_ ADDRESS ~ MEDICAL 2 MEDICINE/DRUGS 3 LESS 1% A.G.I. (Line 18 - 1040) 4 NET MED/DRUGS ETRE STNG Dl BSE REG AES BERG TY CIR SY Ca ES AB SAR, SERRE BETTS es pate 2 Luts hub y JFK Act 6 (3 ) ___- SOC. SEC. NO. DEDUCTION SCHEDULE | _J21 PARTNERSHIP SHARE GIRL/BOY SCOUTS HEART FUND/CANCER FUN STATE FEDERAL GH & A INS. (% + EXCESS) a DR. | || a a ; st XMAS & EASTER SEALS |__| \ “DR. DR. DR. OR. DR. DR. DR. we 6b HOSPITAL PROSTHETIC APPLIANCES HEARING AID Gc AMBULANCE * LABORATORIES . TRAVEL FOR MED. | () UD |] misc. ORGANIZED CHARITIES } | | [POLITICAL CONTRIBUTIONS _| CHURCHES ° BES 22 OTHER THAN CASH Sf | [CASUALTY OR THEFT LOSS(ES) NO 25 1.OSS BEFORE ADJUSTMENT 20 INSURANCE REIMBURSEMEN I z= 27 Ditference (not less than zero) 28 ($100 LIMITATION PER CAS.) TT ror, cas. on THEET L055 NL EaSRERE it = rn oO m | coal re > 2 m ° ¢ a o m Oo e oo a S Sly MEDICARE INS.: GLASSES 7 MEDICAL EXPENSES LESS REIMBURSED BY INS. 8 LESS 3% ADJ. GROSS INC. 9 1 +:% (TO $150) OF H & A INS. 10 TOTAL MEDICAL DED. TAXES 1ISTATE & LOCAL INCOME 12 REAL ESTATE  13STATE & LOCAL GASOLINE " 14 GENERAL SALES TAX 15a PERSONAL PROPERTY 15b PERSONAL PROPERTY AUTO 16 STATE DIS. INS. H Ww SALES TAX AUTO 17 TOTAL TAXES INTEREST (TG WHOM PAID) 18 MORTGAGE 20 TOTAL INTEREST p} 3° Hi ROSSIBONPE STATI SHEE SA aR, LophawleyFalif. Form 104 4 PC TPB ttunionvproressionat oves _ | rE LS OY | [32 cHiLD & DEP. CARE (Form 2441) PUT BB income Tax PREPARATION | P| OST unirorms/Prorec. CLOTHING | || SQ| | LAUNDRY AND CLEANING cY.7 4 f- Auto Use Mii [EMPLOYMENT AGENCY FEES | 34 TOTAL MISC. DED. COSY SUMMARY OF ITEMIZED DED. |] TOT. DEDUCTIBLE MEDICAL & DENTAL EXPENSES (FROM LINE {Q) 36 TOTAL TAXES (From LINE 17) 37 TOTAL INTEREST (Line 20) 38 TOTAL CONTR. (Line 24) 39 CAS. & THEFT LOSS(ES) (Line29) AOA ae | DEDUCTIONS (FROM LINE 34) a ui : ~ STATE FEDERAL a S N | | | a ATL SERRE 41 TOTAL ITEMIZED DEDUCTIONS > ENTER ON FORM 1040 LINE 45 REMARKS ; 4 vi f) ta Q alr
SERRE A SS ohh Da aE SRI OUR ET TET BARE UU J SUN IS SRT PR ER Salad NES POSE PE MG PEND LE GASSER OT IORI ULB ARER OBE Lh Be 2 LLIS huey NO. : a aa “C@RLENDAR YEAR OR ' JOM ee ‘SOC. SEC. NO. JFK Act 6 (3) Ve SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION PRINCIPAL BUSINESS ACTIVITY : BUSINESS NAME . an , EMPLOYERS NO. BUSINESS ADDRESS INVENTORY AT BEGINNING OF YEAR MERCHANDISE PURCHASED /36077| _| LABOR TOTAL _ LSLO77)| | {NVENTORY AT END OF YEAR : | OD | GROSS PROFIT GROSS [NCOME a nn . 2G . OTHER BUSINESS DEDUCTIONS t AUTO AND TRUCK EXPENSE } AIDED ; | )FO00!