[104-10433-10212.pdf — page 119]
# SCHEDULE B (Form 1040) Supplemental Schedule of Income and Retirement Income Credit(From pensions and annuities, rents and royalties, partnerships, and estates or trusts) Attach this schedule to your Income tax return, Form 1040# 1967Part 1. PENSION AND ANNUITY INCOMEA-General (State of your Tax Return1 Investment in contract.2 Expected return.3 Percentage of income to be excluded (line 1 divided by line 2).(If your employer contributed part of the cost and your contribution will be recovered tax-free within 3 years,4 Amount received this year.5 Amount excludable (line 4 multiplied by line 3).% 6 Taxable portion (excess of line 4 over line 5).4 Amount received this year.5 Taxable portion (excess, if any, of line 4 over line 3).if you did not completely recover the cost in prior years, enter the total amount received on line 4 and omit lines 1 through 3.)B-Special Rule (Where your employer contributed part of the cost and your contribution will be recovered tax-free within 3 years,if you did not completely recover the cost in prior years, enter the total amount received on line 4 and omit lines 1 through 3.)1 Cost of annuity (amounts you paid).2 Cost received tax-free in past years.3 Remainder of cost (line 1 less line 2).Part II.-RENT AND ROYALTY INCOME| 1. Kind and location of property | 2. Total amount of rents | 3. Total amount of royalties | 4. Depreciation (explain in Part IV) or depletion (attach explanation) | 5. Repairs (attach itemized list) | 6. Other expenses (attach itemized list) || -------------------------------- | ------------------------ | ---------------------------- | ---------------------------------------------------------------------- | --------------------------------- | ---------------------------------------- ||                                  |                          |                              |                                                                        |                                   |                                          ||                                  |                          |                              |                                                                        |                                   |                                          ||                                  |                          |                              |                                                                        |                                   |                                          |1. Totals2. Net Income (or loss) from rents and royalties (column 2 plus column 3 less columns 4, 5, and 6)Part III.-INCOME OR LOSSES FROM PARTNERSHIPS, ESTATES OR TRUSTS, ETC.1. Partnerships (name, address, employer identification number, and nature of income)2 Small business corporations (subchapter S-name, address, and employer identification number)3 Estates or trusts (name, address, and employer identification number)TOTAL OF PARTS I, II, AND III (Enter here and on, page 2, Part II, line 3, Form 1040).Part IV.-SCHEDULE FOR DEPRECIATION CLAIMED IN PART II ABOVE-This schedule is designed for taxpayers using the alternative guidelines and administrative procedures described in Revenue Procedures 62-21 and 65-13 as well as for those taxpayers who wish to continue using practices in effect prior to these revenue procedures. Where double headings appear, use the first heading for depreciation under Revenue Procedures 62-21 and 65-13 and the second heading for other authorized practices.| 1. Group and guideline class or description of property | Cost or other basis at beginning of year | Cost or other basis | Date acquired | 4. Asset retirements in year (amount) (applicable only to Rev. Proc. 62-21) || ------------------------------------------------------- | ---------------------------------------- | ------------------- | ------------- | --------------------------------------------------------------------------- ||                                                         |                                          |                     |               |                                                                             ||                                                         |                                          |                     |               |                                                                             ||                                                         |                                          |                     |               |                                                                             ||                                                         |                                          |                     |               |                                                                             |2 Total additional first-year depreciation (do not include in items below)Total cost or other basis2 Total depreciation (Enter here and in Part II, column 4 above)# SUMMARY OF DEPRECIATION|                                     | Straight line | Declining balance | Sum of the years-digits | Units of production | Additional first year (section 179) | Other (specify) | Total || ----------------------------------- | ------------- | ----------------- | ----------------------- | ------------------- | ----------------------------------- | --------------- | ----- || 1 Under Rev. Procs. 62-21 and 65-13 |               |                   |                         |                     |                                     |                 |       || 2 Other                             |               |                   |                         |                     |                                     |                 |       |