piel | wits bon © . Reference copy, JFK Collection: HSCA NAME, Cn M wen Lb C ° ADDRESS ts Kuby CALENDAR YEAR 19 | 7 Bates —_._—. SOC. SEC. NO, ___ me ws. DEDUCTION SCHEDULE “MEDICAL STATE T FEDERAL |CONTRIBUTIONS STATE FEDERAL "2 MEDICINE/DRUGS i 4 = 21 PARTNERSHIP SHARE a 3 LESS 1% A.GA. (Line 18-1040) _ GIRL/BOY SCOUTS ry... fT 4 NET MED/DRUGS _ [| HeaRrrunovcanccr Fung | ss || sof 5H & A INS. (% + EXCESS) OY | | Reocrossunireoruno \ |  — s [| ff fa OR. \ _ | | XMAS & EASTER SEALS \i (7 Al [|] OR. Po ESE ORSARIEED GIN TES | of DR. , tsi—‘isSC —_ POLITICAL CONTRIBUTIONS. | rf] DR. Sd GZB0| | cuurcnes fF P| OR. fi ee es ns (es OR. fo pt es ee ee OR. ae ee re ee OR. ) po ee ee ee }—— NN 22 favicon: Pot re 6b HOSPITAL | [24 TOTAL CONTRIBUTIONS > sol [ 90] PROSTHETIC APPLIANCES Ys SSC ASUALTY OR THEFT LOSS(ES) ' ys sP26 INSURANCE REIMBURSEMENT ; {sd 6c AMBULANCE || «27 Difference (not less than zero) rT {| LABORATORIES |S «28 $100 Limi TATION PER CAS.) TRAVEL FOR MED. | (Y UH TO] [Bror.cas.ontHertLoss > 4 | _JMISCELLANEQUS DEDUCTIONS MEDICARE INS. | [30auimony GLASSES YT 31 UNION/PROFESSIONAL DUES 7 MEDICAL EXPENSES aad 7 | [32cHitb & DEP. CARE (Furm 7441 “LESS REIMBURSED BY INS. 33 INCOME TAX PREPARATION 8 LESS 3% ADJ. GROSS INC. PL 2 unitorms/PRorec. CLOTHING | +%(TO$150) OFH&AINS. |... | | LS OI] Launory AND CLEANING 10 TOTAL MEDICAL DED. > ST] [| [2eb |. | Auto use Mi TAXES _INVEST. COUNSEL & PUBS (Sched 11 STATE & LOCAL INCOME EMPLOYMENT AGENCY FLES 12 REAL ESTATE SAFE DEPOSIT BOX. 13 STATE & LOCAL GASOLINE TEL. REQ. IN BUSINESS 14 GENERAL SALES TAX 15a PERSONAL PROPERTY {5b PERSONAL PROPERTY AUTO IGSTATE DIS.INS.H = oW SALES TAX AUTO ~” had : 34 TOTAL MISC. DED. UMMARY OF ITEMIZED DED. i 6 Tor. OEDUC TIBLE MEDICAL & DENTAL PENSES (FROM LINE 10) 36 TOTAL TAXES (From LINE 17) 7 TOTAL INTEREST (Line 20) B TOTAL CONTR. (Line 24). QCAS. & THEFT LOSS(ES) (Line29) TOTAL MISCELLANEOUS DEDUCTIONS (FROM LINE 34) STATE FEDERAL | BERREER ~ > 5 17 TOTAL TAXES TEREST (1G WHOM PAID) 18 MOR TGAGE P= SESE 4 TOTAL ITEMIZED DEDUCTIONS ENTER ON FORM 1040 LINE 45 REMARKS E bas rd BS ie (RG 233) (Btu. en PTY TE PWR TT TI meg oe epee rd Tyce er NTT reer emaee + Sree agen pee ay en ap rete
A 4 ABR Ie . gt. ateEeaewbieta.d Reference copy, JFK Collection: HSCA (RG 233) guna. _ wp, SOC. TSEC. NO. ADDRESS ___ Beas sai be. = ue FISCAL YEAR ENDING 19 SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION PRINCIPAL BUSINESS ACTIVITY BUSINESS NAME EMPLOYERS NO, BUSINESS ADDRESS TOTAL RECEIPTS 5 > —_——— INVENTORY AT BEGINNING OF YEAR MERCHANDISE PURCHASED : BERGREEL oo A S INVENTORY AT END OF YEAR GROSS PROFIT 35277] —— — GROSS INCOME OTHER BUSINESS DEDUCTIONS ADVERTISING 4 | a2] | aura AND Truck Expense Idea Mt Ay UY lt BOO! a BAD DEBTS CASH SHORT COMMISSIONS DELIVERY DEPRECSATSON ( SCHEDULE ATTACHED ) . | (437 | : j | Al OUES AND SUBSCRIPTIONS ENTERTAINMENT AND PROMOTIONAL __ENTERTAINMENT AND PROMOTIONAG ___ _ INSURANCE . / || INTEREST ey | JANITOR SERVICE — rd LAUNDRY | DY Tt LEGAL AND ACCOUNTING T2701] | MAINTENANCE = JFFICE SUPPLIES AND EXPENSE RENT R se} SS Saino REPAIRS SALARIES AND WAGES SALARIES OFFICERS SUPPLIES TAXES AND LICENSES ~ ie A) TAXES - PAYROLL TELEPHONE TRAVEL UTILITIES PARK? NG i RL open eee ee ce tener ene ee oe Amen emer no Ms elke NET PROFIT OR( LOSS ) + FRDERAL RETURN maitcin “WET PROFIT OR LOSS ) - STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF. Gal re NW 559235 'DOSTHABTAATHSS- PHOge 240 a FE
