’ r aa ‘ rages oe a we gy ee *, Form 1040 1976) . ‘ . , ee fe ‘ Page 2 co “7 -Income other than Wages, Dividends and Interest 4 29 Business income or (loss) (attach Schedule C) . . . , oe ee [29 . 30a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) soe . | 30a | ‘ b 50% of capital gain distributions (not reported on Schedule D—-see page 10 of Instructions). _30b- _ _ 31 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) . . . 31 __. . 32a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) . 32a _. b Fuily taxable pensions and annuities (not reported on Schedule E—see page 10 of Instructions) _32b- _ '33 Farm income or (loss) (attach Schedule F) re a | __ . _does not apply if refund. is for year in which you took. the : i } " .34 State income tax refunds \ standard deduction—others see page 10° of instructions ne ) 124 | ; 35 Alimony received . . - - Co ee | 35 | ji 36 Other (state nature and source—-see e page 1 of Instructions) >. ! 37 Total (add lines 29 through 36). Enter here and on tin el2.. | i iene) Adjustments to Income 38 Moving expense (attach Form 3903) ___ 39 Employee business expense (attach Form 2106) coe we ee _ 40a Payments to an individual retirement arrangement from attached Form 5329, Part HW. 2... 40a __ b Payments to a Keogh (H.R. 10) retirement plan . . . : woe ee | 40D __ 41 Forfeited interest penalty for premature withdrawal (see page 12 of ‘instructions) an . | AL __ 42 _ _rotal I (add lines 38 through 41). Enter here and on line 14 , oe ee eee Bm | 42 Tax Computation . 43 ” Adjusted. gross income (from line 15c). If you have unearned income and can be claimed as a . dependent on your parent’s return, check here > [ja and see page 9 of Instructions 44a If you itemize deductions, check here Cl and enter. total from Schedule A, line 40, and attach Schedule A a b Standard deduction—If you do not itemize deductions, check here > ["], and: : 7 If you checked 2 or 5, enter the greater of $2, 100 OR 16% of line 43—but not more than $2, 800. ‘the box on { 1 or 4, enter the greater of $1, 700 OR 16% of line 43—but not more than $2, 400 line 3, enter the greater of $1,050 OR 16% of line 43—-but not more than $1,400° . ” 45. Subtract line 44 from line 43 and enter difference (but not less than zero) ‘46° Multiply total number of exemptions claimed on line 6f by $750 : ‘ 47 Taxable income. Subtract line 46 from line 45 and enter difference (but not less than zero) . ,° If line 47 is $20,000 or less and you did not average your income on Schedule. G, or figure your tax on Form 2555, Exemption of Income Earned Abroad, find? ¢ your tax in Tax Table. Enter tax on line 16 and check appropriate box. ° If line 47 is more than $20,000, figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, Z, or if applicable, the alternative tax from Schedule UD, income averaging from Schedule G, tax from Form 2555 or maximum tax from Form 4726. Enter tax on line 16 and check appropriate box. ela F*] Credits Credit for the elderly (attach SchedulesR&RP) - - - - poe ee ee tt ts 48 an 3 Credit for child care expenses (attach Form 2441) ; _49 _ _ 50 Investment credit (attach Form 3468) . _50 |. _ 51 Foreign tax credit (attach Form 1116) bones . i _ 52 Contributions to candidates for public office credit (see page 212 of Instructions) . 52 __ _ 53 Work Incentive (WIN) Credit (attach Form 4874) _53 _ }_Total (add lines 48 through 53). Enter here and on line 19 a = 2 f= Other Taxes 55 Tax from recomputing prior-year investment credit (attach Form 4255) . 2 | BB {| + 56 Minimum tax. - Check here > [, and attach Form 4625. 6 6 we ee ee we | 5G : 57. Tax on premature distributions from attached Form 5329, Part 5 a OY A - _ 58 Self- employment tax (attach Schedule SE) . . - .- Se oe ee 58 __ 2&0. — 59 Social: security tax on tip income not reported to employer (attach Form 4137) woe ee ee “59 : ~~ 60 Uncollected employee social security tax on tips (from Forms W-2) 2. we eee te “60° oot ; ~~ 61 Excess contribution tax from attached Form 5329, Part IV. . Ck ee ee ee “61_ ” tf 62 Total (add lines 55 through 61). Enter here and on fine 21 woe eee ee eB 1 G2 Bo | Other Payments = “ 2 _ _Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers—see page 13 of ‘lnstructions) . |_£3_ {| 64 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) . . . 64 _ | ' 65 Credit from a Regulated Investment Company (attach Form 2439)... - se we ee _65* _ | -66 Total (add lines 63 through 65). Enter here andonline23e_. . - sss | | i t
Sa Lr patie deg ragtime ebneearieee per nseermaneernt tere oe SEE T rremaiame Tome me emer ee _ 7" Scthed: Lies AaB—Iitemized E Deductions AND Jor 1040) = Dividend and Interest Income. «| Department of the ice ead Attach to Form 1040. > See Instructions for Schedules A and B (Form 1040). *. Internal Revenue Service * Name(s) as shown on Form 1040 Deductions (Schedule B on back) Contributions (See page 15 of Instructions for examples.) - Schedule A—lItemized Medical and Dental Expenses (not compensated by insurance , ‘or otherwise) (See page 13 of Instructions.) 1 One half (but not more than $150) of in- surance premiums for medical care. (Be _ Sure to include in fine 10 below) _2 Medicine and drugs 21 a Cash contributions for which you have receipts, cancelled checks or other written evidence . . . ee —_— b Other cash contributions. List donees : and amounts. & ___.._...0.------22--------- _ »,, 3 Enter 1% of line 15c, Form’ 1040 . — - 4 Subtract line 3 from line 2. Enter differ; | 00 fur neemmmmmmennnaes — ence (if less than zero, enter zero) pac ecengeeecensee ce receecceetc eters opens pasercs tee snes tere — 5 Enter balance of insurance premiums for arn, Ais Fae Se a a rs . © > medical care not entered on line 1 a ite wad ae Sad Se Cs a - * .. 6 Enter other medical and dental expenses! | J pvvrvvorver= tpeceeese EN eed ee a Doctors, dentists, nurses, etc. 22 Other than cash (see page 15 of ir instruc- b Hospitals. . . - ok ae tions for-required statement) - 4. °° © Other (itemize—include hearing aids, 23 Carryover from prior years . ———— dentures, eyeglasses, transportation, 24 Total contributions (add lines 21a through / 2 etc.) > : 23). Enter here and on line 37... > £3). Enter ere and on Nine Sf ! Casualty or Theft Loss(es) (See page 15 of Instructions.) | Note: /f you had more than one loss, omit lines 25 through 28 and see page 15 of Instructions for guidance. 25 Loss before insurance reimbursement . 26 Insurance reimbursement . i eeeeoeencee venececeqeceeeeeeseeeeeeeee hee & 27 Subtract line 26 from line 25. Enter dif- ; 0 ccnangeegnaespenteserenceecessneesens Per ference (if less than zero, enter zero) __ ae 7 Total (add lines 4 through 6c) . 2. V— 28 Enter $100 or amount on line 27, which- 8 Enter 3% of line 15c, Form 1040. ever is smaller . . . oe ee . “4 Subtract line 8 from line 7 (if less than 29 Casualty or theft loss (subtract line 28 D ). i from line 27). Enter here and online 38. & “3. zero, enter zero) - 10 Total (add lines 1 and 9). Enter here and Miscellaneous Deductions (See page 15 of Instructions.) online 34... . 0.72. - . 30 Alimony paid : ‘ _ aos Taxes (See page ‘13 of. instructions.) 31 Union dues . oo —_ ‘* "41 State and local income. . - - - 32 Other (itemize) P| | 12 Real estate. . . .- . see nn nn en >," 13 State and local gasoline (see gas tax tables) oe penne eer c nee eeee ence gece cee cennaneen ence eee ee gee ee ee '. *> 14 General sales (see sales tax tables) nn nn TG fg 15 Personal property, . «© «© = + nnn EB ” 16 Other (itemize) > 33 Total (add lines 30 through 32). Enter 17 Total (add lines 11 through 16). Enter BS | ‘ hereandontline35 . . 2 > here and on line 39 . eb Z 7 Interest Expense (See page 14 of Instructions.) Summary of Itemized Deductions 48 Home mortgage - - - + + «+ = + 19 Other (itemize) D> .......-...-..-:sseccesesceeeeeeeeees 34 Total medical and dental—line 10 . 35 Total taxes—line 17. 36 Total interest—line 20 ste : “: c C: 39 Total miscellaneous—tine 33 . do ceeeeecuetacadnntabaceseenenepesoonsuanescneneceseeneeeene: ——__-__ 40 Total deductions (add lines 34 through ' 20 Total (add lines 18 ‘and 19). Enter here 39). Enter here and on Form 1040, line and on line 36 - - see _.& 44... .. . 22. 2, ~ 218-054—1 + BER 54923. Doold:32245535 Page 7.
Schedules A&B (Form 1040) 1976 Schedule B—-Dividend and Interest Income , Page 2 . Cee  EEEEEEESEnET Warmest eed Name(s) as shown on Form 1040 (Do not_enter name and social security pumber if shown on other side) ecuri : aaa? JFK Act 6 } Interest Income terest is $400 or less, do not complete this part. But unt of interest received on Form 1040, fine 11. : ERAT =} Dividend Income . ‘Pat ‘+ Note: If gross dividends (including capital gain distributions) ahd Note ’ other distributions on stock are $400 or Jess, do not complete this | ent. part. But enter gross dividends less the sum of capital gain dls- 71 includes earnings from savings and loan associations, tributions and non-taxable distributions, if any, on Form 1040, |}. mitijal savings banks, cooperative banks, and credit unions line 10a (see note below). : » ‘ad w&ll as interest on bank deposits, bonds, tax refunds, etc. ‘1 Gross dividends (including capital gain distributions) and other Interest also includes original issue discount on bonds and distributions on stock. (List payers and amounts—write (H), other evidences of indebtedness (see page 16 of Instructions). (W), (J), for'stock held by husband, wife, or jointly) ; (List payers and amounts) nn | | re a | | eT ener | | | RS | Me |. | |] | ee re, es i, a a’ ive) 2 Total of line 1 a es 3 Capital gain distributions (see page 16 of Yj ce a ca Instructions. Enter here and on Schedule D, 7 | | line 7). See note below |_| Yy a Se 4 Nontaxable distribu- , Ys, : iz tions (see page 16 of ——— - : - - — ' Instructions). . . .«Lo dE a " § Total (add lines 3 and 4)... . . (2 6 Dividends before exclusion (subtract line 5 from line 2). Enter here and on Form 8 Total interest income. Enter here and on 1040,line10a_. . . . . - es Form 1040, line 11 . . . . . Note: !f you received capital gain distributions and do not need Schedule D to report any other gains or losses or to compute ~ the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040, line 30b. ; Dos Fim |. Foreign Accounts and Foreign Trusts 5 1 Did you, at any time during the taxable year, have any interest in or signature or other authority over a bank, securities, or other financial account in a foreign country (except in a U.S. military banking facility operated by a a U.S. financial institution)?» 6. 2 ee C] Yes\j&..No _ If-“Yes,’ attach Form 4683 (For definitions, see Form 4683.) ee ‘ “#." 2 Were you the.grantor of, or transferor to, a foreign trust during any taxable year, which foreign trust was in , . being during the current taxable year, whether or not you have any beneficial interest in such trust?. . . . . [] Yes <2No . f-“Yes,” attach Form 4683 (For definitions, see Form 4683.) +x U.S. GOVERNMENT PRINTING OFFICE: 1976-—-O-218-054 218-054-1 -Dogid: 32245535 Page 8p rcpt
“SCHEDULE C. Profi & or (Loss) From Business or Profession ~S" wes. (Form'1040 ; (Sole Proprietorship) aie Corn Oe » os Partnerships, Joint Ventures, etc., Must File Form 1065. — Internal Revenue Service & Attach to Form 1040. © See Instructions for Schedule C (Form 1040). ~ Name of proprietor ' b . JFK Act 6 A Principal business activity (see Schedule C Instry fons) &.. <2 BMIGE. ; product D..... Sn ee ko Bite B Business name b...... WOCPkeey I3tSTH.O. ee eeeeee Co FEE. SHO Cc Employer identification number Pas. ro D Business address (number and street » AGED... Yee Tyee Em cesotsseeeeneatoeaceeses “ ‘ City, State and ZIP code e......... ENCha accel Tee G3! GL occ c cece cc eeececennene ceeeegee cee cuseesseseceeusseeeenereted fee woe E Indicate method of accounting: (1) [7] Cash (2) Accrual (3) [-] Other B.............-.--- eseseeesessooseneenseseuseeaneegnetsenceereneeeey ceseeee ‘ F Were you required to file Form W-3 or Form 1096 for 1978 (see Schedule C Instructions)? . uo. . If “Yes,” where filed B>.............peeceeeeeeeeeeceeeeeeceeeescceeececuapesssceeeccaseeensaeeecsceeseapeeeersaaeres veeeeegeeceees pceeseeeeseaeeneeesesesecaeenepesgeneeetaaeaes 'G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in 1976? : toe eo. a ' H Method of inventory valuation Be... pe eee ee cee cece cee gene cnet gen te ce rene reneeseepecersseeeeeeeneeneacces Was there any substantial change in ome ; the manner of determining quantities, costs, or valuations between the opening and. closing inventories? (If “Yes,” attach explanation) . . 1: 1 Gross receipts or sales $,...........----.--.----- Less: returns and allowances $..............2--------- Balance > | 2 | Vf. EB 2 Less:.Cost of goods sold and/or operations (Schedule C-1, line 8) . . . . «. « . 2 | —_— . 8 3 Gross profit. . . . eS 2 an en " £1 4 Other income (attach schedule) . a ae rs __ 5 Total income (add lines 3 and 4) ee er | 6 Depreciation (explain in Schedule 3) ye oe ee oe ee ek: ae Een Dee a 7. Taxes on business and business property (explain in- Schedule C2) es OD 8 Rent on business property 2, ee ee ee Beep eee 9 Repairs (explain inScheduleC-2) . . . . “ ; . | oc eeegeceestseseeseseees veseee — 10 Salaries and wages not included on line 3, Schedule C-1 (exclude 2 any paid t: to yourself) . a ee ' ll insurance. . . a a , 12 Legal and professional fees 13 Commissions . rn 14 Amortization (attach statement) . . . ee en 15 (a).Pension and profit-sharing plans (see Schedule Cc Instructions) W5(a) pp (b) Employee benefit programs (see Schedule C Instructions) ©. . . - ee es oe (:) 2 16. Interest on business indebtedness , . a 3 17 Bad debts arising from sales or services 2 | 18 Depletion . 3 19 Other business expenses 5 (specify): e  .) es acca, Seno (D) 2 eee ee ee eee eee See ce eee ee | eee eee eect teemeneee [pee eneee (0) ene ce ee ce ee ene ee ne ee ee cee eee ee [eee neem ceeencnee [eeeeenee ‘ (A) ne eee ee ge ee ere eee ce tence [epen eee cee e nec ec een acre eeeneeee  ) aaa f) one nee ec ee ce ene ne pe eee | cence eee teen ene nent eee f eee eee (Q) -------------- = enn nee eee en nnn nen enn cence erences | ore rec ce ene coro enececee [eeeeees (Ih) nnn nn enn eee cence ten be enenes | pene ena ee cece en cenenee [eeeee es , ) “pecnne nescence ccenccensenece eeee| cee ce ne cece eeeetegereceee Leeeeeee: ee i (k). Total other: business expenses (add lines 19{a) through 190) - »- Gwe; : : a : 20 Total deductions (add lines 6 through 19(k)) ._. . yor ; : 21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on Form 1040, line 29. ALSO : | enter on. Schedule SE, line 5(a). . . . . 35 SCHEDULE C—1.—Cost of Goods Sold and/or Operations (See ‘Schedule C instructions for Line 2) ; 1 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) . . . wo Sk en nn ms 2 Purchases $ beweeecececeesenseeeeeeges Less: cost of items withdrawn for personal use $....................-..... Balance el EEE EE 3 Cost of labor (do not include salary paid to yourself) . . 20. ee ee ee ee eS en Nene A Materials.and supplies 2. 6 6 6 ee ee ee ee ee A .. . § Other costs (attachschedule) 2 2 6 ee ee ee ee ee ee LBL en ‘ 6 Total of lines lthrough5 © 2 1 ee 6 ee ee 6. en _ 7 Less: Inventory atendofyear . . . woe ee ee eZ i 8 Cost of goods sold and/or operations. Enter here and on line 2 above - os + se ee el 8 . Did you claim a deduction for expenses of an office in your home?. . . / ee ew we ee ee el he 6 Yes . [No 218-055~1
,NW 55923 DocId:32245535. Page 10 ee _ - 7 Schedule © (Form 1040) 1976 Page 2 SCHEDULE C-2.—Explanation of Lines 7 and 9 an . ut Line No. v Explanation Amount Line No. Explanation . Amount SCHEDULE C-3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, use Form 4562. d. Depreciation e. Method of . rae b. Date c. Cost or 1 : in f. Life g. Depreciation for a. Description of property acquired | ~ — other basis 3 He enable | depreciation or rate this year SO aE 1 Total additional first-year depreciation (do riot include in items below) ———$<$—$ $$ ___ $< 6 2 Other depreciation: Boas et DO, 4 Less amount of depreciation claimed in Schedule C-1, page 1 5 Balance—Enter here and on page 1, line 6 SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4) Enter information with regard to yourself and your five Name EXPerise account Vi highest paid-employees. In determining the five highest | Owner . . . . se ee a Wildl Lille paid employees, expense account allowances must be | 2 7 7 nnn srnnnrenennnnnersneetene i added to their salaries and wages. However, the informa- 1 tion need not be submitted for any employee for whom | 2 ; . the combined amount is less-than $25,000, or for yours | 7 rn nn a self if your expense account allowance plus line 21, page 3: : 1, is less than $25,000. . 4 Did you claim a deduction for expenses connected with: 5 . . (1) Entertainment facility (boat, resort, ranch, etc)? .. 1 Yes 1) No (3) Employees’ families at conventions or meetings? . Ol Yes (] No - (2) Living accommodations (except employees on business)? ( Yes (] No (4) Employee or family vacations not reported on Form W-2? -[] Yes [] No. st US. GOVERNMENT PRINTING OFFICE : 1976--0-218-085 . 218-055-2 :- 4
‘;.' Department of the Treasury i ‘Internal Revenue service m Attach to Form 1040. © See Instructions for Schedule D (Form 1040). “: Name(s) as shown on Form 1040 ed SCHEDULE D | Capital Gains amd] LOSS@S (Examples of property to be reported on this '. (Form 1040) ae kt are gains and losses on stocks, bonds, and similar investments, and gains (but not 1978 losses) on personal assets such as a home or jewelry.) Secial security number JEK Act 6 Ruby e. Cost ‘or r other basis, b. Date c. Date Kind of property and description . ired id d, Gross sales pri as adjusted (seo” f. Gain or (loss) team, 100 shares of *'2"! Co.) (Moss day, yt.) (Mo., “tay, yt.) woe Ses Pa evens of aale (d less e) 2 _~—sCEnter your share of net short-term gain or (loss) from partnerships and fiduciaries . 2... - _2. : 3 Enter net gain or (loss), combine lines land2 ... 2. 2 te ee soe ee _3_ : 4 — Short-term capital loss carryover attributable to years begining after 1969 (see instruction ) . {4 ) 5 Net short- term gain or (loss), combine lines 3 ‘and 4 ee 5 14 45 - 16, : 4 Capital gain distributions . . . . . ; Loe res oe ae Enter gain, if applicable, from Form 4797, line A(ay(1) (see Instruction A) toe ee ee (LB Enter your share of net long-term gain or (loss) from partnerships and fiduciaries . . . . . |_ 9 Enter your share of net long-term gain from small business corporations (Subchapter S).. . . _10_ ” Net gain or (loss), combine lines 6 through 10... » oe ge LE ‘b Enter here and enter as a (loss) ¢ on Form 1040, line ‘30a, the smallest of: Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction I. |32 a a long-term gain or (loss), combine lines:1l.and 12)... .. .1 13; ( Ys T=] Summary of Parts | and Il (if You Have Capital Loss Carryovers From Years Beginning Before Complete This Part. See Form 4798, Parts Ill, IV and V.) \ Combine lines 5 and 13, and enter the net gain or (loss) here. . ee ee 8 ee es 14 If line 14 shows a gain— ; a Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part IV for "computation of alternative tax). Enter zero if there is a loss ornoentryonline13. . . . . {15a ’ b Subtract line 15a from line 14. Enter here and on Form 1040, line30a . . . . . . . « [_15b If line 14 shows a loss—-~ i 7 en a Enter one of the following amounts: (i) | If line 5 is zero or a net gain, enter 50% of line 14; (ii) If line 13 is zero or a net gain, enter line 14; or, , (iii) If line ® and line 13 are net losses, enter amount on line 5 added to 50% of amount on 16 ; line se ee eal soe a aE. 16b | | (i) The amount on line 16a; ‘$1,000 ($500 if married ‘and filing a separate return); on , - (iii) Taxable income, as_adjusted_ (see Instruction J). . CEE 218-056-1
vas ” . Schedule D (Form 1040) 1976 . . . “ . page 2 ; : TER... Computation of Alternative Tax (See Instruction S to See if the Alternative Tax Will Benefit’ You) 17 Enter amount from Form 1040, line 47°. 2 1 ee ee ee | _ 18, Enter amount from line 15a (or Form 4798, Part lV, line 1C)) . (28 | : “19 Subtract line 18 from line 17 (if line 18 exceeds line 17, do not complete | the rest of this s part. The e Alter: native Tax will not benefit you). 6 6 es es ee Note: If line 18 does not exceed $25, 000 ($12, 500 if married filing separately), omit lines 20 through 23 and enter zero on line’24, + 20 Enter $25,000 ($12,500 if married filing separately)... ee ee ee JPOP (21 Add lines 19 and 2006. ee | BR , 22 Tax on amount online l7*® 2. 6 wk |-22- ——__} ; 23 Tax onamountonline21*. . . . 2. ee ee ee 188 : 24 Subtract line 23 from line 22... ee ' 25 Taxon amount online 19*. 6 6 1 {| 26 Enter 50% of line 18 but not more than $12,500 ($6, 250 if married filing separately)... . _26 eee . 27 Alternative Tax—add lines 24, 25, and 26. If smaller than the tax ‘figured on the. arnount on Form 1040, | line 47, enter this alternative tax on Form, 1040, line 16. Also check the Schedule D box on Form 1040, line 16 Ce ee ee ee ee | 27 nt NE RL A ARTE eR . "+ * *If the amount.on which the tax is to be computed is $20,000 or less use the Tax Table; if more than $20,000 use Tax Rate Schedule X, Y, of Z. A AS Se Note: Enter your capital loss carryovers from 1976 to 1977: oe Pre-1970 Short-term (from Form 4798, Part Il or Part V) . Long-term (from Form 4798, Part Il or Part V) . an Re , oie . ‘Wy U.S. GOVERNMENT PRINTING OFFICE : 197%5—-O-218-056 218-056-1