| | Ra BAD DEBTS CASH SHORT ee COWMI5S 10NS | [ot DELIVERY DEPRECIATION ( SCHEDULE ATTACHED } - . : | {32397 | | DUES AND SUBSCRIPTIONS ENTERTAINMENT AND PROMOTIONAL So ; a INSURANCE : | 2s | - - 2 INTEREST | Weey | | JANITOR SERVICE 7 ; ee LAUNDRY | DYE LEGAL AND ACCOUNTING ; T -QIO! | MAINTENANCE QFFICE SUPPLIES ANO EXPENSE a | OY . RENT | Pt | | REPAIRS ; : : : nC wae SALARIES AND WAGES SALARIES OFFICERS SUPPLIES | TAXES AND. LICENSES ~~ N : DN TAXES + PAYROLL TELEPHONE TRAVEL UTILITIES PARKING TE TT NET PROFIT OR( LOSS ) - FEDERAL RETURN 7: NET PROFIT OR LOSS ) ~ STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF. as) 7 PROFESSIONAL STATIONERS INC. FORM 104, : a : SCHEDULE ww 55993 "Pedra seo45535 Page 74 a hoy a
es: oa BENS STC RN has aa SPIRE eer aN PR BA RO SLY OTE EGE ER SAE Lo it ‘s r z < & w pee . sad a oa br un e . ao jw ry i : a < ; wo > & uw te ve << wo {a} az nm fe z oO xo uw a vs “a Oo 2 ou w 2 a w z 8) Zh ON ; a <3 ' wd aan : « b ‘ ' 22 Ps fe] . z O° c) Si Z iz a Ee Za .. o . YQ. N a= — wo QO w Ee oo zy « uw ae “O- ° u a VU PS a . : 9 - 4, ~ 4. ~N Mr * x - z a o a = < rs) Lj _& Qa il fan) ba ro) ol ut S _ a uJ rr x rs) uw ax n _ 3 aH 3 a 3 < 2 cs) - x JFK Act 6 (3) ° 3 rE : am we > =x 5 RS J ea) <«z < = < wv . ul . a ul o z «< n | Ss i L KIND OF PROPERTY TOTALS PROFESSIONAL STATIONERS — NW 55923 Doold:32245535 Page 75
BE Be [pro a Be DBP BE ™ , . . ‘ ™~. a - t eS uN 4 : 1 oe Leaman & , , a anal oe | (2 Lccoywacnee? the Treasury / latcrmal Rovonuo Somice  _ reg N\5/6 )) Bee] Ce WQS) titclviccal lmcome ens Wwoturi *. =. Cet Ue is) 7 cunt iy deDoecal OB, 1972, or othor (mabla yoor Beginning ceeeeeceescneeeeecaeaeaenterecseees : Meet OT Rta Sot cand U1 (IT folnd 5 “pm, wea frat nemco cod jalddld Initials of bots) Lost nama : “ of > Gh rv i WINES RUBY ; « fy foe cen ee ea eR A OT 7 OE et! wd, Including cf jacn3 Gemabce, c7 uscd reuto) : od boa er ree | pen | om Sone, Emproyod i . uals A Ne wp MEE NSUSL, VO ee . Cinota BF roa ole 5 - win. Ihe ei 2 nity one: : Exemptions Rogular / 65 orovor / Blind Enter Bt J . ; Lo : »mysMbor Fe op dw ” . G Yousof#. . .. . & , OF ia G/ onos an . . . , } . . . cs as . Che em loa 2) Bing ke roeuen (evon if Paty cna had incase) 7? Wifo (husband). . CJ CJ Cc 2 “i ‘ | SP ag. tenets I? witc Giuchand) ts atca | O First names of your dopandont children who Itved with {oa : Se ask Poccurty nunabor ond fae you _Frad, Brinn, Elf’gn, Thoman. ob rs, | ° ‘ ‘ ‘ “ . pee eer ee ee a creme ere ener oe ere oe emer ‘ ah ‘ . oe : ; coe ee ne Wonk ec caawenganee © nk meena files “a Sgn lento MELLON. RIOR HOE tp HE ie 4 : _ ' : en Unt: : : , }4 or ee SS | ., wee ee bmn ee eee cnn an anos anemia HIT LH 4, 4 Jf gnc t eo thac’: mdcne child (Gi vyouret cath | 9 Number of other dopandonts (from line 32) 6. 4 fy. SO ugectcl OU th ae y . 10 Total oxemptions claimcd . . . . - - «Pl @ (IA tL oo to iao, tia, cad 6chcy criployCa eornponication. yy ynaveiteuior etce ongomstion) + |_24 ee wh | we ekg. f as eet4) §..2 Mo80 32% Loss oxeluaton § 70000 patance . [>| Aae eet : OO t vol €odords and ether Clatributioga cro over $200, llst in Part | of Schedule B.) mh ee Sig, PF C299 oF. tous, entor Cota! without listing in Schedule tee a Tb. dba de sere ° ry oye dhe SEITE Lit evog CES9, onter tatcl and list in Port I of Schedule 8 mL AD cing syn nen wegca, Gviccnds, and interest (from ling 45). 