‘ 4 hee . : Reference copy, JFK Collection: HSCA (RG 233 . 3 rG) ’ - & to Zz J < ow on Go oo” a : > ~- wee “| : we a 6 | « uw - ; ; | WwW = - | > gf | = ™ : a z : | z | w Y é | a ! <c | 3) ‘g : . t : o 7 t f { | ; zh cr PT] TET TL | <°oO | a me i : « Vv a | . oe CCCCEEETLET ° i > ; . <I Ze ma) N ac 2H E eo « ya aoa “OO - a vo g 2 aH ~ u | : f. b S wi | - 7 | < i rs) is : : Miiiiiniiiii a . iz ; EET | _ “ | 5 ow : a} esa | “” | . o < a an : a > | eS 5 2 S&S = ~ Hi | =” ! z a : : gg | c : 5 i z i re) . wo ; wl { ; 4 ‘ w ' © ‘ = | : : : j > * . S : 3 z : \ 2 S 7 7) * | y 9 F | w S ; 28 , z= @ 1 "ia < 18 5 |= rie a ws ~ o a ry Nw 35 $23 Doold:32245535 Page i191
Reference copy, JFK Collection: HSCA {RS » CALIFORNIA n - - , a [ICOM TAK | 7 opt , i, cr othar taxabl: , 1972, ending ; ~~ LAST PANS hie vAL(S) RUBY ZIP CODE occu. | Yours ‘ade tLing Ge Caistor pla Parody) wits Hounovd . oe te ube rhe se Fe SEPT ASSP TORRE TTT ERRORS LEENA tt PAL NATED MT ES OEMS Se AREA Tim SWE, ' uhh. §, Esagndonts—Do not tist yourself, your spouse or person who qualifies you as head of household : ie BANE (Include tet cama and/or address If éiffereat fron yours) NELATIONSINI? Pred, Bedams. ELLG05. THOMA cece cence timnetar meen nena sans toe mmmneminacmnamsrrrsemersssaraceee sean ee ee’ Peer rer mer Terre ieter itt ttre ee ee someones Entar ...Number > 5 nnn nee nee set eee nnemee ne tenant 6. Elind (refer to instructions) 7. Jet tr) dependant end blind oxomations (add lines 5 and 6) “Number ‘of ‘blind exemptions claimed & 6- af 2 i fea) pee) wo) ed sah Eehecula (AOD re of itd il ory £569, ¢ COLL o AOC TESL LEIS LE Bh SIE ATED Et EET SAE EIA SITS ccrBsZ Ho ee ip under GEOL .J tind i I) ica Feole cod onion co fsa VY, ' a finn “J or mare cc 3 9 end 18, xh {irom paga 2, ling 56) Lok ke ke sue woes 15 fren 12}, Figure yeur tes on v thls carcunt by usiey 3 coro Tox Rato 7 ass rx chs a toe ee oo o. ' Li isn Teta, a Tox fet ni sdule aa Q Sch: tuto (C1540) Cos : ; - 4 —025, Uanicd esuple or head cf Rouschold—20 2 2. PIB) 99 | OU . qr =--Totsl stan fine 7 above, Ak MB... 19 327100 a er ee (irom page 2, fine $3). 1 we Lo . . Pa 23. (st wx fealy (subtract jing 22 from ting 21). 2. 1 rn pe - 24, Tax un pieterense income (5 ee instructions—attach Schedule (540) ) . 3 25, Toit tc Rel ity (add fines 23 and 24). 0, ee ee ee 3 26. foich Cat ‘ornla ‘incorsa tr withnatd (attesh Form(s) V2 or GE-2P to front) . . . {| . . ~ 27, 1072 Caffuraia estlmetsd tax payments... ee ee re 14 ., ane “429 fgets Galli orale SBI tax withheld (attach Form DE 1964 to fco of rotur 1. we | 28 To ‘ 28, Tteh aymodts todd tn. 2627 ond 20) 0 Cf 28 "% wee ae PERT TARTS OE a oar ae as a ca Ca RE haere ae oe Re ne REEL akc nee eer nt RY te PES YN mig Poy In full. Mail pa ment with return to 6| 30 2 a8 tine 25 bs larger than fine 29, entor CAARHCE DUE. Frdachise Tax Hoaid, Sacramento, CA 9986/7. S101 lina 29 is terger than line 25, enter Gveneaviaent, {fall tetuin ta P.O. Bor 135M z ~. + 30, ting