ae Sag, OE oe aggro reer + Teor Le 2 SCHON O40) ©60|-Computation of Social Security Self-Employment Tax: |: O78 an Department of the Treasury f> Each self-employed person must file a Schedule SE. [> Attach to Form 1040. v ~ Internal Revenue Service [> See Instructions for Schedule SE (Form 1040). , a a ear - © If you had wages, including tips, of $15,300 or more that were subject to socia! security or railroad retirement taxes, do not fill in this schedule (unless you are eligible for the Earned Income Credit). See Instructions. i Olt you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE. Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits. NAME OF SELF-EMPLOYED PERSON (AS SHOWN ON SOCIAL SECURITY CARD) Social security number of “Pp WY - fe ta. SS y self-employed person p> ’ Business activities subject to self-employment ta A grocery store, restaurant, farm, etc.) > ° ® If you have only farm income complete Parts | and Ill. © If you have only nonfarm income complete Parts Il and III. © If you have both farm and nonfarm income complete Parts I, II, and III. . ~ EGE. “} Computation of Net Earnings from FARM Self-Employment : . You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line 2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and 2 must be completed even if you elect to use the FARM OPTIONAL METHOD. : JFK Act 6 (3) REGULAR METHOD ' [{ a Schedule F, line 54 (cash method), or line 72 (accrual method) |_24_ je 1 Net profit or (loss) from: b Farm partnerships . . 2 2. . eee ee ee ee | 2 Net earnings from farm self-employment (add lines laandb). . . . 2. {2 __|__- :. 3 If gross profits a Not more than $2,400, enter two-thirds of the gross profits . . ‘12 from farming * are: b More than $2,400 and the net farm profit is less than $1,600, Enter $1,600 3 ‘ 1 Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 70 (accrual YY Yy YY YY YZ; Yyyg ; method), ‘plus the distributive share. of gross profits from farm partnerships (Schedule K-1 (Form 1065), line 14) YH Yy Yj Yj , as explained in instructions for Schedule SE. . WM We Ue YY onas 4 Enter here and on line 12a, the amount on line 2, or line 3 if you elect the farm optional method . 4 ; Elelai..) Computation of Net Earnings from NONFARM Self-Employment a ‘Schedule C, line 21. (Enter combined amount if more than one business.) 5a FARM OPTIONAL METHOD | . b Partnerships, joint ventures, etc. (other than farming) . . . .« . + . _pb ——_ = c Service as a minister, member of a religious order, or.a Christian Science ‘ REGULAR METHOD | - practitioner. (Include rental value of parsonage or rental allowance fur- 5 Net profit or - nished.) if you filed Form 4361, check here > [] and enter zero on this (loss) from:. - Vine. . vo ee Coke ee es 5 d Service with a foreign government or international organization . . . _5d_ See Form 1040 “in- e Other Cee ions for line 36.) Specify Boe e ieee cece cee cceeeeeee cece ceneeceeeeeee {De 6 Total (add lines Sathroughe) . - 6 6 we ge pe 6 , 7 7 Enter adjustments if any (attach statement) . . . .. re a : ; 8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7) . . ; oa . If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 WY Wy a through 11-and enter amount from line 8 on line 12b, Part III, . ; ‘ Yy mo Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than $1,600 and less YY than two-thirds of your gross nonfarm profits,“ and you had actual net earnings from self-employment of Yj 9 4 $400 or more for at least 2 of the 3 following years: 1973, 1974, and 1975. The nonfarm optional method can only be used for 5 taxable years. © NONFARM OPTIONAL METHOD 9 a Maximum amount reportable, under both optional methods combined (farm and nonfarm) . . 9a b Enter amount from line 3. (lf you did not elect to use the farm optional method, enter zero) . 9b ‘© Balance (subtract line 9b from line 9a) . , ok ee ee 9c 10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever issmaller. . . 2. 2. 1... 10 11 Enter here and on line 12b, the amount on line 9c or line 10, whichever is smaller... . 1 |. ; 2 Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu: (ao eee tive share of gross profits from nonfarm partnerships (Schedule K-1 (Form 1065), line 14) as explained in instruc- ty Le, WY Y yy tions for Schedule SE. Also, include gross profits from services reported on line 5c, d, and e, as adjusted yy Yj Yj by line 7. : Yy Ue, ey Uy, PGE} Computation of Social Security Self-Employment Tax : 12 Net earnings or (loss): a From farming (from line 4). 2 2. 1 2 ww. ee, df Ra ; b From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) . . . | 12b_ 354 & 13 Total net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400, ; you are not subject to self-employment tax. Do not fill in rest of schedule.). . 2. 2°. 0. 08, _13 > S wh a 14 The largest-amount of combined wages and self-employment earnings subject to social security or railroad retirement taxes for 1976 is . 2. 1 1 we ee ee ee ke ee ey | 4 ~ $15,300 | 00 15 a Total “FICA” wages and “RRTA” compensation . . . . . |_15a | Y V7 y/ ~ b Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA . rey VY V/ WY) V/ c Totaloflines15aandb. . 2. ee ee ee eg ee ee ee | BO : : 16 Balance (subtract line 15c fromline 14)... ee ee ee | 1 : ; “17 Self-employment income—tine 13 or 16, whicheveris smaller. . . . . . 3...) {17 2546 . : , 18 Self-employment tax. (If line 17 is $15,300.00, enter $1,208.70; if less, multiply the amount on line ee : 17 by .079.) Enter here and on Form 1040, line 58 . ‘NW 55923 Docld:32245535 Page 13
FS , Capital Loss Carryover (Computations of Capital Loss Carryovers and Summary of Capital Gains and Losses if Pre-1970 Capital Losses are Carried to 1976.) b> Attach to Form 1040. Note: Complete Only Page 1 of This Form to Compute Your Capital Loss Carryover if Your 1975 Schedule D 40), lines 4(a) and 12(a), DO NOT SHOW A LOSS. ; wPartls Post-1969 Capital Loss Carryovers to 1976 (Complete this part if the amount on your 1975 Schedule D MPartl ae (Form 1040), line 16(a), is larger than the loss deducted on your 1975 Form 1040, line 29a.) ‘orm f . Department of the Treasury Internal Revenue Service . Name(s) as shown on Form 1040 JEK Act 6 Section A.—Short-term Capital Loss Carryover 1 Enter loss shown on your 1975 Schedule D (Form 1040), line 5; if none, enter zero and ignore | .a lines 2 through 6—then go to line 7... . 2. | a me 2 Enter gain shown on your 1975 Schedule D (Form 1040), | line 13, If that line is “blank or shows , - _aloss, enter a zero. . . 2 _ 3 Reduce any loss on line 1 to the extent “of anygainonline2. . . . ww ee ee ee we | on 4 Enter amourit shawn on your 1975 Form 1040, line 29a. . 2. ew ee 4 _ 5 Entersmallerofline3or4. . 2 1 1 we ee ee ee ew FB 6 Excess of amount on line 3 over amount on line 5 6 ww ge 6 | Note: The amount on line 6 is your short-term capital loss carryover from 1975 to 1976 that is attributable to years beginning after 1969. Enter this amount on-your 1976 Schedule D (Form 1040), line. 4. . Section B.—Long-term Capital Loss Carryover 7 Line 4 less line S (Note: If you ignored lines 2 through 6, enter amount from your 1975 Form 1040, line 29a). 7 __ a 8 Enter loss from your 1975 Schedule D (Form 1040), line 13; if none, enter zero and ignore lines , ~ 9 through 12... . . . . {8 _ -9 Enter gain shown on your 1975 Schedule. D (Form 1040), line 5. If that line is blank or shows ; , a loss, enter_a zero ke ee ee TL ft 10 Reduce any loss on line 8 to the extent of any gain on line 9 ge ee ek ee _10_ | — , 11 Multiply amount online 7by2...°.~=« © 12 Excess of amount on line 10 over amount on 1 line 7 toe ee ee ke rn 12 Note; The: amount on line 12 is your long-term capital loss carryover from 1975 to 1976 that. is attributable to years beginning 7 after 1969. Enter this amount on your 1976 Schedule D (Form 1040), line 12. aPartillel Schedule D (Form 1040), line 16a, is larger than the loss deducted on your 1976 Form 1040, line 30a.) Section A. —Short- term Capital Loss Carryover '. 1 Enter loss shown on your 1976 Schedule D Form 1040), line 5; if none, enter zero and ignore lines 2 through 6—then go to line 7 . Lo a 2 Enter gain shown on your 1976 Schedule D ‘(Form 1040), fi line 13! if that line is blank or shows a loss, enter a zero . . Loe ek _ 2 ' 3 Reduce any loss on line 1 to the extent of any gain online2. 2. 2 1 we ee (Be 4 Enter amount shown on your 1976 Form 1040, line 30a . _ 4 : 5 Enter smaller.of line 3 or 4 .. toe _5 6 Excess of amount on line 3 over amount on line 5 . 6 2 Post-1969 Capital Loss Carryovers from 1976 to 1977 (Complete this part if the amount on your 1976 - Note: The amount on line 6 is your short-term capital loss carryover from 1976 to 1977 that is attributable to years. beginning , after 1969. Enter this amount in the space provided on page 2 of your 1976 Schedule D (Form 1040). . Section B.—Long-term Capital Loss Carryover Line 4 less line 5 (Note: If you ignored lines 2 through-6, enter amount from your 1976 Form 1040, tine 30a) Enter loss:from your 1976 Schedule D (Form 1040), line 13; if none, enter zero and ignore lines 9 through 12 9 Enter gain ‘shown on your 1976 Schedule D (Form 1040), 1 line 5, I that line is blank or shows a a loss, enter’a, zero . coe ee Loe ‘40 Reduce aay loss on line 8 to the extent of any gain on line9 . "11° Multiply amount on line 7 by 2 . Loe "12 Excess of amount on line 10 over amount on line 11 . : - Note:' The amount on line 12 is your long-term capital loss carryover from 1976 to 1977 that is attributable to years beginning a after 1969. Enter this amount in the space provided on page 2 of your 1976 Schedule D (Form 1040). Form 4798 (1976) - NW 55923 ‘Doel: 32245535 _ Page 14 nee en ES
wiWtl,82923 Docld: 32245535 Form ‘4798 (1976) Page 2 Do Not Complete the Rest of This Form if You Do Not Have a a Pre-1970 Capital Loss Carryover to 1976 (See Instruction A). ‘ Instructions A. Who Should. File.— . If your’ 1975 Schedule, -D (Form. 1040), lines 4(a) and 12(a) show a loss: (1) use Part“ Ii, below, to determine your capital loss carryover .to 1976; (2) coniplete your 1976 Schedule D (Form 1040), lines 1 through 13 to reporticapital gains and losses for the current year and any post-1969 capit ISS Carryovers, and (3) complete Part IV to figure your net capital gain or (loss) for 1976 and the capital loss limitation if necessary. Use (Part V to figure capital loss carryover from 1976 to 1977 for pre-1970 lossés or a combination of pre-1970 and post- 1969 losses. B. Part-IV, Line 19 or 33.—if there is a gain and a loss on the lines mentioned in the instructions for Part IV, fine 19 or 33, enter the gain reduced by the amount of the loss. If the Joss exceeds the gain enter a zero. If there is a gain and no loss, just enter the gain. C. Part IV, Line 22 or 36.—Jf there is a loss and a gain on the lines mentioned in the instructions for Part IV, line 22 or 36, enter the loss reduced by the amount of the gain. If the gain exceeds the loss enter a zero. If there is a loss and no gain, just enter the loss, _ D. Married Taxpayers Fiting Separate Returns.—If you are married and filing a separate return the limitation for Part iV, lines 9(b)(li) and 27(b) is $500, increased by amounts attributable to pre-1970 short- term capital loss components, but the combined total may not exceed $1,000. If there is a loss in Part IV, line 2, complete Part IV, Section E. If there is a loss in Part IV, line 5, complete Part IV, Section D, lines 14 through 22 (assuming all the lines in Section D were not other. .wise required to be completed) ignoring the note under line 14. E. Additional information.—For information about capital assets, investment interest expense deduction adjustment, aiternative tax, ete., see the Instructions for Schedule D (Form 1040). Pre-1970 and Post-1969 Capital Loss Carryovers to 1976 (Complete this part if-the amount on your SEE 1975 Schedule D (Form 1040), Form 1040, line 29a.) lines 2 through 20—then go to line 21 . 2 Enter gain shown on your 1975 Schedule D (Form 1040), line 13. If that line is is blank or shows a loss enter a Zero . 3 Reduce loss on line 1 to the extent of any gain on line 2. Note: Jf line 4(a) on your 1975 Schedule D (Form 1040) is blank, IGNORE lines. 4 through lL, enter a zero on line 12—then go to line 13. 4 Combine lines 3 and 11 on your 1975 Schedule D (Form 1040). Enter: the gain; if zero or a ‘loss, enter a zero. Note: /f line 4 is zero IGNORE lines 5 through 11, enter on line. 12 , the loss from your 1975 Schedule D (Form 1040), line 4(a)— “then go to line 13. 45) Enter any gain from your 1975 Schedule ° (Form 1040), line 3. ON aA Enter smaller of line 4or5. Enter excess of gain on line 4 over line € 6 otherwise, enter a zero ee Reduce any gain on line 7 to the extent of any loss on line 8 wo 10 Enter loss from your 1975, Schedule D (Form 1040), line 4(a); other- wise enter.a zero. . . ne 11 Add the gains on lines 6 and 9 . 12 Reduce the loss on line 10 to the extent of any gain on line 11. ‘13 Pre-1970 short-term capital loss (Enter smaller of line 3 or 12). . ' 14 Short-term capital loss attributable to years: beginning after 1969 (excess of line 3 over ‘tine L 15 Enter : ‘any loss from line 13, above 16 Enter loss deducted on your 1975 Form 1040, ‘line 29a . 17 Pre-1970 short-term toss carryover to 1976 (excess of line 15 over line 16—if line 15 does not exceed line 16, enter zero). Enter here and’ in Part IV, me 2. 18 Enter any loss from line 14, above 19 Enter excess of line 16 over line 15—if line 16 does n not exceed line 15, enter zero . 20 Post-1969 short-term loss carryover to 1976 (excess of line 18 over line 19—if line 18 does not exceed line 19, enter zero). Enter here and on your 1976 Schedule D (Form 1046), line 4 . 21 If you. were required to complete Part IV of your'1975 Schedule D (Form 1040), enter any’loss from your 1975 Schedule Dd (Form 1040), line 30; otherwise, enter ero... 22 Enter excess of line-19 over line 18—if line 19 does not exceed line 18, enter zero. (Note: if you, ignored lines 2 through 20 above, enter amount from your 1975 Form 1040, line 29a). 23 Pre-1970 tong- -term loss carryover to 1976 (excess o of line 21 over line 22—if line 21 does not exceed line 22, enter zero), Enter here and in Part IV, line 5 24 If you were required to complete Part IV of your 1975 Schedule D (Form 1040), enter any loss from your 1975 Schedule D (Form 1040), tine 31. However, if Part IV was not required, enter any loss from your 1975 Schedule D (Form 1040), line 13. 25 Enter excess of line 22 over line 21 ..........: Ce 7 - does not.exceed line ai, ‘enter zero.) . 26 Post-1969 long-term loss carryover to 1976 (excess of line 24 over line 25—if line 24 does not exceed line 25, enter zero). Enter here and on your 1976 Schedule D (Form 1040), line 12 Page 15, ey 1 Enter loss shown on your 1975 Schedule D (Form 1040), line i if none, enter:zero and ignore Enter -loss from your 1975 Schedule D > (Form 1040), line 12a): x 2 (IF line 22 line 16(a) or line 33, is larger than the loss deducted on your 1975 4), 5/035 | _ 16 18 19 | al S217) 22 oo 2 | SER97 |
Section A.~—Short-term Capital Gaing‘and Loses ke : , Amount from_1976 Schedule D (Form 1040), line 5. “2 Amount from Part Ill, line 17, oe, 3. Net short-term gain or (joss), combine lines band 2. if Section B.—Long:term Capital Gains and Losses / 4° Amount from 1976 Schedule D (Form 1040), line 13, 5, Anfount from Part Ill, line 23 . Soe, 6 Net long-term gain or (loss), combine lines 4 and 5. yo Section C.—Summary of Sections A and B 4 . *“7-Combine lines 3 and 6 and enter the net &ain or (loss) here , 8 If line 7 shows a gain— tg (a) of line 7, whichever is smaller (see Schedule D (Form 1040), Part ative tax). Enter zero if there is a loss or no entry on line 6 7. Enter here and on Form 1040, line 30a 9-If line 7 shows a loss— “a If losses -are’ shown on BOTH lines 5 and 6, omit lines 9(a) and (b) and go to Section D. ‘Otherwise, ...: ar, , , Jf (a)’ Enter one of the following amounts: is (+ If line 3 is zeroora net gain, enter 50% of line 7; . li) If line 6 is zeroora net gain, enter amount from line 7; Or : ‘ (iii) If line-3 and line 6 are net losses, enter amount on line 3added to 50% of amount ¢ 2°, 0mlin€6.°., a Bee em" : - (b) Enter‘ here ‘and enter as a (loss) on Form 1040, line 30a; the smallest of: : The amount on line 9(a); : : . Te (il) $1,000 (married taxpayers filing separate returns see Instruction D); or (iii) Taxable .Income, as adjusted (see Instruction J in ‘Instructions for Schedule D (Form : «Section D.—Capital Loss Limitation—Where Losses Are Shown on Both Lines 5 AN Enter loss from line 3; if line 3 is zero'or a gain, enter a zero . Lo Enter loss from.line 6 “12 ‘Enter gain, if'any:: from line 3; if line 3 is zero or a loss, enter a zero , +13" Reduce loss on line! 11 to the extent of the gain, if any, on line 12. :14 "Combine amounts on 1976 Schedule D (Form 1040), lines 3 and J} and-if gain, enter gain; if zero or a loss, enter a zero cae Note: if the entry on line 14 is zero, OMIT lines 15 through 21 and «i. enter on line’22 the loss shown on line 5. . ~ Enter gain, -if any; froin 1976 Schedule D (Form 1040), line 1 16:'Enter smailer. of:amount on line 14 or linel5- , non line 14 over amount on line 16 17:;Enter‘excess of gai Enter’ loss from line 2: if line 2 is blank, enter a zero toe. Reduce ‘gain,-if. any," on line 17 to the extent of loss, if. any, on line 18 (series. : Instruction By. 7/2 : ; co ‘ -20%Enterloss’ from’ line 5 re i Add ‘the gain(s) on line(s) 16 and 19° Pee, : . 2:Reduce the loss on line 20 to the extent of the gain, if any,'on line 2] (see Instructor for on 23° Enter, smatier of aniount on line 22 or line 13 (if line 22 is zero, enter a zero) 24‘ Subtract amount on line 23 from the loss on Ine IZ. 0. sg 25 ‘Enter 50% of the amount on line 24. 26 Add lines 10, 23, and 25) Ce ‘ 27. Enter here-and enter‘as’a (loss) on Form-1040, line 30a, the smaliest of: : (a)"Amount.on line 26". « ne a oo 4 (b), $1,000 (Married taxpayers filing separate returns see Instruction D); or |, - ma 1 1040)) | “(c) Taxable Income, as adjusted (see Instruction J in Instructions for Sch
: MEDICAL 90 TOTAL INTEREST -: WM PRE92 SimDochdiB224553500cPage 17 é CALENDAR YEAR __ feo " JFK Act 6 (3 Soc. SEC. NO. DEDUCTION SCHEDULE . | ONTRIBUTIONS _ [STATE] FEDERAL 4D EMARKS ih 7 [STATE | FEDERAL CONTRIBUTIONS | STATE 2 MEDICINE/DRUGS ||| [2tacasncontrisutions \[ | TBLESS1%AGI.(Line 18-1000) | +(| | ——~dE—sd2tbeartNersnpsuare YT “"QNET MED/DRUGS O_o cisvsoy scours OT 5H & A INS, (% + EXCESS) | e¥OS, | vearrrunpicancenruno]\ || PO Ga or. ff eocrossunitrenruno, [fT DR. A Pe DR. YO PROSTHETIC APPLIANCES rT _| | «| [CASUALTY OR THEFT (LOSS(ES)” i HEARING AID: rT | | | [@cossperore abvustment [| Gt AMBULANCE rT OSOCSdNC (STC~sYSCiz‘ “LABORATORIES Tr SC*«dsCSCédES Ss 2B isto cimitationrercas.. [of fT . “MEDICARE INS. | {| [30armony CC GLASSES [SSCL SSSSSCd:CS*d 34 unionvproressionaLoues | | Of  “TMEDICAL EXPENSES T_T [pees] [azincome Tax preraration [| | fT LEssReimeuaseDBYins. | «| -'i| Sd ~S i Sirormsprorec.cromHinc{ | OT 8 LESS 3% ADJ. GROSS INC. [SSL et smattrootsanosuppiies || IsnitosisnorHaams. | | | JSQE | avutouseiamace of. TT “OTOTAL MEDICAL DED. | ad LL IG ALL | INVest.counsecapussiscneaf | |  _—is TAXES | empLovmenT aGency Fees | «(|| TTSTATE & LOCAL INCOME - [|_| <e-t_ | sare erositsox. Od] CCT SC V2REALESTATE | | @2Y4 | tecreainsusiness [| | | = | 1BstateaLocaLcasoune | «| S«dT Ss Se. | Pouiticaccontrigutions [| Of 14 GENERAL SALES TAX | | yay {| [| [| = 1a PERSONAL PROPERTY Se A GS QO “Wheersonacerorenrvauro || | .2ai,[ —s «| rd “16 SALES TAX AUTO. Pe eee -—{ |__| 18 TOTAL MISC. DED. » ae TTT SCT CSCCCSCSCSsSCSCSSSUMMARY OF ITEMIZED DED. | stare |, FEDERAL - INTEREST (TO WHOM PAID _ [85 TOTAL TAXES (From Line 17) | | 18 MORTGAGE PT TT py sat [sérota: iterest (wine 20) [Tf -AQINSTALLMENT LOANS ee rca CO : a — AO iNteR ON FORM 1040 LINE 44 Sm tO 2620. _ rE es eee ee orm 101 7"
1.0. NO. ALENDAR YEAR 19 Th. Ro . a JFK Act 6 (3) : ie) soc. SEC. NO . FISCAL NEAR ENDING _. 19 m : — SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION “OT BRINCIPAL BUSINESS ACTIVITY BUSINESS NAME .” EMPLOYERS NO. \BUSINESS ADDRESS .. & FNVENTORY AT BEGINNING OF YEAR i4y- MERCHANDISE PURCHASED * LABOR °-.. . oP , ”. th _—_ - ; ‘ TOTAL nee | "INVENTORY AT END OF YEAR Vs." GROSS PROFIT |: GROSS INCOME . OTHER BUSINESS DEDUCTIONS “* ADVERTISING Z “TS AUTO AND TRUCK EXPENSE “BAD DEBTS ‘0° CASH SHORT .=- COMMISSIONS pet DEORWERY - “V5. DEPRECIATION’ ( SCHEDULE ATTACHED } — DUES AND SUBSCRIPTIONS oon ‘ 1. | moe dg ‘ENTERTAINMENT AND PROMOTIONAL INSURANCE . “ENTEREST “JANITOR SERVICE - ~~ . _ LAUNDRY ‘*LEGAL AND ACCOUNTING MAINTENANCE OFFICE SUPPLIES: AND EXPENSE ‘yes RENT “1, REPAIRS © ‘i SALARIES AND WAGES SALARIES OFFICERS roo. SUPPLLES ») “TAXES AND LICENSES TAXES - PAYROLL “TELEPHONE Ue CUTILITEES MC INET, PROFLT:-OR ( LOSS ) - FEDERAL RETURN | | AS¥G o" NET PROFIT OR LOSS ) - STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF. ) po Pa ; - a PROFESS 1 ONAL STATIONERS. INC. FORM 104 . Hetowls | LOS ANGELES, CALIF. SCHEDULE __. NW, 55923 . DoqId:32245535° Page 18 ce oo re a
(3) 1.D. NO.. ALENDAR YEAR 19 Wh ISCAL YEAR ENDING 5 ey ADDRESS , . : = soc. SEC. N 19_ co p ie) et Ne fy nD ee RATE(%) DEPRECIATION SPEC 20% . . | METHOD: | q q | DEP ALLOWED I PRIOR YEARS KIND OF PROPERTY OR LIFE _ FOR THES YEAR fh ‘ S Sen yer | t » i iM 55923 DocIad Page i195 : 39945535 re TOTALS ; ; Add 20% Additional Depreciation on Items Purchased THIS Year. ne ae 2 7 - TOTAL DEPRECIATION THIS YEAR voy ok Prt OS ‘ 70 : — = : — - : NERS t : . . . ft . . et a om —_ oe aoe tee om {PROFESSIONAL sTaTio ERs INC LOS. ANGELES + CALIF FORM No Om ; a ok ba.” seneource
INDIVIDUAL ° ceee/ INCOME TAX | - PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) "| Check -fxrCalendar Year . Enter social security number(s) only if moe au not shown on label. | a One: O Fiscal Year Ending—___—1977 READ "FOR PRIVACY. NOTIFICATION SEE PAGE 2 OF INSTRUC TIONS | JFK Act 6 (3) occu- Yours 3/3 PATION | Spouse's If line 1 or 3 ‘checked, enter + $25 If tine 2, 4 or 5 checked, enter $50 § Dependents — Do not list the person who qualifies you as head of household st a Personal 4 © Head of Household—Enter name of qualifying . individuat Blind (see instructions) Number of blind exemptions _____—. X $8 o Widow(er) with dependent child (Year spouse died 197_.} Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20 I a : f attach copy 2 of "Form(s) W-2 to face of this ) 10 Wages, salaries, tips and other employee compensation; featur, if unavailable, see instructions, Page 10 § «11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540)) 12. interest. Enter total (if over $400, complete and attach Schedule B(540) ) 13 Income other than wages, dividends and interest (from line 48) 14 Total (add lines 10, 11, 12 and 13) 15 Adjustments to income (from line 55) 16 Adjusted gross income (subtract line 15 from line 1a) o If you do NOT ‘itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on’ tine 19. © If you itemize deductions OR tine 16 is $15,000 or more, complete lines 17 and 18. aw ‘Deductions: . Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked) “18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule-—Enter tax on line 19 ES <q ATTACH COPY 2 OF FORM W-2 HERE > “19 Tax from (check one) {_] Tax Table ax Rate Schedule 0 Income Averaging Schedule (G or Gel) . 20 Total exemption credits (from line 9, above) Loe - . 21 Tax fiability (subtract line 20. from line 19—if line 20 is greater ‘than line 19, enter zero) 22 Other credits (from line 68—Including Special Low Income Tax Credit) . Lok . 23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line i, enter zero) Cok ee “24> Other taxes (from line 71)... . +--+: ee ee ee ee ee 25 Total tax liability (add lines 23 and 24) a Le 26 Total California income tax withheld (attach W-2 or W-2P to face of this return) . . . . . .MY 26). : Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to thes est of my knowledge and belief it is true;:correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. A = _= 27° Renter's credit—if you lived in rented property on March 1, 1976, complete Part.l on page 2... 27 3 28 1976 California estimated tax payments © © 2. - 6 ee ee ee es . $428 E29 Excess California SDI tax withheld (see instructions). . 2 2 2. ee ee ee ee + O29 “2 GO Total Credits, ©... ee ee oe E 31. If tine 25 is larger than tine 30, enter BALANCE DUE. If it is equal to-line 30; enter zero. = . Mailreturn to: : FRANCHISE TAX BOARD PAY IN FULL —> a31 om s : SACRAMENTO, CA 95867 . Do not write in n these spaces i 32 If line 25 is smaller than line 30, enter amount OVERPAID rrr: sy ye P “ + az 33 Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks. ; ; 8 Mail return to: . FRANCHISE TAX BOARD <n P.O. BOX 13-540. (8. SACRAMENTO, CA 95813 2 34 Amount of line 32 to be credited on your 1977 ESTIMATED TAK i: Te if you do NOT want State income tax forms and instructions mailed to you next year, check here C] See Instructions, Page 9° BE . a” x eo a 2 SIGH errs signature ~ Date . “ > Srna signature (other, than gaxpaye a Date “Ne. HERE, PP Spatansnnan abe a lope ern od Date Address (and Zip code)
