TRIPLICATE—Pace 5
To BE RETAINED BY COLLECTOR

1936 RETURN

CAPITAL-STOCK TAX Assessment List, Form 23.4
For Year Ending June 30, 1936

INTERNAL REVENUE SERVICE
Revised 1936

|
|
Form 707
TREASURY DEPARTMENT

(Month)

|
| _—
| DOMESTIC CORPORATIONS
| (Sec. 105, Revenue Act of 1935, 74th Cong., Public, No. 407)

This return must be filed, in triplicate, with the Collector
of Internal Revenue for your district on or before July 31,
1936, and the tax must be paid on or before that date. {

(FOR WASHINGTON USE ONLY)

‘To be stamped by collector, showing
district and date received

1. Name -
(Print name of corporation, joint-stock company, or association)

2. Address -

(‘The address must be that of the principal place of business. Give “street and number”,
3. Name of parent company, if any swe (District filed
4, Name of subsidiary, if any No. shares held ..........-. (Distriet filed

(If more than one, at icts where filed)

5. Nature of business in detail -
6. Incorporated or organized in State of .. - Month .... Day ou Year
7. Was a capital-stock tax return filed for the preceding taxable year ended June 30, 193: If filed under a different name,

state the name . (District filed -... ---)

8. | DECLARED VALUE OF ENTIRE CAPITAL STOCK ...

(The value declared mast be definiteand unqualified. A value must be declared in every case regardless of whether exemption from the tax is claimed. See instructions 1 and 2.)

9, EXEMPTIONS.—The Act provides for an exemption from the tax only on the grounds indicated below. Corporations claiming exemp-
tion must (1) declare a value for the capital stock under item 8, (2) check the appropriate block under item 9 showing the basis of
the claim, and (3) submit with the return a full statement of the evidence specified under the block checked.

oO Corporation exempt from income tax under section 101, Revenue Act of 1934. (1) State under which subsection of section 101
- . (2) Furnish information required by instruction 4.
CJ insurance company subject to tax under section 201, 204, or 207, Revenue Act of 1934. State which section -..

C1 Corporation not doing business. (1) Furnish information required by instruction 6, (2) Declare value of capital stock in item 8
above.

CoMPuration oF Tax i For Use ov Taxrayes For Use oF DEPARTMENT

|
10. Declared value (must be identical figure entered in item 8). Is. =

11, Tax at rate of $1.40 for each full $1,000 in item 8.

12. Penalty for delinquency in filing returns (see inst. 7).

13. Interest at 6 percent per annum beginning August 1, 1936...

14. Total tax, penalty, and interest. --|

15. State amounts of outstanding capital stock and surplus as of date of the close of income-tax taxable year used in declaring value for capital
stock. (If nonstock organization, so indicate and attach statement of net worth.)

NUMBER OF SHARES | Pan Gratzp) Vauce Per Snare Torars

Capital stock: Preferred._

Common.

Capital or paid-in surplus... XXXXXXXNKXX | XXXNXXXKXXX

Surplus reserves.. XXXXXXXXXxx | XXXXXNXKXXX

Surplus and undivided profits. xxxxxxxxxxx | xxxxxxxxxxx |.

We, the undersigned ...

tle)

and ... .-, of the corporation for which this

(Name of treasurer, assistant treasurer, or chief accounting officer) (Title)

return is made, being severally duly sworn, each for himself deposes and says that this return, including any accompanying statements,
has been examined by him and is, to the best of his knowledge and belief, a true and complete return, made in good faith, for the taxable

year stated, pursuant to the Revenue Act of 1935 and the Regulations issued thereunder.

day of -..

Sworn to and subscribed before me this -...

NOTARIAL ~ ‘Wame)~ : CORPORATE, . ~~ Wame) (Title)
SEAL SEAL

2-177


INSTRUCTIONS

Unless otherwise stated, the sections of the law mentioned
throughout these instructions refer to sections of the Revenue Act
of 1935. For further information regarding the tax, see Capital
Stock Tax Regulations 64 (1936 Edition).

