6 6 ew ee ke we te ke elt
[15479]9 Net long-term gain (or loss) from lines 5, 6a, 6b, 7, and 8. 1. 1 ww Sw ee ee ee we eee
[15481]10 Combine the amounts shown on lines 4 and 9, and enter the net gain (or loss) here. «1's 4 1 6 oe we
[15482]11 H line 10 shows a GAIN—Enter 50% of line 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a loss or no
[15484]entry on line 9.) (See reverse side for computation of alternative tax). 0.0. 6 ee we ee te
[15485]12 Subtract line 11 from line 10. Enter hera and in Part iV, line 1, on reverse side. . 1. 1 ew te ek le
[15487]the amount on Form 1040, page 1, line‘11b, computed without regard to capital gains or Josses; or (c) $1,000. . . ©
[15489]. Part II—-GAIN .FROM DISPOSITION OF -DEPRECIABLE PROPERTY. UNDER SECTIONS 1245 AND 1250—
[15490]- assets held more than 6 months (see instructions for definitions)
[15491]Where double headings appear, use the first heading for section 1245 and the second heading for section 1250.
[15493]a. Kind of property and how acquired (if necessary, attach statement
[15494]of descriptive details not shown below—write 1245 or 1250
[15496]d, Gross sales price
[15497]_ to Indicate type of asset)
[15499]b. Date acquired
[15500](mo., day, yt.)
[15502]¢, Date sold
[15503]<mo., day, yr.)
[15505]f. Depreciation allowed (or allowable) since acquisition’
[15507]- f, Ordinary gain
[15508]fh i. Prior to January 1, 1962 | f-2. After Decom ber 31, 1961
[15510]h. Total gain (lesser. of -2 oF bh)
[15512]g. Adjusted basis -
[15513]Cd less g)
[15515](8 less sun of f-l and fH 22)
[15517]After December 31, 1963
[15519]Prior to Tonuery 1, 1964 (see instructions)
[15523]2 Total ordinary gain. Enter here and in Part IV, line 2, on reverse side rrr)
[15524]3 Total other gain... Enter here and in Part |, line 5; however, if the gains do not exceed the losses when this amount is.
[15525]_combined with other gains and losses from section 1231 property enter the total of column j in Part IH, jine i.
[15529]1, Gain or loss
[15530](f plus g less h)
[15532]@, Cost or other basis, cost of
[15533]subsequent improvements (if
[15534]not purchased, attach expla-
[15535]nation) and expensa ot sale
[15537]~ f. Other ain
[15538]he loss) .
[15540]SEITE: Sela 2 ARETE: Page 16 Loewe Te
[15542]r= Re MBA
[15544]Date ante es Pees ‘ to sek, tance eee
[15546]FED
[15548]a | '
[15549]at 1
[15551]ve |
[15553]U.S. Individual U.s. Teds .
[15554]A neome Ta A Be e ace t oe yel i Tanuaty oem 31, 1967,
[15556]1967, ending ,19.....
[15558]_ ed sRugternal Revenue Service
[15559]|
[15561]. or other taxable year beginning .....:-.
[15562]_ First nario and Initial (If joint return, use first names and middle initials of both)
[15564]Last ‘namo Your social security number —
[15566]Bao y2i2ge7
[15568]. Your occupation oo
[15571]ZIP code Spousg!) fsociol security number
[15572]BYGIIESVIO.
[15574]Spouse's occupation
[15576]5 Samucl_and Phyllis
[15578]E Home addrass (Number and streot or rural Toute)
[15580]a . A nes
[15582]City, tawn or post office, and/State
[15586]Enter below nam nd address used on your return for 1966 (if same as above, write *Same’’). | If none filed, give reason. if changing
[15587]from saparate to joint or joint to separate returns, enter 1966 names and addresses.
[15589]Your Filing Status—check only one: Your Exemptions Regular 65orover “Blind enter
[15590]. . -]
[15592]la ©). Single , 2a Yourself . . « O o jarease
[15593]: . . : of boxes [oa --
[15594]Ib Married filing joint return (even if only one had income) | 2b Spouse . + + -0O OC . J checked | 224.
[15595]1c 0) Married filing separately. If spouse is also filing @ ietura, | 3a First hames of your dependent children who lived with}
[15596]7 °° enter Her (his) social security number in side provided above you':. posal QLOLG LD sjacesneetoven ;
[15597]. and give tlrst name here : sectessectens wo hh Se ec GMMAEcrervesscaresaneeees
[15598]id ( Unmarried Head of Household 3b Number of other dependents (from page 2, Part 4, line 3)
[15600]Ye O Surviving widow(er) with dependent child 4 Total exemptions claimed _.
[15602]oO Be euch ctiem ow:
[15603]Signature of preparer othor-
[15605]bye 27
[15606]|Z LM dishes
[15608]3 income 5 Wages, salaries, tips, etc. If not shown on attached Forms W-2 attach explanation |5_
[15609]x Hane 6 Other income (from page 2, Part Il, line 8) 6
[15610]& all income |_7 Total (add lines 5 and 6) 7
[15611]3 of Bath | 8 Adjustments to income (from page 2, Part Ill, line 5) 8
[15612]’ ' = and wife “g Total income (subtract line 8 from line 7) : 9
[15613]a 2 Find tax 10 Iftyou do not itemize deductions and line 9 is less than $5,000, find your tax from 10 :
[15614]‘5 from table tables in instructions. Do not use lines lla,'b,.c, ord. Enter tax on line 12, :
[15616]2 lla If you itemize deductions, enter total from page 2, Part lV, line 17 : me,
[15617]eB \f' you do not itemize deductions, and line 9 is $5,000 or more enter the larger of: / Ee 2 f a
[15618]o (1) 10 percent of line 9; OR (2) $200 ($100 if married and filing separate return) lial, ; :
[15619]ae Joo pius $100 for each exemption claimed on line 4, above. Y
[15620][3 . +
[15621]Ss ean Deduction under (1) or (2) limited to $1,000 ($500 if married and filing separately). Yyy
[15622]~~ iT fe
[15623]a 7 a 7
[15624]rata b hi 1 i “ Brelm . :
[15625]2 Tats lib Su tract ine 11a from line 9 _ eve, SOB ;
[15626]8 lle Multiply total number of exemptions on line 4, above, by $600 3 & fol} (6) fe) me
[15627]a "| 21d Subtract line.1ic from ling lib. Enter balance on this line. (Figure your tax on this :
[15628]von be amount by Using tax rate schedule on page 11 of instructions.) Enter tax on line 12.
[15629]- “ - - are + = _—— _ = a —————.
[15630]. 12 Tax (from either Tax Table, see line 10, or Tax Rate Schedule, see lines Lla=11d) _
[15631]: 13 Total credits (from page 2, Part V, line 4) ; . oe
[15632]_Your 14a Income tax (subtract line 13 from line 12) .
[15633]Tax 14b Tax from recomputing prior year investment credit (attach, statement)
[15634]i Credits 15 Self-employment tax (Schedule C-3 or F=1)
[15635]: wand ee et?! tex (add lines 14a, 14b, and 15). ;
[15636]2 Pay. 17 Total Federal income tax withheld (attach Forms W--2)
[15637]5 men ts 18 Excess F.I.C.A. tax withheld (two or more employers—see page 5 of instr.)
[15638]6. 19 (J Nonhighway Federal gasoline tax—Form 4136, (3 Reg. lnv.—Form 2439 ) 19.
[15639]2 1967 Estimated tax payments (include 1966 overpayment allowed as a credit)
[15640]& Total (add lines 17, 18, 19, and 20)
[15641]5 Balance “32 Mf payments (line 21) ate less than tax (line 16); enter Balance Due. Pay in full with this return
[15642]3 Due or 23 If payments (line 21) are Jarger than tax (line 16), enter Overpayment -
[15643]& Refund “24 Amount of line 23 you wish credited to 1968 Estimated Tax
[15644]£ 25 Subtract line 24 from 23. Apply to: (1) U.S. Savings Bonds, with excess retunded or
[15645]8 Under penalties of porjury, | declare that |’ have examined this return, Including, accompanying schedules and statemdnts, and to ‘the best of my knowledgo and bolief It Is
[15646]Nas cérréct; and complete, If prepared by a person other then taxpayer, his declaration is based on all Information of which he hes any Wena ff, Va
[15648]‘Sign p
[15649]here 6
[15651]cpay oF
[15652]7 eV Se
[15653]ote Kistie Mr ke Kecow en Set iain hos
[15655]6301
[15657]Please.
[15659]went oe ce ter ce
[15665]| SCHEDULE. > | Gains and Losses From Sales or Exchanges
[15666](Form 1040) | of Property
[15668]Us, Treasury Department
[15669]Internal Revenue Service Attach this schedule to your income tax return, Form 1040
[15671]Hi
[15672]2 a. Kind of ° on . . Fe Cost or ather
[15673]Ad Of Prop. b. Description quired. asis, cost o!
[15674]arty. Indicate (Examples: 100 sh. of Enter d. Date 2. Dat g. Depreciation | subsequent improve-
[15676]; : . ; 6 sold ft, Gross sales . 4, Gain of loss
[15677]ecacurity, reat "2" Ga, 2 story brick, deter, (magi se) {mo., doy, ye) |”, price as Shee purchased attach (t plus g less h)
[15679]a “ (Specify) vf: etc.) (See . . ‘ acquisition . explanation) and
[15681]a instr.) . . expense of sale
[15683]VELY,
[15685]| L227.
[15687]“2 Enter your share of net short-term gain (or loss) from partnerships and fiduciaries .
[15688]3 Enter unused: short. term capita! loss carryover from. preceding taxable years (attach. statement) . eee ew
[15689]= 4 Net short-term gain ‘(or less), fiom lines 1, 2) and 3. Se ee ee ee ee Loa . toes .
[15691]oo! * Long-term capital gains and losses—assets held rnore than 6 months (12 months or more for certain livestock)
[15693]5 Enter gain from Part It, line 3. . .
[15695]oh ee 5; pSiteed.| Ly
[15697]Total long-term gross sales price ,
[15699]Enter the full amount of your share of net long-term gain (or loss) from partnerships and fiduciaries. . . . + »|/-
[15700]Enter unused long-term capital loss carryover from preceding. taxable years (attach statement). 2. . 2 2 6 « :
[15701]Capital gain dividends (see Form 1040 Instructions, page6) - . - +» + + : er er?
[15702]Net long-term: gain (or loss) from lines 5,6,7, and8. ‘
[15704]wanna
[15706]10 Combine the- amounts shown on lines 4 and 9, and enter the net gain (orloss) here. we we ee
[15707]11 If line 10 shows a GAIN—Enter 50% of line 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a Joss or no
[15709]entry on line'9.) (See reverse side ‘for computation of alternative tax)... 2 eee ee ee es ee -
[15710]12 Subtract line 11 from line 10. Enter here and In Part IV, line ‘Ly! on reverse sida, 6 se 6 eee ee .
[15712]13 Mf line 10 shows a Loss—enter here and in Part IV, line 1, the smallest of the. iallowing: (a) the amount on line 10; (b)
[15713]the amount on,page 1, line 11b, Form 1040, computed without regard.to capital gains and losses; or (c)- $1,000. . «
[15715]Part IH—GAIN-FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250-—~
[15717]assets held more than 6 months (see instructions for definitions)
[15718]Where double headings appear, use the first heading for section 1245 and the second heading for section 1250.
[15720]b. Date acquired c, Date sold 3 ft ra ine basis. cost of
[15722]~b. . d 7 subsequent improvements (if
[15724](ine., day, yr.) (mo., day, yr.) Gross sales price not purchased, attach orate
[15725]q nation) and expense of sale
[15727]a. Kind of property and how acquired (if necessary, attach statement
[15728]of descriptive details not shown below—write 1245 of 1250 ~
[15729]to indicate type of asset)
[15731]f. Depreciation allowed (or allowable) since acquisition
[15732]. |. Ordinary gain
[15734]— | g Adjusted basis h. Total gain. lesser of f-2 or hi i
[15735]Th, Prior to January 1, 1962 | f-2. After December 31, 1961 | (o/oss sum of f-1 and f-2) (d tess 8) Messer oft zor ny Je einer gain
[15736]ee OR gga | Miler Doce ---- . Gee instructions)
[15738]- 2 Total ordinary gain. ‘ Enter here and in Part IV, line 2, on reverse side. . « . 2. 28
[15740]_ 3 Total other gain. Enter here and in Part J, line 5; however, if the gains do not exceed the losses when this amount Is
[15741]«++ combined with. other gains and losses from section 1231 property enter the tatal of column j in Part it, lina 1. . ,
[15742]7 — Hi . W—79725-1
[15744]SG)
[15749]fn Tacome from courcesother thanwages, etc.
[15751]1b Exclusion (see instructions).
[15753]1, le Capital ‘gain distributions
[15755]"Interest (list payers and amounts below)
[15757]oom 2 Total interest income .
[15759]. 5 Sale or exctiange of property (attach Schadule D) .
[15761]soe . Miscellaneous income (state nature and source) ..
[15763]* g TOTAL (add lines 1f, 2, 3, 4, 5, 6, and ne
[15765](d) Did depona-
[15767]of $500 or more?
[15769]fe). Amount YOU Tonished
[15770]for depandent’s support,
[15771]it 100% write “AL
[15773]<P Amount furnished’ .
[15775]® Relationship i 5 Noninslived in your
[15776]7 by OTHERS ine includ.
[15778]home. If born o¢ died dur-
[15779]Ing yoar wilte * “BY or “D"
[15781]‘J TTiemized deductions—Use only If you donotuse
[15783]“tax table or standard deduction,
[15785]la. Gross dividends and other distributions on stock (list payers | Medical and dental expense (not compensated by insurance or
[15786]and amounts-—write (H), (W), W), for stock held by husband, ‘wife, ‘or | othernvise)—Attach itemized list.
[15788]1 One-half (but not more than $150) of ine
[15789]surance premiums for medical care. .
[15791]Total cost of medicine and drugs . « -
[15792]Enter 1% of line 9, page 1
[15794]Subtract tine 3 from line 2 (not less than zero)
[15795]Other medical, dental expenses (include
[15796]balance of insurance premiums for medi-
[15797]cal care not deductible online 1) . . .
[15798]Total (add lines 4.and5) . .
[15799]Enter 3% of line 9, pagel... + e
[15800]Subtract line 7 from fine 6 (not less than zero) .
[15801]Total (add lines 1 and 8) . ;
[15803]Total line Ja
[15805](see page 6 of instructions).
[15807]Jd Nontaxable distributions |
[15808](see page 6.of instructions). |____—__—-a-= | ae
[15810]le Total (add. ‘lines 1b, 1c, and 1d).
[15811]lf Taxable dividends {ine * la less line le—-
[15812]not less than zero) ad
[15814]Earnings from savings and loan assoc. and credit unions.
[15816]10 Total cash contributions 2... 1 + 6 |iscesneeeeees
[15817]~142 Other than cash (see instructions for required.
[15818]. statement). Enter total of such items here
[15819]{12 ‘Carryover from prior years (soo page 8 of Instr.)
[15821]+] 13, ‘Total contributions (add lines 10, 11,
[15822]and 12—see instructions for limitation) >
[15824]Other interest & nks, bone tax refunds, etc.)
[15825]Ast Aatl te. a.nd. 20 giseel,
[15827]cesceessseseerscsnenese - Taxes.— Real estate. 2 «ee
[15829]“State and_jocai gasoline . .: « th.
[15830]General ‘eatdg {soa page 15 of Instructions).
[15831]State and local income. . . 6 6's
[15833]3 Pensions and annuitics, rents and royalties, pat
[15835]Personal rope
[15836]nerships, estatos or trusts, etc. (attach Sch. B) . rs property
[15838]14 Total taxes. we ee ee
[15839]Interest oxpense.—Home Mortgage :
[15840]‘Other (itemize
[15841]‘Be yt. al ia
[15842]Freeh bags
[15843]ALS Gm .
[15845]15 Total interest expense
[15847]4 Business Income or loss (attach Schedule c).
[15849]dula F) .
[15851]6 Farm incoma or loss (attach Sche
[15853]float ee
[15855]7 Total miscellaneous Income... P —— | Misc Hangous deductions. .— (sea page 9 of Instructions) ..........-- :
[15856]Ss
[15860]Enter here and on page 1, line 6. .
[15861]7 a Yy !
[15862]Te |
[15864]Teal] Adjustments to income a A ee ee
[15866]i wick pay’, if included in ine 5 pagel (at | 17 TOTAL DEDUCTIONS (add lings @, 13, 14,
[15867]; Ent d >
[15868]2 Moving expenses (attach Form 3903) . 1, and 16). Enter hore and on page 1, tine lla.
[15869]7] Credits
[15871]tirement income credit (Schedule B) .
[15873]3 Employee business expense (attach Form
[15875]2106 or other statement) . 1 1 + « Jacesssesnerene: seeneefeescee i
[15876]4 Payments by self-employed persons to re- 2 Investment credit (Form 3468). - +
[15877]tirement plans, etc. (attach Form 2950SE) . 13 Foreign tax credit (Form 1116)... - —_
[15878]——|.4 TOTAL CREDITS (for page 1, line 13). >
[15879]5 TOTAL ADJUSTMENTS (ines 1 through re EXPENSE: ACCOUNTS—If you had an_oxpense 7 Le or charged
[15881]Enter here and on page l,lineB . expenses to your employer, check here C).and see page 7 of Instructions,
[15883]Yr U.S, GOVERNMENT PRINTING OFFICE :1957—-O-260-001 2 . oh—10—THRSE-I
[15886]1~£906£—9T
[15888]BOjAlaS snuaaay jeuse}U) uawyiedag Gnseoay *S*N—Z—AA W003
[15892]Pur sweu S.ATAOTUNY quid 30 adAy
[15894]“009'9¢ uy? a20W Jou ynq ,,
[15896]‘uonewsojUy xe] awoouy yesopag
[15898]Japun 7
[15900]UMOYS Sagem Se -aures oy} aE sade 9saya “Usoys Jou ale jing “SaxEy ‘Aaanoas
[15901][21908 03 Joaiqns-aran. sade IMA JE ‘aakojdwuia fq paysodaz sdrj sapnyouy , stig09 TLL a9 eotyg
[15902]“sourinsul Ai{rqrsip pur “SIOATAINS “98P-PlO 305 -%e-e pur Sujauag souemmnsuy 6 5 ' ~
[15903]Tardsoyy 305 Ys sapnpour 2G}p Jo ares yy Toa) Epanoos Tepos aqy ¢ BAY eukoyy oN £29
[15905]; “UINIAI XE} IWOIU! INOA UO saiTe[es PUE , ; Aqny °d Teoenwes
[15908]rUoIsnjaxa , Atd y15,, 10 suoT | L662 . €
[15909]« . . "90K ‘i al — =
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[15926][96 L ingwanvis X¥L ONY 39VM °0D °2IN teatlO-f£eqtusys ‘|uz
[15928]. SQT9QS2=9£
[15931]Reference copy, JFK Collection: HSCA (RG 233)
[15933]JFE £E8S85S5INATION COLLECTION
[15934]IDEN STEEL CATION FORM
[15936]wgency: HSCA TS\ CO Wy
[15940]Yecord Series: WNOMBERED FILES
[15942]Roency File Number: OO “ET,
[15943]jriginstor: GHyeen Reo Y, Sane .
[15944]Yrom: - R by.» Samuel........2-- eee eee eee eee R .
[15948]Docrment Type : Other Tertyal
[15950]Classification: a Cc 5 T
[15951]Restrictions: Gpen 18 1B iC 2(8) 4
[15952]Current Status: O CD x
[15954]Date of Lest Heview: / /83
[15956]Ut
[15957]o
[15959]Openiug Cr iterig:
[15961]Comments: uf Cave m ira ia ~
[15963]Box #: 102 Folder Tat ie:
[15965]NW 88326 Docid:32245535 Page 171
[15967]> =o Sree es seni is ba ERAT UME ANE wRIG, aaa A gat
[15968]7 : Reference copy, JFK Collection: HSCA (RG 233) eS
[15970]INBIVIDUAL
[15971]ae INCOME TAX
[15972]LACE PREADDRESSED LABEL HERE, If available. (Correct name and address, if necessary) Check —f<[Calendar Year
[15974]ater social security number(s) only” if incorrect or not shown on labe One: Fiscal Year Ending___1977
[15976]CEL = = — OR C TIFICATION
[15977]NAME u joint return, give first names and initials ‘al “both) LAST NAME gee PRIA Sr iaataueT ions
[15979]PRESENT HOME ADDRESS (Number and street, including apartment number, or ty Fal route)
[15983]CITY, TOWN OR POST OFFICE, STATE AND “ZIP CODE
[15984]A .
[15986]6 Personal it tine 1 or 3 ‘checked, enter $25 t ;
[15988]If line 2, 4 or 5 checked, enter $50.
[15989]7 Dependents —
[15990]Do not list the person who qualifies you as head of household
[15993]{ ! 54) 26st en a
[15995]Total Number __ 2 x $8047 Io 80
[15996]8 Blind (see instructions) Number of blind exemptions _____— x $8 00
[15997]93 Total exemption credits (add lines $ 7 and 8) Enter here and on 1 tine 20
[15999]ae CREDITS
[16001]10 Wages, ‘salaries, “tips ‘and other employee “compensation { attach ‘pny 2 of Form(s) W.2, to face of is)
[16002]11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
[16003]12 Interest. Enter total (if over $400, complete and attach Schedule 8(540))
[16004]13° Income other than wages, dividends and interest (from line 48) ,
[16005]44 Total {add fines 10, 11, 12 and 13)
[16006]15 Adjustments to income (from line 55) .
[16007]16 Adjusted gross income (subtract line 15 from line 14)
[16009]© If you do NOT itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on tine. 19.
[16010]© If you itemize deductions OR line 16 is $15,000 or more, complete lines 17 and 18.
[16012]17 Deductions: Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked)
[16013]18 Taxable income (subtract tine 17 from tine 16) Compute tax from Tax Rate Schedule—Enter tax on line 19
[16015]49 Tax from (check one) ia Tax Table ‘ax Rate Schedule CJ Income Averaging Schedule (G or Gel) .
[16016]20 Total exemption credits (from line 9, above) an . Sos .
[16017]21 Tax liability (subtract line 20 from line 19—if line 20 is greater ‘than tine 19, enter zerc) Cee ee ee ee PAP LLL De
[16018]22 Other credits (from line 68—Including Special Low Income Tax Credit) . hone
[16019]23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter zer0) Coe ee ee ee ew PAB PLT RIL.
[16020]24 Othertaxes (from line 71) 2 6 ee
[16021]25 Total tax liability (add lines 23 and 24) .
[16022]26 Total California income tax withheld (attach W-2 or W-2P to face of this return) BY 26 1
[16023]27° Renter's credit—if you lived in rented property on March 1, 1976, complete Part 1 on page 2 ce
[16024]28 1976 California estimated tax payments an 6 28
[16025]29 Excess California SDI tax withheld (see instructions) .
[16027]30 Total Credits. 2. 2 2. ee
[16029]31 If tine 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero
[16031]Mail return to: FRANCHISE TAX BOARD $$ $$$ PAY IN FULL —> =P
[16033]SACRAMENTO, CA 95867 Do not write in these spaces
[16035]32 If line 25 is smaller than line 30, enter amount OVERPAID
[16037]33 Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks.
[16038]Mail return to: FRANCHISE TAX BOARD
[16039]P.O. BOX 13-540
[16040]SACRAMENTO, CA 95813
[16042]34 Amount of line 32 to be credited on your 1977 ESTIMATED TAX . . 1. ee
[16044]if you do NOT want State income tax forms and instructions mailed to you next year, check here oO See Instructions, Page 9
[16046]<1 ATTACH COPY 2 OF FORM W-2 HERE >
[16048]TT
[16049]Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the:best of my knowledge
[16050]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.
[16052]2 > SIGH ae signature . . Date > omar signat
[16055]social security number on check or money order. ATTACH HERE >
[16057]Date
[16060]_— Te . = FRR ry q
[16061]- Reference copy, JFK Collection: #SCA (RG 233) eS ESE
[16062]Me cane eeeeteen :
[16063]an . Cnr anne = Pa ge-2-Form 540.{1976) |
[16064]PART | ~ Renter's Credit -— All questions must be answered
[16066]35 Did you, on March 1, 1976, live in rented property which was your principal residence? ..... 0 Yes Ho If no, you may not claim this credit
[16067]36 Was the property you rented exempt from property tax?. w . ee ee O Yes ONo _ If yes, you may not claim this credit
[16068]37 Did you tive with any other person who claimed you as a dependent for income tax purposes?.. . . GYes OONo_ If yes, you may not claim this credit
[16070]38 Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance?. O Yes O No If yes, see page 3 of instructions
[16072]PART fl — Other Income
[16074]39 Business income (or loss) (attach Schedule C(540)) 2
[16075]40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule DiS40)). 1 6 es
[16076]41 Net gain (or loss) from supplementa! schedule of gains and tosses (attach Schedule D-1(540))
[16077]42 Pensions andannuities ©.) 0 a
[16079]43 Rents and royalties sche ee
[16081]. EDULE E
[16082]44 Partnerships .. 2.2... FORM (840) Jo
[16083]45 Estates andtrusts . 2...) GL Le
[16084]46 Farm income (or loss) (attach Schedule F(540)}. 0 6 6 ee
[16086]47 Miscellaneous income
[16088](a) Fully taxable pensions and annuities (not reported on Schedule E(540))
[16089](b) Alimony ..... a
[16090](c) Other (state nature and source} “ _.
[16091]Enter total of lines 47(a), 47(b), and 47(c) 2 0 ee
[16093]Total (add fines 39 thru 47). Enter here and on line 13. 2 1 eee
[16095]PART Ill — Adjustments to income
[16097]49 “Sick pay,” if included in line 10 (see instructions - attach Form FTB 3805T)
[16098]50 Npoving expenses (see instructions - attach Form FTB3805U) 2 0
[16099]51 Employee business expenses (See instructions - attach Form FTB 3805N). 2 2 ee ee
[16100]52 Military exclusion (see instructions) - - - 6 6 ee
[16101]§3(a) Payments to an individual retirement arrangement (attach FTB 3805P) 2. ee ee
[16103](b) Payments toa Keogh (H.R. 10) retirement plan. 2... ee ee
[16105](c) Payments to a self-employed ‘Defined Benefit Plan’... 2 6 0 ee
[16107]Enter total of lines 53({a), 53(b), and 53(c) 2 2 ee a
[16108]54 Forfeited interest penalty (see instructions), ©.
[16109]55 Total adjustments (add lines 49 thru 54). Enterhere and on tine lS 2...
[16111]PART IV - Itemized Deductions
[16113]© Attach Schedule A(540) and enter sub-totals on lines 56 thru 62, below
[16115]56 Total deductible medical and dental expenses (from Schedule A(540), line 10)
[16116]57 Total taxes (from Schedule A(540), line 17). 6
[16118]58 Total interest expense (from Schedule A(540), line 20) .------ ee
[16119]59 Total contributions (from Schedule A(540), line 24) 2 2 ee
[16120]60 Total casualty loss (from Schedule A(540), line 29)... 6
[16121]61 Total miscellaneous deductions (from Schedule A(540), line 33)... 2 2 ee
[16122]62 Total child care and adoption expenses (from Schedule A(540), line 37). 2. 2. ee ee
[16123]63 Total itemized deductions (add lines 56 thru 62). Enter here and on line17 2...
[16125]PART V — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW
[16127]64 ‘Other State’’ net income tax credit (attach copy of other state return and Schedule $(540)). 2. 6. 6 2 ee ee ee ee @) CT rr
[16128]65 Retirement income credit (attach Schedule R(540)) 2. 2 @) 65 |
[16129]66 Special low income tax credit (see special instructions). © 0 6. @ 66 eceeedseceeee
[16130]67 Solar energy tax credit (see special instructions)... . 6... eee te ® 67
[16131]68 TOTAL (add lines 64 thru 67). Enter here and on line 22 2... ee 68
[16133]PART VI - Other Taxes
[16135]69 Tax on preference income (see instructions - attach Schedule P(540)..... ee 69
[16136]70 Tax on premature distributions from attached Form FTB 3803P ow. 70
[16137]71 Total (add lines 69 and 70) enter here and on line 24.6 6 ee 71
[16139]PART Vil - Reconciliation to Federal Return — If adjusted gross income on Federal Return is different from line 16, page 1, explain below.
[16141]NW 88326 Docid:32245535 Page 173
[16143]Reference copy, JFK Collection:
[16145]HSCA (RG 233) "he
[16147]SCHEDULE
[16149]FORM 540 |
[16151]Name as shown on Form 540
[16153]CALIFORNIA es
[16155]ITEMIZED DEDUCTIONS
[16157]Attach to Form 540
[16159]USE ONLY If YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION
[16161]Madical and dental expenses (not compensated by Insurance or otherwise) for
[16162]medicine and drugs, doctors, dentists, nurses,
[16163]hospital care, Insurance premiums for medical
[16164]care, ete.
[16166]1. One half (but not more than $150) of insurance
[16167]premiums for medical care.......................
[16169]2. Medicine and drugs...................00..00000,
[16170]3. Enter 1% of line 16, Form 540...000...0 0.0.2.0,
[16171]4, Subtract line 3 from line 2. Enter difference (if less
[16172]than zero, enter zero)......... 0. eee
[16173]5. Enter balance of insurance premiums for medical! care
[16174]not entered on line 1............0..........00 08
[16175]6. Other medical and dental expenses:
[16176](a) Doctors, dentists, nurses, etc..................
[16177](b) Hospitals 0602. occ ence n cues
[16178](c) Other (itemize)__...
[16180]. Total—{Add tines 4, 5, 6a, b, and c)
[16181]8. Enter 3% of fine 16, Form 540...0........0......
[16183]9. Subtract line 8 from line 7. Enter difference (if less | |
[16184]than zero, enter zero)................00.0.00000.
[16185]144 |
[16187]10. Total—(Add lines 1 and 9. Enter here and on Form
[16188]540, line 56)...0. eee eee
[16190]Taxes
[16191]11. Auto license—Excess of registration and weight fees
[16192](see instructions)............. 00.000 cc cece eee ee
[16193]12. Real estate. 2200s
[16194]13, State and focal gasoline...
[16195]14, General Sales.......... 0.000... cece eee
[16196]15. Personal property (Boat and Aircraft)..............
[16197]18. Other (itemize)...
[16199]17. Total tares—iAdd lines 11 thro 16. ‘Enter here and
[16200]on Form 540, line 57) ............. 0.0.0.0 eee
[16202]Interest Expense
[16204]18. Home mortgage... 02.
[16205]19, Other (itemize).............. ne en
[16207]20. Totat—(Add lines 18 and 19. Enter here and on | , Cj
[16208]Form 540, tine 58)..........0.....0.2.00002005 2 J
[16210]NW 68226 Dochd:37245535 Page 174
[16212]24. Total— (Add tines 21a thru 23.
[16214]Contributions
[16215]21(a). Cash contributions for which you have receipts,
[16216]canceled checks, etc.
[16217](b). Other cash contributions. List donees and
[16220]22. Other than cash.—See instructions for required state-
[16223]23. Carryover from 1974 & subsequent years — See
[16224]instructions
[16226]Maximum de-
[16227]duction may not exceed 20% of adjusted gross
[16228]income. Enter here and on Form 540, line 59).....
[16230]Casualty or Theft Loss(es)
[16231]NOTE: If you had more than one loss, omit tines 25
[16232]through 28—See instructions for guidance
[16236]5. Loss before insurance reimbursement ,.......-+---
[16237]26. Insurance reimbursement.................00.0.000,
[16238]27. Subtract line 26 from line 25, Enter difference
[16239](If less than zero, enter zero)... 6-2 eee eee :
[16240]28. Enter $100 or amount on line 27, whichever is
[16241]smaller.
[16242]29. Casualty 0 or theft Joss 5 (subtract | line 28 from
[16243]line 27. Enter here and on Form $40, line 60)
[16245]Miscellaneous Deductions —
[16247]30, Alimony paid to... cise cee eee e eee ence rene ee nes
[16248]31, Employment Education Expense.
[16249]32, Union dues
[16251]Other (itemize).
[16253]33. Total (Add lines 30 through 32. Enter here and
[16254]on Form 540, fine 61)
[16256]Child Care and Adoption Expense
[16257]34. Child care expenses — Attach Form 3805X..... teveees
[16259]35. Total adoption expense. ...- |
[16261]Less 3% of line 16, Form 540. -
[16262]36. Net adoption expenses — See instructions
[16264]for maximum limitations. . 6. 6. ee eee ee
[16265]37. Total child care and adoption expenses
[16267](add liries 34 and 36, Enter here and on
[16269]Form 540, tine 62)... ........0. 04 oe
[16272]Reference copy, JFK Collection: HSCA (RG 233) “""r-ANgiFEr
[16274]. Mee i pe ;
[16276]CALIFORNIA —
[16278]DIVIDEND AND INTEREST INCOME
[16280]Attach to Form 540
[16282]‘FORM 340
[16284]lame as shown on Form 540
[16286]PART I—DIVIDEND INCOME
[16288]tine 1—Gross Dividends and Other Distributions on
[16289]tock——-lf gross dividends and other distributions (including capital
[16290]ain dividends) on stock were $400 or less, do not complete
[16292]tions), less nontaxable portion, if any, on Form 540, page 1.
[16293]Do NOT deduct the $100 federal exclusion.
[16295]“Capital gain dividends” are treated as ordinary dividends for
[16296]State income tax purposes and not as capital gains as permitted
[16297]under the federal law.
[16299]is part; but enter gross dividends (including copital gain distribu-
[16301]Gross dividends and other distributions on stock—List payers and amounts—Write (H), (W), UJ), for stock hetd by husband, wife, jointly.
[16303]Total dividends .
[16304]Nontaxable distributions .