0. 6. Oe we | PA LOLS. ty ineoria (Cue! oo “ciel poy.” moving oxpanses, etc. from ting 50) . . } Mo RE vem Meo £6 (edjuctcd (40 kacomo) oe sa Teena cal foucould UO ff you do not omize deductions =O 4 US : lt. HOUR LaPL  rCuia, oA Ho &7 Is undor $10,000, Neo 37 bs $10,039 OP iit iz MT REPLY wad {yn ia VcdIes ond ontor on GO Hivo BR GO WFO FO 1° . Coto DT fe oe CHO 83. re a if a Tor bhs WA! sf Tot Rota Schcculo X, V, or Z ' | ‘ hey Ff ae ecw sft re Tee ee ee pee en uh nod ar J Coho Schedule G [or | | Form 4726 | 36 |_ ; | nn oo fet Cevom lind GA). ea ee fog fore Checyag fe" “fcaoivact Ine 19 vom lino BY. 6 ee ee ee ‘| ws pve Snes; @rom ling G7). ee ee 7 pup 13820 and BB) roe | OG ieed Foc’, | ncome tax withheld (aftesh Forms W-2 | 3 / 2h, SCV? Ecili,., dl tax peymcnte (include amount allowed ' “4 Ye | PG aCe Gu ACT] roturay) © ee | 2 ‘Fg | bo Laan coke ita Form 4868, Lopiieation for Automatic Extension | YoSS bs op Vio tO F14B, Indwidual Invonma Tax Return. 6. | 2; | fe thee Boye nits Grom ting 7B). eee 26 ce ee , : a ‘ Poy ta full with rotur. Coto ot | 6DF . ta} Leg 28 fou g7 tan line 27, enter BALANCE DUE IRS eliceh or moncy order gayoblo om | B wae & fat ; . EN “ ; £2 Internat Rocaue Scruizo ee oa ebay altho tY & Pages than lino 22, onter omount OVERPAID. 6 6 ww et. LAO} 7 Po PE PBB CB EP OUUNEBUD LO VOU oe ype Be 9 | combo vi ~ . y v tet Ps ,* . ent ey ar ’ : gt a * poo PE US gu, ch ory tis during Gha Sanable yoas, have any intorost in or cignatura or othor authority —_.., nip oe He Cope & seg. <ceuyttlas, ev efor financial a¢count in a forcign country (oxcept iaa U.S. : Ny ry fh Le Solty open "od by o U.S. Anoncial institution? =. 2 2. ee el el Vo 2] Ne . poe). we" 1 Fem 4693. (Cor definitions, see Form 4683.) __ wee . An 40 2 le cura % cemplete Revenue Sharing (lines 33 and 34) on next page. — . a : ed Wie. pom to of Conky, be dosbira thet | isvo caarained Ula ruta, including ccearapenying scheduloa cond ctatamonts, ond to tho gost of my knewicdgo ond botici - ad. it th ted, G yeect, Cho Catiplot), Doclaration cf Groparer (othor tian taxpoyer) is boocd ca ail intermotion of tHich he hoo ony finovlcdgo. ; 8] Onn Vis we ere woe cena ~—|[>, EDWARD J, | AbARPR Rb i Lore Your Aen ua Dato Propcrot Ales HO he ble Das | ct 17835 VENTURA BLYD., SUITE 106 Wife"? (husband's) signature (if filing jointly, BOTH must sign ovon Wonty one had mcomes | — Address (lind GIN GSE AL It’ Sly. Meat, cr Sea Oss De. - c a! . - : TEL. (213) 881-7350 an : pe Doo ae S.S, 568-40-9527 ae NW 55923 Docld:32245535 , Page 76 ° ; , :