1. Filing return—Every domestic corporation (including an
association, common-law trust, and any organization by whatever
name known which acts or does business in an organized capacity,
whether created under and pursuant to State law, agreement,
declaration of trust, or otherwise, the net income of which is dis-
tributable among the members on the basis of their proportionate
interests in the capital invested in the business or in the property
of the organization), which was in existence during the period
July 1, 1935, to June 30, 1936, or any fractional part thereof, must,
unless’ specifically exempted, file a capital stock tax return in
triplicate with the collector for the district in which is located
its principal place of business, The return must be complete in
every respect. So-called parent and subsidiary corporations must
each render a separate return and make a separate declaration
of value,

2. Declared value—(a) For purposes of the declared value,
the term “capital stock” is equivalent to the net worth of the
organization, regardless of whether it is a stock or nonstock cor-
poration, an association, or other entity taxable as a corporation.
“Capital stock”, therefore, includes: (A) the capital paid in by
the shareholders for capital stock, or as a capital surplus, or
otherwise, (B) surplus and undivided profits, and (C) all other
items, tangible and intangible, which eater into the net worth of
the otganization,

(b) The declared valuemust be definite and unqualified and must
be stated as an amount in United States dollars, or as “Zero” in
the event it is intended to make a declaration of no value. State-
ments such as “None”, “No value”, “Deficit”, and similar expres-
sions, or specific amounts stated as deficits, will be construed as
declarations of “Zero.” The value must be declared as of the
close of the income-tax taxable year ended subsequent to June 30,
1985, and on or prior to June 30, 1936, Thus, if the income-tax
return is made on a calendar year basis, the value must be de-
clared as of December 31, 1935, or if the income-tax return is
made on the basis of a fiscal year ended with any other month
from July 1935 to and including June 1936, the value must. be
@eclared as of the end of such fiscal year. In the case of a newly
organized corporation which does not have an income-tax taxable
year ended on or prior to June 30, 1936, the value must be declared
as of the date of organization,

(c) In making the declaration of value upon this return, a cor-
poration is not bound by any declaration of value made upon a
return for a prior year, and may exercise unrestricted judgment
and discretion in determining the current declared value. Ex-
treme care should be exercised in making the declared value,
since: (A) once declared the value cannot be changed, amended,
or corrected, (B) the value is the base for computing the capital
stock tax for the first taxable year and for computing the ad-
justed declared value of the capital stock for subsequent years,
and (C) the value is a prime factor in determining the excess-
profits tax liability under section 106 of the Act.

8. Corporations claiming exemption from the capital stock
tax.—Three classes of corporations (or organizations) are en-
titled to exemption from the capital stock tax: (1) corporations
enumerated in section 101 of the Revenue Act of 1934; (2) insur-
ance companies subject to income tax under section 201, 204, or
207 of the Revenue Act of 1934; and (3) corporations not carrying
on or doing business at any time during the period July 1, 1935,
to June 30, 1936.

4, Exemption as a corporation enumerated in section 101 of
the Revenue Act of 1934.—In every case, where not already estab-
lished under section 215 (c) (1) of the National Industrial Recov-
ery Act or under section 701 (c) (1) of the Revenue Act of 1934,
the exemption from the capital stock tax under section 105 (¢) (1)
as a corporation enumerated in section 101 of the Revenue Act of
1984 must be established by an official ruling. For that purpose
a capital stock tax return must be filed, complete in all respects,
including a definite and unqualified declaration of value for the
capital stock (see paragraphs 1 and 2) and specifying the sub-
section of section 101 under which exemption is claimed. The
return must be accompanied by evidence that the corporation is,
in fact, within the exempted class specified, As a part of such
evidence, the corporation must file with the return a statement
setting forth (1) the character of the organization, (2) the pur-
pose for which it was organized, (3) its actual activities, (4) the
sourees of its income and the disposition thereof, (5) whether
or not any of its income is credited to surplus or may inure to
the benefit of any private sharcholder or individual, and (6) in
general all facts relating to its operations which affect its right
to exemption. There must also be attached to the return a copy
of (1) the charter or articles of incorporation, (2) the by-laws of
the corporation, and (8) the latest financial statement showing the
assets, liabilities, receipts and disbursements of the organization.
Original documents should not be submitted as all evidence be-