[16306]. Taxable dividends—Subtract line 3 from line 2. Enter here and on line 11, form 540
[16308]PART II-—INTEREST INCOME
[16310]Interest on bonds, debentures, loans, notes, tax refunds and all
[16311]spes of savings accounts including banks, credit unions and postal
[16312]avings is taxable.
[16314]Interest on the following obligations is exempt from tax:
[16316](a) Bonds and other obligations (other than tax refunds) of the
[16317]United States, the District of Columbia and territories of
[16318]the United States. (Interest on Philippine Islands obligations
[16319]issued on or after March 24, 1934 is not exempt.)
[16321](b) Bonds (but not other obligations) of California and its polit-
[16322]ical subdivisions issued after November 4, 1902.
[16324](c) Interest on bonds of Alaska and Hawaii issued prior to their
[16325]achieving statehood.
[16327]Note: If total taxable interest income was $400 or less, do
[16328]not complete this part; but enter the total amount of interest
[16329]received on Form 540, page 1.
[16331]Interest income—List payers and amounts. tcl cceeee ceaeeennenneeennee noon suena eesenensaeeenansuneeeeaeeeeonceesieatineescneeceneveceeieessrmeennefecescue ecsaeeeeseenefbe sconces
[16333]Se a Y PSF.
[16335]NW 88326 Docld:32245535 Page 175
[16337]more
[16339]Reference copy, JFK Collection: HSCA (RG 233) eS a oe
[16341]CALIFORNIA
[16343]PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
[16345](Sole Propristorships)
[16346]I flo on Form 503
[16348]tach this schedulo to your income tax return, Form $40 or 540NR _— Parinorships, joint ventures, ote. must filo on Form 565
[16349]ly Ity Numbe
[16350]Name and Address of Business
[16351]e.
[16353]f
[16354]oplty PBisTRo CoFrz+ : erilae i Bi
[16355]Principat buginess activity {i.e., tetail-hardware; wholesale~tobacco; services—legal; ete). SZ#. vA
[16356]_ Indicate method of accounting: (cash, 9 fqraccrual; CU OtR OT aes eecee ences eeceenennnenne encanta nee na mo
[16357]Were Forms 591, 592, 596 and 599, tse year filed (if required)? YES (NO
[16359]Methed of inventory valuation _...... ee
[16360]Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
[16362]CO YES (NO if.“Yes,” attach explanation.
[16364]me as shown on Form 540 or S40NR al Secur
[16368]Om:
[16370]1 Gross receipts, sales, or fees $........--------Less returns and allowances Gc escscnsceseecennsneenenentevenene Balance &
[16371]2 Inventory at beginning of year (if different from last year's closing inventory, attach explanation)...........
[16373]3 Purchases $...........-...—-----Less cost of items withdrawn for personal use $_........-------—- |
[16374]4 Cost of labor (do not include salary paid to yourself) / . | Sd
[16376]§ Materials and supplles........... 00.00.00 eee eee eee tn ete seers eet ens es
[16377]6 Other costs (explain.in Schedule C-2 or attach Schedule)... 0.0.0.0. 000 cee eee eens ee
[16378]7 Total of fines 2 thd 6. ..e..c oc ccc cece cece eee eet tte es ites TT
[16379]8 Inventory at end of this year... 0.0... eee eens eters ese ee eyes
[16380]9 Cost of gaods sold (subtract line B from fine 7)... 0. ees bebe bb bbb bebe eet nent b ene ee
[16381]D Gross profit (subtract line 9 from fine cca
[16382]| Other income (attach schedule)... 0.00... ccc cece eee eee erent es nese ene e ees cbc te yet teens .
[16383]2 Total income (add tines 10 and 1.2.0.2... eee ee ener eens c eee
[16385]. ‘ OTHER BUSINESS DEDUCTIONS
[16386]'3 Depreciation (explain in Schedule C-1 or attach Schedule)........
[16388]‘4 Taxes on business and business property {explain in Schedule C-2 or attach Schedule)....00... 00. eee eee [Cs
[16389]15 Rent on business property............0000 2 cece eee eee neers teens esses nese
[16390]‘6 Repairs (explain in Schedule C-2 or attach Schedule) . CSCS ( ,
[16392]i7 Salaries and wages not included on line 4 (exclude any paid to yourself)....... 2.2... 2. cee eee
[16396]19 Legal and professional fees......... re Soe b need bebe brett bent eter e npr rnb net e nes
[16398]14 Amortization (attach statement)... 00.00.0060. 0 0c eet n nes |
[16399]72 Retirement plans, etc. (other than your share, see instructions). eee | SY
[16400]°3 Interest on business indebtedness..........-...----00 02ers Mc e ete nee e teen tees TCS
[16402]"34 Bad debts arising from sales or services (Not applicable if reporting on cad, baris) ccc vtec eteveteneeee | —sSY
[16405]28 Depletion (attach schedule).......... 0.60020. e ieee ee reenter Tennessee
[16407]96 Other business expenses (explain in Schedule C-2 or attach Schedule).................05-02 20 eee e renee [C—SY e
[16408]“7 Total of fines 13 thy 26.0200... eee net re shaming
[16410]28 Net profit (or loss) (subtract line 27 from fine 12), Enter here and on Page 2, Form 540 or S40NR....... oe. ae ee | bce cee ed | Sc“
[16412]Cost or Depreciation Method of Life or Depreciation
[16413]. allowed (or allowable) computing prec
[16414]other basis in prior years depreciation Rate for this year
[16416]Group and guideline class Date
[16418]bg or description of property Acquired
[16422]eee [
[16424]BBs a RO (OO
[16427]& [Oo
[16431]7 a
[16433]aS -
[16435]Ssk a a DO
[16437]gee [oO
[16439]Ses a NL GS .
[16440]as RC CO
[16442]- te ‘ . 2 aT “eae
[16443]Reference copy, JFK Collection: HSCA (RG 233)
[16447]ie sd CAPITAL GAINS AND LOSSES
[16449]Attach to Form 540 or 540NR
[16451]Use this schedule to report gains and losses on stocks, bonds and similar investments,
[16452]and gains (but not losses) on personal assets such as a home or jewelry.
[16454]Name as shown on Form 540 or 540NR
[16457]PART l—Assets Held Ona Year or Less
[16458]@. Cost or other basis as
[16459]adjusted, cost of subte.
[16460]a. Kind of property and description b. Date acquired c. Date sold d. Gross sales quent improvements (if f. Galn or loss
[16461](Example, 100 shares of ‘‘Z'' Co.) (mo,, day, yr.) (mo., day, yr.) price not purthesed, attach Cd. fesse.)
[16463]explanation) and ex
[16464]pense of sale
[16466]2. Enter gain ‘(or loss), if applicable, from line 17, Schedule D-1 (540) (attach copy) .
[16467]3. Enter your share of net gain or loss from partnerships. and fiduciaries .
[16468]4. Net gain or loss, combine lines 1, 2 and 3
[16470]PART il—Assets Held More Than One Year But Not More Than Five Years
[16472]6. Enter gain (or loss), if applicable, from line 19, Schedule D-1 (540) (attach copy) .
[16473]7. Enter your share of net gain or loss from partnerships and fiduciaries . .
[16474]8. Net gain or loss, combine lines 5, 6 and 7 (If gain, see 540 instructions, line 24a (Preference Income))
[16476]10. Enter gain (or loss), if applicable, from line 21, Schedule D-1 (540) (attach copy). 2... ww en .
[16477]11. Enter your share of net gain or loss from partnerships and fiduciaries . See eee
[16478]12. Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a (Preference Income))
[16480]PART iV—Summary of Capital Gains and Losses
[16482]13. Enter amount from line 4 .
[16483]14, Enter 65% of the amount on line 8 . .
[16484]15. Enter 50% of the amount on line 12...
[16485]16. Enter unused capital loss carryover from preceding taxable vey 45, , computation
[16486]17. Combine the amounts shown on lines 13, 14, 15 and 16
[16487]18. If line 17 shows a gain, enter here and on page 2, Part il of Form 540. or ‘540NR .
[16488]19. If line, 17 shows a loss, enter here and on page 2, Part Il of Form 540 or S40NR the smallest of:
[16490](a) amount on lines 17;
[16492]{b) the taxable income-for the toxable year (computed without regard to gains or losses from sale or exchange
[16494]of capital assets; or
[16496](c) $1,000 ($500 in the case of a husband or wife filing a separate return)
[16498]NW 88326 Docid:32245535 Page
[16500]5
[16502]RESIDENT
[16504]Reference copy, JFK Collection: HSCA (RG 233)
[16506]TAXABLE YEAR
[16508]INDIVIDUAL
[16509]CALIFORNIA.
[16510]INCOME TAX
[16512]PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary)
[16514]Enter social security number(s) only if incorrect or not shown on labet.
[16516]NAME Jif joint return, give first 2; initials of both)
[16517]AMMUEL LP 3
[16519]Check Soetalendar Year
[16520]One: {7} Fiscal Year Ending
[16522]; " FOR FEDERAL PRIVACY ACT NOTIFI-
[16523]LAST NAME CATION SEE PAGE 2 OF INSTRUCTIONS
[16525]1976
[16527]: at.
[16528]Spouse's Social
[16529]Qo: -
[16533]OCCU.
[16535]Yours
[16536]PATION
[16538]Spouse's
[16540]an 6,
[16541]FILING STATUS—Check
[16542]1 & Single
[16543]2K Married filing joint return (even if only one had income)
[16545]If line 1 or 3 checked, enter $25
[16546]6 Personal If line 2, 4 or 5 checked, enter $50). 2 2. |. Le
[16548]7 Dependents — Do not list yourself, your spouse or the person who qualifies you
[16549]as head of household. Enter name and retationship.
[16551]3 (1 Separate return of martied person—Enter spouse's
[16552]social security number and full name here
[16554]ELISA
[16555]THOMAS
[16557]8 Blind (refer to instructions) Number of blind exemplions B® a X $8
[16558]3 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20
[16560]4 () Head of Household Enter name of qualifying
[16561]individual ce ee eee
[16563]CO Widow(er) with dependent child (Year spouse died 197___)
[16565]wo
[16567]{ Attach copy 2 of Formis} W-2 to face of this ?
[16568]} return. If unavailable, see mstructions, Page 6 4
[16570]10 Wages, salaries, tips and other employee compensation
[16571]11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
[16572]12 Interest. Enter total (if over $400, complete and attach Schedule B(540) )
[16574]13 Income other than wages, dividends and interest (from line 48)
[16576]14 Total (add fines 10, 11, 12 and 13)
[16578]15 Adjustments to income (from tine 55) . .
[16580]16 Adjusted gross income (subtract line 15 from line 14)
[16582]© If line 1 or 3 is checked and line 16 is $4,000 or less, enter zero tax on line 23. Bo not complete
[16583]© If ling 2, 4, of 5 is checked and line 16 is $8,000 of less, enter zero tax on line 23. 7 lines 17 thru 22
[16585]© If you do NOT itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on tine 19.
[16586]© If you itemize deductions OR tine 16 is $15,000 or more, complete lines 17 and 18.
[16588]17 Deductions: Itemized (frum me 62) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 ot 5 checked)
[16589]18 Taxable income (subtract tine 17 trom Jine 16) Compute tax fyem Tax Rate Schedule—Enter tax on tine 19
[16591]“4 ATTACH COPY 2 OF FORM W-2 HERE »
[16593]19 Tax from (check one) Tax Table Tax Rate Schedttegy Income Averaging Schedule (G or G-1) O
[16594]20 Total exemption credits (from fine 9, above) 7
[16596]21 Tax liability (subtract tine 20 from line 19—if line 20 is greater than line 19, enter zero)
[16598]22° Other credits (from line 65) i ,
[16599]23° “Net tax liability (subtract line 22 from line 2!—-if line 2? is greater than tine 21, enter zero)
[16600]24 Tax on preference income (see instructions—attach Schedule P(540) )
[16602]25 Total tax liability (add lines 23 and 24) So
[16604]26 Total California income tax withheld (attach W-2 or W-2P to face of this return) 2
[16605]27° Renter's credit—if you lived in rented property on March 1, 1975, complete Part 1 on page 2 . .&&
[16607]28 1975 California estimated tax payments . . 2. | . a |
[16608]29 Excess California SDi tax withheld {attach Form DE 1964 to face of this return) , « ee
[16609]# 30 Total prepayment credits (add tines 26 thru 29) So, mm | 30 —O
[16610]= 31° If line 25 is farger than tine 30, enter BALANCE DUE. ff it is equal to line 30, enter zero. .
[16611]oe Pay in full and mail with return to: FRANCHISE TAX BOARD PAY IN FULL ——> & =) —
[16612]a
[16613]- SACRAMENTO, CA 95867 Do not write in these spaces
[16614]=) 32 If fine 25 is smaller than line 30, enter amount OVERPAID ne oy)
[16615]z 33 Amount of fine 32 to be REFUNDED TO YOU. Allow at least six weeks.
[16616]S Mail return to: FRANCHISE TAX BOARD a 33 E
[16617]: P.O. BOX 13-540 M
[16618]& SACRAMENTO, CA 95813 A
[16619]Ee
[16620]=< 34 Amount af line 32 to be ctedited on your 1976 ESTIMATED TAX. 7 Es &——— ESTIMATED TAX| R
[16622]Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
[16623]belief it is true, correct and complete. If prepared by a person other than taxpayer, his declaration is based on alf informotion of which he has any knowled3e.
[16625]SIGN >i signature Date | >
[16627]rite social security number on check or money order. ATTACH HERE >
[16629]Preparer’s signature (other than taxpayer) ee ne og Date
[16632]NW salad! FRE Paasche -PageaTae i ate
[16634]Reference copy,
[16636]JFK Collection: HSCA (RG 233)
[16638]SCHEDULE
[16640]FORM 540
[16642]Name as shownon Form 540 _
[16643]A EL LL!
[16645]If your adjusted gross Income is $8,000 or less and your fillng status is “Married, Filing Jointly, " “4 40 of Household,” or “Widowler) With Dependent child, ‘
[16646]do not itemize, enter zero on Form 540, line 23, and check the tax
[16648]or $4,000 or tess and your fillng status Is “Single,”
[16649]table box.
[16651]r “Married, Filing Separately,”
[16653]CALIFORNIA
[16655]ITEMIZED DEDUCTIONS
[16657]Attach to Form $40
[16659]A
[16661]USE ONLY (F YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION
[16663]Medical and dental expensas (not compensated by insurance or otherwise) for
[16664]medicine and drugs, doctors, dentists, nurses,
[16665]hospital care, insurance premiums for medical
[16666]care, ete.
[16668]1. One half (but not more than
[16669]premiums for medical care
[16671]2. Medicine and drugs
[16672]3. Enter 1% of line 16, Form 540
[16674]4. Subtract line 3 from line 2. Enter difference (if less
[16675]than zero, enter zero)
[16677]$150) of insurance
[16679]5. Enter balance of insurance premiums for medical cate
[16680]not entered on line I
[16682]6. Other medical and dental expenses:
[16683](a) Doctors, dentists, nurses, etc.
[16684](b) Hospitals 00000200020 Joe.
[16685](c) Other (itemize)...
[16687]7. Total—(Add tines 4, 5, 6a, b, and c)...... 00...
[16689]8. Enter 3% of line 16, Form 540.......... 20.0...
[16691]§. Subtract line 8 from line 7. Enter difference (if less
[16692]than zero, enter zero).
[16694]. Total—tAdd lines 1 and 9. Enter here and, on Form
[16695]540, line 56)...
[16697]Child Adoption Expense
[16698]11. Total expenses paid or incurred—Attach itemized list
[16699]12, Enter 3% of line 16, Form 540..................
[16700]13. Subtract line 12 from line 11—See instructions for
[16702]maximum limitations. (Enter here and on Form 540,
[16703]fine SI). ene ee
[16705]Taxes
[16707]14. Real estate... 66.2 .
[16708]18. State and focal gasoline... 0202... eee
[16709]16. General Sales.......0.00.000.00 cece cece ee
[16711]17.
[16713]Auto license—Excess of registration and weight fees
[16714](see instructions)... ......0....... 0.0 c eee eee
[16716]Personal property (Boat and Aircraff)..............
[16717]Other (itemize). esc eeeeeeeeceeeeeeceeceseeecetcceee ot
[16719]18.
[16720]19.
[16722]2
[16724]interest Expense
[16726]21.
[16727]22.
[16729]23. Total—(Add Isnes 2! and 22. Enter here and on
[16731]Contributions —
[16732]24,
[16734]25.
[16736]26.
[16740]. Carryover
[16742]28.
[16744]Miscellaneous Deductions
[16746]Casualty or Theft Loss(es)—See instructions
[16747]NOTE:
[16748]through 33 and follow instructions for guidance.
[16750]29.
[16751]30.
[16753]31.
[16755]32.
[16756]33.
[16757]34.
[16758]35.
[16759]36.
[16760]37.
[16761]38.
[16763]38.
[16765]Home mortgage
[16766]Other (itemize).
[16768]Form 540, line 59)
[16770]Cash contributions for which you have receipts,
[16771]canceled checks, etc.
[16772]Other cash contributions.
[16774]List donees and amounts
[16776]Other than cash.—See instructions for required state-
[16777]ment . . Ce ett eee
[16778]from 1974—See instructions..........
[16779]Total—tAdd lines 24, 25, 26, and 27. Maximum de-
[16780]duction may not exceed 20% of adjusted gross
[16781]income. Enter here and on Form 540, line 60)
[16783]If you had more than one loss, omit lines 29
[16785]Loss before insurance reimbursement
[16786]Insurance reimbursement
[16788]Subtract line 30 from line 29. Enter difference (if line
[16789]30 is greater than line 29, enter zeio)............
[16790]Enter $100 or amount on line 31, whichever is smaller
[16791]Casualty or theft loss (line 31 Jess fine 32)........
[16792]Alimony paid... eee
[16793]Child care—See instructions
[16794]Union dues. eee eee
[16795]Employment educatlon expense—See instructions...
[16796]Other—titemize)
[16798]Total—Add lines 33, 34, 35, 36, 37, and 38.
[16799]here and on Form 540, line 61)
[16801](Enter
[16804]Reference copy, JFK Collection: HSCA (RG 233)
[16806]“Fr
[16810]PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
[16812](Sole Proprieterships)
[16814]Partnorships, joint vontures, otc., must Alo oa Form 365
[16816]yen, Form 540 or SG4ONR
[16818]C. Principal business activity (i.e, retailhardware; wholesale~tobacco; services—legal; etc.)
[16819]D. Indicate method of accounting:  ( cash; acer CO other,
[16820]E. Were Forms 591, 592, 596 and 599, for the cig filed (if required)? Lies O NO
[16821]F. Method of Inventory valuation Bm. te nec cccce eceneeeeceeeeesneteceneeenensaneees cscs sveeeeeceeseecseeceeneenpisteciesssesceneenesersss nesesonesueneeteceessserssosseanersersereceansaesucaes weeeeeneescs
[16822]Was there any substantial change in ‘the manner of determining quantities, costs, or valuations between the opening and closing inventories?
[16823]O YES (NO If “Yes,” attach explanation.
[16825]1 Gross recelpts, sales, or fees $0. .0.............Less returns and allowances $202
[16826]2 Inventory at beginning of year (if diferent from last year's closing inventory, attach explanation)...........
[16827]3 Purchases $. |. Less cost of items withdrawn for personal use $ ..
[16828]4 Cost of labor (do not include salary paid to yourself)
[16829]5 Materials and supplies................. Se eee bebe
[16830]6 Other costs (explain in Schedule C-2. or attach Schedule). Se ee be beet ee be vee tees
[16831]7. Total of tines 2 thu 6............... ee ee been e beer eee nee
[16832]8 inventory at end of this year... Cee be beeen eee
[16833]9 Cost of goods sold (subtract line 8 from line n rn cose ee
[16834]10 Gross profit (subtract line 9 from line 1)
[16835]11 Other income (attach schedule)...... . . Lo Cee _ . Se cee
[16836]12 Total Income (add lines 10 and 11).. vee . . ee beet nett bee beeen eee
[16837]OTHER BUSINESS DEDUCTIONS
[16838]13 Depreciation (explain in Schedule C-1 or attach Schedule) .
[16839]14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule). Lo. rn
[16840]15 Rent on business property .
[16841]16 Repairs (explain in Schedule C-2 or attach Schedule)
[16842]17 Salaries and wages not included on tine 4 (exclude any paid to yourself)
[16843]18 Insurance eee ee
[16844]19 Legal and professional fees, 0 8 .
[16845]20 Commissions .. Looe ee eee
[16846]21 Amortization (attach statement). rn re Snes
[16847]22 Retirement plans, etc. (other than your share, see ‘instructions)
[16848]23 Interest on business indebtedness... 0.202. cence eee
[16849]24 Bad debts arising from sales or services (Not applicable if reporting on cash basis).... © | 200...
[16850]25 Depletion (attach schedule). . ene bern e evens
[16851]26 Other business expenses fexplain in Schedule C2 or attach Schedule). . bbe beens
[16852]27 ~~ ‘Total of UInes 13 thru 26. a ar
[16854]Depreciation Method of
[16856]: Group and guideline class Date Cost or ‘ Depreciation
[16857]a Pr : . allowed (or allowable) computing :
[16858]wes or description of property Acquired other basis in prior years depreciation for this year
[16860]Ss
[16861]oC
[16862]es
[16863]253
[16866]x]
[16867]Sis EXPLANATION
[16869]so
[16870]oo &
[16871]BEs
[16872]Be"
[16873]352
[16874]go
[16877]Reference copy, JFK Collection: HSCA (RG 233)
[16879]CALIFORNIA
[16881]CAPITAL GAINS AND LOSSES
[16883]Attach to Farm 540 or S40NR
[16885]TAXABLE
[16887]SCHEDULE |
[16889]FORM 540
[16891]Use this schedule to report gains and losses on stocks, bonds and similar investments,
[16892]and gains (but not losses) on personal assets such as a home or jewelry.
[16894]Name as showin on Form 540 or 540NR// 4 , ~SoelT Be
[16895]AMUAEL | i iY (erie:
[16897]i es ae f\ A Pe ne aan, cel
[16899]PART !—Assets Held One Year or Less
[16901]: @. Cost or other basis as
[16902]adjusted, cost of subse-
[16903]a. Kind of property and description b. Date acquired t. Date sold . Gross sales quent improvements (If ft. Gain or loss
[16905](Example, 100 shares of ‘‘Z" Co.) {mo., day, yr.) (mo.. day, yr.) orice fot purchased, attach (d. fesse.)
[16906]explanation) and = ex-
[16907]pense of sale
[16909]—oltald Loss. cn ee ED oc ccccssessnefesssessesesnttnesiseeenfecseeesesesennsstaeeei
[16910]a core (v0, 3 6 0 “ye : worsens eenenneens nena eee
[16911]USED [2724 JOR/D- |
[16913]> tne gain (or loss), if applicable, from line 18, Schedule D-1 (540) (attach copy) .
[16914]3. Enter your share of net gain or loss from partnerships and fiduciaries .
[16915]4, Net gain or loss, combine lines 1, 2 and 3
[16917]_ PART ll—-Assots Held More Than One Year But Not More Than Five Years
[16919]6. Enter gain (or loss), ‘if applicable, from line 20, Schedule D- 1 (540) (attach copy) .
[16920]7. Enter your share of net gain or loss from partnerships and fiduciaries .
[16921]8. Net gain or loss, combine lines 5, 6 and 7
[16923]PART IIl—Assets Held More Than Five Years
[16925]10. Enter gain (or ‘loss), if applicable, from line 22, Schedule D-1 (540) (attach copy) .
[16926]11. Enter your share of net gain or loss from partnerships and fiduciaries .
[16927]12. Net gain or loss, combine lines 9, 10 and 11
[16929]PART iV—Summary of Capital Gains and Losses
[16931]13. Enter amount from line 4
[16932]14. Enter 65% of the amount on line 8
[16933]15. Enter 50% of the amount on line 12.
[16934]16. Enter unused capital loss carryover from preceding taxable years (attach compotion
[16935]17, Combine the amounts shown on lines 13, 14, 15 and 16
[16936]18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540. or ‘540NR
[16937]19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of:
[16938](a) amount on lines 17;
[16939](b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
[16940]of capital assets; or
[16942]NW B8326 SON: 3I99455¢5+Page 484 hoshand ac wife fillan ao cannarnte return)
[16944]Reference copy,
[16946]BSCA (RG 233)
[16948]JFK Collection:
[16950]FORM 540
[16952]Name as Showa on Tax Return
[16953]Sammut. £
[16954]a aa
[16956]PART |
[16958]CALIFORNIA
[16960]SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
[16962](Sales or Exchanges Including Involuntary Conversions)
[16963](Attach to Form 540, S40NR, 541 or 565)
[16965]Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220
[16967]Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
[16969]Date acquired
[16970](mo., day, yr.)
[16972]1. meas of Sections 18211, 18212-18, 18219, one 18220 property. _
[16974]VU OP LEY. Bit CoFFEEe
[16976]Correlate lines 1(A) through 1(D) with these columns oe ad
[16978]Gross sales price Loe
[16979]. Cost or other basis and expense of sale
[16980]Depreciation allowed (or allowable)
[16981]Adjusted basis, line 3 fess line 4
[16982]. Total gain, subtract line 5 from line 2
[16983]if Section 18211 property:
[16985]N[oa a awn
[16987](a) Depreciation allowed (or allowable) after applicable date.
[16989](See Instruction D-3) .
[16990](b) Line 6 or line 7(a), whichever is smaller
[16991]8. if Section 18212-18 property:
[16992](a) Enter additional depreciation after 12-31-63 and before
[16993]1-1-7] ,
[16994](b) Enter additional depreciation after 12. 31 70
[16995](c) Enter line 6 or line 8(b), whichever is smaller .
[16996](d) Line 8(c) times applicable percentage (Instruction D- 4).
[16997](e) Enter excess, if any, of line 6 over line 8(b)
[16998](f) Enter line 8(a) or line 8(e), whichever is smaller .
[16999](g) Line 8(f) times applicable percentage (Instruction D-4)
[17000](h) Add line 8(d) and fine 8(g) . . oo.
[17001]9. If Section 18220 property:
[17002](a) If farm land, enter soil and water conservation expenses
[17003]for current year and four preceding years
[17005](b) If farm property, other than land, subtract line 7(b) from
[17007]line 6; OR, if farm land, enter line 6 or line 9(a), which-
[17008]ever is smaller (see Instruction D-5)
[17009](c) Excess deductions account (see Instruction D-5)
[17010](d) Enter line 9(b) or line 9{c), whichever is smaller .
[17011]10. tf Section 18219 property:
[17012](a) Soil and water conservation expenses made after 12-31-69
[17013](b) Enter amount from line 9(d), if any; otherwise, enter a zero
[17014](c) Enter excess, if any, of line 10(a) over 10(b)
[17015](d) Line 10(c) times applicable percentage (Instruction D-5)
[17016](e) Line 6 less line 10(b)
[17017](f) Enter smaller of line 10(d) or line 10(e)
[17018]SUMMARY OF PART I
[17019]11. Enter amounts from line 6... . .
[17020]12. Enter amounts from lines 7(b), B(h), 9(d) ‘and 106) toe
[17021]13. Subtract line 12 from line 11, enter here and in appropriate
[17022]Section in Part Il (see Instruction D-2)
[17024]14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part Ill
[17026]NW°88320-Docldt32245935 Page 182
[17028](Complete Property Columns (A) through (D) up to Line 10(f) before going to Line 11)
[17030]Date sold
[17031](mo., day, yr.)
[17033]Property
[17034](B)
[17036]Property
[17037](A)
[17039]Property
[17040](Dd)
[17042]Property
[17043](C)
[17045]| LPP.
[17048]Reference copy, JFK Collection: HSCA (RG 233)
[17050]Lf. “CALENDAR YEAR 19 AS
[17051]“ADDRESS
[17053]MEDICAL Pstare  [ Feoenat (CONTRIBUTIONS FEDERAL
[17054]a
[17056]2 MEDICINE/DRUGS _
[17057]3 LESS 1% A.GA. (Line 18 - 1040)
[17058]4NET MED/DRUGS
[17059]5H &AINS. (4 + EXCESS)
[17060]6a DR.
[17062]DR.
[17064]oR.
[17066]ae |
[17070]OR. \ ;
[17071]oR. ;
[17075]sURHREEEEE
[17076]SHI:
[17078]6b HOSPITAL _
[17079]PROSTHETIC APPLIANCES
[17080]HEARING AIO
[17082]CASUALTY OR THEFT (LOSS(ES)
[17083]25 LOSS BEFORE ADJUSTMENT
[17084]26 INSURANCE REIMBURSEMENT
[17086]_Ge AMBULANCE
[17087]LABORATORIES 26 ($100 LIMITATION PER.CAS.)
[17088]TRAVEL FOR MED. i tf 29 ror. CaS OR THEFT LOSS
[17090]a MISCELLANEOUS DEDUCTIONS
[17092]30 ALIMONY
[17094]31 UNION /PRUF SIONAL DUES
[17095]TE.2-7F | [32 cuiro a ver. cane (Form 2441)
[17096]33 INCOME TAX PREPARATION
[17097]UNIFORMS/PROTEC, CLOTHING
[17098]SMALL TOOLS AND SUPPLIES
[17099]LAUNDRY AND CLEANING
[17100]AUTO USE/UAMAGE
[17102]INV EST. COUNSE L & PUBS. (Sched
[17103]EMPLOYMENT AGENCY FEES
[17104]SAFE DEPOSIT BOX
[17105]TEL. REQ. IN BUSINESS
[17106]POLITICAL CONTHIBU TIONS
[17108]___MEDICARE INS.
[17109]GLASSES _
[17110]TMEDICAL EXPENSES
[17111]LESS REIMBURSED BY INS.
[17112]8 LESS 3% ADJ. GROSS INC.
[17113]9 a
[17114]1+:% (TO $150) OF H & A INS. _
[17115]10 roTAL MEDICAL DED.
[17116]TAXES
[17117]TISTATE & LOCAL INCOME
[17118]TZREALESTATE
[17119]12 STATE & LOCAI. GASOLINE
[17120]14 GENERAL SALES TAX
[17121]15a PERSONAL PROPERTY ;
[17122]15b PERSONAL PROPERTY AUTO
[17123]16 saLES TAX AUTO
[17125]34 rorAL MISC. DED.
[17127]SUMMARY OF ITEMIZED DED. STATE FEDERAL
[17129]TOF Gr DUCTIALE MEDICAL & DENTAL
[17130]EPPENSES TE ROM LINE 10)
[17132]36 TOTAL TAXES (From LINE 17)
[17134]37 TOTAL INTEREST (Line 20) -——|—|
[17136]17 TOTAL TAXES ___ bl [%
[17137]INTEREST (TO WHOM PAID)
[17138]18 MORTGAGE
[17140]38 TOTAL CONTR. (Line 24)
[17142]39 CAS. & THEFT LOSS(ES) (Line29)
[17144]40 TOTAL MISCELLANEOUS
[17145]OEDUC TIONS (FROM LINE 34)
[17147]Ay Porat TTEMIZ ED DEDUCTIONS
[17148]ENTER ON FORM 1040 LINE 45
[17150]REMARKS
[17152]2OTOTALINTEREST ss LOE
[17154]0 bd . Ferny Vibe SCHEDULE
[17156]NW 88326 Docld:32245535 Page 183 -
[17158]Reference copy, JFK Collection: BSCA (RG 233)
[17160]NAME
[17162]ADDRESS FISCAL YEAR ENDING
[17164]19
[17166]SCHEDULE OF PROFIT ( OR LOSS y FROM BUSINESS OR PROFESSION
[17168]PRINCTR4SL BUSINESS ACTIVITY
[17169]BUSINESS NAME EMPLOYERS NO.
[17173]BUSINESS ADDRESS
[17175]I
[17177]TOTAL RECEIPTS
[17178]paneer
[17179]INVENTORY AT BEGINNING OF YEAR
[17181]MERCHANDISE PURCHASED
[17183]i
[17184]TOTAL
[17186]LESS INVENTORY AT END OF YEAR
[17188]a
[17190]GROSS PROFIT
[17192]AGWFATISING
[17194]ager SP TRUCK EXPENSE
[17196]fan. ne ais
[17198]c OMM TE ss TONS
[17200]ObR LIVER
[17202]DErPLEIATION ( SUMPDULR BLLUe
[17204]SUES AND SURSCRIPTIONS
[17208]ENTERTAINMENT AND PROMO T? ONAL
[17210]INSURANCE
[17212]INTEREST
[17214]PANE EOR ANU “AUL Ihe
[17216]any ft ZPUNSE
[17218]OPP ECE SUPPLIES
[17220]RENT
[17222]REPAIRS AND MAINTONANCE
[17224]SALARIES AND WAGES
[17226]SUPPLIES
[17228]TAXES AND LICENSES
[17230]TAYES PAYROLL
[17232]TELEPHONE AND UTILITIES
[17234]~Boialt es as TRB zB re) R
[17236]NET PROFIT eR {Loss } FEDERAL RETURN ‘
[17237]NED PROFIT OF (L055 ) STATE RETURN « SFE DEPREC. SCHEQULE FOR DIFF. Ariz wT Tt |
[17238]SCHEDULE OF DEPRECIATION
[17240]DATE YEARS | COST OR PRIOR [DEPRECIATION
[17241]KIND AND L LOCATION | QF PROPERTY | acguiReo . | OR % | OTHER BASIS DEPREC.
[17243]PROFESSIONAL STATIONERS INC FORM 1OAA
[17244]LOS ANGELES, CALIF.
