OMB No. 1545-0172 Depreciation and Amortization

Form 4562 (Including Information on Listed Property)

Department of the Treasury

Internal Revenue Service

Attachment

© See separate instructions. Sequence No. 67

Name(s) shown on return Business or activity to which this form relates Identifying number

Election To Expense Certain Tangible Property (Section 179) (Note: If you have any “Listed Property,”

complete Part V before you complete Part I.)

1 Maximum dollar limitation. If an enterprise zone business, see page 1 of the instructions 1 $17,500

2

Total cost of section 179 property placed in service during the tax year. See page 2 of the

instructions

2

3 Threshold cost of section 179 property before reduction in limitation 3 $200,000

4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- 4

Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married

filing separately, see page 2 of the instructions

5

5

(a) Description of property (b) Cost (c) Elected cost

6

7 Listed property. Enter amount from line 27 7

8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 8

9 Tentative deduction. Enter the smaller of line 5 or line 8 9

10 Carryover of disallowed deduction from 1994. See page 2 of the instructions 10

11 Taxable income limitation. Enter the smaller of taxable income (not less than zero) or line 5 (see instructions) 11

12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 12

13 Carryover of disallowed deduction to 1996. Add lines 9 and 10, less line 12 © 13

Note: Do not use Part II or Part III below for listed property (automobiles, certain other vehicles, cellular telephones,

certain computers, or property used for entertainment, recreation, or amusement). Instead, use Part V for listed property.

MACRS Depreciation For Assets Placed in Service ONLY During Your 1995 Tax Year (Do Not Include

Listed Property.)

(b) Month and

year placed in

service

(c) Basis for depreciation

(business/investment use

only—see instructions)

(d) Recovery

period (a) Classification of property (e) Convention (f) Method (g) Depreciation deduction

Section B—General Depreciation System (GDS) (See page 2 of the instructions.)

15a 3-year property

b 5-year property

c 7-year property

d 10-year property

e 15-year property

f 20-year property

Residential rental 27.5 yrs. MM S/L

property

g

27.5 yrs. MM S/L

Nonresidential real MM S/L

property

h

MM S/L

Section C—Alternative Depreciation System (ADS) (See page 4 of the instructions.)

16a Class life S/L

b 12-year 12 yrs. S/L

c 40-year 40 yrs. MM S/L

Other Depreciation (Do Not Include Listed Property.) (See page 4 of the instructions.)

17 GDS and ADS deductions for assets placed in service in tax years beginning before 1995 17

18 Property subject to section 168(f)(1) election 18

19 ACRS and other depreciation 19

Summary (See page 4 of the instructions.)

20 Listed property. Enter amount from line 26 20

Total. Add deductions on line 12, lines 15 and 16 in column (g), and lines 17 through 20. Enter here

and on the appropriate lines of your return. Partnerships and S corporations—see instructions

21

21

22 For assets shown above and placed in service during the current year, enter

the portion of the basis attributable to section 263A costs 22

For Paperwork Reduction Act Notice, see page 1 of the separate instructions. Cat. No. 12906N Form 4562 (1995)

Part IV

Part I

Part II

Part III

© Attach this form to your return.

39 yrs.

(99)

Section A—General Asset Account Election

14 If you are making the election under section 168(i)(4) to group any assets placed in service during the tax year into one or more

general asset accounts, check this box. See page 2 of the instructions ©
Form 4562 (1995) Page 2

Listed Property—Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and

Property Used for Entertainment, Recreation, or Amusement

Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only

23a, 23b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.

Section A—Depreciation and Other Information (Caution: See page 5 of the instructions for limitations for automobiles.)

23a Do you have evidence to support the business/investment use claimed? Yes No 23b If “Yes,” is the evidence written? Yes No

(i)

Elected

section 179

cost

(h)

Depreciation

deduction

(g)

Method/

Convention

(f)

Recovery

period

(e)

Basis for depreciation

(business/investment

use only)

(d)

Cost or other

basis

(c)

Business/

investment

use

percentage

(b)

Date placed in

service

(a)

Type of property (list

vehicles first)

24 Property used more than 50% in a qualified business use (See page 5 of the instructions.):

%

%

%

25 Property used 50% or less in a qualified business use (See page 5 of the instructions.):

% S/L –

% S/L –

% S/L –

26 Add amounts in column (h). Enter the total here and on line 20, page 1 26

27 Add amounts in column (i). Enter the total here and on line 7, page 1 27

Section B—Information on Use of Vehicles

(f)

Vehicle 6

(e)

Vehicle 5

(d)

Vehicle 4

(c)

Vehicle 3

(b)

Vehicle 2

(a)

Vehicle 1 Total business/investment miles driven during

the year (DO NOT include commuting miles)

28

29 Total commuting miles driven during the year

Total other personal (noncommuting)

miles driven

30

Total miles driven during the year.

Add lines 28 through 30

31

Yes No Yes No Yes No Yes No Yes No Yes No

Was the vehicle available for personal

use during off-duty hours?

32

Was the vehicle used primarily by a

more than 5% owner or related person?

33

Is another vehicle available for personal

use?

34

Section C—Questions for Employers Who Provide Vehicles for Use by Their Employees

Yes No

Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,

by your employees?

35

Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees?

See page 6 of the instructions for vehicles used by corporate officers, directors, or 1% or more owners

36

37 Do you treat all use of vehicles by employees as personal use?

Do you provide more than five vehicles to your employees, obtain information from your employees about

the use of the vehicles, and retain the information received?

38

39 Do you meet the requirements concerning qualified automobile demonstration use? See page 6 of the instructions

Note: If your answer to 35, 36, 37, 38, or 39 is “Yes,” you need not complete Section B for the covered vehicles.

Amortization

(e)

Amortization

period or

percentage

(b)

Date amortization

begins

(c)

Amortizable

amount

(d)

Code

section

(f)

Amortization for

this year

(a)

Description of costs

40 Amortization of costs that begins during your 1995 tax year:

41 Amortization of costs that began before 1995 41

42 Total. Enter here and on “Other Deductions” or “Other Expenses” line of your return 42

Complete this section for vehicles used by a sole proprietor, partner, or other “more than 5% owner,” or related person.

If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.

Part VI

Part V

Printed on recycled paper

Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are

not more than 5% owners or related persons.