Fok tee Fe RR I TT TNE SS EE SER Paye 2 Form 540 (1976) O Yes “atlo If no, you may not claim this credit o Yés ONo_ If yes, you may not claim this credit O Yes ONo~ If yes, you may not claim this credit ‘, ‘38 Did you or your spouse claim the homeowners’ property. tax exemption or receive public assistance?: OYes ONo If yes, see page 3 of instructions “. PART Il - Other Income 39 Business income (or. loss) (attach Schedule C(540)) . . ke eg re a ee 2 OF RD 40 Net gain (or loss) from sale or exchange of capita! assets (attach Schedule D(540)). 2 we ee Cp eee eee. @ | 40 » 41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540)). 2. ee ee ee es PS cceceeeepveneeees Dieses feeeee - 42.Pensions and annuities . . Se Le re 43 Rents and royalties ATTACH | oe . 1 SCHEDULE E 44 Partnerships .°.. .. . Form (840) |i ns _ 45 Estates and trusts’... ee rn 346 -Farm income (or loss) (attach Schedule F(540)).. . - 2... eee cl, See See ee ee 47 Miscellaneous income , (a) Fully taxable pensions and annuities (not reported on Schedule E(540)) : (b) Alimony 2 eee = (c} Other (state nature and source) — : / . Enter total of lines 47(a), 47(b), and 47(c) .. . 2... ee ee Dee Total (add lines 39 thru 47), Enter here and on line 13... ee ee rr PART Ill - Adjustments to Income 49 “Sick pay,” if included in tine 10 (see instructions - attach Form FTB 3805T) . a wees ee be ee a ‘50 Moving expenses (see instructions - attach Form FTB 3805U) ee kk ee ee ° " ‘51 Employee business expenses (See instructions - attach Form FTB 3805N). 0... 2.2.2.0. 0 0-0 ee eee be ee 52 Military exclusion (see instructions) Le ee ’ Be Lo 53(a) Payments to an individual retirement arrangement (attach FTB 3805P) Le ee ee : ae (b) Payments to a Keogh (H.R. 10) retirement plan Cee ee (c) Payments to.a self- -employed ‘‘Defined Benefit Plan’ oc. ce ee ee ee ee LBC EERE Enter total of lines.53(a), 53(b), and 53(c) 2. 2 .. 54 Forfeited interest penalty (see instructions)... ee ee Le 55 Total adjustments (add lines 49 thru 54). Enter here and online 15 . . , . Le eee ne So ee bo es PART IV — Itemized Deductions , o-Attach Schedule A(540) and enter subetotals on tines 56 thru 62, below . 56 Total deductible medical and dental expenses (from Schedule A(540), line 10) 57 Total taxes (from Schedule A(540), line 17). 6 6 ee bee ee ; 58: Total interest expense (from Schedule A(540), line 20)... eee eee ee Le ee 59 Total contributions (from Schedule A(540), line 24) 2 0. 1. 60 Total casualty loss (from Schedule A(540), line 29). See . ee : 62 ‘Tota! miscellaneous deductions (from Schedule A(540), line 33)... 6 oe ee Dee '62 Total child care and adoption expenses (from Schedule A(540), line 37)... ....02.2-0. : - §3 Total itemized deductions (add lines 56 thru 62). Enter here and on linel7 .. 2... 2... ree the PART V — Other Credits:- SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW 64 Other State’’ net income tax credit (attach copy of other state return and Schedule §(540)). . ee ee 65° Retirement income credit (attach Schedule R(540)) 2. 2. 66 Special low income tax credit (see special instructions). ....... Se ee we ee 67, Solar energy tax credit (see special instructions). . 2... 2 eee ee Se "68 TOTAL (add lines 64 thru 67). Enter here and on line a on Poee : "| PART VI — Other Taxes , 68 Tax on preference. income {see instructions - attach Schedule P(540)..... tak Lo ‘70 Tax on premature distributions from attached Form FTB3805P ...... rare Ce 71. Total (add tines. 69 and 70) enter here and on line 24-0 0 0 Den ee vay 4 NW 55923 Docla: 32245535 Page’ 22 - ' we ne er ee eee vee EET OE”
wee : . A me tet ae gggecr a eee TAC CALIFORNIA Name as shown on Form 540 JFK Act 6 (3) USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION - Medea! and dental expenses (not compensated by Insurance or otherwise) for Contributions medicine and drugs, doctors, dentists, nurses, . 21(a). Cash contributions for which you have receipts, hospital care, Insurance premiums for medical ; ; canceled checks, etc. SECO SIST eres Serres 4 “ : care, etc. to (b). Other cash contributions. List donees and amounts "1. One half (but not more than $150) of insurance premiums for medical care....................05, 2. Medicine and drugs.................. Deedee 3. Enter 1% of line 16, Form 540.............0..0.,, “4, Subtract line 3 from line 2. Enter difference lif less than zero, enter 2€F0).. 0... eee eee ment ........ ce eg eevee evteereeees oc cacc, pesseerbeseenseenseeeneape ~. §, Enter balance of insurance premiums for medical care 23. Carryover from 1974 & subsequent years ~ See "-’. not entered on fine 1.......... 0... ee instructions . 0... 66... eee eevee eee ees S 6. Other medical and denta! expenses: 24, Total— (Add-lines 2la thru 23. Maximum de- duction may not exceed 20% of adjusted gross. (a) Doctors, dentists, nurses, etc... Liebe teens a income. Enter here and on Form 540, line 59) ..... (b) Hospitals .. 0.0.0.0 eens Loos {c) Other (itemize)_....,.... creceeeenengsentemeeewnseennnnermersat tt Casualty or Theft Loss(es) NOTE: If you had more than one loss, omit lines 25. through 28—See instructions for guidance 25. Loss before insurance reimbursement ..,.. a vate 26. Insurance reimbursement............ ae nS 27. Subtract line 26 from line 25, Enter difference (If less than zero, enter zero) ... Maes eee oe 28. Enter $100 or amount on line 27, whichever is 9. Subtract line 8 from line 7. Enter difference (if less than zero, enter zero).............. 0.0 ccs ee eee smaller. 10. Total—{Add lines 1 and 9, Enter here and on Form Qu . 29. Casualty ¢ or theft loss 5 (subtract | line 28 trom t 540, line 56)...... cca cee bene eee eenees wee . og tine 27. Enter here and on Form 540, line 60) : Taxes — Miscetlaneous Deductions 11. Auto license~-Excess. cof Fegistration and Weight fees (see instructions)........r.. oye et a 12. Real estate... 0000s 13. State and local gasoline........ geen cnet ene ees 14, General Sales... 12.00.00... cece cece eee eee eee 15. Personal property (Boat and Aircraft).............. 30. Alimony paid to: ........... Lecce eceeeeeqereaeets 31. Employment Education Expense . Levee 32. Union dues Other (itemize) 33. Total (Add lines 30 through 32. Enter here and on Form 540, line 61) 17. Total taxes—(Add lines 11 thru 16. Enter here and on Form 540, line 57) .......... 0c cee eee ee Child Care and Adoption Expense foo, 34. Child care expenses — Attach Form 3805X . 0... e poeeteeeeecessestecee foresees 35. Total adoption expense... - - [sd . Less 3% of line 16, Form 540. - ; 36. Net adoption expenses — See instructions Interest Expense 18.. Home mortgage. 9.0.0... bev ce eee ees 18. Other (itemize)... a cette desea pees ec ees for maximum limitations... 2... 2. eee ee 37. Tota! child care and adoption expenses (add liries 34 and 36. Enter here and on : 26. Total—(Add lines. 18 and 19. Enter here and on . Form 540, fine 62)... 1... . ee eee ee 4 Form 540, tine 58)...............-00 eee _ ety eg ik Siw 55923 Docla: 32245535 Page 23
ET RET ’ . e 9 » [FORM 840 _| CALIFORNIA "DIVIDEND AND INTEREST INCOME Attach to Form 540 Name as shown on Form 540 {ime 1—Gross Dividends and Other Distributions on Steck—tf gross dividends and other distributions (including capital gain. dividends) on stock were $400 or fess, do not complete ‘this part; but enter gross dividends (including capital gain distribu- PART I—DIVIDEND INCOME tions), less nontaxable portion, if any, on Form 540, page 1. Do NOT deduct the $100 federal exclusion. “Capital gain dividends” are treated as ordinary dividends for State income tex purposes and not as capital gains as permitted under the federal law. 1. Gross dividends and other distributions on stock—List payers and amounts—Write (H), (W), UU), for stock held by husband, wife, jointly. 2. Total dividends . 3. Nontaxable distributions 4, ‘Taxable dividends—Subtract line 3 from line 2. Enter here and on 1 line iL form 540 PART lI—INTEREST INCOME Interest on bonds, debentures, loans, notes, tax refunds and all types of savings accounts including banks, credit unions and postal savings is taxable. oO “~Anterest on the following obligations is exempt from tax: ‘ (a) Bonds and other obligations (other than tax refunds) of the -. + United States, the District of Columbia and territories of the United States. (Interest on Philippine Islands obligations issued on or after March 24, 1934 is not exempt.) (b) Bonds (but not other obligations) of California. and its s polit- ical subdivisions issued after November 4, 1902. (c) Interest on bonds of Alaska and Hawaii issued. prior to their _achieving statehood. Note: If total taxable interest income was $400 or less, do not complete this part; but enter the total amount of interest received on Form 540, page 1. a. Total interest Income. Enter here and on line 12, Form 540 NW. 55923 Doold: 32245535 Page 24
CALIFORNIA — . £ ~ PROFIT (OR LASS) FROM BUSINESS OR PROFESSION (Sole Proprictorships) ‘Attach this schodulo to your income tax return, Form 340 or 540NR — Partnorships, Joint ventures, ofe, must filo on Form 563 Name as shown on Form 540 or 540NR _ , : ° . tt ae Ly | JFK Act 6 (3) A. Name and Address of Business vn . B. Federal Employer |.D. No. Dooplty. pistRo Core S Hp, [60 yee Boul aah: dp, IS - 2654s" 7 ¢. Principal bus iness activity (ie., retail-hardware; wholesale-tobacco; services-legal “ete. S28! a”, 1oe ~ sone 2! = D. Indicate method of accounting: [1 cash; SSeraccrual; CO) Other pee eee eee ecendannienntnneeeeesnamasepaneeeepempermncncana atte E. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? YES NO \ F. Method of inventory valuation B_.... 17 a0 nnn ere , eee eeren eee ennnetnnetnnesneetntnnesnentneergeeninetestneecneennesteeaipaenemmeeeeell ‘ _- Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories? : “0 YES (NO If."Yes,” attach ‘explanation. os "1 Gross receipts, sales, or fees $.-_____- Less returns and allowances $.......-------—------ - Balance & 2 Inventory at beginning of year (if different from last year's closing inventory, attach explanation) 3 Purchases $............._-..-Less._ cost of items withdrawn for personal use a cocecesnesacee - | ee * 4 Cost of labor. (do not include salary paid to Ef Levene fT t—C“Csi‘CSCiszCS "5 Materials and supplies....0........00-00000c0 cee cece eee e ees occ cubes cb vetnteneree: ae fT —CSCsd 6 Other costs (explain iri Schedule C-2 or attach, Schedule)........ eee eee eee T CCSCsiszr (7 Total-of fines 2 th 6.00.0... eee a Pe 8 Inventory at end of this year.......... 26. pee eee eevee eens eee TCS - 9 Cost of goods sold (subtract line 8 from line |) eee ove eesenes bce een nee bocce teen etn e es an 10 Gross profit (subtract line 9 from line 1)... cee eee Ll egeees bended net e ete n eet bbc ete etc eeees 14 Other income (attach schedule)....... cov veceeneees wee geet ee eeeeees Scenes a ae bocce gveadeveuvrreeees oe 12° Total Income (add lines 10 and 10). occ epee ete dt pete sec bct ees veteeieen ees coe seepeeees boc cv vec eetpeeseeees ‘ i OTHER BUSINESS DEDUCTIONS ; . 13 Depreciation (explain i in 1 Schedule C-l or attach Schedule)... 6.0... ee ees [ 14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule).................-0-- T—sSY _ 15. Rent on business property cbc eect eben ee een egy ynetees ee Dinca yee eees Cleve ene eens PT ; - 16 Repairs (explain in Schedule C-2 or attach Schedule). voc be bt pee tte e nent ete ee es Move eeeees T —“CSsCCSdY : JO ‘ o: 17 Salaries and wages not included on line 4 (exclude any paid to yourself).............0... 0. eee reese | —Y a 4 “18 Insurance ........: bbc b beet bt brett eb tp et et debt greet beet rt ete e tet re pest sneer ener es ee ee » 19 Legal and professional fees......... epee bese eeee obec eee Meee eect eee e ete ete ees ee boat 20 Commissions ........ obec cease ves vegeenes bee e eee eee cov ce tbe t eevee eben beveverees | sd a 21 Amortization (attach statement) cece cee tee bebe te vegnees Tete ees beet edge bene v eee es cee es 22. Retirement plans, etc. (other than your share, see instructions). Cc eu cb e eee epg enaes oc cveeaeueneees Tr —S 23 Interest on business indebtedness...............-..0.0000e gee ee ed cect eee ete gene aes a | ne 24 Bad debts arising from sales or services (Not applicable if reporting 0 on cad basis) cee eevee teen tee eens TT C—C—sSY ; 25 Depletion: (attach schedule)..........0... 2.0... eect tee ‘x Toe, Seve eveteeens | —SY 28 Other business expenses (explain in Schedule C-2 or attach Schedule)... 0.0.00 cee epee et eee T—CSCSY . | ° 27. Total of Hines 13 thru 26.00.26 eee: ee efiinimins 0 28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or 540NR....... ae A T Seve e ee | sve . TT Os eee brs Group and guideline class Date Cost or Depreciation Method of Life or Depreciation allowed (or allowable) computing _ or description of property Acquired other basis in prior years depreciation Rate for this year ~ Schedule C-1 Depreciation Claimed on line 13. ‘Be rh on EXPLANATION “AMOUNT ae EXPLANATION _ | AMOUNT {eo — : O33 L | ee sse|__| a Oe CO mPENSY pocld: 32245535 Page 25 SCHEDULE F ON REVERSE
sere , CAPITAL GAINS AND LOSSES "Name as shown on Form 540 or 540NR _—_ ; = : : . Sh fin LOSh JFK Act 6 (3) PART I—Assets Held One Yoar or Less Peas Fey TN UE IIT CALIFORNIA Attach to Form 540 or S40NR ' Use this schedule to report gains and losses on stocks, bonds and similar investments, and gains (but not losses) on personal assets such as a home or jewelry. e. Cost or othor bes adjusted, cost of euubse. : : a. Kind of property and description b. Date acquired c. Date sold - O, Gross sales quent improversents (if f. Gain er loss: (Example, 100 shares of ‘'Z’’ Co.) (mo., day, yr.) (mo., day, yr.) price not purchased, ottath (d. less @.) . . explanation) and a pense of salo - 2, 3. Enter gain (or loss), if applicable, from line 17, Schedule D-1 (540) (attach copy) . Enter your share of net gain or loss from partnerships and fiduciaries . . 4 Net gain or loss, combine lines 1, 2 and 3 6. 7. 8. - PART Ilt—-Assets Hold Mere Than Five Years 10. 11. 12, “PART l—Asseots Held More Than One Year But Net More Than Five Years a Gn RLS ES CEOS cS Enter gain (or loss), if ‘applicable, from line 19, Schedule D-1 (540) (attach copy) . Enter your share of net gain or loss from ‘partnerships and fiduciaries . Loe eee Net gain or loss, combine lines 5, 6 and 7 (If gain, see 540 instructions, line 24a (Preference Income)) . . . « « z x: Enter ¢ gain (or ios), if applicable, from line 21, Schedule D-1 (540) (attach copy) . Enter your share of net gain or loss from partnerships and fiduciaries . Coe kee Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a Preference Income)) - PART !V-—Summery of Capital Gains and Losses 13. mrs 1S. ‘16. 17. ~ 18. 19. ' « (b) the taxable income. for the taxable year. (computed without regard to gains or losses from sale or exchange _NW.,55923,. Docld:3 Enter amount from line 4 Enter 65% of the amount on line 8 . . Enter 50% of the amount on line 12. . . 5 Enter unused capital loss carryover from preceding taxable ve ol 2 ch computation) Combine the amounts shown on lines 13, 14, 15 and 16 If line 17 shows q gain, enter here and on page 2, Part Il of Form 540. or '540NR If line 17 shows-a loss, enter here and on page 2, Part It of Form 540 or S540NR the smallest of: (a) amount on lines 17; of capital assets; or (ce) $1 000 ($500 in the case of a husband or wife filing a separate return)
Cope ARATE ae feos acon ae 3 ig - Department of the Treasury—=Inter*al Revenue Service : ” rl yO E q 440 U iS Individual Income Tax Return a 1675 For the year January t-December 31, 1975, or other taxable year bogianing does oe 1975, COOH Co ce “ i -- Sam Name (If joint return, give ye Ps pe als of both) Last name Your social security number For Privacy Act Notification, .- oe a 2 ik JFK Act 6 (3) see page 2 of Instructions. . z Present SAM Me “(Number and te i “Sidfioding apaitment number, or tural ¢ B os ” | Salat For IRS lise only ; . : eo _ fPIRCHER Sar {pL Beoeee 3 City, Jown or post office, State and ZIP code . Yous >» : * S 3 Spouse’s > ee. : 4 Requestcd | by A in what city, town, village, B Ho you live within the lepal | C ln’ what county and State do you live? | OD In what township do Census Bureau etc., do yolive? |: limits of the city, town, etc.? rns ; State you live? (See page 4.) ; for Revenue _ oo ; os ; Sharing L oS MWELES Yes [7] No [_] Don't know MV GELES | CA s * ns t ~ , q - . . ; _ | 1 ( Single (check only ONE box) 6a Regular ae ee JX Spouse Donos thecked: pe . . o 2 mM Married filing joint return (even if only one had income) b First names. of pu (ispegient children who ; : 3 3 “| Married filings separately. If spouse is also filing five 2 lived with you Ev S _ a} spouse's ‘social security number in designated “space above ao) TH Oo” Enter 0. - ! ” and enter full = S number pe | A i on : fame here *, e c Number of other dependents (from line 27) ; : & 4c] Unmarried Head. of, Household (See page 5 of instructions) | & d Total (add jines 6a, b, and c) no Y a oe Me , > ‘ ute Age 65 or over. .O Yourself [7] Spouse, Enter a a 5 [] Qualifying widower) with dependent child (Year Blind . .. -O Yourself [7] Spouse: checked pe r ; - spouse died ® 19 __—+?). See page 5 of Instructions. 7 Total (add li lines 6d ande) .°. en ‘ ° 8 Presidential Election Do you wish to designate $1 of your taxes tor this fund? toa Yes IZ No Note: We you check the ‘‘Yes'’ 4 c Fund { d h d te $17. — Yes. ZY — box(es) it will not increase your : ampaign | un Hf joint return, does your Spouse wish to designate es YZ No | tax or reduce your refund. rt omnes _ | 9 Wages, salaries: tbs ‘and other employee compensation sole, see ‘pane Wee a »~ oe. eet 9 —_O Ss 7 and . ” 10a Dividends (ie oes tine) $....: 1? cet aes , 10b Less exclusion $.. SL? beens Balance » oI (if gross dividends and other $b fon: are over $400, list in Part | of Schedule B.) res . If $400 or less, enter total without listing in Schedule B 11 Inte rest incame. [ Ht over $400, enter total and list in Part i of Schedule Bo 12 Income other than wages, dividends, and interest (from line AG). 13. Total (add lines 9, 10c, 11, and 12); te eee 14 > Adjustments to income (such as ‘sick < pay," moving expenses, etc. from line 42). (if Jess than $8, 000, see page 8 of In- 15 Subtractine 14 from line 13 (Adjusted Gross Income) ores on “Larned Income Credit.’’) : Income ° _ Please attach Copy B of Forms W-2 here | t @ If. you do not itemize deductions and line 15 is under $15,000, find tax in Tables and enter on line. 16a: ; . , J e If you itemize deductions or line 15 is $15,000 or more, go to line 43 to figure tax. : aan ni es ce @ CAUTION. if you-have unearned income and can be claimed as a dependent on your parent's return, check here } > (| and see page 7 of instructions. : c 16a Tax, check if from: Tax Tables Tax Rate Schedule X, Y, or Z : ; 1 yz , | ScheduleD —s_» Schedule G | OR U Form 4726 16a : > b Credit for personal exemptions (multiply line 6d by $30) a 4 Pa} c Balance (subtract line 16b from line 16a). 0. ee et , . |e Le 4 7 17. Credits (froni line 54) 2 - ee an or Cae , 5 18 Balance (subtract line 17 from line 16c) . Ce oo _ 18 je 2 19 Other taxes (from line GB). . soe es oe _ a : . § | 20 Total (add lines 1Band 19). : attach forme W.2 et a CHE EFAS a E 21a Total Federal income tax. withnete a em ° as’ _21a_ —7_ 2 _. _ e - al rg " f 1975 estimated tax payments credit from 1974 return) _ > 5: OD a Y full with this return. Write Y° ; | - c Earned income credit Coe c YY 7, Sree security. number on Y “dl <<. j ae . - . : : y make payable to Internal a my fi d Amount paid with Form 4868 d __ Revenue Service. a e Other payments (from line 67) . e Millay 22 Total (add lines 21a through e) Please attach Check or Money Order here i. . e. 23 If line 20 is larger than line 22, enter BALANCE DUE IRS . fone rs oa 23. . "| : Q z . _(Check here D> Cl], if Form 2210, Form 221UF, of statement is attached. ‘See | page 8 of Instructions.) . . : os 4 =] we os 24 .Hf line 22 is larger than line 20, enter amount OVERPAID. . . . . . 2 . 1 24 ‘ - EG] 25 Amount of line 24 to be REFUNDED TO YOU «© 2. re oe re . = a, . . , : LEC ddd ; a 5/26 Amount of line 24 to‘be cred- | | Va ater PW aerpaymnent | ‘i (Oe Ml y wide : ; 5 peti: 4 gy retunded (line 25), make no entry on line: 26, ay -ited on 1976 estimated tax. Ph | 26 FE wceteat tee LLM Mili itiiiiiitisilblitiss Sinai xy s Under penalties of perjury, | declare that 1} have examined this return, including accompanying schedules and ee and to the best of my knowledge and belief it ~ a oe . is truc, cottect, and complete. Declaration of prepares (other than taxpayer) is based on all information ot which preparer has any knowledge, . ‘ . Sign , “| Gy S i i oy here » i : cy, >: Ae ; j ca . ‘ : Preparer's signature (other than nt ; pp. L ; eo, . a DT, JFK Act 6 7 a Spouse's gig s i Address (a ~ Car! . . 2 Woaenioed “NW 55923 vpoctass2245s351