U.8, OVERNMENT PRINTING OFFICE

Pace 8

comes a part of the records of the Bureau and, under the rules
of the Department, may not be returned, The corporation, if a
farmers’ co-operative association, should also submit Questionnaire
Form 1028 or, if a domestic building and loan association, Ques-
tionnaire Form 1027, and furnish all of the information required
therein. Copies of the proper form may be secured from the col-
lector, Since exemption from the capital stock tax is dependent
upon exemption from filing Federal income tax returns, reference
is made to Chapter X of Regulations 86 under the Revenue Act
of 1934 for more detailed information in regard to the evidence
required in such cases. If, however, the corporation has received
a letter from the Commissioner exempting it from filing Federal
income tax returns, submit a copy of such letter in lieu of the
foregoing evidence.

5. Exemption as an insurance company.—In every case, where
not previously established under section 215 (c) (2) of the National
Indusirial Recovery Act or section 701 (c) (2) of the Revenue Act
of 1934, the exemption from the capital stock tax under section
105 (c) (2) as an insurance company subject to the tax imposed
by section 201, 204, or 207 of the Revenue Act of 1934 must be
established by an official ruling. For that purpose a capital stock
tax return, complete in all respects including a definite and un-
qualified declaration of value for the capital stock (see paragraphs
1 and 2) must be filed. The return must state the section under
which the corporation is subject to income tax.

6. Exemption as not doing business—A corporation which
claims exemption on the ground that it was not carrying on or
doing business at any time during the year ended June 80, 1936,
must file a return, complete in all respects including a definite
and unqualified declaration of value for its capital stock (seo
paragraphs 1 and 2), even though exemption was allowed for the
previous tazable year. In every instance, the claim for exemption
must be supported by an affidavit of one of the responsible officers
having knowledge of the facts, in which the following information
must be set forth:

(a) A general statement of the operations prior to Jaly 1, 1935,

and a detailed statement of the operations for the period
July 1, 1985, to June 30, 1986. The latter statement must
be complete and show all transactions such es—purchases,
orders, commitments, sales, agreements, contracts (includ-
ing contracts of employment), acquisitions of property for
stock of the corporation, ete.

() A detailed statement of the receipts and disbursements for
the period July 1, 1935, to June 30, 1936, and of all
exchanges of assets, if any.

(c) A comparative detailed statement of the assets and labili-
tles as of June 30, 1935, and June 30, 1936, respectively,
with a full explanation of the changes reflected by the
comparative statement.

(d) Copies of the minutes of all meetings of the stockholders
and of the board of directors held during the year ended
June 30, 1936, and of all reports made by an executive
or other standing committee, or any governing body.

(e) If exemption is claimed as a new corporation which did not
engage in business activities prior to July 1, 1936, submit
the information required under (a), (b) and (d) for the
period between date of Incorporation and June 30, 1936,
and in addition furnish (1) an excerpt from the charter,
setting forth the corporate powers, and (2) a statement of
assets and liabilities as of June 30, 1936.

7, Penalties and interest.—Failure to file a return on or before
July 31, 1936 (or before the expiration of the period of extension)
eauses to accrue the following graduated scale of penalties: 5 per-
cent of the amount of the tax if the failure is for not more than
80 days, with an additional 5 percent for each additional 30 days,
or fraction thereof, during which failure continued. Such penal-
ties may not, however, exceed 25 percent in the aggregate. Re-
gardless of whether extension is granted, failure to pay the tax
on or before July 31, 1936, causes to accrue interest at the rate of
G percent per annum beginning August 1, 1936, until paid. Failure
to pay within 10 days after the issuance of notice and demand
based on assessment approved by the Commissioner, causes to
acerue a penalty of 5 percent of the total assessment and interest
at the rate of 6 percent per annum on the entire assessment from
10 days after issuance of notice and demand until date of pay-
ment. Severe penalties for willful failure to pay tax, keep records,
file returns, or for false or fraudulent returns, are imposed by law.

