JFK Act 6 (3) _ NAME, ADURESS__ | SCHEDULE NO. SC SCHEDULE OF DEDUCTIONS _—_vear ENDED_ MEDICAL FEDERAL | STATE [SONTRIBUTIONS - FEDERAL & STATE CHURCHES wa 2. DRUGS AND MEDICINES ai COMMUNITY CHEST/UNITED CRUSADE Sus. of so. enss Rea __ SALVATION ARMY/GOODWILL INDUSTRIES a i | te PARTNERSHIP RETURN Look avout peoucrion Pook otter oncanizez cHaritigs: a ; a =cut ____TOTAL CONTRIBUTIONS se =o INTEREST (TO wHoM paip) MORTGAGE LOAN J 2s PE gadan J Nt | Se eS _ (BALANCE OF MEDICAL INSURANCE NOT DEDUCTIBLE ON TOP LINE’ : Oo : Bod i a a ar m ao | {Rit % . Th MISCELLANEOUS DE DEDUCTIONS ALIMONY (EXPLAIN) (| sare perosit sox ree | |i UNION DUES ot al SMALI, TOOLS (GOOD 1 YEAR) TOOLS DEPRECIATION —_- SAFETY EQUIPMENT . UNIFORMS (NOT GEN. WEAR) ' |7, LESS: 3% OF ADJ. GROSS INCOME a | LAUNDRY & CLEANING 8. BALANCE (NOT LESS THAN ZERO) -_|. | | AUTO "MILEAGE @ 9. TOTAL MEDICAL DEDUCTIONS —_ TELEPHONE EXPENSE (NOT REIMB.) (LINE 1 PLUS LINE 8) ; EMPLOYMENT AGENCY FEES LTAXES a “Paar sae DUES & SUBSCRIPTIONS. .° ie eeisE AESs RES FEB $e | OTHERS : | SALES TAX AUTO rT | | | REAL ESTATE TAX . Le aa3/| cI?) | | | PERSONAL PROPERTY TAX | TRAVEL FOR MEDICAL “| AMBULANCE. , GLASSES HEARING AID _ PROSTHETIC APPLIANCES MEDICAL EXPENSES iii LESS: REIMBURSED BY INSURANCE FT Tx xix x] GAS TAX /Q)? cat.@ s()) ¢GAL. ae oe TT | __DISABILITY INSURANCE LESS REIMBURSED BY INS. MISC. TAX x| | SUB TOTAL bop 2. ora sunt nesses ro “FEDERAL STATE | | . TOTAL TAXES PA ; wT "TOTAL DEDUCTIONS | 3/099) Gain een NW BEY9SY Poe: 322499499.,RaIe I eeag VENTIIRA RAIN EVARN CHITE RIA FNCINA CALIFARNIA Q12146
ae Profit for Loss) From Busine SS or Profession | ‘(Sole Proprietorship) _ VW Penartment of the Treasury > Partnerships, joint ventures, etc., must file en Form 1065. im Internal Revanue Service pm Attach to Form 1040. . Nama(s) as stiown on Forin 1040 ., . . an . - Secial ic number . Ss >J and Phy s Rube Sa Oe - Samuel an h Llis by ; . So JFK Act 6 (3) A Principal businass aetivity ..POOd Service | coe product o.. (Sea separate instructions) (For. example: retail —-hardware: wholasafa—tobaceo; serulcas——legat: “Inanuiacturing—-turniture; ete.) B Business name -.--- Snack Rare. waeeeuee eanee G “Employer identification Number weeeeeetee ‘ebpneeceececcaneseeces weeee _ 5418 Van Nuys Blvd... Van “uve, California 91 401. . D Business address .2 07. A te ee rete ee oe E£ indicate method of accounting: 30 cash; “(2) Ci accrual, (3) my) other. © F Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening 2 and closing inventories? C) YES [ NO. If ‘Yes,’ attach explanation. | : “G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 19712 (See “Item G” in “separate: instructions tor Sc hedule Cc) ne ‘(ZIP code). CO YES fR NO. If “Yes,” where. were they filed? D> i Sy ‘ ® 1 Gross receipts or gross sales $. 00... eectes wae Less: Returns and allowances $........