vom 2106 Employee Business Expenses

b f the T Calendar year 1969 or other taxable year 19 69
jepartment of the Treasury tant,
DegINNINg ..-.-ree-ecenneenneseneeenereeereent 969, and ending ..... nevesoresenveraneseneet LD ncevone
Internal Revenue Service ginning } if you use this form, attach it to Form 1040
Your name Social security number Occupation in which expenses were incurred
it
Employer's name Employer's address

PART I.—Employee Business Expenses which are Deductible in Computing Adjusted Gross Income on Line 15c, Form 1040
Z om

1, Travel expenses while away from home on buisiness (number of days
(@ Railroad, airplane, boat, etc, fates se ee ee ee ee ee ee
(b) Meals and lodging. 2 2 2 6 ew ew ew ee ee eee ew of.
(c) Automobile expenses (from Schedule A). « 2 © ee 2 ee ee ee ww
(a) Other travel expenses (specify)

Total travel expenses « ss 2 es ee ew ee we ew ee we

2. Local transportation expenses (not between home and worl
(@) Local bus, streetcar, andtaxl fares. 2 2 ew ee we we ee ee we eee
(b) Automobile expenses (from Schedule A) «2 2 ee ee ee ee ee ee
(¢) Other (specify)

Total local transportation expenses e » 2 «© ee ee ee ew eee
‘3. Outside salesman’s expenses:
(a) Automobile expenses (from Schedule A)e « « oe oe ee ee ee ew

(b) Other (specify)

Total outside salesman’s expenses « « 6 6 © © © ee eh eee ee ee ee
4. Employee expenses other than traveling, transportation, and outside salesman’s, expenses to the extent of the
reimbursement 2. 2 2 2 2 © ee ee ee we we we ew ww ee eee wee we

5. Total of lines 1,2,3,and4. ee ee eee ee ee ee eee ee es
6. Less: Amount of employer’s payments for above expenses (other than amounts included on Form W-2). + 2 +
7. Excess expenses (line 5 less line 6), Enter here and include In line 15b, Form 1040. . « wee eB |__.

8. Excess payments (line 6 less line 8). Enter here and include in Part Ill, Schedule E (Form i040)... ss ss I$
PART II.—Employee Business Expenses which are Deductible if You Itemize Deductions on Schedule A (Form 1040)

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

$.

2. Total 2 ew ee ee ee ew ew tw hw ee he

Hf you itemize your deductions, rather than elect to use the standard deduction, deduct expenses under Miscel. TD Yy
laneous Deductions,” Schedule A (Form 1040). Yy Yj

PART III.—Additional Information to be Furnished by Persons Claiming a Deduction for Educational Expenses

4. Name of educational institution or activity .
2. Address ... .
3. Were you required to undertake this education to meet the minimum educational “requirements to qualify in your employment, trade, of
business? os ee ee ee ee ee ee ww ee ew ee Ly Yes F] NO
4, Will the program of study undertaken qualify you for a new trade or business?» «6 se 6 ee ee ee we + DE Yes [No
5. If your answer to question 3 or 4 is “'No,” state the reason for obtaining the additional education and show the relationship between the
courses taken and your employment during the period

6. List the principal subjects studied at the educational institution or describe your educational activity

10—80010-1


Form 2106 (1969)

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 reimbursement. For a more
detailed explanation of these expenses, see the instructions
for Form 1040.

Business expenses paid (reimbursed) to you by your em-
ployer, must be included on page 1, part I, line 6, unless they
have been included on your Form W-—2. Any such amounts

Instructions

Page 2
shown on your Form W-2 should be reported as wages on line
11, Form 1040. Check with your employer if you are in doubt
as to whether or not the payment is included in your Form

For a detailed explanation of the rules relating to deductions
for travel, entertainment, and gift expenses, see Publication
463 which you can obtain from the District Director's office.
a Use Form 3903 for computation of the moving expense

eduction.

SCHEDULE A—Automobile Expenses

__SCHEDULE B—Computation of Automobile Basis

Note: Use either the Regular or the Optional method. If you
use the regular method, prepare a separate Schedule A for each
automobile,

A. Months auto held for business use «
B. Total mileage for months inA. «

months
miles
miles

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.)

C. Portion of B applicable to business .

(Include expenses only for the num
Regular Method: (f07'of" months indicated tn A abo

Old Car Traded-in:

1, Gasoline, oil, lubrication, etc. 2 2 « «
2. Repairs 2 2 2 1 2 2 we ee
3. Tires, supplies, ett. . 2 6 2 2 2 «
4. Other: (Specify) In-
clude interest, taxes,
insurance, etc. (Enter
parking fees and tolls
on line 18 below) .

5. Total . 2 2 ee we ww ww e FF,

6. Percentage of expense applicable to busi-

ness (line © above divided by line B above). . %

7. Business portion {line 5 multiplied by line 6) .

8. Depreciation from Schedule C, col. (h). . |g,

9, Line 8 divided by 12 months. . . . «

10. Multiply line9 byA, above. . . 2 » «©
11. Total (line 7 plus line 10) (see line 17)... |$

. The standard mileage rate applies to. tho
Optional Method: (or business miles of all automobiles..

The optional method cannot be used if depreciation has been claimed
in a prior year using a method other than straight line (or where addi-
tional first-year depreciation has been claimed).

12. Enter 15,000 miles or the mileage on line
C above, whichever issmaller. . 2. . «
Multiply line 12 by 10¢ and enter result
here . 2 se © ew ee ew oF,
14. Excess, if any, of line C over 15,000 miles .
15. Multiply line 14 by 7¢ and enter result here. |$.
16. Total (line 13 plusline 15). . - » » «I$

meee Miles

13.

wee Miles

Summary:

17. Enter the amount from line 11 or line 16,
whichever is used . 2 2 2 + 2 6 @
18. Add parking fees and tolls (if any) here .

1. (a) Total mileage accumulated. . 2 «
(b) Portion applicable to business. .
(c) Percentage applicable to business

(line (b) divided by line (a)) . 2 2 6

2. Purchase price or other basis. « « «

3. Less: Trade-in allowance. . 2 2 6
4. Difference (line 2 less line 3). 2 6 6 oe

5. Line 4 multiplied by percentage on line
ks
6. Less: Gain (or plus loss) on previous
tradein 2 2 2 we ew ee ew

7. Difference (line 5 less line 6). «

Basevecensonsnsecesene

8. Depreciation allowed or allowable. . .

9. Gain (line 8 less line 7) or Joss (line 7 fess
line 8) on business portion of car. . . |$

Present Car:

10. Purchase price or other basis. . «. «

11. Less: Estimated salvage value. (See in-
structions on Schedule E (Form 1040).). . «

12, Balance (line 10 less.jine 11). 2 6 6 «|S
13. Line 12 multiplied by percentage on line
6 of ScheduleA . 2 2 2 2 « oe

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

19. ‘Total. Enter here and in appropriate sec-
tions of Partl, pagel. . . . . . I$ 15. Basis for computing depreciation. ._ . I$
SCHEDULE C—Depreciation of Automobile
i Dat Basis (From line 15, | Age when | Depreciation allowed in| Method i jati
Mako and style of vehicle | gchatvea | "Schedule 6) Meare’ | eh or years "| MeMGbsreciation = lor ive Geo] rarsration
‘@ ) © @ @ © ® (ny

‘Fee AHY US. GOVERNIENT PRINTING OFFICE : 1969—O-953-954

16—80810-2