## Page 1

JFK Assassination System

Identification Form

Agency Information

Date:

10/1/201

AGENCY:

RECORD NUMBER :

HSCA

180-10073-10093

RECORD SERIES:

NUMBERED FILES

AGENCY FILE NUMBER :

004876

Document Information

ORIGINATOR:

RUBY, SAMUEL

FROM:

RUBY, SAMUEL

TO :

TITLE :

DATE:

PAGES:

SUBJECTS:

01/24/1978

118

RUBY, SAM

RUBY, JACK, BACKGROUND, ASSOCIATES AND RELATIVES

DOCUMENT TYPE: OTHER TEXTUAL

CLASSIFICATION: Unclassified

RESTRICTIONS:

3

CURRENT STATUS:

Redact

DATE OF LAST REVIEW: 10/25/1995

OPENING CRITERIA :

COMMENTS :

W/cover letter. Box #:102.

Heleased under the John F. Kennedy

assassination Records Collection Act of

1 992 (44 USC 2107 Note]. Case#:NW

38326 Date: 2025

v9.1

NW 88326 Docld:32245535 Page 1

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## Page 2

16250 Bircher Are.

Granadatills, ca.

91344

Jan. 24,1978

004876

NW 88326 Dold 32245535"Page 2

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## Page 3

Form

2

Departmon? of tho Treasury

Intornal Revenuo Sorvica

Return for Individual

Retirement Savings Arrangement

1976

(Under Sections 408 or 409 of the Internal Revenue Code)

Only This Side of Form is

→ Attach to Form 1040.

Open to Public Inspection -

If you have established a retirement savings arrangement you must complete Pärt I and Part II and attach this

form to your individual income tax return, Form 1040. In addition: (1) if you claim a deduction on your Form 1040

for contributions to your retirement savings arrangement, complete Part III; (2) if you have made contributions in

excess of your allowable limitation for this year or prior years, complete Part IV; (3) if you are not yet age 59½

when you receive a distribution from your retirement savings arrangement which is not due to a disability, a rollover

contribution to another plan or retirement savings arrangement, or the transfer of an amount to a former spouse

under a divorce decree, you must complete Part V; (4) if you are 70½ or older on the last day of the year, see in-

structions to determine if you are required to complete Part VI.

Name

Address (Number and street)

SAmUEL D Ruby

L50

BIRCHER S

City or town, State and ZIP code

RAMADA

HILLS CA

If you are not required to file a Form 1040 check here

Parl

Individual and Retirement Savings Information

1 Type of individual retirement savings arrangement:

(a

Individual retirement account

(b)

Individual retirement annuity

(C)

Individual retirement bonds

2 Were you during any part of the year an active participant in a qualified pensior,

profit sharing or stock.bonus:

plan, including a qualified Keogh (HR 10) plan, or were you covered under a section 403 (b) annuity or custodial

account or under a government retirement plan other than the

Railroad Retirement Acts?

(Volunteer firemen and military reservists see specific instructions for line 2) -

Yes

If "Yes," you are not allowed a deduction for your 1976 contributions to your individual retirement arrangel

Under penalties of perjury, declare that I 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 the taxpayer, this declare

of which the preparer has any knowledge.

stbased on all information

Your signature

Date

95-294144%

Preparer's signature (other than taxpayer)

Preparer's

identification number.

(see General Instruction B)

Date

Preparer's address'and ZIP code

1322 VANOWEN SEVAN NAyS CA 9142S

Form 5329

- NW 88326 1

Docld:32245535 Page 3

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## Page 4

Form 5329: (1976)

This Page Is Not Open to Public Inspection

Page

Attach Copy B of Form 5498 here

Your Social Security Number .

1322-16-2917.

3 filed by surviving spouse or beneficiary of an individual who created this retirement savings arrangement check here D

and enter name and social security number of individual for whom the arrangement was established t.

4-Indicate your age as of the end of the year (If you checked item 3 do not complete this item):

= (a) [ Under age 59.½

Age 59½ to 70/

Over age 70½ (if you check item (c) complete Part VI below)

5 (a) If, during the year, you received a distribution of your entire account from a qualified pension, profit-

sharing or stock bonus plan, because either (i) you terminated employment or (ii) your employer

terminated the pian, and you transferred (rolled over) such distribution to your arrangement, check here .

(b) If you checked (a) did you transfer the entire amount of the distribution (less any amounts you con-

tributed to the qualified plan-see instructions) to your arrangement within 60 days of receipt of such

distribution (or 12/31/76 if (a)(ii) applies and you received such distribution prior to 11/2/76)? •

(c) If (b) was "Yes," complete lines (i) through (jii) below:

Yes

Month!

Day

No

Year

(i)

Date of transfer to arrangement

(il) Date distribution was made to you from the plan

(iti) Name of trustee or insurance company to which the transfer was made (If bonds were purchased state "Bonds") »...

(d) (i)

if within one taxable year, you received a distribution of your entire account from your employer's qualified pension,

profit-sharing or stock bonus plan because the plan was terminated by your employer did you:

(A) receive such amount on or after July 4, 1974 but prior to January 1, 1976,

amount, reduced by the amount of the income tax paid on the distribution on

your 1974 or 1975 income tax return, to an arrangement and

(C) file a claim for refund of such tax paid? (Check "Yes"' only if (A), (B) and (C) ALL apply.) .

,, (ii) If (d)(i) is "Yes," and you have received such refund or credit for such tax paid enter:

Yes

No

Month i

Day

! Year

(A) Date refund or credit received . . .

(B) Date refund or amount of credit was contributed to your retirement savings arrangement

Note: See Definition C in the Instructions concerning rollover contributions.

6 lf, during the year, you transferred any funds from one retirement savings arrangement to another retire-

Month

Day

Year

ment savings arrangement, enter the date of transfer here .

Caution: Such a transfer may be a taxable distribution.

7 If, during the tax year covered by this form, you have entered into a prohibited transaction under section 4975 or borrowed any amount from

your retirement savings arrangement or pledged any part of your arrangement as security for a loan, check here . .

•

Note: See instructions for the tax consequences of such transactions.

RPart:1:2

Computation of Allowable Deduction

(If you have entered into a prohibited transaction under section 4975, do not complete Part III or Part

IV for the retirement savings arrangement with which you entered into such prohibited transaction.)

8 Wages, tips and other compensation from Form 1040 (if a joint return do not include compensation of spouse)

(See definition B in the instructions for the meaning of compensation.)

9 15% of line 8 or $1,500, whichever is lesser (if you are 70½ or over or answered "Yes" to line 2, enter zero) .

10 Amount paid by you or on your behalf under all your retirement savings arrangements (do not include any

amounts which were considered as "rollover contributions,"

see lines 5 and 6, or the purchase price of any

individual retirement bonds redeemed within 12 months of their date of purchase (see instructions) or life

insurance portion of your endowment premium as reported on Form 5498 box 6) .

11 Allowable deduction, lesser of line 9 or line 10 (enter here and on Form 1040, line 40a)

Pan.IV.s

Tax on Excess Contributions

12 Tax on excess contributions (see Part IV of the Specific Instructions if Part Ill, line 10 exceeds line 11). Enter

tax from worksheet here and on Form 1040, line 61

Part Va Tax on Premature Distributions

13 Tax on premature distributions (see Part V of the Specific Instructions if you received a distribution from

your retirement savings arrangement before you have attained age 59½). Enter tax from worksheet here and

on Form 1040, line 57.

Tax on Undistributed Retirement Accounts and Annuities

(See Instructions before completing this Part.)

14 Tax based on current year distribution method, see worksheet in Instructions

15 Tax based on aggregate distribution methods, see worksheet in Instructions

16 Tax due, lesser of line 14 or 15, enter here and on Form 1040, in your total for line 62. On the dotted line to

the left of the line 62 entry space write "4974 tax," and show the amount

# U.S. GOVERNMENT PRINTING OFFICE: 1976-0-218-176

E.I. 13.2687299

NIM%88326 Dosld 32245535 Page 4,

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## Page 5

11040

Department of the Treasury-Internal Revenue Service

U.S. Individual Income Tax Return

197

For the year January 1-December 31, 1976, or other taxable year beginning

This space for IRS use only

, 1976 ending

, 19

Name (If joint return, give first names

and initials of both)

ast name

Your social security number

SAMUELPHVS

Ru

322/21

799>

Present home address (Number and street, including apartment number, or rural route).

For Pfivacy Act Notification,

Spouse's social security no.

16250

BIRCHER ST

see page 5 of Instructions.

349180420

City, town or post office, State and ZIP code

Осси-

Yours D

pation

Spouse's

E

6a Regular

• Yourself

• Spouse

Enter number of

boxes checked I

b First names of your dependent children who

lived with you_

S15A

Filing Status

Please attach Copy B of Forms W-2 here

Please attach Check or Money Order here

1D

Single

(Check only ONE box)

21g

Married filing joint return (even if only one had income)

3

Married filing separately. If spouse is also filing give

spouse's social security number in designated space above

and enter full

name here D

4

Unmarried Head of Household.

See page 7 of instructions

Exemptions

Enter

number

c Number of other dependents (from line 7)

d Total (add lines 6a, b, and c)

to see if

you qualify t

e Age 65 or older. !

Yourself

Spouse

Enter

number

5

Qualifying widow(er). with dependent child (Year

Blind.

Yourself

Spouse

of boxes

spouse died

19

). See page 7 of Instructions.

$ TOTAL (add lines 6d and e)

checked

7 Other dependents:

(b) Relationship

(c) . Months lived in your

(d) Did

dependent

(e) Amount furnished for dependent's support

home.

(a) Name

born

or

died

have income of $750

during year, write B or D.

or more?

By

YOU. If 100%

By

OTHERS

includ-

write ALL.

ing dependent.

$

$

8 Presidential Election

Do you wish to designate $1 of your taxes for this fund?

Yes

No

Note: If

you

check the

"Yes''

Campaign Fund

boxes) it will not increase your

If joint return, does your spouse wish to designate $1?

Yes

No

tax or reduce your refund.

9

Wages, salaries, tips, and other employee compensation

(Attach Forms

W-2.

It unavail-

able, see page 6 of Instructions.)•

9

= 0

Oa Dividends See pages 9 and

16 of Instructions.

1Ob less exclusion.

Balance b

(If gross dividends and other distributions are over $400, list in Part | of Schedule B.)

10c

11' Interest income.

It $400 or less, enter total without listing in Schedule B)

1 If over $400, enter total and list in Part Il of Schedule BY

11

Income

12

51.95

Income other than wages, dividends, and interest (from line 37)

12

13

Total (add lines 9, 10c, 11 and 12) .

13

25

46

77.41

14

Adjustments to income (such as moving expense, etc. from line 42)

14

15a Subtract line 14 from line 13 . .

15a

b Disability income exclusion (sick pay) (attach Form 2440)

15b

2741

10..

c Adjusted gross income. Subtract line 15b from line 15a, then complete Part Ill on back.

(if less than $8,000, see page 2 of Instructions on "Earned Income Credit.")

15c

77%1

Tax Table

Tax Rate Schedule X, Y or Z

16

Schedule D

Tax, check if from:

Schedule G

Form 2555

OR

Form 4726

17a Multiply $35.00 by the number of exemptions on line 6d

17a

1Y0

16

Enter

larger

(If box on line 3 is checked

see

page 10 of

of a

17c

astructions,

Tax, Payments and Credits

b Enter 2% of line 47 but not more than $180 ($90 if box 3 is checked)

17b

or b

18

Balance. Subtract line 17c from line 16 and enter difference (but not less than zero)

18

19

Credits (from line 54)

19

20

Balance. Subtract line 19 from line 18 and enter difference (but not less than zero)

20

21

Other taxes (from line 62)

21

22

Total (add lines 20 and 21) .

Total Federal income tax withheld.

(attach

Forms

22

or

W-2,

W-2P

to

front)

23a

(include

amount

b

OWEd

1976 estimated tax payments • as credit from 1975 return) •

23b

(from page 2

602

Pay

amount on line 25 in

full with this return. Write

c Earned income credit. of Instructions)

23c

social security number on

d Amount paid with Form 4868

23d

check or money order and

make payable

to Internal

Revenue

Service.

e Other payments (from line 66)

24

23e

TOTAL (add lines 23a through e)

24

Due or Refund

25

• If line 22 is larger than line 24, enter BALANCE DUE IRS

25

(Check here & |

J, if Form 2210 or Form 2210F is attached. See page 10 of instructions.)

26

• If line 24 is larger than line 22, enter amount OVERPAID

26

27

28

Amount of line 26 to be credited on 1977 estimated tax

28

D

27

322

Amount of line 26 to be REFUNDED TO YOU

7

7: 21

Under penalties o1 perjury, I declare that I have examined this return

including accompanying schedules and statements, and to the best 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

Sign here

Your signature

Date

Spouse's signature (if filing jointly, BOTH must sign even if only one had income)

Preparer's signature (and employer's name, if any)

95

-2941449

Identifying number (see instructions)

Date

Address (and ZIP code)

.? і

218-052-2

NW 88326 Docld:32245535 Page 5

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## Page 6

'Page 2

Form 1040 (1976)

"Parti

Income other than Wages, Dividends and Interest

29

Business income or (loss) (attach Schedule C)

30a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D)

b 50% of capital gain distributions (not reported on Schedule D-see page 10 of Instructions)

31 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797)

32a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E)

b Fully taxable pensions and annuities (not reported on Schedule E-see page 10 of Instructions)

33

Farm income or (loss) (attach Schedule F)

29

30a

30b

31

32a

32b

33

3,4

35

3846

000

Alimony received

36 Other (state nature and source-see page 11 of Instructions) »

36

37

37

Total (add lines 29 through 36). Enter here and on line 12

2546

Part It

Adjustments to Income

38

Moving expense (attach Form 3903)

39

Employee business expense (attach Form 2106)

.. 40a Payments to an individual retirement arrangement from attached Form 5329, Part III

b Payments to a Keogh (H.R. 10) retirement plan

41 Forfeited interest penalty for premature withdrawal (see page 12 of Instructions)

42

Total (add lines 38 through 41). Enter here and on line 14

38

39

40a

40b

41

42

Part 11I 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 & and see page 9 of Instructions

43

7741

44a If you itemize deductions, check here # ], and enter total from Schedule A, line 40, and attach Schedule A

b Standard deduction—If you do not itemize deductions, check here & J, and:

If you checked

2 or 5, enter the greater of $2,100 OR 16% of line 43—but not more than $2,800

44

5686

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)

45

46 Multiply total number of exemptions claimed on line 6f by $750

46

• 47 Taxable income. Subtract line 46 from line 45 and enter difference (but not less than zero)

47

2085

3000

o 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

/*D, income averaging from Schedule G, tax from Form 2555 or maximum tax from Form 4726. Enter tax on line 16 and check appropriate box.

Part.V.

Credits

48 Credit for the elderly (attach Schedules R & RP)

49 Credit for child care expenses (attach Form 2441)

50 Investment credit (attach Form 3468)

51

Foreign tax credit (attach Form 1116)

52

Contributions to candidates for public office credit (see page 12 of Instructions)

48

49

50

51

52

53

53

Work Incentive (WIN) Credit (attach Form 4874)

54

Total (add lines 48 through 53). Enter here and on line 19

PartiVe.

Other Taxes

55

Tax from recomputing prior-year investment credit (attach Form 4255)

56 Minimum tax. •

Check here → [. and attach Form 4625

57

Tax on premature distributions from attached Form 5329, Part V .

58

Self-employment tax (attach Schedule SE)

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 Excess contribution tax from attached Form 5329, Part IV

54

55

56

57

58

59

60

61

280

280

62 Total (add lines 55 through 61). Enter here and on line 21

Part VE Other Payments

63

64

65

• 66

Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers-see page 13 of Instructions)

Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136)

Credit from a Regulated Investment Company (attach Form 2439)

Total (add lines 63 through 65). Enter here and on line 23e

# US. GOVERNMENT PRINTING OFFICE: 1976-0-218-052

62

63

64

65

66

210-052-2

NW 88326 Docld:32245535 Page 6

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## Page 7

Schee les

(Form 1040)

Department of the Treasury

Internal Revenue Service

AaB-itemized Deductions AND

Dividend and Interest income

* Attach to Form 1040. > See Instructions for Schedules A and B (Form 1040).

1976

Name(s) as shown on Form 1040

S. Ff. Kuby

Your social security number

32212.299

Schedule A-Itemized Deductions (Schedule B on back)

Medical and Dental Expenses (not compensated by insurance

Contributions (See page 15 of Instructions for examples.)

or otherwise) (See page 13 of Instructions.)

21 a Cash contributions for which you have

1 One half (but not more than $150) of in-

receipts, cancelled checks or other

surance premiums for medical care. (Be

sure to include in line 10 below) .

written evidence

b Other cash contributions. List donees

2 Medicine and drugs

and amounts. D

3 Enter 1% of line 15c, Form 1040 .

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.

b Hospitals.

c Other (itemize include hearing aids,

dentures, eyeglasses, transportation,

etc.) *

sH

7 Total (add lines 4 through 6c)

8 Enter 3% of line 15c, 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

on line 34

Taxes (See page 13 of. Instructions.)

11 State and local 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) b

1941

SCH

17 Total

(add lines 11 through 16). Enter

here and on line 35

D

Interest Expense (See page 14 of Instructions.)

1128

18 Home mortgage

19 Other (itemize) D

-...

sett

20 Total (add lines 18 and 19). Enter here

and on line 36 .

25/2

22 Other than cash (see page 15 of instruc-

tions for required statement)

23 Carryover from prior years

24 Total contributions (add lines 21a through

23). Enter here and on line 37

Casualty or Theft Loss(es) (See page 15 of Instructions.)

Note: If 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

27 Subtract line 26 from line 25. Enter dif-

ference (if less than zero, enter zero)

28 Enter $100 or amount on line 27, which-

ever is smaller

29 Casualty or theft loss (subtract line 28

from line 27). Enter here and on line 38

Miscellaneous Deductions (See page 15 of Instructions.)

30 Alimony paid . .

31 Union dues .

32 Other (itemize) #

33 Total (add lines 30 through 32). Enter

here and on line 39

Summary of Itemized Deductions

34 Total medical and dental-line 10 .

35 Total taxes—line 17 •

36 Total interest-line 20

37 Total contributions— line 24

38 Casualty or theft loss(es)-line 29

39 Total miscellaneous-line 33 •

40 Total deductions (add lines 34 through

39). Enter here and on Form 1040, line

44

1941

1128

2511

100

5686

218-054-1

÷ NW 88326 Docld:32245535 Page 7

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## Page 8

Schedules A&B (Form 1040) 1976

Schedule B-Dividend and Interest Income

Name(s) as shown on Form 1040 (Do not enter name and social security number if shown on other side)

S.+P

RUDY

Dividend Income

Note: If gross dividends (including capital gain distributions) and

other distributions on stock are $400 or less, do not complete this

part. But enter gross dividends less the sum of capital gain dis.

tributions and non-taxable distributions, if any, on Form 1040,

line 10a (see note below).

1 Gross dividends (including capital gain distributions) and other

distributions on stock. (List payers and amounts-write (H);

(W), (J), for stock held by husband, wife, or jointly)

Page 2

32212

322 12 1497

APärt 23 Interest Income

Note: If interest is $400 or less,

do not complete this

enter amount of interest received on Form 1040, line 1 Part. But

Interest includes earnings from savings and loan associations,

mutual

savings

banks,

cooperative banks,

and credit

unions

as well as interest on bank deposits, bonds, tax refunds, etc.

interest also includes original issue discount on bonds

and

other evidences of indebtedness (see page 16 of Instructions).

(List payers and amounts)

NOTE ON WOODLEY

4959

BISTRO

TRANSWORLD

WORLD

12

11

19/

12

2 Total of line 1

3 Capital gain distributions (see page 16 of

Instructions. Enter here and on Schedule D,

line 7). See note below

4 Nontaxable distribu-

tions (see page

16 of

Instructions) .

5 Total (add lines 3 and 4)

...

6 Dividends before

exclusion (subtract line

5 from line 2). Enter here

and on Form

8 Total interest income. Enter here and on

1040, line 10a

Form 1040, line 11

5195.

Note: If 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.

Foreign Accounts and Foreign Trusts

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

U.S. financial institution)?

- ...•..

.....

Yes

If "Yes," attach Form 4683 (For definitions, see Form 4683.)

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

If "Yes," attach Form 4683 (For definitions, see Form 4683.)

# U.S. GOVERNMENT PRINTING OFFICE: 1976-0-218-054

• No

218-054-

#NW 88326 Docld:32245535-Page 8-

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## Page 9

SCHEDULE C

(Form 1040)

Department-of the Treasury

Internal Revenue Service

Profit or (Loss) From

Business or Profession

(Sole Proprietorship)

Partnerships, Joint Ventures, etc., Must File Form 1065.

• Attach to Form 1040.

• See Instructions for Schedule C (Form 1040).

1976

Name of proprietor

5.+P Ruby

Social security number

32212

799

A Principal business activity (see Schedule C Instryctions) •

SERNICE

B Business nameD. WOODLEy 151STRO

COFFEE

3/10 c Employer identification number →95-26S1S75

• Business address (number and street)

City, State and ZIP code D

Encino.

16055 CAn Tyst

316BLVD

E Indicate method of accounting:

Cash (2 K

2 Accrual

(3) • Other D

Yes

No

F Were you required to file Form W-3 or Form 1096 for 1978 (see Schedule C Instructions)? .

If "Yes," where filed D

G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in 1976?

H Method of inventory valuation D

the manner of determining quantities

costs, of valuations between the opening and closing inventories? (If "Yes," attach explanation)

1 Gross receipts or sales $..

.. Less: returns and allowances $

Was there any substantial change in

Balance D

Income

2 Less: Cost of goods sold and /or operations (Schedule C-1, line 8)

3 Gross profit

4 Other income (attach schedule) .

5 Total income (add lines 3 and 4)

6 Depreciation (explain in Schedule C-3)

7. Taxes on business and business property (explain in Schedule C-2) •

8 Rent on business property

9 Repairs (explain in Schedule C-2)

10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself)

I1 insurance .

12 Legal and professional fees

13 Commissions.

14 Amortization (attach statement)

15 (a) Pension and profit-sharing plans (see Schedule C Instructions)

(b) Émployee benefit programs (see Schedule C Instructions)

Deductions

16 Interest on business indebtedness

17 Bad debts arising from sales or services

18 Depletion

?

3

4

5

6

7

8

9

10

11

12

13

14

15(a)

(b)

16

17

18

19 Other business expenses (specify):

(a) ..

(b)

(d)

(e).

(f)

(g)

(h)..

(k) Total other business expenses (add lines 19(a) through 19(j)) .

20 Total deductions (add lines 6 through 19(k))

19(k)

20

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) .

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, attach explanation)

2 Purchases $...

Less: cost of items withdrawn for personal use $...

Balance D

3 Cost of labor (do not include salary paid to yourself)

3

4 Materials and supplies

5 Other costs (attach schedule)

6 Total of lines 1 through 5

7 Less: Inventory at end of year

8 Cost of goods sold and/or operations. Enter here and on line 2 above

5

6

7

8

Did you claim a deduction for expenses of an office in your home?.

3546

7 Yes

] No

218-055-1

88326 Doeld 32245535 Page 9

---

## Page 10

2221a00:

Schedule C (Form 1040) 1976

SCHEDULE C-2. Explanation of Lines 7 and 9

Line No.

Explanation

Page 2

Amount

Line No.

Explanation

Amount

SCHEDULE C-3.—Depreciation (See Schedule C Instructions for Line 6)

If you need more space, use Form 4562.

a. Description of property

b. Date

cquired

Cost or

other basis

d. Depreciation

allowed or allowable

TO Yan

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

¿ 2 Other depreciation:

c. Method of

computing

depreciation

f. Life

or rate

g. Depreciation for

this year

ScH

106

3 Totals

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)

Name

Expense account

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. However, the informa-

tion need not be submitted for any employee for whom

the combined amount is less than $25,000, or for your-

self if your expense account allowance plus line 21; page

1, is less than $25,000.

Did you claim a deduction for expenses connected with:

1

2

3

4

5

(1) Entertainment facility (boat, resort, ranch, etc.)?

(2) Living accommodations (except employees on business)?

Owner .

106

Salaries and Wages

• Yes

• No

(3) Employees' families at conventions or meetings?

• Yes 0 No

• Yes

• No

(4) Employee or family vacations not reported on Form W-2? • Yes

0 NO

U.S. GOVERNMENT PRINTING OFFICE : 1976-0-218-055

218-055-2:

NW 88326 Docld:32245535 Page 10

---

## Page 11

SCHEDULE D

(Form 1040)

Department of the Treasury

Internal Revonua Servico

Name(s) as shown on Form 1040

Capital Gains and Losses (Examples of property to be reporied on this 1

Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not

losses) on personal assets such as a home or jewelry.)

1976

• Attach to Form 1040.

• See Instructions for Schedule D (Form 1040).

Social security number

322 12 799

[Part I:

+P RuDI

Short-term Capital Gains and Losses-Assets Held Not More Than 6 Months

(Example,

''Z':

b. Date

acquired

(Mo., day, уr.)

Date

sold

d. Gross sales price

(Mo., day, yr:)

8.

Cost or other basis,

as adjusted (500

Instruction

F) and

expense of sale

• Gain or (los

1 less o)

2

Enter your share of net short-term gain or (loss) from partnerships and fiduciaries

Enter net gain or (loss), combine lines 1 and 2

Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction l)

Net short-term gain or (loss), combine lines 3 and 4

-Partal. Long-term Capital Gains and Losses-Assets Held More Than 6 Months

4

5

741!

6

INSTALEMENTSALE

3355

7

Capital gain distributions

8

Enter gain, if applicable, from Form 4797, line 4(a)(1) (see Instruction A)

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) .

9

10

11

'11" Net gain or (loss), combine lines 6 through 10

12 Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction l)

13

Net long-term gain or (loss), combine lines 11 and 12

Part l

Summary of Parts 1 and Il (If You Have Capital Loss Carryovers From Years Beginning Before 1970, Do Not

Complete This Part. See Form 4798, Parts I!!, IV and V.)

14

15

Combine lines 5 and 13, and enter the net gain or (loss) here

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 or no entry on line 13

14

15a

b Subtract line 15a from line 14. Enter here and on Form 1040, line 30a

It line 14 shows a loss

a Enter one of the following amounts:

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,

(ji) If line 5 and line 13 are net losses, enter amount on line 5 added to 50% of amount on

b

Enter here and enter as a (loss) on Form 1040, line 30a, the smallest of:

(0).

The amount on line 16a;

$1,000 ($500 if married and filing a separate return); or,

Taxable income, as adjusted (see Instruction J)

SEE 4798.

15b

16a

16b

11000

218-056-1

(88326 Docld: 3224

535 Page]

---

## Page 12

Schedule D (Forn 1040) 1976

Page 2

Part v

3 Computation of Alternative Tax (See Instruction S to See if the Alternative Tax Will Benefit You)

17 Enter amount from Form 1040, line 47 . :

17

18. Enter amount from line 15a (or Form 4798, Part IV, line 8(a))

19 Subtract line 18 from line 17 (if line 18 exceeds line 17, do not complete the rest of this part. The Alter:

native Tax will not benefit you)

Note: If line 18 does not exceed $25,000 ($12,500 it married filing separately), omit lines 20 through

23 and enter zero on line 24.

18

19

• 20 Enter $25,000 ($12,500 if married filing separately)

20

21 Add lines 19 and 20

21

22 Tax on amount on line 178 .

22

23 Tax on amount on line 21* .

23

24 Subtract line 23 from line 22

24

25 Tax on amount on line 19*.

..

25

26 Enter 50% of line 18 but not more than $12,500 ($6,250 if married filing separately)

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

26

27

#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, or Z.

Note: Enter your capital loss carryovers from 1976 to 1977:

Short-term (from Form 4798, Part Il or Part V) .

Long-term (from Form 4798, Part |1 or Part V) •

Pre-1970

Post-1969

7958

48Y

# U.S. GOVERNMENT PRINTING OFFICE: 1976-0-218-056

218-056-1

NW 88326, Docld:32245535 Page 12---

---

## Page 13

Ter.

SCHEDULE

• SE

(Form 1040)

Computation of Social Security Self-Employment Tax

Department of the Treasury

Internal Revenua Service

≥ see Instructions tor schedule se (for sood.

• Each self-employed person must file a Schedule SE. > Attach to Form 1040.

197

• If you had wages, including tips, of $15,300 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.

@ 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 OF SELF-EMPLOYED PERSON (AS SHOWN ON SOCIAL SECURITY CARD)

Social security number of

self-employed person

32212. 7997

Business

activities subject to self-employment tax

(grocery store, restaurant, farm, etc.) t

• If you have only farm income complete Parts I and Ill.

@ If you have only nonfarm income complete Parts Il and III.

• If you have both farm and nonfarm income complete Parts I, I1, and III.

Part I3

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 72 (accrual method)

1 Net profit or (loss) from:

b Farm partnerships

2 Net earnings from farm self-employment (add lines la and b)

la

1b

2

FARM

OPTIONAL METHOD

3 If gross profits

a Not more than $2,400, enter two thirds of the gross profits.

from farming.' are:

b More than $2,400 and the net farm profit is less than $1,600, Enter $1,600

3

' Gross profits from farming are the total gross profits from Schedule F, line 28 (cash

as explained in instructions for Schedule SE.