it. Form 1040 (1975) Page 2 fae (a) NAME (b)- Relationship (c) Months fived in your (cd) Did de- {e) Amount YOU (f) Amount fur- . * wn : home. If born or died pendent have furnished for de- nished by OTHERS L during year, write B or D. income of pendent’s sup- including .depend- ! = @ . $750 or more? port. If 100% ent. a ey write ALL. : fe o og a a OO o . 27 Total number of dependents listed in column (a). Enter here and online 6c . . . - ee ee et > I Mituee Income other than Wages, Dividends, and ‘Interest " 28 Business income or (loss) (attach Schedule C). . . . iy woe ee 28 27, | 29a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) toe. a ee [298 _ ») , - 29b 50% of capital gain distributions (not reported on Schedule D—see page 9 of Instructions) ... _29b_ ee SS 30. Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797)... 30 _ 23/3 __ : 3la Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) . _3la_ —_— | 31b Fully taxable pensions and annuities (not reported on Schedule Ese page 9 of Instructions) . 3ib | 32 Farm income or * Hoss) (attach | Schedule ae soe . a ' 34 Alimony received ee Je | BA 35 Other (state nature and source—Sce page 9 of Instructions) ® ooo. oe ; 35 aaa a al (add lines 28 throug: h 35). Enter here and on line 12. Boe ee a 36 Zt Z ? 2 . ‘ WEZGSIME Adjustments to Income : t | a -37 “Sick pay.”’ (attach Form 2440 or other required statement). . re re Lae . . : 38 Moving expense (attach Form 3903) 2. 6 6 6 ee ee _ 38 : 39 Employee business expense (attach Form 2106 or statement) Coe ee ee 39 40a Payments to a Keogh (H.R. 10) retirement plan... . toe ew ew tee | 408 : 40b Payments to an individual retirement arrangement from attached Form 5329, Part Wl Lee a” 3 1S. ‘| 41 Forfeited interest penalty for premature withdrawal-—see page 10 of Instructions . . . | 43 i. -42.. Total (add lines 37 through 41). Enter here and online 14 . |... en 42 Tax Computation (Do not use this part if you use the Tax Tables to find your tax.) . “43 Adjusted gross income (from line 15). . Ce ee ee eee | 4B: _F £92 . “A4 (a) If you itemize deductions, check here » c “] and enter total from Schedule A, line 41 yj and attach Schedule A re Co _— 7 : (b) If you do not itemize deductions and line 15 is $15, 000 or more, check here ® [7] and: 44 o? 3 o 7 : if box on line 2 or 5 is checked, enter 16% of line 15 but not more than $2,600; if box [f° 0 [> 7 -on line 1 or 4 is checked, enter $2,300; if box on line 3 is checked, enter $1, 300 . . . “4 45 Subtract line 44 from line 43... Coe eee ew | 45 28S 7 46 Multiply total number of exemptions claimed on line 7, ‘by $780. Coe ee ee ee | 467 3 A 47. Taxable income. Subtract line 46 from line 45 2... we ee eee ee ee LT —— >. (Figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, or Z, or if applicable, the alternative . (l tax from Schedule D, income averaging from Schedule G, or maximum tax from Form 4726.) Enter tax on line 16a. ! 2 48 Retirement income credit (attach Schedule R) . 48 _ Ki 49 Investment credit (attach Form 3468) . 49 _ : © | 50 Foreign tax credit (attach Form 1116) . soe ee woe ee 50 ___ : 51 Contributions to candidates for public office credit—see page 10 of Instructions 51 _ 52 Work Incentive (WIN) credit (attach Form 4874) 52 i 53 Purchase of new principal residence credit (attach Form 5405) . 53 . | a 54 Total (add lines 48 through 53). Enter here and on line 17 . 54 ~~ | 4 55 Tax from recomputing prior-year investment credit (attach Form 4255) WeTusE 55 Omen ' Pi 56 Tax from reconiputing prior-year Work tncentive (WIN) credit (attach Schedule) . . _ 56 ; _ ! .. | 57 Minimum tax. Check here ® [7], if Form 4625 is attached. . 7 ae _ £ 58 Tax on premature distributions from attached Py ates er. _ 58 . 1 ©! 59 Self-employment tax (attach Schedule SE) . ey ¥ Gy) 19 on 59 _ os > z __ ‘4 60 Social security tax on tip income not reported to employer (attach Form.4137) . _ 60 __ ik 61 Uncollected employee social security tax on tips (from Forms W-2) 61 __ “a 62 Excess contribution tax from attached Form 5329, Part IV : Loe ee 62 |. ___ f 63 Total (add lines 4 (5b through 6: G6? 2). Enter here and on dine 19.2 eee 63 SPE | Y Part Vi. Bee “Payments _ 64 Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more empioyers—see page 10 of Instructions)... . 2. «te _ 64 _ a 65 Credit for Federal tax on special fuels, nonhighway gasoline and jubricating oil (attach Form 4136) © tee ee | 65 | “i 66 Credit from a Regulated Investment Company (attach Form 2439) . 2. 6 ee ee ee 66 |. ne __ 3 67 Total (add lines 64 through 66). Enter here and on line 2le . . 1. we ee ee 67 . ot . ye U.S. GOVERNMENT PRINTING OFFICE : 1975~O-575-050 . . . a 16——H2510-1 AW SS923 Docid:32245535 Page 25
wey see eo Schedules As&B—Itemized Deductions AND: bes (Form 1040) Dividend and interest Income Department of the Treasury p> Attach to Form 1040. p> See Instructions for Schedules A and B (Form 1040). le pe a Internal Revenue Service Name(s} as shown on Form 1040 _ ja ANU EL Schedule A—Itemized Deductions (Schedule B on back) JEK Act 6 Medical and Dental Expenses (not compensated by insurance or otherwise) (See page 11 of Instructions.) ; 1 One half (but not more than $150) of in- j surance premiums for medica! care. (Be sure to include in line 10 below) woe 2 Medicine and drugs : - oe 3 Enter 1% of line 15, Form 1040... _— Contributions (See page 12 of Instructions for examiples.) 21 a Cash contributions for which you have receipts, cancelled checks or other written evidence soe sete b Other cash contributions. List donees _ and amounts. oe eee ——————___ - 4 Subtract line 3 from line 2. Enter differ- ence (if less than zero, enter zero)... |_| 5 Enter balance of insurance premiums for medical care not entered on line 1... | - 6 Enter other medical and dental expenses: ‘ _ a Doctors, dentists, nurses, etc. 2... |---|; —— 22 Other than cash (see page 12 of instruc: tions for required statement) . aa “bp Hospitals. . . . ee | a po e Other (itemize —include hearing aids, 23 Carryover from prior years . . : _— ot dentures, eyeglasses, transportation, 24 Total contributions (add lines 2la through / f ar etc.) > 23). Enter here andonline 38... > 9, Casualty or Theft Loss(es) (See page 13 of Instructions.) : Note: /f you had more than one loss, omit lines 25 through 28 — and see page 13 of Instructions for guidance, 25 Loss before insurance reimbursement . |} 26 Insurance reimbursement 27 Subtract line 26 from line 25. Enter dif- ference (if less than zero, enter zero) | Tota! (add lines 4 through 6c) —_—___~ 8 Enter 3% of line 15, Form 1040 2... |—_______|___ ra 9 Subtract line 8 from line 7 iw less than - zero, enter zero) 10 Total (add lines 1 and 9). Enter here and ne on tine 35 [SZ Taxes (See page il of Instructions.) 28 Enter $100 or amount on line 27, which- ever is smaller - oe 29 Casualty or theft loss (subtract line 28 from line 27). Enter here and on line 39° b> “Miscellaneous Deductions (See page 13 of Instructions.) 30 Alimony paid 31 Union dues . 11 State and local income . . . . . .- __ 12 Real estate. . - . - - - e + - __ 13 State and Jocal gasoline (see gas tax tables) _ 14 General sales (see sales tax tables) 15 Personal property . , 16 Other (itemize) > 32 Expenses for child and dependent care services (attach Form 2441) 33 Other (itemize)  ___owww lle f 34 Total (add lines 30 through 33). Enter here and online 40 .. 1 > Summary of Itemized Deductions A | 17 Total (add lines 11 through 16). Enter / here and on line 36... > 07 Interest Expense (See page i2 of Instructions.) 18 Home mortgage . oe . 19 Other (itemize) ® ...........0...2---. eee 35 Total medical and dental—line 10 36 Total taxes—line 17 . 37 Total interest—line 20 doe eee eee ben nace recta e deena decnoceeeem een eee ee ne cece een eee | 38 Total contributions—line 24 st been ee eee nn ee cnet enn cence een enee anes (oom eseee ee nn 39 Casualty or theft loss(es)—line 29 . Total miscellaneous—line 34 . . >. . ae rr RR Total deductions (add lines 35 through 20 Total (add lines 18 and 19). Enter here p 40). Enter here and on Form 1040, line and online 37... . > 44... ee ee 16—82507-1 oN S5923 Doold:32245535. Page 25
i “SCHEDULE C Profit or (Loss) From Business or Profession oo ot (Form 1040) (Sole Proprietorship) oo mo: dot Department of the Treasury « Partnerships, Joint Ventures, etc., Must File Form 1065. oo 197 a, vo Internal Revenue Service » Attach to Form 1040. ® See Instructions for Schedule C (Form 1040). : on Form 104 A Principal business activity (see Schedule C ies > ww EKV! GC! — ; product m=. U AL. C.F CS TH Maly... Co FFEE. B oP mpioyer identification number > 9S-2LbS 1 SIY D Business address (number and street > / 6 Q SS EMTU a A LVP veceeeaeceeeeeeeeeeeeees  sccapeatesssessteseessteevavers ‘Name(s) as shown s City, State and ZIP code m........Z=. MEAN O CB LLBIG ccc eC | E Indicate method of accounting: (1) ia Cash (2) iyi Accrual (3) Cj Other Bocce ceeeeuececeneeeuneece deeeeeendnee i F Were you required to file Form W-3 or Form 1096 for 1975? (see Schedule C Instructions) . , * If “Yes,” where filed Deo... cece cece cee eceeeeneeereeeeee es ecsevanacaesassseasecaveveseeseseeveveterceslevseecadceelessvslavstvivietsteneestieeeeeeeetse Q G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in 19757?) 7 ww ww eee “ H Method of inventory valuation Bo... ee ooo ceccececeetteteeees oevceeseesenes oaceceeseeeeeetntrceeseeetes Was there any substantial change in the manner of determining quantities, costs, or valuations belween the opening and closing inventories? (Hf “Yes,” atlach explanation) —. 1 Gross receipts or sales $....0..0... eee Less: returns and allowances $............. cteteeeeeees Balance > ooo enceeeccececaereeeee | oeeeee fo E 2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8) 2. 2 eee 2 _ , Ss 3 Gross profit Co toe ‘ Ke Luann DE ¢ _ 4. Other income (attach schedule) 2... A fe _ ; ’ 5 Tota! income (add fines 3 and 4) a: 5 __ 6 Depreciation (explain in Schedule C-3) ceo ee 6 ° 7 Taxes on business and business property (explain in Schedule C—2) OF de , 8 Rent on business property oe Se: ee Oe | 9 Repairs (explain in ScheduleC-2) 2 6. 6 ee ee es re en nen 10 Salaries and wages not included on line 3, Schedule C—1 (exclude any paid to yourself) . ie a ee a . 11 Imsurance . 2. ee . UD) lle ecececaseaee cece e[eceees 7 "| 492 Legal and professional fees. 6 6 eee eee tereeee fees 13 Commissions a one | AS ep 14 Amortization (attach statement) ~ 6 6 6 LL SO ee 15 (a) Pension and profit-sharing plans (see Schedule C Instructions) .-. . . . |. . W5(a)] oe pee 3 (b) Employee benefit programs (see Schedule C Instructions) . ~~ . . . . «© | . 2 ne io w 16 Interest on business indebtedness a 16 2 17 Bad debts arising from sales or services 3 | 18 Depletion . See ee " 2 19 Other business expenses (specify): at 1 (k) Total other business expenses (add lines 19(a) through 19(j)) . , 19(kK) _ 20 Total deductions (add lines 6 through 19(k)) . re : 0 21 Net profit or (loss) (Subtract line 20 from line 5). Enter here and on Form 1040, line 28. ALSO | | enter on Schedule SE, line 5(a) . Be ee ee ee 21 SCHEDULE C—1.—Cost of Goods Sold and/or Operations (See Schedule C Instructions for Line 2). 1 Inventory at beginning of year (if different from last year’s closing inventory, allach explanation) . . wf. pe 2 Purchases $........000.--2.000.:006 Less: cost of items withdrawn for personal use $.................00- Balarice ee a el nnn Dn a 3 Cost of labor (do not include salary paid to yourself) . - . - 6 1 1 1 ee ee ee en Pe A Materials and supplies © 20. 1 ee ee ee eee eeecenceee feeeee . 5 Other costs (attach schedule) oe eee, oo. my 3 ee —_— | ° 6 Total of lines 1 through 2 1 ee Be eee eeefeceee oe ‘4 7 Less: Inventory atendofyear 2... 1 ee ee te ee an __ . 4 . 8 Cost of goods sold and/or operations. Enter here and on line 2 above... ss: “a 8 —_ 1--82517-1 HW 55998 Doold:32245535 Page 30
phe ited ' ¢ ast ae aaa + ms . x ‘ . ' « : “Schedule C (Form 1040) 1975 , . Page 2 - St, SCHEDULE C—2,—Explanation of Lines 7 and 9 ; mS “Line No. Explanation ; ‘Amount Line No. Explanation + Amount oa. ' Fama hed t ¢ SCHEDULE C-— Depreciation (See Schedule C Instructions for Line G) Tf you need more space, you may use Form 4562. Note: If depreciation is Computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, or the Guideline Class ©” . . Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline | Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)~L1(b)(5)(vi) and 1.167(a)-12, the pro- visions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970. (See Publication 534.) Check box if you ‘made an election this taxable year to use [_] Class Life (ADR) System and/or [_] Guideline Class Life System. 3 ; a. : d. Depreciation e, Method of . ‘ toe oS a. Group and suideline class b. Date rn Cost or allowed or allowable computing {. Life g. Depreciation for : or description ol property acquired - . other basis in prior years depreciation or rate this year _ 1 Total additional first-year depreciation (do not include in items below) 2 Depreciation trom Form 4832 . y no 3 Depreciation from Form 5006 . ( Mobove ) | Wy , 4 Other depreciation: , ; . Buildings . Furniture and fixtures . Transportation equipment . Machinery and other equipment J Other (specify)..........000.2. ee 5 Totals 6 Less amount of depreciation claimed in Schedule C-1, page 1 7 Balance—Enter here and on page 1, line 6 . . SCHEDULE C~4.— Expense Account Information (See Schedule C Instructions for Schedule C—4) Enter information with regard to yourself and your five highest paid Name _Expense account _oataries and Wages _ employees. In determining the five highest paid employees, expense | Owner. ... . . . 2. Us Wy, YU account allowances must be added to their salaries and wages. How- ) 4 . : ever, the information need not be submitted for any employee for | | UU ee EE whom the combined amount is less than $25,000, or for yourself if Bonne ctecece terete reece eetnes Senate | eteeeneereeeeeee cata) eaten anne a . your expense account allowance plus line 21, page 1, is tess than Bol ieeecgcecee ee eee eter eee cence eaenee [ree see eeeeee fete ewes || ween cece eee e erences [ere e ee $25,000. a . Did you claim a deduction for expenses connected with: 5 (1) Entertainment facility (boat, resort, ranch, etc.)? . . [7] Yes twAflo (3) Employees’ families at conventions or meetings? . . (1 Ves No ch (2) Living accommodations (except employees on business)? [7] Yes I (4) Employee or family vacations not reported on Form W-2? [7] -Yes No str US. GOVERNMENT PRINTING OFFICE : 1975-© 575-053 Mims825 17-1 “NW 55923 Doold: 32245535 Page 31
“SCHEDULE D Capital Gains and LOoSS€S (Examples of property to be reported on this | Dy (Form 1040) Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not ot Department of the Treasury | foSSes) on personal assets such as a home or jewelry.) i Internal Kovenue Service >» Attach to Form 1040. ® See Instructions for Schedule D (Form 1040). Social security number’ Sauuer A ty JEK Act 6 MEETS Short-term Capital Gains and osses—Assets Held Not More Than 6 Months (3) ” : a" Date c. Date - e. Cost or other basis, - Kind of property and description acquired “sotd d. Gross sales price _as adjusted (see f. Gain or (toss) ‘ (example, 100 shares of ‘'2’* Co.)- (Mo., day, yr.) (Mo., day, yt.) instruction fF. and (d less ° a (OU rE 1 ; ee i { i ee . . “8 2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries 2 ae 3 Enter not gain or (loss), combine lines 1 and 2 . 3 4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction 1) : (b) Short-term. capital loss carryover attributable to years beginning after 1969 (see instruction I). ‘ 5 Net short-term gain or (loss), combine lines 3, 4(a) and (b) ._- : . os , : Et.almm@ Long-term Capital Gains and Losses—Assets Held More Than 6 Months — . ‘ 6 . faeces a | ere a enenninemernnnmevenae | arene ener nceeneerens | antenna | etait emmrn Rtas | seek RN a) 7 Capital gain distributions . 8 ~~ Enter gain, if applicable, from Form 4797, line 4(a)(2) (see instruction nA) 9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries . . . 10 Enter your share of net long-term gain from small business corporations (Subchapter S) . Co 1l Net gain or (loss), combine lines 6 through 10 . soe . toe ee ee 12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction 1) . 12(a)|_¢ $3 aoeece ee (b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction No. |: (b) |" ¢ _ 13 Net long-term gain or (loss), combine lines 11, 12(a) and (b)_ .) w 7 ee 13 Zia Summary of Parts | and Il 14 Combine the amounts shown on lines 5 and 13, and enter the net gain or (loss) here . is \f line 14 shows a gain— ; (a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part VI for computation ' of alternative tax). Enter zero if there is a loss or no entry on line 13 . oe ; (b) Subtract line 15(a) from line 14, Enter here and on Form 1040, tine 29a : 16 If tine 14 shows a loss— * : & If losses are shown on BOTH lines 12(a) and 13, omit lines 16(a) and (b) and yo to Part IV ' . (see Instruction J). » Otherwise, (a) Enter one of the following amounts: : (i) If amount on line 5 is zero or a net gain, enter 50% of amount on line 14; . (ii) If amount on line 13 is zero or a net gain, enter amount on line 14; or, A oo ‘ (iii) If amounts on line 5 and line 13 are net losses, enter amount on line 5 added to i 50% of amount on line 13. . oe woe (b) Enter here and enter as a (loss) on Form 1040, line 29a, the smallest of: ; (i) The amount on line 16(a); sf ; (ii) $1,000 ($500 if married and filing a separate return—if a loss is shown on line . 4(a) or 12(a), see instruction N for a higher timit not to exceed a $1, 000); or, (iii) Taxable income; as adjusted (see Instruction M) . . oe 1 ‘ “NW 55993 Docld:323245535 Page 32 16—-82511-1
4 4 “NW 55923 DoclId:32245535 Page 33 . 26 Reduce gain, if any, on line 24 to the extent of loss, if any, on line 25 (see Instruction K) Schedule D (Form 1040) 1975 , page 2 Part IV Capital Loss Limitation—Where Losses Are Shown on Both Lines 12(a) AND 13 17 Enter loss from line 5; if fine 5 is zero or a gain, enterazero. . 2. 1. ee ew ee eee 17 18 Enter loss from line 13... ee ee Be ee _18 19 Enter gain, if any, from line 5; if line 5 is zero or a loss, enter a zero. . . Cok ee ee 19 —_ 20 Reduce loss on line 18 to the extent of the gain, ifany, online 19 2. . . . . . 2 |20 21 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero 21 S/ Q Ss a Note: If the entry on line 21 is zero, OMIT lines 22 through 28, and enter on tine 29 the loss shown on line 12(a). 22 Enter gain, if any, from line 11 . 22 23 Enter smaller of amount on line 21 or line 22. 23 24 Enter excess of gain on line 21 over amount on line 23 24 25 Enter loss from line 4{a); if line 4(a) is blank, enter a zero. «. . 25 —-—o-~n 26 27 27 Enter loss from line 12(a) . a 28 Add the gain(s) on line(s) 23 and26.... . . . 2. . «+ + « [28 SLOSS 29 Reduce the loss on line 27 to the extent of the gain, if any, on line 28 (see Instruction L) . 30 Enter smaller of amount on line 29 or line 20 (if line 29 is zero, enter a zero) . 31 Subtract amount on line 30 from the loss on line 20. 32 Enter 50% of the amount on line 31 . 33 Add lines 17, 30, and 32 a 34 Enter here and enter as a (loss) on Form 1040, line 29a, the smatlest of: (a) Amount on line 33; (b) $1,000 ($500 if married and filing a separate return—see Instruction N for a higher limit not to exceed ‘1, 000); or, (c) Taxable Income, as adjusted (see Instruction M). . toe - oe ee 34 | ( Complete Part V if You are Married Filing a Separate Return and Losses are Shown on Lines 4(a) and 14 (See Instruction N) 35 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero. - © © - + + 35 {oe Note: /f the entry on line 35 is zero, OMIT lines 36 through 42, and enter on line 43 the loss shown on ; line 4(a). 36 Enter gain, if any, from line3 . _ 36 37 Enter smaller of amount on line 35 or line 36 . _37_ 38 Enter excess of gain on line 35 over amount on line 37 . _38_ __ _ 39 Enter loss from line 12(a); if line 12(a) is blank, enter a zero . Cee ee ee 39 = 40 Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 (see ‘instruction K) _40_ ; , 41 Enter loss from line 4(a) . 41 42 Add the gain(s) on line(s) 37 and 40. _42— 43 Reduce the loss on line 41 to the extent of the gain, if any, on line 42 (see Instruction Ly. 43 Hee een EZR Computation of Alternative Tax (See Instruction W to See if the Alternative Tax Will Benefit You) 44 Enter amount from Form 1040, line 47 . 44 45 Enter amount from fine 15(a) . . Loe 45 ; 46 Subtract amount on line 45 from amount on line 44 (but not less than zero) . 46 _ 47 Enter smaller of amount on line 13 or line 14... _47 ; If line 47 does not exceed $50,000 ($25,000 if married filing separately), check here > q and omit 2 lines 48 through 54. . 48 Enter your share of certain long-term gains from partnerships, fiduciaries, and small business cor- : ; porations referred to as “certain subsection (d) gains’ (see Instruction W) . . _ 48 ‘ 49 Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger . _49 If tine 49 is equal to or greater than line 47, check here > (| and omit lines 50 through 54. : 50 Muitiply amount on line 49 by 50% _50_ ; 51 Add amounts on lines 46 and 50 . . toe ee es | St). 52 Tax on line 44 or 45, whichever is greater (use Tax Rate Schedule in instructions) ~ _52_ 53 Tax on the amount on line 51 (use Tax Rate Schedule in instructions) _53- 54 Subtract amount on line 53 from amount on line 52. | 4, _ 54 55 Tax on the amount on line 46 (use Tax Rate Schedule in instructions) . . J. | 55 ; 56 If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 250, of line 49 . re : 57 Alternative Tax—add amounts on lines 54 (if applicable), 55, and 56. if smaller than the tax figured on the amount on Form 1040, line 47, enter this alternative tax on Form 1040, line 16a. . . . 57 yr U.S. GOVERNMENT PRINTING OFFICE ; 1975-O-575-054 a 16—82511-1
