Form 990-T (1967) 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, page 2). +

Schedule J—OTHER DEDUCTIONS (See Instruc!

Explanation Amount

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

TAX RATE SCHEDULE FOR TRUSTS TAXABLE AT INDIVIDUAL RATES

. If the amount on line 31,
Enter on line 11, page 1: page 2, is: Enter on line 11, page 1:

14% of the amount on line 31, page 2, | Over $20,000 but not over $22,000-- $6,070, plus 48% of excess over $20,000.
Over $500 but not over $1,000-. $70, plus 15% of excess over $500. Over $22,000 but not over $26,000. $7,030, plus 50% of excess over $22,000.
Over $1,000 but not over $1,500... $145, plus 16% of excess over $1,000. Over $26,000 but not over $32,000-- $9,030, plus 53% of excess over $26,000.
Over $1,500 but not over $2,000_--- $225, plus 17% of excess over $1,500. Over $32,000 but not over $38,000-- $12,210, plus 55% of excess over $32,000.
Over $2,000 but not over $4,000_--. $310, plus 19% of excess over $2,000. Over $38,000 but not over $44,000... $15,510, plus 58% of excess over $38,000,

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

$690, plus 22% of excess over $4,000.
$1,130, plus 25% of excess over $6,000.
Over $8,000 but not over $10,000--- $1,630, plus 28% of excess over $8,000.
Over $10,000 but not over $12,000-. $2,190, plus 32% of excess over $10,000.
Over $12,000 but not over $14,000-- $2,830, plus 36% of excess over $12,000.

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

Over $44,000 but not over $50,000-- $18,990, plus 60% of excess over $44,000.
Over $50,000 but not over $60,000-- $22,590, plus 62% of excess over $50,000.
Over $60,000 but not over $70,000-- $28,790, plus 64% of excess over $60,000,
Over $70,000 but not over $80,000... $35,190, plus 66% of excess over $70,000.
Over $80,000 but not over $90,000-. $41,790, plus 68% of excess over $80,000.

$3,550, plus 39% of excess over $14,000.
$4,330, plus 42% of excess over $16,000. | Over $90,000 but not over $100,000. $48,590, plus 69% of excess over $90,000.
$5,170, plus 459% of excess over $18,000. | Over $100,000... $55,490, plus 70% of excess over $100,000.

(050—10-—-70895-1


Exempt Organization Business

roRM 990-T Income Tax Return | 1967

(Under Section 511 of the Internal Revenue Code)
U.S, Tresaury Department For the calendar year 1967 or other taxable year beginning

1 1967, and_ending - = +19.
_ PLEASE TYPE OR PRINT. Employer Identification Number

NAME OF ORGANIZATION (In case of employees’ trust described in

Section 401(a) and exempt under section

501(a), give the trust's identification
umber.)

ADDRESS (Number and street)

City or town, State, and ZIP code) Nature of unrelated trade or business activity

NAME OF TRUST'S FIDUCIARY Date of current exemption or determina-
tion letter and cade section under which
you are exempt.

ADDRESS OF TRUST'S FIDUCIARY

TAX COMPUTATION
ORGANIZATIONS TAXABLE AS CORPORATIONS S (See General Instruction aay)

1 Taxable income (line 31, page 2)

2 Surtax exemption (line 1, $25,000, or amount ‘apportioned u under section 1561, whichever is essen)

Blinellesstine2 2. 0 ee

4 (a) 22 percentoflinel 2... ee
(b) 26 percent of line3 . . . . oe

(©) If multiple surtax exemption is elected under section n 1562, enter 6 percent of line2 .

5 If alternative tax computation is made in separate statement, enter such tax here. . . .
6 Total income tax (line 4 or 5, whichever is lesser). - . - - - ee ee ee ee
7 Less: (a) Foreign tax credit (attach Form 1118). . . 2. 1 ee se ee ee

(b) Investment credit (attach Form 3468). . 2. 2 1 ee ee ee ee
8 Balance of income tax. 6 ww we ee ee ee ee
9 Tax from recomputing prior year investment credit (attach statement) . . . . . e+e

10 Total income tax (line 8 plus line 9. _ Enter here and on line 18)

TRUSTS TAXABLE AT INDIVIDUAL RATES (See General Instruction A(2))

11 Tax on line 31, page 2 (from Tax Rate Schedule, page4) ©... 1 ee ee ee ee ee ee fa
12 If alternative tax computation is made in separate statement, enter such taxhere. . . . e+
13 Total income tax (line 11 or 12, whicheveris lesser). 2 2. 6 ee ee ee ee

14 Less: (a) Foreign tax credit (attach Form 1116)... ee ee eee ee
(b) investment credit (attach Form 3468)... 1 1 ee ee ee

15 Balance of income tax... - a Se eee
16 Tax from recomputing prior year investment eredit attach statement) Se ee
17 Total income tax (line 15 plus line 16. Enterhere andonline18) . . . . - eee ee ee ee

TOTAL INCOME TAX

18 Total income tax (from line 10 or 17, whichever is applicable). - . . . ee ee ee
19 Credits: (a) Credit from regulated investment companies (attach Form 2439). . . .
(b) Tax deposited—Form 7004 application for extension (attach copy). . . «
(©) Credit for U.S. tax on nonhighway gas. and lub, oil (attach Form 4136) . .

20 If tax (line 18) is larger than credits (line 19), the balance is TAX DUE. _ See instr. D for Tax Deposit System ——3» | ———____
21 If tax (line 18) is less than credits (line 19). . . . . . Enterthe OVERPAYMENT here. , ———_____»

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. If prepared by a person other than taxpayer, his declaration is based on all information of
which he has any knowledge.