[17246]NW 88326 Docld:32745535 Page 184
[17248]SCHEDULE
[17250]Reference copy, JFK Collection: HSCA (RG 233)
[17252]al route)
[17254]Ge Rept eed cae 1 Bbatastinet a lead gaa w) UNE yE
[17256]FL 3
[17257]RESIDENT INDIVIDUAL ie
[17258]CALIFORNIA |
[17259]INCOME TAX |
[17261]PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) For calendar year or
[17262]Enter social security fumber(s) only if incorrect or not shown on label. : Taxable year ending 4 197 |
[17263]NAME (ip jpint return, a and initials of both) F Ce Your Social Security Number
[17264][
[17267]PATION
[17269]| Yours
[17271]Spouse’
[17273]FILING STATUS—Check Only One:
[17274]1 © Single
[17275]2 Married filing joint return (even if only one had income)
[17277]EXEMPTION CREOITS If line 1 or 3 checked, enter $25
[17278]6 Personal If line 2, 4 or 5 checked, enter $50
[17280]7 Dependents — Do not list yourself, your spouse or the person whu qualifies you
[17281]as head of household. Enter name and relationship.
[17283]4 (J Head of Household—Enter name of qualifying Total Number & __ a x $8
[17284]individual, - -}8 Blind (refer to instructions) Number of blind exemptions » __.
[17286]5 0) Widowler) with dependent child crear spouse died » 197_)] 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20
[17288]3°C Separate return of married person—Enter spouse's
[17289]social security number and full name here
[17291]10 Wages, salaries, tips and other employee compensation | At!2ch copy 2 of Boras) TW-2 ta face of this |
[17293]) return. tf unavailable, attach explanation.
[17295]11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
[17296]12 Interest. Enter total (if over $400, complete and attach Schedule B(540))
[17298]13 Income other than wages, dividends and interest (from tine 48)
[17300]14 Total (add lines 10, 11, 12 and 13)
[17302]15 Adjustments to income (from line 54)
[17304]16 Adjusted gross income (subtract line 15 from tine 14)
[17306]+ If you do NOT itemize deductions AND line 16 is under $10,000, find tax in Tax Table and enter on line 19.
[17308]* If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.
[17310]17 Deductions: itemized (from line 61) OR Standard ($1,000 if line 1 or 3 checked—$2,000 if fine 2, 4 or 5 checked)
[17311]18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on fine 19
[17313]eee ee A eRe
[17315]19 Tax from (check one) Tax Table (7) Tax Rate Schedule y Income Averaging Schedule (G o G-1) 0
[17316]20 Total exemption credits (from line 9, above)
[17318]21) Tax Hability (subtract line 20 from tine 19—if line 20 is greater than line 19, ‘enter reo)
[17320]22> Other credits (from line 65—Includes special low income tax credit) .
[17322]23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter + 2er0)
[17323]24 Tax on preference income (see instructions—attach Schedule P(540))
[17325]<4 ATTACH COPY 2 OF FORM W-2 HERE »
[17327]genet
[17329]A 25 Total tax liability (add fines 23 and 24)
[17331]= 26 Total California income tax withheld (attach Form(s) W-2 or W-2P to face of this return) :
[17332]© 27 Renter's credit—it you lived in rented property on March 1, 1974, complete Part 1 on page 2 . i
[17333]E 28 1974 Catlfornia estimated tax payments f
[17334]'g 29 Excess California SDI tax withheld (attach Form DE 1964 t to face of this ‘return, _. . Be
[17335]E 30 Teta prepayment credits (add lines 26 thru 29)... | 2 2 ee
[17337]2 = 31 If tine 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero. —_ ‘
[17338]4 E Pay in full and mail with retura to: FRANCHISE TAX BOARD PAY IN FULL —>
[17339]a 5 SACRAMENTO, CA 95867 Do not write in these spaces °
[17340]w & 32 If line 25.is smaller than line 30, enter amount OVERPAID z
[17341]Qa = i
[17342]Zc Mail return to: FRANCHISE TAX BOARD :
[17343]=o P.0. BOX 13-540 : . .
[17344]= Ss. : SACRAMENTO, CA 95813 M ‘i
[17345]3 E 33° Amount of line 32 to be REFUNDED..(Allow at least six weeks) -——— REFUND TO YOU —» 33 ["
[17346]E £ 34 Amount of line 32 to be credited on your 1975 ESTIMATED TAX . . . | 34 A .
[17347]4 7
[17348]2 Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and stotements, and to the ‘best of my knowledge and E
[17349]&. boliof it is true, correct ond complete. If preparod by a person othor than taxpayer, his doclaration is based on all information of which he has any knowledge. i
[17350]3 Ff
[17351]a
[17352]2 SIGN > vou signature Dats B seat rate oe than taxpayer) f
[17353]x 717 VANOWEN STREE i
[17354]NW ae HERE Praozaass05-Page 105 return Date Address (and Zip code) 0 ey an srne,
[17357]Reference copy, JFK Collection: HSCA (RG 233) tganeg-.
[17359]CALIFORNIA
[17361]ITEMIZED DEDUCTIONS
[17363]Attach to Form 540
[17365]TAXABLE
[17367]Use only ‘it you do not use the Tax Table or take the standard deduction.
[17369]Medical and dental expenses (not compensated by insurance or otherwise) for interest Expense
[17370]— medicine and drugs, doctors, dentists, nurses, hospi- ,
[17371]tal care, insurance premiums for medical care, etc. 22. Home mortgage .
[17373]. 23. Installment purchases
[17375]1. One half (but not more than $150) of insurance 24. Other (itemize)
[17377]premiums for medical care
[17378]2. Medicine and drugs 2 2 2... ee ee ee Pepe. ecceneeesey veaveneviees teveaecees cis toute cer ce cesnumtcts feneeens  )ocaeeaceeeeereecbeeseees
[17380]3. Enter 1 1 of adjusted Bross income shown on Form
[17382]4. Subtract line 3 from tine 2. Enter difference (if line
[17383]3 is greater than fine 2, enter zero)
[17385]5. Enter. balance of insurance premiums for medical
[17386]care not entered on line 1 .
[17388]6. Other medical and dental expenses:
[17389](a) Doctors, dentists, nurses, etc.
[17390](b} Hospitals .
[17392](c) Other (itemize) .
[17394]25. Total tAdd lines 22, 23 ‘and 24, Enter here an
[17395]on Form 540, page 2, line 58)... . YG
[17397]Contributions oo
[17399]26. Cash contributions for which you have receipts, ¢ can-
[17400]celed checks, etc.
[17402]27. Other cash contributions. List donees and amounts
[17404]7. TotaltAdd tines. 4, 5, ‘6a, i" and 0) rs rs i
[17405]8. Enter 3% of adjusted _Bross income shown on
[17406]Form 540... Loe
[17408]28. Other than “cash. — See instructions . for “ewuted
[17410]9. Subtract fine 8 from line 7. Enter difference (if statement
[17412]line 8 is greater than line 7, enter zero)
[17414]uo 29. Total—{Add tines 26, 27 and 4 Maximum deduction Ay
[17415]10. Total—iAdd lines 1 and 9. Enter here and on . "may not exceed 20% of adjusted gross income.
[17416]Form 540, page 2, tine 55). > L3S¢ Enter here and on Form 540, page 2, tine 59) . > ]
[17418]Child Adoption Expense ; Miscellaneous Deductions
[17419]Casualty or Theft Loss(es}—See Instructions
[17420]1. Has expenses paid or ncurred—Attach itemized NOTE: If you had more than one loss, omit lines 30
[17421]. . ne ree res through 34 and follow instructions for guidance.
[17423]12. Enter 3% of adjusted gross income shown on Form 30. Loss before insurance reimbursement . . . . .
[17424]SQ 31. Insurance reimbursement . . . .
[17426]13. Subtract. line 12 from line 11—See instructions 32. Subtract line 31 from tine 30. Enter ditterence tit
[17427]for maximum timitations. (Enter here and on Form ine 31 is greater than tine 30, enter zero) . ©.
[17428]540, page 2, line 56) rd 38. Enter $100 or amount on line 32, whichever is
[17430]smaller
[17432]34. Casualty or theft loss ine 32 less line 331
[17434]35. Alimony pald
[17436]36. Child care—See instructions
[17438]37. Union dues
[17440]38. Employment education expense—See instructions
[17441]39. Other—See instructions (itemize) .
[17443]Taxes
[17445]14. Real estate
[17447]15. State and local gasoline
[17448]18. General sales
[17450]17. Auto license-——Excess of registration a and weight fe fees
[17451](see instructions) . :
[17453]18. Personal property .
[17455]19. State disability insurance (SDl)—Employer Private
[17456]disability plans do not qualify . .
[17458]20. Other 2... 2 lo ae
[17459]21. Total taxes—{Add lines 14 through 20. Enter here 0 40. Total—Add lines 34, 35, 36, 37, 38 and 39. (Enter
[17460]and on Form 540, page 2, line 57) . : Y here and on Form 540, page 2, ‘ine 60).
[17462]NVW88276, Docid:32245535 Page 186
[17464]K pireres YY
[17466]aT)
[17470]SO ee eg Co TT oR NR ED RE REO EL
[17472]Yee, 2 renee nae
[17476]co
[17478]wR ee - : 7 “. Reference copy, JFK Collection: HSCA (RG 233)
[17480]) CALIFORIIA
[17482]PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
[17484](Solo Propriatorships)
[17486]SCHEDULE
[17488]FORM 3540
[17490]Attach this schedule to your income tax return, Farm 540 or S40NR —_—_— Pertnorships, joint vonturas, otc., must file on Form 565
[17492]Name as shown on Form 540
[17494]ee, DOCial Security Number
[17496]A. Principal business activity te R " Cc eo ceed product... LOA CC “than.
[17498](See Instructions for “Item A.” (For Wa retail—-herdwores. ree ONE pprobenses 1 elcar loess monvfocturing—furniture; etc.)
[17500]B. Busine: me.. Woo PLE ral loyer identification nymb E52 ASE. Fé...
[17501]D. Business address (OLS 5 PisTR RA CyPreet. y CA wo “CANS "9 93/76
[17503]E. Indicate method of accounting: (_} cash; WW accrual; Oj 2 - ceeeeeteeeeteeeeee
[17504]F. Were Forms 591, 592, 596 and 599, are calendar year filed (if required)? “¥ Yes” D ‘No.
[17505]G. Method of inventory valuation > “ST
[17507]Was there any substantial change in the manner of determining quantities, costs, or + valuations between the c opening 3 and closing Inventories?
[17509]O) Yes NO. _ If “Yes,” attach explanation.
[17510]IMPORTANT—A!l applicable lines and schedulos must be Allod in.
[17512]" 1 Gross receipts or sales $s Less returns and allowances $_......______... Balance ee oo.
[17513]S| 2 Less: Cast of goods sold (Schedule C-1, line 29) and/or operations (attach schedule). 2 2. 1 2.
[17514]Q| 3 Gross profit... | Se ee a.
[17515]Z| 4 Other income (attach schedule) Ck ke
[17516]5 TOTAL income (add lines 3. and 4) . 2. 1. wee ee | SY
[17517]6 Depreciation (explain in Schedule C-3) . . . . a ces ie
[17518]7 Taxes on business and business property (explain in "Schedule (> ) re Se
[17519]8B Rent on business property 2. 6. ee ac tecencescectecedeeeees
[17520]9 Repairs (explain in Schedule C-2) 2 6 1 fcc eceneceecnereefeceeee
[17521]10 Salaries and wages not included on line 24, Schedule C- 7 (exclude a any ‘paid t to yourself) . -
[17522]1} Insurance. a Ser es Deenene
[17523]12 Legal and professional fees . oe seeeeeeceeseeceneecueeeeedecee eee
[17524]13 Commissions . on nee
[17525]14 Amortization (attach statement) wee re ne ieee
[17526]{TS (a) Pension and profit-sharing plans (see Instructions for line 15(a)) wee ee ee kk _
[17527]3 (b) Employee benefit programs (see Instructions for line 15(b)) 2-6 hee ceannnsecbeseeee
[17528]5 16 Interest on business indebtedness . ree Pree
[17529]3/17 Bad debts arising from sales or services 2 | i eeettteee cee eteetece bce
[17530]@/18 Depletion . . . rs [eee Meee
[17531]9159 Other business expenses o (pects
[17532](a)...
[17533](b)... esseeeeeccceene
[17534](c)...
[17535](d)..
[17536](e)...
[17538](h). Total other business expenses (add lines 19(a) through 19(g)) . See ee ew ge
[17539]20 Total deductions (add lines 6 through 19). 2 1. we ee ee CR
[17541]21 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR ©
[17543]SCHEDULE C-1. COST OF GOODS SOLD (See Schedule C Instructions for fine 2)
[17545]22 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)
[17546]23 Purchases $0... ... Less cost of items withdrawn for personal use $....................... Balance >
[17547]24 Cost.of labor (do not include salary paid to yourself) 2. 2... ;
[17548]. 25 Materials and supplies 2 6 2 6 6 we ee
[17550]26 Other costs (attach schedule) 2 2 5. 1 we ee tt ee te .
[17551]27 Total of lines 22 through 26 2 6 1 ac acennneneeecfeceeeee
[17552]28 Less: Inventory at end of year. . 6. Ce ke ee ek
[17553]29 Cost of goods sold. Enter here and on line 2, ‘above
[17555]Nw-88226 Docld:32245535 Page 187
[17557]Naam 9 mor rere ne
[17559]en RE Sop) San ee
[17561]TE Me ener gee cnrecegny eget nitnae
[17563]ELA RRR ee one me RTT Ie re OE Ree eee
[17565]Reference copy, JFK / Collection: HSCA (RG 233) ""~
[17567]SCHEDULE
[17570].
[17571]i
[17572]i
[17573]1
[17574]t
[17576]1
[17578]if
[17579]FT sao? agen n «
[17581]CAPITAL GAINS AND LOSSES
[17583]Attach to Form 540 or S40NR
[17585]Use this schedule to report gains and losses on stocks, bonds ond similar investments,
[17586]and gains (but not losses) on personal assets such as a home or jewelry.
[17588]Name ag shown on Form 5 ONR /)
[17589]a wer Pi tert U_-
[17591]PART I-——Assets Hold One Year or Less
[17593]e. Cost or other basis as
[17594]adjusted, cost of subse-
[17596]a. Kind of property and description b. Date acquired ¢. Date sold d. Gross sales - quent improvements (if f. Gain or toss
[17597](Example, 100 shares of ‘‘2'" Co.) : (mo., day. yr.) (mo., day, yr.) price not, suenesed. qracn (4. less @.)
[17598]explanation ani . .
[17600]COR FORA TGA cco ere).
[17602]ee a
[17603]Beh ere sl leer |
[17609]“2. ‘Enter | gain ‘(or ‘loss), if applicable, from line 18, Schedulo D. 7 (540) (attach copy) .
[17610]3. Enter your share of net gain or loss from partnerships and fiduciaries .
[17611]4, Net gain or loss, combine lines 1, 2 and 3
[17613]PART !!—Assets Held More Than One Year But Not More Than Five Years
[17615]6. Enter gain (or loss), if applicable, from line 20, Schedule D-1 (540) (attach copy)
[17616]7. Enter your share of net gain or loss from partnerships and fiduciaries . .
[17617]8. Net gain or loss, combine lines 5, 6 and 7
[17619]PART Iil—Assets Held More Than Five Years —
[17621]Pe. (4.78 L053. BRKYOUER |.
[17623]ES LO
[17625]geet age
[17627]10. Enter gain (or foss), if cpplicabie, from line 22, Schedule D-1 (540) (attach copy) .
[17628]11. Enter your share of net gain or loss from partnerships and fiduciaries . .
[17629]12. Net gain or loss, combine lines 9, 10 and 11
[17631]2 a em sama aR en
[17633]we emus cen ene
[17635]PART iV—Summary of Capital Gains and Losses
[17637]13. Enter amount from line 4 .
[17638]14. Enter 65% of the amount on line 8
[17639]15, Enter 50% of the amount on line 12. .
[17640]16. Enter unused capital loss carryover from preceding taxable years (attach computation
[17641]17. Combine the amounts shown on lines 13, 14, 15 and 16
[17642]18. If line 17 shows a goin, enter here and on page 2, Part Il of Form 540 or ‘540NR
[17643]19. If line 17 shows a loss, enter here and on page 2, Part I of Form 540 or 540NR the smallest of:
[17644](a) amount on lines 17;
[17645](b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
[17646]of capital assets; or
[17648](c) $1,000 ($500 in the case of a husband or wife filing a separate return)
[17649]NW-88426—-Boel 3245535 —-Page-188- —______—__
[17651]tal ty
[17653]-Fe.. . Reference copy, JFK Collection: H8SCA (RG 233)
[17656]ADDRESS
[17660]——— SOC. SEC. NO.“
[17662]DEDUCTION SCHEDULE
[17664]MEDICAL STATE T FEDERAL [CONTRIBUTIONS STATE FEDERAL
[17666]MISCELLANEOUS DEDUCTIONS
[17667]30 aLimoNY
[17668]31 UNION/PROFESSIONAL DUES
[17669]32 CHILD & DEP. CARE (Furm 2441}
[17671]MEDICARE INS.
[17672]GLASSES
[17674]“2 MEDICINE/ORUGS i 4 21 PARTNERSHIP SHARE P|
[17675]3 LESS 1% AGI, (Line 18 - 1040) . GIRLIBOY SCOUTS qr]. |
[17676]4 NET MED/DRUGS _ [| HEARTFUND/CANCERFUNg [| |
[17677]5H & A INS. (% + EXCESS) _ 0 Y | Regenescunmo rune \ Las
[17678]6a DR. , ee ee XMAS & EASTER SEALS \L JF 8)
[17680]OR. Pe | j |_| MISC. ORGANIZED CHARITIES] |
[17681]OR. {sis = POLITICAL CONTRIBUTION
[17682]oR, ee ee
[17683]OR. fo [| po P|
[17684]a 4 —=
[17685]oR. a
[17686]a 22oTHER THANCASH
[17687]4 een
[17688]Gb HOSPITAL 4 | [24 ToTAL CONTRIBUTIONS > Bde
[17689]PROSTHETIC APPLIANCES iL. — CASUALTY OR THEFT LOSS(ES)
[17690]HEARING AID 25LOSSBEFORE ADJUSTMENT |__|
[17691]I — 26 INSURANCE REIMBURSEMENT
[17692]6c AMBULANCE i] | [27 difference (not less than zero) —
[17693]LABORATORIES —s 28 ($100 LIMITATION PER CAS.)
[17694]TRAVEL FOR MED. | (J UPD "a 2@ror.cas.onTHEeTLoss Df ss
[17697]7 MEDICAL EXPENSES
[17698]‘LESS REIMBURSED BY INS.
[17699]8 LESS 3% ADJ. GROSS INC.
[17700]9
[17702]|
[17703]i
[17705]UNIFORMS/PROTEC,. CLOTHING
[17707]Auto Use
[17709]a
[17711]| 263
[17712]+:% (TO $150) OF H& AINS._- | Las
[17713]10 TOTAL MEDICAL DED. a! &~ be
[17714]TAXES INVEST. COUNSEL & PUBS.(Sched
[17715]T1ISTATE & LOCAL INCOME
[17716]12 REAL ESTATE
[17717]13 STATE & LOCAL GASOLINE
[17718]14 GENERAL SALES TAX
[17719]15a PERSONAL PROPERTY
[17720]I5b PERSONAL PROPERTY AUTO
[17721]IGSTATE DIS.INS.H = oW
[17723]SALES TAX AUTO
[17725]“i
[17727]EMPLOYMENT AGENCY FLES
[17729]SAFE DEPOSIT BOX :
[17731]TEL. REQ. IN BUSINESS
[17733]2
[17735]|. |
[17737]7 | |
[17742]|_| 34 TOTAL MISC. DED.
[17745]|
[17747]SUMMARY OF ITEMIZED DED. STATE
[17748]B ror. DEDUCTIBLE MEDICAL & DENTAL
[17749]PENSES (FROM LINE 10)
[17750]36 TOTAL TAXES (From LINE 17)
[17751]37 TOTAL INTEREST (Line 20)
[17753]38 TOTAL CONTR. {Line 24).
[17754]39 CAS. & THEFT LOSS(ES) (Line29)
[17756]40 TOTAL MiSCELLANEOUS
[17757]DEDUCTIONS (FROM LINE 34)
[17759]all
[17760]Pt
[17762]iY.
[17765]N
[17767]17 TOTAL TAXES
[17768].NTEREST (TG WHOM PAID)
[17769]18 MORTGAGE
[17773]HE
[17775]19 INSTALLMENT LOANS
[17776]MERRILL ¢
[17777]TRAD +
[17779]SS BA
[17781]i
[17782]Iv)
[17784]‘ n
[17785]} m
[17787]m
[17788])
[17790]r
[17792]47 LOTAL ITEMIZED DEDUCTION
[17793]ENTER ON FORM 1040 LINE 45 aa
[17795]REMARKS
[17797]Nz
[17799]NOVA S¥e IESE S2245535_ Page 1Bet
[17801]|
[17802]|
[17803]|
[17804]|
[17806]re em RTE Tm ewer per ee cari pee ce me ap te eaten eee area en pore eee pesca
[17809]ORE, 4 ABRs
[17811]Loge. aMeteviienbetad Reference copy, JFK Collection: HSCA (RG 233)  ggapeargws ap
[17813]cnt eee -_ . j
[17815]a ee ee i
[17817]- ute ’ . ia
[17818]NAME L h LL tS huey NO. CALENDAR YEAR 1 OY
[17819]OR
[17820]; Pe ; Mies SOC. SEC. NO.
[17821]ADDRESS o, ‘ime en a FISCAL YEAR ENDING
[17823]19
[17825]7 SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION
[17826]_ PRINCEPAL BUSINESS ACTIVITY
[17827]BUSINESS NAME EMPLOYERS NO.
[17829]BUSINESS ADDRESS
[17830]TOTAL RECEIPTS
[17831]mmm AAT
[17833]INVENTORY AT BEGINNING OF YEAR
[17834]MERCHANDISE PURCHASED
[17836]a
[17838]: 5
[17839]S|
[17841]P|
[17843]af |_|
[17848]a
[17850]a
[17852]TOTAL 440791 _|
[17853]|
[17857]INVENTORY AT END OF YEAR
[17859]GROSS PROFIT
[17861]S
[17863]GRUSS INCOME
[17865]OTHER BUSINESS DEDUCTIONS
[17867]ADVERTISING - , | oe? |)
[17868]AUTO AND TRUCK EXPENSE | Daype-Po AT a. WY. O44 |_|
[17869]aAo DEBTS a
[17870]CASH SHORT ee
[17871]COMMISSIONS : FT
[17873]DELIVERY
[17875]|
[17876]DEPRECIATION ( SCHEDULE ATTACHED ) ; | (339 | |
[17879]QUES AND SUBSCRIPTIONS
[17881]ENTERTAINMENT AND PROMOTIONAL
[17883]|
[17884]i
[17886]tNSURANCE. 7
[17889]JANITOR SERVICE
[17890]LAUNDRY
[17891]LEGAL AND ACCOUNTING
[17894]i
[17895]-
[17897]MAINTENANCE
[17899]OFFICE SUPPLIES AND EXPENSE
[17900]RENT
[17901]REPAIRS
[17903]S| | bid
[17905]SALARIES AND WAGES
[17906]SALARIES OFFICERS
[17908]SUPPLIES
[17909]TAXES AND LICENSES
[17911].
[17912]96
[17913]LS
[17915]TAXES - PAYROLL
[17917]TELEPHONE
[17918]TRAVEL
[17920]UTILITIES
[17922]TARK( NG
[17924]WE
[17926]NET PROFIT OR( LOSS ) - FRDERAL RETURN
[17928]a gy oan +) Ae
[17929]NET PROFIT OR 10SS ) «- STATE RETURN ( SEE DEPREC, SCHEOULE FOR DIFF, Kw) LYOD | !
[17931]NW 883265 Decld:32285935° Page 190" '°¢ ; SCHEDULE
[17935]4 Lee oe : Reference copy, JFK Collection: HSCA (RG 233) i%s,.
[17937]z fe. . i
[17938]2 it
[17939]. : 2,
[17940]ru) k «€ 1
[17941]4 - a> 4
[17942]2 a 2 wee |
[17943]z « t
[17945]< s F
[17946]a a
[17949]al ae 4
[17952]a a = 4 c
[17953]3 oO «zo f
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[18033].
[18035]NW 68326 Docid:32245535 Page 191
[18037]Reference copy, JFK Collection: HSCA (RG 233)
[18039]TAXABLE YEAR. |
[18042]me
[18044]REST DEY iv
[18046]ode. VIDUAL
[18048]: CALIFORNIA
[18049]bite -
[18051]| 1972, ending
[18053]LAST AAIZ
[18054]RUBY
[18056]ra idelieg epartmaat nuc.bsr, er rurst revto)
[18058]ce
[18059]o
[18061]ZIP CODE
[18063]PATION i
[18065]occu. Yours
[18070]crane ar RRR A IERIE tt LNCS ETNA TE YO AEA SSdieest “SERRE WE,
[18071]5, Brseadonts-—Do not fst yourself, your spouse or person who qualifies you as head of houcciiald :
[18072], HAUG Cneluda tet cara and/or address If 6ifcreat from youra) AZLATIONSHIF
[18074]J sisi retain Feed, Brian, Elisa, Thomaa. ... — :
[18075]cis i ietura—Enter ‘enous! ‘6 soclal on
[18076], Enter
[18078]G6. Elied (refer to instructions) Number of blind exemptions claimed & 6-
[18080]27. Fetsl 6 pendent od Blind oxomptions (add lines 5 and a. .
[18082]t2 end ottech euheduly (Bos
[18083]syst (rom paca 2, ne AM.
[18085]a (from paga 2, ling 56) 2 ww ee bee ee we
[18086]; 12), Figure yeur tot on 1 thls emount by using tha a ppropriata Tox Rata
[18088]a Tox 222) Cenetule Gl g Schvulo CGS)...
[18090]Alou. .
[18092]tar icd eg “uple or head of fe uschold€59 2 0. 15 5
[18094]--Jots! en fino 7 above, Au. kB...
[18095]ud (edd Hine 18 and Le ee
[18097]) Cvbtact fing 20 from ting WP
[18098](irom page 2, fing 89). ee
[18099]taf (subtract ling 22 from ting 21). 2 1. Cok ee et
[18101]G
[18102]pe . 24, Tax vs 1 pret ense incana (see instructions—attach Schedule pi540)) :
[18103]_3 25, Toil te te i ty tad fines 23 and 24) 2 7 2 2. ee
[18104]3 : 28. Tots) ech. fornia ‘peore ‘tex withhold (attech Form(s) W2 or GE-2P to frort) .
[18105]~ _ ah W878 ‘Catierals estinatad fad puymonts . 6 6 ee es Lone ee
[18106]: eB Bae abciale, £01 te Stok id (attach Form DE 1964 to fece of roturnl ' -
[18107]2 - _ — onsen muses pos La PETES ee =
[18108]Tote
[18109]wo af en , he Pay In full. “Mail ayment with raturn to ; flea
[18110]5 soos 0. Uf lis 3 25 Is larger th ine 29, entor CALAMCE DUE. Franchise Tax Board, Sacramento, CA 95857. ° °° * &! 30 eee
[18111]GO Buee +, ‘ ' {all retuin ta P.O, Box 13-540, oo , |
[18112]pees att tite 29 9 is lerges than tino 25, enter GVERPAYIENT. Sacramento, CA $5813, Ce
[18113]J - 3 Bt bing a to bo (a) “nerunbeo, (Atlowr at leest cl woeks for your refund) 2. | . - |
[18114]eo 7 4... (b} Credited on 1973 estimated tar. 6. ee
[18115]= see an oa eR EPS ANN A ATER IIE IRD A TPE snamiessieia mak rat errors
[18116]SF Under pacaities of perfery, | dccteza that 1 ive panied this return fatlusing peeonnanying seheduie end tloterents, and to tha best of ty bnoulees2 ond | Do Ral write tn thes
[18117]= 7 if is Gus, cerrect and come Wf prepared by a pertun other thon taxpayer, his declaration ts based on alt Information of which he hes ony teratedge.
[18118]a _ . EDWARD L. LAMBERT
[18119]£ Sh i) D> Yeur ‘igs fling Jointly, BOTH rans sign is Goer a cA ea a E
[18120]. 1 +
[18122]NW 88326 Docld:32245535 Page 192
[18124]Reference COPY, JFK Collection:
[18126]WetWZD BEVUCTIOS
[18128]fered ¢9 Perm 829
[18130].
[18132]if on3 ssouge Itemizos éccuctions, the olker may not use tha Tox 7 c7 cla.
[18133]32 staadard duduction. [f you ehvose to Itemizo your deductions, camzcia 0
[18134]annronriata liems bolow. ; . at
[18136]Cc. .pisetions
[18138]23. Cosh—Including checks, “money orders, ete.
[18139](iterize) a”
[18141]a rs at 1S of Caste
[18142]Fora a0 Le
[18144]poe
[18146]3. Total cech contr
[18148]“1 (tse thon cach (scp instructions). Entcr total
[18149]Ee
[18151]oe fot Leeds “a lines 23 and 24,
[18152]ms
[18156]po ¢
[18160]Bik 0213p 00) aR
[18162]ie)
[18165]a) ROR
[18166]u foe i
[18167]Mi 1 .
[18169]29, Yet Add lines 26, 27 end 28. Enter here and
[18170]on Form 540, pas De ee
[18172]23
[18174]cua Bader a3 i
[18176]Cas or Theft ft Losslesh-29 fastrucdens
[18178]NOTE: Hf you hed more than one casualty or theft
[18179]lol. cecaitenes, omit tines 59 throught JJ and foilos
[18180]ingaucuons for ‘guidance.
[18182]35. Loss Dalora adjustments 2. 6 ee es
[18183]31. Insurance rolmbursemant . 6 6 eg eee
[18184]32. $100 fimitation © 0 6 6 wee ee Messer
[18185]93, Add Hines 31 ond 320. =. 7 1
[18187]Casualty or theft (oss. (Ling 30 fess fina 33)
[18189]5
[18191]1 sdb “é 11898 oJ ud Hunt
[18193]. RNS cvo—See instructicas . 6 2.
[18195]3. Gther—Fer education, alimony, uanlon duss, ete.
[18196]Seo Instructions _..... sesetteecssneenaese
[18198]a7, Total miscollancous Geductlons—-Add IInes 34, 35
[18200]ol rote tedeomallt ‘tires 14 ehough 20, Enter
[18201]and 36. (Entot hare and on Form 540, page Ap
[18203]. hero end on Fone £60, para dbo... ab | 2)
[18205]841,00
[18207]ay ene i
[18209]NW 88326 Dochd:32#45535 Page 193
[18211]Reference copy, JFK Collection:
[18213]ALICORRIG
[18215]SCHEDUL E
[18217]—_ PROF (621 LESS) FRAN CUSHIESS 62 PROFESSION
[18219]{Salo Prenrictorshigs) ..
[18221]7Tlo en Com é.
[18222]wanes wth
[18224]Utehab Sseu. Miiif fos. welt
[18226]mS Sm
[18228]UFOIy C8ts, Go
[18230]soe ener are ee Tarr en nN A EO NN OTN EN OAL OS OTT SET
[18232]‘ WEEE oaneene cee @ PROMUCE ee oe ee scancceseregnuneveseteotive rae
[18233]4 (far examples | retail nord WOIO: vihelssalo—tobacto; sorvices logals munulasiusing-- “furnltura; ete)
[18234]aes anshoot Bar: hk Bur cles te sue wana Cx Fodoral omployor identification numbor........---
[18236]Oy Raginess 6 ceweeeeeeee PAO VOW GUYS BAvds oo VGA NUYh, Oss]
[18237]“et ise stating: - i cash; []- ‘eccrual; a other.
[18238]SS 57 G99, B22 2 andl & fee) for the calohtcr year filed dif required)? ([] Yes {) No
[18240]boundaries of # ng ‘city, town, ote. indicated? oe
[18242]54 13 ‘Van, “Nuya Bivd. Van Nuys, Califormha i eee
[18244]boy
[18246]3 Hoemied
[18249]3 (eiae chechedule) 2...
[18251]‘phan iseu Inuiructions for tina Pay ee
[18253]groraa (209 dactruciiens for ling VER)
[18256]= (0) Toral & other business expenses (add ‘lines 19(a) through 19(0)) toe ee .
[18257]20° ~ Total deductions (add lines 6 through 19). . . . . Cee ee ee
[18259]2 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR
[18261]a
[18263]NW 88326 Docid:32245535 Page 194
[18267]N
[18269]SEBEL MS RAPER dP ORES A
[18271]ea aA ONE
[18273]GALIFORNIA - ee
[18274]- nal GAS AND TT
[18275]a CAPITAL GAINS AND LOSSES
[18277]f FORM
[18279]s nomedule to report gains and losses on stacks, bonds and similar investments,
[18280]ere gains (but not lozses) on personal assets such os a home or jewelry.
[18282]Use thi
[18284]Seciai Security Number
[18286]Yas
[18288]ame as shown on Form 540 or 542562
[18290]Samuel and "hvilis Buby
[18292]SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS
[18294]“
[18295]#. Cost or other bs sis, as
[18297]adjusted. cast of
[18298]subsequent izaroverents | f. Gain er los.
[18299]if not purchased, (d less e}
[18300]attach eaplanation)
[18301]and expense of sae
[18303]b. Date acquired c. Date sold
[18305](mo., day, yr.) | (mo. day. yr.) 2 G: ss sales price
[18307]a. Kind of aroperty and desis
[18308](Examate, 100 shares of "2" C3 *
[18310]| |
[18311]ee cad ni
[18312]foo fe
[18314]SCHEDULE ATTACE = |
[18316]“2. Enter your share of net short-tezm gain (or loss) from partnerships and fiduciaries
[18318]3. Enter net gain (or loss), comoire lines Tand2. 0.0. 6 8 ee ee et .
[18319]4. Enter unused short-term capita: loss carryover from preceding taxable yeors (attach statement)
[18320]5. Net short-term gain (or loss}, combine lines 3and 4. .