er a . a re rr ce a are ene ner IEA pt ple ne  n ae ee a oe (). SCHEDULE SE —— ne (Form 1040) Computation of Social Security: Self- Employment Tax . 1975 7 Department of the Treasury p> Each self-employed person must file a Schedule SE. p> Attach to Form 1040. ; : Internal Revenue Service > See Earned Income Credit Instructions on page 8 and Instructions for Schedule SE (Form 1040). : @ If you had wages, including tips, of $14,100 or more that were subject to social security or railroad retirement taxes, do not fill ‘in this schedule unless you are eligible for the Earned Income Credit. See Instructions. ft @ If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE. Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits. i. NAME OF SELF-EMPLOYED PER OF SHOWN ON SOCIAL SECURITY CARD) Social security number of | ¢ , MA: A L self-employed person p> JFK Act 6 uf Business activities subject to self- AB ent tax (grocery store, restaurant, farm, etc.) >» f @ If you have only farm income complete Parts | and Ill. @ If you have only nonfarm income complete Parts Il and Ml. @ If you have both farm and nonfarm income complete Parts |, il, and Il. - Computation of Net Earnings from FARM Self-Employment 7 You may elect to compute your net farm. earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line ! 2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and - 2 must be completed even if you elect to use the FARM OPTIONAL METHOD. REGULAR METHOD (a) Schedule F, line 54 (cash method), or line 74 (accrual method) . 1 Net profit or (loss) from: (b) Farm partnerships 2 Net earnings from farm self-employment (add lines 1(a) and (b)) . . oe see FARM OPTIONAL METHOD (a) Not more than $2,400, enter two-thirds of the gross profits - oe I a) 3 If gross profits * , from farming ' are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1, 600 . wet 1Gross profits trom farming are the total gross protits from Schedule F, line 28 (cash method), or line 72 (accrual wl y method), plus the distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line 14) as Vy yy 4 A . explained in instructions for Schedule SE: lll ! 4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method . Computation of Net Earnings from NONFARM Self-Employment YyYy Le (a) Schedule C, line 21. (Enter combined amount if more than one business.) . . (b) Partnerships, joint ventures, etc. (other than farming) . . . . oe REGULAR METHOD | (c) Service as a minister, member of a religious order, or a Christian Science prac- 5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If you (loss) from: filed Form 4361, check here B® [] and enter zero on this line (d) Service with a foreign. Bovernment or international organization (See Form 1040 (e) Other | structions for tine 35.) Specify. > 6 Total (add lines 5S(a) through (e)) 7 Enter adjustments if any (attach statement) 8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6 6, as adjusted by. line 7) : _ If line 8 is $1,600 or more OR if you do riot-elect to use the Nonfarm Optional Method, omit-lines 9 through 11 and enter amount from line 8 on line 12(b), Part Hl. Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than. $1,600 and less than two-thirds of your gross nonfarm profits,? and you had actual net earnings from. self-employment of $400 or more for at least 2 of the 3 following years: 1972, 1973, and 1974. The nonfarm optional method can only be used for 5 Yy taxable years. Up. a ° NONFARM OPTIONAL METHOD 9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) . . © $1,600 ; (b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.) . . (c) Balance (subtract line 9(b) from line 9(a)) . 7 ww we b. ‘4 : 10 Enter two-thirds of gross nonfarm profits ? or $1,600, whichever is smaller . .). . . we 11 Enter here and on tine 12(b), the amount on line 9(c) or line 10, whichever is smaller . poe 2Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3; plus the distributive Uy Y Yy _— share of gross profits from nonfarm partnerships (Schedule K-1 (Form 1065), line 14) as explained in instructions Yy Y UY noo for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7. |Z Ze YY YYy a MZ Computation of Social Security Self-Employment Tax 12 Net earnings or (loss): (a) From farming (from line 4)... 2. . 1 wee Loe ek a NS (b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) . 13 Total net earnings or (loss) from self-employment reported on line 12. (If Line 13 is less than $400, you are not subject to self-employment tax. Do not fill in rest of schedule.) . .. . wo 14 The largest amount of combined wages and self- employment earnings subject to social Security ¢ or railroad retirement taxes for 1975 is . 2. 1 1... . re . ___ $14,100_ 100 15 (a) Total ‘‘FICA’ wages and ‘'RRTA’’ compensation. . . Lo |__| — oe a (b) Unreported tips subject to FICA tax from Form 4137, line 9 orto RRTA. . _ we . (c) Total of lines 15(a) and (b) Be ; 16 Balance (subtract line 15(c) from tine 14); 2... we ee ee me ] . 17 Self-employment income—line 13 or 16, whichever is smaller... : Loe kok 18 Self-employment tax. (If line 17 is $14,100.00, enter $1,113.90; if less, muted t the amount on line 17 by .079.) Enter here and on Form 1040, line 59. 7 U.S, GOVERNMENT PRINTING OFFICE : 1975-O-575-058 oe a an 16--82518-3 NW 55823 ~Bocld: 32245535 Page 34
NW 55923 Docid: 32245535 Page 35 Bzuwie Computation of Social Security Self-Employment Tax “SCHEDULE SE (Form 1040) Computation of Social Security Self-Employment Tax | 975 Department of tho Treasury p> Each self-employed person must file a Schedule SE. p> Attach to Form 1040. Internal Revenue Service p Sce Earned Income Credit Instructions on page 8 and Instructions for Schedule SE (Form 1040). @ if you had wages, including tips, of $14,100 or more that were subject to social security or railroad retirement taxes, do not fill in this schedule unless you are eligible for the Earned Income Credit. See Instructions. @ |f you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE. Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits. NAME OF ,SELF-EMPLOYED PERSQN (AS SHOWN ON SOCIAL SECURITY CARD) | Social security number of . self-employed person » JFK Act 6 (3) Business activities subject to self- “emplo | (-ROAE EER @ If you have only farm income complete Parts | and lil. @ if you have only nonfarm income ‘complete Parts Il and nT @ If you have both farm and nonfarm income complete Parts |, fl, and Ill. Bitia ee Computation of Net Earnings from FARM Self-Employment . .You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line 2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1, 600. However, lines 1 and 2 must be completed even if you elect to use the FARM OPTIONAL METHOD. REGULAR METHOD . (a) Schedule F, line 54 (cash method), or line 74 (accrual method) . (b) Farm partnerships . 2 Net earnings from farm self-employment (add lines 1(a) and (b)) . oe ee 3 gross profits METHOD | (a) Not more than $2,400, enter two-thirds of the gross s profits Loe ; from farming ’ are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 . 1Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 (accrual GY method), plus the distributive share of gross profits from. farm partnerships (Schedule K-1 (Form 1065), line 14) as explained in instructions for Schedule SE. GUE Hy, 1 Net profit or (loss) from: YH VM MMA ‘ Cla 4 Enter here and on line 12 2(a), the amount on line 2, or line 3 if you clect the farm optional method Part Computation ‘of NetEarnings from” NONFARM Self-Employment ~ (a) Schedule C, line 21. (Enter combined amount if more than one business.) . (b) Partnerships, joint ventures, etc. (other than farming) . . . . soe ee REGULAR METHOD] .(c) Service as a minister, member of a religious order, or a Christian Science prac- 5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If you ‘ (loss) from: filed Form 4361, check here B® [] and enter zero on this line (d) Service with a foreign government or international organization (See Form 1040  in- (e) Other structions for line 35.) Specify > 6 Total (add lines 5(a) through (e)) 7 Enter adjustments if any (attach statement) 8 Adjusted net earnings or (loss) from nonfarm self- -employment (line 6, as adjusted: by line 2) . If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 } through 11 and enter amount from line 8 on line 12(b), Part III. Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than $1,600 and less than two-thirds of your gross nonfarm profits,? and you had actual net earnings from self-employment of $400 or more for at least 2 of the 3 following years: 1972, 1973, and 1974. The nonfarm. optional method can only be used for 5 taxable years. NONFARM OPTIONAL METHOD 9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) . (b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.) . (c) Balance (subtract line 9(b) from line 9(a)) . eee ee 10 Enter two-thirds of gross nonfarm profits? or $1,600, whichever is smatler . 11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller . ; 2Gross profits from nontarm business are the total of the gross profits from Schedule C, line 3, plus the distributive share of gross profits from nontarm partnerships (Schedule K-1 (Form 1065), line 14) as explained in instructions for Schedule SE. Also, include gross profits trom services reported on lines 5(c), (d), and (e), as adjusted by line 7. 12 Net earnings or (loss): (a) From farming (from line 4). 2. 2. 1. we ee se tee te (b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) -. 13 Total net earnings or (loss) from self-employment reported on line 12. (Hf Line 13 is less than $400, you are not subject to self-employment tax. Do not fiil in rest of schedule.) . 14 The largest amount of combined wages and self- employment earnings subject to social | security ¢ or railroad retirement taxes for 1975 is . .. . ___ $14,100 100 15 (a) Total ‘‘FICA’’ wages and ‘“‘RRTA” compensation. . . . — a — __ . (b) Unreported tips subject to FICA tax from Form 4137, line 9 orto RRTA.. . (c) Total of lines 15(a) and (b) . ©. 7 ew we eee es 16 Balance (subtract line 15(c) from line 14) . 2. 2 So. . 17 Self-employment income—line 13 or 16, whichever i is smaller . . . - by 079) Enter here and on Form 1040, line 59 . yc U.S. GOVERNMENT PRINTING OFFICE : 1975—O-575-058 . 16-—-B2518-3
i ‘ 4797 Supplemental Schedule of Gains and Losses oo Oo _ Form Sales, Exchanges and Involuntary Conversions under 1975 . Department of the Treasury ‘ Sections 1231, 1245, 1250, 1251, and’ 1252 Internal Revenue Service To be filed with Form 1040, 1041,. 1065, 1120, etc. —See Separate Instructions vt - Name(s) as shown on return | Parti | Sales or Exchanges df Property Used in Trade or "Basiness, and | (Section 1231) TL f. Cost or other basis, 7 SECTION A.—Involuntary Conversions Due to Casualty and Theft (See Instruction E) 1 a. Kind of property (if necessary, . , ; e. Depreciation al. | cost of subsequent im- . - attach additional descriptive b. Date acquired) c. Date sold d. Gross sales lowed (or allowable) | provements (if not pur- g. Gain or (loss) details not shown below) (mo., day, yt.) | (mo., day, yr.) price since acquisition | chased, attach explana. (d plus e less f) tion) and expense of sale ! 2 Combine the amounts on line 1. Enter here, and on the appropriate line 2 as follows . 7°. 0. 1. we es . (a) For all except partnership returns: 1 . (1) If line 2 is zero or a gain, enter such amount in column g, line 3. 7 4 (2) If line 2 is a loss, enter the loss on line 5 : ‘ ne | Mo, _ ©) For partnership returns: Enter the amount shown on line 2 above, on Schedule K (Form 1065), line 6. 4 Combine the amounts on fine 3. Enter here, and on the appropriate line as follows . (a) For all except partnership returns: a (1) If line 4 is a gain, enter such gain as a long-term capital gain on Schedule D (Form 1040, 1120, etc.) that is being filed. See we instruction E. ; (2) If line 4 is zero or a loss, enter such amount on line 6. (b) For partnership returns: Enter the amount shown on line 4 above, on Schedule K (Form 1065), line 7. BEM 9 Ordinary Gains and Losses f. Cost or other basis, a. Kind of property (if necessary, : e. Depreciation al- | cost of subsequent im- . attach additional descriptive b. Date acquired} c. Date sold d. Gross sales lowed (or allowable) | provements (if not pur- 5 a onto details not shown below) (mo., day, yr.) | (mo., day, yr.) price since acquisition chased, attach explana- . tion) and expense of sale 5 Amount, if any, from line 2(a)(2) 6 Amount, if any, from line 4(a)(2) 7 Gain, if any, from page 2, line 21 9 Combine amounts on tines 5 through 8. Enter here, and on the appropriate line as follows . ; (a) For all except individual returns: Enter the gain or (loss) shown on tine 9, on the line provided for on the oe : , return (Form 1120, etc.) being filed. See instruction F for specific line reference. - (b) For individual returns: : 7 ee — (1) if the gain or (loss) on line 9, includes losses which are to be treated as an itemized deduction on Schedule A (Form 1040) (see instruction F), enter the total of such loss(es) here and include on Schedule A (Form 1040), line 29— identify as “loss from Form 4797, line 9(b)(1)"" . (2) Redetermine the gain or (loss) on line 9, excluding the loss (if any) entered on line 9(b) (1). Enter here and on Form 1040, line 30 Looe eee 16—82504-1 — . Oe < Form 4797 (1975) « . _ BW S5923 Doold: 32245535 Page 34
, NW 55923 Docld: 32245535 Page 37 ° Form 4797 (1975) 7 . , : Page 2 Gain From Disposition of Property Under Sections 1245, 1250, 1251, 1252—Assets Held More than Six Months (See Separate Instructions) Disregard lines 18 and 19 if there are no dispositions of farm property or farmiand, or if this form is filed by a partnership. 10 Description of sections 1245, 1250, 1251, and 1252 property: . |. Pate acquired mn ee, | OODLE. EY. B. (ST. Property (C) Relate lines 10(A) through 10(E) to these columns » » 11 Gross sales price . 12 Cost or other basis and expense of sale . 13 Depreciation allowed (or allowable) 14 Adjusted basis, line 12 less tine 13 15 Total gain, line 11 less line 14. 16 tf section 1245 property: (a) Depreciation allowed (or allowable) after ap- plicable date (see instructions) . . . . (b) Enter smailer of line 15 or 16(a) ; . . , 17 If section 1250 property: (a) Enter additional depreciation atter 12/31/83 . ; , . a rand before V/L/70 2 Penne cece etteeeeeenete | eoeeceneeeteeeereetene| sreeeees ee, iar wets [oceeeeecenerececeeeees (b) Enter additional depreciation after 12/31/69 sesee eee eeeeseeceeseee 2 eceeeceees [eeseeeeeeeeeeee ne nT OE | (c) Enter smaller of line. 15 of 1709). 0 | ee -n ee en ee ee ene cece ee | eee e teen ene e recente | cece eee c eect eet ec ees |ececee gee ensceee samen) ores tetenmeenembereees -(d) Line 17(c) times applicable percentage (see : . instruction’G.4) -. vo [scence ence ee eee e ccc ee fcc e ence ene c tesa estes |ee sence eee eteees|eeeeneeetaneeeceeccee peeeeneceen eeceeeeeeee (e) Enter any excess of tine 15 over line 11(b )g [eneeeee eee ee eee cece: [penn cee nee eee eee rete fee ee eet areca cede ceeees| mene eeceeaecereeeeces denen eeneeeee eee en (f) Enter smaller of line 17(a) or 17(e) . : (g) Line 17(t) times applicable percentage. (see . instruction G4). : : _ . . (h) Add lines 17(d) and 17() 18 If section 1251 property: (a) ‘lf farmland, enter soil, water, and land clear- ing expenses for current year and the four preceding years . . (b) ‘f farm property other than tand, subtract ‘line ‘16(b) from line 15; OR, if farmland, enter ‘smaller of line 15 of 18(a) (see instruction . : Cs) a OO weeeeecececee ceeeceees (c) Excess deductions account (see instruction . ne __ (da) Enter r smaller of line 18(b) or 18(c) . . 19 If section 1252 property: (a) Enter soil, water, and land clearing expenses : . ; made after 12/31/69 . oe ra I ONS Onn Se bn (b) Enter amount from line 18(d), if none enter a 51 0 cc cece | ceecececececeeesenenes (c) Enter any excess of line 19(a) over line 19(b) (d) line 19(c) times applicable percentage (ee : instruction G.5). . Fa nn Sn SN a (e) Line 15 less line 19(b) , (f) Enter smaller of line 19(d) or 19{e) . . Summary of Part Ill Gains (Complete Property columns (A) through (E) through line 19(f) before going to line 20) 20 Total gains for all properties (add columns (A) through (E£), tine 15)... , se ee ee . oe DYE... . 21 Add columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter here and on line7 . . 7 sone 2231/3 - s7 0S. _ WULS, GOVERNMENT PRINTING OFFICE 13995 —-O-575-158 ‘ . Jo . , . 16--82504~1 22 Subtract line 21 from line 20. Enter here and in appropriate Section in Part | (see instructions E and G.2) . €
rom 4798 Department of the Treasury Internal Revenue Service A. Who Should File.-—You wil! need to complete either . Part 1 or Part Il of this form if you have a capital. loss to Capital Loss Carryover » (From 1974 to 1975) m Attach to Form 1040. JFK Act 6 B. How to Compute Carryover.—lIf you have a capital _ loss carryover, complete either Part | or Part Ii of this form, but do not complete both. WNW 55923 Docld:32245535 carry over to 1975. oe 1. Complete only Part | if lines 4(a) and 12(a) on . your 1974 Schedule D (Form 1040) DO NOT SHOW A LOSS. “2. “Complete only Part Il if either (or both) line 4(a) or line 12(a) on your 1974 Schedule D (Form 1040) shows © a loss. You will have a capital loss to carry to 1975 if the amount on your 1974 Schedule D (Form 1040), line 16(a), or line 33, is LARGER THAN the loss deducted on your 1974 Form 1040, line 29. 5 GEG Post-1969 Capital Loss Carryovers nnn aan Section A,—Short-term Capital Loss Carryover Enter loss shown on your 1974 Schedule D (Form 1040), line 5; if none, enter zero and ignore lines 2 through 6—then go to line 7 . oo Loe 2 Enter gain shown on your 1974 Schedule D (Form 1040), line 13. i that line is "blank or "shows aloss, enter a zero. 6 2 ee ne 3 Reduce any loss on line 1 to the extent of any gain on line 2 . . 3 - a“ . \ oo 4 Enter amount shown on your 1974 Form 1040, line 29 4 \ f . — = 5 Enter smaller of line 3 or 4 . 5 6 Excess of amount on line 3 over amount on fine 5 6 Note: The amount on line 6 is your short-term capital loss carryover from 1974 to 1975 that is attributable to years beginning after 1969. Enter this amount on your 1975 Schedule D (Form 1040), line 4(b). sO Section B.—Long-term Capital Loss Carryover _ 7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1974. Form 1040, line 29) . : . oo 8 Enter loss from your 1974 Schedule D > (Form 1040), line 13: if none, enter zero and ignore lines 9 through 12 9 Enter gain shown on your 1974 Schedule D > (Form 1040), line 5. if that line is ‘blank or “shows a loss, enter a zero 10 Reduce any Joss on line 8 to the extent of any gain on line 9 11 Multiply amount on line 7 by 2 . 12 Excess of amount on line 10 over amount on line 11 . Note: The amount on line 12 is your long-term capital loss carryover ; from “1974 to ‘1975 that is attributable to years beginning after 1969. Enter this amount on your 1975 Schedule D (Form 1040), fine 12(b). Form 4798 (1975) Page 38
— ie Ea ne alae i 2 Pie LLIS k uBy 7 - CALENDAR YEAR 19° (3) 5 JFK Act 6 OC. SEC. NO. DEDUCTION SCHEDULE - MEDICAL STATE nn CASUALTY OR THEFT (LOSS(E 26 INSURANCE REIMBURSEMENT 27 26 ($100 LIMITATION PER CAS.) MISCELLANEOUS DEDUCTIONS OALIMONY.— - . 1 UNION/PROFESSIONAL DUES 2 CHILD & DEP. CARE (Form 2441 3 INCOME TAX PREPARATION: UNIFORMS/PROTEC. CLOTHING SMALL TOOLS AND SUPPLIES LAUNDRY AND CLEANING AUTO USE/DAMAGE INVEST. COUNSEL & PUBS.(Sched ___ EMPLOYMENT AGENCY FEES SAFE DEPOSIT BOX TEL. REQ. IN BUSINESS POLITICAL CONTRIBUTIONS PROSTHETIC APPLIANCES ) HEARING AID 6c AMBULANCE LABORATORIES ’ TRAVEL FOR MED. | uh ' a MEDICARE INS. GLASSES 7 MEDICAL EXPENSES - LESS REIMBURSED BY INS. 8 LESS 3% ADJ. GROSS INC. g . I +:% (TO $150)-OF H & A INS. + (QTOTAL MEDICAL DED. : _TAXES "STATE & LOCAL INCOME — AZREAL ESTATE ' T3STATE & LOCAL GASOLINE | 14GENERAL SALES TAX 15a PERSONAL PROPERTY | ISbeERSONAL PROPERTY AUTO . I6SALES TAX AUTO FEDERAL STATE FEDERAL " "_2MEoIcINE/ORUGS [| Fs casts conmeunutions “Xf __{_}__ '.. JLESS 1% A.G.I. (Line 18 - 1040) 21h PARTNERSHIP SHARE ss es \- @ANET MED/DRUGS i GIRL/BOY SCOUTS Y [| ff. | » “BH &AINS. (% + EXCESS) ——pst 4 HEARTFuND/cANCcCERFUND | ———sdYsS iad] ;  _Baor. Se a Re | Ton, [Tse oncanizeo cnanitesf tf OR. fo | | 877) | churcres ye ee oR, (—— — en 2s OR. 7 es a RO | or SF _ SO i |_| | [@otnertHancash fT = Zi canny OVER FROMPRION val |} I. 6b HOSPITAL | 24 TOTAL CONTRIBUTIONS £84 |__| . |_| || | | | | ~~ b ; PS i 34 TOTAL MISC. DED. UN _ [| | 2a gl | P| pA | ot | ee Pt p ee = UMMARY OF ITEMIZED DED. 35 TOT. OEDUCTIBLE MEDICAL & DENTAL EXPENSES (FROM LINE 1 36 TOTAL TAXES (From LINE 17) 37 TOTAL INTEREST (Line 20) 38 TOTAL CONTR. (Line 24) 39 Cas. & THEFT LOSS(ES) {Line29) 40 TOTAL MISCELLANEOUS . DEDUCTIONS (FROM LINE 34} STATE FEDERAL 17 TOTAL TAXES INTEREST (TO WHOM PAID 1B MORTGAGE | E bh IDINSTALLMENT LOANS MLSC ‘ : is aN weéma _d wo ZBL TOTAL ITEMI7 Ef) DEDUCTIONS | —_ Fe [) C. & 4 ENTER ON FORM 1040 LINE 45 REMARKS hid : a 20 TOTAL INTEREST PS] Professional Stationers, Inc. j : . se . Late . “ DT sentinel! Calc 91605 : SCHEDULE WW 55923 Docid: 32245535 ; ; kj 7 g 3 ft o 2 bh — La) Tee le a te eee a eaten cm
ry oy - NAME —e OR soc. SEC. NO. JEK Act 6 “<" ADDRESS FISCAL YEAR ENDING "| 19 EDULE OF PROFIT OR LOSS FROM BUSINESS OR PROFESSION PRINCIPAL BUSINESS ACTIVITY BUSINESS NAME . . . EMPLOYERS NO. BUSINESS ADDRESS TOTAL RECEIPTS INVENTORY AT BEGINNING OF YEAR MERCHANDISE PURCHASED TOTAL LESS INVENTORY AT END OF YEAR tt GROSS PROFIT GROSS INCOME nt \ : : OTHER BUSINESS DEDUCTIONS ADVERTISING : a AUTO AND TRUCK EXPENSE - BAN DEBTS a COMMISSIONS rn ee Ae eR DELIVERY nn DEPRECIATION ( SCHEDULE BELOW ) QUES AND SUNSCRIPTIONS a nr } - ENTERTAINMENT AND PROMOTIONAL _ INSURANCE INTEREST JANITOR AND HAULING a LEGAL AND ACCOUNTING { OFFICE SUPPLIES AND EXPENSE IE oe RENT REPAIRS AND MAINTENANCE re SALARIES AND WAGES SUPPLIES. % : TAXES AND LICENSES TAXES PAYROLL TELEPHONE AND UTILITIES. in NET PROFIT OR (LOSS ) FEOERAL RETURN | . NET PROFIT OR (LOSS ) STATE RETURN - SEE DEPREC, SCHEDULE FOR DIFF, GIssrx C907 ea ScHEDULE OF DEPRECIATION : DA COST OR 3 ; OTHER BASIS | PROFESSIONAL STATIONERS INC FORM JO4A : Lo ; : LOS ANGELES, CALIF. Bo met SCHEDULE “MW 55923 DocId:32245535 Page 41. ~ | os ld vA
1. SELLING PRICE: CASH 2 NOTES 3 MORTGAGE TRANSFERRED 4 | OTHER 5. GROSS SALES PRICE (14+2+3+4) 6. COST OR BASIS 7. LESS ACCUMULATED DEPRECIATION _ 8... PRIOR TO 1—1—62 9. PRIOR TO 1—1-64 40. AFTER 12-31-61 “44. ST. LINE AFTER 12-31-63 - 42. _ EXCESS OVER S/L.1-64/12—69 +, 13. EXCESS OVER S/L AFTER 12-31-69 | «29, RECOGNIZED GAIN — ORDINARY “NW 55923 _Docld:32245535 - Page 42 _ DESCRIPTION OF PROPERTY. np 23. CASH (1) 24.. PRINCIPAL COLLECTIONS - 5. - EXCESS MORTGAGE OVER BASIS 26.. OTHER (4) . | f H, LJ ? hu ey Calendar Yr: - , iy oo * NAME Srouerd Pay r £ bre. SEC. NO, VE 19 GAINS ON | INSTALLMENT SALES | v DATE SOLD IE ‘a DATE ACQUIRED TYPE OF ASSET: | _ oe CAPITAL | SEC. 1245 -|_ SEC. 1250 14. ADJUSTED BASIS (6—7 THRU 13) 15. EXPENSES OF SALE 16. TOTAL ADJUSTED BASIS (14 + 15) 17. TOTAL GROSS PROFIT (5 — 16) 18. TOTAL GROSS PROFIT ~ ORDINARY . TOTAL GROSS PROFIT — OTHER . CONTRACT PRICE (1 +2 +4) 21, GROSS PROFIT % — -22. PAYMENTS RECEIVED YEAR OF SALE 27. TOTAL PAYMENTS (23 THRU 26) 28. RECOGNIZED GAIN 30. RECOGNIZED GAIN — OTHER ORDINARY INCOME TOTAL neers SECTION 1245 SECTION 1250 CAPITAL GAIN ABLE PAYMENTS REPORTED BALANCE REPORTED BAL ANCE REPORTED _ BALANC! Toth Ye A nes eee 4 le Ennio : ; v ~ CCHENHIE .