a to bo (a) “nerueiben, (Allow at tcest six wooks for your refund) 2... o | ; . | g ; +». (b) Credited on 1973 estimated tax. ee , at Ds I LE A EE a PL ET ET tS ES = eon paneer Soest 5 Urzcr panzittss of perdry, § declera that | hao examined this return, Intlading accompanying acheduies and ttatements, and to the best of cy tnouteese and | Dowotwrite: we ; pes pelle ig is Crue, cerrect and complete. If prepared by a pertun other thon taxpayer, his Ceciaration ts based on alt Information of whlch he hes ony knowledge. G EDWARD L. LAMBERT raay o xz ars r “gigstnOT filing Jointly,” BOTH mest sign sie |B ily Bs ane aPa 3 ene | Do, I ul t WW 55923 Docld:32245535 Page i192
Reference COPY, JFK (Collection! 2 Et BEBUCTIO.IS faired t9 Ferm 6.9 ions, the other may Got use the Tox Teo!2 c? cla: 4; vhoose to itemiza your deductions, cammcta 0 23. Cash—Including checks, “money orders, ete. titaraize) eo ceeeeeetne ceesuenes syuhseessannsesuecaeeencenecs ea Tota! cech contribut “1. Ghar don cash (ceo instructions). Entcr total 14 + 8 8 . Maximum daduction _. sted afuss ineens. creat eee “st axceed 60rd cad ou 123 i m 125 ‘ AE eet aS Doni RT OR TENE te A Aa 2, tot: 1_thed | lines 6 26, 7 ond 28. enter here and on Form 340, pz: 2d oo voowsannarammns SD, in sot at pure S99 4 ee ee : 23, Gthor (owniza) . sossqnenienceen canine y or r Thott A Lossles\-Soo fastruciens ROTE: wtf you hed more than one casualty or thoft lol. efurtencs, omit tines 39 through 33 and follow ciel de at Lt ! phd te ge kk ek tongs 4 IG3é retrans for guidance, 23. Los3 Bilore edlustments Incuranco rolmbureomant ye og eee | SDT laeenescenseceremes $100 Iimitation 2. 6 6 we ee tae ¢ Add lings 31 ond 320. =. 7 7 Casualty or theft loss. (Line 30 fess line 33) ad OS [2 Can ‘ 1h dvd Fut ; *e vee hes Erra—See instructicas 2. 1... ae : wa ea Gihsr-—For education, alimony, unlon dues, etc. —See lastructions eee tceeee Total miscollancous deductlons~-Add IInea 34, 3 eh rated tales lfc ‘tins 4 “hag 20, “Enter ibe and 36, (Enter haro and on Form 540, pago 2 » thera end on Fona £40, peta 2). 6. eC ESRC? te ib 27 rere n bam: 55923 Docid: 32245535 Page 193
Reference COPY, JFK Collection: a - iz. PROFIT (G2 LESS) FROM CUSEIESS OR PROFESSION (Calo Prenrtctorships) a4 rime gen Crm £6. a, Busi & Dep QALNR —— etaagehicz fotn2 viz Fae BERN RE, ESE ome ata perirt er eeeret wali Cochab Seu itd ee i ' ' + Mareen SS) ne i it on rare if ced Serviced eeceecne @ PROMUCE on eect centers: veccectceecevanstsessreteanmness i item Yat ACY _ (fer eaarmplar re fails hordware: Veholssala—tobacco; sees adogal, mmauulaciuriny--furniiera; ate.) ay PE DTUD cece ceebectee Snares ae, tees cece wtaag Ga Fodoral omployor idontification mumbor.. een seeeee ceecereeeceedea! ON Beginess cddress. epee 5448 Van. ‘Nuya, Bivd. Van Nuys, Californda. oo we ee ere 7 eorts) mathed -ef ese 2 ating: - fy cash; []-accrual; [[} other. > cis 59D, 392, 4 aos 2 and & £o.,-for the calehtcr year filed {if required)? (4) Yes £,] No a oo we . . . : MI Le dw @03cb. sundaries of the’ city, town, ete, ind! cated? Coe ee ek ew ew ew Vy ee 6 Ves CIN = ae haw . : . 7 tg? 18 Dig sine ‘eit ie cr 4 ci ithe taxctila ‘year? Ce ee Yes (J &. ‘Mow ncn cy csonth of the: inxeb! 