---222-2-seee ener S 1 lececepeleececevecsecdecceense” 2 ‘Inventory at beginning of yaar (if different from fast year’s closing inventory ’ attach explanation)... eee ee Toke vee leed eee tede tence . a 3 Merchandise purchased $............... ceecnectecesccasecesceseeenseees , less cost of any iterns [| - ce er a ot withdrawn from business for personal Use $........c-:ce: order cscteeee teens cee [ecteedneeeneeseeeeeeetedfeceeed ; : Se i - - SCHEDULE - Cost of labor (do not include salary paid to yourself) ATTACHED, Material and supplies .. oe ew ee : Other costs (explain in Schedule C1). wwe ee et a _ Total of lines 2 through 6 ©. we ee ee ee a eeneneecenec nee teeepeeeyoeneee Inventory at end of this year 2. 6 2 we ee oe ; a Cost of goods sold and/or operations (subtract line 8 from line 7)... ae - 10 Gross profit (subtract line 9 from line 1) mo OTHER BUSINESS DEDUCTIONS 11 Depreciation (explain in Schedule C~2) : 12 Taxes on business and business property (explain in Schedule C-1) . w On anu oa 13 Rent on business property ee ee y ee ann Dl a 14 Repairs (explain In Schedule C-l) 2. we ee ee , oh voeeege des leeeelcneenest enaeee 15 Salaries and wages not included on-line 4 (exclude any paid to yourself) - ee wee enone ceecene concen peewee ‘WG-Insurance . . we ee a a ale _ 17- Legal and professional a Le coe Le 18-Commissions .°. 6 6 ee ee ee 19 Amortization (attach- statement) . . . 20 (a) Pension and profit-sharing plans (See instructions). woe, a - i a i- (b) Employee benefit programs (See Instructions) . a 21 Interest on business indebtedness . <-. 2. 0s ee eke 22 Bad debts arising from sales or services . a 23 Depletion .: . Coe ea ee a ee ete ee ee ew ee valeneesneenceeeecetene -|--n--- we 24 Other. business expenses (axplain in Schedule C—1) Sy : a 25 Total of lines 11 through 24 . cee ae 26 Net profit {ov Jos9) (subtract lins 25 from line J) Enter hara and on line. 34, Form 1040. ALSO enter an Schedule SE, Part 1, line 1 2 850 HF SCHEDULE C-1. “EXPLANATION OF LINES 4, 12, 14, “AND. 24 | “tine No. | “Explanation ~ ~ “Amount 7 ‘pocld:32245535 Page 96°) /
Samuel and Phyllis Ruby SUPPLEMENT TO SCHEDULE C: (Ral. of Lease) MW 55923 Docld: 32245535 Page S87 ~ (3,428.50) “$7,350.33: $2,900.00 “1,000.90 $3,428 (343,479.18. “176.63 © $43,394.94 A iel7 “$7, 768 38 6,989.55 $10,778.83: Income. _ ; - Less: Sales Tax Cost of Gooda Seld a ms Berinning Inventory oe a ; re a So 800.69 Purchases oe Te es a Beverage/milk 4,980.70 — Croceries. , 15,169.50 © — Meat 2,570.35 -- _ Bakerv/bread 7 =. 248 15« 62 Total Available  §607 wiz. Less: Ending inventory nan. cae Adjusted Gross Profit | — ‘Expenses |. . ies a a os ; : Casual lahor. 2. 3. ne me ote “A812 °. Rent. | a ES a5, 87 09 Payroll) | 3,640.03 . Telephone 148.00 Tnsurance © 190.59_ Advertising ee ABLTO Accounting 5175.00 .- . Miscellaneous 27,04 0 Equipment: . 2 AGO3 6 Maintenance/tepatrs” ae 136.19 © ‘Taxes/licenses. 556.06 -°.. Hostery — 130.04 Auto / 317.14. Linen. 17.830 -- Donations 24,00 -"- Less: Depreectatiton 7 NET PROFTT © DEPRECTATION: Equipment 4/70 ° $10,990,09 2,000.00 2-2 °5 vr, st. ' Covenant not | : oe rr . to Compete 5,990.00 1,900.90. 5 -¥r. SL. Leasehold. Imp, 3,900,00- 428,500 5° 7 velo st. 428,50 50.