8, Signatures and verification—The return must be signed and
verified under oath or affirmation by at least one of the responsible
officers of the corporation, and preferably by the president, vice
president, or other executive officer, and by the treasurer, assist-
ant treasurer, or chief accounting officer. If a receiver, trustee in
bankruptcy, or assignee is operating the property or business of the
corporation and the corporation does not file the return, such offi-
cer shall execute the return for such corporation, attaching thereto
a dated copy of the court order appointing him and a statement
disclosing whether his custody has been continuous since that date.

a-4717




Pace6

LAW

SECTION 105, REVENUE ACT OF 1935

(a) For each year ending June 30, beginning with the year end-
ing June 80, 1936, there is hereby imposed upon every domestic cor-
poration with respect to carrying on or doing business for any part
of such year an excise tax of $1.40 for each $1,000 of the adjusted
declared value of its capital stock.

* * * * * * *
(¢) The taxes imposed by this section shall not apply—

(1) to any corporation enumerated in section 101 of the
Revenue Act of 1934, as amended ;

(2) to any insurance company subject to the tax imposed
by section 201, 204, or 207 of such Act, as amended.

(d) Every corporation liable for tax under this section shall
make a return under oath within one month after the close of the
year with respect to which such tax is imposed to the collector for
ithe district in which is located its principal place of business or,
if it has no principal place of business in the United States, then
to the collector at Baltimore, Maryland. Such return shall contain
such information and be made in such manner as the Commissioner
with the approval of the Secretary may by regulations prescribe.
The tax shall, without assessment by the Commissioner or notice
from the collector, be due and payable to the collector before the
expiration of the period for filing the return, If the tax is not paid
when due, there shall be added as part of the tax interest at the
rate of 6 per centum per annum from the time when the tax
became due until paid. All provisions of law (including penalties)
applicable in respect of the taxes imposed by section 600 of the
Revenue Act of 1926 shall, insofar as not inconsistent with this
section, be applicable in respect of the taxes imposed by this
section. The Commissioner may extend the time for making the
returns and paying the taxes imposed by this section, under such
rules and regulations as he may prescribe with the approval of
the Secretary, but no such extension shall be for more than sixty
days.

(e) Returns required to be filed for the purpose of the tax
imposed by this section shall be open to inspection in the same
manner, to the same extent, and subject to the same provisions
of law, including penalties, as returns made under Title 11 of
the Revenue Act of 1926.

(f) For the first year ending June 30 in respect of which a tax
is imposed by this section upon any corporation, the adjusted
declared value shall be the value, as declared by the corporation
in its first return under this section (which declaration of value
cannot be amended), as of the close of its last income-tax taxable
year ending at or prior to the close of the year for which the tax
is imposed by this section (or as of the date of organization in the
case of a corporation having no income-tax taxable year ending at
or prior to the close of the year for which the tax is imposed by
this section). For any subsequent year ending June 30, the
adjusted declared value in the case of a domestic corporation shall
be the original declared value plus (1) the cash and fair market
value of property paid in for stock or shares, (2) paid in surplus
and contributions to capital, (3) its net income, (4) the excess

of its income wholly exempt from the taxes imposed by Title I
of the Revenue Act of 1934, as amended, over the amount dis-
allowed as a deduction by section 24 (a) (5) of such title, and (5)
the amount of the dividend deduction allowable for income tax
purposes, and minus (A) the value of property distributed in
liquidation to shareholders, (B) distributions of earnings or profits,
and (C) the excess of the deductions allowable for income tax
purposes over its gross income; adjustment being made for each
income-tax taxable year included in the period from the date as of
which the original declared value was declared to the close of its
last income-tax taxable year ending at or prior to the close of the
year for which the tax is imposed by this section. The amount
of such adjustment for each such year shall be computed (on
the basis of a separate return) according to the income tax law
applicable to such year. * * *
(9) * * * * * *

(h) The capital stock tax imposed by section 701 of the Reve-
nue Act of 1934 shall not apply to any taxpayer with respect to
any year after the year ending June 30, 1935,

SECTION 106. EXCESS-PROFITS TAX

(a) There is hereby imposed upon the net income of every cor-
poration for each income-tax taxable year ending after the close
of the first year in respect of which it is taxable under section 105,
an excess-profits tax equal to the sum of the following:

6 per centum of such portion of its net income for such income-
tax taxable year as is in excess of 10 per centum and not in
excess of 15 per centum of the adjusted declared value;

12 per centum of such portion of its net income for such income-
tax taxable year as is in excess of 15 per centum of the adjusted
declared value.