2 year ; did you evn this businos ae ID ee . coo zd in. weowesecemrase ao wen ramen i wn rhe wn. : Jouhs lis Oe “ier cesses 3 3 (entee ch oc eens sdulo) woe ee a « f. as - ‘ « . . . . ’ . . . . . . « . . ve * . « « * * . . . . . . . a . . : dole C-1 (eucldv any paid to yours: el). ek 3 ? a beet ow * ” . * oe ‘ ‘ . ’ ° . . . . . . . ’ . ° . . . . . ’ . . ‘e . .. - (sea factruciicna for ling 13 53) a Har ed aye if. ope. . . . . . . . . . . . . Perr rret i tet erer tie. er et Per hrs Se dn eemmmmen neces seer e nomen € “gt? ae Baa me pane nee same mm emee enh ee sewer eewmnsmeemee Pe ere ee sae t ee eeeeee Peer errr laren emementenes see teene ce: ween ne tee te ewmewee ee 8 . <4 ©) Total @ other business expenses (add lines 19(a) through 19(0)) . 26 ~*~ Total deductions (add lines 6 through 19) . . 1. . Ce ek (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR NW 35923 Dooid:32245535 Page i194
ARLE BS i NE EER Po NAAT PIN SW RHE “NW 55923 Docld: 32245535 Page 195 po > i f fl ‘D I f . | TAXABLE CALIFORNIA | Sin 071 CAPITAL GAINS AND LOSSES ea Attach to Form 540 or S40NR Use this schedule to report gains and losses on stocks, bonds and similar investments, ers gains (but not losses) on personal assets such as a home or jewelry. —— Seciai Security Me : Name as shown on Form 540 or 577 4% tial Security Humbe “Gamuel and Phvilis Buby : e. Cost or other b: :i5, as | adjusted. cast of a. Kind of arnperty and desoristian. b. Date actuired c. Date sold i . . $ subsequent ixsrovereats | {, Gain er loss H a G: xs sales price t Cif not purchased, (3 less e) (Example, 160 shares of "2" 2 ~ 1 (mo, day, yr.) | (mo. day. yr) E | attach eaptanation) and expense of sate ane SCHEDULE ATTACHE = | . | 2. Enter your share of net short-tesm gain (or loss) from partnerships ond fiduciaries 3. Enter net gain (or loss), comoir= lines 1 and 2 . 4. Enter unused short-term cagitc: loss carryover from preceding taxable years (attach statement) 5. Net short-term gain (or loss}, combine lines 3 and 4. “F. Eiiel Guia if opplicoble trom tase 4, Schedule D-1 (Form 540) (attach copy) eee assess 8. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries . 2. 6 ee ee 9. Net gain (or loss), combine lines &.through 8 ee ee . 10. Enter unused long-term capite! joss carryover from preceding taxable years (otlach statement) 2... 14,274,009). 11. Net long-term gain (or loss}, combine lines 9 and 10. 12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here 2 - - 6 ee ee (15,522.99). 13. If line 12 shows a gain— (a) Enter 50% of line 11 of 56% of line 12, whichever is smaller. Enter zero if there is a lass or no entry on line 11 eee (b) Subtract line 13(a) from line 12. Enter here and on line 32, Form 540 (line 33, Form S40NR) © 6 fone eeeeeeee eteenteecteee 14, if line 12 shows a loss— oO a (a} Add lines 4 and 10 (if lines 4 and 10 are blank, enter a zero here and on lines 14(b) and 14(c) and go to fine 14(d)) we Coke ee a (b) Combine lines 3 and 9—# gain, enter gain; if loss, enter zero. Coe ee ee (c) Enter smallest of (i) line 14{a) less line 14(b); (ii) the amount of taxable income on Form 540 or 549NR, computed without capital gains and or losses-—determine this figure via a side computation; or (ii) $1,000 | —_ (d) Combine lines 3 and 9—ié loss, enter loss; if gain, enter zero here and on line 14(e) and go to fine V4/f) . fee eee (e) Enter smallest of (i) the emmount of taxable income on Form 540 or 540NR, computed without capital qains and or losses, tess line 14£c}—determine this figure via a side computation; (ii) $1,000 ($500 if married and filing separately); (iii) # live 3 is zero or shows a gain, 50% of line 14(d); (iv) if tine 9 is zero or shows a gain, amount on line 14/d3; or (v) if lines 3 and 9 show losses, line 3 added to 50% of line 9 . . . - (f) Enter here, and on line 32. Form 540 (line 33, Form 540NR), the sum of lines 14(c) ond 14(e)—(Do not enter an amount grecter than $1,000) . Coe eee Soe ee ees ( 1,900,09) Carrvover (1-)) (814,572,009) See Instructions on Back
Nw TH928,,Do0cTd: 32245535 Page 196 SCHEDULE es CALIFORS VR an 7) ia er ITEMIZED DEDUCTIONS . Attach to Form 540 [ FORM 540 Nama as shown on Form 540 jtemizad vs, Standard Deduction—-You have a choice between two deduction if one spouse itemizes deductions. the other may not use the Tax Tab'e ecrc3 meiheds. You can either itemize your deductions or take a standard deduction as the standard deduction. 1 you choose to itemize your deductions, complete explained in the 9 ‘0 Instructions. On separate returns of a husband and wile, appropriate items below. Medical and dental expenses (not compensated by insurance or otherwise) far medicine and drugs, doctors, dentists, nurses, hospital cure, insurance —_sopremiums for medical cara, etc. . One half (but not more than $150) of insurance premiums for medical care © 2 ee ee ] { . Madicing and drugs . : . . Enter 1% of adjusted gross income shown on Form 540 . Subtract fine 3 from line 2. Enter difference ‘if less than zero, enter zero) | Enter balance of insurance premiums for medical care not entered on fine | _ Other medical and dental expenses (attach itemized list) _ Total—iadd tines 4, 5 and 6) | Enter 3% of adjusted gioss income shown on Form 6A0 . | Subtract tine B from line 7. Enter difference (if less than sero, enter mi) 9 ; | Total--iAdd fines Land 9). 2 1 eee es i 10 150 fii 7 & 5 woDaewwt moh WH — — 2 Child Adoption Expense 11. Total expenses paid of incurred—Attach itemized fist 12. Enter 3% of adjusted gross income shown on Form 540 . 13. Subtract line 12 from line 11—See instructions for maximum limitations . Taxes 14. Real estate . 15. State and focal gasoline 18. General sales . a 17. Aufo license—Excess of registration and weight fees (see instructions “ 18. Personal property . . 19. State disability insurance (SDN Employer ‘private disability ‘plans do not quality co ee ee : 20. Other (specify) . ness de cece up tnaete tnt cee ee ce wnee saueaesate tettentee venneeeete so ep canine umeaseee 21. Total taxes—(Add ‘lines 4 ‘through 20) Contributions 92. Cash—Including checks, money orders, ete. {itemize} _. 23. Total ‘cash ~ contributions toes Lae CC ee ee | 2B LL pee 24. Other than cash (see instructions). Enter total here ‘ Soe ee ee en ee 25. Totai—Add lines 23 and 24—Maximum deduction may not exceed 20% of adjusted BInSs income. eS Interest Expense 28. Home mortgage 27, Instatlment purchases” 28. Other {itemize) _ 29. Total—iAdd lines 26, 27 and 28). 0 0 ee Ce Miscellaneous Deductions 32. For child care, alimony, union dues, casualty losses, ete. —See instructions litemize) . - — _- ee |! Deen ees 3. Total, miscellaneous deductions Ce ee ee er on $40 her 32. Totat deductions—{Add lines 10, 13, 23, 25. 29 and 31). Enter total here and on Form 440, page 2, in space provided .Shoo.. 4,0'°O D% Schadula A on raverse