SCHEDULE SE Computation of Social Security Self- Empl oyment Tax | {Form 1040) > Each self-employed person must file a Schedule SK. coe ope is om "| Department of the Treasury + internal Revenue Service : > A ttach to Form 1040. > If you had wakes, including: tips, of $7.600 or more That were subject to Zoclal secunty taxes, do not fillin this page. > If you had more than one business, combine profits anu losses froin al your businesses and far ms an this Si dule SE. y: benstits. Important. —The ‘self. employment incame reported below will be credited to your sociai security record and cused in figuring social ‘se Name of self- -empioyed person (as showrvon social sécurity card) Social security - number . an co ; oe of self-employed person Business ess activities subje ctto ‘self- employment! tax . (procery store, restaurant, ‘farm, etc. ) > Computation of Net Earnings from BUSINESS Self-Employment (other than farming) 1 Net profit (or loss) shown in Schedule C (Farm 1040), fine 26. (Enter combined amount if more than’ one on . . 7,3! 50} 33 business.) 2 a . ne a a ae 2 Net income (or loss) from exc hided SERVIER OF SOUrces included on lieve ! wo a . TIEZ Specify excluded. services: or SOUTCHS on. . ‘ eeleees vediseenti rete ed . ee 3 Net earnings (or loss) from business self- employment (Subtract ine Z 2 from line 1. and enter here and ne . 7 (350 33 ‘ on fine 8(a). Part tl below.) soe. mememara ' IEE. Computation of Net Earnings from FARM Self Employment . - : ; > aber + A farmer may elect to compute net farm earnings using ‘the OPTIONAL METHOD (line: 6, below) INSTEAD. OF THE REGULAR. METHOD (line 5, below) if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600... If your gross profits from farming are not more than $2,400 and you elect to use the optional method, you need not complete : eo _ dines 4 and 5. . D Computation under Regular Method | 4 Net farm profit (or loss) from: oo : (a) Schedule F, line 52 (cash method), or line 71 (acerual method) . (b) Farm: partnerships Be . '5 Net-earnings froin self- employment from farming. Add lines AG) and 1th) a . Computation under Optional Method - a ne 6 H gross profits froin farming are:* ° ; ; , ee ne ’ (a) Not more than $2,400, enter two-thirds of the gross’ profits eens see (b) More than $2,400 and the net farm profit is less than $1,600, enter $1, 600 *Note. —Gross profits from farming are the total of the gross profits from Schedule F, line 28 (cash. method), or line 69 (accrual method), plus: the distributive share of Bross” profit from farm partnershios as explained in instructions for Schedule SE. . . 7 : 7 €nter here and on lifie. Bt), Part tH, below, the amount on line 5 (or line 6, if you use. the optional, method) . . Computation of Social Security Self. Employment Tax 8 Net earnings (or loss) from self-employment— | ‘(a) From business (other than farming) from tine-3, Part |, above “S ‘(b) From farming (from, line 7, Part UW, above) . “(c) From partnerships, joint ventures, etc. (other than farming) eo. (d) From service as a minister, member of a religious order, Gra Cherie stian Science prs actitioner. If you - [ . filed Form 4361, check here {.j and enter zero on this line’ (e) From service with a foreign government ¢ or international organization (f) Other. (director’ s fees, etc.). Specify ; (If tine 9 is: less than $400, you are not subject to self- -employment. tax. Do not’ lt in rest of page.) .10 The largest amount of combined wages and self employment earnings subject i . tosocialsecuritytaxis . . .. ; sone 11 (a) Total “FICA” wages as indicated on 1 Form w-2 a (b) Unreported tips, if. any, subject to FICA tax from ‘Form 4137, line 9 . . (c) Total of lines 11(a) and 11(b) . a ae 12 Balance (subtract line 11(c) from line 10)... Co ee, oh 13 Seif. ‘employment income—tine 9 or 12, whichever: is. smaller . . os 14 if tine 13 is $7,800, enter $585.00; if fess, muitiply the amount on line 13 by. 075 | . . . : 15 Railroad employee's and. railroad employer representative’ 5 5 adiu stinent for hospitai insurance, e benetits Pe tax fram Form 4469 . .. . a art . ee ye ye ___37,800 00: fs ‘NW 55923 DocId:32245535 Page 98
