rorM 2106

US, Treasury Department

Internal Revenue Service | _ or other taxable year beginning

STATEMENT OF EMPLOYEE BUSINESS EXPENSES

Calendar year 1966

1966, and endin;

(ATTACH THIS STATEMENT TO YOUR TNDIViDUAL INCOME TAX RETURN)

Instructions.—ti, as an employee, you were required to
travel and incur business expenses, or to incur transportation,
outside salesman, or education expenses during the taxable
year, use of this form will help to determine your correct deduc-
tion for income tax purposes. 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 ex-
penses, see page 7 of the instructions for Form 1040.

If you were paid (reimbursed) by your employer for employee
business expenses, you must include such payments as reim-
bursemenis on line 6 of this form, unless they have been in-

1040. Check with your employer if you are in doubt as to
whether or not the payment is included in your Form

Rules on proof of deductions for travel, entertainment, and
gift expenses are set forth in detail in Publication No. 463
which can be obtained at any Internal Revenue Service Office.
For employees, the general rules are: (1) If you have adequately
accounted to your employer you will not again be ‘ired to
provide proof to support your deduction; (@) If you have not
made an accounting to your employer you must have com-
plete, accurate, and current records—estimates are not accept-
able; 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.

cluded on your Form W-2. Any such amounts shown on your Use Form 3903 for computation of the moving expense de-
Form W-2 should be reported as wages on page 1, line 5, Form duction,

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 (page 1, line 9,
1. Travel expenses while away from home on business (number of days -...

(a) Railroad, airplane, boat, etc., fares
(b) Meals and lodging
() Automobile expenses (from Schedule A).

(d) Other travel expenses (specify) ...

of Form 1040).

Total travel expenses.

2. 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)

Total outside salesmen's expenses

4, Employees’ expenses other than traveling, transportation, and outside salesmen's expenses to the extent of

the reimbursement
8. Total of lines 1, 2, 3, and 4.

6. Less: Amount of employer's payments for above expenses (other than amounts included on FormW-2)
or excess employer payments (line 6 less line 5).

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

Enter excess expenses on page 2, Part III, line 3, Form 1040.

Report excess employer payments on page 2, Part II, line 7, Form 1040 as “Excess Reimbursements.”"

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) ....

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 (1966) Page 2
SCHEDULE A—AUTOMOBILE EXPENSES SCHEDULE B—COMPUTATION OF AUTOMOBILE BASIS

+ a + Note.—If the vehicle was acquired for cash only or by trade-in of
Note: Use cither the Regular or the Optional method in | another vehicle which was not used in business, complete only lines 10
computing your automobile expenses. through 15 below. If acquired by trade-in of another vehicle

previously used in’ business, complete lines 1 through 15, (The

A, Total mileage for the year... - miles | Dasis for depreciation must be recomputed each succeeding year if
B. Portion applicable to business. the percentage of business use changes.)
Regular method: Old Car Traded-In:
1, Gasoline, oil, lubrication, ete 1. (a) Total mileage accumulated ......... __.. miles
2. Repairs (b) Portion applicable to business....... _ .... miles

3, Tires, supplies, etc.
4. Other (specify) (do

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

not include parking 2. Purchase price or other basis.
fees and tolls). 3. Less: Trade-in allowance. .
8. Total 4. Difference (line 2 less line 3) .
6. Percentage of expense applicable to busi- 5. Line 4 multiplied by percentage on line
ness (line B above divided by line Aabove) ___% | 1)
7. Business portion (line 5 multiplied by line 6) $. 6. Less: Gain (or plus loss) on previous
8. Depreciation from Schedule C, col. (h).... — =» | trade.in
9. Total (line 7 plus line 8) (see line 15).. $________ | 7. Difference (line 5 less line 6) .
Optional method:
10. Enter 15,000 miles or the mileage on line B 8. Depreciation allowed or allowable. .
above, whichever is smaller........6606 0 sessseesseeeees miles | 9, Gain (line 8 less line 7) or loss (line 7 less
11, Multiply ine 10 by 10¢ and enter result here $__ line 8) on business portion of car.
12. Excess, if any, of line B over 15,000 miles... _ miles | Present Car:
13. Multiply line 12 by 7¢ and enter result here. $_________ | 10. Purchase price or other basis
14, Total (line 11 plus line 13).....+...+-. § 11. Less: Estimated salvage value. (See page
18, Enter the amount from line 9 or line 14, B-2 of instructions for Form 1040).......

whichever is used .
16, Add parking fees and tolls (ifany) here .
17. *Total deductible automobile expenses .. §,

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

13, Line 12 multiplied by percentage on line
6 of Schedule A

1 The optional method cannot be used if depreciation has been
claimed in a prior year using a method other than straight line (or .
where additional first-year depreciation has been claimed). 14, Less: Gain (or plus loss) on line 9 above. .

*Allocate to appropriate sections of item A on page 1.

15. BASIS for computing depreciation ....... .
SCHEDULE C—DEPRECIATION OF AUTOMOBILE

i Date Basis (From line 15, | Age when | Depreciation alowed in | Method of computin Rate (%)__| Depreciation deductible
Make and style of vehicle acquired Schedule B) acquired Preor years Gepreciation "| or fe (eats) for this year
@) (b) LO} @) LO} 10} @® (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 [] No, If "Yes," attach a
statement from your employer to this effect.

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? [] Yes [1 No.
4, List the principal subjects you studied at the educational institution shown in question 1 above or describe your educational activity

5, If you were a candidate for a degree, what is the degree?

U.S. GOVERNMENT PRINTING OFFICE :1966—O-220-081