rors 2106 STATEMENT OF EMPLOYEE BUSINESS EXPENSES

chute yer 1962
US, Treasury Department | ot or taxable year beginning ..... .--1 1962, and ending ......-... woot 19.--~

Re ——
Internal Revenue Service (ATTACH THIS STATE! INDIVIDUAL INCOME TAX RETURN)

IMPORTANT NOTICE—THE REVENUE ACT OF 1962 PROVIDES STRICTER RULES, STARTING JANUARY 1, 1963,
ON DEDUCTIONS FOR TRAVEL, ENTERTAINMENT AND SIMILAR EXPENSES. ALL TAXPAYERS HAVING
SUCH EXPENSES SHOULD MAINTAIN DETAILED RECORDS THAT WILL ENABLE THEM TO REPORT ACCU-
RATELY AND SUBSTANTIATE THESE EXPENSES. FOR DETAILS SEE SECTION 1.274 OF THE INCOME TAX
REGULATIONS OR CONTACT ANY INTERNAL REVENUE SERVICE OFFICE.

If, as an employee, you were required to travel and incur business gxpenses, or toincur transportation, outside salesman or
education expenses during the taxable year, use of this form will help to determine your correct deduction 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 reim-
bursement. ‘For a more detailed explanation of these expenses, see page 4 of the instructions for Form 1040.

Your name ‘Your social security number

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 of days. )

(a) Railroad, airplane, boat, etc., fareS,......eeeeeeeeseeeeeeeeeees seeeeneceee Goons
(b) Meals and lodging....... seeeeeeeeee
(c) Automobile expenses (from Schedule A). :
(a) Other travel expenses (specify) ....-.-..-.-csesecseeeesnsecceccnececeescennesencnccasesceeeee seeeen

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)
(c) Other (specify)

Total local transportation expenses. .

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

Totaloutside salesmen’s expenses.

4, Total of lines 1, 2, and 3.00... seneeeee
8. Less: Amount of employer's payments for above expenses .
6, Excess expenses (line 4 less line 5) $_____, or excess employer payments (line 5 less line 4) $.

Deduct excess expenses from salary, wages, etc., before entering that income on line 1, page 1,
Form 1040,

Report excess employer payments on line 1, page 1, Form 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) ... a

2 Total.
8. Less: Amount of employer's payments for these expenses. fee
4, Excess expenses (line 2 less line 3) $____, or excess employer payments (line 3 less line 2) $

If you itemize your deductions, rather than elect to use the standard deduction, deduct excess expenses
under ‘Other Deductions” on page 2 of Form 1040.

Report excess employer payments on line 1, page 1, Form 1040 as ‘Excess Reimbursements.”



Form 2106 (1962)

Page 2

SCHEDULE A—AUTOMOBILE EXPENSES

SCHEDULE B—COMPUTATION OF AUTOMOBILE BASIS

1

>

Other (specify) ~..

5. Total.

6. Total mileage during year .........

7. 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) $....

10. Depreciation from Schedule C, col. (h)....

i.

*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, (a) Total mileage accumulated

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

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

2. Purchase price or other basis. ..
3. Less: Trade-in allowance...
4. Difference (line 2 less line 3)

5. Line 4 multiplied by percentage on line
(-) ee

6. Less: Gain (or plus loss) on previous
HAdEINS 0... cece eee eeee eee eee e eee ee,
7. Adjusted basis on business portion of car... -...
8. Depreciation allowed or allowable....... —_—______
9. Gain (line 8 less line 7) or loss (line 7 less
line 8) on business portion of car..... vee
Present Car
10. Purchase price or other basis...........+

11. Less: Estimated salvage value, (See page
B-3 of instructions for Form 1040.)

12. Balance (line 10 less line 11)

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

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

15. BASIS for computing depreciation

SCHEDULE C—DEPRECIATION OF AUTOMOBILE

, Date Basis From fine 15, | Age when | Depreciation allowed in| Method of computin Rate (%)_ | Depreciation deductible
Make and style of vehicle acquired Sede B) acquired prior years depreciation" | of lfe years) | for this year
@ (b) 10} (¢) © 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

statement from your employer to this effect.
3. If your answer to question 2 is “No,””
the courses taken and your employment during the period

attach a

‘Yes

state the primary purpose of obtaining the additional education and show the relationship between

Is it customary for other members of your trade or profession to undertake similar education? LC] Yes C1 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? _..

"Fe USS. GOVERNMENT PRINTING OFFICE: 1962-—O-G46859