[18322]Enter gain if applicable from line 4, Schedule D-1 (Form 540) (attach copy) - - - - + + + rs eects ceees
[18323]8. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries
[18324]9. Net gain (or loss), combine lines Eéthrough 8 2. ee es eee.
[18325]Enter unused long-term capite! joss carryover from preceding taxable years (otiach statement) . - 2 - ee 12 nA)
[18327]Net long-term gain (or loss}, combine lines 9and 10.
[18329]12. Combine the amounts shown os lines 5 and 11, and enter the net gain (or loss) here. - - se ee
[18330]13, If line 12 shows a gain— ,
[18331](a) Enter 50% of line 11 of 56% of line 12, whichever is smaller. Enter zero if there is a lass or no entry on line 117 oe ceeeeeenee:
[18332](b) Subtract line 13(a) from line 12. Enter here and on line 32, Form 540 (line 33, Form S40NR) 2 eee bee eee eee eee
[18333]14. If fine 12 shows a loss— a
[18334](a} Add lines 4 and 10 (if lines 4 and 10 ara blank, enter a zero here and on lines 14{b) and 14(c) and go to
[18335]fine W4(d)) we re . we
[18336](b) Combine lines 3 and 9—if gain, enter gain; if loss, enter zero. see et oo coeeessnnnnneecaceeeet’
[18337](c) Enter smallest of (i) line 14(a) less line 14(b); (ii) the amount of taxable income on Form 540 or 549NR,
[18338]computed without capital gains and or losses—determine this figure via a side computation; or (ii) $1,000 | ee oe
[18339](d) Combine lines 3 and 9—#é loss, enter loss; if gain, enter zero here and on line 14{e) and goto fine 14/F) 6) eee eres
[18341](e) Enter smallest of (i) the mount of taxable income on Form 540 or 540NR, computed without capital gains
[18342]and or losses, less line 14£c}—determine this figure via a side computation; (ii) $1,000 ($500 if married and
[18343]filing separately); (iii) i line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows a
[18344]gain, amount on line 14/d:; or {v) if lines 3 and 9 show losses, line 3 added to 50% of line 9 Loe
[18345](f) Enter here, and on line 32, Form 540 (line 33, Form 540NR), the sum of lines 14(c) ond 14(e)—(Do not
[18346]enter an amount greeter than $1,000)... 6. eee Soke eee
[18348]¢ 3,000,90)
[18350]Carrvover (1- 2) ($14,552.00)
[18352]“NW 88326 Docld:32245535 Page 195 fan Instructions on Bock
[18354]NW 88326.-Docld:32245535 Page 196
[18356]TAXA@LE
[18358]SCHEDULE
[18360]ITEMIZED DEDUCTIONS .
[18362]Attach to Form 540
[18364][ FORM 540
[18366]Nama as shown on Form 540
[18368]Dhy
[18370]itemized vs, Standard Deduction—You have a choice between two deduction if one spouse itemizes deductions. the other may fot use the Tax Table cr cy
[18371]meinecs. You can either itemize your deductions of take a standard deduction as the standard deduction. if you chase to itemize your deductions, compiete >
[18372]explained in the 9° ‘) Instructions. On separate returas of a husband and wile, appropriate items below.
[18374]Vedieal and dental expenses (not compensated by insurance or otherwise) far medicine and drugs, doctors, ceatists, nurses, hospital cre, insurance
[18375]mined 303 ee
[18376]premiums for medical care, etc.
[18378]1. Ona hati (but not more than $150) of insurance premiums for medical care
[18380]2. Medicing and drugs . 1. ee ef 2 oe ceeeteee |
[18382]3. Enter 1% of adjusted gross income shown 0 on Form 540 Soe ee
[18384]4. Subtract line 3 from line 2. Enter difference ‘if less than zero, enter ret0) a
[18386]5. Enter balance of insurance premiums for medical care not entered on fine 1 2 2 6. ee ee ee Be eee!
[18388]6. Other medical and dental expenses (attach itemized lis) © © 2 6 ee Co ee eee f 6 |
[18390]7. Yotal—fadd fines 4, 5 and 6) 2 2. Co }
[18392]8. Enter 3% of adjusted gross income shown on Form 5A Soe . . Lo. en Oe. ee
[18394]9. Subtract tine B from line 7. Enter difference (if fess than gero, enter soo) ns Lo
[18395]10. Total--iAdd lines 1 and 9) . . . . em | 10 150 {iG
[18397]Child Adoption Expense
[18399]11, Total expenses paid of incurred—Attach itemized list
[18401]12. Enter 3% of adjusted gross income shown on Form 540 .
[18402]13. Subtract line 12 from tine 11—See instructions for maximum limitations .
[18404]Taxes
[18406]14. Real estate .
[18408]15. State and locat gasoline
[18410]16. General sales . a
[18411]17. Auto Jicense—Excess of registration and weight tees see instuctions a.
[18412]18. Personal property .
[18414]19. State disability insurance (SD) Employer ‘private disability ‘plans: do not quality
[18415]20. Other (specify) .
[18417]21. Total tares—iAdd ‘lines 7) ‘through 20)
[18419]Contributions
[18420]"92. Cash—Including checks, money orders, etc. (itemize)... -
[18422]23. Total cash contributions . . . 1. 2 ee ee 23 |. een a.
[18423]24. Other than cash (see instructions). Enter total here ‘ Lone .
[18424]25. Total—Add lines 23 and 24—Maximum deduction may not exceed "20% af adjusted. pinss income 2. 2 2
[18426]Interast Expsnse
[18428]28. Home mortgage
[18429]27, Installment purchases”
[18430]28. Other (itemize)
[18432]29. Total—iAdd lines 26, 27 and 28) 0 ee Ce
[18434]39. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize) ........ ....
[18436]M. Tetal miscellaneous deductions. . Cn cee ee eee em | OT $0 he:
[18437]32. Tots! deductions—{Add fines 10, 13, 21, 25. 29 and 31). Enter total here and on Form 440, page 2, in space provided .S/i 0... | 32 | 4,910 9e
[18439]Schaduln A on raveria
[18441]Pepa fi TAXABLE
[18443]Rell |
[18444]ey i (Gag Hy | 19 i
[18445]PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION |
[18447](Sole Proprietorships)
[18449]Attach this schedule to your Income tax return, Form 340 or 540NR —- Partnerships, joint ventures, etc., must fila on Form 56.
[18451]Sneiai Security Number:
[18453]Name as shown on Form 540 or 540NR
[18454]Saruel and Phyllta Ruhy
[18456]Food Service _ product
[18458]‘For sxomple: retail hardware; wholesola—toborca; services legal, manvfocturing— furniture; etc)
[18460]A. Principal business activity
[18462]B. Business name. ... Snack Rar . cou _ wre ° S- Federal aes identification number.
[18463]Saas i ; yyw y .
[18464]D. Business location .. “541€ Van Bre WS aivd oo an “Mavs, Ca Terni a | oa Co
[18465]‘Number ‘ond steal or rural route) (City post office) “State. {Z1? code
[18467]E. Indicate method of accounting: [a cash; [1] accrual; (] other (describe) bce ce ceeee cueeene cee tttane cae tiseennssceteentteet ttneetetseegen seen
[18469]F, Was there ony substantial change in the manner of determining quantities, costs or valuations between the opening and closin=
[18471]inventories? () Yes [q No. If “yes,” attach explanation.
[18473]G. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? [i¥es fi No
[18475]> 1. Gross receipts or gross sales $ . a Less: Returns and allowances $ .
[18476]: 2. Inventory at beginning of year (If different than last year’s closing inventory cttach [ |
[18477]explanation) . . Coe ee an re ; Do SCHED LE’
[18479]Merchandise purchased $ , loss cost of ony items with- ATTACIIED
[18480]drawn from business for personal use $
[18482]Cost of labor (do not include solary paid to yourself)
[18484]Material and supplies. . Coe ee ee
[18486]Other costs (explain in Schedule c. » .
[18488]Total of lines 2 through 6 .
[18490]. Inventory at end of this year . .
[18492]Cost of goods sold and/or operations (subtract line 8 from line 2). Coke ee
[18494]Gross profit (subtract line 9 from line 1}... a ee nen
[18495]_ OTHER BUSINESS DEDUCTIONS —
[18497]: Depreciation (explain in Schedule C-2) . .
[18499]¢ 12. Taxes on business and business property (explain in Schedule C. 1)
[18501]» 13. Rent on business property .
[18503]14, Repairs (explain in Schedule C-1) .
[18505]15. Salaries and wages not included on line 4 (exclude : any. y paid to > yourselt).
[18507]16. Insurance . 2. . .
[18509]17. Legal and professional fees .
[18511]18. Commissions... 6 we Co kk ke ee ee ee
[18513]19. Amortization (attach statement) woe. oe ee ee eee
[18515]" 20. (a) Pension and profit-sharing plans (see instructions)
[18517](b) Employee benefit programs (see instructions) .
[18519]21. Interest on business indebtedness .
[18521]22. Bad debts arising from sales or services .
[18523]; 23. Depletion of mines, oil and gas wells, timber, etc. "(attach ‘schedule)
[18525]24. Other business expenses (explain in Schedule C-1)
[18527]g 25. Total of lines 11 through 24
[18529]» Net profit (or loss) (subiract line 25 from line 10). ‘Enter here and on pag: 2 Form 540 « or “540NR
[18531]7,350) 33
[18533]SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24
[18535]— ee a ncaa ow lieeeseen ——————
[18536]Exnlanatlon i . 7 Explanation Amevat
[18540]fiw 88328 'Docid:32245535 Page 197 oO Page
[18544]Oo
[18545]i i | | TAXABLE
[18546]CALUFORRA 0
[18548]ae CAPITAL GAINS AND OSES
[18550]Use this schedule to report gains and losses on stocks, bonds and similar investments,
[18551]and gains (but not losses) en personal assets such as a home or jewelry.
[18555]SCH
[18557]“sy
[18558]DULE
[18560]‘ Secial Secu rity Humber
[18562]Name as shown on Form 540 or S40NR
[18564]Samuel and Phyllis Puby ; : Boo Ee i
[18566]SHORT- TERM—ASSETS HELD NOT MORE THAN 6 MONTHS
[18568]rs T
[18569]a. Kind of property and descriation b. Date acquired c. Gate sold
[18571](Example, 100 shares of 2" Co.) (mo., day. yr.) | fimo., day, yr.)
[18573]i f. Gain or loss
[18575]dG: ns sales. price 7 (d tess e)
[18577]attagh expt tanation)
[18578]and expense of sate
[18580]os “SCHEDULE ATTACHED : ‘j 9248.90)
[18582]aan renee
[18586]—— et
[18587]a of.
[18589]ha
[18591]“2. “Enter. your ‘share of net short- term gain (or loss) from partnerships ‘ond fiduciaries
[18593]3, Enter net gain (or loss), combine lines } and 2 .
[18595]4. Enter unused short-term capital loss carryover from preceding ‘taxable | years (ottach statement)
[18596]5. Net short-term gain (or loss), combine lines 3 and 4 .
[18598]LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS
[18600]7. Enter gain if applicable from line 4, Schedule D-1 (Form 540) (attach copy)
[18601]8. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries . . .
[18602]9. Net gain (or loss), combine lines 6 through 8 . . . woe
[18604]10. Enter unused long-term capital loss carryover from preceding taxable years ‘(ottach statement)
[18606]11, Net long-term gain (or loss), combine lines 9 and 10 .
[18608]12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here .
[18609]13. If line 12 shows a gain— ,
[18610](a) Enter 50% of fine 11 of 50% of line 12, whichever is smaller. Enter zero if there i is a lass or no entry on line 11
[18611](b) Subtract line 13(a) from line 12. Enter here « ond on line 32, Form 540 (line 33, Form 540NR) :
[18612]14. If line 12 shows a loss—
[18613](a) Add lines 4 and 10 (if lines 4 and 10 are blank, enter o zero here and on fines 14(b) and 14(c) and go to
[18614]line 14(d)) . . . .
[18615](b) Combine lines 3 and 9—if goin, enter gain; if loss, enter zero .
[18616](c) Enter smallest of (i) line 14(a) less line 14(b); (ii) the amount of laxoble income on Form 540 or 5AONR,
[18617]computed without capital gains ond or losses—determine this figure via a side computation; or (iii) $1,000
[18618](d) Combine lines 3 ond 9—f loss, enter loss; if gain, enter zero here and on line 14{e) and go to line 14/f)
[18619](e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital qains
[18620]and or losses, fess line 14(c)—determine this figure via a side computation; (ii) $1,000 ($500 if married and
[18621]filing separately); (iii) if line 3 is zero or shows a gain, 50% of line 14{d); (iv) if line 9 is zero or shows a
[18622]gain, amount on fine 14(d); or (v) if lines 3 and 9 show losses, line 3 added ta 50% of line 9 :
[18623](f) Enter here, and on line 32, Form 540 (line 33, Form 540NR), the sum of lines 14{c) and 14(e)—(Do not
[18624]enter an amount greater than $1,000) - So ee ee
[18626]( 1,990,00)
[18628]Carrvover (1-5) (814,552.09)
[18630]Seo tastructions on Back
[18632]NW 88326 Dochd:32245535 Page 198 . | _
[18634]KReié@rence Copy, UrK COLLECTION: Adta (Ru “vv) me te
[18636]INDIVIDUAL
[18638]CALIFORNIA
[18640]INCOME TAX
[18642]w the year January 1-December 31, 1973, or other taxable year beginning
[18644]os
[18645]SAMUEL eh Ake AY, ————_ | _—
[18646]ase 5S AM. my. a
[18648]8 PRESENT HOME ADDRESS (Number ope street, including cpartment number, or rdfol route) : "Spouse's Social | ecurly f
[18650]oe
[18652]ta
[18654]Ant
[18656]ow. A : f
[18658]ing Status - Check ‘Only “he . Exemption Credits
[18660]|. © Single . .
[18662]2 te Married 6 filing joint return
[18664]1. 2 Married filing separate return—Enter spouse's full
[18666]If line 1 or 3 checked, enter $25 |
[18667]6. Personal Exemption: [If line 2, 4 or 5 checked. enter SS STO} ...---
[18668]1. Dependents.- Do not list person who qualifies you as head of household. -
[18670]Name (include last name and/or address if different from =PRE, iogship :
[18672]“Total “Number >. oan Sees
[18673]8. Blind {refer to instructions) Number of blind exemptions P ...
[18675]3 (1 Head of Household—Enter name of qualifying
[18676]individual
[18678]5. () Widowler) with dependent child. Enter year spouse
[18680]died 19... 9. Total exemption credits (add lines 6, 7 and 8) Enter here ‘and on
[18681]; : ; ~ Attach copy 2 of Form(s) W-2 to front,
[18682], Income 10. Wages, salaries, tips and other employee compensation Gr unavailable, attach explanation ) .
[18684]11. Dividends—before federal exclusion. Capital gain dividends must be included at 100%
[18685]12. Interest. (See instructions for taxability of federal, state and municipal bonds) .
[18687]13. Income other than wages, dividends and interest (from line 50) .
[18689]14. Total (add lines 10, 11, 12 and 13)
[18691]15. Adjustments to income (from line 56) 2 .
[18693]16. Adjusted gross income (subtract tine 15 from line 14)
[18695]@ If you do NOT itemize deductions AND line .16-is under 10,000, find tax in. Tax Table:and enter.on.tine 19.
[18696]e If you itemize deductions OR line 16 is $10, 000 or more, complete lines 17 and 18.
[18698]17. Deductions: Itemized (from line 63) OR Standard ($1,000 if fine 1 or 3 checked—$2, 000 if fine 2, 4 or 5 checked) | 17 St6 a
[18699]- 18. Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on line —I9 . . 18
[18701]<@ ATTACH COPY 2 OF FORM W-2 HERE >
[18703]‘19. Tax—If an averaging method is used, check appropriate box [] Schedule G, or () Schedule Gi
[18704]20. Total exemption credits (from line 9, above)
[18705]21. Tax Hability (subtract line 20 from liné 19—if tine 20 is presen than line 19, enter rerth
[18706]Your 22. Other credits (from fine 66) Lo
[18707]A and 23. Net tax (subtract line 22 from line 21—if line 22 is greater | ‘than ‘line 21 “enter zero) toe
[18708]Credits 24: Speciat tax credit—from line 75 (see Instructions, page 2, for allowat\ erédit) .
[18709]25. Net Tax liability (subtract line 24 from tine 23—if line 24 is greater thar Whee 23, enter zero) .
[18710]26. Tax on preference Income (see instructions—attach Schedule P(540))
[18711]27. Total tax liability (add tines 25 and 26) |
[18713]28. Renter's credit—if you lived in rented property on March 1, 1973, ¢omplete Part | on page 2
[18714]Your 29. Total California Income tax withheld (attach Form(s) W-2 or W-2P to face of return).
[18716]re ent 30. 1973 California estimated tax payments (include amount allowable as a credit from 1972 return) . ©. = | SOF dpe
[18717]ite 31, Excess California SDI tax withheld (attach Form’ DE 1964 to face of return). © 6 2 2 ws
[18718]32. Total prepayment credits (add lines 28 through 31) .
[18720]Ab Awad TU wervut ene ©
[18722]<4 Write serial security number on check or money order. ATTACH HE!
[18724], 93. If line 27 is equal to or larger than line 32, enter-amount of BALANCE QUE 33
[18725]Balance Pay in full and mail with return to: Franchise Tax Board, Sacramento, CA 95867
[18727]Due 94.- If line 32 is larger than line 27, enter amount OVERPAID . . . . woe
[18729]or Mail return to: Franchise Tax Board, P.0, Box 13-540, Sacramento, CA 95813 io E
[18730]Refund 35, Amount of line 34 to be REFUNDED. (allow at least “g[x weeks for your refund) 2. we =
[18732]36. Amount of line 34 to be credited on your 1974 estimated tax... M
[18733]A
[18735]° not write in these spaces
[18737]“Under penalties of perjury, 1 declare that ! have examined this return, including accompanying schedules and statements, atid to the best of my knowledge and —
[18738]belief it is true, correct and comnlete. {f prepared by a person other than taxpayer, his dectaration is based on all information of whith he has any knowledge.
[18742]NW ww sotERG Brannawsaaeas wen eee Date Rane Cand Bip code)" Breparer’s Employer - or SSA) Number
[18744]Pog ee ea TRE ST
[18746]Reference copy, JFK Collection: SCA (RG 233) ,
[18748]GALIFORNIA
[18750]SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
[18752](Sales or Exchanges Including Involuntary Conversions)
[18753](Attach to Form 540, 540NR, 541 or 565)
[18755]SCHEDULE
[18757]FORM 540
[18759]Name as shown on Tax Return
[18760]BY. EL
[18762]PART | Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220
[18764]Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
[18765]x ees of Sections 18211, 18212. 18, 18219, and 18220 property. (mo. day gr.)
[18766]AY. S. 5AM. a Oke... BAR eeestttesstecsseereveeee| APO | PM BL PR,
[18768]Correlate lines 1(A) through 1(D) with these columns etd jie fer |e Property
[18770]Gross sales price
[18772]Cost or other basis and expense of sale
[18774]Depreciation allowed (or allowable) .
[18776]Adjusted basis, line 3 less line 4
[18778]Total gain, subtract line 5 from line 2
[18780]If Section 18211 property:
[18782](a) Depreciation allowed (or allowable) after applicable date.
[18783](See. Instruction D-3)
[18785](b) Line 6 or line 7(a), whichever is smaller
[18787]8. If Section 18212-18 property:
[18788](a) Enter additional depreciation after 12-31-63 and before
[18789]1-1-7720.
[18791](b) Enter additional depreciation after 12. 31 70
[18793](c) Enter line 6 or line 8(b), whichever is smaller .
[18795](d) Line 8(c) times applicable percentage (Instruction D-4) .
[18797](e) Enter excess, if any, of line 6 over line 8(b)
[18799](f) Enter line 8(a) or line 8(e), whichever is smaller .
[18801](g) Line 8(f) times applicable percentage (instruction & D-4) .
[18803](h) Add line 8(d) and line 8(g) .
[18805]9. If Section 18220 property:
[18807](a) If farm land, enter soil and water conservation expenses
[18809]for current year and four preceding years :
[18811](b) If farm property, other than land, subtract line 7(b) from
[18813]line 6; OR, if farm land, enter line 6 or fine 9(a), which-
[18814]ever is smaller (see Instruction D-5)
[18815](c) Excess deductions account (see [nstruction D-5)
[18816](d) Enter line 9(b) or line 9(c), whichever is smaller .
[18817]10. If Section 18219 property:
[18819](a) Soil and -water conservation expenses made after 12-31-69
[18821](b) Enter amount from line 9(d), if any; otherwise, enter a zero
[18823](c) Enter excess, if any, of line 10(a) over 10(b)
[18825](d) Line 10(c) times applicable percentage (Instruction D- 5)
[18827](e) Line 6 less line 10(b)  . .
[18829](f) Enter smaller of fine 10(d) or line 10(e) oo
[18830]SUMMARY OF PART | (Complete Property Columns TA) through (D) up to Line 10(f) before going to Line 11)
[18831]11. Enter amounts from line 6 ie
[18832]12. Enter amounts from lines 7(b), a(h), 9(d) ‘and 10(f)
[18834]13. Subtract line 12 from line 11, enter here and in appropriate
[18836]Section in Part Il (see Instruction D-2) oo
[18837]14, Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part If... 2... at 12.¥ -_
[18839]Page 200
[18841]N[e or on
[18843]NW°S8320—-Dochdt32245535—
[18846]Reference copy, JFK Collection: HSCA (RG 233)
[18848]>) CALIFORNIA
[18850]INDIVIDUAL INCOME TAX RETURN
[18852]RESIDENT
[18854]For Calendar Year 1970 or Fiscal Year Begun 1970 and Ended 1971
[18855]FIRST NAME(S) AND INITIAL(S) LAST NAME
[18856]Please SAMUEL AND PHYLLIS | RUBY
[18858]Type PRESENT HOME ADDRESS (Number and street, or rural route)
[18859]or. *16250 Bircher
[18861]COUNTY
[18862]Los Angeles
[18864]Print City, TOWN OR POST GFFICE STATE ZIP CODE Your occupation B
[18865]Granada Hills Califernia 91344 | Self-Employed |p—
[18867]NAME AND ADDRESS OF EMPLOYER AT TIME OF FILING Spouse's occusation _
[18868]Self-Employed Housewife
[18870]Adjusted gross income on 1970 Federal
[18872]Return s...8 ry 284.97...
[18874]NAME AND ADDRESS ON 1969 CALIFORNIA RETURN. {Ff SAME AS ABOVE, WRITE “SAME”. IF NONE FILED,
[18875]GIVE REASON.
[18877]11346 Montgomery Avenue Granada Hills, Calif. . ||f siteert tam tige 2. below, exci
[18878]Filing Status 3 Marrled, filing separate return—spouse’s name: ..
[18880]4. I | Unmarried “head of household"—Complete Part I, page 2
[18882](check one} 2. Married, filing joint return
[18884]5. Wages, salaries, tips, etc. (before payroll deductions) if more than two employers, attach schedule
[18885]Income Employer's name Where employed (city and state)
[18886]if Joint return, veeseuseesute vu weeetaeee ewe nee fete neve tee rn ; Ce cee ne OPM be
[18887]{nclude all
[18888]Income of
[18889]both husband
[18890]i 8. Dividends. Enter total here (also list in Schedule 8 (540), Part |, if total’is over $100) 2. . . . | 6)@ 20 |60
[18891]and wife
[18892]& 7. Interest. Enter total here (also list in Schedule B (540), Part I!, if total is over $100) . 2... . Fie.
[18894]ual 2 .
[18895]2 8. Other income (from page 2, line 30) 2 2 2. ee 8
[18896]E
[18897]= 9, Yotal (add lines 5,6, 7 and) ee ef 9h B89 B05 [E27
[18899]= : 10. Adjustments to Income (from page 2, fine 35) ee | TO
[18901]<x It. Adjusted gross Income (subtract line 10 from line 9) .
[18903]© If you do not itemize deductions AND line 11 is under $10,000, find your tax in Tax Table in instructions. Enter tax on line 12.
[18904]© If you itemize deductions OR fine 11 is $10,000 or more, go to Part IV on page 2 to figure tax.
[18906]r r
[18907]tor 12. Tax from (check one): Tax Table [, Tax Computation (page 2, Part IV) QQ, or Schedule G 540) Q ©. J 12 |. 51 [G0
[18908]and 43. Exemption credits (from page 2, line 43) 2 2 1 ww 13
[18910]Credits 14, Tax liability (subtract fine 13'from Une 12). 0. te ee PAY EE oo
[18912]15. Total other credits (from page 2, line 49) 2 2. 2 2. 2 ew ee ee
[18913]16. Net tax flabillty (subtract line 15 from line 14—If $1.00 or less, enter “zero”)
[18915]. 1970 California estimated tax payment or credit from 1969 (if any). if none, enter “zero” . . .
[18917]Balance 18. Balance due—If any (subtract fine 17 from line 16) . . . . . . . . . PAY IN FULL WITH RETURN | 18
[18918]Due or 19. Overpayment—If any (subtract line 16 from tine 17). 6 2 1. . . . . OVERPAYMENT | 19
[18919]Rofund 20. Portion of tino 19 you wish to apply on 197] estimated tex © 2. ee POD Lp oe
[18921]. REFUND
[18923]21. Refund—if any (subtract line 20 from line 19)
[18925]Under penalties of perjury, | declare that 1 have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and
[18926]belief it is true, correct and complete. If prepared hy a person other than taxpayer, his declaration Is based on all information of which he has any knowledge.
[18928]i
[18929]ign D> sssi-iissctae Wf ut BOTH must sign Date DP sisciirs of ‘preparer other than taxpayer
[18931]NOP D> assis singe bite gk AMIBERT-MARKELGS
[18933]56 | RA BLVD.
[18934]© Make Remittance Payable to FRANCHISE TAX BOARD—Mail to se TC KLIF. 91316
[18936]FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814,
[18938]NW 68326 Docid:32245535 Page 201
[18940]Reference copy, JFK Collection: HSCA (RG 233)
[18942]8) GAA WRINWAA—----. -_ ES
[18944]ITEMIZED DEDUCTIONS
[18946]Attach to Form 540
[18950]Ee
[18951]FORM 540
[18953]Name as shown on Form 540
[18955]Samuel and Phyllis Rub
[18957]Itemized vs. Standard Deduction--You have a choice between two deduction if one spouse itemszes deductions, the other may not use the Tax Table or claim
[18958]methods. You can either itemize your deductions o: take a standard deduction as the standard deduction. If you choose to itemize your deductions, ccmplete the
[18959]explained in the 540 Instructions. On separate returns of a husband and wife, appropriate items below.
[18961]Medical and dental expenses (not compensated by insurance or otherwise) for medicim: and drugs, docturs, dentists, nur.es, hospital care, insurance
[18962]a — premiums for medical care, ete.
[18964]1. One half (but not more than $159) of insurance premiums for medical care © 2 © ee ee ee ; 1]
[18965]2. Medicine and drugs . . . . : ee
[18966]3. Enter 1% of adjusted gross income shown on Form 540 Ce ee ee ES
[18967]4. Subtract line 3 from line 2 (if less than zero, enter zero) : ‘ Cr rr
[18968]5. Other medical and dental expenses. Include balance of insurance premiums for n adical care not
[18969]deducted on line 1 (attach schedule) Coe 5
[18970]6. Total—{Add fines 4 and 5)... . a  )
[18971]7. Enter 3% of adjusted gross income shown on Form 540 a 7
[18972]8. Subtract line 7 from tine 6 (if less than zero, enter zero) an
[18973]§. Tatal—iAdd lines 1 and 8) >
[18974]Child Adoption Expense
[18975]10. Total expenses paid or incurred—-Attach itemized list
[18976]11. Enter 3% of adjusted gross income shown on Form 540 Lok
[18977]12. Subtract line 11 from line 10—See instructions for maximum limitations Aad
[18978]Taxes
[18979]13. Real estate .
[18980]14. State and local gasoline
[18981]15. General sales .
[18982]16. Auto license—Excess of registration and weight tees tee instructions)
[18983]17. Personal property .
[18984]18. State disability insurance (§D1)—Employer orivate disability plans ‘do not quality
[18985]19. Other (specify) ve veeeteees beaten tee cree .
[18986]20. Total taxes-—(Add lines 13 through 19) od
[18988]Contributions
[18989]21. Cash—Including checks, money orders, etc. (itemize)...
[18991]22. Total cash contributions
[18992]23. Other than cash (see instructions). Enter total here
[18994]24. Total—Add lines 22 and 23—Maximum deduction may not exceed 20% of adjusted gross income wwe, a
[18995]oe
[18997]Interest Expense
[18999]25. Home mortgage
[19001]26. Installment purchases
[19003]27. Other fitemize) oo...
[19005]28. Total—(Add lines 25, 26 and 27) 2 1 6
[19007]Miscellaneous Deductions
[19008]29. For child care, alimony, union dues, casualty losses, etc—See instructions (itemize). _- cccee ceesauesensevessnese seuenuuaeueesvae eevee wees 1
[19010]30. Total miscellaneous deductions oe Lo so > 730 100] 00
[19011]on a a
[19012]31. Total deductions- (Add tines 9, 17, 20, 24, 28 and 30). Enter total here and on Forn 540. page at te space pre vided S/A. . iat ee 7kS RY
[19014]NIM BB026. Docld:32245535 Page 202 fehe dete Bone cn emetm
[19016]Reference copy, JFK Collection: ESCA (RG 233)
[19018]-PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
[19020](Sole Proprietorships)
[19022]AXABLE
[19024]SCHEDULE
[19026]YEAR
[19028]FORM 540
[19030]Attach this schedule to your Income tax return, Form 540 or 540NR —— Partnerships, joint ventures, etc., must file on Form 565
[19032]Name as shown on Form 540 or S40NR ial ity Nene
[19033]Samuel and Phyllis Ruby Se Gee
[19034]Food | _— ceccssecseeee-g product... . cece se sneeeeeesicees
[19036]"(For exomple: Tetall— “hardware; wholesale—tobacco; pale Segal; man. ufacturing — — furniture; ‘ete.)
[19038]A. Principal business activity...
[19040]Snack Bar k veceetsen v quesewe nae es ceeneenenees ts C. Federal employer identification number. oP 578
[19042]Van. Nuys, California 91401 00 Uw
[19043](State) (ZIP cade)
[19045]B. Business name ..
[19047]D. Business location... 5418 Van. Nuys A Va .
[19048](Number ond street of rural ‘route). {Clty—post office)
[19049]E. Indicate method of accounting: ff] cash; [J accrual; (J other (describe)... ecceeceueseoscneee nese ceneneseeneeseeneeastssnoncesetaaeenstememnessane
[19050]F. Was there any substantial change in the manner of determining quantities, costs or valuations between the opening and closing
[19051]inventories? ([_] Yes No. {f “yes,” attach explanation.
[19052]G. Were Forms 591, 592, 596 “and 599, for the calendar year filed (if required)? []Yes ] No
[19054]1. Gross receipts or gross sales $....-.--2-.-.--0 ---------.. Less: Returns and allowances $e eee cece | Deseecctcete cteetcet cert nrc posers
[19055]2. Inventory at beginning of year ft different than Tost year’s closing inventory attach
[19056]explanation) . rn oo .
[19057]3. Merchandise purchased $.. a vececesese ween less cost of ¢ any ) items with-
[19058]drawn from business for personal use ef. a
[19059]. Cost of labor (do not include salary paid to yourself)
[19060]- Material and supplies we.
[19061]« Other costs (explain in Schedule C. 7
[19062]Total of lines 2 through 6 .
[19063]. Inventory at end of this year . . .
[19064]. Cost of goods sold and/or operations (subtract line 8 from line 2).
[19065]10. Gross profit (subtract line 9 from line Tt ptr rte creer cretefeer cree
[19066]OTHER BUSINESS DEDUCTIONS
[19067]11. Depreciation (explain in Schedule C-2) . .
[19068]12. Taxes on business and business property (explain i in Schedule C. 7
[19069]13. Rent on business property
[19070]14. Repairs (explain in Schedule C- 1). .
[19071]15. Salaries and wages not included on line 4 (exclude « any y paid 10 ” yourself)
[19072]16. Insurance . :
[19073]17, Legal and professional ‘fees .
[19074]18, Commissions .
[19075]19. Amortization (attach statement) .
[19076]20. Retirement plans, ete. (other than your share) .
[19077]21. Interest on business indebtedness .
[19078]22. Bad debts arising from sales or service. .
[19079]23. Losses of business property (attach statement) . oo
[19080]Depletion of mines, oil and gas wells, timber, ete. (attach schedule) .
