rorm 2106

US. Treasury Department inni
Internal Revenue Service | °F other taxable year beginning -.-.

(ATTACH THIS STATEM!

STATEMENT OF EMPLOYEE BUSINESS EXPENSES

Calendar

year 1963

--, 1963, and ending -...
INDIVIDUAL INCOM!

wenn Wee

1963

IMPORTA!

New rules on proof of deductions for travel, entertainment, and gift expenses are now in effect.
in detail in Publication No. 463, which can be obtained at any Internal Revenue Service office.
rules are: (1) If you have adequately accounted to your employer you will not again be required to provide proof to support
your deduction; (2) If you have not made an accounting to your employer you must have complete, accurate, and current
records.—Estimates are not acceptable; and (3) Records must be supported by receipts, paid bills or similar substantiating
evidence for expenditures of $25 or more, and generally for lodging while traveling away from home regardless of the amount.

NT NOTICE

The rules are set forth
For employees, the general

If, as an employee, you were required to travel and incur busi-
ness expenses, or to incur transportation, outside salesman or
education expenses during the taxable year, use of this form will

expenses which you charged to your employer (for example,
through the use of credit cards), or expenses for which you re-
ceived an advance, allowance, or reimbursement. For a more

help te determine your correct deduction for income tax purposes. detailed explanation of these expenses, see page 4 of the instruc-
Include all expenses you paid or incurred as an employee, or _ tions for Form 1040.

Your name

‘Address

Employer's name

Address

State occupation in which expenses were incurred

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

1. Travel expenses while away from home on business: (Number
(a) Railroad, airplane, boat, etc., fares
(b) Meals and lodging. .
() Automobile expenses (from Schedule A)
(@) Other travel expenses (specify)

Total travel expenses.
. Local transportation expenses (not between home and work):
(a) Local bus, streetcar, and taxi fares ..
(b) Automobile expenses (from Schedule A).
(©) Other (specify) ...

Total local transportation expenses.

3. Outside salesmen’s expenses:
(a) Automobile expenses (from Schedule A)
(b) Other (specify)

)

of days

Total outside salesmen's expenses

4, Employees’ expenses other than traveling, transportation and
the reimbursement
Total of lines 1, 2, 3, and 4.
Less: Amount of employer's payments for above expenses

5.
6.
7. Excess expenses (line 5 less line 6) $,

Deduct excess expenses from salary, wages, etc., before
Form 1040,
Report excess employer payments on line 1, page 1, Form

outside salesmen’s expenses to the extent of

, or excess employer payments (line 6 less line 5)...

entering that income on line 1, page 1,

1040 as “Excess Reimbursements.”

B, Employee business expenses which are deductible if you itemize deductions on page 2 of Form 1040.

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

Total .
If you itemize your deductions, rather than elect to use the
“Other Deductions" on page 2 of Form 1040.

standard deduction, deduct expenses under



Form 2106 (1963)

Page 2

SCHEDULE A—AUTOMOBILE EXPENSES

SCHEDULE B—COMPUTATION OF AUTOMOBILE BASIS

1, Gasoline, oil, lubrication, etc

2. Repairs

3. Tires, supplies, etc. .

4. Other (specify) -.

6, Total mileage during year

1. Portion applicable to business

8, Percentage of expense applicable to busi-
ness (line 7 divided by line 6)

9. Business portion (line 5 multiplied by line 8) $_..

(0. Depreciation from Schedule C, col. (h)....
ll. *Total deductible automobile expenses. §.

Allocate to appropriate sections of Item A on page 1.

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 succeeding year if
the percentage of business use changes.)
Old Car Traded-In

1. (q) Total mileage accumulated

(b) Portion applicable to business........

.--- miles
.--- mniles

(©) Percentage applicable to business (line
(b) divided by line (a))..

2. Purchase price or other basis.

Less: Trade-in allowance. .
4. Difference (line 2 less line 3) .

Ling 4 multiplied by percentage on line

Less:

Gain (or plus loss) on previous
trade-ins

Difference (line 5 less line 6)

Depreciation allowed or allowable.......

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.

1k

(See page
B-3 of instructions for Form 1040.) .

Less: Estimated salvage value.

12. Balance (line 10 less line 11) ........... §.

13. Line 12 multiplied by percentage on line
8 of Schedule A..

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

18. BASIS for computing depreciation ....... $.

SCHEDULE C—DEPRECIATION OF AUTOMOBILE

ie Basis pt A hi De iti illowed it Method of tit Rate (%) De ciation deductible
Wataandsoiotvanice | 2a, | Pie tememaveis. | azemner | eranion stores | we eteanting | eZ. | Demat etc
@ () © «@) @) LO) @ hy

SCHEDULE D—ADDITIONAL INFORMATION TO BE FURNISHED BY PERSONS CLAIMING A DEDUCTION FOR
EDUCATION EXPENSES

1, Name and address of educational institution or activity

2. Was the education undertaken in order for you to retain your employment, salary, or status? [] Yes C1] No.

statement from your employer to this effect.

If “Yes attach a

3. If your answer to question 2 is “No,” state the primary purpose of obtaining the additional education and show the relationship between

the courses taken and your employment during the period ..

Is it customary for other members of your trade or profession to undertake similar education? L] Yes C1 No.

4. List the principal subjects you studied at the educational institution shown in question 1 above or describe your educational activity