(b) The adjusted declared value shall be determined as provided
in section 105 as of the close of the preceding income-tax taxable
year (or as of the date of organization if it had no preceding
income-tax taxable year). If the income-tax taxable year in re-
spect of which the tax under this section is imposed is a period of
less than 12 months, such adjusted declared value shall be reduced
to an amount which bears the same ratio thereto as the number
of months in the period bears to 12 months. For the purposes
of this section the net income shall be the same as the net income
for income tax purposes for the year in respect of which the tax
under this section is imposed, except that there shall be deducted
the amount of income tax imposed for such year by section 13
of the Revenue Act of 1934, as amended,

(c) All provisions of law (including penalties) applicable in
respect of the taxes imposed by Title I of the Revenue Act of
1934, as amended, shall, insofar as not inconsistent with this sec-
tion, be applicable in respect of the tax imposed by this section,
except that the provisions of section 131 of that title shall not be
applicable.

(d) The excess-profits tax imposed by section 702 of the Revenue
Act of 1984 shall not apply to any taxpayer with respect to any
income-tax taxable year ending after June 80, 1936.

a—arni7


ORIGINAL—Pacz 1

Form 707
TREASURY DEPARTMENT
INTEENAL REVENUE SERVICE
‘Revised 1936

1936 RETURN |

| CAPITAL-STOCK TAX
For Year Ending June 30, 1936

Assessment List, Form 23.4.

(Month) ”

DOMESTIC CORPORATIONS
(See. 105, Revenue Act of 1935, 74th Cong., Public, No. 407) r
This return must be filed, in triplicate, with the Collector |
of Internal Revenue for your district on or before July 31, |
|

"To be stamped by coll mowin:: | r
© be stamped by collector ae’? | 1956, and the tax must be paid on or before that date.

(FOR WASHINGTON USE ONE)

i, Name .....

(Print name of corporation, joint-stock company, or assoc!

2. Address _

tate”)

(District filed ...
(District filed -...

3. Name of parent company, if any

No. shares held _
iets where filed)

4, Name of subsidiary, if any.
(if more than one, attach list and state number of shares held by parent; also di

5. Nature of business in detail

6. Incorporated or organized in State of .. . Month eee = Day -.. Year - --
7. Was a capital-stock tax return filed for the preceding taxable year ended June 30, 1935? 7 If filed under a different name,
_ (District filed

state the name

8. | DECLARED VALUE OF ENTIRE CAPITAL STOCK -.

(The value declared must be definiteand unquelified, A valuemust he declared in every case regardle:

of whether exemption from the tax is claimed. See instructions 1 and 2.)

9. EXEMPTIONS.—The Act provides for an exemption from the tax only on the grounds indicated below. Corporations claiming exemp-
tion must (1) declare a value for the capital stock under item 8, (2) check the appropriate block under item 9 showing the basis of
the claim, and (3) cubmit with the return a full statement of the evidence specified under the block checked.

(7) Corporation exempt from income tax under section 101, Revenue Act of 1934. (1) State under which subsection of section 101
(2) Furnish information required by instruction 4.
{7 insurance company subject to tax under section 201, 204, or 207, Revenue Act of 1934. State which section

Cj Corporation not doing business. (1) Furnish information required by instruction 6. (2) Declare value of capital stock in item 8
above.

Computation oF Tax

For Use OF DEPARTMENT

10. Declared value (must be identical figure entered in item §)_.

11. Tax at rate of $1.40 for each full $1,000 in item 8_

12. Penalty for delinquency in filing returns (see inst. 7)...

13. Interest at 6 percent per annum beginning August 1, 1936....

14, Total tax, penalty, and interest:

15. State amounts of outstanding capital stock and surplus as of date of the close of income-tax taxable year used in declaring value for capital
stock. (If nonstoek organization, so indicate and attach statement of net worth.)

NuMnER OF SHARES Pak (STATED) VALVE Pak SHARE | Torars

Capital stock: Preferred.

Common..

NXNXXXXNXXNX

Capital or paid-in surplus.......