[19081]25. Other business expenses (explain in Schedule C-1)
[19082]26. Total of lines 117 through 25
[19083]. Net profit (or loss) (subtract line 26 from line 10). Enter here ‘and on page 2 2, Part i, Form 540. or '540NR
[19085]CaNaus
[19087]X)
[19088]S
[19090]Amount
[19092]NW) 828326 Docld:32245535 Page 203 . , Pans 1
[19094]Reference cépy, JFK Collection: HSCA (RG 233)
[19098]SALES OR EXCHANGES OF PROPERTY
[19100]Attach to Form 540 or 540NR
[19103]e
[19104]r
[19107]FORM 540
[19109]ecurity Num
[19111]Name as shown on Form 540 or S40NR
[19112]Samuel and Phyllis Ruby
[19114]Part |I—-CAPITAL ASSETS
[19115]SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS
[19116]f. Cost or other basis,
[19118]- e. Depreciation atfowed cost of subsequent
[19119]a find of property {if necessary, b. Date acquired | c. Date sold @. Gross sales price (or allowable) improvements (if not
[19120]details not shown below) (mo.. day, yr.) | (me., day, ¥7-) (attach schedule) eeplaastions sed
[19122]expense of sale
[19124]9. Gain or loss
[19125](d plus e less f)
[19127]LE ATTACHED 0 fo (15274600)
[19129]“9. Enter your ‘share of net short-term gain (or, loss) from ‘partnerships and fiduciaries
[19130]3.-Enter unused short-term capital loss carryover from preceding taxable years (attach statement)
[19131]4, Net short-term gain (or loss) from lines 1, 2 and 3
[19133]LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS
[19134]5. Enter gain (if any) from line 16, Part It Sn
[19136]6. Enter your share of net long- term gain (or loss) from partnerships and fiduciaries . Coe ee Fe
[19137]7. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)
[19138]8. Net long-term gain (or loss) from lines 5, 6 and 7
[19140](15,274.00)
[19142]9. Combine the amounts shown on lines 4 and 8 and enter the net gain (or loss) here
[19143]10. If line 9 shows a GAIN, enter 50% of line 8 or 50% of line 9, whichever is smaller. (Enter zero ‘it there i is a
[19144]loss or no entry on line 8) . . . Ce ee ee fe
[19145]11. Subtract line 10 from line 9, Enter here ond | on ‘line 17, Part it
[19146]32. If line 9 shows a LOSS, enter here and on line 17, Part II! the smallest of the following:
[19147](a) the amount on fine 9; (b) the amount of taxable income on Form 540 or 540NR, computed without capital
[19149]gains and losses; or (c) $1,000 Carryover Loss (14,274.00). ( 1,000.00)
[19151]Part 1I-SALE OR EXCHANGE OF PROPERTY UNDER SECTIONS 18181--82
[19153]13. Enter gain (if any) from line 22, Part IV. 6 ee
[19154]14. Enter gain (if any) from line 25, Part IV Loe ee ee
[19156]13. Enter your share of gain (or loss) of Section 18181-82 items from partnerships and fiduciaries
[19157]16. Net gain (or loss). If GAIN, enter on line 5, Part |; if LOSS, enter on line 29, Part V
[19159]PART ill-TOTAL NET GAIN OR LOSS FROM SALES OR EXCHANGES OF PROPERTY
[19161]17. Net gain (or loss) from line 10 of 11, Partd 2 6 we ee
[19163]18. Net gain (or loss) from line 31, Part IV tok
[19165]19. Total net gain (er loss)~Combine lines 17 and 18, Enter here ond on Form 540 or Form 540NR, poge 2, Part
[19166]Il, line 23 . : eee ees See ee
[19168]NW 68026) Docid:32245535 Page 204 Schedules cantianed ar rave. cal ; ooo » Pane I
[19170]ate, 2 wee : ~
[19174]SCHEDULE € -- SHAREHOLDERS SHARE OF INCOME AND CREDITS
[19175](If additional space is needed, attach schedule)
[19177]am 0 2)
[19178]Name and Address of Each Shareholder ; . . Social Security
[19180]T . Dope ee
[19182]PAGE 4
[19184]: ESCA (RG 233)
[19186]JFK Collection
[19188]Reference copy,
[19190]. eed a ad
[19192]- SCHEDULE E -- SHAREHOLDERS SHARE OF INCOME AND CREDITS -
[19193]{If additional space is needed, attach schedule)
[19197](1) . (2)
[19198]Sociat Security
[19200]Name and Address of Each Sharahoider
[19201]. Number
[19203]© a). GEORG... LUA ELMS ccc cccpetseseteteesceseseneeeas
[19205]. 30 AVA GALbENs DR NMA) q 35/6
[19206](b) 0. EPR. BIB oo cccccenesscsepersceserenei ny tree
[19207]Y3fo S70 Cree DR. Ret ols Ham. Mich Yolo
[19209]Number of
[19210]Shares
[19212]HSCA (RG 233)
[19214]JFK Collection
[19216]erence copy,
[19218]Le F -— SIAR EN OLOEARS SHARE Ge iNCGiViE ANU Caduiis
[19220](if additionai space is needed, attach schedule)
[19222]. (1) (2) (3) (4)
[19223]Name and Address of Each Sharehoider Social Security Number of Amount taxable as ordinary
[19224]Number Shares. income (schedule K, total of
[19225]- : lines 4 and 8, US. 1120-S)
[19226]{a}. Coa 4 aa - ne ae, '
[19227]PPPS z
[19228]spar) dhySO CHICAGO TL. &
[19230]is) (6) (7) en)
[19231]Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
[19232]page 1, line 5, or page 2, hoider on M1-1040 (enter on MI1-1040, page 1, line 22 M1-1040, each shareholder's
[19234]schedule B, line 6 page 2, schedule 1, line 34 or
[19235]on page 2, schedule 2, line 43)
[19236]difference between column 4
[19237]and column &
[19239]{See instructions)
[19241]NW 68326 Docid:32245535 Page 207
[19243]each shareholder’s pro- proportionate share of Single
[19244]portionate share of per- business tax paid.
[19246]sonal property . taxes (See instructions)
[19248]paid on inventories or :
[19249]the credit for franchise
[19250]fees paid.
[19252]{See instructions)
[19254]: HSCA (RG 233)
[19256]JFK Collection
[19258]Reference copy,
[19260]SCHEOU
[19262]a
[19264]fae)
[19265]Name and Address of Each Shareholder
[19267](5)
[19268]Distributive Income from
[19269]page 1, line 5, or page 2,
[19270]schedule B, line 6
[19272]LE & — SHAAETOLDERS SFIARE OF INCOME AND CRIS
[19274](If additional space is needed, attach schedule)
[19276](6)
[19277]Amount to be used by share-
[19278]holder on MI-1040 (enter on
[19279]page 2, schedule 1, line 34 or
[19280]on page 2, schedule 2, line 43)
[19281]difference between column 4
[19282]and column S
[19283](See instructions)
[19285](2)
[19287]Social Security
[19288]Number
[19290](3)
[19291]Number of
[19292]Shares
[19294](7)
[19296]Enter here and on form
[19297]MI-1040, page 1, line 22
[19298]each shareholder’s pro-
[19299]portionate share of per-
[19300]sonal property taxes
[19301]paid on inventories or
[19302]the credit for franchise
[19303]fees paid.
[19304](See-instructions)
[19306]- (4)
[19308]Amount taxable as ordinary
[19309]income (scheduie K, total of
[19310]lines 4 and 8, U.S, 1120-S)
[19312]a t
[19314]19 7 30./6
[19316](8).
[19318]here and on form
[19320]each shareholder's
[19322]proportionate share of Single
[19323]business tax paid.
[19324](See instructions)
[19326].
[19328]a) 19,7306 | 4b)
[19330](b)}%, 30.18
[19334]Sia Tn
[19336]{c)
[19338](d) . ; ;
[19340]NW 68326 Docid:32245535 Page 208
[19342]‘JFK Collection: SCA (RG 233)
[19344]Reference copy,
[19346]nant a Aro
[19348]0-1040 (NR)
[19350]CivY OF DETROIT INCOME TAX
[19351]CITY OF
[19353]INDIVIDUAL RETURN —|NONRESIDENT
[19355]1976
[19357]DETROIT
[19359]or other taxable year beginning we
[19361]+ 1976,
[19363]ending .
[19365]wy WG. |
[19367]First Name and initial
[19369]Earl R. and Marge
[19371]Last Name
[19373]Ruby
[19375]Your Social Security N ‘Number —
[19377]1
[19379]Your Occupation
[19381]if you are an EMPLCS
[19383]EXTENSION NUNBE!
[19385]BSCA (RG 233)
[19387]PLEASE (If joint return of husband and wife, use first names and middle initials of both) Sales enter your Federal EMPLO
[19389]PRINT | Home Address (Number and Street or Rural Route) - - - Identi ieation No. her¢:
[19390]OR . . Spouse's Social Security Number
[19392]tyre | 18135 Livernois '
[19394]City, Town or Post Office
[19395]Detroit,
[19397]State
[19399]Michigan
[19401]Postal Zip Code
[19403]48221
[19405]A. If married, is spouse filing @ separate return? (] YES
[19407]B.
[19408]moved.) If none filed, give reason.
[19410]Same
[19415]SCHEDULE A— EXEMPTIONS
[19417]Oo
[19419]1
[19422]NAME ;
[19423]Enter figure 1 in the last column to
[19424]tight for each name listed
[19426]Enter the name and address used on your return for 1975 (If the same as above write “Same”.
[19428]Regular
[19430]b f
[19431]qJ O oO xem ptions
[19432]na oO oO checked
[19434]Spouse's Occupation
[19435]Housewife
[19437]lf different, indicate date
[19439]JFK Collection
[19441]Auditor
[19443]Entef
[19445]65 or over Blind
[19447]Enter ‘ 9.
[19449]Months lived in
[19450]your home during
[19451]1976
[19453]Relationship
[19455]OTHER
[19456]DEPENDENTS
[19458]Reference copy,
[19460]4. Total exemptions from lines 1, 2 and 3; enter here and on tine 15 below.
[19462]TOTALS
[19464]Attach Copy of Form DW-2 or W-2 Here
[19466]2 2 ND
[19468]2
[19470]Net profit (or loss) from business — from page 3, Schedule C, line 8
[19472]qd 0
[19474]17. CITY OF DETROIT TAX: Multiply line 16 by .005 (%%)
[19475]PAYMENTS AND CREDITS
[19477]18. a, Tax withheld by employer — from line 6 above — ATTACH Forms DW-2 or W-2
[19478]b. ‘Payments and credits on 1976 Declaration of Estimated Detroit Income Tax
[19480]¢, Other Credits — explain in attached statement (See Instructions) ..
[19482]19, | TOTAL — Add Lines 18a, b, and ¢
[19484]Gain (or loss) from sale or exchange of tangible property in the City of Detroit — from page 3, Schedule €, fine 10.
[19486]12. Total (add lines 6 through 11 of last column) 66... ee
[19488]13, Less: Deductions from page 2, Schedule M, line 5 (if none, enter zero)
[19490]14, Total (line 12 less ine V3) eee need
[19491]15. Less Amount for Exemptions: Enter number of exemptions from line 4 above
[19493]16. TOTAL INCOME SUBJECT TO TAX
[19495]INCOME (if joint return, inciude all income of both husband and wife) :
[19496]5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife :
[19497]Total wages reported Detroit Income Tax WAGES, ETC.. EARNED
[19498]Employer's Name Where employed (City and State) on DW-2 or W-2 Withheld IN DETROIT
[19499]Cobo cleAvers -tve. Deter 7, Mien. |. (64220 09 15. 770b9 | 212902...
[19500]Coao -Rurng SALES, Tue. DE7kOIT, Much. | te, Seeios 0 108 8 250108
[19502]—y2ko.oe |. _ 90, 35222.
[19503]Rental income (or loss) from tangible property in the City of Detroit — from page 2, Schedule B, line 4
[19504]Other income (or loss) from partnerships, etc, — from page 2, Schedule F, line 4.........
[19506]O37.
[19508]: Income ( (or loss) —~ TRUSTS AND ESTATES ONLY — from page 4, Schedule G, line 7 (see instructions for.exemptign to enter on line 15)
[19510]Joc AD FED 22.
[19512]G+ 2G2172
[19514]t713 |
[19516]ch Check or Money Order Here
[19518]TAX DUE OR REFUND
[19520]20.
[19521]21.
[19523]22.
[19525]D Atta
[19527]If your payments (line 19) are larger than your tax (line 17), enter amount of
[19528]Check box if you wish overpayment on line 20 te be: (A) (0 Credited on 1977 Estimated Tax or (8)
[19530]OVERPAYMENT
[19532]Refunded.
[19534]If your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return.
[19535]Make check payable to: "TREASURER, CITY OF DETROIT.” A balance due of less than ene dollar ($1.00) néed not be paid.
[19537]I declare that | have examined this return {including accompanying schedules and statements) and to the best of my knowledge and belief it is true, correct and
[19538]complete. if prepared by a person other than toxpayer, his declaration is based on all information of which he has any knowledge.
[19540]SIGN
[19541]—— > | SIGN HERE
[19542]HERE
[19544]SIGN weve Y
[19546]OS. cere t
[19548]NW 88326 Docid:S¥S45595 FinggeezBgrert
[19550](Spouse's signature and date) (if joint return, BOTH HUSBAND AND WIFE MUST SIGN)
[19552]OCTIIDAIC aster PE fire nv anni AAm
[19554]CERTIFIED PUBLIC RCCOONTANT
[19555]ment, Treasury Division, 104 City-County ROGID GVESTrS EN ila ROARS
[19559]Mich. Dupt., oF Treasury i enn ee ee ee ee A er ey
[19560]: 1
[19562]” ~NN j Balaacta-i a oe 1 em na es Bh
[19563]BeOgO8K oo Scuecuie of Partners or Sharenolders— i876 c
[19564]Parinersiip, Subshapter $ Corp., Professional Corp.
[19565]See instructions on reverse side
[19566]1 Name: 2 Account Number:
[19568]i
[19570]Cobo-Rumar Sales, Inc. 38-1812707
[19571]PAR ; SUMMARY :
[19572]3 Total Number of Partners or Shareholders... cece cceeeeteetet tetera: —o
[19573]4 Total Number of Qualified Partners or Shareholders from Part I|—enter here and on C-8000, line 60a... | 4 |
[19574]Lagi ail QUALIFIED PARTNERS OR SHAREHOLDERS , :
[19575]A NAME AND ADDRESS B SOCIAL CG % | D SHAREHOLDER’S PARTNER’S or SHAREHOLDER’S
[19577]te
[19579]SECURITY NO. Time} SALARY F Share of Bus. Inc. | G Share of SBT Paid} .
[19581]|< Earl Ruby ; ;
[19582]4380 Stoney River; Birm. | @RZMBZMMR }100,| 18,000 | 001100 | 00 00
[19583]| ; a a
[19585]00. | | 60
[19587]00 00
[19589]08 | 00
[19590]00 | 00 |.
[19593]pe Fi
[19595]i
[19597]PAR Hal NGN-QUALIFIED PARTNERS OR SHAREHOLDERS, If more space is needed submit separate schedule and enter totals on line 7.
[19599]UT
[19603]NW 86326 ("Hop xiéyg 4 ign 1PBaep” be I) 7 00 Zz , ron nn
[19605]JFK Collection: SCA (RG 233)
[19607]Reference copy,
[19609]: PAWL bees Ee ; fe :
[19610]Calendar Vear 19 7G THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPON( _ 2
[19611]OR FISCAL YEAR } o
[19613]I . tal
[19614]Beginning 19 ; 7 ON
[19615]Ending Po ronormceuseomy |
[19616]Bx INDIVIDUAL (Check: ; a
[19617][J FIDUCIARY — one) RUBY EARL & MARGIE 6988 5, 9
[19618]18135 LIVERNOTS AVE mo ‘a
[19619]DETROIT MI 48221 “
[19620]Husband's Social Security No. aay
[19621]Se. See:
[19622]i}
[19624]Mo. Day Yr. Wife’s Sociat Security No. 4
[19625]09 30 76 698855 8
[19626]Retroactive Date Intangible Account Number 76 ohne’
[19627]# this return is for an Estate. give Probate. SoD: <arreDs Employer Identification No. Fa
[19630]m
[19632]LINE LINE v
[19633]“ Computation of Tax Due AMOUNT TAX o
[19634]1. Accounts and Notes Receivable (non-income producing only) 1 Ky
[19635]2. Less Accounts and Notes Payable 2 4
[19636]3. Balance Taxable @ 1/10th of 1% 3. “4 —
[19637]4. Accounts and Notes Receivable (income producing only) 4. a
[19638]5, Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2) §
[19639]6. Balance Taxable 8
[19640]7. Income applicable to balance 7
[19641]8. Tax @ 3%% of income (Line 7) or 1/10th of 1% of Balance (Line 6), whichever is greater. | 8.
[19642]9. Stocks and Bonds - - - - - Schedule A, Column 9. . 9.
[19643]10. Mortgages and Land Contracts - - - - - Schedule B, Column 8. —
[19644]11. Annuities - - - - - Schedule C, Column 9. 11,
[19645]12. Beneficiary Return (attach copy hereto) 12.
[19646]13, , TOTAL
[19648]14, : Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return)
[19649]15. BALANCE DUE
[19651]16. Cash on Hand or in Transit as of retroactive date (include cash in safety deposit boxes)
[19653]17. Bank Deposits in Banks Located Outside of Michigan ______»—=ss {or Withdrawn from Mich.
[19655]Banks or Ass’ns. after
[19656]18. Savings in Building and Loan Ass‘ns. Located Outside of Michigan RETROACTIVE DATE.
[19657]19. TOTAL
[19659]20. TAX @ 20¢ per $1000.00 of Line 19
[19661]21, TOTAL TAX DUE (Line 15 pilus Line 20)
[19663]22. . Less Advance Payment of Tax
[19665]23. . TOTAL TAX DUE
[19667]24, Penalties & Interest; Penaity %, S___.___; Interest _____ % __ Months, S.
[19669]28. TOTAL AMOUNT OUE WITH THIS RETURN (Due on or before April 30)... ee beeen eee an ees
[19670]Or Four Months after End of Authorized Fiscal Year
[19672]Make Remittance Payable To: “STATE OF MICHIGAN’ Write your Intangible Account No. on your check,
[19673]Mail To; MICHIGAN DEPARTMENT OF TREASURY, TREASURY BUILDING, LANSING, MICHIGAN 48922
[19675]Business or Profession of Taxpayer: Amount Singie Business Tax Paid: Single Businass Tax Account No.; Telephone Number:
[19676]SALES : §63. 0400
[19678]Year of Last Return Filed: Address of Last Return:
[19679]-
[19680]1998 GAME
[19682]Check which Method: your return is Computed by.
[19683][X] RETROACTIVE DATE [[] MonTHLY AVERAGE
[19685]“| NOTE: if this raturn ts from a Trustee, attach a list of Names and
[19687]Addresses of Beneficiaries and Date of Creation of Trust.
[19689]| declare under the panattins imposed by Act No. 301 P.A. of 1939, as Amended,
[19691]fiat this rating, dneheing nny ndeemnpanying eehortdes ated slalamenta has lean . :
[19693]earned by ma aad to the best of my kaowlelye end belief ia a tua, correct Signature — a — cmon —
[19694]and complete return. .
[19696]Prepared By: 0 ON L, HOLLANDER; PC: Signature
[19698]CERTIFIED PUBLIC ACCOUNTANT ;
[19699]NWS aR Dini: 24S WY PEG CTE MEE-ROAD
[19701]vn Title: (State whether Individual, Owner, Executor, Administrator, Trustee, etc.) :
[19704]ne
[19706]MICHIGAN INDIVIDUAL INCOME TAX RETURN
[19708]for 1975, or taxable year beginning
[19709]Y First name and initial (if joint return, use first names and initials of both)
[19710]Earl R. and Marge
[19712]Home address (number and street or rural route)
[19714]18135 Livernois Sales
[19716], 1975, ending ——______-__, 19
[19718]Your social secu
[19720]Last name
[19722]Ruby
[19724]Your occupation
[19726]wo ne? eee eases social Security tO
[19727]= City, town or post office, and State : ZIP code Spouse's social security no
[19728]3 Detroit, Michigan ~ 48221 ; | |
[19729]= Residency Status during tax year: : Spouse's occupation
[19730]. Resident CT Non-resident | Part-year resident, from ____—- to
[19731]§ © Filing Status: 1. Exemptions: :
[19732]= A CiSingle (a) Enter here the number of exemptions claimed on your
[19733]B Ca Married, filing jointly federal income tax return... 0.2.00... e eee eee _ 4
[19734]¢ (Married, filing separately (see instructions, page 2) (b) Special exemption for paraplegics & quadriplegics . [instructional
[19735]a Name of Spouse —————_____________ (c) TOTAL EXEMPTIONS, add lines 1(a) and I(b)............--- @O_ 4+.
[19736](Give spouse's Soc. Sec. Nao. in the space provided)
[19737]2. STATE Do you wish to designate $2.00 of your taxes for this fund? 2) . COYes &) NO NOTE: you creck ne eS ae oF
[19738]CAMPAIGN FUND \f joint return, does your spouse wish to designate $2.007..... Dyes i NO reduce your refund.
[19739]Vv 3. Adjusted gross income as defined in the Internal Revenue Code and which should be reorted on Federal Form 1040,
[19740]. . ttach copies of any Federal schedules that-indicate-a loss or deduction
[19741]2 line 15, or 1040 A, line 12 trom gross income. (See page 5 of the instructions) .......-- eee eens
[19742]2 4. Additions to adjusted gross income, (from page 2, line 1)
[19743]= 5. Total, add lines 3.and 4.0... ee ee eee resets .
[19744]e 6. Subtractions from adjusted gross income, (from page 2, line 44)............... eee
[19745](2 7. Subtract line 6 from line 5.00... eee tere eer rere es ses wee TD
[19746]Ss 8. Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48) ... @
[19747]3 G. Income subject to tax (subtract line 8 from line 7)... 06.6... - eee eee ttt tenes
[19748]@ 10. Tax: multiply line 9 by 4.37% (0437) 00 ee te ert teens rrr vs
[19749]s CREDITS (See instructions - pages 7-10) AMOUNT PAID CREDIT
[19750]S11. Income tax paid to Michigan cities... ... Soc eevetvans @ ice) Ha. Aqo
[19751]2 12. Contributions to Michigan colleges & universities (attach receipts). @ 12a.
[19752]13. Income tax paid to another state (attach copy of return)........ 13. ©.
[19753]14. Total credits (add lines 11a, 12a, and 13a), enter total here... 66... ee ene eee tee ete tne 14. 20/04
[19754]15. Income tax, subtract line 14 from line 10 (if line 14 is greater than line 10, enter ‘NONE’)).........-...--j 000s Oo. 497184
[19755]16. Credits from any MI-1040 CR form. (see page 9 of instructions). .....--..+--.- +++ +++ 6) ts
[19756]Do not complete lines 17 thru 21 if you have claimed a credit on line 16. :
[19757]17. Household income from line 56.0... 2... . eee eee eres @
[19758]18. Enter 1975 homestead property tax or amount from line 59 ..... ©
[19759]v 19. Tax not eligible for credit, enter 3.5% (.035) of line 17......... 19.
[19760]w» 20. Subtract line 19 from line 18, if line 19 is greater, enter ‘NONE’ .. 20. ; :
[19761]21. Property tax credit, 60% (.60) of line 20, ($600.00 maximum)... 2... 0. ee eee ee 21. —
[19762]35 22. Personal property tax paid on inventory. @ _ 39% (.39)........ 22. Z
[19763]S PAYMENTS ;
[19764]3 23. Michigan tax withheld (attach State copy of W-2).......--.- ccbeceetueeetevesees @ AIS |SO
[19765]= 24. Michigan estimated tax payments............... Oo ccvedeeeeeettveeessenees @ f, 090] 00
[19766]S 25. 1974 overpayment credited 10 1975.... 0... ec e eee eee eee e eee ee (75) . . .
[19767]B26, Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25.......... +. re rere 8. G, 15750
[19768]S 77. it line 26 is less than line 15, enter BALANCE OF TAX DUE HERE............. Slices ecceeee PAL @ 240 |3
[19769]S28. If line 26 is greater than line 15, enter AMOUNT OVERPAID. ....-... 2... 0. sees ve reer rec rees gee 28.
[19770]= 29. Amount of line 28 to be REFUNDED TO YOU... 2.00.0... 0002s occ escent ens REFUND » @ . .
[19771]30, Amount of line 28 to be credited to 1976 estimated tax...... @—__|_ — NO a ot ayo itty on line 20,
[19772]fe)
[19774]This return is due April 15, 1976 or on the 15th day of the fourth month after the close of your tax year.
[19775]Under penalties of perjury, | declare that t nave examined this return. including accompanying schedules and
[19776]statements, and to the best of my knowledge and belief it is true, correct and complete. If prepared by a person
[19778]other than the taxpayer, his deciaration is based on ali information of which he has any knowledge.
[19780]Sign PP vows ae baie FORBUN't HOL CANBER™B'c. ce 2 ate
[19782]NW S88B8 Socld:32245535. Page, 242 aor aust sign even if cnty one had income) CERTIFIED PUBLIC: ACGQUNTANT:
[19784]AAFLIF WIPE Prat bat AAA
[19786]JFK Collection: SCA (RG 233)
[19788]Reference copy,
[19790]tore a reine m1 ¥/6
[19791]2 > Exemptions (number of allowable exemptions times $1,500.00).... 0.0... eee
[19792]3. Subtract line 2 from line 1. (This is your estimated taxable income} an bbe eee
[19793]4. Estimated tax (line 3 times .046 or 4.6%). . nen
[19794]5. LESS: Total estimated tax credit for Michigan city income taxes, personal property tax on inventories, j
[19795]Michigan homestead property taxes and contributions to Michigan colleges and universities ne ‘
[19796]6. Subtract line 5 from line 4. Enter here and online | below............. beets
[19798]MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS— 1 976
[19800]FORM
[19802]Ces
[19803]michigan, MI-1040-ES
[19807]| For calendar year 1976 or fiscal year ending ——_—___________., 19___. STATE OF MICHIGAN
[19808]. Department of Treasury
[19810]Address (number and street)
[19811]City, State, ond ZIP code
[19813]Your estimate of 1976 income tax... enn :
[19814]Estimated income tax withheld and to be withheld during entire year of 1976... 00... .5 0.00.0 c ee eee , \
[19815]ESTIMATED TAX {line I less fine 2). (If tess than $100, no declaration is required)... 6.06...
[19817]COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.
[19819]If this declaration is §(JApril 15, 1976, enter 1/4 of line 3; [“] September 15, 1976, enter 1/2 of line ‘t
[19820]due to be filed on: one 15, 1976, enter 1/3 of fine 3; (CT) Jan. 15, 1977, enter amount on line 3 .
[19821]If you had an overpayment on your 1975 income tax return which you elected to have applied as a [| ‘ cs
[19822]credit against your 1976 estimated tax, enter the amount here........ 0.020.000.0000 0 eee eee 7 a
[19823]To apply entire overpayment crédit to this installment and any excess to the next, enter here the amount on line 5. To spread
[19824]credit evenly.to each installment, divide it by number of instaliments and enter results here... . 2... eee eee eee
[19825]. Amount to be paid with this declaration at time of filing (line 4 less line 6)..........-- Fee ee
[19827]Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing of
[19828]quarterly estimates. Enter lump sum payment here.............
[19831]vent
[19832]sat
[19834]Your social security number
[19836]First name and initial (if joint declaration, use names and initials of both}
[19838]Please
[19839]print
[19840]or type
[19842]Spouse’s social security number
[19844]mB wne
[19848]a
[19850]co ™
[19852]| have examined this deciaration and to the best of my knowledge it is correct. : :
[19853]SiQnaturelS) .o..ccccceccscccccssegeceneesestensesce casescen esesseostsaeusnsseusncerseeneeeeeeascesecsceetsossereaeease Date... cescsseeceecseeeeeeenceeeeesee 19
[19855]MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS— ] 976
[19857]For calendar year 1976 or fiscal year ending —__________, 19___ STATE OF MICHIGAN
[19858]‘ Department of Treasury
[19860]FORM
[19861]MI-1040-ES
[19863]“anergy
[19865]se 14
[19866]Alert
[19867]First name and initial (if joint declaration, use names and initials of both} Last name .
[19869]Address (number and street)
[19871]City, State, and ZIP code
[19872]Detroit, Michigan 48221
[19874]Your social security number
[19876]Please Spouse’s social security number
[19877]print
[19879]or type
[19881]-1. Your estimate of 1976 income tax. nee $1,609 09
[19882]2. Estimated income tax withheld and to be withheld during entire year of 1976 ©. : :
[19883]3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)................ i 3600-909 |
[19884]4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.
[19885]if this declaration is aio 15, 1976, enter 1/4 of fine 3; [JSeptember 15, 1976, enter 1/2 of line 3) ...... cece ot 99 92
[19886]due to be filed on: { June 15, 1976, enter 1/3 of line 3; ([CJJan. 15, 1977, enter amount on line 3 }
[19888]an
[19890]_ If you had an overpayment on your 1975 income tax return which you elected to have applied as a
[19891]credit against your 1976 estimated tax, enter the amount here.......... De cv cee v te erv ees
[19892]. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To
[19893]spread credit evenly to each instaliment, divide it by number of installments and enter results here... a caseeecsenaneeeeaeceseee ee
[19894]7. Amount to be paid with this declaration at time of filing (line 4 less line 6).... 0.0.2.0... occ eee ], 00-00
[19895]8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing
[19896]of quarterly estimates. Enter ump sum payment here... 2
[19898]NW Basen’ Baars 2949595" *paywa'tsr best of my knowledge it is correct.
[19902]Nate . ..19
[19904]JFK Collection: 8SCA (RG 233)
[19906]Reference copy,
[19908]p040(N)” CITY. OF DETROIT INCOME TAX “1975
[19911]TY OF m
[19912]eTROIT INDIVIDUAL RETURN — [NONRESIDENT] _
[19913]D ‘ or other taxable year beginning... oe 1975, ending ... ig
[19914]First Name and Initial . - Last Namie Your ur Social EXTENSION NUMBEL ~~ |
[19915]. an
[19916]Earl R. and Marge _ Ruby _ 3
[19917]. . + eoege lf you are an EMpigs
[19918]PLEASE (If joint return of husband and wife, use first names and ‘middle initials of both) enter your Federal EMPLO 2
[19919]PRINT | Home Address (Number: and Street or Rural Route) Identification No. here:
[19920]OR .
[19921]type, | _ 18135 Livernois a*
[19922]City, Town or Post Office : . State Postal Zip Code wd
[19924]Detroit, Michigan 48221 v
[19925]a 7
[19926]A. If married, is spouse filing a separate return? (1) YES Kt NO. if yes, enter spouse's first MAME... ieee ves é
[19927] cceensvsssgseveshansetenassssaaseensansvassenaneseveceetsneaseeisetuasesaseeeueneceeussseitanienacettcetaaottnie w
[19928]B.° Enter the name and address used on your return for 1974 (if the same as above write “Same”. ‘If different, indicate date 4
[19930]. ‘ . Regular 65 or over Blind Enter '
[19931]' SCHEDULE A— EXEMPTIONS 1. YOURSELF 6 ee ee nd oO o chemations
[19933]oa - . SPOUSE . 2... 1 eee ee ial Oo o :
[19934]2. Enter first names of each of your DEPENDENT CHILDREN who lived with you: Enter i
[19936]Attach Copy of Form DW-2 or W-2 Here
[19938]Qo 9 Gain (or loss) from sale or exchange of tangible property in the City of Detroit — from page 3, Schedule E, line 10
[19940]Oa 11. Income (or loss) —TRUSTS AND ESTATES ONLY — from page 4, Schedule G, line 7 (see instructions for exemption to enter on line 15);
[19942]Attach Check or Money Order Here
[19944]<> 22. if your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return. © 1$.....ccc essences
[19946]moved.) If none filed, give reason. Same
[19948]Auditor
[19950]checked
[19952]Reference copy,
[19953]a
[19955]Denise, Joyce —-~ _
[19956]Months fived in
[19957]Enter figure 1} nN ane last column to Relationship your home uring.
[19958]3. OTHE tight for each name listed .
[19959]THER
[19960]DEPENDENTS ——e | _
[19961]4. Total exemptions from lines J, 2 and 3; enter here and on line 15 below. = : 4
[19962]INCOME (If joint return, include all income of both husband and wife) ~
[19963]5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife : :
[19964]Total wages reported Detroit Income Tax |] WAGES, ETC, EARNED. ;
[19966]Employer's Name Where employed (City and State) - on DW-2 or W-2 . Withheld IN DETROIT
[19967]Gono, Se EAvers . “DE _ 35,000 joa
[19969]2 3S ‘sar"
[19971]& TOTALS 06. eee teens
[19972]7. Rental income (or loss) from tangible property in the City of Detroit — from page 2, Schedule B, line 4.06... beet ttnteneen ete
[19974]8. Other income (or loss) from partnerships, etc. — from page 2, Schedule F, line 4
[19976]10. Net profit (or loss) from business — from page 3, Schedule C, line 8 2.6.6... ieee ee ee eet tee eee
[19978]12. Total (add lines 6 through 11 of last column) .
[19979]13, Less: Deductions from page 2, Schedule M, line 5 (if none, enter zero)
[19980]14, : Total (line 12 less fine 13) ... Lake b ee tebe eee tenes e nye ens vce pene eee ert ene , Lees Rea iche dente
[19981]_ 15. Less Amount for Exemptions: Enter number of exemptions from line 4 above oo... ut srenteereiae and multiply. by $600, bene ce eae $. A, Feo CO
[19982]16. TOTAL INCOME SUBJECT TO TAX 000 nee en eben eres 43 754 1 13
[19983]17. CITY OF DETROIT TAX: Multiply line 16 by .005 (14%)... o.oo ee els AS 7D
[19984]PAYMENTS AND CREDITS _ - '
[19985]18 a. Tax withheld by employer — from fine 7 above — ATTACH Forms DW-2 of W-2... 0.000000 beeen eee eee Soe 3 F702
[19986]b. Payments and credits on 1975 Declaration of Estimated Detroit Income Tax ©0222... 0-20 e ee cee eee ete OW ccccccecesssssteecsasasecsesbeesceseveess
[19987]«. Other Credits — explain in attached statement (See Instructions) 2.0.00... 0. eee Lecce eee nea ee ee
[19988]19. TOTAL — Add Lines 18a, b, and ¢ eee eer aera e eee eeeteee ejs____ BBO
[19990]TAX DUE OR REFUND
[19992]. . . '
[19993]20. If your paymenis (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT ........---050-5- . Sool 2012 2.
[19994]21. ‘Check box if you wish overpayment on line 20 to be: (A) (] Credited on 1976 Estimated Tax or (B) K Refunded.
[19996]Make cheek payable to: “TREASURER, CITY OF DETROIT.” A balance due of less than one dollar ($1.00) need not be paid.
[19998]I declare that | have examined this return (including accompanying schedules and statements) and to the best:of my knowledge and belief it is true, correct and
[20000]SIGN complete. If prepared by @ person other than taxpayer, his declaration is based on all information of which he has any knowledge.
