U.S. Treasury Department—Internal Revenue Service

rors 2106 STATEMENT OF EMPLOYEE BUSINESS EXPENSES | 1960

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| Calendar year 1960, or other Taxable Year beginning -...-.---.------------1 1960, and ending -....

(ATTACH THIS STATEMENT TO YOUR INDIVIDUAL INCOME TAX RETURN)
If, 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 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 6 of the instructions for Form 1040 or page 3 of
the instructions for Form 1040W.

Your name

Address .

Employer's name -....-22.200--

Address -...

State occupation in which expenses were incurred _

A. Employee business expenses which are deductible in computing adjusted gross income (line 11, page 1 of Form 1040 or
line 6, page 1 of Form 1040W).

. Travel expenses while away from home on business: (Number of days____)

(a) Railroad, airplane, boat, etc., fares. . . an $..

(b) Meals and lodging.

() Automobile expenses (irom Schedule A)
(d) Other travel expenses (specify)

Total travel expenses... .

2. Local transportation expenses (not between home and work):
(a) Local bus, street car, 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) 1S.
(b) Other (specify)...

Total outside salemen's expenses

4, Total of lines 1, 2, and 3 .
5. Less; Amount of employer's payments for above expenses coca .
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 5, page 1, Form
1040 or line 1, page 1, Form 1040W.

Report excess employer payments on line 8, page 1, Form 1040 or line 1, page 1, Form 1040W as “Ex-
cess Reimbursements.”

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

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

2. Total . . . . . .
3. Less: Amount of employer's payments for these expenses

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 or Form 1040W.

Report excess employer payments on line 8, page 1, Form 1040 or line 1, page 1, Form 1040W as “Ex-
cess Reimbursements.”



SCHEDULE A—AUTOMOBILE EXPENSES | SCHEDULE B—COMPUTATION OF AUTOMOBILE BASIS

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 8

1, Gasoline, oil, lubrication, ete rn through 13 below. If acquired by trade-in of another vehicle
previously used in’ business, complete lines 1 through 13. (The
basis for depreciation must be recomputed each succeeding year if

2. Repairs 0.0.6.0. ccc cece the percentage of business use changes.)

Old Car Traded-In
1. (a) Total mileage accumulated .........

3. Tires, supplies, eto. ......... bobeeeeees

4. Other (specify) _. (b) Portion applicable to business... .

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

2, Purchase price or other basis.

ba Ko) $, 3. Less: Trade-in allowance. .

6. Total mileage during year . 4. Difference (line 2 less line 3)

5. Line 4 multiplied by percentage on line
7. Portion applicable to business T() vcvccetcesesevettrevsreeteeteewes

8. Percentage of expense applicable to busi-

ness (line 7 divided by line 6)...... esas 6. Depreciation allowed or allowable.......

1. Gain (line 6 less line 5) or loss (line 5 les
line 6) on business portion of car........ $

9, Business portion (line 5 multiplied by line 8) §.
Present Car

8, Purchase price or other basis. Locecee
9. Less: Estimated salvage value. (Estimated

resale or trade-in value of vehicle deter-
11. *Total deductible automobile expenses... $. mined at time of purchase)..............

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

*Allocate to appropriate sections of Item A on page 1. 10. Balance (line 8 less line 9) .......000.-. Se

11. Line 10 multiplied by percentage on line
8 of Schedule A........sccceereseeeeeee -

12. Less: Gain (or plus loss) on line 7 above... ———_______

13. BASIS for computing depreciation 5
SCHEDULE C—DEPRECIATION OF AUTOMOBILE

7 7
Date | Basis From line 13 | Age when | Depreciation allowed in | Method of computing Rate (7%) | Depreciation deductible
Make and style of vehicle | acquired | ‘sch. B) | ‘acquired prior years Gepreciation | orlife (years) for this year
@ LL ® © | @ |. © © © @)

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

a

}. If you were a candidate for a degree, what is the degree? -..
TS, GOVERNMENT PRINTING OFFICE : 19600-56173