4 Enter here and on line 12a, the amount on line 2, or line 3 if you elect the farm optional method

4

BRant l0s2u

Computation

of Net Earnings 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)

5a

5b

3546

c Service as a minister, member of a religious order, or a Christian Science

REGULAR METHOD

5 Net profit or

(loss) from:.

practitioner. (Include rental value of parsonage or rental allowance fur-

nished.) If you filed Form 4361, check here &

• and enter zero on this

line

d Service with a foreign government or international organization

(See

Form

1040

e Other structions for line 36.). Specify →

6 Total (add lines 5a 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 7) .

5c

5d

5e

6

7

8

354k

33 46

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 12b, 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

of your gross nonfarm profits,"

had actual net earnings from self-employment of

$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.

SE

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 9b from line 9a)

10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller

11 Enter here and on line 12b, the amount on line 9c or line 10, whichever is smaller

9a

9b

9c

10

11

$1,600

00

? 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 14) as explained in instruc-

Also, include gross profits from services reported on line 5c, d, and e,

Panille

Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): a From farming (from line 4) .

b From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) .

12a

12b

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.) .

13

3546

3546

14. The largest amount of combined wages and self-employment earnings subject to social security or

railroad retirement taxes for 1976 is

14

$15,300

00

15 a Total "FICA" wages and "RRTA" compensation

b Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA

15a

15b

c Total of lines 15a and b

16 Balance (subtract line 15c from line 14) .

17 Self-employment income-line 13 or 16, whichever is smaller .

15c

16

17

18 Self-employment tax. (If line 17 is $15,300.00, enter $1,208.70; if less, muitiply the amount on line

17 by .079.) Enter here and on Form 1040, line 58

18

3546

280

218-060-1

NW 88326 Docld:32245535 Page 13

---

## Page 14

Form

4798

Departmont of the Treasury

Internal Revenue Service

Capital Loss Carryover

(Computations of Capital Loss Carryovers and Summary of Capital

Gains and Losses if Pre-1970 Capital Losses are Carried to 1976.)

* Attach to Form 1040.

1976

Name(s) as shown on Form 1040

S.xP Rub

Social Security Number

322121

799

Note: Complete Only

Page 1 of This Form to Compute Your Capital Loss Carryover it Your 1975 Schedule D (Form 1040), lines

4(a) and 12(a), DO NOT SHOW A LOSS.

Post-1969 Capital Loss Carryovers to 1976 (Complete this part if the amount on your 1975 Schedule D

(Form 1040), line 16(a), is larger than the loss deducted on your 1975 Form 1040, line 29a.)

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

lines 2 through 6-then go to line 7

1

2 Enter gain shown on your 1975 Schedule D (Form 1040), line 13. If that line is blank or shows.

a loss, enter a zero

2

3 Reduce any loss on line 1 to the extent of any gain on line 2 .

3

4 Enter amount shown on your 1975 Form 1040, line 29a .

4

5 Enter smaller of line 3 or 4 .

5

6 Excess of amount on line 3 over amount on line 5

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 5 (Note: If you ignored lines 2 through 6, enter amount from your 1975 Form 1040, line 29a)

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

10 Reduce any loss on line 8 to the extent of any gain on line 9

11 Multiply amount on line 7 by 2

9

10

11

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 1975 to 1976 that is attributable to years beginning

Enter this amount on your 1976 Schedule D (Form 1040), line 12.

Post-1969 Capital Loss Carryovers from 1976 to 1977 (Complete this part if the amount on your 1976

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

2 Enter gain shown on your 1976 Schedule D (Form 1040), line 13! If that line is blank or shows a

1

loss, enter a zero

3 Reduce any loss on line 1 to the extent of any gain on line 2

4 Enter amount shown on your 1976 Form 1040, line 30a .

2

3

4

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 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

7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1976 Form 1040, line 30a)

7

8 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), line 5. If that line is blank or shows a

loss, enter a zero

9

10 Reduce aly loss on line 8 to the extent of any gain on line 9 .

10

11' Multiply amount on line 7 by 2

11

12 Excess of amount on line 10 over amount on line 11 .

12

Note: The amount on line 12 is your long-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).

Form 4798 (1976)

NW 88326 Docld:32245535 Page 14

---

## Page 15

Form 4798 (1976)

Poge 2

Do Not Complete the Rest of This Form if You Do Not Have a

Pre-1970 Capital Loss Carryover to 1976 (See Instruction A).

Instructions

C. Part IV, Line 22 or 36.-lf there is a loss

and a gain on the lines

A. Who Should File.-

mentioned in the instructions for Part IV, line 22 or 36, enter the loss

your

reduced by the amount of the gain. If the gain exceeds the loss enter

show a loss:

sarryover to 1976: Se Pomplete®

determine your capital

a zero. If there is a loss and no gain, just enter the loss.

your 1976 Schedule D (Form 1040),

D.

lines 1 through 13 to reporticapital gains and losses for the current year

and filing a separate return the limitation for Part

Married Taxpayers Filing, Separate Returns.- you i

are married

lines 9(b)(li)

and

any post-1969 capital doss carryovers;

and (3) complete Part

and 27(b) is $500, increased by amounts attributable to pre-1970 short.

to figure your net capital gain or (loss) for 1976 and the

limitation if necessary.

Use Pärt V to figure capital loss carryover from

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

1976 to 1977 for pre-1970 lossés or a combination of pre-1970 and post-

E.

If there is a loss in Part IV, line 5,

complete

Part IV, Section

D.

1969 losses.

lines 14 through 22 (assuming all the lines in Section D were not other.

B. Part. IV, Line 19 or 33.-lf there is a gain and a loss on the lines

wise required to be completed) ignoring the note under line

14.

mentioned in the instructions for Part IV,

line 19 or 33,

enter the gain

E.

Additional Information.-For

information

about capital

assets,

reduced by the

amount of the loss. If the loss

exceeds the gain enter

investment interest expense deduction adjustment,

alternative tax, etc.,

a zero. If there is a gain and no loss, just enter the gain.

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

sPart 11.2

1975 Schedule D (Form 1040), line 16(a) or line 33, is larger than the loss deducted on your 1975

Form 1040, line 29a.)

1 Enter loss shown on your 1975 Schedule D (Form 1040), line 5; if none, enter zero and ignore

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 blank or shows a loss enter a zero .

3 Reduce loss on line 1 to the extent of any gain on line 2 .

2

3

0741

GOTI

Note: If line 4(a) on your 1975 Schedule D (Form 1040) is blank, IGNORE lines 4 through 11, enter

a zero on line 12—then go to line 13.

4 Combine lines 3 and 1l on your 1975 Schedule D (Form 1040).

Enter the gain; if zero or a loss, enter a zero

5/05

Note: If 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.

¿5, Enter any gain from your 1975 Schedule D (Form 1040), line 3 .

• 6 Enter smaller of line 4 or 5 .

7 Enter excess of gain on line 4 over line 6

5

6

7

5105

8 Enter loss from your 1975 Schedule D (Form 1040), line 12(a);

otherwise, enter a zero :

13322

9 Reduce any gain on line 7 to the extent of any loss on line 8

9

10 Enter loss from your 1975. Schedule D (Form 1040), line 4(a); other-

wise enter a zero .

11 Add the gains on lines 6 and 9 .

10

11

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 line 13)

12

13

14

4291

15 Enter any loss from line 13, above

16 Enter loss deducted on your 1975 Form 1040, line 29a .

15

16

0741

1900

17 Pre-1970 short-term loss 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, line 2.

17

(741 )

18 Enter any loss from line 14, above

18

19 Enter excess of line 16 over line 15—if line 16 does not exceed liné

15, enter zero .

19

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 1040), line 4

20

21 If you were required to complete Part IV of your 1975 Schedule D

enter any loss from your 1975 Schedule D (Form

1040), line 30; otherwise, enter zero.

8217

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 long-term loss carryover to 1976 (excess of line 21 over line 22—if line 21 does not

exceed line 22, enter zero). Enter here and in Part IV, line 5

23

(8217)

24 If you were required to complete Part IV of your 1975 Schedule D

1040), enter any

loss from your 1975

Schedule D (Form

1040), line 31. However, if Part IV was not required, enter any loss

from your 1975 Schedule D (Form 1040), line 13 .

24

25 Enter excess of line 22 over line 21

0: x 2 11f line 22

5839

does not exceed line 21, enter zero.) .

25

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

26

(5839 )

08326 Docld:32245535 Page 15

---

## Page 16

Form: 4798

& Pan IVa

Capital Gains and Losses

Page 3

Section A. Short term Capital Gains and Losses

1, Amount from 1976 Schedule D (Form 1040), line 5

2 Amount from Part I!!, line 17

3. Net short term gain or (ioss), combine lines 1 and 2

1

2

3

241)

741

Section B.—-Long-term Capital Gains and Losses

4 Amount from 1976 Schedule D (Form 1040), line 13 .

5 Amount from Part Ill, line 23

6 Net long-term gain or (loss), combine lines 4 and 5

6

Section C.— Summary of Sections A and B

4841

8701)

7 Combine lines 3 and 6 and enter the net gain or (loss) here .

8 lf line 7 shows a gain -

A (a) Enter 50% of line 6 or 50% of line 7, whichever is smaller (see Schedule D (Form 1040), Part

IV, for computation of alternative tax). Enter zero if there is a loss of no, entry on line 6

(b), Subtract line 8(a) from line 7. Enter here and on Form 1040, line 30a

9• If line 7 shows a loss—

If losses are shown on BOTH lines 5 and 6, omit lines 9(a) and (b) and

Otherwise, #

go to Section

D.

'(a) Enter one öf the following amounts:

4Áa (i) : If line 3 is zero or a net gain, enter 50% of line 7;

il) If line 6 is zero or a net gain, enter amount from line 7; or

(iti) If line 3 and line 6 are net losses, enter amount on line 3, added to 50% of amount

on line 6

(b) Enter here and enter as a (loss) on Form 1040, line 30a, the smallest of:

: (i)

The amount on line 9(a);

(11)

(111)

$1,000, (married taxpayers filing separate returns see Instruction D); or

Taxable Income, as adjusted (see Instruction

1040)) :

J in Instructions for Schedule D (Form

7

91424)

8(a)

(b)

9(a)

(b)

11000

Section D.— Capital Loss Limitation-Where Losses Are Shown on Both Lines 5 AND 6 of Part IV

1o Enter loss from line 3; if line 3 is zero or a gain, enter a zero.

11 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.

10

^11

12

13

14 Combine amounts on 1976 Schedule D (Form 1040), lines 3 and l

and if gain, enter gain; if zero or a loss, enter a zero

14

* Note: If the entry on line 14 is zero, OMIT lines 15 through 21 and

enter on line 22 the loss shown on line 5.. =

15, Enter gain, if any, froin 1976 Schedule D (Form 1040), line 11

16 Enter smaller of amount on line 14 or line 15

17. Enter excess of gain on line 14 over amount on line 16

18 Enter loss from line 2; if line 2 is blank, enter a zero

15

16

17

18

19 Reduce

Instruction B)

gain, it any, on line 17 to the extent of loss, if any, on line 18 (see

19

20 Enter. loss from line 5

20

21 Add the gain(s) on line(s) 16 and 19

21

22. Reduce the loss on line 20 to the extent of the gain, if any, on line 21 (see Instruction GIle:

23 Enter, smaller of amount on line 22 or line 13 (if line 22 is zero, enter a zero).

4' Subtract amount on line 23 from the loss on line 13

25 Enter 50% of the amount on line 24:

26

Add lines 10, 23, and 25

22

23

24

25

26

27 Enter here and enter as a (loss) on Form. 1040; line 30a, the smallest of:

224.

(a) Amount on line 26*

* (b) $1,000 (Married taxpayers filing separate returns see Instruction D): or

(c) Taxable Income, as adjusted (see Instruction J in Instructions for Scliedule D• (Form 1040))

27

218-162-1

88326 Docld:32245535 Page 16:

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## Page 17

NAME:

ADORESS

MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A.G.I. (Line 18 - 1040)

4 NET MED/DRUGS

5H & A INS. (½ + EXCESS)

6a DR.

DR.

DR.

DR.

DR

DR.

DR.

DR.

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

6c AMBULANCE

LABORATORIES

TRAVEL FOR MED. /000

MEDICARE INS.

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.

g

I +: ½ (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

153 PERSONAL PROPERTY

15b PERSONAL PROPERTY AUTO

16 SALES TAX AUTO

17 TOTAL TAXES

INTEREST (TO WHOM PAID)

18 MORTGAGE

19 INSTALLMENT LOANS

S. +P Ruby

STATE

1947

CALENDAR YEAR 19ª.

76

- SOC.SEC. NO.522-12-7999

DEDUCTION SCHEDULE

FEDERAL

CONTRIBUTIONS

21a CASH CONTRIBUTIONS

21b PARTNERSHIP SHARE

GIRL/BOY SCOUTS

1405.

HEART FUND/CANCER FUND

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

POLITICAL CONTRIBUTIONS

548

CHURCHES

STATE

FEDERAL

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS.

24 TOTAL CONTRIBUTIONS

100

CASUALTY OR THEFT (LOSS(ES)

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT

27

28 ($100 LIMITATION PER CAS.)

29 TOT. CAS. OR THEFT LOSS

MISCELLANEOUS DEDUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 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

100

TUD

D Uz8

20

2023

232

121

1459

924

134

22

11281

2482

35.

33 TOTAL MISC. DED

SUMMARY OF ITEMIZED DED.

34 EXPENSES FROM LINE

35 TOTAL TAXES (From Line 17)

36 TOTAL INTEREST (Line 20)

37 TOTAL CONTR. (Line 24)

38 CAS. & THEFT LOSS(ES) (Line 29)

39

TOTAL MISCELLANEOUS

DEDUCTIONS (FROM LINE 33)

40 ENTER ON FORE LOAD LINE 44

REMARKS

STATE

FEDERAL

DL 5686

5686

20 TOTAL INTEREST...

2512

2512

Form 101

---

## Page 18

NAME: SAP. Ruby

HADDRESS

!.D.

CALENDAR YEAR 19 7a

SOC.

SEC. NO: 322-12-7997

FISCAL YEAR

ENDING

- 19

SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION

• PRINCIPAL BÜSINESS

ACTIVITY

BUSINESS NAME

BUSINESS ADDRESS

*• TOTAL RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE

PURCHASED

LÄBOR

EMPLOYERS NO.

88,36

15948

TOTAL

INVENTORY AT END OF YEAR

"GROSS PROFIT

EBSI

LY00

6456

949 A

9491

GROSS INCOME

ADVERTISING

*, AUTO

AND TRUCK EXPENSE

BAD DEBTS

CASH SHORT

-COMMISSIONS

DEDIVERY

DEPRECIATION' ( SCHEDULE ATTACHED )

DUES AND SUBSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR SERVICE

. LAUNDRY

•' LEGAL AND ACCOUNTING

MAINTENANCE

JFFICE SUPPLIES. AND EXPENSE

RENT

REPAIRS

SALARIES

AND WAGES

SALARIES OFFICERS

SUPPLIES

• TAXES AND LICENSES

TAXES - PAYROLL

I TELEPHONE

STRAVEL

'UTILITIES

OTHER BUSINESS DEDUCTIONS

208

106

43₴

50

1608

13

554

28

169

5945

3546

NET, PROFIT::.OR (LOSS) • FEDERAL RETURN

NET PROFIT

OR

LOSS ' - STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF. )

PROFESSIONAL

STATIONERS INC. FORM 104

LOS ANGELES, CALIF.

: NW 88326 Docld:32245535 Page 18

SCHEDULE

---

## Page 19

NAME

ADDRESS.

S+P Ruby

1. DORSEC. N0322-1202957 FISCAL YEAR ENDING

CALENDAR YEAR 19 76

SCHEDULE.OF DEPRECIATION /

SPEC 20%

DEP

AMORTIZATION

KIND OF PROPERTY

EQUIP

GOOdwILL.

COST OR

DATE

ACQUIRED

MO

YR

OTHER BASIS

6/222112

1132.00

DEPRECIABLE

BASIS

2112

DEP ALLOWED

PRIOR YEARS

REMAINING

COST

2112

METHOD

Sila

RATE (%)

OR LIFE

(YRS)

LOYR

DEPRECIATION

FOR

THIS YEAR

106

TOTALS

PROFESSIONAL STATIONERS INC. LOS ANGELES: CALIF.. FORM NO 1O2A

Add 20% Additional Depreciation on Items Purchased THiS Year.

TOTAL DEPRECIATION THIS YEAR

SCHEDULE

106

/•88326 Docld:32245535

Page 19

---

## Page 20

киду

SOC. SEC. NO. 327-12-799

GAINS ON INSTALLMENT SALES

LOFFEE

-12 4

- DATE SOLD

Calendar Yr::

F/Y/E

19 25

19

DESCRIPTION OF PROPERTY

DATE ACQUIRED

TYPE OF ASSET

1: SELLING PRICE: CASH

2.

NOTES

MORTGAGE TRANSFERRED

OTHER

GROSS SALES PRICE (1+2+3+4)

6.

COST OR BASIS

7 LESS ACCUMULATED DEPRECIATION

8.

PRIOR TO 1-1-62

9:69

PRIOR TO 1-1-64

10.

AFTER 12-31-61

«11. 1.

#ST. LINE AFTER 12-31-63

12. k

• EXCESS OVER S/L 1-64/12-69

113.

• EXCESS OVER S/L AFTER 12-31-69

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

23. ir CASH (1)."

24.

PRINCIPAL COLLECTIONS

25. 0х.

•EXCESS MORTGAGE.OVER BASIS

26../

OTHER: (4)

27:" TOTAL PAYMENTS (23 THRU 26)

28:

RECOGNIZED GAIN

29.1 RECOGNIZED GAIN - ORDINARY

30. RECOGNIZED GAIN - OTHER

$

$

ORDINARY INCOME

* TAX.

TOTAL

* ABLE

PAYMENTS

YR:

L9.7S

20448.

N926/ 19503

LESS INT.

СТО РТ. 2.

SEC. 3)

MONIE

4959

SECTION 1245

REPORTED

1418

S35S

SECTION 1250

BALANCE

15416

10061

REPORTED

BALANCE

116 44

9/2175

CAPITAL

%

SEC. 1245

$20148

48152

683001

545228

2313

Y2815

238

43153

$ 2313

522834

5683522

26.86%

20148

-

20118

2313

SI0S

REPORTED

SEC. 1250

$

$

CAPITAL GAIN

BALANCE

%

ANW 885204D6d1d:35245535 Page 20, CALF FORM 96

SCHEDULE

---

## Page 21

INDIVIDUAL

RESIDENT

540

CALIFORNIA

TAXABLE YEAR

1906

INCOME TAX

PLACE PREADDRESSED LABEL HERE, If available.

(Correct name and address, if necessary)

Enter social security number(s) only it incorrect or not shown on label.

NAME (If joint return, give first names and initials of both)

LAST NAME

PRESENT HOME ADDRESS (Number ar

SAMUEL+ PHyLLIS

Run/

street, including apartment number, or rital route)

162

50

BIRCHER

ST

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

22 AnnA.

MILLS

Check

Calendar Year

Опе:

Fiscal Year Ending:

1977

FOR

SEE

PRIVACY

PAGE 2

NOTIFICATION

OF INSTRUCTIONS

Your Social Security Number

322

Spouse's Social Security Numbe

799₴

344:

18 1420

Yours

OCCU•

SE

PATION

Spouse's

• Single

(Check Only One)

2X

Married filing joint return (even if only one had income)

3

I Separate return of married person-Enter spouse's

social security number and full name here

ST

ING

• Head of Household-Enter name of qualifying

individual.

5 • Widow(er) with dependent child (Year spouse died 197.

EXEMPTION CREDITS

6 Personal

If line 1 or. 3 checked, enter $25

l if line 2, 4 or 5 checked, enter $50

7

Dependents

Do not list the person who qualifies you as head of household

ELISA

THomas

6

00

Total Number E

Blind (see instructions) Number of blind exemptions -

Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

Attach copy 2 of Form(s) W-2 to face of this

10 Wages, salaries, tips and other employee compensation; return. I

unavailable, see instructions,

• 11 Dividends—-before federal exclusion. Enter total (if over $400, complete and

attach Schedule B(540))

A 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)

W-2

15

Adjustments to income (from line 55)

16

Adjusted gross income. (subtract line 15 from line 14)

2x$80

7

1110

00

× $8

00

00

10

11

12

13

14

5195

2546

7741

15

L4 16

2241

• If you do NOT itemize deductions AND line 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 lines 17 and 18.

17

18

Deductions: Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked-$2,000 if line 2, 4 or 5 checked)

Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule-Enter tax on line 19

Tax from (check one) • Tax Table

Tax Rate Schedule

Income Averaging Schedule (G or G-1)

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 68-Including Special Low Income Tax Credit) •

D

23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter zero)

24 Other taxes (from line 71)

Total tax liability (add lines 23 and 24)

17

18

19

20

21

22

23

24

25

5686

2055

73

25

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, 1976, complete Part 1 on page 2

ATTACH

-number on check or money order.

28

1976 California estimated tax payments

29

Excess California SDI tax withheld (see instructions)

26

27

28

29

30

Total Credits.

30

31

If line 25 is larger than line 30, enter BALANCE DUE.

If it is equal to line 30, enter zero.

Mail return to:

FRANCHISE TAX BOARD

SACRAMENTO, CA 95867

PAY IN FULL → 5

31

Do not write in these spaces

32

33

If line 25 is smaller than line 30, enter amount OVERPAID

Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks.

Mail return to:

FRANCHISE TAX BOARD

32

> M 33

P.O. BOX 13-540

SACRAMENTO, CA 95813

A

34

Amount of line 32 to be credited on your 1977 ESTIMATED TAX

R

If you do NOT want State income tax forms and instructions mailed to you next year, check here

See Instructions. Page 9'",

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements,

and to the best of my knowledge

änd belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

social

SIGN

Your signature

Date

Preparer's signature

Date

NW

Doeld:32245635 Page 21 return

Date

Address' (and Zip code)

---

## Page 22

this

Paye 2 Form 540 (1976)

PART I - Renter's Credit - All questions must be answered

'35 Did you, on March 1, 1976, live in rented property which was your principal residence?

36 Was the property you rented exempt from property tax?

37 Did you live with any other person who claimed you as a dependent for income tax purposes?

'38. Did you or your spouse claim the homeowners' property tax exemption of receive public assistance?:

• Yes

ọ Yes

• Yes

• Yes

• No

• No

D NO

PART Il - 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 D(540)) .

41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1 (540)!

42. Pensions and annuities

43 Rents and royalties

44. Partnerships

ATTACH

SCHEDULE E

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 E(540))

(b) Alimony .

(c) Other (state nature and source)

Enter total of lines 47(a), 47(b), and 47(c)

48 Total (add lines 39 thru 47). Enter here and on line 13.

PART lil - Adjustments to Income

49' "Sick pay," if included in line 10 (see instructions - attach Form FTB 3805 T)

50 Moving expenses (see instructions - attach Form FTB 3805U)

51 Employee business expenses (See instructions - attach Form FTB 3805N) .

52 Military exclusion (see instructions)

53(a) Payments to an individual retirement arrangement (attach FTB 3805P)

(b) Payments to a Keogh (H.R. 10) retirement plan

(c) Payments to a self-employed "Defined Benefit Plan''

Enter total of lines. 53(a), 53(b), and 53(c)

54 Forfeited interest penalty (see instructions).

55 Total adjustments (add lines 49 thru 54). Enter here and on line 15

PART IV - Itemized Deductions

o. Attach Schedule A(540) and enter sub-totals on lines 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) •

58: Total interest expense (from Schedule A(540), line 20)

59 Total contributions (from Schedule A(540), line 24)

60 Total casualty loss (from Schedule A(540), line 29):

61 'Total miscellaneous deductions (from Schedule A(540), line 33)

62 Total child care and adoption expenses (from Schedule A(540), line 37) .

63 Total itemized deductions (add lines 56 thru 62). Enter here and on line 17

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 S(540)) .

65* Retirement income credit (attach Schedule R(540))

66 Special low income tax credit (see special instructions).

67. Solar energy tax credit (see special instructions) .

68 TOTAL (add lines 64 thru 67). Enter here and on line 22

PART VI - Other Taxes

47 a

47b

47a

53a

53b

53c

56

57

58

59

60

61

62

63

64

65

66

67

68

•69 Tax on preference income (see instructions - attach Schedule P.(540) .

• 70 Tax on premature distributions from attached Form FTB 3805P

71. Total (add lines 69 and 70) enter here and on line 24

69

70

71

PART VII - Reconciliation to Federal Return - If adjusted gross income on Federal Return is different from line 16, page 1, explain below.

If no, you may not claim this credit

If yes, you may not claim this credit

If yes, you may not claim this credit

If yes, see page 3 of instructions

39

40

41

42

3546

(1000)

43

44

45

46

47

48

2546

49

50

51

52

53

54

55

NW 88326 Docld:32245535 Page 22

---

## Page 23

SCHEDULE

FORM 540

Nome as shown on Form 540

CALIFORMA

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

1976

YEAR

Social Security Number

322121799

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.

Contributions

21(a). Cash contributions for which you have receipts,

canceled checks, etc.

(b). Other cash contributions. List donees and

amounts ...

1. One half

(but not more than

$150) of Insurance

premiums for medical care.

2. Medicine and drugs..

3. Enter 1% of line 16, Form 540

4. Subtract line 3 from line 2. Enter difference (if less

than zero, enter zero)

5. Enter balance of insurance premiums for medical care

not entered on line 1.

6. Other medical and dental expenses:

(a) Doctors, dentists, nurses, etc..

(b) Hospitals

(c) Other (itemize)

scH

7. Total (Add lines 4, 5, 6a, b, and c)

8. Enter 3% of line 16,

Form 540

9. Subtract line 8 from line 7. Enter difference (if less

than zero, enter zero)

10. Total-(Add lines 1 and 9. Enter here and on Form

540, line 56)

Taxes

11. Auto license-Excess of registration and weight fees

(see

instructions)

12. Real

estate

13. State and local gasoline

14.

General Sales

15. Personal property (Boat and Aircraft)

16. Other (itemize)..

SCH

17. Total taxes (Add lines 11 thru 16. Enter here and

on Form 540, line 57)

Interest Expense

18.. Home mortgage

19. Other (itemize)

194)

1128

22. Other than cash.—See instructions for required state-

ment

23. Carryover from 1974 & subsequent years - See

instructions

24. Total— (Add lines 21a thru 23.

Maximum de-

duction may not exceed

20%

of adjusted gross

income. Enter here and on Form 540, line 59)

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

26. Insurance reimbursement

27. Subtract line 26 from line 25, Enter difference

(If less than zero, enter zero)

28. Enter $100 or amount on line 27, whichever is

smaller.

29. Casualty or theft loss (subtract line 28 from

line 27. Enter here and on Form 540, line 60)

Miscellaneous Deductions

30. Alimony paid to:..

31. Employment Education Expense...

32. Union dues

Other (itemize)

33.

Total (Add lines 30 through 32. Enter here and

on Form 540, line 61)

Child Care and Adoption Expense

34. Child care expenses - Attach Form 3805X. .

35. Total adoption expense

Less 3% of line 16, Form 540.

36. Net adoption expenses- See instructions

for maximum limitations.

37. Total child care and adoption expenses

(add lines 34 and 36. Enter here and on

Form 540, line 62).

100

20. Total-(Add

lines 18 and 19. Enter here and on

Form

540,

line 58)

25,7

NW 88326 Docld:32245535 Page 23

---

## Page 24

SCHEDULE

CALIFORNIA

DIVIDEND AND INTEREST INCOME

Attach to Form 540

FORM 340

Name as shown on Form 540

TAXABLE

1976

YEAR

322-12'

SAP Ruby

PART

-DIVIDEND INCOME

Line I Gross Dividends and Other Distributions on

tions), less nontaxable portion, if any, on Form 540, page 1.

Stock--If gross dividends and other distributions (including capital

Dọ NOT deduct the $100 federal exclusion.

"Capital gain dividends" are treated as ordinary dividends for

gain dividends) on stock were $400 or less, do not complete

State income tax purposes and not as capital gains as permitted

this part; but enter gross dividends (including capital gain distribu-

under the federal law.

1. Gross dividends and other distributions on stock-List payers and amounts-Write (H), (W), (J), 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 line 11, form 540

PART II INTEREST INCOME

Interest on bonds, debentures, loans, notes, tax refunds and all

(b) Bonds (but not other obligations) of California and its polit-

types of savings accounts including banks, credit unions and postal

ical subdivisions issued after November 4, 1902.

savings is taxable.

(c) Interest on bonds of Alaska and Hawaii issued. prior to their

Interest on the following obligations is exempt from tax:

, achieving statehood.

¡(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.)

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.