ee (Form 1040) b> Attach to.Form 1040. b Examples of property to‘be reported on this Schedule are SCV : . ot Department of the Treasuy -f > gains and losses on stocks, bonds, and similar investments, and gains (but rit losses) | i) ag. Internal Ravenua Service an personal assets such as a home or jewelry: SCHEDULE D ~ Capital Gainsand Losses a | Name(s) as shown on Forrn 1040 Sam uel and Phy llis Rk aby ware te eet rene ee tte - yor r a ee “te. Cost or “other, i oh. How | ot. Mo, day, yr. : ne jas adjusted, cost of sub- | -- cr. “4 a oO Lo acquired. iPut date sold above | ge pat : 8. Kind of aropart di dagetintion .. - ni {voted tin ’ : 3 Hee: sequent improversonts £2 Gain or (toss) , Jsymbol (saa; atguired below ; | explanation) aad ax . ; ; | instructions) gottes Lines ||___panse of sale at. ~~ an ee ase = : - wenn ae eleeetne e teee an a a a 1 ae SCHEDULE: ATTACHED pe cc Ba 4, 208. O9) ; | creche ence cece tenses —t— oon 2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries toe . 2. _ ‘3 Enter net gain or (loss), combine lines land2. . .. 2. . we oe ; & {3 a 4(a) Short-term capital loss component carryover from years beginning before 1970 (see {1 instruction Hy | Ala). 4(b) Short-term capital loss carryover attributable to years beyinning after 1969" (see Instruction H) oe 4(b) a) “Net short-term gain or (108s), combine lines 3, _4(a) and 7 A(b) 2 og: a 5 j Long-te ‘term ‘Capital Gains and Losses—Assets Held More Than ran 6 ‘Months. “ 7 Capital gain distributions. : os a _ Enter. gain if applicable from line acay(1), Form ‘4797 (see Instruction A) oe 9- - Enter.your share of ‘net long-term gain or (loss) from partnerships and fiduciaries re a | ~10 Enter your share of net long-term gain from small business corporations (Subchapter 8)". -. 110 11 ‘Net gain or (loss), combine lines 6throughiO. 2... 2... ee Be ee we to 11 woe tee 12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction H) . A2(a) . (14, 274 12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H)< 12(b) 13. __Net long term gain or (loss), combine Jines 11, 12(a) and 12() re ee | ike 7h 400) rte Summary of Parts | and Il | . oe 14. Combine the amounts shown on lines 5a and 13, and enter the net gain. (loss) here hr oe 14° mers 522. (00) 15 If line 14 shows a gain— . : (a) Enter 50% of line 13 or 50% of'line 14, ‘whicheveri is smaller (see Part vi for r computation of “ alternative. tax). Enter zero if there is a loss or no entry online 13. . F 15a) a ~(b) Subtract line 15(a) from line 14. Enter here and on line 35, Form 1040 | 16 | If line 14 shows a loss—See Instruction |. ': b> Omit lines 16(a) and 16(b) and go to Part IV if losses are shown on lines $1240) and 13. &> Otherwise, (a) Enter ona of the following amounts; ; ; ; me (i) If amourtt on tine 5 is zero or a net gain, enter 50% of amount. on line 14; (i) Jf amount on line 13 is zero or a net gain, enter amount on line 14; or, Ciily if amounts on line 5 and line 13 are net losses, enter amount on ‘Tine ¢ ) added: t to 50% of amount on fine 13. Soe. ’(b) Enter here and on line 35, Form 1040, the smailer of: (i) The amount on line 16(a); 8 2 (ii) $1,000 ($500 if married and filing a separate return—if losses are shown on Tines , 4(a) and 5, see Instruction K for a higher limit not to exceed 31, 000); or, ~ ; i (ili): Taxable income, as adjusted (see instruction 3) Coe Slat Rey . a Carryever WW 55923 Doeld:32245535 Page 99.