Surplus reserves. .....--2-------00----- nee XXXNNXNXN XX | ¥XXXXNKXNKY

cxusxexeenn | eEureneEuEY

Surplus and undivided profit

We, the undersigned - . .
president, or other executive officer) (Title)

of the corporation for which this

and -- (Name of treasurer, assistant treasurer, or chief accounting officer) (Tithe)
return is made, being severally duly sworn, each for himself deposes and says that this return, including any accompanying statements,
has been examined by him and is, to the best of his knowledge and belief, a true and complete return, made in good faith, for the taxable
year stated, pursuant to the Revenue Act of 1935 and the Regulations issued thereunder.

_- 198..

Sworn to and subscribed before me this .. day of -.

NOTARIAL Name} — CORPORATE
‘SEAL (eme) ‘SEAL

Cities

2-177


QUADRUPLICATE—Pacs 7

To BE RETAINED BY TAXPAYER

Form 707
TREASURY DEPARTMENT
INTERNAL REVENUE SERVICE

1936 RETURN |

(Gollection district}

Revised 1936
CAPITAL-STOCK TAX Assessment List, Form 234
For Year Ending June 30, 1936 a _ _
—_—_——_— (Month) (Year)
DOMESTIC CORPORATIONS _
(See. 105, Revenue Act of 1935, 74th Cong., Public, No. 407) gt
| |, This return must be filed, in trfplicate, with the Collector (G08 WASHINGTON UaE ONT)
a by oot of Internal Revenue for your district on’ or before July 31,
To be stamped by collector, showing | 1936, and the tax must be paid on or before that date.
1. Name ...
(Print name of corporation, joint-stock company, or association)
2. Address =
lace of business. Give “street and number ‘eity or town”, and “State”
3, Name of parent company, if any .. _ (District filed
4. Name of subsidiary, if any. No. shares held .. (District filed

(Uf more than one, att jstricts where filed)

5. Nature of business in detail .
6. Incorporated or organized in State of .... -- - Day Year
7. Was a capital-stock tax return filed for the preceding taxable year ended June 30, 1935? If filed under a different name,
state the name ._. (District filed _. _)
8. | DECLARED VALUE OF ENTIRE CAPITAL STOCK . $2 -
(The value declared must be definite and unqualified. A value must be declared in every case regardless of whether exemption from the tax is claimed. See instructions 1 and 2.)
9. EXEMPTIONS.—The Act provides for an exemption from the tax only on the grounds indicated below. Corporations claiming exemp-
tion must (1) declare a value for the capital stock under item 8, (2) check the appropriate block under item 9 showing the basis of
the claim, and (3) submit with the return a full statement of the evidence specified under the block checked.
C1 Corporation exempt from income tax under section 101, Revenue Act of 1934. (1) State under which subsection of section 101
(2) Furnish information required by instruction 4.
C Insurance company subject to tax under section 201, 204, or 207, Revenue Act of 1934. State which section . .
CO Corporation not doing business. (1) Furnish information required by instruction 6. (2) Declare value of capital stock in item 8
above.
Compuramion oF Tax For Use or Taxraver For Ust op DEPARIMENE
10. Declared value (must be identical figure entered in item 8)...
11. Tax at rate of $1.40 for each full $1,000 in item 8...

12.
13.
14.

Penalty for delinquency in filing returns (see inst. 7).

Interest at 6 percent per annum beginning August 1, 1936...

Total tax, penalty, and interest. Is...

15.

State amounts of outstanding capital stock and surplus as of date of the close of income-tax taxable year used in declaring value for capital
stock. (If nonstock organization, so indicate and attach statement of net worth.)

NUMBER O” SHARES Pa (StaTED) VALUE PER SHARE ‘Torats

Capital stock: Preferred.

Common.

Capital or paid-in surplus... XXXXXXKXXXX | XXXNXEXKEXE
Surplus reserve KXXXXXXXxxx | XXXXXEKKNKE
Surplus and undivided profits. xxxxxxxxxxx | xxxxxxxxxxx

and -..

We, the undersigned ...

., of the corporation for which this

(Name of treasurer, assistant treasurer, or chief accounting officer) (Title)

6
return is made, being severally duly sworn, each for himself deposes and says that this return, including any accompanying statements,
has been examined by him and is, to the best of his knowledge and belief, a true and complete return, made in good faith, for the taxable
year stated, pursuant to the Revenue Act of 1935 and the Regulations issued thereunder.