es GAUPUANLA PROFIT (OR ane BUSINESS OR PROFESSION ° (Sole Proprietorships) ; inj‘ aint ventures, etc., must filo on Form 56 Attath this schedule to your Income tax return, Form 540 or 540NR —_——- Portnerships, joint ventures, etc., must file on Form 56: Name os shown on Form 540 or 540NR A. Principal business activity Food S Service _ ; product ee ‘For example: retail- hardware; wholesala—toborco; services ler gal; manvfacturing~ furniture; etc.) 'B. Business name Snack Rar wo ec tee we o if: Federal ere identification number. 1. i } ; Now are a D. Business location ... 541 Van Nuys: Riv ae an Nave, Ca orni _ re . ‘Number and streot or ‘surot route) (City —post office) (Stote, {Z1? code E. Indicate method of accounting: [Q cash; [] accrual; [7] other (describe) ccc nee cece caneseneetee cote ccneesentenes cee cnecers ceeeeeeeteeme tee Ff, Was there ony substantial change in the manner of determining quar atities, costs or valuations between the opening and closin= inventories? (J Yes (No. If “yes,” attach explanation. G. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? [Yes  &! No 1. Gross receipts or gross sales $ . , Less: Returns and allowances $ 2. Inventory at beginning of year (If different than last year’s closing inventory attach of SCHED LE: ATTACHED explanation) . . Ce Merchandise purchased $ _ tess cost of ony items with- drawn from business for personal use $ Cost of labor (do not include solary paid to yourself) Material and supplies . . . fe Other costs (explain in Schedule C. 1) ee Total of lines 2 through 6 . Inventory at end of this year . . Cost of goods sold and/or operations (subtract line 8 from line 2). Lee Gross profit (subtract line 9 from line 1) . OTHER BUSINESS DEDUCTIONS - Depreciation (explain in Schedule C-2) . } Lb Taxes on business and business property (explain in Schedule C. 1) toe ke ee Rent on business property a . . Repairs (explain in Schedule C-1) . . . . , Loe . Salaries and wages not included on line 4 (exclude any, y paid to yourself). ee Insuronce . . a Legal and professional fees . » 18. Commissions. . . Co ee ee 5. 19. Amortization (attach statement) Loe eee Co ek ee ee 20. (a) Pension and profit-sharing plans (see instructions) (b) Employee benefit programs (see instructions) . 21. Interest on business indebtedness . 2 6 6 ee ee 22. Bad debts arising from sales or services ry 23. Depletion of mines, oil and gas wells, timber, ctc. “(attach schedule) . . 2. . ES 24. Other business expenses (explain in Schedule C-1) ‘ 25. Total of lines 11 through 24 ; . - Net profit (or loss) (subtract line 25 from line 10). ‘Enter here ond on pug: 2 Form 540 < or “540NR . 7,350) 33 SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24 a pn a ee a eee ns Lina Ms. Exnlanatlon Amount Line no | “Explanation Amount fw S592) pocld: 32245535 Page 197