CAPITAL GAINS AND Losses _ Attach to Form 540 or S4GHR a Use this schedule to Feport gains and losses ‘on stocks, bonds and. similar investments, cand gains (but not losses) on personal assets such as a home or. jewelry. Name as shown on Form 540 or 540NR _Secial Security Number Samuel and Phyllis Pubv JFK Act 6 (3) SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS f. Gain er loss~. “do (mo., day, yr.) Gf not purchased, 7 _ Od tess e) { > (Examole, 100 shares of “'Z’' Co.) a (mo., day, yr.) | a soy, - | a ee ee . i . , a ‘ oo .@, Cost or other bs 23i5, as : Se St , : , a . adjusted. cast of ca. Kind of property and description : ; b. Date acquired ¢. Date sold 1d Grsy sales price: . Subsequent improvements attach explanation) - - and expense of sale “SCHEDULE. ATTAG WE ae ee ee co ese ay Enter your share of net short-term gain (or loss) from partnerships and fiduciaries 3, Enter net gain (or loss), combine lines } and 2... . . . woe - eee bo. 4, Enter unused short-term capital loss carryover from preceding taxable years {ottoch stotement) : me : 5. Net short-term gain (or loss), combine lines 3 and 4 . , . : : ; Enter gain if applicable from line 4, Schedule D-1 (Fora §40) (attach copy). ae . Enter your share of net long-term gain (or. loss) from partnerships and fiduciaries wae de gop . 9. Net gain (or loss), combine lines 6 through 8... . rs = a ae EE 10. Enter unused long-term capital loss carryover from preceding taxable years (ottach stotement) Lo lay: . Cob “V1, Net long-term gain (or loss), combine lines 9 and 10 . ee sn I Combine the amounts shown on lines 5 and MW, and enter the net gain (or loss) here . ..- . , . If line 12 shows a gain— pS : (a) Enter 50% of line 11 or 50% of line 12, whichever i is smaller. ‘Enter zero if there i is a loss or no entry on n line i {b) Subtract line 13(a) from line’ 12. Enter here and on line 32, Form 540 (line 33, Form S40NR).. 7 14, If ling 12 shows a loss—- oo (a} Add lines 4 and. 10 (if lines: 4 and 10 are ‘blank, enter a zero here and on lines + 1b) and 14(c) and. go to. line 14(d)). vol aa Pe ee ee a ; (b} Combine lines 3 ‘and 9—if gain, enter gain; if loss, enter zero’. on Sok ee bee . (c) Enter smallest of- (i) ‘fine 14(a) less line 14(b); (ii) the amount of taxable income on Form 540 or SAONR, computed without capital gains and or losses—determine this figure via a side computation; or (iii) $1,000- (d) Combine lines 3 and 9—if loss, enter loss; if gain, enter zero here and on line 14{e) and go to line 14(f) (15,522.00). (e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital gains and or losses, less line 14(c)—-determine this figure via a side computation; (ii) $1,000 ($500 if married and filing separately); (iii) if line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows a - gain, amount on line 14(d); 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 l4(e}—(Bo not to. enter an amount greater than $1,000) . 2. 7. ww we ( 1,990,090) | : Sen Instructions on Back | ae Sha oe a . a [MW 55923 Doold:32245535 Page 104