1. Interest income-List payers and amounts.

NOTE ON

WOODLEy

ить

TRANS WORLD

BISTRO

WORD

495%

77

77

141

77

2. Total Interest income. Enter here and on line 12, Form 540

5195

NW 88326 Docld:32245535. Page 24

---

## Page 25

SCHEDULE

FORM 540

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Propriotorships)

TAXABLE

1976

YEAR

Attach phis schodule to your income rax return, form 340 or 540NR

Partnorships, jolnt ventures, ofc, must flo on, Form ses

Social Security Number

Name as shown on form 540 pr 522

Ruby

322-12-7997

B. Federal Employer I.D. No.

A. Name and Address of Business

WOODLEY

BISTRO COFFEE

C. Principal business activity (i.e., retail-hardware; wholesale-tobacco; services-legal; etc.) SERUILE =

SHOP, LOSS VENTURA BLUR INCHOA. 95-26515 78

D. Indicate method of accounting:

• cash;

/accrual;

other...

E. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)?

-YES

• NO

F. Method of inventory valuation &

C.A.

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

• YES D NO If."Yes," attach explanation.

Balance D

1 Gross receipts, sales, or fees $

Less returns and allowances $.

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 s...

A Cost of labor (do not include salary paid to yourself)..

5 Materials and supplies

6 Other costs (explain in Schedule C-2 or attach, Schedule)

Total of lines 2 thru 6.

& Inventory at end of this year

9 Cost of goods sold (subtract line 8 from line 7)

10 Gross profit (subtract line 9 from line 1)

11 Other income (attach schedule)

12 Total Income (add lines 10 and 11)

OTHER BUSINESS DEDUCTIONS

. 13 Depreciation (explain in Schedule C-1 or attach Schedule)

14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule)..

15. Rent on business property

16 Repairs (explain in Schedule C-2 or attach Schedule)

17 Salaries and wages not included on line 4 (exclude any paid to yourself)..

18 Insurance

19 Legal and professional fees.

20 Commissions

21 Amortization (attach

statement

22. Retirement plans, etc. (other than your share, see instructions)

23 Interest on business indebtedness.:

24 Bad debts arising from sales or services (Not applicable if reporting on cast, banis)

25. Depletion (attach schedule).

26 Other business expenses (explain in Schedule C-2 or attach Schedule)

27

Total of lines 13 thru 26.

28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or 540NR

Schedule C-1

Depreciation

Claimed on line 13.

Schedule 6-2

Explanation of Lines

6, 14, 16, and 26.

Group and guideline class

. or description of property

Date

Acquired

Cost or

other basis

Depreciation

allowed (or allowable)

in prior years

5ct

Method of

computing

depreciation

Life or

Rate

3546

Dedreciation

for this year

sett

106

LINE

NO.

EXPLANATION

AMOUNT

LINE

NO.

EXPLANATION

AMOUNT

NW%832E

Docld:32245535 Page 25

SCHEDULE F ON, REVERSE

---

## Page 26

SCHEDULE

CALIFORNIA

FORM 540

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

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

Rube

PART I Assets Hold Ona Your or Loss

a. Kind of property and description

(Example, 100 shares of "" Co.)

b. Date acquired

(mo., day, yr.)

(mo., day, yr.)

• d. Gross sales

price

TAXABLE

1976

YEAR

Social securlty Number

322 12 7999

D

8. Cost

other

adjusted,

basis

as

cost of subse

quent improvements

not

purchased,

(It

explanation)

ottach

DAnIse of

sado

and

1. Gain or loss

(d. less e.)

2. Enter gain (or loss), if applicable, from line 17, Schedule D-] (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 . .

PART If Assets Held More Than One Year But Not Moro Than Five Years

SALE

5355

6. Enter gain (or loss), it applicable, from line 19, 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 (If gain, see 540 instructions, line 24a (Preference Income))

PART Ill- Assets Hold Moro Than Fivo Years

5355

10. Enter gain (or loss), if applicable, from line 21, Schedule D-1 (540) (attach copy)

11. Enter your share of net gain or loss from partnerships and fiduciaries

12. Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a (Preference Income))

PART IV- Summary of Capital Gains and Losses

13. Enter amount from line

14. Enter 65% of the amount on line 8

15. Enter 50% of the amount on line 12

16. Enter unused sapital loss carryover from preceding taxable yeats (arach computarion)

348

(150 422)

17. Combine the amounts shown on lines 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

.19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR phe 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

(e) $1,000 ($500 in the case of a husband or wife filing a separate return)

-MW 88326-Docld:32245535-Page-26

(1561)

11000

---

## Page 27

1040

Department of the Treasury -Internal Revenue Service

US

Individual Income Tax Return

1975

For the year January

I-December 31, 1975, or other taxable Year beginning:

1975, enthus

Name (If joint return, give first

initials of both)

Your social security number

SAMUEL

HYLLIS

R

Last name

Present home address (Number and street,"

cluding apaitment number, or rural

M BY

322/27997

Spouse's social security no.

For Privacy Act Notification,

see page 2 of Instructions.

For IRS use only

116250

BIRCHER J

349: 181420

City

hown or pust office, State and ZIP code

FRANADA

HILLS.LA

Youts D

pation

Spouse's

ter

Requested by

A In whal oly, down, village,

B Do you live within the legal

C In what county and State do you live?

Census Bureau

etc., do you

for Revenue

Sharing

LOSANGELES

limits of the city, town, etc.?

State

D In what township do

you live? (See page 4.)

Yes No I Don't know

LOS ANGELES CA

Enter number of

Single

(check only ONE box)

ба

Regular Yourselt

Spouse

boxes checked a

Married filing joint return (even if only one had income)

b First names of your dependent.

children who

Filing Status

Married filing separately. It spouse is also tiling give

lived with you

spouse's social security number in designated space above

THOMAS

Enter

number

and enter full

name here p

c Number of other dependents (from line 27)

Unmarried Head of Household (See page

5 of Instructions)

d Total (add lines 6a, b, and c)

e Age 65 or over .

Yourself

5

8

Qualifying

widow(er). with dependent child (Year

Blind

Yourself

Spouse.

Enter :

number

Spouse

uf boxes

checked

spouse died a 19

). See page 5 of Instructions.

7

Total (add lines 6d and e)

Do you wish to designate $1 of your taxes for this fund?

Yes

Note: If'

you

check the

"Yes"

boxes) it will not increase your

your

refund.

attach Copy B of Forms W-2 here

Presidential

Election

Campaign Fund

Il joint return, does your spouse wish to designate $1?.

Yes

(Attach Forms

W-2.

9

Wages, salaries; tips, and other employee compensation

able, see page 3 of Instructions.)

pages

17

10b Less exclusion $..

17

Balance

No

No

9

10c

10a

Dividends (i

14

of

Instructions/ $.

Income

(If gross dividends

and other

distributions are over $400, list in Part / of Schedule B.)

11

Interest income.

Ir $100 or less, enter total without listing in Schedule B| :

11 over 3400, enter total and list in Part It of. Schedule B

12

Income other than

wages, dividends, and interest (from line 36)

13 . Total (add lines 9, 1,0c, 11, and 12) .

14: Adjustments to income (such as "sick pay," moving expenses, etc. from line 42) :

(If less than $8,000.

see page 8 of In.

15

Subtract line 14 from line 13 (Adjusted Gross Income) structions on

"'Earned Income Credit.")

11

12

13

14

15

—0.

95

22

32%

85.92.

If you do not itemize deductions and line 15 is under $15,000, find tax in Tables and enter on line 16a.

If you itemize deductions or line 15 is $15,000 or more, go to line 43 to figure tax:

Please

CAUTION. It you have unearned income and can be claimed as a dependent on your parent's return, check here

and see page 7 of Instructions.

16a Tax, check if from:

Tax Tables

Tax Rate Schedule X, Y, or Z

Schedule D

Tax, Payments and Credits

Schedule G

OR

Form 4726

16a

b

120

b Credit for personal exemptions (multiply line 6d by $30)

C

c Balance (subtract line 16b from line 16a)

17

17

Credits (froni line 54)

18

18

Balance (subtract line 17 from line 16c).

19

Please attach Check or Money Order herel

Due

Balance

or Refund

19

Other taxes (from line 63)

20

20

Total (add lines 18 and 19) .

(attach

forms

W-2 or

21a

Total Federal income tax. withheld

W-2P

10

front)

include amount allowed 35

b 1975 estimated tax payments

credit from 1974 return)

c Earned income credit

21a

b

d

800

- 0

598

598

d Amount paid with Form 4868

e Other payments (from line 67)

22

Total (add lines 21a through e)

Pay

amount on line

full with this return.

Write

social security number on

check or money order and

make

payable

to Internal

Revenue

Service.

800

22

23

23 If line 20 is larger than line 22, enter BALANCE DUE IRS

_(Check here &

EJ . it Form 2210, Form 2210F, or statement is attached. See page 8 of Instructions.)

24

-ll line 22 is larger than line 20, enter amount OVERPAID

24

25

Amount of line 24 to be REFUNDED TO YOU

25

20₴

26

Amount of line 24 to be cred.

fall of

overpayment (line 24) is to be

ited on 1976 estimated tax. →

26

refunded (line 25),

make no entry on line 26.

w11200501123n00mnhoonan

Under penalties of perjury,

I declare that i have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it

true,

correct, and complete. Declaration of prepares (other than taxpayer) is based on all information of which preparer has any knowledge.

Sign

here

Your

signatu

Date

Preparer's signature (other than

taxpayer)

Date

Address (and ZIP Code)

362-34-8229

Spouse's isi

dure fil Ailing jointly, BOTH inust sign even it only one had incomes

Ml-.a4011

NW 88326 Docld:32245535 Page

---

## Page 28

Form

1040 (1975)

(a) NAME

(b) • Relationship

Other

Dependents

(c) Months lived in your

home.

born

died

during year, write B or D.

(c)

Did

de-

pendent have

income

of

$750 or more?

(e)

Amount YOU

furnished for de-

pendent's

port.

sup-

If

100%

write ALL.

$

Page 2

(f)

Amount

fur-

nished by OTHERS

including

ent.

depend-

$

27 Total number of dependents listed in column (a). Enter here and on line 6c

Part

Income other than Wages, Dividends, and Interest

28

Business income or (loss) (attach Schedule C) .

29a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D)

29b 50% of capital gain distributions (not reported on Schedule D-see page 9 of Instructions)

30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) .

31a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) .

31b Fully taxable pensions and annuities (not reported on Schedule E-see page 9 of Instructions)

32 Farm income or (loss) (attach Schedule F)

33

State income tax refunds (slous not araly fortund is for year in which

you took the ).

deduction--others see

page 9 of Instructions

34

Alimony received

35

Other (state nature and source--See page 9 of Instructions)

28

29a

29b

30

31a

31b

32

33

34

7559

1051

2313

36 Total Gadd lines 28 through 35). Enter here and on line 12

35

36

8822

Part 11

Adjustments to Income

37 "Sick pay." (attach Form 2440 or other required statement) .

38 Moving expense (attach Form 3903)

39

Employee business expense (attach Form 2106 or statement)

40a Payments to a Keogh (H.R. 10) retirement plan .

40b Payments to an individual retirement arrangement from attached Form 5329, Part III

41 Forfeited interest penalty for premature withdrawal--see page 10 of Instructions

42. Total (add lines 37 through 41). Enter here and on line 14

37

38

39

40a

40b

41

42

375

375

Part Ill

Tax Computation (Do not use this part if you use the Tax Tables to find your tax.)

43 Adjusted gross income (from line 15)

43

8592

44 (a) If you itemize deductions, cleck here a

I and enter total from Schedule A, line 11

and attach Schedule A

(b) If you do not itemize deductions and line 15 is $15,000 or more, check here a

and:

If box on line 2 or 5 is checked,

44

5735.

enter 16% of line 15 but not more than $2,600; if box

on line 1 or 4 is checked, enter $2,300; if box on line 3 is checked, enter $1,300

45 Subtract line 44 from line 43

45

2857

46 Multiply total number of exemptions claimed on line 7, by $750 .

46

. 47 Taxable income. Subtract line 46 from line 45

47

3000

- 02

(Figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, or Z, or if applicable, the alternative

tax from Schedule D, income averaging from Schedule G, or maximum tax from Form 4726.) Enter tax on line 16a:

Credits

48

Retirement income credit (attach Schedule R) .

48

49

49

Investment credit (attach Form 3468) .

50

Foreign tax credit (attach Form 1116)

50

51 Contributions to candidates for public office credit-see page 10 of Instructions

51

52 Work Incentive (WIN) credit (attach Form 4874)

52

53

Purchase of new principal residence credit (attach Form 5405) •

53

54

Total (add lines 48 through 53). Enter here and on line 17

54

Taxes

Other

55

Tax from recomputing prior-year investment credit (attach Form 4255) .

NOTUSEL

55

56 Tax from recomputing prior year Work Incentive (WIN) credit (attach Schedule)

56

57 Minimum tax. Check here # J. if Form 4625 is attached

57

58 Tax on premature distributions from attached form

58

59 Self-employment tax (attach Schedule SE) .

40

w/ 190

59

60 Social security tax on tip income not reported to employer (attach Form.4137) .

60

98

Part V

61 Uncollected employee social security tax on tips (from Forms W-2)

61

62

Excess contribution tax from attached Form 5329, Part IV

62

63

Total Card lines 5b through 02). Enter bere and on line 19

63

$98

Part Vi..

Other Payments

64 Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers-see page 10 of Instructions) • .

65 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136)

66 Credit from a Regulated Investment Company (attach Form 2439)

67 Total (add lines 64 through 66). Enter here and on line 21e

.

64

65

66

67

i U.S. GOVERNMENT PRINTING OFFICE: 1975-0-575-050

10-H2510-1

NW 88326 Docld:32245535 Page 28

---

## Page 29

Schedules A&B-Itemized Deductions AND

(Form 1040)

Dividend and Interest Income

Department of the Treasury

Internal Revenue Service

• Attach to Form 1040.

• See Instructions for Schedules A and B (Form 1040).

Name(s)

as shown on Form 1040

AMUEL

1975

Your social security numbe

322/2 2997

Schedule A-Itemized Deductions (Schedule B on back)

Medical and Dental Expenses (not compensated by insurance

Contributions (See page 12 of Instructions for examples.)

or otherwise) (See page 11 of Instructions.)

21 a Cash contributions for which you have

1 One half (but not more than $150) of in-

receipts, cancelled checks or

other

surance premiums for medical care. (Be

sure to include in line 10 below) .

written evidence

2 Medicine and drugs

b Other cash contributions. List donees

3 Enter 1% of line 15, Form 1040

and amounts. ~

A 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.

b Hospitals.

c Other (itemize include hearing

aids,

dentures, eyeglasses,

transportation,

etc.) #

SCH

7 Total (add lines 4 through 6c)

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

on line 35

Taxes (See page 11 of Instructions.)

11 State and local incorne .

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)

1521

SCH

17 Total (add lines 11 through 16). Enter

here and on line 36

Interest Expense (See page 12 of Instructions.)

18 Home mortgage

_...

19 Other (itemize) »

1207

ScH

22 Other than cash (see page 12 of instruc-

tions for required statement)

23 Carryover from prior years

24 Total contributions (add lines 21a through

23). Enter here and on line 38

150

Casualty or Theft Loss(es) (See page 13 of Instructions.)

Note: If 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)

28 Enter $100 or amount on line 27, which-

ever is smaller

29 Casualty or theft loss (subtract line 28

from line 27). Enter here and on line 39 *

Miscellaneous Deductions (See page 13 of Instructions.)

30 Alimony paid

31 Union dues .

32 Expenses for child

and dependent care

services (attach Form 2441)

33 Other (itemize) •

SCH-

20 Total (add lines 18 and 19). Enter here

and on line 37

NW 88326 Docld:32245535 Page 29

2852

34 Total (add

lines

30 through 33). Enter

here and on line 40

Summary of Itemized Deductions

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

41

Total deductions (add lines 35 through

40). Enter here and on Form 1040, line

44

152

1202

2851

50

5235

16-82507-1

---

## Page 30

SCHEDULE C

(Form 1040)

Department of the Treasury

Internal Revenue Service

Profit or (Loss) From Business or Profession

(Sole Proprietorship)

Partnerships, Joint Ventures, etc., Must File Form 1065.

Attach to Form 1040.

• See Instructions for Schedule C (Form 1040).

Names as shown on Form 1o

SAMUEL

PHYLLISR

Principal business adi, lee schee piRo CoFFee Stomployer identication number ve

us neste and P code a see.

160SSVENTURA

City, State and ZIP code •

NCINO CA

E Indicate method of accounting:

(1) [27 Cash (2) X Accrual (3) [J

F Were you required to file Form W-3 or Form 1096 for 1975? (see Schedule C Instructions) .

If "Yes," where filed »

G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in 1975?

# Method of inventory valuation *

Was there any substantial change in

the manner of determining quantities, costs, or valuations belween the opening and closing inventories? (If "Yes,"

attach explanation)

1 Gross receipts or sales $.....

Less: returns and allowances $...

Balance A

1

Income

2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8)

2

3 Gross profit

3

4

4. Other income (attach schedule)

5

Total income (add lines 3 and 4)

5

6 Depreciation (explain in Schedule C-3)

6

7 Taxes on business and business property (explain in Schedule C-2)

7

8

Rent on business property

9. Repairs (explain in Schedule C-2)

10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself)

11 Insurance

12 Legal and professional fees

13 Commissions .

14 Amortization (attach statement)

15 (a) Pension and profit-sharing plans (see Schedule C Instructions)

(b) Employee benefit programs (see Schedule C Instructions)

Deductions

16 Interest on business indebtedness

17

Bad debts arising from sales or services

18

Depletion

9

10

11

12

13

14

15(a)

(b)

16

17

18

19

Other business expenses (specify):

(a)

(b)

1975

Social security number

12221

95-2651578

ScH

W)

5159

2y00

(k) Total other business expenses (add lines 19(a) through 19(i)) .

20

Total deductions (add lines 6 through 19(k))

TOTAL

19(k)

20

21

Net profit or (loss) (subtract line 20 fron line 5). Enter here and on Form 1040, line 28. ALSO

enter on Schedule SE, line 5(a) .

SCHEDULE C-1.-Cost of Goods Sold and/or Operations (See Schedule C Instructions

for

21

Line

1 Inventory at beginning of year (if different from last year's closing inventory, attach explanation)

2 Purchases $.:

Less: cost of items withdrawn for personal use $...

Balance a

3 Cost of labor (do not include salary paid to yourself)

4 Materials and supplies

3

4

5

5 Other costs (attach schedule)

6 Total of lines 1 through 5 .

7 Less: Inventory at end of year

8 Cost of goods sold and/or operations. Enter here and on line 2 above

?.

8

2559

2)

10-82517-1

NW 88326 Docld:32245535 Page 30

---

## Page 31

i pal.

*Schedule C (Form 1040) 1975

SCHEDULE C-2.-Explanation of Lines 7 and 9

Line No.

Explanation

Amount

Line No.

Page 2

Explanation

• Amount

.$

SCHEDULE C-3.-Depreciation (See Schedule C Instructions for Line G) 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 atter 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)-11(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.

d. Depreciation

e. Method of

a. Group and guideline class

or description of property

b. Date

acquired

c. Cost or

other basis

allowed or allowable

in prior years

computing

depreciation

f. Life

or rate

&. Depreciation fo

this yea

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

2 Depreciation from Form 4832

(San Nole

3 Depreciation from Form 5006

above

4 Other depreciation:

Buildings

Furniture and fixtures .

Transportation equipment .

Machinery and other equipment

Other (specify)...

SCH

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)

974

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

whom the combined amount is less than $25,000, or for yourself if

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.)?

(2) Living accommodations (except employees on business)?

Name

Expense account

Salaries

Wages

Owner.

2

4

5

DJ Yes

(3) Employees' families at conventions or meetings?

[1 Yes

(4) Employee or family vacations not reported on Form W-2?

:: U.S. GOVERNMENT PRINTING OFFICE : 1915-0 575-053

• Yes

10 Yes

1i-42517-1

L No

• NW 88326 Docld:32245535 Page 31

---

## Page 32

F.30.17 141 1→ 19935

SCHEDULE D

Capital Gains and LOSSeS (Examples of property to be reported

on this

(Form 1040)

Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not

Department of the leasury

losses) on personal assets such as a home or jewelry.)

Internal Kovenue Service

Attach to Formn

1040.

See Instructions for Schedule D (Form 1040).

Naine(s) as shown on Form 1040

SAMUEL & PHYLLIS RUBY

Part l

Short-term Capital Gains and Losses-Assets Held Not More Than 6 Months

1975

Social security number

322127997

D

Kind of property and description

¿Examplo, 100 shares of

"Z"'

Co.).

b. Vate

acquired

(Mo., day, уr.)

c. Date

sold

(Mo., day, yr.)

d. Gross sales price

e. Cost or other basis,

as adjusted (see

instruction F) and

expense of sale

f. Gain or (loss)

(d less e)

2

3

Enter your share of net short-term gain or (loss) from partnerships and fiduciaries

..•

Enter not gain or (loss), combine lines 1 and 2 .

Short-term capital loss component carryover from years beginning before 1970 (see Instruction l)

Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction l) •

Net short-term gain or (loss), combine lines 3, 4(a) and (b) .

Long-term Capital Gains and Losses- Assets Held More Than 6 Months

2

3

4(a)

(b)

5

1741

Capital gain distributions .

8

9

Enter gain, if applicable, from Form 4797, line 4(a) (1) (see Instruction A)

Enter your share of net long-term gain or (loss) from partnerships and fiduciaries

Enter your share of net long-term gain from sinall business corporations (Subchapter S) •

Net gain or (loss), combine lines 6 through 10

12(a) Long-terin capital loss component carryover from years beginning before 1970 (see Instruction l)

Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction 1) •

Net long term gain or (loss), combine lines 11. 12(a) and (b)

Part Ill

Summary of Parts / and lI

14

15

Combine the amounts shown on lines 5 and 13, and enter the net gain or (loss) here .

If 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

(b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29a

16

If losses are shown on BOTH lines 12(a) and 13, omit lines 16(a) and (b) and go to Part IV

(a) Enter one of the following amounts:

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,

(iji) If amounts on line 5 and line 13 are net losses, enter amount on line 5 added to

50% of amount on line 13

(b)

Enter here and enter as a (loss) on Form 1040, line 29a, 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 line

4(a) or 12(a), see instruction N for a higher limit not to exceed $1,000); or,

(iti) Taxable income; as adjusted (see Instruction M) .

NW 88326. Docld:32245535 Page 32

8

9

10

11

12(a)

(b)

13

14

15(a)

(b)

5105

5105

113322

5839

44056

15797

16(a)

(b) 11000,

16-82511-1

---

## Page 33

te: 10.

Pare 2

Schedule D (Form 1040) 1975

Part IV

Capital Loss Limitation-Where Losses Are Shown on Both Lines 12(a) AND 13

17 Enter loss froni line 5; if line 5 is zero or a gain, enter a zero . . .

18 Enter loss from line 13

19 Enter gain, if any, from line 5; if line 5 is zero or a loss, enter a zero .

17

18

19

20

20 Reduce loss on line 18 to the extent of the gain, if any, on line 19

21 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero

21

7056

140562

SiaS

Note: If the entry on line 21 is zero, OMIT lines 22 through 28, and enter on line 29 the

loss shown on line 12(a).

22 Enter gain, if any, from line 11

23 Enter smaller of amount on line 21 or line 22 .

22

23

24

25

26

27

28

5105

SI05

24 Enter excess of gain on line 21 over amount on line 23

25 Enter loss from line 4(a); if line 4(a) is blank, enter a zero .

26 Reduce gain, if any, on line 24 to the extent of loss, if any, on line 25 (see Instruction K)

27 Enter loss from line 12(a) .

- .

(13322)

28 Add the gain(s) on line(s) 23 and 26

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 .

29

30

31

32

33

68217)

5839

33 Add lines 17, 30, and 32

-..

18281

34 Enter here and enter as a (loss) on Form 1040, line 29a, the smallest 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)

34

1100

Complete Part V if You are Married Filing a Separate Return and Losses are Shown on Lines 4(a) and

(See Instruction N)

35 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero

35

Note: If 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 Eriter gain, if any, from line 3

37 Enter smaller of amount on line 35 or line 36 .

38 Enter excess of gain on line 35 over amount on line 37 .

39 Enter loss from line 12(a); if line 12(a) is blank, enter a zero

40 Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 (see Instruction K) .

41 Enter loss from line 4(a) .

42 Add the gain(s) on line(s) 37 and 40 .

43 Reduce the loss on line 41 to the extent of the gain, if any, on line 42 (see Instruction L) .

36

37

38

39

40

41

42

43

Part Vi

Computation of Alternative Tax (See Instruction W to See if the Alternative Tax Will Benefit You)

44 Enter amount from Form 1040, line 47 .

45 Enter amount from line 15(a) .

46 Subtract amount on line 45 from amount on line 44 (but not less than zero) .

47 Enter smaller of amount on line 13 or line 14

If line 47 does not exceed $50,000 ($25,000 if married filing separately), check here » [

• and omit

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)

49 Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger .

If line 49 is equal to or greater than line 47, check here & [ and omit lines 50 through 54.

50 Multiply amount on line 49 by 50%

51 Add amounts on lines 46 and 50 .

52 Tax on line 44 or 45, whichever is greater (use Tax Rate Schedule in instructions)

53 Tax on the amount on line 51 (use Tax Rate Schedule in instructions)

54 Subtract amount on line 53 from amount on line 52

55 Tax on the amount on line 46 (use Tax Rate Schedule in instructions) .

56 If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 25% of line 49

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 •

ir U.S. GOVERNMENT PRINTING OFFICE: 1975-0-575-054

44

45

46

47

48

49

50

51

52

53

54

55

56

57

16-92511-1

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## Page 34

SCHEDULE SE

(Form

1040)

Computation of Social Security Self-Employment Tax

Department of the Treasury

Each self-employed person must file a Schedule SE.

• Attach to Form 1040.

1975

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.

• 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 OF SELF-EMPLOYED PERSON (AS

SHOWN

ON SOCIAL SECURITY CARD)

Social security number of

AMUEL

self-employed person &

Business activities subject to self-employshent tax (grocery store, restaurant, farm, etc.)

SNALK

122. BZAR

2992

* It you have only farm income complete Parts 1 and Il.

• If you have only nonfarm income complete Parts Il and III.

If you have both farm and nonfarm income complete Parts 1, Il, and III.

Part I

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)

1 Net profit or (loss) from:

(b) Farm partnerships

2 Net earnings from farm self-employment (add lines 1(a) and (b))

FARM OPTIONAL METHOD

3 If gross profits

(a) Not more than $2,400, enter two-thirds of the gross profits .

from farming ' are:

(b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600

profits from farming

the total gross profits froin Schedule F.

line 28 (cash

line '72 (accrual

method),

blus the distributive

gross profits from farm partnerships (Schedule K-1 (Form 1065), line 14) as

explained in instructions for Schedule SE

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method

Part I

Computation of Net Earnings from NONFARM Self-Employment

(a) Schedule C, line 21. (Enter combined amount if more than one business.) . .

5159

(b) Partnerships, joint ventures, etc. (other than farming)

(c) Service as a minister, member of a religious order, or a Christian Science prac-

titioner. (Include rental value of parsonage or rental allowance furnished.) If you

filed Form 4361, check here »

and enter zero on this line

(d) Service with a foreign government or international organization

(See

form

1040

(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 7)

5159

5159

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 III.

Note: You may use the nonfarm optional method (line 9 through line 11) only it 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

SE

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)) . .

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

3 Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3; plus the

share

distributive

of gross

for Schedule

se rotits trotu

nonfarm partnerships (Schedule K-1 (Form

line 14) as

explained in instructions

Also, include gross

profits from

services reported on lines

Part

Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): (a) From farming (from line 4)

(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

14 The largest amount of combined wages and self-employment earnings subject to social security or railroad

retirement taxes for 1975 is

15 (a) Total "FICA" wages and "RRTA" compensation .

(b) Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA.

(c) Total of lines 15(a) and (b)

16 Balance (subtract line 15(c) from line 14) :

17 Self-employment incomeline 13 or 16, whichever is smaller

1a sal mol men tax i no 17m 5140 ter 5 1390 5, mully the ar

18 Self-employment tax. (If line 17 is $14,100.00, enter $1,113.90; if less, multiply the amount on line 17

# U.S. GOVERNMENT PRINTiNG OFFICE: 1975-0-575-058

NW 88326. Docld:32245535 Page 34

$1,600

00

5,59

5259

$14,100

00

34109

408

18-82518-33

---

## Page 35

Minals

SCHEDULE SE

(Form 1040)

Computation of Social Security Self-Employment Tax

Department of the Treasury

Each self-employed person must file a Schedule SE.

• Attach to form 1040.

Internal Revenue Service

See Earned

1975

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.

• 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 OF

SELF-EMPLOYED PERSO

(AS SHOWN ON SOCIAL SECURITY CARD)

Social security number of

PHYLLIS

self-employed person

Business

activities

subject to self-employ

349:18:142

ient tax (grocery store, restaurant, farm, etc.) • SNACKbAR

If you have only farm income complete Parts I and III.

• If you have only nonfarm income complete Parts I| and III.

If you have both farm and nonfarm income complete Parts I, Il, and III.

