Form 990-T (1969)

Page 4

Schedule H—INTEREST ON INDEBTEDNESS (See Instruction 16)

Explanation

Amount

Total (enter here and on line 16, page2). - - + + ee ee

Schedule I—TAXES (See Instruction 17)

Explanation

Amount

Total (enter here and on line 17, page2). . . - . . - . ~

Schedule J—OTHER DEDUCTIONS (See Instruction 25)

Explanation

Amount

Total (enter here’and on line 25, page 2). - + + + se

TAX RATE SCHEDULE FOR TRUSTS TAXABLE AT INDIVIDUAL RATES

Mf the amount on fine 5, page 1 or
+ page 2, |

M the amount on tIne 5, page 1 of
on line

Enter on line 16, page 1:

Not over $500.......

Over $500 but not over $1,000.
Over $1,000 but not over $1,500
Over $1,500 but not over $2,000
Over $2,000 but not over $4,000

Over $4,000 but not over $6,000
Over $6,000 but not over $8,000
Over $8,000 but not over $10,000

14% of the amount,

$70, plus 15% of excess over $500.
$145, plus 16% of excess over $1,000.
$225, plus 17% of excess over $1,500.
$310, plus 19% of excess over $2,000.

$690, plus 22% of excess over $4,000.

$1,130, plus 25% of excess over $6,000.
$1,630, plus 28% of excess over $8,000.

on line 33, page 2,
Over $20,000 but nat over $22,000
Over $22,000 but not over $26,000
Over $26,000 but not over $32,000
Over $32,000 but not over $38,000
Over $38,000 but not over $44,000

Over $44,000 but not over $50,000
Over $50,000 but not over $60,000

Enter on line 16, page 1:

$6,070, plus 48% of excess over $20,000.

$7,030, plus 50% of excess over $22,000.

$9,030, plus 53% of excess over $26,000.

$12,210, plus 55% of excess over $32,000.
$15,510, plus 58% of excess over $38,000,

$18,990,
$22,590,

plus 60% of excess over $44,000.
plus 62% of excess over $50,000.

Over $60,000 but not over $70,000...
Over $70,000 but not over $80,000. .
Over $80,000 but not over $90,000

Over $10,000 but not over $12,000
Over $12,000 but not over $14,000

Over $14,000 but not over $16,000
Over $16,000 but not over $18,000
Over $18,000 but not over $20,000

$2,190, plus 32% of excess over $10,000.
$2,830, plus 36% of excess over $12,000.

$3,550, plus 39% of excess over $14,000.
$4,330, plus 42% ot excess over $16,000,
$5,170, plus 45% of excess over $18,000.

Over $90,000 but not over $100,000.
Over $100,000. .

$28,790,
$35,190,
$41,790,

$48,590,
$55,490,

plus 64% of excess over $60,000.
plus 66% of over $70,000.
plus 68% of excess over $80,000.

plus 69% of excess over $90,000.
plus 70% of excess over $100,000.

tess tr U.S. GOVERNMENT PRINTING OFFICE : 1969—O-337-037

(86-1663680)

16~80703-1


990 T Exempt Organization Business Income
en — Tax Return (uncer section 511 of the Internal Revenue Code) 1969
Internal Revenue Service» For the calendar year 1969 or other taxable year beginning

..., 1969, and ending ... 19.

Name of organization ‘Employer Identification Number

(In case of employees’ trust described in
section 401(a) and exempt under section
501(a), insert the trust's identification

Number and street

number.)
City or town, State, and ZIP code Nature of unrelated trade or business activity
Name and address of trust’s fiduciary Date of current exemption letter and

section under whic

you are

Complete page 1 if unrelated trade or business gross Income is $5,000 or less.
Complete the entire form (except lines 1 thru 5) if unrelated trade or business gross income is over $5,000.