RESIDENT For Calendar Year 1971 or Fiscal Year Begun FIRST NAME(S) AND tNtilAt(S) Please SAMUEL AND PHYLLIS . Type PRESENT HOME ADDRESS (Number and street,-or rural route} “or 16250 Bircher Street Print CITY, TOWN OR POST OFFICE a “Granada Hills NAME AND ADDRESS OF EMPLOYER AT TIME OF FING Self Employed sO FILING STATUS—Check Only One: Claim your appropriate: | BLIND and/or QEPENDENT EXEMPTIONS: exemption on fine 16 5. Blind ff Yourself fp Your spouse -Enter number of boxes checked > 1971 and Ended “7 LAST NAME RUBY . Your occupa ion ‘Self Fmploved OUNTY : _ as Anceles STATE California Eo 1. () Single : C¥ Married, filing joint return 3. OF Married, filing separate return—if this item ihecked, enter spouse's 6. Dependents—- Do not Est your sell, yout spouse, of person who qualities yau da head of hous schold NAME tand address if different from yaurs) . RELATIONSHIP - social security number in space above and enter. first name Fredy, Rrtan Rlisay, ‘Thomas 28 Enter” os. here >. . | cues ; Ste! a. fumber om | 6 | 7 40 Unmarried “head. of “household” “Complete Part |, page 22 a Total: blind and ; dependent € exe mations tad lines 5 ‘and ® ... &]7 ine : 8. Wages, salaries, tips, etc. (before payroll deductions) if mote than two. employers, attach list in rt cos . Income . Employer's name - a Oo, Where employed (city. and " state) , 9. Dividends. “Enter total here (complete. and ‘attach Schedule | BS (540), if total is over $100) - 7 ove 10." Interest... Enter total here (complete and attach Schedule B (540), if total is over $100). - aa & 11, Other incoma (from. page 2,.line’ 40) 20... oes ee ta 12. Total (add tines 8, 9, 10 and 11) ‘ = "43. Adjustmants to Incoma (from paye-?, tine 46) oo 14. Adjusted gross income (subtract line 13 from tine 12) . = - © If you do not itemize deductions AND fine 14 is under $10,000, find your tax in Tax Table it in instructions. Enter tax. on fine 1S =. e {f you itemize deductions OR line 14 is $10,000 or more, go to Part IV: on page 2 to figure tax. Enter tax on line 15. , 3 . 15. Tax from (check one): oO Tax. Table, [x Tax Computation (page 2, Part 1V) or (} Schedule G (540), line 21 | 15 25 60 cr 16. Personal Exemption. Single—$25. Married couple or head of household--$50 ao = Your ot M. Multiply total number. of exemptions on fine 7 above, by 38 Tax, | 18. Total exemptions (add lines 16 and 17) and _- 19. Tax liability {subtract line 18 from line 15—not less than zero) Credits 20. Other credits (from page 2, line 62) 21. Net tax (subtract line 20 from fine 19) . ata ; : ; . 22. Tax forgiveness—20% of tine 21 (use Part V on page 2: if reporting i income on. 1 Schedule D 540) . oo NOTE: You must file your return and pay any tax due (line 27) by the due date to be: entitled to this forgiveness 23. Net tax Hability (subtract line 22 from line 21—if $1.00 or less, enter ‘zero) . , “24. Tax on preference income (see instructions) check here (j, if Schedule P (540) is attached _ 25, Total tax liability (add lines 23 and 24) . 26. 1971 California estimated. tax payment (include 1970, overpayment allowed as a credit) . Balance. °27. Balance due—if any (subtract lin: 26 from line 75) 2 2 PAY. IN FULL WITH RETURN ene 28. Overpayment—if any (subtract line 25 from line 26)... 2 2 ws. ee) OVERPAYMENT 29. Portion of line 28 you wish to apply on 1972 estimated tax . Coe oe. 30. Refund—if any (subtract line 29 from line 28)... 2. we ee REFUND Weds wae antes of perjury, 1 declare that 1 have examined this return. including accampanying schedules and statements, and to the best of my knowledge and eFatis true, correct and complete. If prepared by a persca other than taxpayer, ‘Ais declaration is based on all information of cwhich ne has any Sere SQN D> occa wissen eee ae . Your signature cit filing jaiatiy, BOTH must sign Wa Dec ceeceeeeee eee ogee _ a Co Spouse's Hgnature a. : : Date Enter Your Social Security ‘No. on Your Chock or Monay Order. Make | Remittance, Payable to FRANCHISE TAX BOARD — Mail to FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 93867 Mw 55923 Docid: 32245535 Page 165