Part

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)

1 Net profit or (loss) from:

(b) Farm partnerships

2 Net earnings from farm self-employment (add lines 1(a) and (b))

FARM OPTIONAL METHOD

3 If gross profits

(a) Not more than $2,400, enter two-thirds of the gross profits .

from farming' are:

(b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600

1 Gross

profits from

are the total gross profits from Schedule F.

line 28 (cash

method),

plus the

distributive

gross protes from a seederships (schedule me form"

line 72 (accrual

line 14) as

explained in instructions for Schedule SE.

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method

Part li

Computation of Net Earnings from NÖNFARM Self-Employment

(a)

Schedule C, line 21. (Enter combined amount if more than one business.) .

7400

(b) Partnerships, joint ventures, etc. (other than farming)

REGULAR METHOD

5 Net profit or

• (loss) from:

(c) Service as a minister, member of a religious order, or a Christian Science prac-

titioner. (Include rental value of parsonage or rental allowance furnished.) If you

filed Form 4361, check here

and enter zero on this line

(d) Service with a foreign government or international organization

(See

Form

1040

(e) Other

structions for line 35.) Specify

6 Total (add lines 5(a) through (e))

2y00

7 Enter adjustments if any (attach statement) .

8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7)

2y00

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 it line 8 is less than $1,600 and less

than two-thirds of your gross nonfarm profits," and you had actual net earnings from sell-employment of $100 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.

SE

NONFARM. OPTIONAL METHOD

9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .

$1,600

00

(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)) .

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

2 Gross profits from nontarm business are the total of the gross

share

for

of

gross

profits

from

profits from Schedule C. line 3, plus the

distributive

Schedule SE.

Also,

nontarm partnerships (Schedule

K-1 (Form

1065), line

14) as

explained in instructions

include gross profits from services reported on lines

5(c), (d), and (e),

as adjusted by line

Part Ill

Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): (a) From farming (from line 4)

(b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method)

2400

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.) .

ZYDO

14 The largest amount of combined wages and self-employment earnings subject to social security or railroad

retirement taxes for

1975 is

$14,100

00

15 (a) Total "FICA" wages and "RRTA"' compensation .

(b) Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA.

(c) Total of lines 15(a) and (b)

16 Balance (subtract line 15(c) from line 14) .

17 Self-employment income-line 13 or 16, whichever is smaller

18 Self-employment tax. (If line 17 is $14,100.00, enter $1,113.90; if less, multiply the amount on line 17.

by .079.) Enter here and on Form 1040, line 59

# U.S. GOVERNMENT PRINTiNG OFFICE: 1975-0-575-058

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2400

190

10-82518-3

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## Page 36

Form

4797

Department of the Treasury

Internal Rovanua Service

Supplemental Schedule of Gains and Losses

Sales, Exchanges and Involuntary Conversions under

Sections 1231,

1245, 1250,

1251, and 1252

1975

To be filed with Form 1040, 1041, 1065, 1120, etc.-See Separate Instructions

Name(s) as shown on return

SAMUEL

SPHYLLIS

Кив

Identifying number

322-12-7992

Part !

Sales or Exchanges

of Property Used in Trade or Bdsiness, and Involuntary Conversions

(Section 1231)

SECTION A.-Involuntary Conversions Due to Casualty and Theft (See Instruction E)

Kind of property (if necessary,

attach additional describlive

details not shown below)

b. Date acquired

c. Date sold

(mo., day, yr.)

(mo., day, yr.)

d. Gross sales

price

e. Depreciation al.

lowed (or allowable)

since acquisition

f. Cost or other basis,

cost of subsequent im.

provements (if not pur.

chased,

attach explang.

tion) and expense of sale

8. Gain or

(1083)

d plus e lass

2 Combine the amounts on line 1. Enter here, and on the appropriate line as follows

(a) For all except partnership returns:

(1) If line 2 is zero or a gain, enter such amount in column g, line 3.

(2) If line 2 is a loss, enter the loss on line 5.

(b)

For partnership returns: Enter the amount shown on line 2 above, on Schedule K (Form 1065), line 6.

B.—Sales or Exchanges of Property Used in Trade or Business and Certain Involuntary Conversions (Not Roportable in Soc-

tion A) (See Instruction E)

3

LINE

5105

5105

4 Combine the amounts on line 3. Enter here, and on the appropriate line as follows .

(a) For all except partnership returns:

(1) lf 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

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.

Part 1I.

Ordinary Gains and Losses

a. Kind of property (if necessary,

attach

additional descriptive

details not shown below)

b. Date acquired

c. Date sold

(mo., day, yr.)

(mo., day, yr.)

d. Gross sales

price

Depreciation al.

lowed (or allowable)

since acquisition

f. Cost or other basis,

cost of subsequent im.

provements (if not pur.

chased, attach explana-

tion) and expense of sale

Gain or (loss)

(d plus a loss 1)

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

2213.

9 Combine amounts on lines 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 line 9, on the line provided for on the

return (Form 1120, etc.) being filed. See instruction F for specific line reference.

(b) For individual returns:

(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

16-82504-1

NW 88326 Docld:32245535 Page 36

2313

2313:

Form 4797 (1975)

---

## Page 37

Forn: 4797 (19751

Part 111

Page 2

Disregard lines 18 and 19 if there are no dispositions of farm property or farmland, or if this form is filed by a partnership

10 Description of sections 1245, 1250, 1251, and 1252 property:

Date acquired

WOODLEY BISTRO

COFFEESHOP

(mo.,

day,

yr.)

7/11>4

Date sold

(mo.

91/25

(B)

(C)

(D)

(E)

Relate lines 10(A) through 10(E) to these

columns

Property

(A)

INSTA

Property

(B)

Property

Property

(D)

Propert

11 Gross sales price

12 Cost or other basis and expense of sale

13 Depreciation allowed (or allowable)

14 Adjusted basis, line 12 less line 13

Total pain, line 11 less line 14

If section 1245 property:

(a) Depreciation allowed (or allowable) alter ap.

plicable date (see instructions)

(b) Enter smaller of line 15 or 16(a)

If section 1250 property:

Enter additional depreciation atter 12/31/63

ALE

(b) Enter additional depreciation after 12/31/69

(c) Enter smaller of line 15 or 17(9)

(d) Line 17(c) times applicable percentage (see

instruction G.4)

(e) Enter any excess of line 15 over line 17(b) .

(f) Enter smaller of line 17(a) or 17(e) .

(g) Line 17(t) times applicable percentage. (see

instruction G.4)

(h) Add lines 17(d) and 17(g)

18 If section 1251 property:

(a) If farmland, enter soil, water, and land clear-

ing expenses for current year and the

four

preceding years

(b) If farm property other than land, subtract line

16(b) from line 15; OR,

if farmland,

enter

smaller of line 15 or 18(a) (see instruction

G.5)

(c)

Excess deductions account (see instruction

G.5)

(d) Enter 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

(b) Enter amount from line 18(d), if none enter a

zero

(c) Enter any excess of line 19(a) over line 19(b)

(d) Line 19(c) times applicable percentage (see

instruction G.5)

(e) Line 15 less line 19(b)

(t) 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), line 15) ... . . .

21 Add columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter here and on line 7

22 Subtract line 21 from line 20. Enter here and in appropriate Section in Part I (see instructions E and G.2)

# U.S. GOVERNMENT PRINTING OFFICE : 1975-0-575-158

7418

2313

5105

16-82504-1

NW 88326 Docld:32245535 Page 37

---

## Page 38

Form

4798

Department of the Treasury

Internal Revenue Servico

Name(s) as shown on Form 1040

AMMEL

A. Who Should File.—You will need to complete either

Part I or Part Il of this form if you have a capital loss to

carry over to 1975.

Capital Loss Carryover

• (From 1974 to 1975)

• Attach to Form 1040

1975

Social Security Number

322122997

B. How to Compute Carryover.—Ií you have a capital

loss carryover, complete either Part I or Part Il of this

form, but do not complete both.

1. Complete only Part 1 if lines 4(a) and 12(a) on

your 1974 Schedule D (Form 1040) DO NOT SHÖW 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.

Partl

Post-1969 Capital Loss Carryovers,

Section A,-Short-term Capital Loss Carryover

1 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

2 Enter gain shown on your 1974 Schedule D (Form 1040), line 13. If that line is blank or shows

a loss, enter a zero . . . ..

2

3 Reduce any loss on line 1 to the extent of any gain on line 2 .

3

4 Enter amount shown on your 1974 Form 1040, line 29

4

5

5 Enter smaller of line 3 or 4

6

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 1974 to 1975 that is attributable to years beginning

after 1969. Enter this amount on your 1975 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 1974. Form

1040, line 29) •

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

7

8

9

10

10 Reduce any loss on line 8 to the extent of any gain on line 9

11

11 Multiply amount on line 7 by 2 .

-....

i2-

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), line 12(b).

Form 4798 (1975)

NW 88326 Docld:32245535 Page 38

---

## Page 39

Form 4798 (1975)

Part Il Pre-1970 and Post-1969 Capital Loss Carryovers

Section A.-Short-term Capital Losses Identified

1 Enter loss shown on your 1974 Schedule D (Form 1040), line 5; if none, enter zero and ignore

lines 2 through 20—then go to line 21

2 Enter gain shown on your 1974 Schedule D (Form 1040), line 13._If that line 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: If line 4(a) on your 1974 Schedule D (Form 1040) is blank, IGNORE lines 4 through 11, enter

a zero on line 12—then go to line 13.

4 Combine lines 3 and 11 on your 1974 Schedule D (Form 1040).

Enter the gain; or if zero or a loss, enter a zero

-0-i

Note: If line 4 is zero IGNORE lines 5 through 11, enter on line 12

the loss from your 1974 Schedule D (Form 1040), line 4(a)-

then go to line 13.

5 Enter any gain from your 1974 Schedule D (Form 1040), line 3 .

6 Enter smaller of line 4 or 5

5

6

7

—0 -

D

7 Enter excess of gain on line 4 over line 6

8 Enter loss from your 1974 Schedule D

(Form 1040), line 12(a):

otherwise, enter a zero.

9 Reduce any gain on line 7 to the extent of any loss on line 8.

9

13322

3372

10 Enter loss from your 1974 Schedule D (Form 1040), line 4(a); other-

10

wISe

enter a zero

11 Add the gains on lines 6 and 9

-o-

= 0=

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 line 13)

Section B.-Computation of Capital Loss Carryovers to 1975

15 Enter any loss from line 13, above .

15

-0.

16 Enter loss deducted on your 1974 Form 1040, line 29 .

16

1000

17 Loss carryover to 1975 (excess of line 15 over line 16-if line 15 does not exceed line 16, enter

zero). Enter here and on your 1975 Schedule D (Form 1040), line 4(a) •

18 Enter any loss from line 14, above .

19 Enter excess of line 16 over line 15- if line 16 does not exceed line

15, enter zero

19

1002

20 Loss carryover to 1975 (excess of line 18 over line 19—if line 18 does not exceed line 19, enter

zero). Enter here and on your 1975 Schedule D (Form 1040), line 4(b) •

21 If you were required to complete Part IV of your 1974 Schedule D

(Form 1040), enter any loss from your 1974 Schedule D (Form

1040), line 30; otherwise, enter zero

22 Enter excess of line 19 over line 18—if line 19 does not exceed line

• (13322)

18, enter zero. (Note: If you ignored lines 2 through 20 above, enter

amount from your 1974 Form 1040, line 29.)

22

23 Loss carryover to 1975 (excess of line 21 over line 22—if line 21 does not exceed line 22, enter

zero). Enter here and on 1975 Schedule D (Form 1040), line 12(a)

24 If you were required to complete Part IV of your 1974 Schedule D

(Form 1040), enter any loss from your 1974 Schedule D (Form

1040), line 31. However, if Part IV was not required, enter any loss

from your 1974 Schedule D (Form 1040), line 13

24

(5839)

25 Enter excess of line 22 over line 21

.. x 2 (if line 22

does not exceed line 21, enter zero.) •

25

26 Loss carryover to 1975 (excess of line 24 over line 25—if line 24 does not exceed line 25, enter

zero). Enter here and on your 1975 Schedule D (Form 1040). line 12(b)

V 88326 Docld:32245535 Page 39

1

2

3

12

13

14

17

20

23

26

Page 2

GTYI)

--

22911

1000

(17Y1)

(3322)

( 5839)

---

## Page 40

NAME :

ADDRESS

MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A.G.I. (Line 18 - 1040)

4 NET MED/DRUGS

5 H & A INS. (½ + EXCESS)

ba DR.

DR.:

DR.

DR.

DR.

DR.

DR.

DR.

SAMMELLPHYLLES

322-12-7997

_ SOC. SEC. NO.

DEDUCTION SCHEDULE

STATE

FEDERAL

CONTRIBUTIONS

21a CASH CONTRIBUTIONS

21b PARTNERSHIP SHARE

GIRL/BOY SCOUTS

687

HEART FUND/CANCER FUND

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

877

CHURCHES

ruder.

_ CALENDAR VEAR 19 25

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

6C AMBULANCE

LABORATORIES

TRAVEL FOR MED.

1002

MEDICARE INS.

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.

9

I +:½ (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

17 TOTAL TAXES

INTEREST (TO WHOM PAID)

18 MORTGAGE

1679

270

1332

150

101

19 INSTALLMENT LOANS

MISC

TRANSWORLD

S BA

STATE

FEDERAL

70

1629

258

1321

150

1521

23,2

48

20S

z2

180

7

10.0

12857

150

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT (LOSS(ES)

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT

27

28 ($100 LIMITATION PER CAS.)

29 TOT. CAS. OR THEFT LOSS

MISCELLANEOUS DE DUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Form 2441)

33 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

50 1501

34 TOTAL MISC. DED.

SUMMARY OF ITEMIZED DED

35 тот

EXPENSES

36 TOTAL TAXES (From LINE 17)

37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. (Line 24)

39 CAS. & THEFT LOSS(ES) (Line29)

LO DEDUC TION

OSSE TRON LISE 34

STATE

FEDERAL

1573

52351

"NIEN ON

REMARKS

20 TOTAL INTEREST

Professional Stationers, Inc

2837

Form 101

Nerth Hallyweard California,

NW 88326" Docld:32245535 Page 40

SCHEDULE -

---

## Page 41

SAMUELE PHYLLIS.

RuBy

32217-7997

CALENDAR YEAR 10 25

FISCAL YEAR ENDING

19_

48924

SCHEDULE OF

PROFIT

TOR LOSS ) FROM BUSINESS OR PROFESSION

PRINCIPAL BUSINESS ACTIVITY

BUSINESS NAME

BUSINESS

ADDRESS

TOTAL

RECEIPTS

INVENTORY

AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

TOTAL

LESS INVENTORY AT END OF YEAR

GROSS PROFIT

GROSS INCOME

ADVERTISING

AUTO

AND

EXPENSE

HAD

DEBTS

COMMISSIONS

DELIVERY

DENRECIATION ( SCHEDULE BELOW Y

DUES AND SURSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR AND HAULING

LEGAL

AND ACCOUNTING

OFFICE SUPPLIES AND EXPENSE

OTHER BUSINESS DEDUCTIONS

REPAIRS AND MAINTENANCE

SALARIES AND WAGES

SUPPLIES

TAXES AND

LICENSES

TAXES PAYROLL

TELEPHONE AND UTILITIES

LINEN

CONTRACT LABOR

EMFLOYERS NO.

800

2Y031.

2Y831

-0-

2Y831

24093

24093

99

18.00

174

126

285

150

4151

240

57.

168

158

Yyy.

1634

2559

NET PROFIT

NET

PROFIT

OR

OR

(LOSS

(LOSS)

NO.

KIND AND LOCATION OF PROPERTY

EQUIPMENT

FEDERAL RETURN

STATE RETURN. SEE DEPREC.

SCHEDULE FOR DIFF. (5) 5159(W) LY GO

SCHEDULE OF DEPRECIATION

DATE

YEARS

COST OR

ACQUIRED

METH

OR %

OTHER BASIS

2/I//SIL

TYR

10228

PRIOR

DEPREC

1339

DEPRECIATION

THIS YEAR

974

G000 WiLh

414

35000

PROFESSIONAL

STATIONERS INC

FORM 101

LOS ANGELES, CALIF.

NW 88326 Docld:32245535 Page 41

SCHEDULE.

V.

---

## Page 42

NAME .

SAMUEL PHYLON RUBY

SOC. SEC. NO.

GAINS ON INSTALLMENT SALES

DESCRIPTION OF PROPERTY

DATE ACQUIRED

-OFFEI

TYPE OF ASSET:

1. SELLING PRICE: CASH

2.

3.

4.

5.

6.

7.

8.

9.

NOTES

MORTGAGE TRANSFERRED

OTHER

GROSS SALES PRICE (1+2+3+4)

COST OR BASIS

LESS ACCUMULATED DEPRECIATION

PRIOR TO 1-1-62

PRIOR TO 1-1-64

10.

11

12.

13.

AFTER 12-31-61

ST. LINE AFTER 12-31-63

EXCESS OVER S/L 1-64/12-69

EXCESS OVER S/L AFTER 12-31-69

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

23.

CASH (1)

24.

PRINCIPAL COLLECTIONS

25.

EXCESS MORTGAGE OVER BASIS

26.

OTHER (4)

27.

TOTAL PAYMENTS (23 THRU 26)

28

RECOGNIZED GAIN

29.

RECOGNIZED GAIN - ORDINARY

30.

RECOGNIZED GAIN - OTHER

$

$

$

$

ORDINARY INCOME

TAX-

ABLE

YR

1975

TOTAL

PAYMENTS

LESS INT.

(TO PT. 2.

SEC.

3)

MONE

SECTION 1245

REPORTED

7418

jECTION 1250

BALANCE

15416.

REPORTED

BALANCE

Calendar Yr:

F./Y/E

іу 25

19:

9/7/75

CAPITAL

SEC. 1245

$20148

48152

68300

$45228

SEC. 1250

$

$

%

20313

42965

238

13153

$ 2313

522834

$ 683001

3682%

$

20148

-

20148

2313

5105

CAPITAL GAIN

REPORTED

BALANCE

%

NW 86326

espersees pages

СОНЕПНІЕ

---

## Page 43

RESIDENT

4, 540

INDIVIDUAL

CALIFORNIA

INCOME TAX

TAXABLE YEAR

21975

PLACE PREADDRESSED LABEL

HERE,

if available.

(Correct name and address, if necessary)

Enter social security numbers) only if incorrect or not shown on label.

NAME (If joint return, give first,

and initials of both)

LAST NAME

AMHEL

Ruby

PRESENT HOME LODRESS Number and are indusing apartment number

sural route)

16250

IRCHER

T

CITY, TOWN OR POST OFFICE, STATE AND LIP PILLS

RANADA

A

Check

5 Calendar Year

One:

[J Fiscal Year Ending-

.1976

FOR

FEDERAL

PRIVACY

ACT

NOTIFI-

CATION SEE PAGE 2 OF INSTRUCTIONS

Your Social Security Numbe

322

12

7997

Spouse's Social Security

349

OCCU-

Yours

PATION

Spouse's JE

FILING STATUS-Check Only One:

EXEMPTION CREDITS

1 0 Single

• If line l or 3 checked, enter $25

6 Personal

If line 2, 4 or 5 checked. enter $50

2 M

Married filing joint return (even if only one had income)

• 650

00

7 Dependents - Do not list yourself, your spouse or the person

30

who qualifies you

Separate return of married person-Enter spouse's

as head of houschold. Enter name and relationship.

social security number and full name here

ELIS

THOMAS

4 D Head of Household Enter name of qualifying

individual_

Total Number 1-

× $8•

7

16

00

Blind (refer to instructions) Number of blind exemptions a

× $8

00

5 D Widow(er) with dependent child (Year spouse died 197.

Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

9

10 Wages, salaries, tips and other employee compensation Altar if unavailable see instructions,

Form(s) W.2 to face of

66

00

this

Page 6. 1.

• 10

11

Dividends—-before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))

• 11

12

A 12 Interest. Enter total (if over $400, complete and attach Schedule B(540))

€ 12

95

13 Income other than wages, dividends and interest (from line 48)

13

8822

14

Total (add lines 10, 11, 12 and 13)

14

3984

15

Adjustments to income (from line 55)

15

16

Adjusted gross income (subtract line 15 from line 14)

• If line 1 or 3 is checked and line 16 is $4,000 or less, enter zero tax on line 23.

• if line 2, 1, or 5 is checked and line 16 is $8,000 or less, enter zero tax on line 23.

lines.17 thru. 22

lines t, chrulete

• 16

8984.

COPY 2

• If you do NOT itemize deductions AND line 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 lines 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)

17

5735

18

Taxable income (subtract line 17 trom line 16) Compute tax

from

Tax Rate Schedule-Enter tax on line 19

18

3249

19 Tax from (check one) Tax Table O

Tax Rate Schedute

Income Averaging Schedule (G or G-I) D

19

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)

20

2.2

21

22

Other credits (from line 65)

23. Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter zero)

22

—0=

24

Tax on preference income (see instructions-attach Schedule P(540))

23

24

25

Total tax liability (add lines 23 and 24)

25

→0 .

ATTACH

26

Total California income tax withheld (attach W-2 or W-2P to face of this return)

26

27

Renter's credit-if you lived in rented property on March 1, 1975, complete Part 1 on page 2

27

ATTACH FORM DE 1964 HERE

security number on check or money order.

28

1975 California estimated tax payments

.

28

29

Excess California SDI tax withheld (attach Form DE 1964 to face of this return)

4129

30

Total prepayment credits (add lines 26 thru 29)

30

—0

31

If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero.

Pay in full and mail with return to:

FRANCHISE TAX BOARD

SACRAMENTO, CA 95867

PAY IN FULL →

• 31

32

If line 25 is smaller than line 30, enter amount OVERPAID

Do not write in these spaces

€ 32

Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks.

Mail return to:

FRANCHISE TAX BOARD

P.O. BOX 13-540

33

E

SACRAMENTO, CA 95813

M

Amount of line 32 to be credited on your 1976 ESTIMATED TAX

ESTIMATED TAX

R

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and

Write social

belief it is true, correct and complete. If prepared by a person other than taxpayer, his declaration is based on all information of which he has any knowledge.

SIGN

Your signature

Date

Preparer's signature (other than taxpayer)

HERE D

joint return

NW 88326 Docld:32245535 Page

Date

Address (and Zip code)

367-34819

---

## Page 44

• .-

Page 2 Form 540 (1975)

PART 1 - Renter's Credit — All questions must be answered

35

Did you, on March 1, 1975, live in rented property which was your principal residence?

36

Was the property you rented exempt from property tax?

37 Did you live with any other person who claimed you as a dependent for income tax purposes?

38

Did you or your spouse claim the homeowners' property tax exemption or receive public assistance?

• Yes

• Yes

Yes

Yes

PART Il - 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 D(540))

41

Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540) )

42

Pensions and annuities

43

Rents and royalties

44

Partnerships

ATTACH

SCHEDULE E

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 E(540))

(b) Alimony

(c) Other (state nature and source).

Enter total of lines 47(a), 47(b), and 47(c)

48

Total (add lines 39 thru 47). Enter here and on 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)

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)

54

Forfeited interest penalty (see instructions)

55

Total adjustments (add lines 49 thru 54). Enter here and on line 15

PART IV — Itemized Deductions -

• 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)

.57

Total child adoption expenses (from Schedule A(540), line 13)

58

Total taxes (from Schedule A(540), line 20)

59

Total interest expense (from Schedule A(540), line 23)

0

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) )

64

Retirement income credit (attach Schedule R(540) )

65

TOTAL (add lines 63 and 64). Enter here and on line 22

No

• No

• No

• No

If no, you may not claim this credit

It yes, you may not claim this credit

If yes, you may not claim this credit

If yes, see page 6 of instructions

47 a.

47b

47c

39

40

41

42

43

44

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

25J9

10.00

1313

8822

150.%

1207

> 857

150

5135

PART VI - Reconciliation to Federal Return — If adjusted

gross income on Federal Return is different from line 16, page 1, explain below.

DIVEX

12

TRA

373

NW 88326 Docld:32245535 Page 44

---

## Page 45

SCHEDULE

CALIFORNIA

ITEMIZED DEDUCTIONS

FORM 540

Attach to Form 540

TAXABLE

41975.

YEAR

Name as shown, on Form 540

AMUEL

PHYLLIS

Киву

Social Security Number

322-12-2992

If your adjusted gross income is $8,000 or less and your filing status is "Married, Filing Jointly," "Hea

of Household." or "Widow(er) With Dependent Child,"

or $4,000 or less and your iling status is "Single." or "Married, Filing Separately," do not itemize, enter zero on Form 540, line 23, and check the

tax

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.

Interest Expense

21. Home mortgage.

22. Other (itemize).

1. One half (but not more than $150) of insurance

premiums for medical care

2. Medicine

and drugs

3. Enter 1% of line 16, Form 540

4.

Subtract line 3 from line 2. Enter difference lif less

than zero, enter zero)

5. Enter balance of insurance premiums for medical care

not entered on line 1

6. Other medical and dental expenses:

(a) Doctors, dentists, nurses, etc..

(b) Hospitals

(c) Other (itemize)

SCH

23. Total-lAdd lines :21

Form 540,

line

59)

and 22. Enter here and on

2857

Contributions

24. Cash

contributions for

which you have

receipts,

canceled checks, etc.

25. Other cash contributions. List donees and amounts

7. Total-(Add lines 4, 5, 6a, b, and c)

8. Enter 3% of line 16, Form 540.

9. Subtract line 8 from line 7. Enter difference (if less

than zero, enter zero).

10. Total-(Add lines 1 and 9. Enter here and,

on Form

540, line 56)

Child Adoption Expense

11. Total expenses paid or incurred-Attach itemized list

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)

Taxes

14. Real

estate

15. State and local gasoline.

16. General

Sales.

17. Auto license-Excess of registration and weight fees

(see instructions)

18.

Personal property (Boat and Aircraft)

19. Other (itemize)..

SCH

20. Total taxes (Add lines 14 thru 19. Enter here and

on Form 540, line 58)

NW 88326. Docld:32245535 Page 45

1509

ScH

26. Other than cash.-See instructions for required state-

ment

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. Insurance reimbursement.

31. Subtract line. 30 from line 29. Enter difference (if line

30 is greater than line 29, enter zero)

32. Enter $100 or amount on line 31, whichever is smaller

33. Casualty or theft loss (line 31 less line 32)

34. Alimony paid

35. Child care-See instructions

36. Union dues.

37. Employment education expense-See instructions

38. Other-(itemize)

150

1207

39.

Total-Add lines 33, 34, 35,

36, 37, and 38. (Enter

here and on Form 540, line 61)

---

## Page 46

SCHEDULE

CALIFORNIA

TAXABLE

19 25

FORM 340

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Solo Propriotorships)

YEAR

Attach this schedule to your Income tax 1

1, form B40 or 340NR

Name as shown on Form 540 or 540NR

SAMUEL

PHyLLIs RuBy

Partarships, lolnt vanturas, ofe, must fle on Form 568

Soclal Security Number

322-12-2997

A. MOORE BUT ST ROCOFFEESHOP

WOOPLEY

C. Principal business activity (i.e., retail-hardware; wholesale-tobacco; services-legal; etc.)....

SERVICE

95-2651578

-NACKBAR

method of accounting:

accrual:

F. Method of inventory valuation a

ory 2a bation 599, for the alga yot filed (it required)?

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

• YES

• NO

If "Yes," attach explanation.

1 Gross receipts, sales, or fees $.

...Less returns and allowances $...........

Balance a

¿ Inventory at beginning of year lif different from last year's closing inventory, attach explanation).

3 Purchases $.

Less cost of items withdrawn for personal use $_......

4 Cost of labor (do not include salary paid to yourself)

5 Materials and supplies

6 Other costs (explain in Schedule C-2 or attach Schedule)

7 Total of lines 2 thru 6

8 Inventory at end of this year.

g Cost of goods sold (subtract line 8 from line 7)

10 Gross profit (subtract line 9 trom line l)..

11 Other income (attach schedule)

12

Total Income (add lines 10 and 11)

OTHER BUSINESS DEDUCTIONS

13 Depreciation (explain in Schedule C-l or attach Schedule)

14 Taxes on business and business.property (explain in Schedule C-2 or attach Schedule)

15 Rent on business property

16 Repairs (explain in Schedule C-2 or attach Schedule)

17 Salaries and wages not included on line 4 (exclude any paid to yourself.

18 Insurance

19 Legal and professional fees

20 Commissions

21 Amortization (attach statement)

22 Retirement plans, etc. (other than your share, see instructions).

23 Interest on business indebtedness.

24 Bad debts arising from sales or services (Not applicable if reporting on cash basis)

25 Depletion (attach schedule)..

26 Other business expenses (explain in Schedule C-2 or attach Schedule).

27

Total of lines 13 thru 26

28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form

540 or 540NR

Schedule C-1

Depreciation

Claimed on line 13.

Group and guideline class

or description of property

Date

Acquired

Cost or

other basis

Depreciation

allowed (or allowable)

in prior years

SCH

Method of

computing.

depreciation

Life or

Rate

2559

Depreciation

for this year

Schedule G2

Explanation of Lines

6, 14, 16, and 26.

LINE

NO.

EXPLANATION

AMOUNT

LINE

NO.