Unrelated business taxable income computation—When unrelated trade or business gross income is $5,000 or less

1 Unrelated trade or business gross income (State sources .....
2 Less deductions. . . Se ee
3 Unrelated business taxable income before specific deduction .
4 Less specific deduction. 2 2... ee 1,000.00
5 Unrelated business taxable income. . 1... eee ee
TAX COMPUTATION
ORGANIZATIONS TAXABLE AS CORPORATIONS (See General Instruction aay
6 Unrelated business taxable income (line 5 above, or line 33, page 2) . . . see ee
7 Surtax exemption (line 6, $25,000, or amount apportioned under section 1561, whichever is is lesser) «
Bline 6 less line7. 6
9 (a) 22% of line 6.
(b) 26% of line 8 . .
(©) If multiple surtax exemption | is elected under section 1562, ¢ enter 6 percent of line 7 .
10 If alternative tax computation is made in separate statement, enter such tax here. . . 2. 2 1... we
11 Income tax (a) (line 9 or 10, whichever is lesser). . . . « oe wae
(b) Tax Surcharge—10% of line 11(2) (Fiscal Years, see instruction page 4)
12 Less: (a) Foreign tax credit (attach Form 1118)... .... 1...
(b) Investment credit (attach Form 3468)... ... .
13 Balance of income tax. - . - 2. ee woe

14 Tax from recomputing prior year investment credit (attach Form 4255) . So
15 Total income tax (line 13 plus line 14). Enter here and on line 23 .
TRUSTS TAXABLE AT INDIVIDUAL RATES See General instruction rom

16 Tax on line 5 above or line 33, page 2 (from Tax Rate Schedule, page 4)
17 If alternative tax computation is made in separate statement, enter such tax here .
18 Income tax (a) (line 16 or 17, whichever is lesser) . :

(b) Tax Surcharge—10% of line 18(a) (Fiscal Years, see instruction page 4).
19 Less: (a) Foreign tax credit (attach Form 1116). . . 1. 1 7 ee ee ee

(b) Investment credit (attach Form 3468) .

8

20 Balance of incometax. . . . 1... . .
21 Tax from recomputing prior year investment credit (attach Form n 4255) Se ee
22 Total income tax (line 20 plus line 21). Enter here and on line 23. . . . coe ee

TOTAL INCOME TAK

23 Total income tax (from line 15 or 22, whichever is applicable). . . . 2... 1 1 wee
24 Credits: (a) Credit from regulated investment companies (attach Form 2439) .
(b) Tax deposited—Form 7004 application for extension (attach copy) .
(c) Credit for U.S. tax on nonhighway gas and lube oil (attach Form 4136) .
25 TAX DUE (line 23 less line 24). See instruction D for Tax Deposit System . 6... ee.
26 OVERPAYMENT (line 24 less line 23)... . ee le

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is
true, correct, and complete. it prepared by a person other than taxpayer, his declaration 1s based on all information of which he has any knowledge,

CORPORATE
‘SEAL

individual or firm signature of preparer ‘Kddross Te—80703-1


Form 990-T (1969)

Page 2

UNRELATED BUSINESS TAXABLE INCOME COMPUTATION

UNRELATED TRADE OR BUSINESS GROSS INCOME
Gross sales (where inventories are Less: Returns and

an income-determining factor) allowances ..

2 Less: Cost of goods sold (Schedule A)... - . ee
3 Gross profit from sales... ee ee ee

4 Gross receipts (where inventories are not an income-determining factor).
5 Less: Cost of operations (Schedule B).

6 Gross profit where inventories are not an income-determining factor .

7 (@) Net capital gain from cutting timber (attach statement) .

(b) Net ordinary loss from cutting timber (attach statement) . See
(c) Ordinary gain from disposition of depreciable property under sections 1245 and 1250 (attach statement)

& Income (or loss) from partnerships (attach statement) .
9 Business lease rents (Schedule C). . . . - So ee
lo Total unrelated trade or business income—add lines 3, and 6 ‘through 9 9
DEDUCTIONS

(Except contributions, deductions must be directly connected with the unrelated business)
11 Compensation of officers or trustees (ScheduleE) © 6 ee ee
12 Salaries and wages (not deducted elsewhere) . La
13 Rents. 6 ee
14 Repairs (do not include capital expenditures). . . . + ~
15 Bad debts (Schedule F if reserve method is used) 2 2 se ee ee ee ee
16 Interest (Schedule HH)... ee ee ee
17 Taxes (Schedule I)... - . a

