rorm 2106

U.S. Treasury Department

eginning
Internal Revenue Service | P&BiM!

Statement of Employee Business Expenses
Calendar year 1967 or other taxable year

.-. 1967, and ending ......
(ATTACH THIS STATEMENT TO YOUR INDIVIDUAL INCOME TAX RETURN)

1967

7 19......

Instructions.—Include all expenses you paid or incurred
as an employee, or expenses which you charged to your
employer (for example, through the use of credit cards), or
expenses for which you received an advance, allowance, or
reimbursement. For a more detailed explanation of these
expenses, see page 8 of the instructions for Form 1040.

on your Form W-—2 should be reported as wages on page 1,
line 5, Form 1040. Check with your employer if you are in
doubt as to whether or not the payment is included in your
Form W-2.

Rules on proof of deductions for travel, entertainment,
and gift expenses are in Publication No. 463 which you

can obtain free at any Internal Revenue Service office.
Use Form 3903 for computation of the moving expense
deduction.

Business expenses paid (reimbursed) to you by your
employer, must be included on line 6, unless they have
been included on your Form W—2. Any such amounts shown

| Employer's name

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 .

(b) Meals and lodging .

(c) Automobile expenses (from Schedule a».

“d) 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) .
(c) Other (specify)

Total local transportation expenses

. Outside salesman's expenses:
(a) Automobile expenses (from Schedule A) .
(b) Other (specify) .

Total “outside. salesman's expenses .

. Employee expenses other than traveling, transportation, : and outside ‘salesman’ 's expenses to the
extent of the reimbursement .

is

5. Total of lines 1, 2, 3, and 4
6. Less: Amount of employer's payments for above expenses “(other than amounts included on |
Form W-2). . . . |
7. Excess expenses (line 5 less line 6). Enter here and on page 2, Part Mh, line 3, Form 1040 sO
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 |
1040.
; |
1. Business expenses other than those included above (specify) i$.

Total .

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.



Form 2106 (1967)

Page 2

Schedule A—AUTOMOBILE EXPENSES

Schedule B—COMPUTATION OF AUTOMOBILE BASIS

Note: Use either the Regular or the Optional method in com-

puting your automobile expenses.’
A. Total months used in business .

B. Total mileage for months in A .
C. Portion of B applicable to business .
Regular method: ‘side genes only fo th number

1. Gasoline, oil, lubrication, etc. . . . . [§.
2. Repairs toe
3. Tires, supplies, etc. . . . -
. Other (specify) (do
not include parking ..
fees and tolls) .

Total .
Percentage of expense , applicable te to busi-
ness (line C above divided by line B above) .

7. Business portion (line 5 multiplied by line 6). |$......
Depreciation from Schedule C, col. (h) $.

9. Line 8 divided by12months. . . . . {$.
10. Multiply line 9 by A, above $,
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

13. Multiply line 12 by 10¢ and enter result
here... . $.

14. Excess, if any, of line c over 15, 000 miles

-

5.

cy

9

.. months

. miles

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
(ine (b) divided by line (a)) .
2. Purchase price or other basis .

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

4. Difference (line2lessline3). . . . . |§.

5. Line 4 multiplied by percentage on line
51> a

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

7. Difference (line 5 less line 6) .

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:

15. Multiply line 14 by 7¢ and enter result
here... wee LS.

16. = Total (line 13 ‘plus line 15) wee IS.

Summary:

17. Enter the amount from line 11 or line 16,

whichever is used . .

Add parking fees and tolls (if any) here .
*Total deductible automobile expenses . $.

18.
19.
+The optional method cannot be used if depreciation has been claimed
in a prior year using a method other than straight line (or where addi-
tional first-year depreciation has been claimed).
*Allocate to appropriate sections of item A on page 1.

10.
11.

12.
13.

14.

15.

Purchase price or other basis .

Less: Estimated salvage value. (See page
B-2 of instructions for Form 1040.).
Balance (line 10 less line 11) .

Line 12 multiplied by percentage on line
6 of Schedule A .

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

BASIS for computing depreciation .

Schedule C—DEPRECIATION OF AUTOMOBILE

Date Basis (From line 15,
acquired ‘Schedule B)

_0) ©

‘Age when
‘acquired

‘Make and style of vehicle
@)

Depreciation allowed in

Method of computing
prior years depreciation

@ 0)

Rate
or'ite Gers)

@

Depreciation
for a year

(OF

aan

|

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

ra

. Name of educational institution or activity
. Address

XN

3. Are you required to 0 undertake this education to meet the minimum educational requirements to qualify in your employment,

trade, or business?

C1 YES ( NO.
. Will the program of study undertaken qualify you for a new trade or business?

O Yes © NO.

5. If your answer to question 3 or 4 is “NO,” state the reason for obtaining the additional education and show the relation-

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

3 US. GOVERNMENT PRINTING OFFICE

570-260-085