EXPLANATION

AMOUNT

NW 88326

Docld:32245535 Page 46

---

## Page 47

SCHEDULE

CALIFORNIA

FORM 540

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

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

AMUEL

PART I-Assets Held Ono Year or Loss

a. Kind of property and description

(Example, 100 shares of "Z" Co.)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

price

1924 Loss CARNOTER

(20,3607

UsE0190Y.po0zr

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

PART Il-Assets Held More Than One Year But Not More Than Fivo Years

5.

TAXABLE

1975%

YEAR

Socal Secupity Number

332/27992

D

8. Cost

other basis

adjusted,

quent

cost of subse.

not

improvements

purchased,

(it

attach

explanation)

and

ex.

pense of sale

f.. Gain or loss

(d. less e.)

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 Ill Assets Held More Than Five Years

3105

5105

10. Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)

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 Lossos

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 (attach compuration)

17. Combine the amounts shown on lines 13, 14, 15 and 16

3318

(19360)

18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or 540NR

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

NW 88328 061832243535 Pageeat a husband or wife filing a separate return)

(16042)

(1000)

---

## Page 48

SCHEDULE

2D-14

FORM 540

CALIFORNIA

TAXABLE

1925

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges Including Involuntary Conversions)

(Attach to Form 540, 540NR, 541 or 565)

YEAR

Name as shown on Tax Return

SAMUEL

ePHycusRuBy

PART | Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220

Identifying number as shown on return

322-12-2987

D-1

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.

Date sold

1.

(A)

(B)

(C)

(D)

Description of Sections 18211, 18212-18, 18219, and 18220 property

WHORLEY BISTRO

COFFEE StOP

Date acquired

(mo.,

day, yr.)

2/1/24

(mo.,

day, yr.)

9/225

Correlate lines 1(A) through 1(D) with these columns

Property

(A)

Property

(B)

Property

(C)

Property:

(D)

2.

Gross

sales

price

3. Cost or other basis and expense of sale

4.

Depreciation allowed (or allowable)

5. Adjusted basis, line 3 less line 4

6.

Total gain, subtract line 5 from line 2

INSTALLMENT

7. 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

SALE

8.

If Section 18212-18 property:

(a) Enter additional depreciation after 12-31-63 and before

1-1-71

(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)

9.

If Section 18220 property:

(a) If farm land, enter soil and water conservation expenses

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 line 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

10. If Section 18219 property:

(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)

(f)

Enter smaller of line 10(d) or line 10(e)

SUMMARY OF

PART !

(Complete Property Columns (A) through (D) up to Line 10(f) before going to Line ll)

11.

Enter amounts from line 6

12. Enter amounts from lines 7(b), 8(h), 9(d) and 10(f) .

7118

2313

13. • Subtract line 12 from line 11, enter here and in appropriate

Section in Part Il (see Instruction D-2)

S10S

14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part Ill

2313.

NW 883267Docld:32245535 Page 48

---

## Page 49

Schedule D-1(540)

PART II

Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions

(Section 18181-82) see Instruction E

Section A - INVOLUNTARY CONVERSIONS DUE TO CASUALTY AND THEFT

A.

Kind of property (if necessary,

attach statement of descriptive

details not shown below)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales.

e. Depreciation allowed

price

(or allowable)

since acquisition

f. Cost or other basis, cost of

subsequent improvements

(if not purchased,

attach explanation) and

expense of sale

Page 2

id. plus e.

sain (or loss,

less t.1

15.

16.

Combine the amounts on line 15, enter here and also on the appropriate line as follows

(a) For all returns, except partnership returnss (1) If line 16 is zero or a gain, enter amount of each gain or loss, above, in

column (g) of applicable Section B-I, B-2 or B-3; (2) If line 1ó is a loss, enter such amount on line 25 of Part III.

(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

17.

18. Combine the amounts on

line 17, enter here

Section B-2 Property Held More Than One Year But Not More Than Five Years

19.

LINE

5108

20. Combine the amounts on

line.19, enter here

21.

JI0r

Section B-3 Property Held More Than Five Years

22.

23.

Combine the amounts on line 21, enter here

Combine the amounts on lines 18, 20 and 22; enter here and also on the appropriate line as follow:

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 11, respectively, of the Schedule D (Form 541). (2) If line 23 is a loss, enter such amount on line 26 of Part Ill.

(b) For partnership returns: Enter amounts on lines 18, 20 and 22, in Schedule K(565)-see Instruction. E.

PART Ill Ordinary Gains and Losses

a. Kind of property and how

acquired (il necessary,

attach statement of descriptive

details not shown below)

24. Gain, if any, from line 14

25. Loss, if any, from line 16

26. Loss, if any, from line 23

27

b.

Date acquired

(mo., day, yr.)

Date sold

(mo., day, yr.)

d. Gross sales

price

e. Depreciation allowed

(or allowable)

since acquisition

f. Cost or other basis, cost of

subsequent improvements

and expense of sale

Gain (or

2313.

28.

Combine lines 24 through 27, enter here and also on the appropriate

line as follows

(a) For fiduciary and partnership returns: 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) If the gain (or loss) 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

Schedule A (Form 5,40 or 540NR) - Identify 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

NW 88326-Dockd:32245333-Page 49-

2 of Form 540 or Form 540NR, under "Other Income"

2313

231

---

## Page 50

MAME SAMUELL PHYLLIS

• RuBy

"ADDRESS

322-12-7987

- SOC. SEC. NO. -

DEDUCTION SCHEDULE

MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A. G.I. (Line 18 - 1040)

4 NET MED/DRUGS

5 H & A INS. (½ + EXCESS)

ба DR.

DR.

DR.

DR.

DR.

DR.

DR.

DR.

STATE

FEDERAL

CONTRIBUTIONS

21a CASH CONTRIBUTIONS

216 PARTNERSHIP SHARE

GIRL/BOY SCOUTS

682

HEART FUND/CANCER FUND

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITI

877

CHURCHES

_ CALENDAR YEAR 19 _

25

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

SC AMBULANCE

LABORATORIES

TRAVEL FOR MED.

1000

MEDICARE INS.

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.

9

1 +:½ (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

16.29

220

1359

150

11509

17 TOTAL TAXES

INTEREST (TO WHOM PAID)

18 MORTGAGE

1107

19 INSTALLMENT LOANS MISC

TRANSWORED

SBA

STATE

70

1629

258

1321

150

1521

932

48

205

25 TY

186

7

100

20 TOTAL INTEREST

PS

Professional Stationers, Inc.

1110 laurel Surgers lical are!

Neatle helly weard, Calibered

*11e.0ґ,

* NW 88326 Docld:32245535 Page 50

2857

Form 101

12852

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS.

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT ILOSSIEST

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT

27

28 ($100 LIMITATION PER CAS.)

29 TOT. CAS. OR THEFT LOSS

MISCELLANEOUS DEDUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Form 2441)

33 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

150

34 TOTAL MISC. DED.

SUMMARY OF ITEMIZED DED.

DEDUCTIBLE

35 EXPENSES (FROM LINE

MEE COI & DENTAL

36 TOTAL TAXES (From LINE 17)

37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. (Line 24)

39 CAS. & THEFT LOSS(ES) (Line29)

DEDOC TONS THROM LINE 34)

STATE

ITEMIZED DEDUCTIONS

41 ENTER ON MORM 1040 LINE 45

REMARKS

15231

SCHEDULE

FEDERAL

150

1501

FEDERAL

5235

---

## Page 51

SAMUELL PHYLLIS.

RuBy

32212-7997

SEC. NO..

CALENDAR YEAR 19 25

FISCAL YEAR

ENDING

SCHEDULE OF PROFIT

1 OR

LOSS

7 FROM BUSINESS OR PROFESSION

PRINCIPAL BUSINESS

ACTIVITY

BUSINESS NAME

BUSINESS ADDRESS

TOTAL RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

LESS

TOTAL

INVENTORY

AT END

OF YEAR

GROSS PROFIT

GROSS

INCOME

At M

BUSINESS DEDUCTIONS

ADVERTISING

AUTO AND TRUCK EXPENSE

BAD DEBTS

COMMISSIONS

DELIVENY

DEMHECIATION ( SCHEDULE BELOW I

DUES AND SURSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR AND HAULING

LEGAL AND ACCOUNTING

OFFICE SUPPLIES AND EXPENSE

RENT

REPAINS AND

MAINTENANCE

SALARIES

AND WAGES

SUPPLIES

TAXES

AND LICENSES

TAXES

PAYROLL

TELEPHONE AND UTILITIES

LINEN

CONTRACT LABOR

EMPLOYERS NO.

800

ZY13L.

2Y831

-0-

99

1800

92%

284

150

4151

52S

5632

240

178

1S&

44 Y

^19

48924

24831

24093

24093

1653%

2359

NET PROFIT

NET

PROFIT

OR

(LOSS) FEDERAL RETURN

OR

(LOSS) STATE

PETURN . SEE DEPREC. SCHEDULE FOR DIFF.

SCHEDULE OF DEPRECIATION

YEARS

COST OR

NO.

KIND AND LOCATION OF PROPERTY

EQUIPMENT

DATE

ACOUIRED

METH.

OR %

OTHER BASIS

ZYR

10228

PRIOR

DEPREC

1339

[DEPRECTATION

THIS YEAR

974

G000 WILL

4134

35000

-ot

PROFESSIONAL STATIONERS INC

FORM 10AA

LOS ANGELES.

CALIF.

NW 88326 Docld:32245535 Page 51

SCHEDULE

V.

---

## Page 52

NAME

SAMUELlPHYLISRUBY

SOC. SEC. NO.

Calendar Yr.

F/Y/E

DESCRIPTION OF PROPERTY

DATE ACQUIRED -

GAINS ON INSTALLMENT SALES.

COFFEE SHOP

DATE SOLO 9/2/75

TYPE OF ASSET :

1. SELLING PRICE: CASH

2.

3.

NOTES

MORTGAGE TRANSFERRED

OTHER

5.

GROSS SALES PRICE (1+2+3+4)

6.

COST OR BASIS

7. LESS ACCUMULATED DEPRECIATION

8.

PRIOR TO 1-1-62

9.

PRIOR TO 1-1-64

10.

AFTER 12-31-61

11.

ST. LINE AFTER 12-31-63

12.

EXCESS OVER S/L 1-64/12-69

13

EXCESS OVER S/L AFTER 12-31-69

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

23.

CASH (1)

24.

PRINCIPAL COLLECTIONS

25.

EXCESS MORTGAGE OVER BASIS

26.

OTHER (4)

27.

TOTAL PAYMENTS (23 THRU 26)

28.

RECOGNIZED GAIN

29.

RECOGNIZED GAIN - ORDINARY

30.

RECOGNIZED GAIN - OTHER

CAPITAL

$

$

$

ORDINARY INCOME

%

SEC. 1245

$20148

48152

68300

$45228

2313

42945

238

43153

$ 23/3

522834

$68300

36.67%

20148

-.

=0=

20148

2313

SIRS

REPORTED

SEC. 1250

$

$

$

$

TAX-

ABLE

YR

1975

TOTAL

PAYMENTS

LESS INT.

(TO PT. 2.

SEC.

3)

NONE

SECTION 1245

REPORTED

7418

jECTION 1250

REPORTED

CAPITAL GAIN

BALANCE

15416.

BAL ANCE

BALANCE

iy.

25

19

%

NW 88326 Docld:32245535 Page 52

---

## Page 53

1040

Department of the Treasury-Internal Revenue Service

S

¿Individual Income Tax Return

For the year January 1-December 31, 1974, or other taxable year beginning.

1974, ending

Name (If Joint return, give t

narg

and initials of both)

SAMuEL

HYLLIS

Present home address (Number and stropt, including apartment number

RuBy

Last name

COUNTY OF

RESIDENCE

1.62

-SO

BIECHERSI

L

City, town or post oftice, State and ZIP c

GRANADA HILLS CA

Осси-

1974

19.....

Your social security number

322127992

Spouse's social security no.

34918

she

1420

pation

Filling Status (check only one)

Yours #

Spouse's →

Regular / 65 or over / Blind

Single

2

3

Married filing joint return (even if only one had income)

Enter

number

of boxes

checked →

Married filing separately. If spouse

is also filing give

spouse's social security number in designated space above

and enter full

name here

Exemptions

ба Yourself.

b Spouse

c First names of your dependent children who lived with.

you -

ELISA

THOMAS

2

4.0

Unmarried Head of Household (See instructions on page 5)

Enter

number

2

d Number of other dependents (from line 27)

5

Widow(er) with dependent child (Year spouse died • 19

7

Total exemptions claimed

8

Presidential Election

Do you wish to designate $1 of your taxes for this fund?.

Yes

No

Campaign Fund.

If joint return, does your spouse wish to designate $1?

Yes

Noxies" You check the

box(es).

will

"Yog"'

increase

your tax or reduce your refund.

W-2 here

Forms

Copy

attach

Please

Please attach Check or Money Order here

(Attach Forms W-2.

If unavail.

9

Wages, salaries, tips, and other employee compensation

able, see instructions on page 3.)

9

10a Dividends (on

See instructions

pages 6 and 13 s.

136

Income

, 10b Less exclusion

$.

136

Balance

10c

-о -

(If gross dividends and other distributions are over $400, list in Part / of Schedule B.)

11 Interest income.

[i svet s400s e, tet tot and ist in patil or Schedule B].

12 Income other than wages, dividends, and interest (from line 38)

13 Total (add lines 9, 10c, 11, and 12) . :

14

Adjustments to income (such as "sick pay," moving expenses, etc. from line 43)

15

Subtract line 14 from line 13 (adjusted gross income)

11

12

13

14

15

19339

8934

• 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.

• CAUTION. It you have unearned income and can be claimed as a dependent on your parent's return, check here » • and see instructions on page 7.

16

Tax, check if from:

Tax Tables

1-12

Tax Rate Schedule X, Y, or Z

Schedule D

Schedule GOR

Form 4726

48

Tax, Payments and Credits

17

Total credits (from line 54).

18 • Income tax (subtract line 17 from line 16)

19

Other taxes (from line 61) .

20

Total (add lines 18 and 19)

285

28

21a Total Federal income tax withheld (attach Forms

W-2 or W-2P to front)

b 1974 estimated tax payments (include amount

allowed as credit from 1973 return) .

21a

b

c Amount paid with Form 4868, Application for Automatic

Extension of Time to File U.S. Individual Income Tax Return

d Other payments (from line 65) .

d

22

Total (add lines 21a, b, c, and d)

16

•17

18

19

20

Pay amount on line 23

in full with this return.

Write

social

security

number on. check

or

money order and make

payable

to

Internal

Revenue Service.

22

Due

Balance

or Refund

23

If line 20 is larger than line 22, enter BALANCE DUE IRS •

..

23

785

(Check here%

: . if Form 2210, Form 2210F, or statement is attached. See instructions on page 7).

24

If line 22 is larger than line 20, enter amount OVERPAID

24

25

Amount of line 24 to be REFUNDED TO YOU

25

26

Amount of line 24 to be cred

/////,

vie Vatell

ited on 1975 estimated tax.

26

25),

make

entry

Under penalties of perjury, l declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and-beliet

it is true, correct, and complete.

Declaration of preparer (other than taxpayer) is based on all information of which he has any knowledge.

Sign

here

Your signature

Date

Spouse's signa

ust sign even if only one had Income

Preparer's signature (other than taxpayer)

Date

367-34-8229

Address (and ZIP, Code) 1a

Preparer's Emp. Ident. or Soc. Sec. No.

10-83224-1

13717 VANOWEN STREET

NAN NUYS, CA. 91403

367-34-8729

NW 88326 Docld:32245535 Page 53

---

## Page 54

Form

1040 (1974)

(a) NAME

(b) Relationship

Other

Dependents

(c) Months lived in your

home.

If

born

died

during year, write B or D.

(d)

Did

de-

pendent

have

income

of

$750 or more?

(e)

Amount

YOU

furnished for

pendent's

de-

port.

if

sup

100%

write ALL.

$

Page 2

(f)

Amount

fur.

nished by OTHERS

including

ent.

dependi

27 Total number of dependents listed in column (a). Enter here and on line 6d

Part !

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. (attach Schedule E)

32 Farm income or (loss) (attach Schedule F)

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)

5 State income to refunds (soard pelicion roanstantin ee

deduction-others

36 Alimony received

37 Other (state nature and source— see instructions on page 8) »

28

29

30

31

32

33

34

35

36

1100

493%

38 Total (add lines 28, 29, 30, 31, 32, 33, 34, 35, 36, and 37). Enter here and on line 12

.

37

38

8934.

* Part Il

• 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.)

40 Moving expense (attach Form 3903)

41 Employec business expense (attach Forin 2106 or staternent)

42 Payments as a self-employed person to a retirement plan, etc.— see instructions on page 9

43 Total adjustments (add lines 39, 40, 41, and 42). Enter here and on line 14

Part III: Tax Computation (Do not use this part if you use Tax Tables 1-12 to find your tax.)

44 Adjusted gross income (from line 15)

39

40

41

42

43

44

45 (a) If you itemize deductions, check here & [ and enter total from Schedule A, line 41

and attach Schedule A

45

8937e

5590

(b) If you do not itemize deductions, check here & and enter 15% of line 44, but do

NOT enter more than $2,000. ($1,000 if line 3 checked) .

46 Subtract line 45 from line 44 .

46

47 Multiply total number of exemptions claimed on line 7, by $750

47

334.

3:

48 Taxable income. Subtract line 47 from line 46 .

48

344.

(Figure your tax on the amount on line 48 by using Tax Rate Schedule X, Y, or Z, or if applicable, the alternative

tax from Schedule D, income averaging from Schedule G, or maximum tax from Form 4726.) Enter tax on line 16.

Part IV

Credits

49 Retirement income credit (attach Schedule R) .

50 Investment credit (attach Form 3468) . .

51. Foreign tax credit (attach Form 1116) . .

52 Credit for contributions to candidates for public office see instructions on page 9

53 Work Incentive (WIN) credit (attach Form 4874)

54 Total credits (add lines 49, 50, 51, 52, and 53). Enter here and on line 17

49

50

51

52

53

54

48

Y8%

Part.V

÷ Other Taxes

55 Self-employment tax (attach Schedule SE) C

+1.891

.1.90

56 Tax from recomputing prior-year investment credit (attach Form 4255)

57 Tax from recomputing prior-year Work Incentive (WIN) credit (attach schedule)

58 Minimum tax. Check here # [J, if Form 4625 is attached

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

55

56

57

58

59

60

61

285

& Part Via

Other Payments

785.

62 Excess MICA 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) .

65 Total (add lines 62, 63, and 64). Enter here and on line 21d

62

63

64

65

Foreign

Accounts

Did you, at any time during the taxabie 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 U.S. financial institution)?

| Yes D No

If "Yes," attach Form 4683. (For definitions, see Form 4683.)

# U.S. GOVERNMENT PRINTING OFFICE: 1974-0-548-047

16-83229-1

NW 88326 Docld:32245535 Page 54

---

## Page 55

Schedules A&B-Itemized Deductions AND

(Form 1040)

Department of the Treasury

Internal Revenue Service

Name(s) as shown on Form '104

SAMUEL

Dividend and Interest Income

Attach to Form 1040.

• See Instructions for Schedules A and B (Form 1040).

XLLIS

RuBy

Schedule A-Itemized Deductions (Schedule B on back)

1974

Your social security number

322:122992

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

4 Subtract line 3 from line 2. Enter dif.

ference (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.

b Hospitals

c Other (Itemize—include hearing aids,

dentures, eyeglasses, transportation,

etc.)

Contributions (See instructions on page 11 for examples.)

21 a Cash contributions

for

which you

have receipts, cancelled checks,. etc.

b Other

cash

contributions.

List

donees and amounts. →

ScH

7 Total (add lines 4, 5, 6a, D, 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 on line 35

Taxes (See instructions on page 10.)

11 State and local 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) »

1386

ScH

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

Casualty or Theft Loss(es) (See instructions on page 12.)

Note: If you had more than one loss, omit lines 25 through

28 and see instructions on page 12 for guidance.

25 Loss before insurance reimbursement.

26

27

Insurance reimbursement

Subtract line 26 from line 25.

difference (if less

than

zero,

Enter

enter

zero) .

28 Enter

$100

or

amount on line 27,

whichever is smaller

29 Casualty or theft loss (subtract line 28

from line 27). Enter here and on line 39

Miscellaneous Deductions (See instructions on page 12.)

30 Alimony paid

31 Union dues .

32 Expenses for child and dependent care

services (attach Form 2441)

33 Other (Itemize) ».

ScH

17 Total (add lines 11, 12, 13, 14, 15, and

16). Enter here and on line 36

Interest Expense (See instructions on page

10,62

1l.)

18 Home mortgage.

19 Other (Itemize)

SCH

20 Total (add lines 18 and 19). Enter here

and on line 37

2992

34 Total (add lines 30, 31, 32, and 33).

Enter here and on line 40 .

Summary of Itemized Deductions

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

1386

1062

2992

150

41

, Total deductions (add lines 35, 36, 37,

38, 39, and 40).

Enter here

and

on

Form 1040, line 45

5590

10-83231-1

NW 88326 Docld:32245535 Page 55

---

## Page 56

40)

of the Treasury

Revenue Service

Profit or (Loss) From Business or Profession

(Sole Proprietorship)

Partnerships, Joint Ventures, etc., Must File Form 1065.

Attach to Form 1040.

See Instructions for Schedule C (Form 1040)

1974

Name(s) as shown on Form 104

Social security number

A Principal business activity (see Schedule C Instructions) ..

LPHYLLL SERVICE

322122992

SNA

B Business name m.

VOODLEY DISTRO COFFEESHO Employer identification number

5-2657578

• Business address (number and stret) = 16OSSUENTHRABLUD

City, State and ZIP code •..

91316

C

E Indicate method of accounting:

(1) [ Cash (2) A Accrual (3)

Other

Yes

No

F Were you required to file Form W-3, or Form 1096 for 1974? (See Schedule C Instructions.) •

If "Yes," where filed »

G Was an Employer's Quarterly Federal Tax Return, Form 94L fled for this business for any quarter in 19742

H Method of inventory valuation a

Was there any substantial change in

the manner of delermining quantities, costs, or valuations between the opening and closing inventories? (If "Yes," attach explanation)

1 Gross receipts or sales $

Less: returns and allowances $ ......

: Balance →

2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8) •

3 Gross profit

4 Other income (attach schedule)

5

Total income (add lines 3 and 4)

6 Depreciation (explain in Schedule C-3)

7 Taxes on business and business property (explain in Schedule C-?) •

8 Rent on business property

9 Repairs (explain in Schedule C-2)

10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself)

11 Insurance

12 Legal and professional fees :

13 Commissions

14 Amortization (attach statement)

15 (a) Pension and profit-sharing plans (see Schedule C instructions)

(b) Employee benefit programs (see Schedule C Instructions) .

Deductions

16 Interest on business indebtedness

17 Bad debts arising from sales or services

18 Depletion.

19

Other business expenses (specify):

(a)

(b)

(c)

(d)

(e)

(g)

(h)

(i)

(N) 2400

7534

(k) Total other business expenses (add lines 19(a) through 190

20 Total deductions (add lines 6 through 19) :

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)

9934.

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)

2 Purchases $

Less: cost of items withdrawn for personal use $

Balance →

3 Cost of labor (do not include salary paid to yourself)

4 Materials and supplies

5 Other costs (attach schedule)

6 Total of lines 1 through 5 .

7 Less: Inventory at end of year

8 Cost of goods sold and/or operations. Enter here and on line 2 above

NW 88326 Docld:32245535 Page 56

---

## Page 57

Schedule C (Form 1040) 1974

SCHEDULE C-2.—Explanation of Lines 7 and 9

Line No.

Explanation

Amount

$

Line No.

Explanation

Page

Amount.

2

$

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 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)-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.

Check box if you made an election this taxable year to use

a. Group and guideline class

or description of property

b. Date

acquired

Class Life (ADR) System and/or

d. Depreciation

Cost or

other basis

allowed or allowable

in prior years

Guideline Class Life System.

c. Method of

computing.

depreciation

f. Life or

rate

g. Depreciation for

this year

223

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

2 Depreciation from Form 4832 • ( Sce Note)

3 Depreciation from Form 5006

4 Other depreciation:

Buildings.

Furniture and fixtures

Transportation equipment

Machinery and other equipment

Other (specify) ..

SCH

1339

5 Totals

6 Less amount of depreciation claimed in Schedule C-1, page 1

7 Balance-Enter here and on page 1, line 6

1339

SCHEDULE C-4.-Expense Account Information (See

Enter information with regard to yourself and your five highest paid

Schedule C Instructions for Schedule C-4)

Expense account

Name

Salaries and Wages

employees. In determining the five highest paid employees, expense

account allowances must be added to their salaries and wages. How-

Owner

1

ever, the information need not be submitted for any employee for

whom the combined amount is less than $25,000, or for yourself if

your expense account allowance plus line 21, page 1, is less than

$25,000.

3

4

Did you claim a deduction for expenses connected with:

(1) Entertainment facility (boat, resort, ranch, etc.)?

• 0 Yes'

• No (3)

Employees' families at conventions or meetings?

(2) Living accommodations (except employees on business)? [J Yes

3 No (4) Employee or family vacations not reported on Form W-2? • Yes S

I U.S. GOVERNMENT PRINTING OFFICE : 1974-0-548-050

• Yes

16-83228-1

/ 88326 - Docld:32245535 Page 57

---

## Page 58

SCHEDULE D

(Form 1040)

Department of the Treasury

Internal Revenue Service

Name(s) as shou

SAM.

Part 1

Capital Gains and Losses

(Examples of property to be reported on

this Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but

not losses) on personal assets such as a home or jewelry.)

Attach to Form 1040.

See Instructions for Schedule D (Form. 1040).

1974

on

erm 1040

MYLLIS RuBY

Short-term Capital Gains and Losses-

-Assets Held Not More Than 6 Months

Social security number

322/12. 7997

D

a. Kind of property and description

(Example, 100 shares of

Co.)

acquired

(Mo., day, yr.)

c. Date

sold

(Mo., day, yr.)

d. Gross sales price

8. Cost or other basis,

as adjustod (see

instruction D) and

expense of sale

f. Gain or (loss)

d less e)

LOAN TO SUMMITEAGLE CORPORATION 1002

2:

3

4(a)

(b)

5

Enter your share of net short term gain or (loss) from partnerships and fiduciaries

Enter net gain or (loss), combine lines 1 and 2

Short-tern capital loss component carryover from years beginning before 1970 (see Instruction G)

Short term capital loss carryover attributable to years beginning after 1969 (see Instruction G)

Net short term gain or (loss), combine lines 3, 4(a) and (b)

Long-term Capital Gains and Losses—

—Assets Held More Than 6 Months

CHIEFTAIN DEXEL

653

HIEFTAIN DEXE

TESORO

512/22

628

1622

100 UNITRODE

358

10% BC.

212/23.

9/73/24

1055-

2

3

4(a)

(b)

5

1382

1382.

L8Y2-

1532

3062

1000

7241

229

204

122S

4124

2007

3

7

Capital gain distributions

8

Enter gain, if applicable, from Form 4797, line 4(a) (1) (see Instruction A)

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) .

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 G)

(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 (b)

Part Ill

Summary of Parts I and 1l

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—

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.

(b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29

16

If line 14 shows a loss—

• If losses are shown on BOTH lines 12(a) and 13, omit lines 16(a) and (b) and go to Part IV.

(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) It amount on line 13 is zero or a net gain, enter amount on line 14; or,

If amounts on line 5 and line 13 are net losses, enter amount on line 5 added to

50% of amount on line 13 .

(b) Enter here and enter as a (loss) on Form 1040, line 29, the smallest of:

(i) The amount on line 16(a);

$1,000 ($500 if married and filing a separate return-if a loss is shown on line

4(a) or 12(a), see instruction L. for a higher limit not to exceed $1,000); or,

(iji) Taxable income, as adjusted (see Instruction K)

8

9

15839

12(a)

(b)

13322

13

19161

14

121901

15(a)

(b)

10.:

16(a

-18983

(6) <1000

16-R3232-1

NW 88326 Docld:32245535 Page 58

---

## Page 59

SCHEDULE SE

Computation of Social Security Self-Employment Tax

(Form 1040)

• tach self-employed person must file a Schedule SE.

1974

Department of the Treasury

Internal Revenue Service

• Attach to Form 1040. • 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.

• 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.

MAME OF SELF EMPLOVER PERSON AS SHOWN ON SOCAL SECURITY CARDS

Social security number of

PHYLLIS

self-employed person

349:18:1420

Business activities subject to self-employment tax (grocery store, restaurant, farm, etc.) → SWACK.

• If you have only farm income complete Parts I and III.

If you have only nonfarm income complete Parts Il and Ill.

• If you have both tarn and nonfarm income complete Parts

1. 11, and III.

Par

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).

1 Net profit or (loss) from:

( (b) Farm partnerships

2 Net earnings from farm self-employment (add lines 1(a) and (b))

FARM OPTIONAL METHOD I

3 If gross profits

(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

'Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 (accrual

method), plus the distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line

15) as explained in instructions for Schedule SE.

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

(a) Schedule C, iine 21. (Enter combined amount if more than one business.)