[20002]——»> | SIGN HERE
[20004]HERE
[20006]NW 88326| son sti Monae
[20009]re. es
[20011]arty
[20013]ee gk tMemounn THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONC i
[20014]INTANGIBLES TAX RETURN | oe
[20016]OR FISCAL YEAR —_ | %
[20018]Ending 19 RUAY EARL & MARGTE 69 RASS a
[20019]one Is135 LIVERNOTS AVE
[20020]Michigan Corporation Check 9 E TRO I TM I 48 e e 1 a
[20021]One o-
[20022]Foreign Corporation ‘3
[20023]Fiduciary Y JF THIS RETURN Is FOO
[20024]. ESTATE GIVE PROBA
[20025]MONTH DAY YEAR | . County . 3 _
[20026]11) 30} 75 698855 an7| 82 { 75| 12> ‘ite No. Oo
[20027]_RETROACTIVE DATE ACCOUNT NO, | vee | county | cry | x | ic | FILE DATE Date of Death i =
[20029]tm. Computation of Tax Due Fi TA
[20030]. cal
[20031]+, Accounts and Notes Receivable (non-ineonte producing only | {| [| | | 1 S
[20032]2 a ee ee ee OL
[20033]. Less Accounts and Notes Payable. ee . 8
[20034]3. Balance Taxable @ 1/10th of 1%. ee ee 3. . u —_—
[20035]4, Accounts and Notes Receivable (income producing only). ee 4, e
[20036]5. Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2). rT rd 5. ; v
[20037]6, Balance Taxable - —+—_}+— 6. a be
[20038]7. tncome applicable to balance. 7.
[20039]8. Tax @ 342% of income {Line 7) or 1/10 of 1% af Balance (Line 6), whichever is greater. : 8.
[20040]9. Stocks and Bonds----- Schedule A, Column 9. 9.
[20041]10. Mortgages and Land Contracts wees Schedule B, Column &.. - 0.
[20042]11, Annuities ---- - Schedule C, Column 9. |
[20043]12, Beneficiary Return (attach copy hereto) .
[20044]13. TOTAL
[20045]14. Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return) _ : 14, —
[20046]15. BALANCE DUE 15. i
[20047]16. Cash on Hand or in Transit as of retroactive date (include cosh in safety deposit boxes) 16,
[20048]17, Bank Deposits in Banks Located Outside of Michigan | or Withdrawn from Mich. 7,
[20049]: . Banks or Ass‘ns. after
[20050]18. Savings in Building and Loan Ass‘ns. Located Outside of Michigan_____ RETROACTIVE DATE. 18.
[20051]19. TOTAL a
[20052]20, TAX @ 40% per $1000.00 of Line 19, ot |_| .
[20053]2. TOTAL TAX DUE (Line 15 plus Line 20) ai.
[20054]22. Less Advance Payment of Tax 22.
[20055]23. TOTAL TAX DUE 23.
[20056]24. Penalties & Interest; Penalty %, $. - Interest. Yo, Months, $. 24,
[20057]25, TOTAL AMOUNT DUE 25.
[20059]MAKE REMITTANCE PAYABLE TO STATE OF MICHIGAN
[20061]Please forward Remittance for Amount Shown Here
[20062]To: MICHIGAN DEPARTMENT OF TREASURY, LANSING, MICH. 48922
[20064]on or betore April 30, ; ; |
[20066](or four months atter end of authorized fiscal year)
[20068]IMPORTANT—Be Sure to Answer the following Question When Applicable.
[20069]SALES
[20071]: - ao .
[20073]1. Business or Profession of Taxpayer. Phone No.3 63-0499
[20075]. Give year of lost return filed. IG 2H - Address of Last Return lathd! Sa ene
[20076]Check here if return is computed on a Retroactive Date Method._- lor Monthly Average Metheod—____
[20078]owe. ON
[20080]. If taxpayer is a corporation give State and Date of Incorporation.
[20082]Federal Employers Identification Number
[20084]. If this is the return of a Trustee attach list of némes and addresses of beneficiaries and date of creation of trust.”
[20086]» Hf this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.
[20088]U declare under the penalties Inport by Act Na, JOl Pp, AL of 1999, ae Amanced, that this retu\en, Including any accompanying a
[20090]andl to the beat of my knowledge and belief Ina tue, correct and complete return,
[20092]Return Prepared by.
[20094]NW 88326 Docid:32245535 PYyS21WEST re
[20096]heen examined by |
[20098]Sociol Gecurity Number —
[20100]GORDON L. HOLLANDER, P.-C, - “em
[20101]ACCOUNTANT Signed
[20102]N MILE ROAD mae
[20105]i Ue INCOME ANU Caduree
[20107]OO O——
[20109]oUt bucd & — SHARENOCDERS SHARE
[20110]is
[20112](ii aaditionai space i
[20114]needed, attach schedule)
[20116](1) {2} (3) (4)
[20117]Name and Address of Each Shareholder Social Security Number of Amount taxable as ordinary .
[20118]Number Shares income (schedule K, total of i
[20119]lines 4 and 8, US. 1720S) }
[20120]ee i
[20121](Biker my
[20122]esas) eso CHICAGO
[20124]{5) (6) (7) (8)
[20125]Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
[20126]paga 1, line 5, or page 2, holder on Mi-1040 (enter on Ml1-1040, page 1, line 22 MI-1040, each shareholder’s
[20127]schedule B, line 6 . page 2, schedule 1, line 34 or each shareholder’s pro- proportionate share of Single
[20128]on page 2, schedule 2, line 43) portionate share of per- business tax paid.
[20129]-difference between column 4 sonal property taxes (See instructions)
[20130]and column 5 paid on inventories or
[20131]{See instructions) the credit for franchise
[20132]fees paid.
[20133]. : (See instructions)
[20134](a) ube, Syed
[20135]The
[20136]b) YG &Yo-.07
[20137](c)
[20138]SESS SS nn tt
[20139](d).
[20140](e)
[20141](f)
[20142](g) ,
[20143](h) .
[20144](i) oo a ,
[20145]a RR
[20146](j)- ;
[20147]NW 88326 Docld:32245535 Page 216 phar PS
[20148]a Sadie
[20150]:  HSCA (RG 233)
[20152]JFK Collection
[20154]Reference copy,
[20156]NW 60326
[20158]. ware : -
[20161]RRICHIGAN INDIVIDUAL INCOME TAX RETURN
[20163]_ 1975, ending —_______ —_-—_, 19
[20165]for 1975, or taxable year beginning
[20167]Y “First name and inilial (if joint reiurn, use first names and initials of both) Last name ~ {Your social security number_
[20169]Earl R. and Marge Ruby te
[20171]Home address (number and street or rural route) . Your occupation ~
[20173]w 18135 Livernois Sales
[20174]= City, town or post office. and State . ZIP code Spouse's social security no.
[20175]5 Detroit, Michigan 48221
[20176]= Residency Status during tax year: . Spouse's occupation
[20177]7 Resident [J Non-resident CJ Part-year resident, from —_______ to
[20178]“
[20179]S O filing Status: 1. Exemptions:
[20180]~ A CJSingle (a) Enter here the number of exemptions claimed on your
[20182]B Cl Married, filing jointly federal income tax return... eee gaa 4 4
[20184]: ays . . . - . wo e
[20186]¢ CMartied, filing separately (see instructions, page 2) (b) Special exemption for paraplegics & quadriplegics . [nstrsctiona]
[20188]a Name of Spouse ——— ——_______________- (c) TOTAL EXEMPTIONS, add lines Ia) and M(b).......-..----- @__ 4.
[20189](Give spouse's Sac. Sec. No. in the space provided)
[20190]ish t i ; i NOTE: if you check the ‘YES’ boxes
[20191]2. STATE Do you wish to designate $2.00 of your taxes for this fund? 2) CEs KINO aoe t increase your tax OF
[20192]CAMPAIGN FUND If joint return, does your spouse wish to designate $2.007....- O YES KINO reduce your retund.
[20194]3. Adjusted gross income as defined in the Internal Revenue Code and which should be reported on Federal Form 1040,
[20196]. : Attach copies of any Federal schedules that indicate 3 loss or deduction
[20198]line 15, or 1040 A, line 12 trom gross income. (See page 5 of the instructions) ©... 6 ce ee array
[20199]4. Additions to adjusted gross income, (from page 2, line 35)..... 0.6.0.2. eee eee teeter enn
[20200]5. Total, add lines 3.and 4............... bbb bbb bbb debby edb e beet eee een neers
[20201]6. Subtractions from adjusted gross income, (from page 2, line 44)........2 ‘cud ence ene sees eee e eens enn e nee
[20202]7, Subtract line 6 from line 5... eens eee eect e tenn teen eens
[20203]8
[20204]9
[20205]0
[20207]_ Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48) ....
[20209]> Attach State Copy of Form W-2 Here <
[20211]_{ncome subject to tax (subtract line 8 from line 7)... . 2.02.22 ee erence eee teense eters
[20212]10. Tax: multiply line 9 by 4.37% (.0437) 00ers
[20213]CREDITS (See instructions - pages 7-10) AMOUNT PAID - CREDIT
[20215]LL. Income tax paid to Michigan cities....... eve eter c esas @ 00/4 hia. a
[20217]12. Contributions to Michigan colleges & universities (attach receipts) . @ 12a.
[20219]13. Income tax paid to another state (attach copy of return)... ..... 13. ®.
[20221]14. Total credits (add lines lla, 12a, and 13a), enter total here... 1.6... cee eee eee teen ene 14, 20/04
[20223]15. Income tax, subtract line 14 from line 10 (if line 14 is greater than line 10, enter NONE’)... 0... ..- 20ers 15] 241784
[20225]16. Credits from any MI-1040 CR form. (see page 9 of instructions) ........------+20-0 (16) _ ;
[20227]Do not complete lines 17 thru 21 if you have claimed a credit on line 16.
[20229]17. Household income from line 56.0.0... eee eee es @
[20231]18. Enter 1975 homestead property tax or amount from line 59 ..... @
[20232]wy 19. Tax not eligible for credit, enter 3.5% (.035) of line 17......... 19.
[20233]» 20. Subtract line 19 from line 18, if line 19 is greater, enter ‘NONE’... 20. . pe
[20234]5 21, Property tax credit, 60% (.60) of line 20, ($500.00 maximum) ....... 0.000 seers 21. —-
[20235]5 22. Personal property tax paid on inventory. @ LK 39% 6.39). 22.
[20236]S ; PAYMENTS
[20237]23. Michigan tax withheld (attach State copy of W-2).......- 0.0.0 s sees eter ee eee @ AIS yO
[20238]= 24. Michigan estimated tax payments .......... vce eeceeeueneceeeteetnneees @ _ Toe} 2
[20239]S 25. 1974 overpayment credited to 1975......... Sev g cue teceuleetenenesneeaeees (75)
[20240]E26. Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25........--++. bebe tee tet terete, 26. G, ISSO
[20241]S 27. If line 26 is less than line 15, enter BALANCE OF TAX DUE HERE.........0..000-0ccceeeeeeevees PAL @ 340 [3
[20242]'S 28. if line 26 is greater than line 15, enter AMOUNT OVERPAID. 0.0000. 0cceeeeeee 28.
[20243]% 29 Amount of line 28 to be REFUNDED TO YOU... «2.2.2... 0c cece eee etree pe eset tent nes REFUND » @ al
[20244]A 30. Amount of line 28 to be credited to 1976 estimated tax......... 30) ee nod dine See gniryon line 30,
[20246]OFFICE USE
[20248]This return is due April 15, 1976 or on the 15th day of the fourth month after the close of your tax year.
[20249]Under penaities of periury. | declare that | have examined this return, including accompanying schedules and
[20250]statements, and to the best of my knowledge and beliet it ia true, correct and complete. If prepared by a person
[20251]other than the taxpayer. his declaration is based on all information of which he has any knowledge.
[20253]sign D> sescsgmine vps bee B aan! “OLERNGER asi
[20255]Here Ponce a SAC NY ccccc cee cee ce eeeet eens
[20256]PReiiisssasssnpaiva ray. BOTH must sign even if only one had income) } 9675 WESLLTEN Mike 8089 ; A Lan aoa
[20257]- ae ar ny eet a naumont tn — Michiga 89 ‘8, Drawer ving,
[20259]weneee San Can & ffoil eaturn ani
[20261]JFK Collection: SCA (RG 233)
[20263]Reference copy,
[20267]D-1040(N®) CITY OF DETROIT INCOME TAX 197 5
[20269]PLEAS
[20271]TY OF - =
[20273]cniy Git _ INDIVIDUAL RETURN —NONRESIDENT 3
[20275]DE i an or other taxable year beginning... ccc. cee eee . 1975, ending vote tte teeters Voce og
[20277]First Name and Initial - last Name EXTENSION NUJABE:
[20280]Earl R. and Marge Ruby a an ae
[20282]: tgs Your Occupation “TF you are an EMPLO’ GO
[20284]E (if joint return of husband and wife, use first names and middle initials of both) Sales enter your Federal EMPLO bd
[20286]lentification No. here: ise
[20288]PRINT Home Address (Number: and Street or Rural Route) Spouse's Social Security Number
[20290]18135 Livernois ‘ ' =
[20292]ie]
[20293]TYPE
[20295]A.
[20297]B.
[20299]moved.) If none filed, give reason.
[20301]3
[20303]City, Town or Post Office State Postal Zip Code
[20304]Detroit, Michigan 48221
[20306]‘APP.
[20308]Enter the name and address used on your return for 1974 (If the same as above write “Same”. if different, indicate date
[20310]JFK Collection
[20312]Auditor
[20314]Regular : 65 or over Blind Enter ‘ ey
[20315]SCHEDULE A— EXEMPTIONS + 1. yourself «1... . +s an (0: Oo cremations 9
[20316]Oo SPOUSE . . 2... eee eee ral - Oo oO chec +.
[20317]w 2. Enter first names of each of your DEPENDENT CHILDREN who lived with you: : Enter Mo. be
[20318]. . . :
[20319]© Denise Joyce 4-
[20320]= NAME . Months lived in ry
[20321]“ Enter figure 1 in the last column to . Relationship your home during ee
[20322]= 3 right for each name listed 1975 vo
[20323]OTHER ms
[20324]5 DEPENDENTS _
[20325]o i
[20326]= 4. Total exemptions from lines 1, 2 and 3; enter here and on line 15. below. eee cnrrnrrmerraremrrmceim | Oy
[20327]a
[20328]£ INCOME (If joint return, include all income of both husband and wife) ©
[20329]3 5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife ”
[20330]al Total wages reported Detroit Income Tax — WAGES, ETC.’ EARNED
[20331]° Employer's Name Where employed (City and State): on DW-2 or W-2 Withheld IN DETROIT
[20332]'
[20333]= GOR... CREAN EES, FENG co PET LAL 2d Sone OO OMe ad, Sonnac xy Bao Re A te
[20334]Go vvessmnntinnnnnatnnnainnnnnenn sete tteiunnnaintnanennnstnne 14,590) 29 M121 > E,250'50
[20335]5 6. TOTALS eee ete tect cease nett ene n nes 6, S00;0° 3B qe
[20336]oS
[20337]= 7. Rental income (or loss) from tangible property in the City of Detroit — from page 2, Schedule B, line 4...........0. 2 eee ee
[20338]< 8. Other income (or loss) from partnerships, etc. — from page 2, Schedule F, line 4. bce eee eee sep
[20339]9. Gain.{or loss) from sale or exchange of tangible property in the City of Detroit — from page '3, Schedule E, line 10. : va] sasessessnusesneneneeeeresneoenepees “
[20340]10. Net profit (or loss) from business — from page 3, Schedule C, line 8 .............. ee eee eee nets Dy cccecesteeneseeree feccieereeee
[20341]Oat Income (or loss) -TRUSTS AND ESTATES ONLY— from page 4, Schedule ‘G, line 7 (see instructions for exemption to enter on line 15) —
[20342]12, Total (add lines 6 through 11 of last column)... 0.2. eee eee errr ca feraees ae, IEF 113 eevee
[20343]13. Less: Deductions from page 2, Schedule M, line 5 (if none, enter La aS
[20344]14, Total (line 12 less dine 13) 200. ee eee eee Lene eae cote ASA
[20345]15. less Amount for Exemptions: Enter number of exemptions from line 4 above ; a im 2°
[20346]16. TOTAL INCOME SUBJECT TO TAX 43 7544 113
[20348]1
[20350]Attach Check or Money Order Here
[20352]PAYMENTS AND CREDITS ; .
[20353]18 a. Tax withheld by employer — from line "6 above — ATTACH Forms DW-2 or W-2
[20355]19. TOTAL — Add Lines 18a, _b, and ¢c
[20356]TAX DUE OR REFUND
[20358]20. If your payments (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT
[20359]21, | Check box if you wish overpayment on line 20 to be: (A) [] Credited on 1976 Estimated Tox or (B) al Refunded.
[20361]7, CITY OF DETROIT TAX: Multiply line 16 by .005 (42%)
[20363]b. Payments and credits on 1975 Declaration of Estimated Detroit income Tax
[20365]c. Other Credits — explain in attached statement (See Instructions)
[20367]> 22. Wf your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Poy in full with this return. © [$...0..ce eee | eee
[20369]Make check payable to: “TREASURER, CITY OF DETROIT.” A balance due of less than one dollar ($1.00) need not be paid.
[20371]I declare that | have examined this return (including accompanying schedules and statements) and to the bestiof my knowledge and belief it is true, correct and
[20373]SIGN complete. If prepared by a person other than taxpoyer, his declaration is based on all information of which he has any knowledge.
[20374]——e | SIGN HERE
[20375]HERE b
[20376]SIGN HERE .
[20377]: (Spouse's signature and date) (If joint return, BOTH HUSBAND AND WIFE MUST SIGN) CERTIFIED PUBLIC ACCOUNFANT |
[20378]NW 88326
[20380]Docld:3A7Af535: FagadlBepartment, Treasury Division, 104 City-Ca G7 BEST, TEM AIL Minsaan 48224 -
[20382]NW Si aGtbeld: 32245535..Page 219............--...--:
[20384]erper ted an ty/b -
[20385]2 > Exempliins (number of ailowable exemptions times $1,500.00) .
[20386]3. Subtract line 2 from line 1. (This is your estimated taxable income). .
[20387]4, Estimated tax (line 3 times .046 of 4.6%). 662.0. Dob d eve ee eves
[20388]5. LESS: Total estimated tax credit for Michigan City income taxes. personal property tax on inventories,
[20389]Michigan homestead property taxes and contributions to Michigan colleges and universities
[20390]6. Subtract line 5 from line 4. Enter here and on line | below.....
[20392]oS MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR inoiviouats- 1976
[20393]MICHIGAN M1 040-€S
[20395]For calendar year 1976 or fiscal year ending —_____________, 19... STATE OF MICHIGAN
[20396]Department of Treasury
[20398]Address (number and street)
[20399]City, State, and ZIP code
[20401]Your estimate of 1976 income tax... 0. ee
[20402]Estimated income tax withheld and to be withheld during entire year of 1976...
[20403]ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)
[20404]_ COMPUTATION OF INSTALLMENT. Check proper box below and. enter amount indicated.
[20405]if this declaration is {CJ April 15, 1976, enter 1/4 of line 3: (C] September 15, 1976, enter 1/2 of line ‘t an
[20406]due to be filed on: ‘on 15, 1976; enter 1/3 of fine 3; (J Jan. 15, 1977, enter amount on line 3
[20407]. If you had an overpayment on your 1975 income tax return which you elected to have applied as a [
[20408]credit against your 1976 estimated tax, enter the amount here... 6... ee ee
[20409]6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To spread
[20410]credit evenly to each installment, divide it by number of installments and enter results here.......-.-.----- 00s sees
[20411]_ Amount to be paid with this declaration at time of filing (line 4 less line 6)... ee eee
[20413]Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit} with this return eliminates the filing of
[20414]quarterly estimates. Enter lump sum payment here..........
[20417]our
[20419]watt
[20421]First name and initial (if. joint declaration, use names and initials of both}
[20423]Your social security number
[20425]Spouse's social securify number
[20431]om
[20433]| have examined .this declaration and to the best of my knowledge it is correct. .
[20434]SiQnature(S) ...c.cceccecceesecesececeeceeceseeceeseseueeseerceeccnaseaeseseessenescccesesaeeenaeaeasseanensenanesnenees Daten. eee ce ce ceeeeeeeeneneeeee /19
[20436]MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS— ] 976
[20438]For calendar year 1976 of fiscal year ending ____________, 19___ STATE OF MICHIGAN
[20439]Department of Treasury
[20441]am, FORM
[20445]sat
[20447]yet
[20448]- yae
[20450]First name and initial (if joint declaration, use names and initials of both)
[20451]Earl R. and Marge
[20452]Please Address {number and street)
[20453]erye| 18135 Livernois
[20454]City, State, and ZIP code . :
[20455]Detroit, Michigan 48221
[20456]. Your estimate of 1976 income tax... eee
[20457]Estimated income tax withheld and to be withheld during entire year of 1976.00.00... tee
[20458]ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is fequired). ..
[20459]_ COMPUTATION OF INSTALLMENT, Check proper box below and enter amount indicated. - ©
[20460]If this declaration is hon 15, 1976, enter 1/4 of line 3; (September 15, 1976, enter 1/2 of line3) :....- [a 490,90
[20461]due to be filed on: { June 15, 1976, enter 1/3 of line 3; (Jan. 15, 1977, enter amount on line 3 } ;
[20462]If you had an overpayment on your 1975 income tax return which you elected to have applied as a
[20463]credit against your 1976 estimated tax, enter the amount here... 6.2...
[20464]6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To
[20465]spread credit evenly to each instaliment, divide it by number of installments and enter results here.
[20466]. Amount to be paid with this declaration at time of filing (line 4 fess tine a
[20467]_ Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing
[20468]of quarterly estimates. Enter lump sum payment here :
[20470]mh WR
[20472]on
[20474]on
[20476]oe
[20477]| have examined this deciaration and to the best of my knowledge it is correct.
[20479]and
[20481]: HSCA (RG 233)
[20483]JFK Collecticn
[20485]Reference copy,
[20487]~ tar PAE 4k
[20488]ceeures s earintinnyn i :
[20489]se aang THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONE — El
[20491]* Revenue Division
[20492]INTANGIBLES: TAX RETURN
[20494]faa]
[20496]Calendar Year 19. nN
[20498]OR FISCAL YEAR —____ . . co °
[20501]Ending. 19 rt
[20503]a
[20507]d : RUBY EARL & MARGIE 698 85 5
[20508]eso | : 18135 LIVERNOILS AVE : . +
[20509]artnership. r Check DETROTLTT MI GA221
[20511]One rn _
[20513]Michigan Corporation
[20515]Foreign Corporation
[20517]POSTED FILED
[20519]Y IF THIS RETURN {§ FO!
[20520]ESTATE GIVE PROBA
[20522]Fiduciary
[20524]MONTH DAY “YEAR
[20525]11 30 75 : 698R55
[20527]RETROACTIVE DATE , ACCOUNT NO.
[20529]County____
[20531]1 2 File No..
[20533]FILE DATE Date of Death
[20535]COUNTY city eT
[20537]“e Computation of Tax Due © in TA 5
[20539]JFK Collection
[20541]1, Accounts and Notes Receivable (non-income producing only).
[20543]. Less Accounts and Notes Payable.
[20544]. Balance Taxable @ 1/10th of 1%.
[20546]. Accounts and Notes Receivable (income producing only).
[20548]. Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2
[20550]Pal
[20551]Reference copy,
[20553]. Income applicable to balance.
[20555]. Tax @ 32% of Income (Line 7) or 1/10 of 1% of Balance (Line’6), whichever is greater.
[20557]. Stocks and Bonds ----- Schedule A, Column 9.
[20559]4
[20561]A
[20563]Nt
[20565]2.
[20567]3
[20569]4
[20571]5
[20573]6. Balance Taxable
[20576]8.
[20578]9
[20580]0
[20582]10. Mortgages and Land Contracts ----- Schedule B, Column 8.
[20583]11, Annuities +--+ Schedule C, Column 9.
[20584]12. Beneficiary Return (attach copy hereto}
[20585]13. . TOTAL .|
[20586]4, [3S ous
[20588]14, Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return) _
[20589]15, . BALANCE DUE
[20591]16. Cash on Hand or in Transit as of retroactive date {include cash im safety deposit boxes)
[20593]17, Bank Deposits in Banks Located Outside of Michigan _ er Withdrawn from Mich.
[20594]Banks or Ass’ns. after
[20596]RETROACTIVE DATE.
[20598]15 22 0alG”
[20599]18. Savings in Building and Loan Ass‘ns. Located Outside of Michigan
[20600]19, TOTAL
[20602]a SS
[20603]20, TAX @ 40¢ per $1000.00 of Line 19.
[20605]21. . TOTAL TAX DUE (Line 15 plus tine 20) it a7
[20607]22. Less Advance Payment of Tax
[20609]23. TOTAL TAX DUE : 24. 2\be als
[20610]24, Penalties & Interest; Penalty — _ __%, $______;_ Interest. %___.__Months, $. 24} || —
[20611]25. TOTAL AMOUNT DUE : 25. Ale o2|&5
[20612]MAKE REMITTANCE PAYABLE TO STATE OF MICHIGAN ; : ;
[20613]Please forward Remittance for Amount Shown Here on or betore April 30.
[20614]To: MICHIGAN DEPARTMENT OF TREASURY, LANSING, MICH. 48922 (or four months after ond of authorized fiscal year)
[20616]IMPORTANT=Be Sure to Answer the following Question When Applicable.
[20617]1. Business or Profession of Taxpayer. SA Le . phone Ne G3- OOD
[20619]. Give year of last return filed. ogy SAE of Last Return. al t =
[20621]. Check here if return is computed on a Retroactive Date Method__-_____________Hm_or Monthly Average Method
[20622]. If taxpayer is a corporation give State ‘and Date “of Incorporetion———____________ Federal Employers Identification Number.
[20624]. If this is the return of a Trustee attach list af names and addresses of beneficiaries and date of creation of trust.”
[20626]Own ww
[20628]. If this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached,
[20630]te declare uncer the panaltios Imposed by Act No. A201 P, A, of 1999, as Amended, that thie return, Including any accompanying ached
[20632]hoen examined by +
[20634]and ta the heat of my knowledye and bealief ie a true, corert auc complete return. Social becurity Number ——
[20635]Return Prepared by, GORDON L. HOLLANDER, P.C. i: “ened
[20636]; 19675 ACCOUNTANT Signed
[20637]NW 88326-Bocid:322455 35g Raga,4 ST TEN MILE ROAD Tite
[20639]p] i a0nge Clee et te eee te a It
[20642]—gGteuce & — SHAR EZAGLOEAS SHAAE UF INCGWE ANG Cacia
[20644](if additional space is needed, atiach schedule):
[20646]. : { {3)
[20647]Name and Address of Each Shareholder Social Security Number of
[20648]: : Number Shares
[20650]S
[20652](4)
[20653]Amount taxable as ordinary
[20654]income (schedule K, total of
[20655]tines 4 and 8, U.S. 1720-S)
[20657]42 etoot
[20659]om
[20660]Co, Sto .oT
[20662]US tan IPSUM SS ESO CHICAGO FLL. below
[20663](C) oc ee eee Le eee
[20664]id)... ces, cove ven eaebeentateeeees
[20665]-) sen eee Lee eee
[20667](5) ; (6) (7) (8)
[20669]Distributive Income from Amount to be used by share-
[20670]page 1, line 5, or page 2, holder on MI-1040 (enter on
[20671]schedule B, line 6 page 2, schedule 1, line 34 or
[20673]on page 2, schedule 2, iine 43)
[20674]difference between column 4
[20675]and column &
[20677](See instructions)
[20679]Enter here and on form
[20680]M1-1040, page 1, line 22
[20681]each shareholder's pro-
[20682]portionate share of per-
[20683]sonal property taxes
[20684]paid on inventories or
[20685]the credit for franchise
[20686]fees paid.
[20688]Enter here and on form
[20689]MI-1040, each’ shareholder's
[20690]proportionate share of Single
[20691]business tax paid.
[20692](See instructions)
[20694](a) UL, Gyo
[20696]: .
[20698]ib) YL &Ynor |.
[20700](c)
[20702](h)
[20704]NW 88326 Docld:32245535 Page 221
[20706][iene Cl .
[20708]HSCA (RG 233)
[20710]JFK Collection
[20712]Reference copy,
[20714]SCHEDULE F — SHAREHOLDERS SHARE UF INCOME AND CHE) 13
[20716]4
[20718](2) (3) a)
[20720]Name and Address of Each Shareholder -
[20722](5)
[20723]_ Distributive Income fram
[20724]‘page 1, line 5, or page 2,
[20725]schedule B, line 6
[20727]{lf additional space is needed, attach schedule)
[20729](6)
[20731]Amount to be used by share- ©
[20733]holder on Mi-1040 (enter on
[20734]page 2, schedule 1, line 34 or
[20735]on page 2, schedule 2, line 43)
[20736]difference between column 4
[20737]and column 5
[20739](See instructions)
[20741]Social Security
[20742]Number
[20744]Number of
[20745]Shares
[20747](7)
[20749]Enter here and on form
[20750]MI-1040, page 1, line 22
[20751]each shareholder's pro-
[20752]portionate share of per-
[20753]sonal property taxes
[20754]paid on inventories or
[20755]the credit for franchise
[20756]fees paid.
[20758](See fastructions)
[20760]Amount taxable as ordinary
[20761]income (schedule K, total of
[20762]lines 4 and 8, U.S. 1120-S)
[20764]14 7 20.6
[20766](8).
[20768]here and on’ form
[20770]each shareholder's
[20772]proportionate share of Single
[20773]business tax paid.
[20774](See instructions)
[20776]SS TF TT
[20778]9730/6 4G.6/
[20782]UtG.GT
[20784]OP BO
[20786]NW 88326 Dochd:32245535 Page 222
[20788]JFK Collection: H8SCA (RG 233)
[20790]Reference copy,
[20793]wien, Dept, of Treasur
[20795]a
[20797]WD mat Na es a a tn
[20799]BeOooS | sais We OF Partners or Shar 1976 c
[20800]| Parts shia, Subshaater $ Corp., Profe essional Corp.
[20801]: See instructions on reverse side
[20802]1 Name: 2 Account Number:
[20803]Cobo-Rumar Sales, Inc, 38-1812707
[20804]t
[20806]pier | SULIMARY
[20808]t
[20809]I
[20810]i
[20812]“3” Total Number of Partners or Shareholders... 00... ooo e ccc cevececeeecc vets ceceeeeeceeeecces <
[20813]4 Total Number of Qualified Partners or Shareholders from Part li—enter here and on C-8000, line 60a... as .
[20815]Ayan | QUALIFIED PARTNERS OR SHAREHOLDERS
[20817]“PARTNER S or SHAREROLDER $
[20819]‘A NAME AND ADDRESS B SOCIAL C % | DSHAREHOLDER’S | E
[20820]SECURITY NO. Time} SALARY vn F Share of Bus. Inc. | G Share of SBT Paid
[20822]| ‘Earl Ruby.
[20824]580 Stoney River; Birm.
[20826]% : 00 al tol
[20828]00
[20830]Sa 0}; 4 00} | 00
[20832]oo sf
[20836]T H
[20837]| PAR G at NGN-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is neoded submit separate schedule and enter totals on line 7.
[20839]is
[20841]| never
[20843][als % | 00 | 00
[20845]| 00
[20847]TOTALS
[20848]NW-88326-Boltd 3224
[20850]hand Part Ill
[20851]es page 2 )
[20853]JFK Collection: BSCA (RG 233)
[20855]Reference copy,
[20857]ltenl, wept. oF ireasury we Ne ee eee ee see
[20859]nyt es aor —- ea" amalna fay a PD mi ration on “es NTA Byars. nh ~ n
[20860]my - GOSS Oi Caras oi Selend aers— iwi6 oC
[20861]tue at | Day! ne Crataal . an > bud
[20862]Yr na wu mt retin aa x: a" ¢ f
[20863]Parimersiaip, SUscuasiey ) Gore, r7e: fog sval Corp.
[20864]See instructions on reverse side
[20865]11 Name: ; . 2 Account Number:
[20867]Cobo Cleaners, Inc. | : 38-1806433
[20868]layin» | SURIRIARY .
[20869]i 3 Total Number of Partners or Shareholders...... EE
[20870]4 Total Number of Qualified Partners or Shareholders from Part It—enter here and on C-8000, line 60a....[ 4 |
[20872]pad ul QUALITIED PARTNERS OR SHAREHOLDERS
[20874]te
[20876]A NAME AND ADDRESS B SOCIAL C % | DSHAREHOLDER’S |E % PARTNER’S or SHAREHOLDER’S
[20877]SECURITY NO. Time| SALARY Own. | F Share of Bus. Inc. | G Share of SBT Paid
[20878]> | ————=—= —————— ——— a
[20879]ae Earl Ruby
[20880]80 Stoney River; Bim. 10% 144,600 | 90 | Loe |. | 00 00
[20881]: % | 00 % | 00 00
[20882]; %, | 00 % | 00 004
[20883]% 100} 4% | 00 00
[20884]% 00 % 00 004
[20886]reorer i! TOTALS (Part I and Part Ili)
[20887]_ NW+88326-Bocld: 32245535 Page 224
[20891]JFK Collection: HSCA (KG 233)
[20893]Reference copy,
[20895]NW-88326
[20897]wica, Jest. of Treasury
[20899]Cobo Cleaners
[20900]hutine - | SUMMARY
[20903]ror)
[20905]2D o ee
[20907]a Ga
[20909]We i ene ee ee
[20911]ers OF
[20913]vie
[20915]We ween
[20917]Subchaater S Carp. Pro
[20919]See instructions on reverse side
[20921]‘Inc.