Sworn to and subscribed before me this -. .. day of -... --» 193.
NOTARIAL | ~~ (Wamey CORPORATE — ame”
SEAL ‘SEAL

2-aniz




DUPLICATE—Pace 3

Form 707
TREASURY DEPARTMENT.
INTERNAL REVENUE SERVICE,
‘Revised 1936

1936 RETURN oo

CAPITAL-STOCK TAX Assessment List, Form 238A
For Year Ending June 30, 1936

~~ (Monti Weary
DOMESTIC CORPORATIONS —_
(Geo. 105, Revenue Act of 1935, 74th Cong., Public, No. 407) (Pare) (Line)
This return must be filed, in triplicate, with the Collector (FOR WASIIINGTON USE ONLY)
of Internal Revenue for your district on or before July 31,
eo Re eter ano" 7= | 1936, and the tax must be paid on or before that date.

1, Name .... ee
(Print name of corporation, joint-stock company, or association)
2. Address -...
(The address must be that of the principal place of business. Give “street and number”, “city or town”, and “‘State”)
3. Name of parent company, if any a (District filed
4. Name of subsidiary, if any... ._ No. shares held (District filed
(if more than one, attach list Iso districts where filed)
5. Nature of business in detail . _
6. Incorporated or organized in State of Month ... Day Year -
7. Was a capital-stock tax return filed for the preceding taxable year ended June 30, 1935? .... If filed under a different name,

(District filed .. )

state the name _.

8. | DECLARED VALUE OF ENTIRE CAPITAL STOCK .. $. -

(The value doclared must be definite and unqualified. A value must be declared in every case regardless of whether exemption from the tax is claimed. See instructions 1 and 2.)

9 EXEMPTIONS.—The Act provides for an exemption from the tax only on the grounds indicated below. Corporations claiming exemp-
tion must (1) declare a value for the capital stock under item 8, (2) check the appropriate block under item 9 showing the basis of
the claim, and (3) submit with the return a full statement of the evidence specified under the block checked.

1 Corporation exempt from income tax under section 101, Revenue Act of 1934. (1) State under which subsection of section 101
- .- (2) Furnish information required by instruction 4.
C1 Insurance company subject to tax under section 201, 204, or 207, Revenue Act of 1984. State which section -

O Corporation not doing business. (1) Furnish information required by instruction 6. (2) Declare value of capital stock in item 8
above.

Computation or Tax For Use oF TAXPAYER | For Use oF DEPARTMENT

10. Declared value (must be identical figure entered in item 8)

11. Tax at rate of $1.40 for each full $1,000 in item 8.
12. Penalty for delinquency in filing returns (see inst. 7)-

13. Interest at 6 percent per annum beginning August 1, 1936...

14. Total tax, penalty, and interest.

15. State amounts of outstanding capital stock and surplus as of date of the close of income-tax taxable year used in declaring value for capital
stock. (If nonstock organization, so indicate and attach statement of net worth.)

‘NUMBER OF SHARES Pa (Statep) VaLvE Pen SHARE ‘Torars

Capital stock: Preferred.

Common.

XXXXXXXXXXX | XX¥XXXXXXXXX |

Capital or paid-in surplus.

XXXXXXxxxxx | XXXXXXXXXXX

Surplus reserves.

XXXXXxXxxxxx | xx¥XNXXX XXX X |

Surplus and undivided profits...

We, the undersigned ...

(Name of president, vice president, or other executive officer)

and ..

(Name of treasurer, assistant treasurer, or chief accounting officer) (Title)
return is made, being severally duly sworn, each for himself deposes and says that this return, including any accompanying statements,
has been examined by him and is, to the best of his knowledge and belief, a true and complete return, made in good faith, for the taxable
year stated, pursuant to the Revenue Act of 1935 and the Regulations issued thereunder.

Sworn to and subscribed before me this . day of -.-......

NOTARIAL jame) ~ CORPORATE ~ (Name) (itis)
‘SEAL ‘SEAL

“ficial capacity of officer administering oath)

aoa?