2Y00

(b) Partnerships, joint ventures, etc. (other than farming)

REGULAR METHOD

5 Net profit or

(loss) from:

(c) Service as a minister, member of a religious order, or a Christian Science prac-

titioner. (Include rental value of parsonage or rental allowance furnished.) If

you filed Form 4361, check here [ and enter zero on this line .

(d) Service with a foreign government or international organization .

(e) Other structions for line 37.) Specify

6 Total (add lines 5(a), (b), (c), (d), and (e)) .

2Y00

7 Enter adjustments if any (attach statement)

8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7) .

If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9

2Y00

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: 1971, 1972, and 1973. The nonfarm optional method can

SE

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. Aiso, 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)

$1,600

00

(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)) . .

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

Part 1l1

Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): (a) From farming (from line 4)

(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 form.)

14 The largest amount of combined wages and self-employment earnings subject to social security tax for 1974 is

2400

2Y00

$13,200

00

15 (a) Total "FICA" wages as indicated on Forms W-2

(b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9

(c) Total of lines 15(a) and (b) .

16 Balance (subtract line 15(c) from line 14)

17 Self-employment income-line 13 or 16, whichever is smaller

18 lf line 17 is $13,200, enter $1,042.80; if less, multiply the amount on line 17 by .079

13200

2Y00

190

19 Railroad employee's and railroad employee representative's adjustment from Form 4469, line 10

20 Self-employment tax (subtract line 19 trom line 18). Enter here and on Form 1040, line 55

17U

# U.S. GOVERNMENT PRINTING OFFICE : 1974-0-548-055

18-83234-1

NW 88326 Docld:32245535 Page 59

---

## Page 60

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

Internal Revenue Service

Attach to Form 1040.

• 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.

• 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

OF SELF-EMPLOYED PERSON (AS SHOWN ON SOCIAL SECURITY CARD)

SAMUEL!

• 4. 84

self-employed person * 322122992

Business activities subject to self-employment tax (grocery store, restaurant, farm, etc.)

SNACK

BAR

If you have only farm income complete Parts I and III.

• if you have both farm and nonfarm income complete Parts I. Il, and III.

• If you have only nonfarm income .complete Parts I1 and III.

Part

Computation of Net Earnings from FARM Self-Employment

I farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method

ine 2, if his gross profits are: (1) $2,400 or less, or (2) niore than $2,400 and net profits are less than $1,600. However, lines i and

2 must be completed even if you elect to use the FARM OPTIONAL 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))

/ (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

' Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 (accrual

method), plus the distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line

15) as explained in instructions for Schedule SE.

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method

Part ::

Computation of Net Earnings from NONFARM Self-Employment

(a) Schedule C, iine 21. (Enter combined amount if more than one business.)

753Y

(b) Partnerships, joint ventures, etc. (other than farming)

REGULAR METHOD

5 Net profit or

(loss) from:

Service as a minister, member of a religious order, or a Christian Science prac-

you the told end sled one or re sane f

titioner. (Include rental value of parsonage or rental allowance furnished.) If

(d) Service with a foreign government or international organization

(e) Other structions for line 37.) Specify

6 Total (add lines 5(a), (b), (c), (d), and (e)) .

153%

7 Enter adjustments if any (attach statement)

8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7)

SS8Y

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 1II.

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

SE

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

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))

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)

(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 form.)

14 The largest amount of combined wages and self-employment earnings subject to social security tax for 1974 is

15 (a) Total "FICA" wages as indicated on Forms W-2

(b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9 :

(c) Total of lines 15(a) and (b)

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 17 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

# U.S. GOVERNMENT PRINTING OFFICE : 1974-0-548-055

$1,600

00

7534

2534

$13,200

00

13200

TaBY

595

595

18-H3234-1

NW 88326 Docld:32245535. Page 60

---

## Page 61

3468

Department of the Treasury

Internal Revonue Servico

Name

Computation of Investment Credit

• Attach to your tax return.

1974

SAMUEL

1 PHYLLIS

RuBy

Identifying number as shown on

pago 1 of your tax return

1 Qualified Investment In new and used property. (See Instructions C ana

322-12-7997

D for eligible property.)

NOTE: Include your share of investment in property made by à partnership, estate, trust, small business corporation, or lessor.

Type of

property

Line

(1)

(2)

Life years

Cost or

(3)

basis

(See Instruction G)

Applicable

percentage

(0)

(4)

quallfied Investment

(Column 2 x column 3)

3 or more but less than 5

33⅓

New

Property

(b)

5 or more but less than 7

66⅔

(c)

•7 or more

100

(d)

3 or more but less than 5

Used

Property

(See Instructions for

dollar limitation)

33⅓

(0)

5 or more but less than 7

66⅔

(1)

7 or more

10228

100

2 Total qualified investment-Add lines l(a) through 1(f) .

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 and 4 .

6

(a)

Limitation

(b)

Individuals-Enter amount from line 16, page 1, Form 1040

(c)

Estates and trusts—-Enter amount from line 24 or 25, page 1, Form 1041 .

Corporations-Enter amount from line 5, Schedule J, Form 1120 .

7 Less: (a) Foreign tax credit

(b) Retirement income credit (individuals only)

(c) Tax on lump-sum distributions. (See instruction 7.)

8 Total-Add lines 7(a), (b), and, (c)

..

10 (a) Enter amount on line 9 or $25,000, whichever is lesser. (Married persons filing separately, con-

trolled corporate groups, estates, and trusts, see instruction for line 10.)

(b) If line 9.exceeds line 10(a), enter 50% of the excess

10228

10278

216

716

Y8

48

11 Total-Add lines 10(a) and (b)

12 Investment credit-Amount from line 5 or line 11, whichever is lesser (enter here and on line 50,

-48

Form 1040; line 6(b), Schedule J, Form 1120; or the appropriate line on other returns)

Schedule A

48

If any part of your investment in line l above was made by a partnership, estate, trust, small business corporation, or lessor, complete the following:

Name

(Partnership, estate, trust, etc.)

Address

Property

New

Used

Life years

$

$

If property is disposed of prior to the life years used in computing the investment credit, see instruction E.

1033238-1

NW 88326. .Docld:32245535 Page 61

Form

3468

(19

---

## Page 62

Form

4798

Capital Loss Carryover

(From 1973 to 1974)

Departmant of the Treasury

Attach to Form 1040.

1974

Internal Revenue Service

Name(s) as shown on Form 1040

SAMUEL

122 PHyLLIs RuBy

Social

Socurity Number

1322: 12:8992

A. Who Should File.-You will need to complete

B. How to Compute Carryover.—If you have a capi-

either Part 1 or Part Il of this form if you have a capital

tal loss carryover, complete either Part I or Part Il of

this form, but do not complete both.

loss to carry over to 1974.

1. Complete only Part I 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

amount on your 1973 Schedule D (Form 1040), line

16(a), or line 33, is LARGER THAN the loss deduct.

ed on your 1973 Form 1040, line 29.

LOSS.

2. Complete only Part Il if either (or both) line

4(a) or line 12(a) on your 1973 Schedule. D (Form

1040) shows a loss.

PartU

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 and 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

.....

1(2741)

2

3 Reduce any loss on line 1 to the extent of any gain on line 2

3

4 Enter amount shown on your 1973 Form 1040, line 29

5 Enter smaller of line 3 or 4

5

..••

6 Excess of amount on line 3 over amount on line 5

6

(2241)

1000

1000

(1741)

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) . .

8 Enter loss from your 1973 Schedule D (Form 1040), line 13; if none, enter zero and ignore lines

9 through 12

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.

7

-0

8

9

10 Reduce any loss on line 8 to the extent of any gain on line 9

10

11 Multiply amount on line 7 by 2

11

12

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 88326 Docld:32245535 Page 62

---

## Page 63

Form 4798 (1974)

& Part I

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 go to line 21

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 loss on line 1 to the extent of any gain on line 2

Note: If line 4(a) on your 1973 Schedule D (Form 1040) is blank, IGNORE lines 4 through 11, enter

a zero on line 12- then go to line 13.

4 Combine lines 3 and 11 on your 1973 Schedule D (Form 1040). Enter

the gain; or if zero or a loss, enter a zero

4

Note: If line 4 is zero IGNORE lines 5 through 11, enter on line 12. the

loss from your 1973 Schedule D (Form 1040), line 4(a)- then go

5 Enter any gain from your 1973 Schedule D (Form 1040), line 3

6 Enter smaller of line 4 or 5

5

6

7

7 Enter excess of gain on line 4 over line 6

8 Enter loss from your 1973 Schedule D (Form 1040), line 12(a); other-

wise, enter a zero

8

9

9 Reduce any gain on line 7 to the extent of any loss on line 8

10 Enter loss from your 1973 Schedule D (Form 1040), line 4(a); other-

wise enter a zero

10

11

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 line 13)

Section B. Computation

of Capital Loss Carryovers to 1974

15

15 Enter any loss from line 13, above

16 Enter loss deducted on your 1973 Form 1040, line 29

16

17 Loss carryover to 1974 (excess of line 15 over line 16— if line 15 does not exceed line 16, enter

zero). Enter here and on your 1974 Schedule D (Form 1040), line 4(a)

18 Enter any loss from line 14, above

18

19 Enter excess of line 16 over line 15- if line 16 does not exceed line 15,

enter zero .

19

20 Loss carryover to 1974 (excess of line 18 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)

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

22 Enter excess of line 19 over line 18-if line 19 does not exceed line

2(13322

18, enter zero. (Note: If you ignored lines 2 through 20 above, enter

amount from your 1973 Form 1040, line 29.) •

22

23 Loss carryover to 1974 (excess of line 21 over line 22—if line 21 does not exceed line 22, enter

zero). Enter here and on 1974 Schedule D (Form 1040), line 12(a)

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), line 13

24

25 Enter excess of line 22 over line 21

.. x 2 (If line. 22 does not

exceed line 21, enter zero.)

25

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)

# US. GOVERNMENT PRINTING OFFICE: 1974-0-548-157.

52-0781521

NW 88326 Docld:32245535 Page 63

1

2

12

13

14

17

20

23

26

Page

2

13322)

---

## Page 64

NAME.

ADDRESS

322-12-7997

soC.

SEC. NO.

CALENDAR YEAR 19 ? Y

FISCAL YEAR

ENDING

19

PRINCIPAL

BUS INESS

BUSINESS

NAME

ACTIVITY

BUSINESS ADDRESS

TOTAL RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

LABOR

TOTAL

INVENTORY AT END OF YEAR

GROSS PROFIT

SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION

EMPLOYERS NO.

68084

36079

36822

35279

32805

32805

GROSS

INCOME

OTHER BUSINESS DEDUCTIONS

ADVERTISING

AUTO AND TRUCK EXPENSE

BAD DEBTS

INDOMI AT 159

CASH

SHORT

COMMISSIONS

DELIVERY

DEPRECIATION ( SCHEDULE ATTACHED )

DUES AND SUBSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR SERVICE

LAUNDRY

LEGAL

AND

ACCOUNTING

MAINTENANCE

JFFICE

SUPPLIES AND EXPENSE

RENT

REPAIRS

SALARIES AND WAGES

SALARIES OFFICERS

SUPPLIES

TAXES AND LICENSES

TAXES • PAYROLL

TELEPHONE

TRAVEL

UTILITIES

PARKING

NET PROFIT

OR (LOSS) • FEDERAL RETURN

NET PROFIT

OR

LOSS) • STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF.

PROFESSIONAL'":

STATIONERS

INC.

FORM 104

NW. 88326 D8cfd:32245535 Page 64

332

1800

1339

16

1844

47

7841

991

5912

1063

32

43

1784

(H) 7334

SCHEDULE

---

## Page 65

NW 88326

Docld:32245535

Page 65

NAME

ADDRESS

SAM & PHyLLS RUBY

322-12-7997

1.D.

NO.

OR

SOC

SEC. NO. -

CALENDAR: YEAR 19 ?Y.

FISCAL YEAR ENDING

19

SCHEDULE OF DEPRECIATION/

AMORTI ZATION

KIND OF PROPERTY

EQUIPMENT

GOOQWILL

COST OR

DATE

ACQUIRED

MO

YR

OTHER BASIS

4/174 10228

41/2435000

SPEC 20%

DEP

DEPRECIABLE

BASIS

DEP ALLOWED

PRIOR YEARS

RATE (%)

REMAINING

OR LIFE

METHOD

DEPRECIATION

FOR

THIS YEAR

10228-0-10228 SL. TYR 1339|

1339

TOTALS

PROFESSIONAL STATIONERS INC. LOS ANGELES, CALIF.

FORM NO 102A

SCHEDULE.

---

## Page 66

RESIDENT

* 540%

INDIVIDUAL

CALIFORNIA

INCOME TAX

TAXABLE YEAR

$19,74

PLACE PREADDRESSED.

LABEL HERE,

it

available.

(Correct name and address, if necessary)

Enter social security numbers) only it incorrect or not shown on label.

NAME (Unjoint return, give first

and initials of both)

AMUEL

PMYLLIS

PRESENT HOME ADDRESS (Number and str

i, including apartment number, or Tural route)

16250

IRCHE

Киву

CITY, TOWN OR POST OFFICE, STATE AND

, ZIP CODE

SRANADA

HILLS

For calendar year or

Taxable year ending-

197

Your Social Security Number

322

2997

Spouse's Social Security Number

34918

1420

Yours

OCCU-

PATION

FILING STATUS Check Only One:

EXEMPTION CREDITS

1 D Single

2 i Married filing joint return (even if only one had income)

3 [ Separate return of married person-Enter spouse's

social security number and full name here

( If line 1 or 3 checked, enter $25

1 If line 2. 4 or 5 checked, enter $50

7 Dependents - Do not list yourself, your spouse or the person who qualities you

as head of household. Enter name and relationship.

ELISA

THOMAS

605.0

4 C Head of Household-Enter name of qualifying

individual.

5 0 Widow(er) with dependent child (Year spouse died → 197_

Total Number »

Blind (refer to instructions) Number of blind exemptions a

Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

10 Wages, salaries, tips and other employee compensation

i return.

unavailable.

attach explanation.

W.2 to face of this ?

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

W-2

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 line 19

• It you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.

Deductions: Itemized (from line 61) OR Standard ($1,000 if line 1 or 3 checked-$2,000 if line 2, 4 or 5 checked)

Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule-Enter tax on line 19

- X $8

× $8

7

8

16

10

11

12

13

14

15

16

136

8934

1019

9020

17

18

19

Tax from (check one) Tax Table O

Tax Rate Schedule

Income Averaging Schedule (G or G-1) O

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(540) )

25

Total tax liability (add lines 23 and 24)

17

18

19

20

21

22

23

241

25

5468

360г

3

56.

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 1, 1974, complete Part 1 on page 2

28

1974 California estimated tax payments

29

Excess California SDI tax withheld (attach Form DE 1964 to face of this return)

30 Total prepayment credits (add lines 26 thru 29)

31

26

27

ATTACH FORM DE 1964 HERE

security number on check or money order.

32

Write social

SIGN

Your signature

HERE

Spouse's signature-if filing a joint return

NW 88326 Docld:32245535 Page 66

30

-0+

If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero.

Pay in full and mail with reture to:

FRANCHISE TAX BOARD

SACRAMENTO, CA 95887

If line 25. is smaller than line 30, enter amount OVERPAID

Mail return to:

FRANCHISE TAX BOARD

P.O. BOX 13-540

SACRAMENTO, CA 95813

Amount of line 32 to be REFUNDED. (Allow at least six weeks)

Amount of line 32 to be credited on your 1975 ESTIMATED TAX

PAY IN FULL —>

31

Do not write in these spaces

32

E

M

REFUND TO YOU -

33

34

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and

boliet it is true, corroct and complote. If prepared by a person other than taxpayer, his declaration is based on all information of which he has any knowlodge.

• Date

Date

Preparer's sionature

(other

than taxpayer)

Date

83717 VANOWEN STREET 362-31872

Address (and Zip code)

THAT HUYS, CA. 914pfeparer's FEIN (or SSA) Ni

1367-34-8729

---

## Page 67

Page 2 Form 540 (1974)

PART I - Renter's Credit — All questions must be answered

- 35

Did you, on March 1, 1974, live in rented property which was your principal residence?

35

Was the property you rented exempt from property tax?

37

Did you live with any other person who claimed you as a dependent for income tax purposes?

38

Did you or your spouse claim the homeowners' property tax exemption or receive public assistance?

1 Yes

Yes

Yes

Yes

See Instructions, Page 3, for Allowable Credit

No

No

No

No

If no, you may not claim this credit

If yes, you may not claim this credit

If yes, you may not claim this credit

If yes,

see page 3 of instructions

PART Il - 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 D(540))

41

Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540) )

42 Pensions and annuities

43

Rents and royalties

44 Partnerships

ATTACH

SCHEDULE E

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 E(540))

(b). Alimony

(c) Other (state nature and source)..

Enter total of lines 47(a), 47(b), and 47(c)

48 Total (add lines 39 thru 47). Enter here and on 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)

51 Employee business expenses (see instructions - attach statement)

52 Military exclusion (see instructions)

33

Payment as a self-employed person to a retirement plan, etc.

54 Total adjustments (add lines 49 thru 53). Enter here and on line 15

ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE

PART IV - Itemized Deductions - DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION.

• Attach Schedule A(540) and enter sub-totals on lines 55 thru 60, below

55

• Total deductible medical and dental expenses (from Schedule 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)

Total contributions (from Schedule A(540), line 29)

60 Total miscellaneous deductions (from Schedule A(540), line 40)

61 Total itemized deductions (add lines 55 thru 60). Enter here and on line 17

39

40

4]

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

9934

100a

8934

138.6

9Y.0

2992

150

5468

PART V - Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW

52 "Other State" net income tax credit (attach copy of other state return and Schedule S(540))

63 Retirement income credit (attach Schedule R(540))

62

63

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 widower) with dependent child) or $4,000 or

less (single or separate return of married person) enter the amount from line 21. If Adjusted. Gross Income includes Capital

Gains, complete Schedule B1. See Page 3 of Instructions

(b) Enter total here from line 4, Schedule B-1. If zero or a loss, enter zero

646|

64a

85

TOTAL (add lines 62 thru 64a. Enter here and on line 22

65

PART VI — Reconciliation to Federal Return — If adjusted gross income on Federal Return is different from line 16, page 1, explain below.

DIUE X136

NW 88326 Docld:32245535 Page 67

---

## Page 68

SCHEDULE

CALIFORNIA

FORM 540

ITEMIZED DEDUCTIONS

Attach to Form 540

Name as shown on Form 540

SAMUEL

1 PayLeis RuBy

Use only it you do not use the Tax Table or take the standard deduction.

Medical and dental expenses (not compensated by insurance

or otherwise) for

Interest Expense

medicine and drugs, doctors, dentists, nurses, hospi-

tal care, insurance premiums for medical care, etc.

22. Home mortgage .

1.

One half (but not

23.

Installment purchases

more than $150) of insurance

24. Other (itemize)

premiums for medical

care

2. Medicine and drugs

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)

5. Enter, balance of insurance

premiums for medical

care not entered on line 1

6.

Other medical and dental expenses:

(a) Doctors, dentists, nurses, etc.

(b) Hospitals .

(c) Other (itemize)

25.

SCH

Total (Add lines 22,

23 and 24. Enter here and

on Form 540, page 2, line 58)

Contributions

26. Cash contributions for which you have receipts, can-

celed

checks,

etc.

27.

Other cash contributions. List donees and amounts

TAXABLE

41974)

YEAR

Social Security Number

322/2.2992

2992

SCH

7. Total-(Add lines 4, 5, 6a, b, and c)

8. Enter

3% of adjusted

gross income shown on

Form 540

9. Subtract

line

18

from

line 7.

Enter

difference (if

line 8 is greater than line 7, enter zero)

10.

Total-(Add lines

1 and 9.

Enter here

and

on

Form 540, page 2, line 55)

Child Adoption Expense

11. Total expenses paid or incurred-Attach itemized

12. Enter 3% of adjusted gross income shown on Form

540

13. Subtract line

12 from line 11-See instructions

for maximum limitations. (Enter here and on Form

540, page 2, line 56)

Taxes

14. Real estate

15. State and local gasoline

16. General sales

17. Auto license-Excess of registration and weight fees

(see instructions)

18. Personal property

19. State disability insurance (SOl)-Employer private

disability plans do not quality

• 20. Other

SCH

21. Total taxes (Add lines 14 through 20. Enter her

and on Form 540, page 2, line 57

(Rov. 1974)

NW 88326

Docld:32245535 Page 68

1386

28.

ScH

Other than cash. - See instructions for required

statement

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 Losses)See Instructions

NOTE:

through you had more than.

one loss, omit lines 30

and follow instructions for guidance.

30. Loss before insurance reimbursement

31. Insurance reimbursement

32.

Subtract line 31 from line 30. Enter difference (if

line 31 is greater than line 30, enter zero)

33.

Enter $100 or amount on line 32, whichever is

smaller

34.

Casualty or theft loss (line 32 less line 33).

35.

Alimony paid

36.

Child care-See instructions

37.

Union dues

38.

Employment education expense-See instructions

39.

Other-See instructions (itemize)

150

9y0

40.

Total-Add lines 34, 35, 36, 37,

38 and 39. (Enter

here and on Form 540, page 2, line 60)

---

## Page 69

SCHEDULE

C

FORM 540

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Solo Propriotorships)

TAXABLE

1924

YEAR

Attach this schodule to your income tax return, form 3A0 or SAONR

Partnorships, joInt vontures, atc, must flo on Form S8S

Social Security Number

AM&

322122822

A. Principal business activity

SERVICE

SNACKBAR

(See Instructions for

B. Business name....

8. Bug a 20 SEE BISTER A GERRE e

sacco; services-legal; manufacturing-furniture; efc.)

Fod ral player identification number: 25-26515?8

91316

E. Indicate method of accounting:

• cash;

& accrual;

other

(21P code)

F. Were Forms 591, 592, 596 and 599, for the daf year filed it requirad)? A Yos

© No

C*

G. Method of inventory valuation »

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

• YES

NO.

If "Yes," attach explanation.

IMPORI

applicable lines and schedules must be Alled in.

1 Gross receipts or sales $

Less returns and allowances $

Balance D

2 Less: Cost of

goods sold (Schedule C-1, line 29) and/or operations (attach schedule) .

3 Gross profit

4

Other income

(attach schedule)

TOTAL income (add lines 3 and 4)

6 Depreciation (explain in Schedule C-3)

7 Taxes on business and business property (explain in Schedule C-2)

8 Rent on business property

9 Repairs (explain in Schedule C-2)

10 Salaries and wages not included

on line 24, Schedule C-I (exclude any paid to yourself)

11 Insurance

12 Legal and professional fees .

13 Commissions :

14 Amortization (attach statement)

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

Bad debts arising from sales or services

8

Depletion

19 Other business expenses (specify):

(a)...

(b).

(c).

(d)

(e).

(f)

(g).

(h)

Total other business expenses (add lines 19(a) through 19(g)) .

20

Total deductions (add lines 6 through 19)

scit

21 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR

9934

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 $

Less cost of items withdrawn for personal use $

24. Cost of labor (do not include salary paid to yourself)

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

NW 88926 Docld:32245535 Page 69

Balance P

---

## Page 70

Schedule C (Form 540) (Rev. 1974)

SCHEDULE C-2. Explanation of Lines 7 and 9

Line No.

Explanation

: Page 2

Amount

Line No.

Explanation

Amount

$

SCHEDULE C-3.

DEPRECIATION (See Schedule C Instructions for line 6).

NOTE: Depreciation may be computed by

using the Asset Guideline Classes specified in Federal Revenue Procedure 72-10, regardless of when assets were

placed in service. If this method is used, do NOT use the lower Limit or the Upper Limit (ADR) Ranges. Attach

detailed statement of depreciation computation.

a. Group and guldeline class

b. Date

or description of property

acquired

1.4011

other basis

d. Depreclation

allowed or allowable

in prior years

e. Method of

computing

depreciation

f. Life or

rate

g. Depreciation for

his year

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

2 Asset Guideline Class System

(See Note above)

3

Other depreciation

Buildings .

Furniture and fixtures

Transportation equipment.

Machinery and other equipment.

Other (specify) .

1339

4 Totals

5 Less: Amount of depreciation claimed elsewhere in Schedule C-1

6 Balance-Enter here and on page 1, line 6 .

1339

SCHEDULE C-4. Expense Account Information

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. However, the infor-

mation need not be submitted for any employee for

whom the combined amount is less than $10,000, or

for yourself if your expense account allowance plus

line 21, page 1 is less than $10,000.

Did you claim a deduction for expenses connected with:

(1) Entertainment galiy (boat, resort, ranch, etc.)?

• Yes

(2) Living accommodations (except employees on business)?

n Yes

NW 88926-Docid 2245535 Page-70-

(See Schedule C Instructions for Schedule C-4)

Name

Expense Account

Salaries and Wages

Owner

2

4

5

(3) Employees' families at conventions or meetings?

• Yes

* No

(4) Employee or family vacations not reported on Form W-2?

• Yes

K NO

---

## Page 71

SCHEDULE

D

FORM 540

CALIFORNIA

TAXABLE

31,97.42

CAPITAL GAINS AND LOSSES

YEAR

Attach to Form 540 or 540NR

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 540gr

AMUEL

PHYLLIs RuBy

Soclal Security Humber

322127997

D

PART I-Assets Held One Year or Less

a. Kind of property and description

(Example, 100 shares of "Z" Co.)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

price

e. Cost or

other

basis as

adjusted; cost of subse.

quent improvements

(if

not

purchased,

attach

explanation)

and

ex-

pense of sale

f. Gain or loss

(d. less .e.)

LOANTASUMMITEAGLE

1OO CHIEFTAINPEER

1/20/7=

CORPORATION

6/10/74

658

1382

1382

11000)

120

2223

2. Enter gain (or loss), if applicable, from line 18, Schodule 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

PART Il-Assets Held More Than One Year But Not More Than Five Years

2433)

5.

100 TESORO

100 UNIT RODE

1002 CA

PET

5/2202

115/02

1232

21614

21 97Y

13/9

1622

35.8

1053

2817

1532

13251

2357,

6. Enter gain (or loss), if applicable, from line 20, Schedule D-1 (540) (attach copy)

7. Enter your share of nét gain or loss from partnerships and fiduciaries

8. Net gain or loss, combine lines 5, 6 and 7

PART Ill-Assots Held More Than Five Years

9.

PT LOSS CARRYOVEK!

16063)

LESS/000 -

10. Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)

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

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 (attach computation)

E1273

(15063)

17. Combine the amounts shown on lines 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

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

(c) $1,000 ($500 in the case of a husband or wife filing a separate return)

NW 88326 Docld:32245535 Page 71

(4Y06)

20260)

(000)

---

## Page 72

NAME

ADDRESS

"SAMUEL

AlHyLLis RuBy

322-12-7997

CALENDAR YEAR 1 27.

SOC. SEC. NO.

"MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A.G.I. (Line 18 - 1040)

4 NET MED/DRUGS

5 H & A INS. (½ + EXCESS)

Ga DR.

DR.

DR.

DR

DR

DR.

DR.

DR.

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

6c AMBULANCE

LABORATORIES

TRAVEL FOR MED. 10210

MEDICARE INS.

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.

9

+:½ (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 STATE DIS. INS. H

W

SALES TAX AUTO

17 TOTAL TAXES

INTEREST (TO WHOM PAID)

18 MORTGAGE

•19 INSTALLMENT LOANS

MERRIL

SBA

STATE

1386

940

DEDUCTION SCHEDULE

FEDERAL

CONTRIBUTIONS

21 PARTNERSHIP SHARE

GIRL/BOY SCOUTS

HEART FUND/CANCER FUN

30Y

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

POLITICAL CON TRIBUTIONS

930

CHURCHES

STATE

FEDERAL

20

130Y

26.8

50

1396

24

7952

2543

26.3

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS.

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT LOSS(ES)

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT

27 Difference (not less than zero)

28 ($100 LIMITATION PER CAS.)

29 TOT. CAS. OR THEFT LOSS

MISCE LLANE OUS DEDUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Form 2441)

33 INCOME TAX PREPARATION

UNIFORMS/PROTEC. CLOTHING

SMALL TOOLS AND SUPPLIES

LAUNDRY AND CLEANING

Auto Use

Mi

INVEST. COUNSEL & PUBS.(Schedli

EMPLOYMENT AGENCY FEES

SAFE DEPOSIT BOX

TEL. REQ. IN BUSINESS

34 TOTAL MISC. DED.

SUMMARY OF ITEMIZED DED.

35 TOT

EDUCTIBLE MEDICAL & DENTA

XPENSES (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)

EDUC TIONS ( FROM LINE 34

150

STATE

150

FEDERAL

41 ENTER ON

REMARKS

1040 LINE 45

X 3468: 5590

20 TOTAL INTEREST

39924

12992

NW 880260Decld:32245665, Rage 7angeles, Calif. Form 101

---

## Page 73

3060560100 145736:7018788

NAME .

SAMUEL

CALENDAR YEAR .19

24.

ADDRESS

322-12-7997

SOC. SEC. NO. -

MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A.G.I. (Line 18 - 1040)

4 NET MED/DRUGS

5 H & A INS. (½ + EXCESS)

6a DR.

DR.

DR

DR.

DR.