“| 4 “Nw S3923 Doold:32245535 Page 43 INDIVIDUAL . CALIFORNIA NS’ INCOME TAX a PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) ‘} Check SaeCalendar Year Enter social security number(s) only if incorrect or not shown on label. - One: = [7] Fiscal Year Ending 1976 FOR FEDERAL PRIVACY ACT NOTIFI- CATION SEE PAGE 2 OF INSTRUCTIONS NAME_UA(If joint return, give first pi: initials of both) ALVA E be Pi PLL IS JFK Act 6 (3) OCCU- Yours /& PATION Spouse's FILING STATUS neck wi) EXEMPTION CREDITS If line 1 or 3 checked, enter $25 1 nN Single 6 ‘Personal Hf line 2, 4 or 5 checked, enter $50 7 Dependents — Do not list yourself, your Spouse or the person who qualifies you as head of household. Enter name and relationship. . ELISA THOMAS | 8 Blind (refer to instructions) Number of blind exemptions m= x SBC, 5 [1 Widow(er) with dependent child (Year spouse died 197__}} 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20 7 Married filing joint return (even if only one had income) 3 OO Separate return of married person—Enter spouse’s social security number and full name here 4 [) Head of Household—Enter name of qualifying individual { Attach copy 2 of Form(s) W-2 to face of this ? 10 Wages, salaries, tips and other employee compensation ) return. If unavailable, see instructions, Page 6 | 11 Dividends—before federal exclusion. Enter total {if over $400, complete and attach Schedule Bt540)) 12 Interest. Enter total (if over $400, complete and attach Schedule B(540) )- 13 Income other than wages, dividends and interest (from line 48) 14 Total (add lines 10, 11; 12 and 13) 15 Adjustments to income (from line 55) 16 Adjusted gross income (subtract line 15 from line 14) ® ff line 1 or 3 is checked and line 16 is $4,000 or less, enter zero tax on line 23. Da not complete © If line 2, 4, or 5 is checked and tine 16 is $8,000 or less, enter zero tax on line 23. | lines 17 thru. 22 © If you do NOT itemize deductions AND tine 16 is under $15,000, find tax in Tax Table and enter on line 19. © If you itemize deductions OR line 16 is $15,000 or more, complete tines 17 and 18. 17 Deductions: Itemized (from line 62) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked) 18 Taxable income (subtract line 17 {rom line 16) Compute tax fyem Tax Rate Schedule—Enter tax on line 19 “4 ATTACH COPY 2 OF FORM W-2 HERE » 19 Tax from (check one) Tax Table [ Tax Rate Scheddteg Income Averaging Schedule (G or G-1) O 20° Total exemption credits (from line 9, above) : 21 Tax liability (subtract line 20 from tine 19—if line 20 is greater than line 19, enter * zero) 22° ‘Other credits (from tine 65) . 23. Net tax liability (subtract line 22 from fine ‘it line 22 is ereater than jine 21, enter + 2e10) 24 Tax on preference income (see instructions—attach Schedule P(540)) 25° Total tax liability (add lines 23 and 24) 26 Total California income tax withheld (attach W-2 or W-2P to face of this return) . 27° Renter’s credit—if you lived in rented property on March 1, 1975, complete Part 1 on page 2 28 1975 California estimated tax payments 29 Excess California SDI tax withheld (attach Form DE 1964 t to face of this return) 30 Total prepayment credits (add lines 26 thru 29) ' P.O. BOX 13-540 SACRAMENTO, CA 95813 34 Amount of line 32 to be credited on your 1976 ESTIMATED TAX . a] = . . . . . . . . . . . . . . r bs = 31 If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero. o Pay in full and mail with return to: FRANCHISE TAX BOARD samme PAY IN FULL —> tm 31 or a a SACRAMENTO, CA 95867 , Do not write in these spaces a 32 If line 25 is smaller than line 30, enter amount OVERPAID ee iy) ‘ = ‘33° Amount of line 32 to be REFUNDED TO YOU. Allow at least six “weeks. S Mail return to: FRANCHISE TAX BOARD 1 33 = ao < E <x <——: ESTIMATED TAK ; 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 knowled3e. Write social security number on check or money order. ATTACH HERE » g SIGN signature ; Date - 2 P caer Signature (other than taxpa ’ HERE b> ef ee JEK Act 6 (3) Spouse’s signature—if filing a joint return Date . . ” Address (and Zip code)
{ { a 1 ' ‘ 1 t 4 i PART IV — itemized Deductions — “57 Total child adoption expenses (from Schedule A(540), tine 13) Page 2 Form 540 (1975) PART | — Renter's Credit — All questions must be answered 35 Did you, on March 1, 1975, live in rented property which was your principal residence? . . . . Qj Yes yh vo If no, you may not claim this credit 36 Was the property you, rented exempt from property tax? . . . toe oe ew we ew ee) 6 Yes ONo . if yes, you may not claim this credit 37 Did you tive with any other person who claimed you as a dependent | for income tax purposes? . . [] Yes °( No If yes, you may not claim this credit 38 Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance? ([) Yes (0 No If yes, see page 6 of instructions PART Ii — Other Income 39 Business income (or loss) (attach Schedule C(540)) ~ 40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule 01540) 41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D- 1(540)) 42 Pensions and annuities ATTACH SCHEDULE E 44 Partnerships . . 2. FORM (540) 45 Estates and trusts . 46 farm income (or loss) (attach Schedule F(540) } 47 Miscellaneous income” ’ (a) Fully taxable pensions and annuities (not reported on Schedule £(540) (b) Alimony ae (c) Other (state nature and SOUTCE oe eceeeeree reser enscassenssatnenntansocarsnenssavoeecceeacenenee Enter total of lines 47(a), 47(b), and 47(c) . 48 Total (add lines 39 thru 47). Enter here and on line 13. 43 Rents and toyalties PART lil — Adjustments to Income “Sick pay,” if included in line 10 (see instructions — attach statement) 50 Moving expenses (see instructions — attach statement) 51 Employee business expenses (see instructions — attach, statement) 52 Military exclusion (see instructions) . 53 Payment as a self-employed person to a retirement plan, etc. ‘(see instructions) §4 Forfeited interest penalty (see instructions) Lo. : 55 Total adjustments (add lines 49 thru 54). Enter here and on line 15 © Attach Schedule A(540) and enter sub-totals on lines 56 thru 61, below 56 Total deductible medical and dental expenses (from Schedule A(540), line 10) 58 Total taxes (from Schedule A(540), line 20) 59 Total interest expense (from Schedule A(540), line 23) 60 Total contributions (from Schedule A(540), line 28) 61 Total miscellaneous deductions (from Schedule A(540), line 39) 62 Total itemized deductions (add lines 56 thru 61). Enter here and on line 17 PART V — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW. 63 “Other State’ net income tax credit (attach copy of other state return and Schedule S(540)) 2. 2. 2. 2 2 wk eegecens 64 Retirement income credit (attach Schedule RIS40)) 2. ee ‘O) ; 65 TOTAL (add lines 63 and 64). Enter here and on line 22 MW 55923 Dooltd:322455355 Page 44
“NW 55923 Docld:32245535 _ 4. Subtract line 3 from line 2. Enter difference (if less Taxes FORM 540 Name as shown_on Form 540 yp MIAEL _, by If your adjusted gross income is $8,000 or less and your filiig status is “Married, Filing fointly,” “4 ‘(f of Household,” or “Widowler) With Dependent Chifd, r “Married, Filing Separately,” do not itemize, enter zero on Form 540, line 23, and check the tax or $4,000 or less and your filing status is “Single,” table box. USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION Medical and dental expenses (not compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospital care, insurance premiums for medical care, etc. , 1. One half (but not more than $150) of insurance ia premiums for medical care................ Dees 2. Medicine and drugs. 2.00... eee 3. Enter 1% of line 16, Form 540 ; than zero, enter zero)....2 0.0... eee 5. Enter balance of insurance premiums for medical care not entered on line 1.6... eee 6. Other medica! and dental expenses: ~ ’ (a) Doctors, dentists, nurses, etc.......... re (b) Hospitals 00... reece eee (c) Other (itemize) eect cece ecneceeeteecnee tees 9. Subtract line 8 from line 7. Enter difference (if less S| than -zero, enter zero)...............-..2..000.. 10. Total—(Add lines 1 and 9. Enter here and on Form 540, line 56)............ ee RL IT. : Child Adoption Expense 11. Total expenses paid or incurred—Attach itemized list [ood 12. Enter 3% of line 16, Form 540.................. _ 13. Subtract line 12 from line 11—See instructions for maximum limitations. (Enter here and on Form 540, line 57)... cece ees 14. Real estate... eee 15, State and local gasoline...........0...-.0...20 04s 16. General Sales...... bbc cee tee cee eee ee enened 17. Auto license—Excess of registration and weight fees (see instructions)....................0. 0c eee 18. Personal property (Boat and Aircraft).............. 19. Other (itemize) 20. Total taxes—(Add lines 14 thru 19. Enter here and on Form 540, line 58).......... 0.0.00... ese eeee, Page 45 > CALIFORNIA ITEMIZED DEDUCTIONS Attach to Form 540 30. Insurance reimbursement.................... cones 31. Subtract line 30 from line 29. Enter difference (if line " 33. Casualty or theft foss (line 31 less tine 32)........ TAXABLE. 41975. YEAR JFK Act 6 (3) Interest Expense 21. Home mortgage... 6... eee 22. Other (itemize) 23. Total—(Add lines .2! and 22. Enter here and on Form 540, line 59) Leet b ene e teen ete Contributions . 24. Cash contributions for which you have receipts, canceled checks, etc......... cect b eens 25. Other cash contributions. List donees and amounts 26. Other than cash—See instructions for required state- ment ....... Se eee cee e eset e beeen eee 27. Carryover from 1974—See instructions.......... , 28. Total—(Add lines 24, 25, 26, and 27. Maximum de- duction may not exceed 20% of adjusted gross income. Enter here and on Form 540, line 60)...... Miscellaneous Deductions Casualty or Theft Loss(es)—See instructions _ NOTE: If you had more than .one loss, omit lines 29 through 33 and follow instructions for guidance. 29. Loss before insurance reimbursement.............. : 30 is greater than tine 29, enter zero)............ 32. Enter $100 or amount on line 31, whichever is smaller 34. Alimony paid.) 0... eee eee 35. Child care—See instructions. Levee eens wegen es 36. Union dues.................0000.0000. coeeeeeees 37. Employment education expense—See instructions... . 38. Other—litermize) ee ecsccseeseecneeeeeteenseeeeeeenen a 39. Total—Add lines’ 33, 34, 35, 36, 37, and 38. (Enter . - here and on Form 540, line 61)..:........0...... : —
— @ CALIFORNIA 4 PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION ” 7 (Sole Proprietorships) ; Ww Attach this schedule to your Income tax turn, Form 540 or S40NR oe Partnerships, joint ventures, etc., must file on Form 563 ‘| Name as shown.on Form 540 or S40NR a’, ’ y) ' : ecurity Number . aMuEeltdt fHyrrs Kuey ; B. Federal Employer |.D. No. 1 A. Name and Address of Businesg y ; _ ©, Principal business activity (i.e., retail-hardware; wholesale-tobacco; services—legal; ete) om & AM Coe BA (Pi Lk bb AE. ‘4D. Indicate method of accounting: D cash; roen a eeaceceececceceenseoreeeeeceneenecceceescecceneneneettee a '£, Were Forms 591, 592, 596 and 599, for the cal -filed (if required)? iphves 0 NO ° : F. Method of inventory valuation B....... PA 6 Sl Yo ceeeeneeecssetcespscanassnansananaensnaeesge rane iessensetsnnnnvsssesessteeeeseeueeeee . Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories? CO YES [NO If “Yes,” attach exptanation. : ; Ys 1 Gross receipts, sales, or fees $c cece Less returns and allowances $........... eee lesescanenpeesieeee Balance > a 2 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)... .... a Cr 3 Purchases $.................-............Less cost of items ‘withdrawn for personal use $_.. 2... eee ceseseeeee CY 7 4 Cost of labor (do not include salary paid to yourself)... .5. 0.6... cee tenes a = § Materials and supplies.................. once et nent netted Meee cece Lee a 6 Other costs (explain in Schedule C-2 or attach Schedule)... 0.02.00. 0 cece cece cece eee e eens rr “7 Total of lines 2 they 6. ees oeeeees Lecce Pp 8 Inventory at end of this year eee es Dolce eee Pd at . -9 Cost of goods sold (subtract line B from line 7)...... 0.00. ce cece ce ceveceeceeeeeeeveereteretevees cc cece eee gee eens 10 Gross profit (subtract line 9 from line I... cette ey eed ce eee eeeus vee beet eunees “19 Other income “(attach schedule)... 0... eee ceeeeeeees eee bbb te ee ce ees “1 42 Total Income (add lines 10 and 11)................ vee eects veeteeeees beveee a. cove eve ubetvtrtttet te eebieeree. : : OTHER BUSINESS DEDUCTIONS “43 Depreciation (explain in Schedule C-1 or attach Schedule)............ | t—SY '! 44 Taxes on business and business-property (explain in Schedule C-2 or attach Schedule)................. an fT * 15 Rent on business property... ...00 00.0.0. eee eee ees sd ; “+ 16 Repairs (explain in Schedule C-2 or attach Schedule). 66... eek eee cones. vee beeen | 17 Salaries and wages not included on line 4 (exclude any paid to yourself)..................0.0000 nee | s—SCsdY 18 Insurance 20 tents cece cette center ee es Pe 19 Legal and professional fees......... a Pe 20 Commissions... 0.0. nett e ences Lee cee cee | —sSY 21 Amortization (attach statement)... ....0....00...0. 0.00. c ee eee weet e ence tenes fT 22 Retirement plans, etc. (other than your share, see instructions)... .. ree 23 Interest on business indebtedness................-.........000- tebe c dee be ce teen nn ees Pd 24 Bad debts arising from sales or services (Not applicable if reporting on cash basis)...................... | —SCY SF 97 Total of Hines 13 th 28 neta oo. ae “. 28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or S40NR.... ¢ Ce Le cece we AG G Group and guideline class Cost or Depreciation Method of Life or Depreciation . allowed (or allowable) computing : or description of property other basis in prior years depreciation Rate : for this year eee ( - ) geet seet OQ GO OY . ass ‘ : . . > S33 (7 a CN A t ok ges | Se a ge( SG DO NW 35923 Dooid:32245535 Page 46 . ; . :
os  & —— CAPITAL GAINS AND LOSSES Attach to Form 540 or S40NR Use this schedule to report gains and losses on stocks, bonds and similar investments, and gains (but not losses) on personal assets such as a home or jewelry. Name as shown on Form 540 or 540NR Ca V PART I—Assets Held One Year or Less ~ ' a D te. Cost or other basis as adjusted, cost of subse- JFK Act 6 (3) a. Kind of property and description . b. Date acquired c. Date sold d. Gross sales - quent improvements (if f..Gain or loss ‘ (Example, 100 shares of ''Z’’ Co.) (mo., day, yr.) (mo., day, yr.) price not purchased, attach Ad. fesse) |. | oe . explanation) and = ex- : : pense of sale 4 "2. ‘Enter gain ‘(or loss), ‘if “applicable, “from line 18, ‘Schedule D- 1 (540) (attach copy) . 3. Enter your share of net gain or loss from partnerships and fiduciaries . - 4, Net gain or loss, combine lines 1, 2 and 3 es Se reer Fer Oc re rere PART 1l—Assets Held More Than One Year But Not More Than Five Years * 6. Enter gain (or loss), if applicable, from line 20, Schedule D-1 (540) (attach copy) 7. Enter your share of net gain or loss from partnerships and fiduciaries . 8. Net gain or loss, combine lines 5, 6 and 7 PART tli—Assets Held More Than Five Years “ 10. Enter gain (or loss), if applicable, from ‘line 22, Schedule D-1 (540) (attach copy) i : 11. Enter your share of net gain or loss from partnerships and fiduciaries . 12. Net gain or loss, combine lines 9, 10 and 11 PART IV-——Summary of Capital Gains and Losses i 13. Enter amount from line 4 , 14. Enter 65% of the amount on line 8 15. Enter 50% of the amount on line 12 . . 16. Enter unused capital loss Carryover from preceding taxable years (ottach compuration i 17. Combine the amounts shown on fines 13, 14, 15 and 16 * % 18, If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or ‘540NR . 4 19. if line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of: - (a) amount on lines 17; ; ; (b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange of capital assets; or Pyw 55949 $4000 68500.i9 the casepaf,a hysband or wife filing a separate return)
“NW (B5/9%34,)DoecIld: 32245535 Page 48 1 t ‘ ‘ 10. If Section 18219 property: af 12. Enter amounts from lines 7(b), 8(h), 9(d) and 10(f} SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES (Sales or Exchanges Including Involuntary Conversions) (Attach to Form 540, S40NR, 541 or 565) , FORM 540 Name as shown on Tax Return PART | Gain From Disposition of Property Under Sections 18211, 18212- 18, 18219, 18220 Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership. 1. Description of Sections 18211, 18212-18, 18219, and 18220 property._ (mo. day. 9) LAN WOOP tM. BISTRO... OFF EE ot MOF ...|. L 2S. Correlate lines 1(A) through 1(D) with these columns ———> ee Property 7 Gross sales price Cost or other basis and expense of sale Depreciation allowed (or allowable) . Adjusted basis, line 3 less line 4 Total gain, subtract line 5 from line 2 If Section 18211 property: (a) Depreciation allowed (or allowable) after applicable date. (See Instruction D-3) (b) Line 6 or line 7(a), whichever is smaller 8. If Section 18212-18 property: (a) Enter additional depreciation after 12-31-63 and before ; 1-1-7] . (b) Enter additional depreciation ‘after 12. 31 70 (c) Enter line 6 or line 8(b), whichever is smaller . (d) Line 8(c) times applicable percentage (Instruction D-4) . (e) Enter excess, if any, of line 6 over line 8(b) (f) Enter line 8(a) or line 8(e), whichever is smaller . (g) Line 8(f) times applicable percentage (Instruction D-4) (h) Add line 8(d) and line 8(g) Lo. 9. If Section 18220 property: (a) If farm land, enter soil and water conservation expenses No as wp for current year and four preceding years . (b) If farm property, other than land, subtract line 7 (b) from - line 6; OR, if farm.land, enter line 6 or fine 9{a), which- ever is smaller (see Instruction D-5) (c) Excess deductions account (see Instruction D-5) (d) Enter line 9(b) or line 9(c), whichever is smaller . (a) Soil and water conservation expenses made after 12-31-69 (b) Enter amount from line 9(d), if any; otherwise, enter a zero (c) Enter excess; if any, of line 10(a) over 10(b) ({d) Line 10(c) times applicable percentage (Instruction D-5) (e) Line 6 less line 10(b) an i (f) Enter smaller of line 10(d) or line 10(e) . SUMMARY OF PART | (Complete Property Columns (A) 11. Enter amounts from line 6 through (D) up to Line 10(f) before going to Line 11)’ 13. - Subtract line 12 from line 11, enter here and in appropriate Section in Part H (see Instruction D-2) Lok! , 14. Total of Property Columns (A) through (D), fine 12. Enter here and on line 24, Part Hil
' Schedule D-1(540) ‘+ PART Il Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions 7 (Section 18181-82) see Instruction E ‘Section A— INVOLUNTARY CONVERSIONS DUE TO CASUALTY AND THEFT f. Cost or other basis, cost of subsequent improvements (if not purchased, attach explanation) and expense of sale g. Gain (or toss) (d. plus e. less f.)- e. Depreciation allowed (or allowable) since acquisition a. Kind of property (if necessary, attach statement of descriptive details not shown below) d. Gross sales” price c. Date sold (mo., day, yr.) b. Date acquired (mo., day, yr.) we ae OME TE 16. Combine the amounts on line 15, enter here and also on the appropriate , Tine as follows (a) For all returns, except partnership returns: (1) If line 16 is zero or a gain, enter amount of each gain or- loss, above, in. - column (g) of applicable Section B-1, B-2 or B-3; (2) If line 16 is a loss, enter such amount on line 25 of Part Ill. (b) For partnership returns: Enter gain(s) and loss(es) in Schedule K (Form 565). See Instruction E. Section B-—— SALES OR EXCHANGES OF PROPERTY USED IN TRADE OR BUSINESS AND CERTAIN INVOLUNTARY CONVERSIONS (Not Reportable in Section A) Section B-1 Property Held One Year or Less . 22. Combine the amounts on line 21, enter here . -23. Combine the amounts on lines 18, 20 and 22; enter here and also on the appropriate line < ds follows . (a) For all returns, except partnership returns: (1) If line 23 is a gain, enter the amounts from lines 18, 20 and 22, on lines 2, 6 “and 10, respectively, of the Schedule D (Form 540), or if filing Form 541, enter amounts from lines 18, 20 and 22, on lines. 2, 7 and 1), respectively, of the Schedule D (Form 541). (2) If line 23 is a loss, enter such amount on line 26 of Part Whe (b) For partnership returns: Enter amounts on lines 18, 20 and 22, in Schedule K(565)—see Instruction. E. — PART #11 Ordinary Gains and Losses | ' a. Kind of property and how ‘ acquired (if necessary, a attach statement of descriptive details not shown below) f. Cost or other basis, cost of subsequent improvements and expense of sale e. Depreciation atlowed (or allowable) since acquisition d. Gross sales price c. Date sold (mo., day, yr.) b. Date acquired (mo., day, yr.) 0: Gain (or loss} (4. plus e. less f.) ~ Gain, if any, from line 14 25. Loss, if any, from line 16 26. Loss, if any, from line 23 27. Po, rns nner teens Sennen Se en rs 28. Combine lines 24 through 27, enter here and also on the appropriate line as follows (a) For fiduciary and partnership réturns: Enter the gain (or loss) shown on line 28 on the line provided for « on ‘the - return being filed—see Instruction F for specific line reference. ; (b) For individual returns: (1) tf the gain (or floss) on line 28 includes losses which are to be treated. as an itemized deduction on Schedule A (Form 540 or S40NR) (see Instruction F), enter the total of such loss(es) here and on ” Schedule A (Form 540 or 540NR)—ldentify as loss from line 28(b)(1), Schedule D-1. (Form 540) ‘ (2) Redetermine the gain (or loss) on line 28, excluding the loss (if any) entered on line 28(b)(1). Enter here . and on e 2 of Form 540 or Form 540NR, under “Other Income”
JFK Act 6 (3) FEDERAL STATE fo Td | | fe —— fe fT | Td | 3598) ta F | . - MEDICAL. i+, 2-MEDICINE/DRUGS 3 LESS 1% A.G.1, (Line 18 - 1040) 4 NET MED/DRUGS 5H & AINS. (% + EXCESS) fa DR. OR. OR. DR. OR. DR. DR. DR. . ioe 4 om: SERRE , NN eT O 4 IE 6b HOSPITAL PROSTHETIC APPLIANCES HEARING AID Ge AMBULANCE LABORATORIES TRAVEL FOR MED. o-, MEDICARE INS. GLASSES 7 MEDICAL EXPENSES . LESS REIMBURSED BY INS. 8 LESS 3% ADJ. GROSS INC. 9 14+:% (TO $150) OF H & A INS. 10 TOTAL MEDICAL DED. TAXES 11 STATE & LOCAL INCOME 12 REAL ESTATE 13 STATE & LOCAL GASOLINE 14 GENERAL SALES TAX 15a PERSONAL PROPERTY 15b PERSONAL PROPERTY AUTO 16 SALES TAX AUTO : | : ~~ | () ’ = 0) Hh e 17 TOTAL TAXES INTEREST (TO WHOM PAID 18 MORTGAGE . 7 1 | ul 19 INSTALLMENT LOANS ry) ras Cx) - ARQ d 5 Ww Professional Statior 20 TOTAL INTEREST AAD baused Courgess Hie PSI North Hall paeored, MW 55993 Boocld:32245535 Page 50 Q 5 3 an S DEDUCTION SCHEDULE et Ta A Be a CALENDAR Y SOC. SEC. NO. : ) ONTRIBUTIONS STATE | 1b PARTNERSHIP SHARE : ‘XMAS & EASTER SEALS MISC. ORGANIZED CHARITIA CHURCHES Ro a ra m= OTHER THAN CASH 3 CARRY OVER FROM PRIOR YRS 4 TOTAL CONTRIBUTIONS SUALTY OR THEFT (LOSS(E LOSS BEFORE ADJUSTMENT a MISCELLANEOUS DEDUCTIONS ; INVEST. COUNSEL & PUBS.(Sched EMPLOYMENT AGENCY FEES SAFE DEPOSIT BOX TEL. REQ. IN BUSINESS . POLITICAL CONTRIBUTIONS TOTAL MISC. DED. SiS C : oO > nn ) Fy Vv) STATE SUMMARY OF ITEMIZED DED. EXPENSES (FROM LINE 10} 36 TOTAL TAXES (From LINE 17) 37 TOTAL INTEREST (Line 20) 38 TOTAL CONTR. (Line 24) 39 CAS. & THEFT LOSS(ES) (Line29) TOTAL MISCELLANEOUS DEDUCTIONS (FROM LINE 34) ST TTA 41 TOTAL ITEMIZED DEDUCTIONS ENTER ON FORM 1040 LINE 45 REMARKS SCHEDULE . FEDERAL 2 FEDERAL ‘NNT
eee -NW 55923 Docld:32245535 Page 51 A \V ADDRESS f LINEN _ “4 . . wot tee - we eons L| ; S s Ru by “cavenoas a Ze OR soc. SEC. NO. JEK Act 6 (3) FISCAL YEAR ENDING t 219 EDULE OF PROFIT OR LOSS FROM BUSINESS OR PRO STON PRINCIPAL BUSINESS ACTIVITY BUSINESS NAME : EMPLOYERS NO, BUSINESS ADDRESS INVENTORY AT BEGINNING OF YEAR MERCHANDISE PURCHASED I TOTAL LESS INVENTORY AT END OF YEAR rn RR, GROSS PROFIT A tt GROSS INCOME : OTHER BUSINESS DEDUCTIONS an NR A “ADVERTISING AUTO AND TRUCK EXPENSE BAD DEBTS COMMISSIONS DELIVERY DEPRECIATION ( SCHEDULE BELOW ) —-— DUES AND SUSSCRIPTIONS ENTERTAINMENT ANG PROMOTIONAL ASRS Ener ee nc INSURANCE, RL INTEREST Re a a a ct RL JANITOR AND HAULENG LEGAL AND ACCOUNTING OFFICE SUPPLIES AND EXPENSE RENT REPAIRS AND MAINTENANCE SALARIES ANO WAGES SUPPLIES TAXES AND LICENSES TAXES PAYROLL TELEPHONE AND UTILITIES CoNnTRA-CT LAB O RC NET PROFIT oR (LOSS ) FEDERAL RETURN . i] NET PROFIT OR (LOSS ) STATE RETURN - SEE DEPREC. SCHEQULE FOR DIFF. TAY Sis TW) Yap Scent LE OF DEPRECIATION YEARS COST OR PRIOR [DEPRECIATION KIND AND LOCATION OF PROPERTY. ACOUIRED METH. | OR % | OTHER BASIS DEPREC. THIS YEAR — HANS SL L| 27k 10228) ne), ae PROFESSIONAL STATIONERS INC FORM 104A Los ANGELES, CALIF.
