USS. Treasury Department
Internal Revenue Service (Attach this statement to your individual income tax return)

om 3903 Moving Expense Adjustment (966

(See instructions before completing this form)
Name and address as shown on page 1 of Form 1040 _

Did you receive an allowance or reimbursement from your employer for any expenses related to this move which were not
actual travel expenses for you and members of your household, or transportation expenses of your household goods and
personal effects? (See instruction 5.)° Oo Yes [] No

Dates Departed “Arrived.
of
me. 19... = 19.
(a) What is the distance from your former residence to your (b) What is the distance from your former residence to

new business location?

.... Miles your former business location? — -........... miles

NOTE: The moving expense deduction is not allowed unless distance (a) is 20 or more miles farther than distance (b). However, any reimburse-
ment must be included in income reported on your return (see instruction 1).

Name and address of employer at old location

Name and address of employer at new location

Address of old residence

Period of employment in new location (see instruction 2 7 ~ Total number of weeks

From .......

SCHEDULE OF EXPENSES

mn

Travel expenses:

(a) Railroad, airplane, boat, etc., fares 2. 2. 2. . 1. ww we eee Ge

(b) Meals and lodgingen route 2 2. ww ke freee eeeeeeee

(c) Automobile expenses (attach schedule)

Total travel'expenses © 6 ww ee ee GL

2 Transportation of household and personal property (see instruction 3)

3 Total moving expenses (addlinesland2) . . 2... ee ee eee ee

4 Reimbursement for this move (other than amounts included on Form W—2) (see instruction 6) . .

5 If employer's payments (line 4) are less than moving expenses (line 3), enter the excess expenses
here and on page 2, Part Ill, line2,Form1040 . 2. . . www we ke ee

6 If employer’s payments (line 4) are larger than moving expenses (line 3), enter the excess pay-
ments here and on page 2, Part Il, line 7, Form 1040 as ‘Excess moving reimbursement” .



INSTRUCTIONS

1. Employees, including new employees, can deduct mov-
ing expenses which include the cost of moving household
goods, personal property, the cost of traveling from the tax-
payer's former residence to his new residence, and the moving
of an employee’s personal automobile to his new place of
residence.

The deduction is allowed only if (a) the change in job
location would have added at least 20 miles to the distance
to work if the taxpayer had not moved to a new residence, or,
if (b) he had no former principal place of work, his new
place of work is at least 20 miles from his former residence.
In either case, during the 12-month period immediately fol-
lowing his arrival in the general location of his new principal
place of work, the taxpayer must be a full-time employee, in
such general location, during at least 39 weeks.

2. The term “moving expenses” includes only those ex-
penses which are reasonable under the circumstances of the
particular move. Generally, expenses are reasonable only if
they are paid or incurred for movement by the shortest and
most direct route available from the taxpayer's former resi-
dence to his new residence by the conventional mode or modes
of transportation actually used and in the shortest period of
time commonly required to travel the distance involved by
such mode.

3. Expenses of moving household goods and personal ef-
fects owned by the taxpayer or a member of his household
from the taxpayer's former residence to his new residence in-
cludes the actual cost of transportation or hauling, packing
and crating, in-transit storage, and insurance,

4. Expenses of traveling from the taxpayer's former resi-
dence to his new residence include the cost of transportation
and of meals and lodging en route (including the date of ar-
tival) of both the taxpayer and members of his household,
who have both the taxpayer's former residence and his new
residence as their principal place of abode. The deduction
for traveling expenses is allowable for only one trip made by
the taxpayer and members of his household; however, it is not
necessary that the taxpayer and all members of his household
travel together or at the same time. Members of the tax-
payer's household do not include, for example, an individual
such as a servant, governess, chauffeur, nurse, valet, or per-
sonal attendant.

If the taxpayer uses his own automobile as the mode of
transportation he can compute the transportation expenses in
either of two ways: (1) the actual out-of-pocket expenses, for
example, gasoline, oil, repairs, etc., or, (2) at a rate of 5 cents
per mile. If you claim out-of-pocket expenses you must keep
adequate records to verify the amount. If you use the op-
tional method of 5 cents per mile you need only verify the
mileage used in the computation. (Attach schedule.)

5. Moving expenses do not include such items as costs in-
curred in the purchase or sale of property, losses arising from
the sale of property, penalties for breaking leases, mortgage
penalties, expenses of refitting rugs or draperies, expenses of
connecting or disconnecting utilities, losses arising from the
disposal of memberships in clubs, tuition fees, and similar
items.

Travel expenses do not include, for example, living or other
expenses of the taxpayer and members of his household fol-
lowing their date of arrival at the new place of residence and
while they are waiting to enter the new residence or waiting
for their household goods to arrive; expenses in connection
with house or apartment hunting; living expenses preceding
the date of departure for the new place of residence; expenses
of trips for purposes of selling property; expenses of trips to
the former residence by the taxpayer pending the move by his
family to the new place of residence; or any allowance for
depreciation.

6. Include on line 4 of this form, all payments (allow-
ances or reimbursements) received from your employer for
expenses incurred in connection with your moving unless they
have been included on your Form W-2. Any such amounts
shown on your Form W/2 must be reported on line 5, page 1,
Form 1040. Check with your employer if you are in doubt
as to whether or not the payments are included in your
Form W-2.

7. The 39-week and 12-month period begin on the date
you artive in the general location of your new principal place
of work. Generally, this is the date on which you arrive in
the new area, immediately before you commence regular work
on the new job, regardless of when your family arrives or
when you move into the new residence. It is not necessary
that you actually have employment on the date you arrive at
the new location. It is not necessary that you work for one
employer for the 39 weeks, nor that the weeks be consecutive.
It is necessary only that you be employed on a full-time basis,
and within the general commuting area of such place of em-
ployment for at least 39 weeks during the 12-month period
following your arrival in the new area.

If, on or before the due date of your return, you have not
met the 39-week full-time employment test, but it appears that
by the end of the 12-month period that this requirement will
be met, you may claim these moving expenses on your 1966
return. However, you may claim this adjustment after you
meet the test in 1967 by filing either an amended 1966 return
or a claim for refund on Form 843 based upon the allowable
moving expenses. If you choose to claim this adjustment on
your 1966 return before meeting the 39-week test but then
fail to meet the test in 1967, you must either include the
amount as income on your 1967 return or file an amended
1966 return eliminating the adjustment claimed.

U.S. GOVERNMENT PRINTING OFFICE: 1966—O-220-100