DR.

DR.

DR.

STATE

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

6c AMBULANCE

LABORATORIES

TRAVEL FOR MED. 10V0

MEDICARE INS..

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED BY INS.

8 LESS 3% ADJ: GROSS INC.

9

1

+:½ (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 STATE DIS. INS. H

W

SALES TAX AUTO

1386

17 TOTAL TAXES

INTEREST (TO WHOM PAID)

18 MORTGAGE

N 940

19 INSTALLMENT LOANS

MERRILL LYNCH

TRANS NOBO

SIA

DEDUCTION SCHEDULE

FEDERAL

CONTRIBUTIONS

21 PARTNERSHIP SHARE

GIRL/BOY SCOUTS

SoY

HEART FUND/CANCER FUN

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

POLITICAL CONTRIBUTIONS

930

CHURCHES

20

1504

268

123

138b

TIE

727

•4.3

141

1952

2543

263

178.

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS.

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT LOSS(ES)

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE HEIMBURSEMENT

27 Difference (not less than zero)

28 ($100 LIMITATION PER CAS.)

29 TOT. CAS. OR THEFT LOSS

MISCELLANEOUS DEDUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Form 2441)

33 INCOME TAX PREPARATION

UNIFORMS/PROTEC. CLOTHING

SMALL TOOLS AND SUPPLIES

LAUNDRY AND CLEANING

Auto Us:

Mi

INVEST. COUNSEL & PUBS.(Schedl

EMPLOYMENT AGENCY FEES

SAFE DEPOSIT BOX

TEL. REQ. IN BUSINESS

34 TOTAL MISC. DED.

SUMMARY OF ITEMIZED DED.

35 т0

EDUCTIBLE MEDICAL & DENTA

XPENSES (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)

40 DE DỘC TONG THOM LINE 34)

STATE

150

150

STATE

11 TOTAL

ITEMIZED DEDUCTIONS

ENTER ON FORM 1040 LINE 4!

REMARKS

1 3468

20 TOTAL INTEREST

NW 88326 CD@elaT32245535. Page 79ngeles, Calif. Form 101

3992 2992

FEDERAL

750

FEDERAL

15590

---

## Page 74

NAME

ADDRESS

322-12-7997

sOC.

SEC. NO.

CALENDAR YEAR 19 2 Y

FISCAL: YEAR.END.ING

19

SCHEDULE OF PROFIT (OR LOSS )

FROM BUSINESS

OR

PROFESSION

PRINCIPAL BUSINESS ACTIVITY

BUSINESS NAME

BUSINESS ADDRESS

RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

LABOR

TOTAL

INVENTORY AT END OF YEAR

GROSS

PROFIT

EMPLOYERS NO.

36079

36039

68084

352-79

32805

37805

GROSS

INCOME

OTHER BUSINESS DEDUCTIONS

ADVERTISING

AUTO AND TRUCK EXPENSE

BAD DEBTS

1000 MI AT 15%

CASH

SHORT

COMMISSIONS

DELIVERY

DEPRECIATION ( SCHEDULE ATTACHED )

DUES

AND SUBSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR SERVICE

LAUNDRY

LEGAL

AND ACCOUNTING

MAINTENANCE

JFFICE

SUPPLIES AND EXPENSE

RENT

REPAIRS

SALARIES AND WAGES

SALARIES OFFICERS

SUPPLIES

TAXES AND LICENSES

TAXES

• PAYROLL

TELEPHONE

TRAVEL

UTILITIES

PARKING

NET PROFIT

OR ( LOSS ) • FEDERAL RETURN

NET PROFIT

LOSS) • STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF.

PROFESSIONAL STATIONERS INC.

FORM

NW 88326 Docid:32245535 Page 74

104

332

1800

1339

16

•/.

97

7841

991

5912

1063

38 R

32

45

# T83Y

2282

1929

SCHEDULE

---

## Page 75

NW 88326

Docld:32245535

Page 75

NAME - SAM & PHYLLS RUBY

ADDRESS

322-12-7997

• 1.D

NO.

OR

SoC.

SEC.

NO. -

CALENDAR YEAR 19

FISCAL YEAR ENGING

19

7Y.

SCHEDULE OF DEPRECIATION / AMORTIZATION. .

KIND OF PROPERTY

GOODWILL

COST OR

DATE

ACQUIRED

YR

OTHER BASIS

2/11410228

41/7435000

SPEC 20%

DEP

DEPRECI ABLE

BASIS

10228

DEP ALLOWED

PRIOR YEARS

REMAINING

COST

T0228

METHOD

SiL.

RATE (%)

OR LIFE

(YRS)

DEPRECIATION

FOR

THIS YEAR

TYR 133%

TOTALS

PROFESSIONAL STATIONERS INC.

LOS ANGELES, CALIF.

FORM NO

102A

SCHEDULE

1339

---

## Page 76

46:33

il.s

US

intornol Rovonuo Sorico

fadividest Income Tax Koturn

thosoulcune di 8-DocChol r 08, 1972, or othor Chaablo your bogianing ..

, 1972, onding ..

1972

Lost nomo

1i!

RUBY

Vour cosiol C

322

Tra sint

mi, incledling er cadr3 dendor, C3 resc) scuto)

Sestas

Carisocie

sity one:

349

VCSO

120 11320

soil toployod

To'o

Rogular / 65 or ovor / Elice Entor.

numeor

GI BONOD

chostica

fring k

riurn (ovon ifaely eno had incomo)

Tri% li wito (hucrand) is dico

Exemptions

6 Yourself

8 Wifo (husband) .

O First nomes of your dopandori childron who lod with

you Exsda BelaRa Ellen thomaR

2

Js mito

indone child (Cn " yoor of Cough

коС

9

Number of other dopondonts (fram ling 32)

20 Total exemptions claimed

(Attoch Form Wi-2 to front

,tro, dos, una caner cmployco componication. " unato, ulcal be ironion) •

di leiri

6C) 8.002000

.... &20 Loss onclusion &

70.00

Bulance . D

il rock" leondo und effica diatributioro cro ovor $200, Hot in Port I of Schudule B.)

19 9220 or leus, enter tobal withoud listing in Schodule &™

fore aly Los over (503, onter &etel and lot in Port Il of Schodulo B.

cio pu orchen wagci, Gridonds, and intorost (from line 45).

7: 3 21, 126, 18 n0C 84) 01 0

fectroce

, do iseomo frica ca "diel Foga" moving orponsos, etc. from lino 50) .

from lica 86 (edjuctca (cus dacomo) •

tricorock

U li you do nol lomize doductions

MOUr liV

j Koura,

ond lino 8% Is under $80,000,

*: 910): g

wad isa in visico ond ontor on

Cit.

C'10 23

82G

22

13

00.

15

5,904

3, 9002

40

10

17

5,900 29)

0 18 y011

itomizo

doduct! ing et

icl:

200.

Tos Roto Schoculo X, Y, or &

Schcoule & /or

Form 4726

To ad ess,

tirom lino 62) :

ermo er fesosraci lino 19 (rom lino 18). .

cor Caty

:; (from lino

G7)

16:106

.:3'20 and 28)

Tecd For

! Incomo san withhold (asicen Forms W-2

7-2p () nont) .

30i? ecili. i dai peyments (include emount allowed

MOraCk wom 1971 roturn).

nel Gok la Form 4868, fpplication for fiutomatic Extension

so ilno do fi: 4.8. Indviduat fotomo Tax Return.

il 6 EudoRo (from lino 78) .

JL (C2 Mis 23, 24, 25, and 20)

80

29

20

21

23

0

588

52

70

23

24

25

26

zil

Poy la full vies rotum. Cloto

ino 22 ieasr.3r Cian lino 27, enter BALANCE DUE IRS

chock or monoy order gayoblo

co Inteznal tomauo Scrues

D

₴3

52270

Wl1088 l trje 3hon lino 22, enter omouns OVERPAID

D

20

20

553.1

Sigo

voro

2200

sys, c3li dm during do tonable yoor, hove any intorest in or signature er othor authority

i (.r

cirillos, er stor financloi account in a foroign country (oncept in a U.s.

AJ by o U.S. Anoncial instilution)?

1 80, 13 Nº

co. 38 Frin 4003. (lor definitions, dee Form 4683.)

Do dura do crimplate Rovenue Sharing (lines 33 and 34) on next page.

an: 1100 di corazy, 1 de duro thet 1 lovo cromined illo rodura, including eccomponying schodulos end ctoromonto, and lo tho bost of my knericico and bollo

no dros, erroca, chi euplot. Doctoration of gruparer (uther Phon tospoyer le bouch en al

information of thich he hos ony lincisledgo.

Your neandoro

Dato

EDWARD

vin SERT

CONSULTANT

Doto

17835 VENTURA BLVD., SUITE 106

Wite'o (husband's) signature (if tiline jointly, BötH nust sign ovon i only one had income)

TEL. (213) 881-7350

S.5. 568.40.9521

NW 88326 Docld:32245535 Page 76

---

## Page 77

Pogo

Forra 2050 (1072)

(O) NAR,!

(0) Rolasianohip

(c) Mentho livod In your

hoiro.

18 born

or

during yoor, writo

diod

Of

D.

(d)

Did

do-

pendont hovo

COme

$750 or moro?

0) Amount

YOU

furnished

for

de-

ondoni!

support.

• 100% trito AL

OTHERS

includ-

ing dopendont

$

it:

1300

1':

To Reil

condones heral column (a). Enter horo ond on lina 9

lad on da your pii.:

(1). County

catca ito nomo: I nol, chest hero D

1 2202800

1,00

867 persons ineteded on lina 10

of thsir own; or. (2)

sacipal picca of residonco

l':

11 C.

C.."

la Were

6.269

13,000

00

1003010 de: 50 Mom Unpolomontal Colcdulo of Bolno Oud Loscos (asoch Form 4797)

2) Pedal nd Car Canuideo, ront and royofües, pornorchipo, astores or trusts, arc. (attach Schodula E)

Eo Form tussure for locol Baltoeh Schodulo f)

6) Folly Canadio i

bions and annuities (nes roporica on Eshodulo E-coo Instructions on page 8) .

39 50% d8 euptol galn atanbutions (nos ropanca ea Eelcaulo D) .

13, 22a80 decamo ratune, repulton sea instructions en page 0) .

5,969

Tered tres 35 Barounh 44). Enter Boro and on Mino 84

: ) 60.

dashed

•is Ausco cottosh form 2640 or oshor roguirca slatemont) .

o lord 3009)

C3

20

"JU!

1.15.

33 Li

Meet Loreen 6on BoarOone: 130, 08S. (000 Form 4840)

1pA3, 48. 13mud 39). Put 2 boo cod en lino 80

joe.

Sit

Eljusic

so incom (suern lino 87)..

Sis:

i, ontor doint frem Schcaula A, line 40 and attach Schedulo A

30.4

ductions, ontor 15% of lino 51, but do NOT enter mora

881,6.00 to 3 is chosica)

58

52

3. 992 40

4, 423

00

53

51 Baidiang deed numbér cit onomptions cloimod on lina 10, by $750 .

55

8, 568

3, 250

(3,681

40

00

60)

¿Photo lodenao, Subtrues lino 54 from lino 53 .

diger vecr ton on tin omount on line 55 by using Tan Rote Schedulo X, Y or Z, or if applicable, the alternative taz from Sched-

scio cloragity from Schedulu G, or maximum tax from Form 4726.) Enter tor on ling 18.

..

t's fock

Li

"uds

i Racid lines 015, 57, 58, 59, ond 60). Entor horo and on lino 89

D

Pilss Vo.

Mis Tere

0a colder. pen..und 8an (rSu.ch Schedulo SP.) .

Ag Can from rocomputing prior-year investmond credit (cütch Form 4255) .

Ca Diniran con gera inotarctiono on pogo 80). Chock hero DJ. l8 Form 4625 is attached

C3 socina scurly dan en tip income nos rogeriod to omployor (attach Form 4137) .

3 placelicated cimployco« betul sucurity ton en tips (from Forms W-2) .

7 luer dues Moos 62, 68, CA, 65, and 66). Emor hero cui cn lino 21

D

did l me bet so?

C'3 LACOso UleAson Mihacia 8u0 er moro aployors aco instructions on page 10)

Ca Crodid for recorul don od opock. Ruold, nontghway gecoline ond lubricating oil (attach form 4136)

Do Grodie Wrom o kosuted Invosmont Corpany (orch Fomn 2139) .

Va ToBal Cudd Inco 688, 69, Ord 20). Entor baru ond on Moo 203

D

1A1: GOVERNHENT PRINTING CARIS 1010 6 4.01 000

i GiPO 73 1411

62

63

522 70

65

63

67

522

70

€3

60

70

78

NW 88326 Docld:32245535 Page 77.cm

---

## Page 78

Echodotos Ael Itomicod Doductions AND

Dividond and Interest Income

Deportment of the froggury

Intarnal Rovened Servica

Name(o) as howl en rorm 1030

* Attach to Form 8040

1972

322 22: 2998

1.0a0d

sombec 1 filectiono (Schedule 8 on bach)

Contributions.- Cash-including chceks, monay ordcis, C8€.

(Iromize see instructiona on page 11 for examplas.)

17C.

3O0N9-5

Mom 3, decion, dontees, nuras,

jar mcale: y enfo, cig.

ip.

160. (LO

i .

3 c

o initist

"sit

i, 30t1e

Frcort donia of tisurane: premlums for

randical car: no; ontorod en line 1

6 Isomiar.

editor racdieal ond dantal or

i douring, ales, denturos,

80 Total cash contributlono.

29 Othor than cosh (000 Instructlons on

page 12 for roguirod statement). Entor

total for such iterns hore.

20 Carryover from prior years.

21 Total contributions (Add lines 18, 19, and

20. Enter hero and on line 35, balow.) D

Intoroos orpenso.

22 Homo morigogo . . .

23 Inotallmont purchasos.

24 Othor (Itomizo)

200,00

14: 131, Be Cs.10.

1 insure. 0f l 28 Form 8030,

Subtri!

c lau Blem We% Endor diffor.

unce d luca dha zoro,

JitOr 2070).

antot 083.

381

Enter toro

simon P

no caro

273 Serio car local ensolnd (sud gas tor tobloo)

26 Coneri solas (que saloo, sas tablos) .

Stato sad logsl incomo

2i Porsoust crogary

sQ Coher.

87 Potal

Deo sAdd liner

•88 through 16.

Enter Moro en on lind

A, bolow.).

23

Toral intorast organco (Add linca 22

23 ond 24. Entor hero and on ling 36,

balow.)

Casually or theft loss(c3)

Soe instructions on page 12. NOTE: 18

you had more than one

casualty

thott loss occurrence,

OMIT lines

26

through

29 and soa page

12 of 8he

instructions for guidanco.

23 Loss before odjustments .

27 Insuronce roimbursement

28 $100 limitation.

29 Add Iines 27 and 28

30 Casualty

or theft loss.

(Excess of lino

26 ovor line 29. Enter here and on line

37, below.)

150

Child and dopondont care

from Formn 2442. (Enter here and on

ling 38, below.) ,

Miscolioncous

deductions

alimony,

Union

dues,

page 13).

etc.

(500

instructions on

842

00

32 Total miscellancous dosuctiono (Entor

hore ond on line 39, bolow.) :

Summary of Nomizad Deductions

a0 Total daduests mcdie 1 and dontal engances (trom lino 80) .

?.. Total doncs fram lino 4d)

SJ. Yotal contributions (frein line 21)

30 Total Intorove expense (trum lino 25) .

37

Casualty and thaft losolos) (from line 30).

20

Child and dopcident sure expenses (from line 31) .

39 Total miscellaneous deductions (from line 32) .

40 TOTAL ITEMIZED DEDUCTIONS. (Add lines 33 through 39. Enter here and on Form 1040, line 52. S./ A D

3. 2.322

$100

00

'1.5

'CO

11. 8

20

3,234

00

4,423

00

NW 88326: Docld: 32245535: Page-78

---

## Page 79

Maile

Manen sover Rue

. IDENTIFICA..

INNO 302-1-7992

AUDRESS.

7211

PEDERAL

SCHROULE OF DEDUETIONS

STATE

CONYRIBUTIONS

CHURCHES

YEAR ENDED

FEDERAL & STATE

160a

1195 CE MALANCAR, RSOLMAIN3R

3510 dend

w:00016..130

1.1010

110 00

30'8

NO S

JUNTISTH

COMMUNITY CHEST/ UNITED CRUSADE

SALVATION ARMY/GOODWILL INDUSTRIES

REO CROSS

IMAS & EASTER SIALS

HEART FUND/CANCER FUND

PARTNERSHIP RETURN

PAYROLL DEDUCTION

CITY OF HOM

159

OTHER ORGANIZEO CHARITIES:

TOTAL CONTRIBUTIONS

INTEREST (TO WHOY PAID)

MORTGAGE LOAN COLONIAL MATE.

SICA

VSTALLMENT LOA

SAL AIRBA

ZEN.

-FASE INEST FANERIA

700 гл

30400

FEDERAL & STATE

20932

79600

. 12:01%

JGG

00 V60 1113

=

.252

MEDIC/S

PPLADES

EXPENJER

SACO DELAVOR

TUTO

: TAT

SEBOR VAL

2I 22007 INSURANCE

100 00

P00BBA1

OVATIL

6600

sin@

63020

TOTAL INTEREST

MISCELLANEOUS DEDUCTIONS

FELERAL & STATE

ALIMONY (EXPLAIN)

SAFE DEPOSIT BOX FEE

UNION QUES

SMALL TOOLS (GOOD 1 YEAR)

TOOLS DEPRECIATION

SAFETY EQUIPME:T

UNIFORMS (NOT GEN WEAR)

LAUNDAY @ CLEANING.

AIITO

MIL EAGF. 110

PILEPHONE EXPENSE (NOY PLIMB)

EMPLOYMIGNI AGENCY FREG

DURS & DUOSCRIFTIONO

INCOME TAI PREFARATION

CHILO CARE

OTHERS:

VOTAL MISC. DEDUCTIONS

CASUALTY LOSSES (EXPLAIN)

FEDERAL & STATE

SUB TOTAL

LESS REIMBURSED BY INS

SUB TOTAL

LESS BIDO DO POR FACH CASUAITY

TOTAL CA: UALTY LOSSES

FEDERAL

POYAL FAXIS

Nw 86326 Docd:324555 Bage.2"

242.00.097.00

17835 VENTURA BOULLVAKU, SAIE 106

TOTAL DEDUCTIONS

ENCINO, CALIFORNIA 91316

---

## Page 80

SCHÉDULE C

(Form 1040)

Profit (or Loss) From Business or Profession

(Sole Proprietorship)

Dopartment of the Trcasury

Attach

80 Form 2040.

Intornal Rovonue Sorules

• Partnerships, joint venturos, otc., must file Form 1065.

Nano(s) as sicin on Form leco

Soused and.

Phyllis Ruby

ervica

& Prineluct bunics ustlvicy.

68006005076 06:07000

1972

Social sacurity

numbar

322

12 ÷ 7997

(for ramplo: ratoll horavor: wholala lobacco; sorico logal; monufocturing furnituro; arc.)

Oracle Bor

5616 78K Nuy B248. C Employor Idolfcation Number

D Busine.

C Indico&s mutir D bi accolang: (8) 83

cook;

82) D accrual;

(3) [] other.

E Were yu roguidad to fila Form 1096 for 1972? (See Schedula C Instructions)

O YES LINO. If "Yes," where filed? D

8, 13 thio

singce located wi

¿ala sho boundarics of sho city, Rown, cic., indicorad? & YES I NO.

a Wro on Employoro Quaterly Fodoral Tan Rosura, Form 948, allod do phla bubinods for ony quartor In 1972? M YES RE NO.

¡eDiTANia all coplicablo linca and echedulca must be fillod in.

3

2

Creso rocolio or occa s...

.. Loss roturno ond allowancos $...

Balance D

LcUS: Crus of gooda cold and/or oparatiana (Schedule C-1, line 8)

Greos proft

Cinor tireen foot,

shoeulo)

B

SCHEDULE

ATTACHED

and co be hado one buclacao preparty foxploin in Echodule C-3) .

Bent as belies propory o

Repola forgialn in Cenodula C-3)

So scarica crad togea in licludod on lina 3, Schedula C-s (onclude any paid to yourself .

TECOUL

Comratarlony,

83 funeraction (aticeh customont)

DE 40): Fonsica and preils-sharing plana (sco Schodule C Instructions)

(4) Emplosio bonoto programa (sea Behodule C Instructions)

B6 intire on lusinoce Indebrodneso

27 dia desas crising frei cales or servicco

so borden:

20 duor balaces ongonnas (opselly):

(0)

(c)

(g)

(h)

(0) /

(11)

(1)

(n) ma

(0)

(p)

¡Total othor businoso expanses (add linos 19(a) through 19(o)) .

20

Total deductions (add linos 6 through 19) .

21 Net profit (or loss) (subtract line 20 from line 5). Enter here and on line 35, Form 1040. ALSO enter on

Schedulo SE, line 1

6.969/40

NW 88326-Doeld+32245535 Page 80:

---

## Page 81

samuol aud Phyllao Ruby

1982

SUPPLEMENT TO SCHEDULE C

1008 S0200 B0B

Corden 3000a6089

aachaus

N208400828

BL0B0P6UD

- MC38

Icuse inding inventory

Grood Income

ROUG

Peytob3 C0300

A8/OE01020B

Torso/Racenuou

Honders

AutO

Donationo

Newupppore

NET INCOME

$45,499.72

383.47

$

800.00

4.498.98

16,963.08

2,923.29

3, 102.44

$27,780.79

800.00

$45,216.25

26.980.89

$18,135.46

$ 8,728.82

100.00

3,878.93

323.48

190.00

25.00

254.25

382.25

214.58

12.15

425.29

=0o

62.94

300

NET INCOMF.

LorIpnont

tovnache nos

Co pote

Leanchold Impo

(Beilance of Lease)

$20,000.00

5,000.00

3,000.00

DEPRECIATION

$4,000.00

2,000.00

957.00.

5 Y8O SL

2 Y8. SL

7 Y&. SL

2,237.,56

$10,397.90

32920220

$ 6,969.40

$2,000.00

.8,000.00

428.50

$3,428.50

NW. 88326 Decld:32245535, Page 81

---

## Page 82

$1.

SCHEDULE SE

Computation of Social Security Self-Employment Tax

(FOr NO1O)

> Ecch soli omployca parson must fito o Schedulo SE.

Deporimont of tha freocury

1972

Internot Rovenuo Servlos

[> Astach 8e Form 8030.

DIP you bad wegos, including tipo, of $9.000 or moro thet woro subject to social security taxes, do not fill in this pago.

D I8 you hod moro than ona buslnoss, comblna profits and losses from all your businesses and farms on this Schodule SE.

Imperian& —Whe seli-employinont Income reported bolow will be crodited to your social security record and used in figuring social security bancilts.

Social cocurity numbor

al call-employed porcon

322

12 / 7997

mustness cot: ilen subicat Co golf-omployment tax (grocory store; restaurant, farm, etc.) D

Bonussion of Nor Earnings from BUSINESS Sell-Employment (other than

farming)

Nei profit (o luss) shown in Schedulo C (Form 1040), line 21. (Entor combinad amount if more than one

6,969

2! Was leonard a doood duce oneludod corleos or coureos Included on line 1 .

S) dot oardlego tr 1000) fiGin business cold-crploymond (Subtract lino 2 from ling 1, and onter hore and

in llso (a) colow.)

Computatien

of NoR Earnes Wein FARLa SoN-Employmen8

6, 969

40

your ercus prolly from farming are not mero than $2,400 and you olect to use the optional method, you need not complete lines

Computation under Rogular Motica

14 Met term proft (or 103s) from:

(0) Schodulo F, lina 54 (cash method), or line 74 (accrual method)

(b) Farm parinerships i.

its slot gumpin efam seifraployment from forming. Add linos A(a) ond (b).

station undor Optional Mesica

as Nato don 29,000, ontor swo-silets ol tho cross profits.

chero do a 2,200 La Bio not farm firette lo loco 8hon 58,600, ontor S8, 600

223%

or lao 22 (escruul mothed), plus tha alutelbutivo share of gross proilt from form

las da onallned in Instrueloria for Schcdulo SE.

7 Enter hard ondion lIna 8(b), below, sha amount on line 5 (or line 6, if you use the optional

mathod) .

j:Concuraliquot Social Socurity Self-Employment Tai

8 Nat oarnings (or loss) from self-employment-

(0) Fren business (othor than farming) from line 3, above

(0)

From farming (from lino 7, above)

6c) From Layinorships, joint vanturos, cic. (other than farming).

1d) From, corsico as a ministor, membor of a religious ordor, or a Christian Science practitioner. If you

Mcd agra 4361, chock hero [| and ontor soro on this line

(0) fitri

sler wish a fortion novornirions or infornational organisation .

6,960 40

¿ D. voral noe cordlago (or lono) from soll amployinone roported on line 8.

108 1io 9 10 8uu0 shon £4so, you are not cubjodi do poll omployront don. Da nor fill In roos of pogo. )

10 The largood amount of combined wages and self-employone carningo subject

80 soclal cucurly tax for 1972 is

$9.000

00

18 (a) Totni "FiCA" wagos as indicated on Form W-2.

(b) Unroporiod tips, li any, subject to FICA tax irom

Form' 4137, lino 9.

(c) Total of lines 18(a) and i1 (b)

32 Dalanco (subtract lino 12(c) from line 10) .

13 Self-employmont income line 9 or 12, whichever is smaller.

3A 1i line 83 lo $9,000, ontor $675.00; if less, multiply the amount on line 13 by .075.

÷ 85 Railroad Cnployco's and railrood employoo represontativo'o adjutmont for hospital insurance benefits

don trom Moin 4169 .

86 dold-umpluviment due (oubtrace line 15 from lino 84). Entor here and on Form 1040, lino 62

6, 969

522

40

80

522170

NW 88326 Doc|d 32245535. Page 82

---

## Page 83

SCHEDULE D

(Forro

1040D

Department of the Treosury

Internal Revenue Sorvico

Capital Gains and Losses

D

Attach to Form 1040.

• Examplos of proparty to ba reporiod on this Schedule

are

gains and losses on stocks, bonds, and similar investments, and gains (but not losses)

On personal assets such as a home or jewelry.

Name(s) as shown on Form 1040

SamaR Cha Phyllis Ruby

jacolor Cupiend Gaino Ond Loop0s-- Assots Mold Not More Than 6 Months

1972

Social security numbar

322

12'

7997

(D)

oGguired.

Entor lottor

inctruction

0)

Cso., doy,

yr.

Put doto seid obova

dotted lino ond doto

equired

below

doitca lIno)

d Giode abloo prico

o. Coot or uthor bosio.

os odjuated (000

instruction E) ond

Oxponco of solo

%. Goin (or loos)

(d loes o)

SCHLOULE ATTACHED

14,496

4,296

DQ)

00

B8ND

400

Entor your ohare of nos chordterm goin (or loos) from partnerships and fiduciarios

Entor not coln (or J0do), combino linos 1 and 2

Sher un empital leco component corryovor from your baginning botoro 1970 (000 Instruction H)

Shen 80rm supkal leco earryover attraurablo to yoore boginning oftor 1969 (coo Instruction H)

No those 2f goln for loco, combine linoo 3, 360) and 4(b) •

1 Long 3am Cautal Gains ond Lessos-Ussots lold More Than 6 Months

2

380)

4(b)

200 00

Capltol.coin aloerlautions

Exter Cela gy applleablo from line 4(0>688, Form 4797 (600 Instrucilon A) .

Entor your chord of nos long-term goin (or loss) from partnerships and fiduciaries

:20

Entor your choro of not long-term goin from small businoss corporations (Subchapter 5) .

те вою

Not gain (or lass), sombine lines 6 &hrough 10

8&10) Long-dorm capital loss component corryover from yoars beginning before 1970 (sae Instruction H)

12(6)

Long-term capital loco carryover attributable to years boginning after 1969 (see Instruction H) .

•23

Net long-term gain (or loss), combine lines 11, 12(a) and 12(b)

i summary of larts 1 and li

Combine the amounts shown on lines 5 and 13, and enter the net gain or loss here . .

25

36

Entor 50% of lino 13 or 50% of lino 14, whichever is smaller (see Part VI for computation

or altornativo tai). Entor zero i thoro is a loss or no entry on lino 13.

(b) Subpract line 151a) from line 14. Enter here and on line 36, Form 1040 .

Omit linos 16(0) Lind 1G(b) and 00 80 Part IV if lodoes are shown on BOTH lines 12(a) and 13.

(0) ereor Gno of to following amounto:

(i) l8 amour? on lino 5 lo zoro or a nes goin, onter 50% ol amouni on lino 14;

(il) l8 amount on line 13 is zoro or a net gain, enter amount on line 14; or,

(ill), If amoungs on line 5 and lino 13 aro not losses, enter amount on line 5 added to

50% of amount on line 13 .

(b) Enter here and enter as a (loss) on line 36, Form 1040, the smaller of:

The amount on line 16(a);

$1,000 ($500 if married and filing a separate return-if a loss is shown on line

4(a) or 12(a), see instruction M for a higher limit not to excred $1,000); or.