, te ee ee et ae i + 28. RECOGNIZED GAIN NW 55923. Docld:32245535, Page 52 : oe tH} cht uU By Calendar Yr. ; iy oF NAME « SOC. "SEC. NO, SV /E 9 2 “NOTES _ | | 4e [et 3 MORTGAGE TRANSFERRED . . | fT 4. OTHER - es ee es ee 5. GROSS SALES PRICE (1424344) | | | LB KFOO | TT 6. COST OR BASIS ZZ i$ 7. ‘LESS ACCUMULATED DEPRECIATION 8. PRIOR TO 1—1--62 9. ° PRIOR TO 1-1-64 10. AFTER 12-31-61 WW ST. LINE AFTER 12-31-63 12. EXCESS OVER S/L 1-64/13—69 13. EXCESS OVER S/L AFTER 12-31-69 - < oe SS ee - GAINS ON INSTALLMENT SALES. wos DATE SOLD Te — TYPE OF ASSET: | : CAPITAL | SEC. 1245 SEC. 1250 DESCRIPTION OF PROPERTY _to 0 DATE ACQUIRED nd .SELLING PRICE: CASH 14. ADJUSTED BASIS (6-7 THRU 13) 15. EXPENSES OF SALE 16. TOTAL ADJUSTED BASIS (14 + 15) 17. TOTAL GROSS PROFIT: (5 — 16) 18. TOTAL GROSS PROFIT — ORDINARY 19. TOTAL GROSS PROFIT — OTHER 20. CONTRACT PRICE (1+2+ 4) 21. GROSS PROFIT % 22. PAYMENTS RECEIVED YEAR OF SALE SE 23. CASH (1) 24. PRINCIPAL COLLECTIONS 25. EXCESS MORTGAGE OVER BASIS 26. “OTHER (4) 27, TOTAL PAYMENTS (23 THRU 26) 29. RECOGNIZED GAIN — ORDINARY 30. RECOGNIZED GAIN — OTHER ORDINARY INCOME TAX- LESS INT. toee PT ABLE “PAYMENTS REPORTED BALANCE REPORTED ont TYR | Ys gl | Ff — Hie
3 SE eae PEE! EROS s 0 a - Departinent of the Treasury—Internal Revenue Service eS PUSS usi ‘Individual Income Tax Return. ; Loccecceesestesesteseascecsessece 1974, ENdiNg oo --cleoeceeecccecceeseceseeeseey DQ seeseeee COUNTY OF RESIDENCE Spouse's, A jar / 65 or over a] Blind | Filing. Status (check only one) Exemptions I a: _1 © Single Ga Yourself . i oO. ee 2 (4 Married filing joint return (even if only one had income) .b Spouse. . . B -. ’ so of boxes > 2 oa 3 ” Married filing separately. {f spouse is also filing give c First names of your dependent children who lived with " : spouse's social security number in designated space above ou” ; se to coe and enter full og you name here > it : THo h4 AS 0 “ 4 [7] Unmarried Head of Household (see instructions on page 5) cs a ~ umber > a > d Number of other dependents (from line 27) . > 5 L] Widow(er) with dependent child (Year Spouse died® 19 )} 7 Total exemptions claimed oo Lo a > 1 Election & Do vou Note: If you check the "Yes" box(es). it -will not increase your. tax-or reduce your refund. ; 8 Presidential Election » Do you wish to designate te $1 of your taxes for this fund? . Campaign: Fund . If joint return, does your spouse wish to designate sv . . ( Attach Forms W-2. If unavail- <i : . 9 Wages, salaries, tips, and other employee compensation able, see instructions on page 3) ae . | 10a Dividends (cag imtsctons ye 3H — 10b ‘Less exclusion 336. Balance: > | 10c (if gross dividends and other distributions are over $400, list in Part | of Schedule B.) 41° Interest income. | If $400 or less, enter total without listing in Schedule B ” If over $400, enter total and list in Part ll of Schedule B 12 Income other. than wages, dividends, and interest (from | line 38) . 13 Total (add-lines 9, 10c, 11, and 12) wee ee ee 14 Adjustments to income (such as “‘sick pay," moving, expenses, etc. from line 43) . 15 Subtract line 14 from line 13 (adjusted gross income) . . - @ If you do not itemize deductions and line 15 is ‘under $10,000, find tax in Tables and. enter on line 16. @ if. you. itemize deductions or line 15 is $10,000 or more, go to line 44 to figure tax. . ee . e@ CAUTION. |f you have ‘unearned income and can be claimed as a dependent on your parent's return, check here > [] and see instructions on page. 7. Tax, check if from: _Tax Tables 1-12 | ' Tax Rate Schedule X, Y, or Z” Schedule GJOR[_| Form 4726 | Please attach Copy B of Forms W-2 here | Schedule D 17 Total credits (from line 54). 18 - Income tax (subtract line 17 ‘from line 16) | -19 Other taxes (from line 61) . . doe 20 Total (add lines 18 and 19)... 2 ee ee ee z =] 2 Oo 4 a @ | 2a Total Federal income tax withheld (attach Forms ; ees - 5 . W-2orW-2Ptofront). . . . -, | 21a _ Us ay amount on line 23 1% ‘ : E ‘- pb 1974 estimated tax payments (include amount . : Y Write, with, this return. Y. o S allowed as credit from 1973 return). 2... ‘b —_ ] money ordey check or 7 - c¢ Amount paid with Form 4868, Application for Automatic : i bl t Int I KS Extension of Time to File U.S. ett income Tax Return c _—_ UL Reve Service. ome jy a  @ Other payments (from line 65) . . . . .°. d 22 Total (add lines 21a, b, c,andd) . . .-. . . TO 23 If line 20 is larger than line 22, enter BALANCE DUE IRS... Uh - p Please attach Check or Money Order here] . o. Az c . 6 Ee an (Check here > CJ , if Form 2210, Form 2210F, or statement is attached. See instructions on page 7. ).! Q @| 24 If line 22 is larger than line:20, enter amount OVERPAID .. ante < » | (25 Amount of line 24 to be REFUNDED TO YOU . ede : a ° : 26 Amount of line 24 to be cred-, : 7 om, i Ger ’ 4 of overpayment (line: WG Ue {0 bee |e , rr rn ; refunde 5 : ae ited on 1975 estimated tax. ® | 26 : [a Coe GON loots Miva Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best:of my knowledge a - it is true, correct, and complete. Declaration of Preparer {other than taxpayer) ts based'o on all information of which he has any knowledge. Sign 7 Dore a . : - ann : oo Dra sais oie than JFK Act 6 _ Spouse! 8 saat af TH must sign even if only one had Income) | a Address (end HP Pode) Be Prope : - 98717 VANOWEN st REET, ; HAN NUYS, CA. 91403 “WO B8aze-1 NW 55923 ...Doe1d:32245535 . Page 53 °° 7
EB RDG gale TAL Form ‘1040 (1974) : a sO , ow Page 2 - nn eevee ao (a) NAME. ‘ (b) Relationship (c) Months lived in your | (d) Did = de- (e) Amount YOU | (f) Amount —fur- °° n . - home. If born or died | pendent have | furnished for de- | nished by OTHERS. = . during year, write B or D. income of pendent’s sup- including depend: = @ i $750 or more? {| port. If 100% ent. _ ony : : write ALL. : oe : Qa . 27 Total number of dependents listed in column (a). Enter here and on line 6d . “Income other than Wages, Dividends, and Interest 28 Business income or (loss) (attach Schedule C) . 29 Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) . 30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) . 31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (aitach Schedule E) . 32 Farm income or (loss) (attach Schedule F) se 4 woe ee ee 33 Fully taxable pensions and annuities (not reported on Schedule E—see instructions on | page 8) . 34 50% of capital gain distributions (not reported on Schedule D—see instructions on page 8) . does not apply if refund is for year in which you took the). 8 35 State income tax refunds standard deduction—others see instructions’ on page 36 Alimony received .~ . 2. 2. ee ue woe ee eke ee 37 Other (state nature and s source—see instructions on page 8) » > 38 Total (add lines 28, 29, 30, 31, 32, 33, 34, 35, 36, and 37). Enter here and online l2 . Adjustments to income 39 “Sick pay.”’ (From Forms W-2 and W-2P. If not shown on Forms W-2 or W-2P, attach Form 2440 or statement.) |_39 40 Moving expense (attach Form 3903) . woe : 40 41 Employee business expense (attach Form 2106 or statement) tee ee ee te ee | AT : 42 Payments as a self-employed person to a retirement plan, etc.—see instructions onpage9 . 42 43 Total adjustments (add lines 39, 40, 41, and 42). Enter here and online 14... . 43 Part Wt. ER Computation (Do not use this part if you use Tax Tables 1-12 to find your tax.) 44 Adjusted gross income (from line 15) . . . og: EQS. Y eee 45 (a) If you itemize deductions, check here >» Ol and enter ‘total from Schedule A, line 41 - ° and attach Schedule A. . so (b) If you do not itemize deductions, check here > q and enter 15% of line 44, but do NOT enter more than $2,000. ($1, 000 if tine 3 checked!) we 46 Subtract line 45 from line 44 47 Multiply total number of exemptions claimed on + line 7, by $750 48 Taxable income. Subtract line 47 from line 46. . . 48 tt . — aan (Figure your tax on the amount on line 48 by using Tax Rate Schedule x, Y, or rZ, or if applicable, the | alternative - . tax from Schedule D, income averaging from Schedule &, or maximum tax from Form 4726.) Enter tax on line - 16. - GWM Credits 49 Retirement income credit (attach Schedule R) . . . 2 4 6 2 ee ee took 49 _ |: 50 Investment credit (attach Form 3468) 2. 2 1 wee ea ee ee ee BOL] eee r ‘61. Foreign tax credit (attach Form 1116) . . . . . 2°. ee -) 52 Credit for contributions to candidates for public office—see instructions on page9.. . . . |_52 ; 53-Work Incentive (WIN) credit (attach Form 4874) © to . 54 Total credits (add lines 49, 50, 51, 52, and 193). Enter here and. on ‘line 17 : MZUAMe Other Taxes 55 Self-employment tax (attach Schedule SE) .- 56 Tax from recomputing prior-year investment credit (attach Form 4 55) “ 57 Tax from recomputing prior-year Work Incentive (WIN). credit (attach schedule) : 58 Minimum tax. Check here » [_], if Form 4625 is attached -. soe 59 Social security tax on tip income not reported to. employer (attach Form 4137) « 60 Uncollected employee’ social security tax on tips (from Forms W-2) 61 Total (add lines 55, 56, 57, 58, 59, and 60). Enter here and on line 19 . 7 Other her Payments _ ee tae ge meen eee nen ater amet eae na tn ne tt Seer ttn mn etree 62 Excess FICA tax withheld (two or more employers—see instructions on page 9). 63 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) . 64 Credit from a Regulated Investment Company (attach Form 2439) . « 2 | Did you, at any time during the taxabie year, have any interest in or signature o or other authority over — ; me 20 & | a bank, securities, or other financial account in a foreign country (except | ina U.S. military banking ; “ £ 3 facility operated by a U.S. financial institution)? .. . . _ Boe . > o Yes, ‘a No = =" “ «x | If “Yes,” attach Form 4683. (For definitions, see Form A683. ) ; : : 7 eS ws an . Fe U.S. GOVERNMENT PRINTING OFFICE :1974--O-548-047 . Ct 16--83220- + , o 4 /HW 55923 DoclId:32245535 Page 54
a eS cae oe TA AERUR AES at SLE E CO ORS LT eee TRIS ERE ae, lad a Schedules A&B—Itemized Deductions AND (Form 1040) _ Dividend and Interest Income Department of the Treasury Internal Revenue Service p> Attach to Form 1040. p>» See Instructions for Schedules A and B (Form 1040). wn Name(s) as shown on Form ‘104 SA Mu EL. a ‘Medical and Dental Expenses (not compensated by insurance or otherwise) (See instructions on page 10.) 1 One half (but not more than $150) of insurance premiums for medical care. (Be sure to include in line 10 below) 2 Medicine and drugs 3 Enter, 1% of line 15, Form 1040 4B JFK Act 6 (3) .21 a Cash contributions for which you . have receipts, cancelled checks,.etc. b Other cash contributions. List donees and amounts. »_____ 4 Subtract line 3 from line 2. Enter dif-- ee ee eee ne secene tee ececeeee sence et nnceceeeeeccce: ee re ference (if less than zero, enter zero) . : : 5 Enter balance of insurance premiums | ° so DPrecrnseceese nee ceecncence cer ewe recess anennenn Sanne Geneeereee emia re for medical care not entered on line 1. . ; 6 Enter other medical and dental expenses: | ee nent oe a Doctors, dentists, nurses, etc. b Hospitals . woe ee c Other (Itemize—include hearing aids, dentures, eyeglasses, transportation, ete. Dn dann Banca 22 Other than cash (see instructions on. . page 11 for required statement) 23 Carryover from prior years 24 Total contributions (add lines 21a, b , 22, and 23). Enter here and on line 38 . LT . Casualty or Theft Loss(es) (See instructions on page 12.) ~ Note: /f you had more than one loss, omit lines 25 through — 28 and see instructions on page 12 for guidance. Loss before insurance reimbursement . 26 Insurance reimbursement. 27 Subtract line 26 from line 25. Enter difference (if less than zero, enter zero) . Soe ee ee 28 Enter $100 or amount on line 27, : whichever is smaller. . . 7 29 Casuaity or theft loss (subtract line 28 from line 27). Enter here and on line 39 ™. 7 Total (add lines 4, 5, Ga, b, and c) 8 Enter 3% of line 15, Form 1040. 9 Subtract line 8 from line 7 (if less than zero, enter zero) 10 Total (add lines 1 and 9). Enter here and online 35... > Taxes (See instructions © on page 10) 30 Alimony paid 31 Union dues . 11 State and loca! income 12 Real. estate 13 State and local gasoline (see gas tax tables) 14 General sales (see sales tax tables) 15 Personal! property: . 16 Other (itemize) » 32 Expenses for child and dependent care services (attach Form 2441) :33 Other (Itemize) ® ow... ee 34 Total (add lines 30, 31, 32, and 33). 17 Total (add lines 11, 12, 13, 14, 15, and - Enter here and on line40. 2. . 1 D> 16). Enter here and on line 36 Interest Expense (See instructions on = 11.) : Summary of Itemized Deductions 18 Home mortgage . 19 Other (Itemize) > 35 Total medical and dental—line 10. : 36 Total taxes—line 17 37 Total interest—line 20 38 Total contributions—line 24 .. 39 Casualty or theft loss(es)—line 29, 40 Total ‘miscellaneous—line 34. AL ‘Total deductions (add lines 35, 36, 37, | 38, 39, and 40), Enter here’ and on S00. 20 Total (add lines 18 and 419). | Enter here 24 ? and online 37... > Form 1040, line 45 ‘* 16—83231-1 NW 35923 Doold: 322455355 Page 35
BEE Le ee TES LS © i “bos FR RANE FM SET EE REE, ak bt iia ie Profit or (Loss) From Business or Profession (Sole Proprietorship) BaP o! the Treasury Partnerships, Joint Ventures, etc., Must File Form 1065. PRevenue Service p> Attach to Form 1040. p See Instructions for Schedule C (Form 1040). y as a. on Form “Le Lo: A Principal business > 2. (sea Schedule C Tnst ryctions) >... wh Ee tC, &,...... 5 product >. +0 f B Business name > WU/eag. Le eis IST Be CoFI a ‘ C Employer identification number ».. Pp. D Business address (number and UC 1G OSS SoreEE pe Fence en een ee ceca cc eeseeen enc aeenecneceeceeneceeeeeees L City, State and ZIP code mE MCS ALO. A... 6 . . € Indicate method of accounting: (1) ry Cash (2) 15h Accrual (3) () Other eee F Were you required to file Form W-3, or Form 1096 for 1974? (See Schedule C instructions.) . If “Yes,” where filed oc cne eens caves erece bee cnee eseeecgeee cece ese seeceesceneeee enna ne cteeendeceneneacenene G Was an Employer's Quarterly Federal Tax Return, Form 94}, filed for this business for any quarter in 1974? . 4, H_ Method of inventory valuation Be. eset ee o_S- pees cuetescecassseesseeenecenseeneeees lle Was there any substantial | change in ; the manner of determining quantities, costs, or valuations between the opening and closing inventories? (If “Yes,” attach explanation) . 1 Gross receipts or sales $0.00... ccssscseseee Less: returns and allowances $ ....... ecetetsaccesutsetsesssssas : Balance | =e ' 2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8) . S| 3 Gross profit. 2. 6 6 ee Le ae Moy =] 4 other income (attach schedule) 5 Total income (add lines 3 and 4) 6 Depreciation (explain in Schedule C-3) 2. 2 6 6 ee ccceseeeeeserstgsetettseeefereen DNS 7 Taxes on business and business property (axplain in Schedula C~2) : , “ 8 Rent on business property) 2 606 6k ee ts . penne eeeednennenes peeceeeces | eoneee : 9 Repairs (explain in ScheduleC-2) . . . . ee . an ee ee oo 10 Salaries and wages not included on line 3, Schedule eC (exclude 2 any paid t to yourself)  . eee reece eeceeevegenseeaee, cosas ce! 11 Insurance. a fn nnn cee 12 Legal and professional fees ee fe veeeteeees an oe 13 Commissions . . . .°. a cewt 14 Amortization (attach statement) Loe ee Coe ee ek oe in (eee a 15 (a) Pension and profit- -sharing plans (see Schedule C instructions) 20. 0. 0. ce eee peceanceeeneneesenccceeeeeee ees, (b) Employee benefit programs (see Schedule C Instructions) . Se ee ecueceuneeaseensenesceaeee — _ 16 Interest on business indebtedness . ee : 17 Bad debts arising from sales or services 18 Depletion . . - 19 Other business expenses (specify): Deductions (k) Total other business expenses (add ti tines 19(a) through 1 20 Total deductions (add lines 6 through 19) Loe 21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on Form 1040, line 28. ALSO 50 | q B aa enter on Schedule SE, line 5(a) Loe eee SCHEDULE C—1.—Cost of Goods “Sold ‘and/or Operations See Schedule r Tstructions for Line 2) ee ee 1 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) © ©). fli. wt zi . 2 Purchases $..........-------:-t-seee+ Less: cost of items withdrawn for personal use $..........--. sc cheeetieneteseen ” Balance >. cn 3 Cost of labor (do not include salary paid to yourself) a oo ; 4 Materials and supplies . § Other costs (attach schedule) 6 Total of lines 1 through 5 7 Less:. Inventory at end of year to . 8 Cost of goods sold and/or operations. Enter here and on line 2 above . ele, NW 55923 Docld:32245535 Page 56
UR RERAT Ca aa MES Mase EA Schedule C (Form 1040) 1974 ‘f. ; ~ SCHEDULE C-2.—Explanation of Lines 7 and 9 : , Line No. Explanation Amount Explanation SCHEDULE C—3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, you may use Form 4562. . . Note: If depreciation is computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, or tha Guideline , Class Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)—11(b)(5)(vi) and 1.167 (a)-12, the provisions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970. (See Publication 534.) 7 . Pe ree Check box if you made an election this taxable year to use [_] Class Life (ADR) System and/or [| Guideline Class Life System. : aoe d. Depreciation e. Method of ‘ . . ren . * a. Group and guideline class b. Date c. Cost or allowed or allowable “computing f. Life or . 8. Depreciation for... or description of property acquired other basis in prior years depreciation rate this year : Total additional first-year depreciation (do not include in items below) ——_—__ ee Depreciation from Form 4832 «7 sce Note \- |.-n-e-nceeeeedecenees ZY W9UWw Depreciation from Form 5006 .¥ above a ZY WJ} Other depreciation: ; , = ; : ; Buildings. . . . . a "Furniture and fixtures Transportation equipment .' Machinery and other equipment . : eer Other (specify)... fe rn a nn DO a en ine ac neecene ene] cone : , & WN STotas . . . 1 ee ee te el — Looe ee eee toe ee oe 6 Less amount of depreciation claimed in Schedule C-1, page 1°. . £23 Name = . Expense account Salaries and Wages 7 Balance—Enter here andon page l,line6. . . . we SCHEDULE C—4.—-Expense Account Information (See Schedule C Instructions for Schedule C-4) . ‘Enter information with regard to yourself and your five highest paid employees. In determining the five highest paid employees, expense account allowances must be added to their salaries and wages. How- ever, the information need not be submitted for any employee for ; ; a whom the combined amount is less than $25,000, or for yourself if wees: : gonqocnesestsessseese| oooeee Heese te: Se your expense account allowance plus line 21, page 1, is less than : : : $25,000.° . . Did you claim a deduction for expenses connected with: ~ . (1) Entertainment facility (boat, resort, ranch, etc.)?. . . (1 Yes jo (3) Employees’ families at conventions or meetings? . (2) Living accommodations (except employees on business)? [1 Yes gS.No (4) Employee or family vacations not reported on Form W-2? [] Yes , . wus. GOVERNMENT PRINTING OFFICE : 1974—O-548-050 : ete : lo ewe a isd , 993. _Doold: 32245535 Page 57
. 8 Enter gain, if applicable, from Form 4797, line 4(a)(1) (see Instruction nA) 9 \ NW 55923 “Docld:32245535 Page 58 a "16 If line 14 shows a loss— DER ai anes ors Ss TERETE ETRE PARLIN FO SSPE oat SCHEDULE D Capital Gains and Losses (Examples of property to be reported on i (Form 1040) this Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but ot Department of the Treasury not losses) on personal assets such as a home or jewelry.) ck Internal Revenue Service p> Attach to Form, 1040. p> See Instructions for Schedule D (Form. 1040). oR at JFK Act 6 may as mae “py 1040 a 7 AM«é FM yenee AUB Yo —— ri Short- on Capital Gains and Losses—Assets Held Not More Than 6 Months -a. Cost or other basis, as adjusted (see instruction D) and expense of sale b. Date acquired . (Mo., day, yr.) a. Kind of property and description ¢e. Date “f. Galn or (loss) (Example, 100 shares of ‘'Z’' Co.) d. Gross sales ‘price (d tess e) sold : (Mo., day, yr.) — | — | Se | | |] — | i | ne | ee | ee | 2. Enter your share of net short-term gain or (loss) from partnerships and fiduciaries 3 Enter net gain or (loss), combine lines 1 and 2 : . : - 4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction 6) . (b) Short-term capital loss carryover attributable to years beginning after 1969 _ Instrsction 6). Net short-term: gain or (loss), combine lines 3,.4(a) and (b) . . . Capital gain distributions . Enter your share of net long-term gain or (loss) from partnerships and fiduciaries. . 10 Enter your share of net long-term gain from small business corporations (Subchapter S). 11 Net gain or (loss), combine lines 6 through 10. .. . . - 12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction 6) . (b) Long-term capital loss carryover attributable to years. beginning after 1969 (see Instruction G) . 13. Net long-term gain or (loss), combine lines 11, 12(a) and 1 (b) ; Mirae Summary of Parts | and Il 14 Combine the amounts shown on lines 5 and 13, and enter the net gain or loss here . -15 If line 14 shows a gain— . ' . (a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part V1 for computation | 154) of alternative tax). Enter zero if there is a loss.or no entry. on line 13. . oe (b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29 . _» If losses are shown on BOTH lines 12(a) and 13; omit lines 16(a) and (b) and go to Part IV. See Instruction H. : & Otherwise, (a) Enter one of the following amounts: ‘ ‘ : (i) If amount on line 5 is zero or a net gain, enter 50% of amount on‘line 14; (i) We amount on line 13 is zero or a net gain, enter amount on line 14; or, (iii) If amounts on line 5 and line 13 are net losses, @nte rt amount on line 5 added to 50% of amount on line 13 . : er - (b) Enter here and enter as a (loss) on Form 1040, line 29, the smallest of: i) The amount on line 16(a); (ii) $1,000 ($500 if married and filing a separate return—if a loss is shown on tine A(a) or 12(a), see instruction L for a higher limit not to exceed $1, 000);, or, (iii) Taxable income, as adjusted (see Instruction K) . AB RIBIE
NW 55923 Doold: 33245535 Page 55 a (Form 1040) p> Each self-employed person must file a Schedule SE. Department of the Treasury p> Attach to Form 1040. p> See Instructions for Schedule SE (Form 1040). @ If you had wages, including tips, of $13,200 or more that were subject to social security taxes, do not fill in this form. SCHEDULE SE Computation of Social Security Self-Employment Tax 1074 APS RES SE NE Fe eg a @ If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE. _ oe a Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits. NAME OF SELF-EMPLOYED PERSON (AS SHOWN ON SOCIAL SECURITY CARD) Social security number of self-employed person ~»> —Paytlis KuBy , Business ‘Activities subject to self-employment tax (grocery store, restaurant, farm, etc.) » SMACK 5 A 4, JFK Act 6 (3) s @ If you have only farm income complete Parts | and Ill. @ If you have only nonfarm income complete Parts land Wh. ee ** @ If you have both farm and nonfarm income complete Parts |, !, and VL. ; GUE Computation of Net Earnings from FARM Self-Employment A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, a line 2, if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and ‘ . 2 must be completed even if you elect to use the FARM OPTIONAL METHOD. , REGULAR METHOD (a) Schedule F, tine 54 (cash method), or line 74 (accrual method). 1 Net profit or (loss) from: | (b) Farm partnerships . . i 2 Net earnings from farm self-employment (add lines 1(a) and (b)) FARM OPTIONAL | (a) Not more than $2,400, enter two-thirds of the gross profits . .:. . (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 . 3 if gross profits from farming ' are: ’ Gross ‘profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 (accrual Y ‘ : - oa method), plus the distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line Yy Yj UY ae 15) as explained in instructions -for Schedule SE. Yy Uy sys 4 Enter here and on line 12(a), the annount on line 2, or line 3 if you elect the farm optional method . Part II Computation of Net Earnings from NONFARM Self-Employment ; 7 (a) Schedule C, iine 21, (Enter combined amount if more than one business.) . _- 9 A 0 Dd nO .|. (b) Partnerships, joint ventures, etc. (other than farming) ee REGULAR METHOD| (c) Service as a minister, member of a religious order, or a Christian Science prac- 5 Net profit or _ titioner, (Include rental value of parsonage or rental allowance. furnished.) If (loss) from:: you filed Form 4361, check here [(] and enter zero on this line . ; , (d) Service with a foreign government or international organization . (See Form 1040 in- . nr (e} Other structions for line 37.) Specify Poo eee eee Leneeecneeeleweepene 6 Total (add: lines 5(a), (b), (c), (d), ana (e)) . 7 Enter adjustments if any (attach statement) ©. 2 © 1 6 ew ee ee 8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted byline 7)... . If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 through 11 and enter amount from line 8 on line 12(b), Part Ill. a . Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than $1,600 and less than two-thirds of your gross nonfarm profits,“ and you had actual net earnings from self-employment of $400 or more for at least 2 of the 3 following years: 1971, 1972, and 1973. The nonfarm optional method can only be used for 5 taxable years. : 7 ‘ . a 2 Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu- tive share of gross profits from nonfarm partnerships (Schedule K—1 (Form 1065), line 15) as explained in instructions for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7. ; . ; : NONFARM OPTIONAL METHOD : ; . - 9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) . (b) Enter amount from line 3. (if you did not elect to use the farm optional method, enter zero.) Lo. (c) Balance (subtract line 9(b) from tine 9(a)) ok ee 10 Enter two-thirds of gross nonfarm profits 7 or $1,600, whicheveris smaller. .° . . , 11 Enter here and on line 12(b), the amount on line 9{c) or line 10, whichever is smalle Computation of Social Security Self-Employment Tax / . ‘ S . . a . . J 12 Net earnings or (loss): (a) From farming (from line 4) . ee ee (b) From nonfarm (from tine 8, or line 11, if you elect to use the Nonfarm Optional Method) . . . 2- YOR 13 Total net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400, . you are not subject to self-employment tax. Do not fill in rest of form.) . -. : 14 The largest amount of combined. wages and self-employment earnings subject to social security tax.for 1974 is. $13,200 — (c) Total of lines 15(a) and (b) . - ew ee ee 16 Balance (subtract line 15(c) from line 14) . re 17 Self-employment income—line 13 or 16, whichever is smaller wee wee es 18 If tine 17 is $13,200, enter $1,042.80; if less, multiply the amount on line 17 by.079 . ‘ we f 9 o 19 Railroad employee’s and railroad employee representative’s adjustment from Form 4469, line 10 , 2 20 Self-employment tax (subtract line 19 from line 18). Enter here and on Form 1040, line 55 . te U.S. GOVERNMENT PRINTING OFFICE : 1974—-O-548-055 : Boe, . 16~—85234-1