[20923]Sherer
[20925]lnmict
[20930]slag
[20932]ow
[20934]onal Corp.
[20936]2 Account Number:
[20938]E%
[20940]Own,
[20942]10@
[20944]_%
[20953]38-180
[20955]7
[20960]6433
[20962]PARTNER’S or SHAREHOLDER’S
[20964]3 Total Number of Partners or Shareholders:.... 0.00. ccc c ccc cc cece ce eee cette eer e eens ene nes
[20965]4 Total Number of Qualified Partners or Shareholders from Part |!—enter here and on C-8000, line 60a... 4 |
[20966]Lugit? 7 QUALIFIED PARTNERS OR SHAREHOLDERS
[20967]) NAME AND ADDRESS B SOCIAL © % |DSHAREHOLDER’'S
[20968]SECURITY NO. Time} SALARY
[20969]: | Earl Ruby , a
[20970]380 Stoney River; Birm.| SORBBMEY| 100) 144,600 | 00
[20972]% 00.
[20973]_ % | 00
[20974]% 00
[20975]g 00
[20976]% 00
[20978]d submit separate
[20980]F Share of Bus. Inc. | G Share of SBT Paid
[20981]| 00 | 00
[20982]| 00 | 00
[20983]| 00 | 004
[20984]| 00 1 00
[20985]| 00 00
[20986]| 00 100"
[20987]{00 [ 00
[20988]| 00 | 00}
[20989]| 00 | 00}
[20990]00 00
[20992]| -
[20993]ridsny Wi] NON-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is neede schedule and enter totals on line 7.
[20995]: .
[20997]Viger
[20999]hy TOTALS
[21001]Part Ul and Part |
[21002]Bocid:327245535 Page 225 )
[21004]00
[21006]00
[21008]00
[21012]I
[21014]00
[21015]00
[21020]| 00
[21022]| 00
[21023]| 00
[21025]| 00
[21027]| 00
[21029]maem gd Ac 4
[21031]JFK Collection: #8SCA (RG 233)
[21033]Reference copy,
[21035]Cobo Cleaners
[21036]| SULIRIARY
[21038]iaAyghe
[21040]3. Total Number of Partners or Shareholders
[21041]1 4 Total Number of Qualified Partners or Shareholders from Part tl—enter here and on C- 3000, line 60a.
[21043]a QUALIFIED PARTNERS OR SHAREHOLDERS
[21045]|
[21046]: A
[21048]Jan
[21052]See vie
[21054]ne OF ;
[21055]Saip, + Subohester & § > tora. Professional Corp.
[21057]Deve’
[21058]Partie
[21062]@ Bae: ram
[21063]Caneel
[21065]S or
[21067]See instructions on reverse side
[21069]Inc.
[21071]2 Account Number:
[21073]Ep
[21075]1976
[21077]_
[21078]I
[21080]r NAME AND ADDRESS | B SOCIAL © % |DSHAREHOLDER’S [E % PARTNER'S or SHAREHOLDER’S
[21081]SECURITY NO. Time} SALARY Own. | F Share of Bus. Inc. | G Share of SBT Paid
[21083]_ Earl Ruby
[21084]380 Stoney River: fr 10% | 144,600 | 00 106 00 00:
[21085]f 0, «| sto 00
[21086]% 00 % 00 00 |.
[21087]I 00 % 00 00 .
[21088]| 4 00 oo}
[21090]oO} ai. 00 - 00
[21091]| .
[21092]% 00 % 00 00
[21093].
[21094]% 00 % _ | 00 00
[21095]% 0} 2 00 00
[21097]aN Abel: NON-QUALIFIED PARTNERS OR SHAREHOLDERS, If more space is needed submit separate schedule and enter totals on line 7.
[21098]i
[21099]00
[21100]00
[21101]00
[21102]00
[21103]00
[21104]00 % . | 00 00
[21105]0 4% | 00 00
[21106]_ = 0) 4 1.00 00
[21107]NW B8dd6-pould ad4484% 'bany Pag!) 7 CO A)
[21109]JFK Collection: SCA (RG 233)
[21111]Reference copy,
[21113]videwene Meese ce tt wee wee semitone Sete cod Waleed we,
[21115]Sosa . . Depariment of Treasucy
[21117]1973, or iaxabie year beginning ©... . ....., G73, ending 2, (AGL,
[21119]“ JIA, uSe irs aames and imibals of Ooth) j +asi name
[21123]= FA, RGE i SV oURY
[21124]+ 7
[21126]ZiP code | Sacuse’s sociai security no.
[21128]fot : | 1
[21130]aie on / cy iS pad : ; Ce ep | i
[21131]1. Exemptions-Enter here iotal number of exemptions claimed on your
[21132]1973 Federal income tax return
[21134]you a Michigan resicent orior to July i, 1972? B€¥es fINo
[21136]CiResident (fuli year)
[21138]status - Check One. Mi Married Filiag Jointly ; C1 Single
[21140]LU Married Filing Separately - Name of Spouse... .... (tee ee CiPari-year from 00.0.0 00. 10 eee
[21141]Give snouse’s social security mG. in space provided : 7 CNonresicent
[21143]VY 3. Adjusied gross income as detined in the Internal Revenue Code and which should be repofted on Federal Form 1040, apa
[21145]2 Attach copies of any Federal schedules that indicate a toss or deduction
[21147]— Line 15 or 1040A, Line 12 trom gross income. (See page 5 of the instructions)... 0 eee eee
[21149]os 4. Adaitions (irom page 2, line 36)... . bees Me een ences
[21151]eC re
[21153](5. 6. Subtractions (irom page 2, line 44)... Tce cece ceees vec beter te eeeteevetvens
[21155]ss 7. Balance tineG Jess line 6). . ee een nner ecb bbb bbb bbe ney
[21157]e 5. Residents multiply exemptions s claimed on line 1 by $1200.00..0 22 ccc cece ea ee
[21159]2 Part-year and agnresident allowance irom line 48............... 0... eee eee ee ete vette eves
[21161]= 9. Income subject to tax (line 7 less fine 8). 00. e ee lee e cee cece eee ee
[21163]~3 (iO. fax: multiply jine 9 by .039 (3.9%) 0. vee ;
[21165]= CREDITS — ; AMOUNT PAID CREDIT
[21167]a ; (See pages-8, 9, and 10 of the instructions) ;
[21168]LL. income ‘ax paid io Michigan cits... 0.2.02. e Lie 7 ta, 2A? eet ,
[21169]12. Contributions io Michigan colleges and universities (aitach receipts) . i2a. ;
[21170]13. income tax paic to another staie (atiach copy of return).......... “3. o—j—2 a—___| ,
[21171]14. Total credits (add lines 114, 12a, and 13a,) enter total here... eee 14, a7
[21172]15. Subtract line 14 from line 10 (If line 14 is greater than line 10, enter NONE)... 000.0000 cee ce ccc cee ceva eevee 15. ee ew
[21173]HomesieaG pioperiy tax relief - ines 16 thru 20 - senior citizens, veterans and blina persons see form MI-L040CR. .
[21175]y 16. Enier 1973 homesiead property tax or line 51.00... @
[21177]_ 2 7. sousenold lacome irom fine 58°......... G@ —___ 1
[21179]= 18. Enier 3.5% (.035) of Household income shown on fine 17......... 18.
[21181]S 19. Diiference between line 16 and line 18 (If line 18 is greater
[21183]2 than line 16, enter NONE). cece eee e ee 19. —__
[21185]§ 20. Enter 60% of line 19 (Maximum $500.00) 0.00000. c cee cece eee a
[21187]= 21. Credit from MI-LO4QCR (attach form MI- 1040CR).. cobb eben bette vce tte ec eees Ot
[21189]= 22. Parsonal property tax paid on inventory........0.......00000. (22) |
[21191]2 23. taveniory iax credit ~ 25% of ling 22........... Lobe chee even nea es Deke eee. 23. —
[21195]= 24, Michigan tax withheld (attach State copy of W-2)....... 00. bce ec eee @ RALl o-
[21197]a 25. Michigan estimated tax paymemts. ee S. GFT) 00
[21198]26. | :
[21199]27. ¢
[21200]28. if a :
[21201]29. lf line 27 is greaier thaa line 5, enter OVERPAYMENT HERE. bocce cease vee, erent teens 29. ee
[21202]30. Amount of tine 29 you wish to apply to your estimated tax payments......................., eve cece aes a J
[21203]31. Amouni to be REFUNDED (subiract line 30 from line 29)... e cece cece eevee cece cee eee eee, ee
[21205]This return is cue April 15, 1974 or on the 15th day of the fourth month after the close of your tax year.
[21207]Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it
[21208]is true, correct and complete. lf prepared by a person other than taxpayer, his declaration 1s based on all information of which he has any knowledge.
[21210]ca . .
[21212]Sign wa Your signature : : Date > Signature of preparer, other than taxpayer Date
[21214]>. Spouse's ‘signature it filing ‘jointly. BOTH must sign even if only ‘one had. income) GORDON Lo HOLLANDER, P. Cc
[21215]Make checks payable to “State of Michigan.” Mail return and payment to — MichgERtisize: Pagdd. eopuitrinrany Michigan 48904
[21217]17350 TEN MILE ROAD Py
[21218]NW 88326 Dochd:32245535 Page 227 , SOUTHFIELD, MICHIGAN 4207¢,
[21220]Here ~
[21223]miptions times $4,560.00) eee eee
[21225]'
[21227]vet. (This is y yOur esiimaied isxable income).......0.......... ov ebeeeeseuu eeu bvitesineseeens
[21228]& Estimated tax Gine 3 times .039 of 5.9%). 000 ee Dee ee eect eee
[21229]5. LESS: Totai estimated tax credit for Micnigan City income taxes, persona: property tax on inveniories,
[21231]whcnigaa homesiea 6 propery taxes anc contribuiions io Michigan colleges and universities... .. eae
[21233]6. Subiraci line 5 from fine 4. Enter here and on fine i below... cece cece cece eves veeees
[21235]Department of Treasury
[21237]MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR InDIVIDUALS_ 2 O74 |.
[21238]|
[21240]|
[21242]: on oT For calendar year 1974 or jiscal year ending 19... STATE OF MICHIGAN
[21244]i First name and initial (if joint declaration, use names and initials of doth) | Last name . Your social security numoer
[21246]| i sO i
[21248]| |
[21249]Please | Address (aumoer and street} . Spouse's social security numoer
[21250]‘ - i y
[21252]print J . .
[21253]or type | : ; : i
[21254]City, State, and ZiP code
[21256]. Your estimate of 1974 income tax-....¢..... Sees. ence teense Looe e eee occas
[21257]stimated income tax withneld and to be withiiele during entire year of 1974.0... eee,
[21258]STIMATED TAX (line 1 fess.iine 2). (If less than $100, no ceclaration is required)............. Meee ee
[21259]. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.
[21261]if tis declaration is STapri 15, 1974, enter 1/4 of line 3; (] September 16, 1974, enter 1/2 of line a
[21262]due to be filed on: 4] June 17, 1974, enter 1/3 of line 3; (J Jan. 15, 1975, enter amount on tine 3
[21264]Roe
[21266]r
[21267]cs
[21269]_
[21271]5. if you had an overpayment on your 1973 income tax return which you elected to have applied as a [| ,
[21272]credit against your 1974 estimated iax, enter the amount here..... 22. eee : =
[21273]9. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To spread
[21274]credit evenly to each installment, divide it by number of instaliments and enter results here............. pees | auceeaeeseeeeeeeeesnseceeeseeeeees ‘
[21275]7. Amount to be paid with this declaration at time of filing (ine 4less line 6)... ee eee eee ee ae
[21276]3. Note: The payment of the estimated tax (lite 3 tess any 1973 overpayment credit) with this return eliminates the iiling of
[21278]quarierly estimates. Enter lump sum payment here... cece
[21280]i have examined this dectaration and to the best of my knowledge it is correct. :
[21281]Signature(s)....eecseceecsecsseseeeere se seseescneceesesssessecoesececossaeseetaqessseseseaaeeguceaessaseseenacsaeesees Date. ee eeeeeeeeceeceesneceeeneeseens 19
[21283]| MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS 2 {7/4} vont
[21284]: Uni
[21286]Ml-1040-ES
[21288]For calendar year 1974 or fiscal year ending -________ 19s STATE OF MICHIGAN
[21289], . . Department of Treasury
[21291]First name and initial (if joint declaration, use names and initials of both) Last name Your social security number
[21293]PL AND STARGE am sg:
[21295]Piease : Address (number and street) . Spause’s social security number
[21298]or type (BIBS LIVERLA OIE - : . ;
[21300]| City, State, and ZIP code. . .
[21301]DST ROT AI CH IGAN Y&Da)
[21302]. Your estimate of 1974 income tax. ete
[21303]. Estimated income tax withheld and to be withheld during entire year of 1974...............
[21304]. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)
[21305]COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated. . :
[21306]lf this declaration is {®April 15, 1974, enter 1/4 of line 3; (]September 16, 1974, enter 1/2 ofline3) $93.80 7
[21307]due io de. filed on: {eae 17, 1974, enter 1/3 of line 3; (Jan. 15, 1975, enter amount on line 3 \
[21308]. If you fad-an overpayment on your 1973 income tax return which you elected to have applied as a
[21309]credit against your 1974 estimated tax, enter the amount here.................... 00.0000.
[21310]6. To apply entire overpayment credit to this instaliment and any excess to the next, enter here the amount on line 5. To.
[21311]spread crecit evenly to each instaliment, divide it by number of installments and enter results here
[21312]. Amount to be aaid with this declaration at time of filing (line 4 less line 6)
[21313]. Note: The payment of the estimated tax (line 3 less any 1973 overpayment credit) with this return eliminates the filing ”
[21314]of quarterly estimates. Enter lump sum payment here... 1 eee
[21316]me OF mw
[21318]an
[21322]1 have examined this declaration and to the best of my knowledge it is correct.
[21323]SiQMAUUE(S) Lae. e cece eee ee cecsegeeceaeseeceaessecceeesecaceceneceecseaeescsaeesaseeeseneeeees sersesteceecesesecceeee Date
[21325]NW 88726 Dochd:3224553 Page RR husband and wife must sign
[21327]er otner re
[21329]1
[21330]PoNeone une indiul Lost 7 : Your Sosias Secuiy Numoer |
[21331]: be f
[21334]G FTG42GS3 Your Occupation
[21335]qi rorer .
[21336]Be Aciiress (Na i are i = x Z
[21337]. RUEY EARL §€ MARGE | Spouse's Secial Security Nurser
[21338]ee tote cain7e ; 1 H
[21339]> LSi35 LIVERNOIS I i !
[21341]cre , © 7
[21342]QETRRIT, ME 48221 P ; OF OR
[21343]; Hi
[21344]CO ee Bo caeeeasoeesennd iene ae
[21345]2
[21346]t
[21347]. 5
[21348]A. if married, is spouse filing a separate return? (J YES Le] NO. If yes, enter spouse's first name... ee i
[21350]L
[21351]8. mo and. address use ‘Same, Wi different, indicate date j
[21352]If none filed, give reason. * budisas
[21353]R Audie
[21355]Regular 65 or cver
[21358]WEDULE A—EMEMPYTIONS (1. voursele . 1...
[21359]SPOUSE. 2... ee
[21361]3. Tote! exemptions from tines 1, 2 and 3; enter here and en line 15 bel OW, — eer vo
[21365]5
[21366], | NAME To Monins lived in | |
[21368]pi Enter figure 1 in the last column to { _ Relationship your home duri H
[21369]3. ! . tight for each name listed 1973 {. i
[21370]| oe
[21372]i | —
[21373]re i |
[21377]a ae a nh Sa
[21378]INCOME (lf joint return, include ail income of beth husband and wife)
[21380]5. Enio cr GROSS income from employers for wages, salaries, commissions, tins, etc. — indicate (W) for wife 1
[21381]. Total wages reported Detroit Income Tax
[21382]Empioyer’s Name Where employed {City and ae) on DW-2 or W-2 Withheld
[21384]ae - as .
[21386]6 ALS
[21388]7. Rental income (or joss) from tangible property in the City of Detroit — from page 2, Schedule 8 line 4..00..0.00. 00. !
[21390]Cther income (or toss) from partnersnips, etc. — from page 2, Schedule F, line 4....... ee ee eee eee
[21392]co
[21394]%. Gain (or loss) from sale or exchange of tangible property in the City of Detroit —from page 3, Schedule E, line 10
[21396]1. Net profi (or ioss) from business — from page 3, Schedule C, line 8 ......... Lee eee ee eee eee
[21398]Less Amount for Exemptions: Enter number of exemptions from line 4 above ...............
[21399]id. TOTAL INCOME SUBJECT TO TAX .......
[21400]17. CITY OF DETROIT TAX: Multiply line 16 by .005 (4%)
[21401]PAYMENTS AND CR EDITS
[21402]‘13. a, Tax withheld -by employer — from line 6 above — ATTACH Forms DW-2 or W-2
[21404]b. Payments and credits on 1973 Declaration of Estimated Detroit income Tax.
[21406]c. Other Credits — explain in attached statement (See Instructions) ©0000... 0.0.00. c cv ee ceceeunae Dee eee
[21407]19, TOTAL — Add Lines 18a, b, and ¢ 0... ce eet be beeen ence.
[21408], TAX DUE OR REFUND
[21409]< © 20, your payments {line 19) are larger than your tax (line 17), eater amount of OVERPAYMENT,
[21410]a
[21413]23, Check box if you wish overpayment on line 20 to be: (A) (7 Credited on 1974 Estimated Tax or (B) Tel Refunded. , |
[21414]oor 4 : we . . woz !
[21415]22. If your tax (iine 17) is larger than your payments {line 19) enter amount of BALANCE DUE “Pay j in full with this return. @ 8 dceeeeee
[21417]thane check payable to: "TREASURER, CITY OF DETROIT.” A balance due of less than-one dollar ($1.00) need not be paid.
[21418]eee ee DETRU TA balance due of less than ‘one dollar (51.00) need not bx
[21420]i deciare that | have examined this return (including accompaaying schedules and statements) and to the best of my knowledge and belief it is true, correct and
[21421]complete. If prepared by @ person other than taxpayer, his declaration is basad on all information of which he has any knowledge.
[21423]SIGN KERE
[21425]{Spouse’s signature and date) (If joint return, BOTH HUSBAND AND WIFE MUST SIGN)
[21427]eerie PUBLIC "eceoe
[21429]AMAIL TO; City Treasurer, 104 City-County Building, Detroiti 7ghi EN FGReS pops ee
[21430]RETURNS MUST GZ FILED BY APRIL 2030U7AFIELD, MICHIGAN “2c
[21432]NW 88326 Docld:32245535 Page 229
[21434]SER WD
[21438]wages TAK F
[21439]Apo ~ < “37.
[21442]i
[21444]|
[21446]Me ae oe SE its i
[21447]i
[21448]i
[21450]Od S.SCAL YEAR
[21452]vee ae RUBY EARL & MARGIE 69 33 5 5
[21453]InCiviGve) i
[21454]serach i 18135 LIVERNGIS AVE
[21456]. oration | | check DETROIT MI 48221
[21457]Nocnigan Corporation | }
[21459]One H
[21461]Foreign Corporation H . . i FILED
[21462]Sida: ! - ——_H#_
[21463]Fiduciary . v Nis FOR AN
[21465]ESTATE GIVE PROBATE
[21467]{  MoaTa DAY | YEAR {
[21468]OAT A ' County.
[21469]ae “~ H Ss
[21470]fous i 2 72 1 98 855 File No.
[21471]RETROACTIVE DATE ACCOUNT NO. Date of Death
[21472]- Line ™ panel tan, fom TT.
[21473]ie WOTADUIHON Of LaxK Lue
[21474]1. Accounts and Notes Receivable (non-income producing only) to
[21476]2. Less Accounts and Notes Payable. a
[21478]Balance Taxable @ i/i0ih of 1% tt
[21480]oD
[21482]. Accounts and Notes Receivable (income producing only).
[21484]. less Accounts and Notes Payabie (use only that portion, if any, not used in-line nn a es ee
[21485]. H i
[21487]7. income applicable to balance
[21491]on
[21493]8. Tax @ 342% of Income (Line 7) of 1/10 of 1% of Balance (Line), whichever is greater.__
[21495]9. Stocks and Bonds-.-++ Schedule A, Column 9,_~
[21496]16. Mortgages and Land Contracts----- Schedule B, Column 8.
[21497]11. Annyities s-.+ + Scheduie C, Column 9.
[21499]TD. Seneficiaey Return (attach capy hereto)
[21502]tae Loss Statutory deduction ($175.00 of $350.00 by husbands and wives filing joint rotuen) — __.
[21504], _———
[21506]15. BALANCE DUE
[21508]i6. Cash on tisnd or in Transit as of retroactive date {include cash in safery deposit boxes)
[21510]{of Withdrawn from Mich.
[21511]Banks or Ass’ns. after
[21513]{ RETROACTIVE DATE.
[21515]i7, Bank Deposits in Banks Located Outside of Michigan.
[21517]18. Savings in Building and Loan Ass’ns. Located Outside of Michigan,
[21519]19. TOTAL
[21521]20. TAX @ 40% per $1060.00 of Line 19.
[21523]2. TOTAL TAX DUE (Line 15 plus Line 20)
[21525]22. : : Less Advance Payment of Tax
[21527]23. TOTAL TAX DUE -
[21528]26. Penalties &, Interest; Penalty %, $2; Interest_ % Months, $. Log
[21530]TOTAL AMOUNT DUE
[21531]RE REMITTANCE PAYABLE TO STATE OF MICHIGAN — ; . A
[21533]Please forward Remittance for Amount Shown Here on or before April 20. i
[21534]To: MICHIGAN DEPARTMENT OF TREASURY. LANSING, MICH. 42922 “(or four months ailer end of authorized fiscal yea:)
[21536]" TMPORTANT—Be Sure to Answer the following Question When Applicable.
[21537]SALES: - G4
[21539]Phone No.=. 3
[21541]i. Business or Profession of Taxpayer:
[21543]2. Give year of last return filed. — LAGI pdcress of Last Return. SAME E
[21545]3. Check here if return is computed on a Retroactive Date nr” ae Monthly Average Method
[21547]4, if taxpayer is a corporation give State and Date of Incorporation. Federal Employers Identification umber.
[21548]5. If this is the return of a Trustee attach list of names and addresses of beneficiaries and date of creation of trust,
[21550]6. if this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.
[21552]| declare under the penalties imposed by Act No, 301 P. A. of 1939, as Amended, that this return, including any = “examined by .
[21553]and to the best of my knowledge and belief is a true, correct and complete return. Social Security Number
[21554]- n 4 ‘ .
[21555]GGNCCN L HOLLANDER, P.C. Signed
[21556]Return Prepared b HED BHE-AGED! ANT —— : . of
[21557]" AEB-PU ONT: Signed
[21558]37350 TEN MILE ROAD .
[21560]Bedress UTHEIELO, -MIGHIGA t8075 Tne State whether Individval Own:
[21561]NW 60326 Dochd:32245535« Page 230n eevease sive “Administtator, Trustee, oid, OF
[21564]we ee
[21566]TAR CON.
[21568]Toof GH15-SIT-S hey, S673}
[21569]TTT
[21570]: i
[21574]AL TOTAL DETROIT INCOME EXPECTED IN 1974 : S j
[21575]: H . i .
[21576]aa (369,00 FOR ACH EXEMPTION) $
[21577]C. SSTMMATED SEYROWT TAXABLE INCOME (LINE A LESS LINE 8) $
[21578]&. ESTUMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 1% OF 1% OF LINE Cc. : | 3 ;
[21579]|
[21581]ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE ib OF DECLARATION 8 OW
[21583]CITY Of DETROIT DECLARATION OF ESTIMATED INCOME TAX . ‘ 7? TS
[21584]For Culendar Year 1974 or Fiscal Year Ending , 19. 2 oe
[21585](PRINT O88 TYPE; . 1 YCuR SOCIAL SECURITY NUMBER CHECK TYPZ OF DECLARATION
[21587]H
[21588]ne
[21589]DDD RES . ot ! i
[21592]SPOUSES SCCIAL SECURITY NUMSER
[21594]INDIVIDUAL
[21595]CORPORATION
[21598]ICICI
[21600]city STATE POSTAL Z2!P CODE saad
[21601]. : Cj CTHSR
[21602]. a
[21603]Nace le. Your 1973 Detroit tacome Tex Soca sunt 1b. Your Estimate of 1974 Detroit Income Tax... ..., | Sooners ; vevttesesenes
[21604]2. Amount of Detroit Income Tax to de withheld or other credit expected in 1974............0....., wee | ae
[21605]THUG 9. ESTIMATED TAX (line 1 fess Hine 2) eee e eee, ee
[21606]4. Computation of Installment: Check Due Date of declaration below and enter poriion of fine 3. as + indicated:
[21608]2504 Oo Apr. 30, 1974-1/4; [-] June 30, 1974—1/3; a Sept. 30, 1974~1/2; dan, 31, 1975—100%
[21610]5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit en ee a)
[21611]nan 6. AMOUNT TO &E PAID WITH THIS DECLARATION (line 4 less line 5)........................ eee. | 5 {
[21614]YOUR
[21616]ECORDS. iF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[21617]MAKE REMITTANCE PAYAELE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tex Return,
[21618]AND MAIL WITH DECLARATION TO: .
[21620]OFFICE OF THE CITY TREASURER — INCOME TAX DIVISION : DATE
[21621]104 CITY-COUNTY BUILDING
[21622]DETROIT, MICHIGAN 48226
[21624]V DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
[21626]O40-85 CITY CF DETROIT DECLARATION OF ESTIMATED INCOME TAX
[21627]For Calendar Year 1974 or Fiscal Year Ending...
[21629]CJ INDIVIDUAL
[21630][EL CORPORATION
[21631]OD PARTNERSHIP
[21632](7 OTHER
[21634]a. Your 1973 Detroit Income Tax $.. AS ‘0-53 1b. Your Estimate of 1974 Detroit Income Tax ...... .
[21636]2." Amount of Detroit Income Tax to be withheld or other credit expected in 1974.....0.0........... 000,
[21637]3. ESTIMATED TAX (line Yb less line 2) 2c b bebe nes 9
[21638]4. Computation of installment: Check Due Date of declaration below and ‘enter portion of line 3 as indicated:
[21640]2 Ape. 30, 1974-1/4; [7] June 30,1974~1/3; (1) Sept. 30, 1974-1/2; (J Jan. 31, 1975-100%
[21641]_5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit
[21642]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).
[21644]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER ee
[21646]DOCUMENT LOCATOR NUMBER
[21648]1 CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tox Return.
[21650]Sunatury oF Taxpayer. Spouse also if joint declaration. . CATE .
[21652]NW 88326 Docid:32245535 Page 231
[21654]3. Cost oF
[21657]|
[21658]|
[21662]ciaimed in Schedule A .
[21663]mere and on fine 21, pape i
[21665]MMAGY Of BEPRECIATIC
[21669]soe instructicas) .
[21670]instructions). .
[21671]5, whichever is lesser). Enter
[21673]NW 88326 Dochd:32245535 Page 232 ; Tow rm iammans
[21676]os aren vet ES, BS Bk oe ee _
[21678]Tanta! maite! Bae fey 2 yearn Rett
[21679]come rental sousing . S of mere Su
[21681]hit lane ben
[21682]FO RUE .coS Gs
[21684]IAP IIT,
[21685]at
[21686]pgerererassery
[21690]AG, Bade
[21691]shane owned,
[21692]year have eay
[21693]31?
[21694]Saye ar ‘ 34 ra .
[21695]é vank, securlliés, or other
[21697]“shoe Fors 5 Tailions, see
[21699]patties f
[21700]Facrtratan)
[21703]GSO Ane Pca,
[21705]be
[21707]NW 88326 Docid:32245535 Page 233 rere ene
[21710]ee ene tee sere MEI Se ee ee tee Lee
[21711], : BONER Wee ee Bee OL = : ~e -  e
[21712]. . . f
[21713]Coof Daly. Ted (Raw. 2-73) .
[21714]: a
[21715]AL TOTAL OSTROW INCOME ERECTED IN 1974 a 1S
[21717]ZACH EXEMPTION)
[21721]VED DETROIT TAXABLE INCOME (LINE A LESS LINE 3)
[21723]TAK-NONRESIDENT INDIVIDUALS ENTER OF 1% L
[21724]2% OF LINE C. ENTER TAX HERE AND ON LINE ib OF DEC
[21726]re wv 4 t
[21727][- Youd sociar srcuany NUMER] SOCIAL SECURE NUMEIR UT chic TYPE OF DECLARATION
[21729]t i
[21730]SPOUSES SOCIAL SECURITY NUM2E
[21732]See
[21734]city STATE POSTAL ZIP CODE ' !
[21735]|
[21737]la. Your 1973 Detroit income Tax Si. 1b. Your Estimate of 1974 Detroit Income Tax ....... !
[21739]2. Amount of Detroit income Tax to be withheld or other credit expect ted in 1974.00.00... cet
[21741]SEIS 3S. ESTIMATED TAX (line 15 less line 2) . : Pee eee ee Se eee ee
[21742]4. Computation of Installment: Check Due Date of declaration below and enter gortion of line 3 as indicated:
[21743]COPY LI} Ape 30, 1972-1 /4; 0] tune 30, 1974-1/3; CE Sept. 30, 1974-3/2; LJ “dan. 31, 1975—100%
[21745]5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit rn
[21746]6. AMOUNT TO SE PAID WITH THIS DECLARATION (line 4 less line Spee ee
[21748]tf YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[21750]VITANCE PAYABLE TO “TREASURER, CITY OF DETROIT” - This declaration of estimated tax is not a Tax Return.
[21752]AND MAIL WITH DECLARATION TO:
[21754]OSFICE OF THE CITY TREASURER — INCOME TAX DIVISION : DATE
[21755]104 CITY-COUNTY BUILDING -
[21756]DETROIN, MICHIGAN 46225
[21758]RFORATION AND SEND FORM SELGW WITH YOUR
[21760]CITY OF DETROIT DECLARATION GF ESTIMATED INCOME TAX a
[21761]For Calendar Year 1974 or Fiscal Year Ending... Do,
[21762]RP CWECK TYPE OF DECLARATION
[21763]ig INDIVIDUAL
[21764]; CORPORATION
[21765]C) PARTNERSHIP
[21766][OTHER
[21768]Lt VS AL AES
[21770]STATE
[21771]Mice IGA
[21773]POSTAL. Zi
[21775]-CODE
[21777]“1a. Your 1973 Detroit income Tax $...... AIPOS | ‘1b. Your Estimate of 1974 Detroit Income Tox Q. Lae
[21778]2. Amount of Detroit income Tax to be withheld or other credit expected in 1974....... ee L
[21779]3. ESTIMATED TAX (line Tb less line 2) 2.0.0.0... eee oe OES —
[21780]4. Computation of Installment: Check Due Date of declaration below and enter pottion “of fine 3 as indicated: [ i
[21782]TT apr. 30, 1974-1/4; [7] June 30, 1974~-1/3; (Sept. 30, 1974-1/2; [Jan 31, 1975-100% | Sel
[21783]5. Less: Amount of overpayment on 1973 return which you elected to claim as a CPE Re 1s
[21785]6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)
[21786]i
[21788]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[21790]DOCUMENT LOCATOR NUALBER
[21792]{ CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not G Tex Reiura.
[21794]Signature of Taxpayor. Spouse also if joint declaration. . OATE
[21796]NW 88326 Dochd:32245535 Page 234
[21800]Name and Addrass of Eaca Snaranoidar
[21802]i i
[21803]| i
[21804]i
[21805]1 :
[21806]i
[21807]1 i
[21809]total
[21810]U.S.
[21812]Income (schedule «x,
[21813]of lines 4 and 8,
[21815]1720-8)
[21817]tine 5, or page 2, schedula a,
[21818]line 6
[21820]NW 88326 Docld:32245535 Page 235
[21822](6)
[21824]Amount to ba used Gy shareholdar on
[21826]Me SO OF Gi ee ek, Bee
[21828]line 43) Giffurence between columa
[21830]4 and column & (sae instructions)
[21833]we Nee ee
[21835]See oe
[21837]s A LESS LINE 8)
[21839]co)
[21841]PROIT INCOME TAX-NONRESIDENT INDIVICUALS ENTER % OF 3
[21843]Uwe
[21845]%& OF LINE C. I's
[21846]PAYERS ENTER 2% OF LINE C, ENTER TAX HERE AND ON LINE Tb OF DECLARATION BLOW
[21848]F DZIRCIT DECLARATION OF ESTIMATED INCOME TAX - °
[21849]y Your 1974 or Fiscal Year Ending 0 . 19... 2
[21851]| YOUR SOCIAL SECURITY NUMBE 7 Pe CHECK TYPE OF DECLARATION
[21852]oe
[21856]Co
[21857]|_ spouses SCCIAL SECURITY Numsealid CORPORATION
[21858]T PARTNERSHIP
[21860](J OTHER
[21862]city _ STATE POSTAL Zi? CODE
[21864]HEI la. Your 1973 Detroit lacome TEx Soo cecccccccsesse veut 1b. Your Estimate of 1974 Detroit Income Tax .......
[21865]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1974
[21866]3. ESTIMATED TAX (line 1 lass line 2) 0 cece eee ee ee
[21867]4, Computation of Installment: Check Due Date of declaration below and enier portion of line 3 as indicated: i
[21868]eouy CJ. Apr. 30, 1974-1/4; [1] June 30, 1974-173; Sept. 30, 1974—1/2; (1) Jan. 31, 1975--100% | Sossceretusnenneiennnee meer
[21869]5 ‘
[21871]oH
[21873]Ne Ne !
[21874]- Less: Amount of overpaymeat on 1973 return which you elected to claim as a credit —— $
[21876]aS - AMOUNT TO 5 PAID WITH THIS DECLARATION (line 4 less dine 5)... .000..0,.0... an ae 5 '
[21880]if YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[21881]Sener
[21883]REMUTANCS PAYAELE TO VTREASURER, CITY OF DETROIT“ This declaration of estimated tex is not a Tox Return.