Form 540 1971 Page 2 | PART. t—dead af $ of Household—It claimed, answer the folowing questions (See Instructions) [Check [} Ne } Never married. oo ; _. 1 Legal separation (interlocutory decree does not : qualify) Date. “one: |} Widow(er) Date.) . a Final divorce/dissolution ‘Date... : , _ _. |. Individual who qualified you as heed of household . ; ‘ . ae os ee : Name cecpeceseeeeeedeveee a Relationship eee ee Age. Gross. income $e a. _|s this person martied?.. Seeleeeees "7 yes, did he or she file. a joint return with spouse? clea Did this person. 0 qualify as your dependent for. = ~ the calendar year 1971? .......Did this person reside in your home forthe entire toxable. year? wae lf not, ‘explain circumstances. , Total amount: necessary tc maintain household $0. 9. 1. - How much did you contribute? $.00.. 7 PART {}—Other Income - 31. Business income (or foss) (attach Schedule € (540)) . 32. Net gain {or !oss) from sale or exchange of capital assets lattach Schedule D (5401) i _ 33. Net gain (or loss) from Supplemental Schedule of Gains and Losses (attach Schedule 0-1 (540) ) - 34. Pensions and annuities. 2)... oe. - 3§, Rents and royalties 2... [ ” Attach | : Schedule £ 36. Partnerships _ (Form 540) 37. Estates and trusts re 38. Farm income (or loss) (attach Schedule F (540)) (a) Fully taxable pensions and annuities (not reported on ‘Schedule 5 ag Misceh | (0) Alimony . laneous _ (c) Gther (state nature and source)... Income Be - (d). Total miscellaneous income add tines 39(a), (b) and {c) ‘40. Total {add lines 31 through 39). Enter here and on page 1, line 1] = a PART Ill—Adjustments to Income. . "Sick pay” if included in line 8 (see instructions—attach - statement) . Moving expenses (see instructions-—attach statement) - . Employee business expense: (see instructions—attach statement) 44, Military exclusion (see instructions for line 8) ‘45. Payments as a self-employed person to a retirement plan, etc., ‘attach Federa Form 295080 os . Total adjustments (add fines 41-through 45). Enter here and on page 1, line 13 PART IW—Tax Computation—Do not use this part ify if you use the Tax Table to find your tax 47. Adjusted gross income (from page 1, line 14) . 48..(a} If you itemize deductions, enter total from Schedule A (540), line 22, and attach Schedule A {b) Ifyou do not itemize deductions, and line 14 is $10,000 or more, enter ; (1) $1,000, if single, or married person filing separate return’ . (2) $2,000, if head of household, or married couple filing joint return © 19, Taxable income (subtract tine 48 from line 47). Figure your tax on this amount by using” - appropriate Tax Rate Schedule in instructions. Enter tax on page 1, line 15 . ' . Complete all lines below. However, if you used the income averaging method to compute your tax on fine 15, omit tines 50. i PART V—Tax Forgiveness 51 and 52, enter on line 53 the amount shown on. tine 41 of Schedule G (540), and complete tines. 54. 