CORPORATE
SEAL

Date ~ individual or firm signature of preparer ‘Address

60—16—70835-1


Form 990-T (1967)

Page 2

UNRELATED BUSINESS TAXABLE INCOME COMPUTATION

UNRELATED TRADE OR BUSINESS GROSS INCOME
Less: Returns and

"

Gross sales (where inventories are

an income-determining factor) . allowances
2 Less: Cost of goods sold (Schedule A). ss ee eee :
3 Gross profit from sales. 6 ee
4 Gross receipts (where inventories are not an income-determining facto).
5 Less: Cost of operations (Schedule B). © 6. ee ee ee
6 Gross profit where inventories are not an income-determining factor... - . - 2 ee es
7 (a) Net capital gain from cutting timber (attach statement). 2 2. 2 2 2 ee ee
(b) Net ordinary loss from cutting timber (attach statement). . . . Lee
(©) Gain from disposition of depreciable property under sections 1245 and 1250 (attach statement)... .
B Income (or toss) from partnerships (attach statement). . 60. 2 6 ee ee ee
9 Business lease rents (Schedule CC). 6 6 0 ee ee
10 Total unrelated trade or business income on lines 3, and 6 to9, inclusive... 1. es ee
DEDUCTIONS
(Except contributions, deductions must be directly connected with the unrelated business)
11 Compensation of officers or trustees (ScheduleE) 2... 1 ee ee
12 Salaries and wages (not deducted elsewhere)... . ee ee ee Se ee
UB Rents
14 Repairs (do not include capital expenditures) . cee : tae
15 Bad debts (Schedule F if reserve method is used)... 2 +e . Le eee
16 Interest (Schedule H). ee
17 Taxes (Schedule I). ee
18 Contributions (attach schedule—see instructions for limitation). 2 5. ee ee ee
49 Casualty or theft losses (attach schedule). 2 eee ee ee
20 Depreciation (Schedule G). - ee ee
21 Amortization (attach schedule). 6. ee ee
22 Depletion (attach schedule)... ee ee
23 Advertising . ee
24 (a) Pension, profit-sharing, stock bonus, annuity plans (attach Form 2950). ss tt ee en ee
(b) Other empioyee benefit plans. 6 6 6 ee ee
25 Other deductions (Schedule J)... = ee
26 Total deductions on lines 11 to 25, inclusive . . Cee ee
27 Unrelated business taxable income before net operating loss deduction (line 10 less tine 26). . vv ee
28 Less: Net operating loss deduction (aitach statement). . 2 6. ee ee ee
29 Unrelated business taxable income before specific deduction. 2... 1. 1 ee ee .
30 Less: Specific deduction... ee ee 1,000.00
31 Unrelated business taxable income wee

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

Method of inventory valuation (specify) —

Schedule B—COST

1 Salaries and wages. . 2 2 2 we
1 Inventory at beginning of year . see 2 Other costs (to be detailed):
2 Merchandise bought for manufacture or sale . @ .

3 Salaries and wages... ee ee ee
4 Other costs (attach schedule). . . « © -
5 Total 2. ee ee ee @ -

6 Less inventory at end of year. . « .
7 Cost of goods sold (enter here and on ‘tine 2,
page 2) .

(b) «

(e) .

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

259 —16—70835-1


Form 990-T (1967)

Schedule C—BUSINESS LEASE RENTS (See Instruction 9)

5. Depreciation
in in Schedule G)

fon of Leased Property 2, Total Rent Received 3, Taxes and Other Expenses 4, Interest

Continuation of Schedule C

9. Gross Rental Income

6. Amount of Unpaid
(Column 2 X Column 8)

7. Adjusted Basis of Leased | 8. Percentage which
Indebtedness

10. Allocable Deductions (Total of
Property (Attach Statement) | Col. 6 is of Col. 7

11. Net Rental Income (or loss) In-
Columns 3, 4, and 5 X Column 8)

cludible (Column 9 tess Column 10)

Total (enter here and on line 9, page 2). . ee ee ee
Schedule E—COMPENSATION OF OFFICERS
3. Time Percentage of Organiza-
1. Name, Address, and Social Security Number of Officer 2.Title Devoted to |__tion’s Stock Owned foment 7, Expense Account
Business |. Common | 5. Preferred

ee eR
Pe

Total compensation of officers (enter here and on line 11, page 2). . . . . « . sw
Schedule F—BAD DEBTS—RESERVE METHOD (See Instruction 15)

2. Trade notes and accounts re-
1, Yoar | ceivable outstanding at end of year

added to reserve

7. Reserve for bad debts

3. Sales on account

5. Recoveries

6. Amount charged
against reserve

‘at end of year

1962.
1963.
1964.
1965.
1966.
1967.

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
‘or description of property

2. Date
acquired

3, Cost or

Depreciation
other basis ed

allowed or allowable
in prior years

5. Method of
‘computing
depreciation

7, Depreciation
‘for this year

1 Total additional first-year depreciation (do not include in items below)

Buildings 2 2 2 ee ee
Furniture and fixtures . .
Transportation equipment woe
Machinery and other equipment .
Other (specify) ..

2Totals se ee ew ee

3 Less amount of depret in claimed

in Schedule C and elsewhere on return. . - « + +

4 Balance—Enter here and on line 20, page2 - + ss ss

"059—16-—70835-1