[21884]MAIL WITH DECLARATION 70: :
[21886]RECORDS
[21888]Ge “5 CITY TREASURER — INCOME TAX DIVISION _ DATE
[21889]104 oily. COUNTY BUILDING
[21890]DETROIT, MICHIGAN 48226
[21892]V DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
[21894]“TOLD-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
[21895]~_ For Calendar Year 1974 or Fiscal Year Ending
[21897](PRINT OR TY?€). ~
[21898]fe GAD
[21900]7 ER | CHECK TYPE OF DECLARATION
[21902]|, ie INDIVIDUAL
[21904]1 ‘O PARTNERSHIP
[21905]i 1 OTHER
[21907]city ™ ee STATE
[21908]Sos mong MPO aa
[21910]“da. Your 1973 Detroit Income Tax s. 1 S80-53 1b. Your Estimate of 1974 Detroit Income Tax
[21911]2. Amount of Detroit incame Tax to be withheld or other credit expected in 1974......................
[21912]ESTIMATED TAX (line 1b less line 2) cece eee,
[21913]4. Computation of installment: Check Due Date of declaration below and ‘enter portion of tine 3 as indicated:
[21915]UE Apr. 30, 1974-1/4; [1] June 30,1974~1/3; [] Sept. 30, 1974—1/2; C] Jan. 31, 1975-100%
[21917]Less: Amount of overpayment on 1973 return which you elected to claim as a Credit
[21918]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5). .
[21920]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER —
[21922]DOCUMENT LOCATOR NUMBER
[21923]w
[21925]L CERTIFY THAT THiS 1S A CORRECT DECLARATION. - This declaration of estimated tax is not a Tex Return.
[21927]ayounsre of Tuapuyer, Spowse also if joint declaration, : CATE
[21929]Nw 88326 Docld:32245535 Page 236
[21931]iN 1974
[21933]MTS (9500.00 FOR EACH EXEMPTION)
[21935]. ‘
[21936]wed .
[21938]c. AVES OETAOIT TAKASLE INCOME (LINE A LESS LINE 3) $ ‘
[21940]o. & TAX—NONRESIGENT INDIVIDUALS ENTER 4 3 :
[21942]KR 2% OF LINE C, ENTER TAX HERE AND ON LINE
[21944]CX T¥Pl OF SECLARAT.
[21946]INDIVIDUAL
[21947]CORPORATION
[21950]w
[21952]NAMES) \PRENT OR TYPE) -
[21954]POSTAL ZIP CODE}
[21956]a ib. Your Estimate of 1974 Detroit Income Tax
[21958]“A
[21960]mouar of Detroit income Tax to be withheld or other credit expected in 1974
[21962]ESTIMATED TAX (ine 12 less line 2) .
[21964]4. Compuraiion of Installment: Check Due Date of daciaration below and enter portion of | iine 3 as indicated:
[21966]coey Cl Ape. 30, i97s—ife; Li] June 30, 1974~1/3, GF sept. 30, 1974-7/2; TJ] den. 31, 197S—100%
[21967]3. Less: Amount of overpayment on 1973 return which you elected to claim as a credit —__;
[21969]AMOUNT TO &E PAID WiTH THIS DECLARATION (line 4 lass Hne 5)
[21971]iTTANCE PAYABLE TO “TREASURER, CITY OF DETROIT“ This declaration of estimated tax is act @ Tex Astura,
[21972]HL WITH DECLARATION TO; : . :
[21974]= OF THE CITY TREASURER — INCOME TAX DIVISION . DATE
[21975]4 CITY-COUNTY BUILDING
[21976]OSTAGIY, MICHIGAN 48228
[21978]3
[21979]% DETACH ON # REORATION AND SEND FORM BELOW WITH YouR & ce
[21980]DP S4G-35 CITY OF DETROIT DECLARATION OF ESTIMATED INCOM TAX
[21981]For Calendar Year 1974 or Fiscal Year Ending. , 19
[21982]SARE PRINT OR TYPE, = Se, [YOUR SOCIAL SECURITY NUMBER | Guack TVoE 0} SHCLALATION
[21984]INDIVIDUAL
[21986]CORPORA i
[21987]ARTNERSH IP
[21988]OTHER
[21990]as
[21992]Ww
[21993]“
[21994]5e)
[21995]Cc
[21996]S
[22000]oO
[22001]18
[22003]a
[22004]fad
[22005]8
[22007]Zz
[22008]Cc
[22010]2
[22012]Hole
[22014]a
[22015]Ox
[22017]CiTv~., . _ STATE POSTAL ZIP_CODE
[22018]MO Pay LQICH IGA Opes
[22020]RIG
[22024]la. Your 1973 Detroit Income Tax $. wt lb, Your Estimate of 1974 Detroit Income Tax
[22025]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1974
[22026]3. ESTIMATED TAX (line 1b less line 2) ......00.0.. To,
[22027]4.
[22029]“Compytation of Installment: Check Due Date of declaration below and enter portion ‘of fine 3 as indicated
[22031]Ld apr. 30, 1974-1/4; [7] -dune 30, 1974-1/3; (2 Sept. 30, 1974-1/2; [0 Jan. 31, 1975—106%
[22032]Less: Amount of overpayment on 1973 return which you elected to claim as a credi>
[22033]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).
[22035]CAT
[22036]fey
[22038]3 :
[22040]g iF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER —
[22042]© | CERTIFY THAT THIS 1S A CORRECT DECLARATION. ; This declaration of estimated tax is not a Tax Return.
[22043]Signature of Taxpayor. Spouse also if joint declaration. _ DATE
[22045]NW 88326 Docld:32245535 Page 237
[22047]SCnEOULE F — SKAREHOLOEAS SHARE OF LACUS AND CAdGiVS
[22048](lf additional space is needed, attach schecuia)
[22049]a
[22050]i
[22051]a 2) (3)
[22052]Name and Address of Each Sharehoidcer Social Security Numer of
[22053]Numibgr Saares
[22055]ave Ha fel LS
[22056]LGW. WASHING Tat tle 7
[22057][ed
[22058]1)
[22059](f) ;
[22060]CG) ces ee cece ee eeee seen ee teen EERE EAGER; EA GA EEE; HH EE; EE ERE EE AGHE EEE AeE Oa EE EHO EE ES
[22061](h) ow... eee eeeeee Leen EEE E EERE EEE EERE EEE ROE SEES REE E EEE EERE EES che taeeeeaes
[22062]1) iecesceeneeeeseeseeneenees seeeee beeeaeaes cheeeeeeeeas vee be eae ceeceeeeaeeesaerntnesatnees
[22063](i) : . ‘
[22064]Se
[22065]CG) celcccececeseeceeeeeensnes eee ues eeteeeneneeaeaeneaes Veeeeee Lee ee nee enee tee eeeees ;
[22066]a Ce Ne
[22067].
[22069](4)
[22071]Amount taxable as ordinary
[22072]income (schedule K, total
[22073]of lines 4 and 8&8 U.S.
[22074]1120-S)
[22076]TTT
[22078](5)
[22079]Distributive income from
[22080]page 1, line 5, or page 2,
[22081]schedule B, tine 6
[22083](6)
[22084]Amount to be used by share-
[22085]holder on Ml-7040 (enter on
[22086]page 2, schedule 1, line 37 or
[22087]on page 2, schedule 2, line 46}
[22088]difference between column 4
[22089]and column 5 (sea instructions)
[22091](7)
[22093]Enter here and on form
[22094]MiI-1040, pace 1, line 25
[22095]each snarehoicer’s aro-
[22096]portionate share of per-
[22098]paid on inventories or
[22099]the credit for franchise
[22100]fees paid.
[22102]{see instructions)
[22104]fa) S169. OG FG, 169-69 a
[22106]{b) G4. 69 9 165.64 Ge
[22107](c)
[22109](d)
[22111](e)
[22113](f)
[22115](h) .
[22116]um i. - a
[22118](i) , :
[22120](i)
[22122]NW 88326 Docid:32245535 Page 238
[22124]Sa i » Mae ond
[22126]eds CY OF Det VECLARALON OF TAD UNO TAK
[22127]oo TAX COMPUTATION SCHEDULE
[22128]C of D-i5-DIT-J (Rev. 8-74}
[22130]A, TOTAL DETROIT INCOME EXPECTED IN 1975 : | S |
[22131]f
[22133]B. EXEMPTIONS (3600.00 FOR EACH EXEMPTION) | $ ;
[22135]C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 3)
[22137]D. ESTIMATED DETROIT INCOME TAX=NONRESIDENT INDIVIDUALS ENTER ¥2 OF 1% OF LINE C.
[22138]ALL OTHER TAXPAYERS ENTER 2% OF LINE C, ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW
[22140]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
[22142]NAME(S) (PRINT OR TYPE)
[22144](INDIVIDUAL
[22145](1 CORPORATION
[22146]( PARTNERSHIP
[22147]O OTHER
[22149]ADDRESS
[22151]POSTAL ZIP CODE
[22155]KEEP la. Your 1974 Detroit Income Tax Sr lb. Your Estimate of 1975 Derroit Income Tax... 0...
[22157]2. Amount of Detroit tncome Tax to ‘be withheld or other credit expected in 1975........... Soe toe
[22159]THIS 3. ESTIMATED TAX (line 1b less line 2) 220 ee een
[22160]4, Computation of instalment: Cheek Due Date of declaration below and enter portion of line 3 as indicated:
[22162]copy G Apr. 30; 1975-1/4; C] June 30, 1975~—1/3; | Sept. 30, 1975—1/2; Cj Jan. 31, 1976—100% = | Pe
[22163]: 5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit ——_
[22165]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 jess line 5)....... cet ee ee eee
[22167]FOR
[22169]“YOUR
[22171]. IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22173]RECORDS
[22175]MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” : This declaration of estimated tax is not a Tax Return,
[22176]AND MAIL WITH DECLARATION TO: . : . .
[22178]FINANCE DEPARTMENT — INCOME TAX DIVISION DATE
[22179]104 CITY-COUNTY BUILDING
[22180]DETROIT, MICHIGAN 48226
[22182]f DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
[22184]D-1040-ES ’ CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX: 57
[22185]~ For Calendar Year 1975 or Fiseal Year Ending.............. pW... 975
[22186]N eo)
[22187]AMES) om PRINT BUI ye ALES Ae. Y UR SOCIAL SECURITY NUMBER I CHECK TYPE OF DECLARATION
[22189]Oaks é F FEM = [C INDIVIDUAL
[22190]ISI BS LIV ELP ALOIS | SPOUSE’S SOCIAL SECURITY NUMBER) b- CORPORATION
[22192]PARTNERSHIP
[22193]cit STATE POSTAL ZIP CODE a
[22194]"Deters im MENiGan 334 een Cl one
[22196]la, Your 1974 Detroit Income Tax $... 367. 34, lb. Your Estimate of 1975 Detroit Income Tax........
[22197]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975............ beens
[22198]3, ESTIMATED TAX (lime 1b fess fine 2) 22.02 ee ee ee eee ee
[22199]4, Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
[22200]Ki Apr. 30, 1975-1/4; [J June 30, 1975-1/3; CJ Sept. 30, 1975—1/2; {J} Jan. 31, 1976-100%
[22201]+ bess: Amount of overpayment on 1974 return which you elected to. claim as a credit «=§ —————-_enremnae °1s
[22202]6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5). 0c ee eee
[22204]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22205]| CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.
[22207]DOCUMENT LOCATOR NUMBER
[22210]‘iqnaiuen of Texpoyer, Spouse alo it joint declaration. . . . DATE
[22212]NW 88326 Docld:32245535 Page 239
[22216]mS SHARE CF
[22218](if additional space is needed, attach sciecdule)
[22220](1)
[22222]Name and Address of Each Shareholder
[22224]aE Rae
[22226]WIYGT OA Bs So
[22228](2)
[22230]Number
[22232]Sipe eeeeeseres
[22234]Social Socurity
[22236]INCOME AND CAGE
[22238](3)
[22239]Nurmmivar of
[22240]Shares
[22242], ; (7)
[22244](4)
[22245]Amount taxable as ordinary
[22246]income (schedule K, total
[22247]of lines 4 and 8 US.
[22248]1120-S)
[22250]schedule B, line 6
[22252]NW 88326 Docld:32245535 Page 240
[22254](5)
[22255]Distributive income from
[22256]page 1, line 5, or page 2,
[22258]bf BE
[22260](6)
[22261]Amount to be used by share-
[22262]hoider on Mi-1040 (enter on
[22263]page 2, schedule 1, line 37 or
[22264]on page 2, schedule 2, line 46)
[22265]difference between column 4
[22266]and column 5 (see instructions)
[22268]Enter here and on forra
[22269]Mi-1040, pase 71, line 25
[22270]each shareholtcor’s pro-
[22271]portionate share of per-
[22272]sonal property taxes
[22273]paid on inventories or
[22274]the credit for franchise
[22275]fees paid.
[22277](see instructions)
[22280]x can enT ae wor Paes a at ‘ . -
[22281]een Neher IN Ae IN WE Coie te NN a Na
[22283]=" TAX COMPUTATION SCHEDULE rind
[22285]“or O-15-DIT-s «Rev. 8-74,
[22287]» TOTAL DETROIT INCOME EXPECTED iN 1975 | $ 4
[22288]. i , i
[22289]7
[22291]B EXEMPTIONS ($600.00 FOR EACH EXEMPTION)
[22293]C. ESTIMATED DETROIT TAXASLE INCOME (LINE A LESS LINE 8) 1 $ i
[22295]OD. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 3 OF 1% OF LINE C. | $ :
[22296]ALi OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Tb OF DECLARATION BELOW
[22298]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 197s
[22299]: For Calendar Year. 1975 or r Fiscal Year Ending .......... eee fh ee fio
[22300]NAME(S) (PRINT OR TYPE)
[22302]CHECK TYPE OF DECLARATION
[22304]CO INDIVIDUAL
[22305][J] CORPORATION
[22306]( PARTNERSHIP
[22307](J OTHER
[22309]| i
[22310]ADDRESS !
[22312]SPOUSES SOCIAL SECURITY NUMBER
[22314]KeEP la. Your 1974 Detroit Income Tax $.00ccccccccseg Th. Your Estimate of 1975 Detroit Income Tax........
[22315]2. Amount of Detroit income Tax to be withheld or other credit expected in 1975
[22317]ciTy STATE POSTAL ZIP CODE
[22319]THiS 3. ESTIMATED TAX (line Tb less line 2). 20 we oe, nee ee $—______
[22320]: 4, Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated: i
[22321]copy Co Apr. 30, 1975-1/4; Cj June 30, 1975-1/3; C5 Sept. 30, 1975-1/2; LL] dan. 31, 1976—100% | Sv Seen Boseaaaee .
[22323]5. Less: Amount of overpayment on 1974 return which you elected to claim as @ credit een $ | ;
[22325]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 2 eee
[22327]FOR $1
[22328]YOUR
[22329]RECORDS \F You ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22330]MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tax Return.
[22331]AND MAIL WITH DECLARATION TO: 5
[22332]FINANCE DEPARTMENT — INCOME TAX OIVISION DATE
[22333]104 CITY-COUNTY BUILDING
[22334]DETROIT, MICHIGAN 46226 :
[22335]oo
[22336]q DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
[22337]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 1G" z
[22338]For Calendar Year 1975 or Fiscal Year Ending... cee Fak Ae i975
[22340]NAMES) _ {PRINT OR TYPE) es
[22342]ADDRESS,
[22346]C PARTNERSHIP
[22347](J OTHER
[22349]la. four 1974 Detroit Income Tox $ di 44. 2G lb. Your Estimate of 1975 Detroit ‘income Tax
[22351]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975...........
[22353]3. ESTIMATED TAX (line 1b iess line 2) Lae Fee . : . ce .
[22355]4, Computation of Instailment: Gheck Due Date of declaration below and enter portion of line 3 as indicated:
[22356]7a Apr. 30, 1975-1/4; \L. June 30, 1975-1/3; a Sept. 30, 1975—1/2; Li Jan. 31, 1976—100%
[22358]5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit LS
[22360]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 20. ... 000,
[22362]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22364]DOCUMENT LOCATOR NUMBER
[22366]| CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.
[22367]Siynuture of Taxpayer. Spovee aise if joint deciarorion. ‘ . DANE
[22369]NW 88326 Docid:32245535 Page 241
[22371]Name and Address of Each Shareholder
[22373](4)
[22374]Amount taxable as ordinary
[22376]a)
[22378]12)
[22380]Number
[22382]Social Security
[22385]Numuar of
[22386]Snares
[22388](5)
[22389]Distributive income from
[22391](6)
[22392]Amount to be used by share-
[22394](7)
[22395]Enter here and ‘on form
[22397]income (schedule K, total page 1, line 5, or page 2, holder on MI-7040 (enter on Mi-1040, pace 7, line 25
[22398]of lines 4 and 8 US. . schedule B, line 6 page 2, schedule 1, line 37 or each snarehoicer’s pra-
[22399]1120-S) on page 2, schedule 2, line 46} portionate share of per-
[22400]difference between column 4 sonal property = taxes
[22401]and column 5 (seo instructions) paid on inventories or
[22402]the credit for franchise
[22403]fees paid,
[22404](see instructions)
[22405](SF 169. 6 165.9 cot
[22406](io) S34. 69 4169.69 es
[22407](c)
[22408](d)
[22409]{e)
[22410](f) .
[22411]. .
[22412]{g)
[22413](h)
[22415](j)
[22417]NW 85326 Dochd:32245535 Page 242
[22419]ON e e | a eed
[22421]rR ED CY Ge Beth GEC AON Ge ESTIVLR ES UNC Oi TAK A ae
[22423]ee ‘ . yi,
[22425]TAK COMPUTATION SCHEDULE ; ad
[22427]C of O-15-DiT-J (Rev. 8-74)
[22429]A. TOTAL DETROIT INCOME EXPECTED IN 1975 ; ; 5 i
[22430]B. EXEMPTIONS (3600.00 FOR EACH: EXEMPTION) =~ ; $
[22431]C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 3) $
[22432]D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER % OF 1% OF LINE C. $ i
[22433]ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW i
[22435]D-3040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 1975
[22436]afd ow
[22438](PRINT OR TYPE)
[22440]NAME(S)
[22442]CHECK TYPE OF DECLARATION
[22443]C7 INDIVIDUAL ;
[22445][ CORPORATION
[22446]( PARTNERSHIP
[22448]ADDRESS
[22450]POSTAL ZIP CODE
[22452]lat Your 1974 Detroit income Tax $.0. ee ; 1b, Your Estimate of 1975 Detroit Income Tax........
[22453]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975........... ee
[22454]THIS 3. ESTIMATED TAX (line 1b less fine 2) 00000 e eben bbe t beet eee nes
[22455]4, Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
[22456]COPY {7} Apr. 30, 1975-1/4; [] June 30, 1975-1/3; [J Sept. 30, 1975-1/2; C] Jan. 31, 1976—-100% |S
[22457]5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit © me
[22458]6, AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5). 0.00.0. eee
[22460]FOR -
[22461]YOUR
[22462]RECORDS IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22463]MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” , This declaration of estimated tax is not a Tox Return.
[22464]AND MAIL WITH DECLARATION TO: . :
[22465]FINANCE DEPARTMENT — INCOME TAX DIVISION : ; . DATE
[22466]104 CITY-COUNTY BUILDING ;
[22467]DETROIT, MICHIGAN 48226 5
[22468]{ DETACH ON PERFORATION AND SEND: FORM BELOW WITH YOUR REMITTANCE
[22469]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX. * Ds
[22470]. ~ For Calendar Year 1975 or Fiscal Year Ending)... 1 WY .. [O75 }
[22471]NAME(S) (8 (PRINT OR TYPE) - _ CHECK TYPE OF DECLARATION
[22472]cS RUMAA SALES ZENS: iB gmat ggg [5 novus
[22473]ADDRESS Bo ae EYP ALOIS [AL CORPORATION
[22474]MGIlES LIVE ALO
[22476]ci _ _ STATE POSTAL ZIP CODE © PARTNERSHIP
[22477]ET Po rT ICHIGAM roe C OTHER
[22479]la. Your 1974 Detroit Income Tax $... 367.39, lb. Your Estimate of 1975 Detroit Income Tax.
[22480]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
[22481]3. ESTIMATED TAX (line 1b jess line 2) 2.0. eee a
[22483]4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
[22484]x Apr. 30, 1975-1/4; L] June 30, 1975-1/3; 0 Sept. 30, 1975-1/2; [) Jan. 31, 1976—100%
[22485]. Less: Amount of overpayment on 1974 return which you elected to. claim as a credit ——_—_—_——> °5
[22486]6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less fine 5)-
[22488]JF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22490]DOCUMENT LOCATOR NUMBER
[22493]| CERTIFY THAT THIS 1S A CORRECT DECLARATION. . This declaration of estimated tax is not a Tax Return.
[22494]‘iqoaiuen of Toapoyer. Spouse ho if joint det tucction. EE -_ “OATE ~
[22496]NW 88326 Docid:32245535 Page 243
[22498]7 — SHARE
[22500]{tf additional space is needed, attach sciieduie)
[22502](1)
[22504]Name and Address of Each Shareholder
[22506]HOLDEAS SHARE OF INCTME BNO CAGES
[22508](Z)
[22509]Social Socurity
[22510]Number
[22512]_ (3)
[22513]Nuinoar of
[22514]Shares
[22516](b) ... ESTALE...OF... GEOR SE... PIARTYS
[22517]FPiuso CHICAGO
[22519](4)
[22520]Amount taxable as ordinary
[22521]income (schedule K, total
[22522]of lines 4 and 8, U.S.
[22523]1120-S)
[22525]a}
[22527]{a) $ Dw 33),36
[22529](b)
[22531]36. 231.37
[22533]NW 88326 Docld:32245535 Page 244
[22535](5)
[22536]Distributive income from
[22537]page 1, line 5, or page 2,
[22538]schedule B, line 6
[22540](6)
[22541]Amount to be used by share-
[22542]holder on Ml-1040 (enter on
[22543]page 2, schedule 1, line 37 or
[22544]on page 2, schedule 2, line 46}
[22545]difference between column 4
[22546]and column 5 (see instructions)
[22548](7)
[22550]Enter here and on forra
[22551]MI-1040, pase 7, line 25
[22552]each shareholder's pro-
[22553]portionate share of por-
[22554]sonal property = taxes
[22555]paid on inventories or
[22556]the credit for franchise
[22557]fees paid.
[22559](see instructions)
[22562]pared Cay Ue eeAN IO UE Cotati TNR ce . ry ~
[22563]: TAX COMPUTATION SCHzDULE iliond
[22564]Cot O-15-DIT-» Rev. 8-74,
[22565]"s, TOTAL DETROIT INCOME EXPECTED IN 1975 ls i
[22566]I
[22567]EXEMPTIONS ($600.00 FOR EACH EXEMPTION) 13
[22568]; a Sa SSR
[22569]C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 8) 13 !
[22570]t ‘
[22571]7 T 7
[22572]D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 1% OF 1% OF LINE C. $ :
[22573]ALi OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Ib OF DECLARATION BELOW
[22575]. =
[22576]_ D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 4G 7
[22577]For Calendar Year 1975 or Fiscal Year Ending... = vey VI. d ~
[22578]NAME(S) (PRINT OR TYPE) CHECK TYPE OF DECLARATION
[22580]OO INDIVIDUAL
[22581](1 CORPORATION
[22582][ PARTNERSHIP
[22583](J OTHER
[22585]i eRe
[22586]ADDRESS . j
[22588]“City POSTAL ZIP CODE
[22590]la. Your 1974 Detroit Income Tax $........cc cee ; lb. Your Estimate of 1975 Detroit Income Tax........
[22591]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975.....0...........000...
[22592]THis 3. ESTIMATED TAX (line 1b less line 2) . an _ _ _ . Soe . .
[22593]4, Computorion of installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
[22594]cory wy Apr. 30, 1975—-1/4; Ci June 30, 1975—1/3; 1 Sept. 30, 1975—1/2; (J Jan. 31, 1976-100%
[22595]5. ‘ess: Amount of overpayment on 1974 return which you elected to claim as a Crecit — msmmmnnennie
[22596]AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... .... be ees .
[22598]FOR —————
[22599]YOUR
[22600]RECORDS (F you ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22601]MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tax Return.
[22602]AND MAIL WITH DECLARATION TO:
[22603]FINANCE OEPARTMENT — INCOME TAX DIVISION DATE
[22604]104 CITY-COUNTY BUILDING
[22605]DETROIT, MICHIGAN 48226
[22606]’ DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE -
[22607]w-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX” Re te z=
[22609]For Calendar Year 1975 or Fiscal Year Ending... vote cee WG, tS/ I
[22611]NAM&S) _ (PRINT OR TYPE)
[22612]ee SCE ANE SS.
[22614]ADORESS, 2135 RIVER NONE
[22616](J INDIVIDUAL
[22617]fl CORPORATION
[22618]‘Cy PARTNERSHIP
[22619]Cc] OTHER
[22621]la. Your 1974 Detroit Income Tox 3. Ah 449.26 lb. Your Estimate of 1975 Detroit Income Tax
[22622]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975............ . cae
[22623]3. ESTIMATED TAX (line 1b less line 2) ..... be eee . eae . ns J
[22624]4 Computation of Instailment: Check Due Date of declaration below ond enter portion of line 3 as indicated:
[22625]he Apr. 30, 1975—1/4; L. June 30,°1975—1/3; a Sept. 30, 1975—1/2; Li Jan. 31, 1976—100%
[22626]5. Less: Amount of overpayment on 1974 return which you elected to claim os a credit
[22627]6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 2.00... Le eee
[22629]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
[22630]\ CERTIFY THAT THIS 1S A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.
[22632]DOCUMENT LOCATOR NUMBER
[22634]nt declararion. DATE
[22636]Signature of Taxpayer, Spovee aise if jo:
[22638]NW 88326 Docid:32245535 Page 245
[22640]Cerne nice) CY Gi Celtis Sete AUN Ge Lot eS ave TAK a, "
[22641]TAX COMPUTATION SCHEDULE aad
[22642]; C of D—-15-DiT-d (Rev. 8-74)
[22643]re
[22644]A. TOTAL DETROIT INCOME EXPECTED IN 1975 5
[22645]1
[22647]B. EXEMPTIONS ($600.00 FOR EACH EXEMPTION) $
[22649]C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B) $
[22650]a 7 rs ed
[22651]D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 14 OF 1% OF LINE C. a i
[22652]ALL OTHER TAXPAYERS ENTER 2% OF LINE C, ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW |! !
[22653]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX : 1975
[22654]. For Calendar Year 1975 or Fiscal Year Ending... cece 119.
[22656]YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION
[22658]SPOUSE'S SOCIAL SECURITY NUMBER|LJ CORPORATION
[22660](1 PARTNERSHIP
[22661](] OTHER
[22663]NAME(S) (PRINT OR TYPE)
[22665]ADDRESS
[22667]city 7 STATE . POSTAL ZIP CODE
[22669]Ja. Your 1974 Detroit Incame Tax $.......cceeen ; th. Your Estimate of 1975 Detroit Income Tox........
[22670]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975..............00 0-000,
[22671]THIS 3. ESTIMATED TAX (line Tb fess line 2) 20 ne cee teeny
[22673]4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
[22674]copy Ci Apr. 30, 1975=1/4; Z} dune 30, 1975-1/3; [) Sept. 30, 1975-1/2; [J Jan. 31, 1976—160% | Senn
[22676]5. Less: Amount of overpayment on 1974 return. which you elected to claim as a credit =< neem
[22677]. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 2.000 oe eee eee
[22679]KEEP
[22681]FOR
[22682]YOUR
[22683]PLOYER, ENTER EMPLOYER JDENTIFICATI iM
[22684]RECORDS IF YOU ARE AN EMPLOYER, 0 NTIFICATION NUMBER
[22685]MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tax Return.
[22686]AND MAIL WITH DECLARATION TO: :
[22687]FINANCE DEPARTMENT — INCOME TAX DIVISION ¥ DATE
[22688]104 CITY-COUNTY BUILDING
[22689]DETROIT, MICHIGAN 48226
[22690]DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
[22691]D-1040-ES CITY OF DETROIT ‘DECLARATION OF ESTIMATED INCOME TAX. ‘ 7 |
[22692]For Calendar Year 1975 or Fiscal Year Ending)... AWD, { j 75
[22693]NAME(S) PRINT OR TYPE) ; CHECK TYPE OF DECLARATION
[22694]A POR: IwNe, z
[22695]ADDRESS L A ra i (© INDIVIDUAL
[22696]) §13S IVERNO! Senn see ua cone
[22697]CIty = ce gy ~~ STATE POSTAL ZIP CODE
[22698]Depeork | Mricrneart 4eo>) (] OTHER
[22699]la. Your 1974 Detroit Income Tax $ I: eee at Tb. Your Estimate of 1975 Detroit Income Tax... . |
[22700]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975............ See
[22701]3. ESTIMATED TAX (line 1b less line 2) 0000. ee a e
[22703]4. Computation of Instaliment: Check Due Dote of declaration below and enter portion of line 3 as indicated:
[22705]CJ Apr. 30, 1975-1/4; (] June 30,1975~1/3; (1) Sept. 30, 1975-1/2; } Jan. 31, 1976—100%
[22707]. Less: Amount of overpayment on 1974 return which you elected to claim as a credit -_oreeee- >
[22709]6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... eee es eo
[22711]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER —
[22712]} CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.
[22714]DOCUMENT. LOCATOR NUMBER
[22717]bigauture of Taapoyer. Spouse also i joint declaration.
[22719]aaa PARTS REAR Se womens 0 aa
[22721]“DATE.
[22723]NW 88326 Docld:32245535 Page 246
[22725]Wt UU Sy CY GF ween uii UeeLmaA UN Ue
[22727]TAX COMPUTATION SCHEDULE
[22729]WN eee GN
[22731]€ of D-15-DIT-J (Rev. 8-74)
[22733]oo
[22734]A. TOTAL DETROIT INCOME EXPECTED IN 1975 s I
[22735]t
[22736]B. EXEMPTIONS ($600.00 FOR EACH EXEMPTION) “| $ ;
[22737]|
[22738]C. ESTIMATED DETROIT TAXABLE [NCOME (LINE A LESS LINE B) $ !
[22740]D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 2 OF 1% OF LINE C. $ i
[22741]ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Ib OF DECLARATION BELOW . !
[22742]a!
[22743]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 197 45
[22745]NAME(S)
[22747](PRINT OR TYPE)
[22749]C INDIVIDUAL
[22750](J CORPORATION
[22751](PARTNERSHIP
[22753](]. OTHER
[22755]ADDRESS
[22757]POSTAL ZIP CODE
[22759]KEEP ja. Your 1974 Detroit Income Tax $......... ee ; Jb. Your Estimate of 1975 Detroit Income Tax........
[22760]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975...........0...0..005,
[22761]THIS 3. ESTIMATED TAX {line ib less line 2) 0.0.0.0 eee
[22762]4. Computation of installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
[22763]copy ( Apr. 30, 1975-1/4; 1} June 30, 1975-1/3; [] Sept. 30, 1975—1/2; CJ Jan. 31, 1976—100% woes
[22764]5. Less: Amount of overpayment on 1974 return which you elected to claim as o crecit eee
[22766]FOR & AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 6... weg
[22767]Eee
[22769]YOUR
[22770]P . ENTER EMPLOYER IDENTIFICATI IM
[22772]RECORDS IF YOU ARE AN EMPLOYER Oo ON NUMBER
[22774]MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” : This declaration of estimated tax is not a Tax Retura. .
[22776]. AND MAIL WITH DECLARATION TO: : :
[22778]FINANCE DEPARTMENT — INCOME TAX DIVISION . DATE
[22779]. 104 CITY-COUNTY BUILDING ‘
[22780]DETROIT, MICHIGAN 48226 :
[22781]| DETACH ‘ON PERFORATION AND SEND FORM. BELOW WITH YOUR REMITTANCE
[22782]D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX @7E
[22783]For Calendar Year 1975 or Fiscal Year Ending... pW. G45
[22784]NAME(S) PRINT OR R_TYPE) YOUR SOCIAL SECURITY NUMBER | CHECK TYPE OF DECLARATION
[22785]2 . = .
[22787]ADDRESS ANCE = Ns =e Se Gea | INoIviDuAL
[22789])E1BS GIVERNOIS [-srouses social secuniTy nunsen| & CORPORATION
[22790]CITY eK — STATE POSTAL ZIP CODE Ci PARTNERSHIP
[22792]repro rh | MIictHiGaadr Ueaoy (J OTHER
[22794]la. Your 1974 Detroit Income Tax $....../. S22... lb, Your Estimate of 1975 Detroit Income Tax........
[22796]2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975 Se ee
[22798]3. ESTIMATED TAX (line 1b less line 2) 00.0000 ee ees .e
[22800]4. Computation of Instaliment: Check Due Dote of declaration below and enter portion of line 3 as indicoted:
[22802]i
[22803]$ /O0;99
[22804]CJ Apr. 30, 1975-1/4; [] dune 30, 1975-1/3; C1 Sept. 30, 1975-1/2; Ci Jan. 31, 1976—100% Seen ss
[22805]. Less: Amount of overpayment on 1974 return which you elected to claim asa cred?) ——————— els G t eos
[22806]6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less fine 5)- 0.000.000 c ec ee els BeUr7
[22808]IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER .
[22809]| CERTIFY THAT THIS 1S A CORRECT DECLARATION, This declaration of estimated tax is not a Tax Return.
[22811]DOCUMENT LOCATOR NUMBER
[22812]a
[22814]Siynuture of Tonpayer. Spouse, also it joint declaration. : OATE
[22816]6
[22818]NW 88326 Docld:32245535 Page 247