55 and 56. | 50. Taxzble income from line 49 above; or page 1, line 14 if Tax Table used 51, Amcunt (if any) entered on Schedule D (540), line 13(a) 52. Adjusted taxable income (subtract line 51 from line 50) 53. Adjusted tax (use same method.as used for determining tax on page I, fine 15) - Add lines 18 and 20, page 1; and enter total here Adjusted net tax (subtract line 54 from line 53). ‘$6: 20% of line 55. Enter here and on page 1, line 22 “Catt Nornia adjusted gross income (from page 1, line 14) $3. Catifornia tax- liability (from page 1, line 19) . . Qe Cresit limitation—line 57 + line 58 2 % (100% inaximum) 3 x line 59 eannot eiceed” tax pi other: stat : 54, Retirement income eredit (attach Schedule R (540) } ° re 3%. Tstel (add fines 60 and 61). Enter here and ‘on page 1, line 20 . and also taxable by California. ART AT Vil-Reconciliation to Federal Return—If adjusted pross income on Federal Return. is _dilferent fron ‘fine. 14, pa me _explain_be below iW 5595 GUIATSSPUSTSI— PAE TO se72aaca a.ts 12 ocom 1) A 08? i
SCHEBULE TAXABLE cree Taran - ‘© CALIFORNIA © Attach te Form 540° - o Ce ne YEAR 3 of San 540 ‘Nema as shown on Farm 540 , Dhy Social Security Number JFK Act 6 (3) Samuel : —. Jtemized vs. Standard Deduction—You have a choice between two deduction if one spouse itemizes deductions, the other may not use the Tax Table or cla: metheds. You can either itemize your deductions or take a standard deduction as © the standard deduction. if you- choos c to itemize your deductions; complete tr eualained in the 540 Instructions. On separate returns of a husband and wife, appropriate items below. — . a Modical and dental expenses (not compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospital « care, insurance © weuica) ang eee premiums for ‘medical care, etc. . One half (out not more than $150) of insurance premiums for medical care. . . Madicina and drugs ; . Enter 1% of adjusted gross income “shown on n Form 540 . Subtract line 3 from line 2. Enter difference (if !ess 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—fAdd fines 4, 5 and 6) . . Enter 3% of adjusted gross income shown on Form 540 . Subtract line B from line 7, Enter difference (if less than zero, enter reo) . Total--(Add lines 1 and 9) . ce Nm ee N —_ o Child Adoption Expense 11. Total expenses paid or incurred—Attach itemized list . 12. Enter 3% of adjusted gross income shown on Form 540 . 13. Subtract line 12 from fine 11—See instructions for maximum limitations . Taxes -- - 14, Real estate . 13. State and focal gasoline ; 18. Generai sales. : : a 17. Auto license—Excess of registration and weight tees (see instructions “. 18. Personal property . . "19. State disability insurance (SON —Empoyer private disabitty plans do not quality oe EE “21, Total taras-—(Add lines 14 through 20) oles De Da: . Contributions em, Do a 22. Cash—Including ‘checks, money orders, ‘ete. (itemize) ~: . 23. Total “cash “contributions : - 24. Other than cash (see instructions). Enter total here ; : 25, Total—Add lines 23 and 24—Maximum deduction may not exceed "20% af adjusted pioss incame Interast Expansa ; - 28. Home ‘mortgage a ae a. Installment purchases, : 28. Other (itemize) . 29. Total—iAdd lines 26, 27 and 28) Miscollaneous Deductions a ONS UECUCTONS: 40 For child care, alimony, union dues, casualty losses, ete.—See instructions (itemize) ence nennnnnnee nee 32. Tata sonst lines 10, 13, 21, 25, 29 and 31). Enter total here and on Form 440, page 2° in space provided” . S/ts-. Rey, 1974) , Do eee iW 559233 Doold: 32245535 Page i107 , Sehodule B on reverse