yeahs. ati ee TBE SECIS RETO E  te aaa SAS EUR SAAN RIA EESE DOR ARNE LET A ES DRAENOR LEE ISOS 8 PS HERA ANN HR NGM Nn ene . hoe . SCHEDULE SE |’ Computation of Social Security Self-Employment Tax | (Form 1040) & Each self- -employed person must file a Schedule SE. . 1974 Department of the Treasury p Attach to Form 1040. p> See Instructions for Schedule SE (Form 1040). Internat Revenue Service @ If you had wages, including tips, of $13,200 or more that were subject to social security taxes, do not fill in this form. @ If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.: Important.—The self-employment income reported below will be credited to your social security record and used in, figuring social security benefits. NAME QF SELF-EMPLOYED PERSO AS SHOWN ON SOCIAL SECURITY CARD) Social security number of 7 ‘ + If-employed person >» Mine Lb WB ° Business activities subject to D sell. -employm: nt tax (grocery store, restaurant, farm, etc.) > ; 4 : . @lf you have only farm income complete Parts | and Ill. @ If you have only nonfarm income ‘complete Parts UW and II. @ If you have both farm and nonfarm income complete Parts |, Hl, and Il. Zia Computation of Net Earnings from FARM Self-Employment A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular “Method, — line 2, if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and 2 must be completed even if you elect to use the FARM OPTIONAL METHOD. REGULAR METHOD | (a) Schedule F, line 54 (cash method), or line 74 (accrual method). . ee 1 Net profit or (loss) from: | (b) Farm partnerships | , a ‘ ; aos 2 Net earnings from farm self-employment (add lines 1(a) and (b)) - 4 FARM OPTIONAL “| (a) Not more than $2,400, enter two-thirds of the gross 5 profits oe 3 if gross profits from fartning ‘ are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 . ' Gross ‘profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 “al es oo aw method), plus the distributive share of gross profits from farm partnerships (Schedule K~1 (Form 1065), line =z we 15) as explained in instructions for Schedule SE. VM . 4 Enter here and on line 12(a), the a1mount on line 2, or line 3 if you elect the farm optional method . ” Pai Computation of Net Earnings from NONFARM Self-Employment (a) Schedule C, iine 21. (Enter combined amount if more than one business.) .. ‘2539 . 7 (b) Partnerships, joint ventures, etc. (other than farming) ne Be REGULAR METHOD] (c) Service as a minister, member of a religious order, or a Christian Science prac- 5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If (loss) from: you filed Form 4361, check here [_] and enter zero on this line . (d) Service with a foreign government or international organization . (Sea Form 1040 in- . (e) Other structions tor line 37.) Specify Pm a2... ee eee nee 6 Total (add: lines 5(a), (b), (c), (d), ana (e)). 6 ee eee ee Le ee 7 Enter adjustments if any (attach statement) : ; , 8 Adjusted: net earnings or (loss) from nonfarm self- employment (line 6, as 's adjusted by line 7) . Sf line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 : through 11 and enter amount from line 8 on line 12(b), Part if. Note: You may use the nonfarm optional method (tine 9 through line 11) only if line 8 is less than $1,600 and less than two-thirds of your gross nonfarm profits,* and you had actual net earnings from self-employment of $400 or more for at least 2 of the 3 following years: 1971, 1972, and 1973. The nonfarm optional! method can only be used for 5 taxable years. ? Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu- tive share of gross profits from nonfarm partnerships (Schedule K-1 (Form 1065), line 15) as explained in instructions for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7. . . NONFARM OPTIONAL METHOD : : 9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) . (b) Enter amount from'tine 3. (If you did not elect to use the farm optional method, enter zero.) . (c) Balance (subtract line 9(b) from tine 9(a)) . - - ee a ‘10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is : smaller : . 11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller . Computation of Social Security Self-Employment Tax 12 Net earnings or (loss): (a) From farming (from line 4) . wa, : ., we . Lo ‘(b) From nonfarm (from line 8, or line’11 if you elect to use the Nonfarm Optional Method) . woe Le -13' Total net earnings or (loss) from self-employment reported on line 12. (If line 13 Is less than $400, we you are not subject to self-employment tax. Do not fillin rest of form.) . . . . «1. os . ZEFY 14 The largest amount of combined wages and self-employment earnings subject to social security tax for 1974 is... 1974 $13, 200— 2 15 (a) Total “FICA” wages as indicated on Forms W-2 . ... . . |__| — = V/, oe “ (b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9. . : VU 7 . . " (c) Total of lines 15(a) and (b) . . rn ; . 16 Balance (subtract line 15(c) from line 14) . . 17 Self-employment income—line 13 or 16, whichever is smaller 18 If line 17 is $13, 200, enter $1,042.80; if less, multiply the amount on line 7 by, 079 . 19 Railroad employee’ s and railroad employee representative's adjustment from Form 4469, line 10 -. 20 Self-employment tax (subtract line 19 from line 18), Enter here and on Form 1040, line 55_. 3% U.S. GOVERNMENT PRINTING OFFICE i 1974—O-548-055 : 4 ce cs vo -  16—-R3234-1 ‘NW-55923 Docld:32245535 Page 60,
Bua nie Department: of the Treasury Internal Revenue Service | Computation of Investment Credit Identifying number a8 shown on . er 2 page ] of yo 3 JFK Act 6 (3) 1 Qualified investment In new and used property. (See instructions C amd’D for eligible prope NOTE: Include your share of investment in Property made by a partnership, estate, (2) (3) - (4) ~ . : Cost basis Applicabl lified | t t Property : Line (See instruction G) percentage (orntie 2 x column’$) htt ee LS 7 ™ - (a) 3314 x New : (b) 662 Property _ / a . re ns nba. Tore Pre , (c) gp} . (4) epety [| Noten eeeeeneewcene Property (0) (See Instructions for dollar limitation) 7 or more ' 2 Total qualified investment—Add lines l(a) through lf)... |, 3 Tentative investment credit—7% of line 2 (4% for public utility Property) . 4 Carryback and Carryover of unused credit ( (s). (See instruction F and instructicn for line 4—attach computation.) 5 _Total—Add lines 3 and4 . noe ee, . (b) Estates and trusts—Enter amount from line 24 or 25, page 1, Form 1041 : : , : . (c) Corporations—Enter amount from line 5, Schedule J,Form1120,. . | | 7 Less: (a) Foreign tax credit soe ee, (b) Retirement income credit (individuals only) (c) Tax on lump-sum distributions, (See instruction 7.) cle ek, 8 Total—Add lines 7(a), (b), and(c) . 2. , |, Boe, 9 Line 6 less line 8 ee 10 (a) Enter amount on line 9 or $25,000, whichever is lesser, (Married persons filing separately, trolled corporate groups, estates, and trusts, see instruction for line 10.) con- (b) If line 9.exceeds line 10(a), enter 50% of the excess . ° - "11 Total—Add lines 10(a) and (b) ‘Schedule A If any part of your investment in line 1 above was made by a Partnership, estate, trust, smalt business Corporation, or lessor, complete the following: © — “i Name ~ . : Property ; ' (Partnership, estate, trust, etc.) Address . i : New : Used Life years of 16—83298-1 Form 3468 ag NW 55923, Docld:32245535 Page 61 a - ; |
IN Te IO Ee Og LES OR OER Tibi AES aE icine HELTER SUA TNS eT, Capital Loss Carryover » (From 1973 to 1974) ® Attach to Form 1040. mm 4798 Department of the Treasury Internal Revenue Service Name(s) as shown on Form 10 . HYLtLLd S A. Who Should File.—You will need to complete B. How to Compute Carryover.—If you have a capi- either Part | or Part II of this form if you have a capital tal loss carryover, complete either Part | or Part II of loss to carry over to 1974. this form, but do not complete both. 1. Complete only Part | if lines 4(a) and 12(a) on” your 1973 Schedule D (Form 1040) DO NOT SHOW A You will have a capital loss to carry to 1974 if the LOSS. . ie amount on your 1973 Schedule D (Form 1040), line 2. Complete only Part Il if either (or both) line NN _ 16(a), or line 33, is LARGER THAN the loss deduct: 4(a) or line 12(a) on your 1973 Schedule D (Form ed on your 1973 Form 1040, line 29. 1040) shows a loss. Miziaee Post-1969 Capital Loss Carryovers Section A.—-Short-term Capital Loss Carryover 1 Enter loss shown on your 1973 Schedule D (Form 1040), line 5; if none, enter zero ond ignore lines 2 through 6—then go to line 7 . 2 Enter gain shown on your 1973 Schedule D > (Form 1040), line 13. If that line is blank or shows a loss, enter a zero : 3 Reduce any loss on line 1 to the extent of any gainon line 2 . 4 Enter amount shown on your 1973 Form 1040, line 29 5 Enter smaller of line 3 or 4 . 6 Excess of amount on line 3 over amount on line 5 Note: The amount on line 6 is your short-term capital loss carryover from 1973 to 1974 that is attributable to years beginning . after 1969. Enter this amount on your 1974 Schedule D (Form 1040), line 4(b). . , Section B.—Long-term Capital Loss Carryover 7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1973 Form "1040, line 29) . . . . re 8 Enter loss from your 1973 Schedule D > (Form 1040), line 13; if none, enter zero and ignore lines Q9through 12... . oye 9 Enter gain shown on your 1973 Schedule D (Form 1040), ‘line 5. If that line is ‘blank or shows a loss, enter a zero 10 Reduce any loss on line 8 to the extent of any gain on line 9 11 Multiply amount on tine 7 by 2 . 12 Excess of line 10 over amount on line 11 Note: The amount on line 12 is your long-term capital loss carryover from 1973 to 1974 that is attributable to years beginning after 1969. Enter this amount on your 1974 Schedule D (Form 1040), line 12(b). Form 4798 (1974) NW 55923 DoeId:32245535 Page. 62
SoA aaa Mel RACE RPE RATT ween Seater Ls Ge Ge Re Ea eS a Reo oe Ce CURD cil BOSE TRAE AOE OES RAY RTD TRE RS Form 4798 (1974) __ Page 2 L: Fart Il (Mg Pre-1970 and Post-1969 Capital Loss Carryovers Section A.—Short- term. ‘Capital Losses Identified 1 Enter loss shown on your 1973 Schedule D (Form 1040), line 5; if none, enter zero > and ignore lines 2 through 20—then gotoline 2] . 2 . a ae Se ‘ ' 2 Enter gain shown on your 1973 Schedule D (Form 1040), | line 13. it that line is blank or “shows oS ; “a loss entera zero... fk ee ee 7 3 Reduce loss on line 1 to the extent of any gainon line2.. . . “3 3 Note: /f line 4(a) on your 1973 Schedule D (Form 1040) is blank, IGNORE lines 4 through 1 11, enter a zero on line 12——then goto linel3._ . 4 Combine lines 3 and 11 on your 1973 Schedule D ) (Form 1040). Enter the gain; or if zero or a loss, enterazero .. : 4 Note: /f line 4 is zero IGNORE lines 5 through 1, enter on ‘line 12. the loss from your 1973 Schedule D (Form 1040), line 4(a)—then go to line 13. 5 Enter any gain from your 1973 Schedule D (Form 1040), line 3. 5 6 Enter smaller of line 4.0r5 . . 6 7 Enter excess of gain on line 4 over line 6 an 8 Enter loss from your 1973 Schedule D (Form 1040), line 12(a); other- | | wise, enter a zero toe ee Coe ee ee 8 9 Reduce any gain on line 7 to the extent of any loss ¢ on line 8° . _9 10 Enter floss from your 1973 Schedule D (Form 1040), line 4(a); other- . wise enter a zero. . Co eee ee ee ee | 1O 11 Add the gainsonlines6and9. 9. . . re ee: 12 Reduce the loss on line 10 to the extent of any gain on line 11. Coe toe 12 | “13 Pre-1970 short-term capita! loss (Enter smaller of line 30r 12)... . J oe. {8 i 14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over line 13) Section B.—Computation of Capital Loss Carryovers to 1974 15 Enter any loss from line 13,above . 2... er ~ . {as 16 Enter loss deducted on your 1973 Form 1040, line29 . . . . . . 16 | 17 Loss carryover to 1974 (excess of line 15 over line 16—if line 15 does not exceed line 16, center . + zero), Enter here and on your 1974 Schedule D (Form 1040), line 4a) as 17 18 Enter any loss from line 14, above . . . “oo fs 19 Enter excess of line 16 over line 15—if line 16 does not t exceed line 15, ‘ enter zero . . . 19 20 Loss carryover to 1974 (excess of line ig over line 19—if line 18 does not exceed line 19, enter ~ zero). Enter here and on your 1974 Schedule D (Form 1040), line 4(b) . . «2. , ee | 20 21 If you were required to complete Part IV of your 1973 Schedule D (Form 1040), enter any loss from your 1973 Schedule D (Form 1040), line 30; otherwise, enter zero .. . ee ee et 21 22 Enter excess of line 19 over tine 18—if line ‘19 does not exceed line 18, enter zero. (Note: if you ignored lines 2 through 20 above, enter amount from your 1973 Form 1040, line 29.). . . . . . . . . 122 _° 23 Loss carryover to 1974 (excess of line 21 over tine 22—if line 21 does not exceed line 22, enter , zero). Enter here and on 1974 Schedule D (Form 1040), line 12(a) 2 wwe we eee 23 24 If you were required to complete Part IV of your 1973 Schedule D (Form 1040), enter any loss from your 1973 Schedule D (Form 1040), line 31. . However, if Part IV was not required, enter any loss from your 1973 Schedule D (Form 1040), line13 . . . 2... 1. we ee LM 25 Enter excess of line 22 over line 21 a 2 (I line. 22 does not exceed line 21, enter zero.) 2. 2. 2 1 1 eee Soe ew we [2B 26 Loss carryover to 1974 (excess of line 24 over line 25—if line 24 does not exceed line 25, enter zero). Enter here and on your 1974 Schedule D (Form 1040), line 12(b) . . 2... we 26. - tr U.S, GOVERNMENT PRINTING OFFICE : 940-548-157, 52-0781621 NW 55923 ‘Docld:32245535 Page .63
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NW 55923 . ‘Docid: 32245535 Page 66 8 LE EPS OR ES ERR RE INDIVIDUAL [ RESIDENT | i3e/ INCOME TAX oS “PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) — For calendar year or Enter social security number(s) only if incorrect or not shown on label. Taxable year ending. . a 197. AUB ; . JFK Act 6 : 7 . occu- Yours 1 ys PATION ) Spouse’ *. 1 © Single 6 Personal if line 2, 4 or 5 checked, enter $50 : ild O 2 Married filing joint return (even if only one had income) |7 Dependents —- Do not list yourself, your spouse or the person whu qualifies you as av of household. Enter name and relationship. . Total Number » - _ 2 : -|8 Blind (refer to instructions) Number of blind exemptions ® — __ x $8 §oO Widowler) with dependent child (Year spouse died » 197) 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20 3 C Separate return of married person—Enter spouse's ~ social security number and full name here 4 a Head of Household—Enter name of qualifying _ individual 10 Wages, salaries, tips and other employee compensation | Attach cupy 2 of Form(s) 2 ta face of this } 2 return. If unavailable, attach exelanation. _ 11 Dividends—before federal exctusion. Enter total (if over $400, complete and attach Schedule B(540)) 12. Interest. Enter total (if over $400, complete and attach Schedule B(540)) 13. Income cther than wages, dividends and interest (from line 48) 14 Total (add lines 10, 11, 12 and 13) 15 Adjustments to income (from line 54) 16 Adjusted gross income (subtract line 15 from line 14) + If you do NOT itemize deductions AND line 16 is under $10,000, find tax in Tax Table and enter on tine 19. + If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18. ; 17 Deductions: Itemized (from tine 61) OR Standard ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 of 5 checked) . . . 18 Taxable income (subtract line 17 from tine 16) Compute tax from Tax Rate Schedule—Enter tax on fine 19 an 19 Tax from (check one) Tax Table (1) Tax Rate Schedule ‘s Income Averaging Schedule (G or G-1) 0 20 Total exemption credits (from line 9, above) . : 21 Tax liability (subtract line 20 from line 19-—if line 20 is greater ‘than line 19, “enter zero) 22 Other credits (from line 65—Includes special low income tax credit) - . 23 Net tax liability (subtract line. 22 from line 21—if line 22 is greater than line 21, enter zero) 24 Tax on preference income (see instructions—attach Schedule P(S40) ) 25 Total tax liabitity (add lines 23 and 24) <@ ATTACH COPY 2 OF FORM W-2 HERE > 26 Total California income tax withheld (attach Form(s) W-2 or W-2P to face of this return) 27 “Renter's credit—if you lived in rented property on March 4, 1974, complete Part 1 on page 2 . 28 1974 California estimated tax payments . 29 Excess California SD! tax withheld (attach Form DE 1964 t to face of this etre) 30 Total prepayment credits (add lines 26 thru 29). 32 If line 25.is smaller than line 30, enter amount OVERPAID 34 Amount of line 32 to be credited on your 1975 ESTIMATED TAX . . . | 34: * ATTACH FORM DE 1964 HERE Write social security number on check or money order. ATTACH HERE > SIGN Yr signature . : . Date on .——— wonatire (other than taxpayer) - ° oo : ; 88717 VANOWEN STREE JEK Act 6 7 HERE Pin signature—if filing a “joint return ; Date TAXABLE YEAR 31 If line 25 is larger than fine 30, enter. BALANCE DUE. If it is equal to line 30, enter zero. an ’ Pay in full and mail with retura to: FRANCHISE TAX BOARD : PAY IN FULL ——> SACRAMENTO, CA 95867 De not write in these spaces Mail return to: .BRANCHISE TAX BOARD 9. Sw | 82 | ee — — = ia P.O. BOX 13-540 a E ee , SACRAMENTO, CA 95813 _ M 33 Amount of line 32 to be REFUNDED. (Allow at least six weeks) ———.REFUND TO YOU —» 33 Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge ond ; belief it is true, correct and complete. ff t prepared by @ person other than taxpayer, his declaration is based on all information of which he has any knowledge. - OR er aE ne m w rae wee ieee
Page 2 Form 540 (1974) ‘PART | — Renter’s Credit — All questions must be answered See Instructions, Page 3, for Allowable Credit 238 -35 Did you, on March 1, 1974, live in rented property which was your principal residence? . . . . ( Yes yd No If no, you may not claim this credit 36 Was the property you rented exempt from property tax? «. |. oo. ele 6G Yes CO No - If yes, you may not claim this credit 37 Did you live with any other person who claimed you as a dependent for income tax purposes? . . [-] Yes [J No -. If yes, you may not claim this credit 38 Did you or your spouse claim the homeowners’ property tax ‘exemption or receive public assistance? [-) Yes C) No If yes, see page 3 of instructions ae PART ll — Other Income " “ Se oe ; ; _ Busiriess income (or loss) (attach Schedule C(540)) , ‘ 40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule D(540)) 41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540) ) Pensions and annuities : Rents and royalties . . | ATTACH , SCHEDULE E Partnerships . FORM (540) Estates and trusts . L Farm income (or toss) {attach Schedule F(540) ) Miscellaneous income (a) Futly taxable pensions and annuities (not reported on Schedule £(540)) ~ oe (b) Alimony woke ; (c) Other (state nature and source) eonseneeen evcesneescacectaneecanten - ceseseeeteceenen peesceeceeseeteseeechaneege ote _ Enter total of tines 47(a), 47(b), and 47(c) . Se . 48 Total (add lines 39 thru 47). Enter here and an line 13 _ PART Ill — Adjustments to Income _ 49 “Sick pay,” if included in line 10 (see instructions — attach statement) 50 Moving expenses (see instructions -— attach statement) . . . . ... - . «es ‘ 51 Employee business expenses (see instructions — attach statement) , “52 Military exclusion (see instructions) © © 2 2 1 LA $3 Payment as a self-employed person to a retirement plan, etc. eo . _ 54 Total adjustments (add lines 49 thru 53). Enter here and on line 15 “see ee ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION. @ Attach Schedule A(S40) and enter sub-totals on lines 55 thru 60, below a . 7 55 Total deductible medical and dental expenses (from Schedute A(540), line 10). ; 56 Total child adoption expenses (from Schedule A(540), line 13). ~ 57 Total taxes (from Schedule A(540), line 21) . , 58 Total interest expense (from Schedule A(540), line 25) 58 Total contributions (from Schedule A(540), line 29) 60 Total miscellaneous deductions (from Schedule A(540), line 40) Total itemized deductions (add tines 55 thru 60). Enter here and on line 17 _ PART IV — Itemized Deductions — PART V — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW. 62 ‘Other State’ net income tax credit (attach copy of other state return and Schedule (540) ) 63 Retirement income credit (attach Schedule R(540)) 64 . (a) Special Low Income Tax Credit —- If Adjusted Gross Income does not include net capital gains from assets held + more than ¢ one year and is $8,000 or less (joint return of married couple, head of household or widow(er) with dependent child) or $4,000 or tess (single or separate return of married person) enter the amount from: line 2i. if Adjusted. Gross Income includes Capital _ Gains, complete Schedule B-1. See Page 3 of Instructions cee b ede, Dae, an "(b) Enter total here from line 4, Schedule B-1. If zero or a loss, enter zero. ae oe af 64b 85 TOTAL (add lines 62 thru 64a. Enter here and on line 22 mo . PART VI — Reconciliation to Federal Return — if adjusted Oss income on Federal Return is different from line 16, page 1, explain below. , EW 55923. Doold:32245535 Page 67
e as shown on Form 540 ute tL. Medical and dental expenses (not compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospi- tal care, insurance premiums for medical care, etc. © 1. One half (but not more than $150) of insurance premiums for medical care ee 2. Medicine and drugs . 2 2. 2 ee bene. 3. Enter 1% of adjusted gross income shown on Form 4. Subtract line 3 from line 2. Enter difference (if line 3 is greater.than line 2, enter zero) . §. Enter. balance of insurance premiums for medical care not entered on line 1 tone . 6. Other medical and dental expenses: - (a) Doctors, dentists, nurses, etc. ... . (b) Hospitals . ; ; {c) Other (itemize) . 7. Total—(Add lines 4, 5, 6a, b, and c) 8. Enter 3% of adjusted gross income shown on ‘Form 540 . . . toe "9. Subtract line 8 from fine 7. Enter difference (if line 8 is greater-than tine 7, enter zero). . © 10. Total—(Add lines 1 and 9. Enter here and on Form 540, page 2, line 55). 2. 2 |. > 1 ; Child Adoption Expense ; 11. Total expenses paid or incurred—Attach itemized . list =. . - rs ns Pe : 12. Enter 3% of adjusted gross income shown on Form 13. Subtract line 12 from tine 11—See instructions. - for maximum limitations. (Enter here and on Form _ 540, page 2, line 56) ©. 2 2 2 1 www Taxes ; 14. R Real estate "15. State and local gasoline ‘16. General sales 17. Auto license—Excess of registration 2 and weit fees (see instructions) to - 18. Personal property . 19. State disability insurance IS1)-—Employer private disability plans do not qualify . ote Other... OCH oe Poeeeseheenene oe 21. Total taxes —(Add lines 14 through 20. Enter here and on Form 540, page 2, line 57). 2. . > (Rev. 1974) ; , WW 55923 -DooId: 32245535 Page 66 4 > cro ATEMIZED DEDUCTIONS Attach to Form 540 Use only if you do not use the Tax Table or take the standard deduction. . 23. Installment purchases 25. Total—(Add lines 22, 23 and 24. Enter here and : Contributions — 7 ce 28. _ 35. Alimony paid 37. Union dues . 39. Other—See instructions (itemize) . JFK Act 6 (3) Interest Expense a 22. Home mortgage . 24. Other (itemize) . on Form 540, page 2, line 58) . > PY: 26. Cash contributions for which you have receipts, ¢ can- mn celed checks, etc. 27. Other cash contributions. List donees and amounts Other than cash. —See instructions for required : ‘Statement . an . 29. Total—(Add lines 26, 27 and 28. Maximum deduction - may not exceed 20% of adjusted gross income. — Enter here and on Form 540, page 2, line 59) . > Miscellaneous Deductions Casualty or Theft Loss(es}—See Instructions NOTE: If you had more than one loss, omit lines. 30. through 34 and follow instructions for guidance. 30. Loss before insurance reimbursement 31. Insurance reimbursement 32. Subtract line 31 from tine 30. Enter difference (it : - dine 31 is greater than line 30, enter zero) . 33. Enter $100 or amount on fine 32, whichever is -  smatler . . 34. Casualty or theft loss (line 32 less ine 33) - 36. Child care—See instructions”. | 38. Employment education expense—See instructions So ‘ 40. Total—Add tines 34, 35, 36, 37, “38 and 39. (Enter here and on Form 540, page 2, tine 60). >
NET EP SIA SRP ETERS AER RIT TERRA SE LET TN ORIG CAES AN NG RE ELH TREE BE EAD PYLE Ll CS SENT ESTATE, NATE. TT ES OR TLS PLINY RITES TN Attach this schedule to your income tax return, Form 540.or S40NR Name as shown on Form 540 A. rine bene activity... te z Ve C. = ee vevevtits cueatensecsssueneeeseetenseesse 7 product Tua CEE ee Instructions for ‘Item . B Business name. Woo LE ey 2 (STR.O Cor FEE D. Business address. /4.0£5.V NTA RA iy Indicate method of accounting:  [_]} cash; F. Were Forms 591, 592, 596 and 599, Son G. Method of inventory valuation .. INCOME DOnOalU a ON = {MPORTANT—AI!! applicable lines and schedules must be filled in. 10 11 12 ot woot (Sole Proprietorships) 4 accrual; NO. _ If “Yes,” attach explanation. Gross receipts or sales $__ Less returns and allowances $_.._.___ Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) . Gross profit . cea te Other income (attach schedule) TOTAL income (add lines 3 and 4) Depreciation (explain in Schedule C-3) Taxes on business and business property (explain in Schedule C. 2) Rent on business property . Repairs (explain in Schedule C-2) . Salaries and wages not included on line 24, Schedule C- 1 {exclude a any ‘paid t to yoursel) Insurance . Legal and professional fees . » PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION (For example. retail—hordware; ape sorvices—legal; manufacturing—furniture; etc.) -€- mber. BRD 6508. 2h. IMBIG es CW identification a calendar year filed if required)? -! Yes . (0 No Was there any substantial change in the manner of Pi ing quantities, costs, 0 or valuations between the o opening 3 ond closing inventories? JEK Act 6 (3) We PMR wee ‘ fe i 13 Commissions .. 14 Amortization (attach statement) Lo. 15 (a) Pension and profit-sharing plans (see Instructions for line 15(a)) (b) Employee benefit programs (see Instructions for line 15(b)) 16 Interest on business indebtedness . 17 Bad debts arising from sales. or services 18 Depletion - 19 Other business expenses es (specify): DEDUCTIONS. (h) Total other business expenses (add lines We) through 19%(g)) . 20 Total deductions (add lines 6 through 19) . foe 21 Net profit (or loss) (subtract line 20 from line 5). Enter here. and on page 2, Form 540 or Form 540NR | - SCHEDULE C-1. COST OF GOODS SOLD (See Schedule C Instructions for line 2) 22 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) .- 23 Purchases $..00 Less cost of items withdrawn for personal | use § veseeeeee bec geen “Balance > ; 24 Cost of labor ;(do not include salary paid to yourself) et -25. Materials and supplies 26. Other costs (attach schedule) . 27 Total of lines 22 through 26 ©. 28 Less: Inventory at end-of year . 29 Cost of goods sold. Enter here and on line 2, ‘above er) . . : New AGe5 - Docld: 32245535 Page 69