18 Contributions (not over 5% of line 29 adjusted per instructions—attach h schedule) .
19 Casualty or theft losses (attach schedule) .
20 Depreciation (Schedule G). . . . . + +s

21 Amortization (attach schedule). . -
22 Depletion 6 6
23 Advertising... - . rr

24 (a) Pension, profit: sharing, stock < bonus, s, annuity plans (attach Form 2950)
(b) Other employee benefit plans (see instructions)
25 Other deductions (Schedule J). . 2. 1 1 ee
26 Total deductions on lines 11 through 25. 6. ee es cee
27 Unrelated business taxable income before allowable exempt activity expenses (ine 1 10 less line 26) .
28 Less: Allowable exempt activity expenses (attach schedule. See instruction 28) . :
29 Unrelated business taxable income before net operating loss deduction (line 27 less line 28) .
30 Less: Net operating loss deduction (attach statement) .
3

32 Less: Specific deduction. . « eee
33 Unrelated business taxable income .

Unrelated business taxable income before specific deduction .

1,000.00

Schedule A—COST OF GOODS SOLD (See Instruction 2) Schedule B—COST OF OPERATIONS

Method of inventory valuation (specify)— ;
= 1 Salaries and wages .

2 Other costs (to be detailed):

1 Inventory at beginning of year .

2 Merchandise bought for manufacture or sale. | ef (@)

3 Salaries and wages . re 2 sescceeeeef (DY

4 Other costs (attach schedule). . . . . «| @)

5 Total 2 ee ee et @ ..

6 Less inventory at end of year. . - [—_$_$$____ (OC) ceeceeeeeeeeeeeeteeeeees

7 Cost of goods sold (enter here and on line 2,

page 2)... ee ee ee ee 3 Total (enter here and on line 5, page 2).

16807031


Form 990-T (1969) Page 3
Schedule C—BUSINESS LEASE RENTS (See Instruction 9)

1, Description of Leased Property 2, Total Rent Received | 3, Taxes and Other Expenses 4, Interest Cexpiain 1 eiete gy

Continuation of Schedule C

6. Amount of Unpaid | 7. Adjusted Basis of Leased | 8. Percentage which | 9. Gross Rental Income | 10. Allocable Deductions (Total of | 11. Net Rental Income (or loss) In-
Indeotedness Property (Attach Statement) | “‘Col.6i8 of Col.7 | (Column 2 % Column 8) | Coiumns 3,4, and-s % Column 8) | cludible (Column'9 less Colunig 10)

Total (enter here and on line 9, page 2)... . . ee ee

Schedule E—COMPENSATION OF OFFICERS

3. Time | Percentage of Organiza-
1. Name and Social Security Number of Officer 2. Title Devoted to |__ tion's Stock Owned
Business

6. Amount of 7. Expense Account
Compensation Allowances

Total compensation of officers (enter here and on line 11, page 2). . . .
Schedule F—BAD DEBTS—RESERVE METHOD (See Instruct

n_15)
Amount added to reserve ]

3. Sales on account | 4. Current year’s —| 6. Amount charged
provision 5, Recoveries against reserve

7. Reserve for bad debts

je notes and accounts re-
‘at end of year

1. Year| 2.08
+ Year| ccivable outstanding atend of year

1964.
1965.
1966
1967
1968.
1969.

Schedule G—DEPRECIATION (See Instruction 20)

Taxpayers using Revenue Procedures 62-21 and 65-13: Make no entry in column 2, enter the cost or other basis of assets held at end of year
in column 3, and enter the accumulated depreciation at end of year in column 4.

1, Group and guideline class 2, Date 3, Cost or 5 Maluod oT 1 6, Lite or | 7, Depreciation
or description of property acquired other basis in prior years depreciation rate for this year

1 Total additional first-year depreciation (do not include in items below)
Buildings 2... ee ee
Furniture and fixtures...
Transportation equipment . .
Machinery and other equipment .
Other (specify)

2Totad .
3 Less amount of depreciation claimed in Schedule C and elsewhere on return. «6 1 ee ee ee ee
4 Balance—Enter here and online 20, page2_. . ee ee ee ee ee ee

16—WOT0S-1