Form m1 06 Statement of Employee Business Expenses
Calendar year 1968 or other taxable year

, 1968, and ending ..
(ATTACH THIS STATEMENT TO YOUR INDIVIDUAL INCOME TAX RETURN)

U.S. Treasury Department | beginning .. , 19.

Internal Revenue Service

1968

Instructions.—Include all expenses you paid or incurred on your Form W—2 should be reported as wages on page 1,
as an employee, or expenses which you charged to your line 5, Form 1040. Check with your employer if you are in
employer (for example, through the use of credit cards), or doubt as to whether or not the payment is included in your

expenses for which you received an advance, allowance, or Form W-2.

reimbursement. For a more detailed explanation of these Rules on proof of deductions for travel, entertainment,
expenses, see page 6 of the instructions for Form 1040. and gift expenses are in Publication 463 which you can

Business expenses paid (reimbursed) to you by your obtain from the District Director's office.

employer, must be included on line 6, unless they have Use Form 3903 for computation of the moving expense

been included on your Form’W-2. Any such amounts shown deduction.

Your name

Address Address

Occupation in which expenses were incurred ...

A. Employee business expenses which are deductible in- computing total income
(page 1, line 9, of Form 1040).

1. Travel expenses while away from home on business (number of days ...
(a) Railroad, airplane, boat, etc., fares. 6 2 6 6 6 ee ee ee
(b) Mealsandlodging. . . . ee we 2 we ew ee ee ee
(c) Automobile expenses (from ScheduleA) . . . 2 6 2 ee ee
(d) Other travel expenses (specify) ...

Total travel expenses. © 6 6 6 ee ee ee ee ee ee ee

2. Local transportation expenses (not between home and work):
(a) Local bus, streetcar, andtaxifares. - 2. 6 ee ee ee ee
(b) Automobile expenses (from Schedule A) .
(c) Other (specify)

Total local transportation expenses . . 6 es 6 ew ee ee ee ee

3. Outside salesman’s expenses:
(a) Automobile expenses (from Schedule A). . - 2 2 ee ee ee
(b) Other (specify) ....

Total outside salesman’s expenses. . 2 - ee ee ee ee ee ee

4. Employee expenses other than traveling, transportation, and outside salesman's expenses to the
extent of the reimbursement. «© 6 6 6 6 6 6 8 ee ee ee ee ee ee
5. Total of lines1,2,3,and4 6 6 6 ee ew ee ee eee ee ee
6. Less: Amount of employer's payments for above expenses (other than amounts included on
Form W-2) . . - a
7. Excess expenses (line 5 less line 6. Enter here and on page 2, Part Ill, line3,Form1040 . . . .

8. Excess payments (line 6 less line 5), Enter here and on page 2, Part Il, in misc. income, Form 1040 .

B. Employee business expenses which are deductible if you itemize deductions on page 2, Part IV, Form

1. Business expenses other than those included above (specify) ....

2 Total. 2 ee ee ee

If you itemize your deductions, rather than elect to use the standard deduction, deduct expenses
under “Miscellaneous Deductions” on Page 2, Part IV, Form.1040.



Page 2

Form 2106 (1968)
Schedule A—AUTOMOBILE EXPENSES — Se=iublleation 463 for

Schedule B—COMPUTATION OF AUTOMOBILE BASIS

Note: Use either the Regular or the Optional method.’ (Use a
separate Schedule A for each automobile.)

A. Months auto held for business use .
B. Total mileage for months inA. .

C. Portion of B applicable to business...

‘Include expenses only for the numbe
Regular method: ("frente indeated in A above).

1. Gasoline, oil, lubrication, etc. . . . .
2. Repairs 2. 1 6 ee we ee
3. Tires, supplies, et. . 2. 2 2 ee
4. Other (specify) (do
not include parking ..
fees and tolls) .
5. Total. 2. ee ee ee ee IF
6. Percentage of expense applicable to busi-
ness (line C above divided by line B above). .
7. Business portion (line 5 multiplied by line 6). |$..
8. Depreciation from Schedule C, col. (h) . |§.
9. Line 8 divided by12months. . . . . |.
10. Multiply lineQ9byA,above . . . . |S.
11. Total (line 7 plus line 10) (see line 17) $.
Optional method: *
12. Enter 15,000 miles or the mileage on line
C above, whichever is smaller ..
Multiply line 12 by 10¢ and enter result
here 2. we ee ee ee ee |S.
Excess, if any, of line C over 15,000 miles.
Multiply line 14 by 7¢ and enter result

%

13.

14,
15.

here... e wee oF
16. Total (line 13 plus line 15) we ee fF.
Summary:
17. Enter the amount from line 11 or line 16,
whichever isused. . . 2. . « « {§.

18. Add parking fees and tolls (if any) here .
19.  ? Total deductible automobile expenses . |$.

4 The optional method cannot be used If depreciation has been claimed
in a prior year using @ method other than straight line (or where addi-

Note: If the vehicle was acquired for cash only or by trade-in of
another vehicle which was not used in business, complete only
lines 10 through 15 below. If acquired by trade-in of another
vehicle previously used in business, complete lines 1 through 15.
(The basis for depreciation must be recomputed each succeed-
ing year if the percentage of business use changes.)

Old Car Traded-In:
1, (a) Total mileage accumulated. . . -
(b) Portion applicable to business. . .
(c) Percentage applicable to business
(line (b) divided by line (a)) .

2. Purchase price or other basis .

3. Less: Trade-in allowance . . . .

4. Difference (line 2lessline3). . . . . |%.

5. HO 4 multiplied by percentage on line

6. Less: Gain (or plus Toss) | on previous
trade-in. . wee

7. Difference (line 5 less line 6) . oe

8. Depreciation allowed or allowable. .

9. Gain (line 8 less line 7) or loss (line 7 less
line 8) on business portion of car. . . |§.

Present Car:
10. Purchase price or other basis. . . .
il.

Less: Estimated salvage value. (See page
B-2 of instructions for Form 1040.). .

12.
13.

Balance (line 10 less line 11). . . . |.

Line 12 multiplied by Percentage on line
6 of Schedule A . rt

14. Less: Gain (or plus loss) on line 9 above .

tional first-year depreciation has been claimed).
? Allocate to appropriate sections of item A on page 1. 15. BASIS for computing depreciation . - |$
Schedule C—DEPRECIATION OF AUTOMOBILE
is, (Fr 3, | Agewhen | Depreciation allowed in | Method of B D
ako andsyteot ence | Salty | Petron ne 16, | Agewhen | Dereon ateedin | ahasetconmuine | txe(c, | Dpxeaon
© @) © @ © ©. @ (O}

Schedule D—ADDITIONAL INFORMATION TO BE FURNISHED BY PERSONS
CLAIMING ‘A DEDUCTION FOR EDUCATIONAL EXPENSES

1. Name of educational institution or activity
2. Address

3. Are you required to undertake this education to meet the minimum educational requirements to qualify in your employment,

trade, or business? 1] YES O NO.

Will the program of study undertaken qualify you for a new trade or business?
If your answer to question 3 or 4 is “NO,” state the reason for obtaining the additional education and show the relation-

0 YES OQ NO.

ship between the courses taken and your employment during the period .... -

6. List the principal subjects studied at the educational institution or describe your educational activity

"FeerAH US. GOVERNMENT PRINTING OFFICE: 196¢—O-290-073