(üi) Taxable income, as adjusted (see Instruction 1)

Carrvover

9

10

12

12(0)

12(0)

233

24

15(0)

15(b)

714,322 005

(24.322 00)

16(b) |(

(13,322.00)

1,000 00

NW 88326 Docid:32245535 :Page 83:

---

## Page 84

S010602 D. and PHYLLIS RUBY

WHAKLY WORK PLAN/TIMI BPORT

SARESMAN NNEIS terseNand PR IiNi

NUMBER L:2

---..

CONTRACT

mer

T, NET

Sollaral

Fresent

8

FUREAISA DETE

PIGE

WIFK ENDING.

NEI SANIeRICA

FTICE

COMMENTS ANI

CLOSTOTSGA

ntaaya MavePileel

621/2

1016 = 73-05% 1304m l22

M=+ 271 7165.221-4-133103.451

(B209)

•.At ?3 MaAPR Der

HEOA Sdma 94217454762 1-9-72158400

28.Co2 CoNU.

43. 98-09%5T 33.00° 13 13207 23243 1-17-73 23520 244

NPaina TAn CRNVl

Cls: 04275% 51155,000

56V 12.20 7 3886-00 1-1-12 22k12 5936

in, Topp

3061

S/0 15252 12225,930°

1117-236511 1152

WRN Co.CRRisaSh 201912

4,533l00

12-03-731

4010 2012 (370)

.Con Msisiilei She

15321-10-91

13.081° 2-9-22

3282 131

wniem Ser Cratoo Sh.

M2 1|2744917-922134779033

Lnr sree

W417752 (73473|21172/2010 12(200

351

Balt.

20 33

205

locin

ne fro lieSh

1ALToce

(DRP)

v I 6cDnS

• 2

1814 211-22/29129

3-13-Z2

19319 19%2

ISMeS1/121 27-512 |3741 3 3-13-73 372712

Gee)1

1T20 21211 3630

3-13-731R88 N2 (4620)

500/00 54122

1302-Đ2l 11742

313•71 9/1º

9% (7630)

(14800)

lellé

TOTALS

NW 88326 Docld:32245535 Page 84

---

## Page 85

SALESIAN NEIS, NOISING Qu , INS

WEEKLY WOKK PLAN/ TIME RIPOK'T

NUMBER

CUSTOMER

NAME

SANITIES

Fresent

ustomer

SAARES

1500-570

e153

1517-522

75:58.41

WERK ENDING FAGE II e

REVENUE

COMMENTS AN

BOOKED

DATE

NET SEE ERICE

EXPENSE

HRL: KLOSSNOTDSGL

4-29-78

1935 "

116%

321199222

15-22%

10:32

50/ (03)

5Ao Code

49 6752

510?.000

511214-28-22

1161=

5:203111=9/55| (45)

1 G BIT 5627812 46435-2374303 5 634071

257. 00-

1481 313121 30239 717-74 36033 1

50 1A0

19118010-92 10122

8-211-761

11).5.991/0%

TA PCIDE SO 0 1a1 180-13

Ten S10 15 81112

236010

1835 8:2472 2033/234

1%

9-4-72

31.32° 18

23355

9-13-22

05127(88591

127416-0-73 28699

9-19-72 1913÷104

(8960)

MAIZEN WAS KIR 8O 143 1-1-33

11'13°

10-3.72 445- 1477 (473)

Mare ChArlese

100

11151

H-1h:22

1487°

10-11-12

251900

15/2

1453 19-18-71

1.48904

10-11-22

<53/9415%

33112211822

1-19-73/10738

(290)

(2909).

88326 Docld:32245535 Page-85a.

---

## Page 86

SAMUEL DIal: PHYLLIS RUBY

WEEKLY WORK PLAN/ TIME REPORT

SALESMAN BACtE and Qu

1972

NUMBER CURIOD: TES

Ter At:

/ Concei

My logise

Tron

- 10031

=

Present

Customer

Lanned

P1

PREM

PRICE 1

SCOTERICE

112-1-71

03021-211

1290021

1: 02-72

10b-72

1-70.72

133-72

122.2.72

1536-71

Л.

5101811

5-- 71

N1 • 22

13•20-721

321-72

1/3.73

5102

Bds.

3671111-21

162

142.31

123%

16. 72

24 152

1-18%

3.82

302)

122%

0335. 00L

101.201-24.72

24.65 2-3-72

25.15

24.90

1-7-22

€3.5. L00

3493 1472

125:10

133.00

2 - 5-72

131.90

= 5.10

3-1-72

25.20

1. 79

3-9-22

12:051

337%

3•15.72

4,31/4

27:30L3-16-723

27.75

347.00

3→4-73

345.00

076-44-4-14-72

25.10

IRASASA

CLOSE

(6a7.50)

2221

23

150

(30. °0)

123

PAA

13s

(4622009

(/995)

Lưc

Fare

5000

2000 E

ME ANANA AIBIICATIONIS

TADAMEL KETTAR

ENGELLA

TOTALS

NW 88326 |Docld:32245535

Page 86:

---

## Page 87

LAUDDIENT

INDIVELAR

CALIFORNIA

INCOME TAX

TARADLE YEN

1 9 72

a yaor 1972-07 otor cueblo your boginning

, 1972, onding

1973

2203

LAST NAME

RUDY

322

Your social secwaily nuber

82!

9998;

a al coco belle eportion nucio, or eurel rossa)

162305745 0819036

349

16

1420

• M-

ZIP CODE

Youro

GaM 097105 0860:010

PATION

Selt

Wild'o

HouDarito

richi?

D. Localoma da col fic yourcle, your opouso or porson tho queiica you as hoad of hourshold

OZLATIONOMIP

13, 026.1 33 06290

Esod, Bassa, E8lo0, Thomae

Gome horg

-Enter

.Number D

5

Number of blind exemptions claimed D

6

B. C3lc:3 (refer do instructions)

8. Tokel dopondone cas Elnd onomadens (add lines 5 and 6)

Cody & di fora(s) wor

10 0003, 1l3, 830, cal 000r amplayoa eccponsaldon.

•No Clusonos, Cator dodel 888 ouor 8590, comploro and attaci Schodule B(540))

¿s lascitolo Enter satal 68 dir $500, complars cha attach Eshodula (8(540)) .

p2. 56. 18003 050u Ca0u 0, D, cad. cad.88)

Succed sCiano Campico 2, Ino 08) :

34. 0Es1fano a Coaudece Uno 19 Preta (ina 12)

0 80 500 E:.

1U. Porta ramatono Ca piaudord acdugiles (from paga 2, lina 56)

09. 65

c3 cher con on lino bu

E Tor Raso Echcûule C?

[ Schodulo 015 (0)

•6 91 4

00. Finge QuaCos. Stigla -$25. Married couple or hecd of houschold-$50

00. COur EroDano-Total on lina 7 above, _4 x 88

20. Per 1 Canapons (ade Quas 18 and 19)

18

19

: 2:0. PC.

glad Knbtract leg 20 from lino 871

12. Cout ero10) lirom pogy 2, ling 59)

29. Col Con Isolaty (subdric8 lino 22 from lino 28)

23. Tan do profumano inguEo (see instructions-attach Schedula P(540) )

25. Total Cen Westy (add dines 23 and 24)

26. Total Galiciata Inceto lon (lühold (attcen Formis) W-2 C7 DE-2P

to front)

26

27

203

23. Enceco Costerolo 890 Ees ENtabold (attach Form DE 1964 d feco of return)

28

80. ToRn Concorda ludd tinos 23, 27 and 28)

2B. 18 Mio 25 la larger Gen, lino 29, entor CALCICE DUE.

SU. 18 leo 20 is larger dian lino 25, enter EUROPAVLENY.

Pay

ronchise Tax Board, Saciamento, CA 95

to

Sacramento, CA 99d6

Moil return to P.O. Box 13.540,

Sacramento,

CA 95013.

32 dino →1 ln 10 del nereo. Allon al locol che wooks for your refund)

(b) Creditor on 8973 estimatod tax

i Conto societ si

EDWARD L. LAMBERT

Your si

Duto

nore

Spouso's olumatero

Dolo

•ENCINO, CAUF.91316.

TEr 7213 881.73:0

5.5. 50840.9521

NW 88326 Docld:32245535- Page 87

50,00

32100

D

Dola

10

11

12

.70.00

22100

3, 969780

60002

TeD.

13

14

0,062

3.000

15

16

18

4, 051

160

20

82 (03

21

22

23

24

25

29

30

31

Do cot enta ta thesa cece

---

## Page 88

10u8 Foru 520 (0992)

Fili blued or Couscheld lf claimed, answer the following questions

(Soo Indructions)

Cliost;

[ Novor married

I Legal copararion (intorlocurory dusroo doss nor qualiíy) Daia

oños

• Widow(or).., Daro

[1 Finel eliverso/ disolution

civicent who qualified sey es hoad pi household Do nor lion his individual as a dopondoni on pago 1, lina 5):

Rolationship

Aga_

Did this porson qualify as your dopandon fer

year: 3072

i Did into porcon reado in your hemo for the ontire parablo year?-

_ of nos, enolain circumoradoss

I3GБM

33

6, 262 30

Jo ta capital asseto (cülech Schouts 01540) .

4'51s ia (er tosst from Us Momental Choruie of Gains and Losses (aftcci Schodule D-1(540))

138 goin (or Joss) →213 lines 33 (2) ond (b)

1.,3!*.

• tianuitina.

in 33:

1) *30,4

Flas

Partner Wear

Ec: 223 01 814083

• Zar To noo "tur losch" (otten "Schedulo 549))

(a) Fully donabla pansions end ennuities (not reported on Schodula El

(:) Alimony

(e) Othor (stora fubure eng cource).....

do dor? ruleckacous Insoira (ad lines 40(al, (8) and (c))

Co: 29 t

My dus Entor fero Cl on pago 8, Mna 88

41.000,002

34

35

36

37

30

39

670.000

00)

40

41

5,969

11'31

done -attach sickomono

42

43

Ing tribun

56,30

draccoolo run pay orly cera anorructiona for viao 8, pega 10a:

45

43

47

VOS

0. 1,01

₫ L

s5 Ca Stood Dodostien

On coparato roderca el carrics lanpaycza both must Manizo dodecticao or both cust tale the alondard doduction

63:

30. 0n1. cocco Sahodula AfiC cad enter des polula en linas 49 through 53, bolou

Ral Caperco: (roin Schedule A(ED), ling 10)

du Bion crcuno dom Segocula A (540), line 19)

firra Schotulo A (SCO), 17o 29)

Culeno (86.0 FActud A (540), Mio 25)

mo8 ospensa (rom Schodula A(con, line 29)

acous Counttora, (irom Schscule A (540), lina 371)

riaductions (adi fines A8, through 53)

48

49

50

51

52.

53

54

2,800

pid cases, tr stigle or marric dorson filing separate return

55

i laid of touchos; or maric 3 couple filing join& rosurn

irt.

"is.

(suctices Che 54) 03 Sunday Deduction (ino 55).

Entor fara and on pago 1, line 15

56

i ta lur faemo Pou DEl a Anothor StreAttach ecal of "other stato" return-and

Retiremont. Insome Credit

sued from courcas within Saria of

end also taxable by California

inducted Care lareno (irora rago 1, lina 14)

g i,

Whitin s

5,"? eV

"is B car

' 1100% n

i anal is lina & leonnot oncocd don paid orhor Dearal

,A:

57

38

59

notiatica to Fougal Beare-li adjusted gross incoma on Federal Return is different from line 14, page 1, explain below

04220-100 0-72 1D. 000L 0 & OOP

NW

88326. DoC/:224

1535

---

## Page 89

BunoR cad thyllio Ruby

*35, Costors, Co

0-23, ramos, kees

ran 627.

à cantang to coco caro, co.

2216

Model one?

Д'

+10094

482524622 To diC

i Enterine a prime for ice!

C3 1.0

"went

•1е-apa

• !"

un!!

% F902 2).

2240 10?

Arcan 8 ince

Gr22h6d9

14014."

126000s

inJ

Kuw.

don done

eg long

No do code Beca

us Car mes

not place onl

→ Contes

I1. E0g t

4

5

8

9

10

82

10

14

15

16

17

18

10

20

N-vn3 12080 Kenn 20. Lio

150.00

21

842.00

CALIFORNIA

DEMEZD DDUCTIONS

Atices to Fana 84a

TANADLE

19

122 t

YEAR

Besici

322

L2:

7990 m

Il one spouse itemizos doductions, the other may rat use the Tor Toble or clot

the ckendord deduction.

Il you eñoose do itemizo your daductions, completo lit

appropriate items bolow.

Coit bations

22.

Cash-including checks,

monoy orders, eic.

(Rorsize)

28

23. Total cash contributions

24. Other than cash (see instructions). Entor total

here

ES.

Totch Add lines 23 and 24. Maximum deduction

nay not enceed 208s of cujusted gross income

inter here and on form 540, page 2

.D

20.

Momo mortgago

80, Inatolimone purchacoo

80. Otnor (itemire) .

Tot? dAdd lines 26, 27 cno 28. Enter nore and

on Form 540, page 2

. D

Casesty cr TDoM Lossles! Soo Instructions

NOTE: I8 you hed more then one casualty

or then

loss occurrence, omit lines 30 througn 33 and follow

inofruetions for guidance.

20. Loss Doforo adjustmonta

J8. Incarcao Polmayroomont

38. $109 Mmitation . .

J3. Add Unas 31 ond 32

34. Casualty or thort loss. (Line 30 less lins 33)

29. ChEss Coro-See instructions

30.

@tar-for education, alimony, union duos, etc.

-Sco Instrucitons

23

24

25

26

38

20

29

39

38

32

33

34

35

33

200.00

Moria

3,232.00

die.

1r 66

$100.00

88. Totcl miscollanoous Caductions-Add Ines 28, 25

and 36. (Entor hore ond on form 540, pogo 2) D

37

Saladulo D ou sovorio

NW 88326 Docld 32245535-Page-89

---

## Page 90

SCHLOULE

TONN BAO

CALIFORNIA

PROFIY OR LOSSI FROC LUSINESS OR PROFESSION

(solo prepriororships)

TAKADLE

19

72

YEAR

322

Sociol Jocurtly Numes

12

1297

Dada Mo 1431380 Rosby

16 clace

Singel.

8/33

56N6 Vou Nuys B8v8..

nod ers unting fleech; escrual;

i produer

(Por osarior raall hardesaro, cholocalo-tobacco, dorvico-logul, manufacturing-furnituro, ors.)

G. Podoral omployor idontification numbor..

Von

Nuys, Callionnie

• anor.

• Yes

No

D:.

No, his lude en the a of the ronablo foor?

y wenths dimo sirablo Near ald you ein shis bucnoss?

12

a coates dude and confere cau ., mod do.

Puera radios or solca $.

Bocs rosurno ara allomances $

Cre or good cola (Sahodula Cal, lino e) and/or oparadions (eñoch sencoulo)

Balanco D

Be nodol)

ion.

burn so many proporsy (osplain in Schodulo (-3)

130)

ideo aná bopenhe includiail on line 3, Schadula C-l (anchude any paid lo yourself.

JE.

wiso

Jend profusional foes.

"Dr Con

asion end prost sharina plang luee inuctions for lins 15(a))

loyou liar de pearce Cons Inciructions for line 1501))

MUC. ta:

it on becinow & dobrcaner

colûn auling from calcas? corvicos

Mich

(el

(0):

80).

(0)

Yes

Yes

NO

L

-SCHEDULR

(0).

): Toral other businoss expensas (add lines 19(a) shrough 1Slo))

20

Toral deductions (add lines 6 shrough 19) .

20, Nor profit (or loss) (subiraci line 20 from line 5). Enter hore and on page 2, Form 540 or Form 540NR

(000. 0078)

NW 8832G-Docld:32245535: Page-90=

6,969

40

Pago i

---

## Page 91

CALIFORNIA

CALIYAL GAINS AND LOSSES

TARADLE

1.9 722

YEAR

17:4

i..;

its.

re:

22" 17995

[-.

is i

B0C23 6.

Chich ton

Dato Coon'

93, (7227

c. Dodo cata

(cra, day, 57.)

6. Gress sales

price

as inter?

- 8220-d

so: bused, chordero

set calen

te foca are brooding raceto s

coryover fiel proceding ronable year (enach salement)

! Cinct BoR and 3

ho Hoar Lap hot Moro Tuan Livo Ycars

45-1

327049

7:23.1

e. Cast oz ctica

quent

322

04-

16,400,00

paar

20296.000.0.

• 200.00

?..

"l'.

Toci

3 Prom panacialea and asuctories

30 T

4 Divo' Scaro 7

?.

ROTT

no 18. Li

i3r

Tin 23

i Cs. too,

97.277711

O, Echodulo Dol 1540) (emash copy)

judio yover, tres! procoding raneblo yoor (@rach Dalomon»)

1SW00, 00 cro V

suit.

Man and Leaco

ina,

cadets

on to a A

ra 522 mo

-Of linos

chows a col, onor haro and on page 2, Fan 1i of form 540 or S40NR

if line 1V shows a'loss, corer hore and on page 2, Pan ll of Form 540 or 540Nl the smallest of:

(e) crosor on lino 17

(a) slic aunoble insome for she penablo your (compulod wilhour rogard to gains or lossos from cale or enchange

of capiral assota)

(e) SP,d00 18500 be sha ceo el a huoband or villo filing a caparala rururn)

(1, 000, 00)

or ryavor (13, 322.00)

NW 88326 Docld:32245535 Page 91

---

## Page 92

7-5-72

41040

U

S

Department of the Treasury / Internal Revenue Service

Individual Income Tax Return

•For the year January 1-December 31.

1971. or other taxable year beginning

1971, ending

First name and initial (lf joint return, use first names and middlo initials of both:

Last name

Your social security number

SAMUEL

AND PHYTIIS

PURY

322

12÷7907

Present homa address (Number and street, including apartment number, or cura! route)

Spouse's social security number

16250 Bircher Street

349

18 : 1420

City, town or post ollico, Staln and ZIP codo

Occu-

Yours Self Employei

Granada Hills, Callfornla

pation

Spouse's

Housevife

Filing Status-check only one:

Exemptions

10

Regular / 65 or

over

Blind

Enter

Single

7 Yourself

number

of boxes

2

Married filing jointly (even it only one had incomm:)

& Spouse (gle inched

3

Married filing separately and spouse is also filing.

5 is checked K

checked

Givo spouse's social security number in

9 First numes of your dependent children who lived with

space ai ova and enter first name here s

you

Ered, Rriana Risa

Unmarried Head of Housenold

homas

Enter

number bal

Surviving widow(er) with dependent child

10 Number of other dependents (from line 33)

Married filing separately and spouse is not filing

11 Total exemptions claimed

Please attach Copy B of Form W-2 to back

12 Wages, salaries, tips, etc. (Attach Forms W-2 to back. If unavailable, attach expianation) :

12

Income

13a Dividends (a580 porest.) $ 42.50

13b. Less exclusion 3...

.:42.50

• (It gross dividends and other distributions are over $100, list in Part I of Schedule 8.)

14 Interest. l Sver sile enter for al an without art

or less. enter total without listine in Sinedule b

I of Schedule B

13c

Balance. b

-1-

14

178/36

15 Income other than wages, dividends, and interest (from line: 40)

15

6.350

153.

16 Total (add lines 12, 13c, 14 and 15).

16

:6.529

12

17 Adjustments to income (such as sick pay," moving expense, etc. fiom line 45)

17

18 Adjusted gross income (subtract line 17 from line 16) :

See page 3 of instructions for rules under which the IRS will figure your tax.

It you do not itemize deductions and line 18 is under $10,000, find tax in Tables and enter on line 19

• If you itemize deductions or line 18 is $10,000 or more, go to line 46 to figure tax.

19: Tax (Check if from: C Tax Tables 1-13, LJ Tax Rate Sch. X, Y, or 7, I Sch. D, [ Sch. G.or. C Form 4726)

18

6,529

19

-0-

20 Total credits (from line 54)

20

21 Income tax (subtract line 20 from line 19)

21.

22 Other taxes (from line 60)

22

55127

Attach here

sec. no. on Check or Money Order.

Write soc.

23 Total (add lines 21 and 22)

24 Total Federal income tax withheld (attach Forms W-2 or W-2P to back) .

25 1971 Estimated tax payments (include 1970 overpayment allowed as a credit)

26

Other payments (from line 64)

27 Total (add lines 24, 25, and 26)

23

55127%

24

25

26

27

Bal. Due

or Refund

Foreign

Accounts

28 11 line 23 is larger than line 27, enter BALANCE DUE Palei pull with de une Male,

551

127

28

29

Sign

here

If line 27 is larger than line 23, enter OVERPAYMENT

30 Line 29 to be: (a) REFUNDED Allow at lassic minks

(b) Credited on 1972 estrnated tax

31

Did you, at any time during the taxable year, have any interest in or signature or other author

ity over a bank, securities, or other financial account in a foreign country (except in a U.S.

military

banking facility

operated

by a

U.S.

financial institution)?

Yes

NO

If "Yes,

" attach Form 4683. (For definitions, see Form 4683.)

Under penalties of perjury,

I declare that I have examined this return, including accomparying schedules and statements, and to the best of my knowledge ant behicl

it is true, correct, and complete.

EDWARD L. LAMBERT

Your signature

Date

Signature of preparer othet An taggaerybapedien

Date

all normatio do che das anya ones.

MVD., SUITE 510

INCINO, CALIE. 91316.

Spouso's senature (if tiling jointly, BOTH must siga even it only one hai in.gme)

'Aidres:

111. 1213: 981 4020

W 88326 Docld:32245535 Page 92

---

## Page 93

Page 2

Form 1040 (1971)

Attach Copy 8 of Form W-2 here. B

•PART I.-Additional Exemptions (Complete only for other dependents claimed on line 10)

32 (3) CAME

(b) Relationship

ic! Meaths lived in your home:

(d) Did

It som or died cumine year.

chichi

de.

have

income

347'0 or more?

(e) Amount

You fur-

nished

for

dep:-dent's

support.

it 100 5 'ntite

ALL.

$

(D)

by

Amoint

furnished

OTHERS

includ.

INg

dependent.

33. Total number of dependents listed above. Enter here and on line 10

PART II.-Income other than Wages, Dividends, and Interest

34 Business income or (loss) (attach Schedule C)

35 Net gain or (loss) from sale or exchange of capital assets (attach Schedule D)

36 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797)

37 Pensions and annuities, rents and royalties, partnerships, estates or trusts, etc. (attach Schedule E).

38 Farm income or (loss) (attach Schedule F)

not re; arted on Schedule E-

39 Miscel- ( (a, Fully taxable pensions and annuities

laneous

(b, 50% of capital gain distributions (not reported on Scheiluie D)

income

(c) State income tax refunds (caution-see instructions on page 7)

(d) Alimony.

(e) Other (state nature and source).

34

35

36

37

38

(1)

Total miscellaneous income (add lines 39(a), (b), (r), (d) and (e))

40 Total (add lines 34, 35, 36, 37, 38, and 39). Enter here and on line 15

PART III.-Adjustments to Income

41 "Sick pay'' if included in line 12 (attach. form 2440 or other required statement)

42 Moving expense (attach Form 3903)

43 Employee business expense (attach Form 2106 or other statement).

44 Payments as a self-employed person to a retirement plan, etc. (attach Form 2950SE)

45 Total adjustments (add lines 41, 42, 43, and 44). Enter here and on line 17

PART IV.—Tax Computation (Do not use this part if you use Tax Tables I-13 to find your tax.)

39

40

41

42

43

44

45

46 Adjusted

gross income (from line 13)

46

47 (a) If you iternize deductions, enter total from Schedule A, line 32 and attach Schedule A

(b) If you do not itemnize deductions, and line 4b is:

47

(1) $10,000 or more but less than $11,538.43, enter 13% of line 46

(2) $11,538.43 or more, enter $1,500.

Note: deduction under (1) or (2) is limited to $750 if married and filing separately.

48 Subtract line 47 from line 46

49 Multiply total number of exeniptions claimed. on line 11, by $675:

48

49

50. Taxable income. Subtract line 49 from line 48

150

(Figure your tax on the amount on line 50 by using Tax Rate Schedule X, Y or Z, or if applicabie, the alternative

tax

from Schedule D, income averaging from Schedle G, or maximum tax from Form 4726.) Enter tax on line 19.

PART V. Credits

51. Retirement income credit (attach Schedule R)

52 Investment credit (attach Form 3468)

53 Foreign tax credit (attach

Form 1116)

54 Total credits (add lines 51, 52, and 53). Enter here and on line 20

51

52

53.

54

PART VI.-Other

Taxes

55 Self-employment tax (attach Schedule SE) :

56 Tax from recomputing prior-year investment credit (attach Form 4255)

57 Minimum tax (see instructions on page 8). Check here Cl, if Form 4625 is attached

58 Social security tax on unreported tip income (attach Form 4137)

59 Uncollected employee social security tax on tips (from Forms W-2)

60 Total (add lines 55, 56, 57, 58, and 59). Enter here and on line 22

55

56

57

58

59

60

PART VII.-Other Payments

61 Excess FICA tax withheld (two or more employers-see instructions on page 8).

62 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136)

53 Regulated Investment Company Credit (altach Form 1439)

64 Total (add lines 61, 62, and 63). Enter here and on line 26

61

62

63

64

7,350

•33

11,000)

00)

6, 350|00

6,529/19

4,010 99

2

,518

20

4

2050

100

-0-

551|27

551: 27

94 4149144

W 88326 Docld:32245535 Page 93.

---

## Page 94

Schedules AaB-Itemized Deductions AND

(Form 1040)

Department of the Treasury.

Internal Revenue Service

Name(s) as shown on Form 1040

Samuel and

Dividend and Interest Income

• Attach to Form 1040.

1971

Phyllis Ruby

Your social security number

322 / 12 ÷ 7997

Schedule A--Itemized Deductions (Schedule B on back)

Medical and dental expenses (not compensated by insurance l

Contributions. -Cash-including

checks,

money orders, etc.

or otherwise) for medicine and drugs, doctors, dentists, nurses,

(Itemize-see instructions on page 10 for

hospital care, insurance premiuns for medical care. etc.

examples)

1 One half (but not more than $150) of in-

surance premiums for medical care. (Be

sure to include in lina 10 below)

2 Medicine and drugs

3 Enter 1% of line 18, Form 1040 .

• 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 Itemize other medical and dental ex-

penses. Include hearing aids, dentures;

eyeglasses, transportation, etc.

18 Total cash contributions .

19 Other than cash (see instructions on

page 10 for required statement). Enter

total for such items here .

20 Carryover from prior years

21 Total contributions

(Add

lines. 18,

19, and 20. Enter here and on line 29,

below.)

Interest expense.

22 Home mortgage

23

Instaliment purchases

24. Other (Itemize)

7 Total (add lines 4, 5, and 6)

8 Enter 3% of line 18, Form 1040

9 Subtract line 8 from line 7. Enter differ-

ence (if less than zero, enter zero)

10 Total deductible medical and dental ex-

penses (Add lines 1 and 9. Enter here

and on line 27, below.)

Taxes.

11 Real estate

12 State and local gasoline (see gas tax tables)

13 General sales (see sales tax tables) .

14 State and local income .

15 Personal property

16 Other

17 Total taxes (Add lines

11 through 16.

Enter here and on line 28, below.)

150

00

25 Total interest expense (Add lines 22,

23, and 24. Enter here and on line 30,

below.)

Miscellaneous. deductions for child

care,

alimony, union dues, casualty losses, etc.

(see instructions on page 10):

2,617 58

743

31

26

Total miscellaneous deductions (Enter

here and on line 31, below.) :

Summary of Itemized Deductions

27 Total deductible medical and dental expenses (from line 10)

28 Total taxes (from line 17) .

-.•

29 Total contributions (from line 21) :

30 Total interest expense (from line 25) .

31 Total miscellaneous deductions (from line 26) :

32 TOTAL ITEMIZED DEDUCTIONS. (Add lines 27 through 31. Enter here and on Form 1040), line 47) S

500

po

150,00

743

31.

2,617

68

500!

4,010.79

NW. 88326 Docld:32245535 Page 94

---

## Page 95

NAME..-

ADDRESS

SCHEDULE NO.

MEDICAL

1. ONE HALF OF MEDICAL INSURANCE

(NOT OVER $130.00)

3. DRUGS AND MEDICINES

3. LESS: 1% OF ADJ. GROSS INCOME

4. NET DRUGS AND MEDICINES

5. DOCTORS/DENTISTS

DR.

DR.

DR.

DR.

DR.

DR.

DR.

DR.

DR.

SaNDAL a PAYLES RUE IDENIFICATION NO, 3M1-1→2997

FEDERAL

150

SCHEDULE OF DEDUCTIONS

STATE

CONTRIBUTIONS

150/00

CHURCHES

YEAR ENDED

FEDERAL & STATE

COMMUNITY CHEST/UNITED CRUSADE

SALVATION ARMY/GOODWILL INDUSTRIES

RED CROSS

XMAS & EASTER SEALS

HEART FUND/CANCER FUND

PARTNERSHIP RETURN

PAYROLL DEDUCTION

OTHER ORGANIZED CHARITIES:

TOTAL CONTRIBUTIONS

INTEREST (TO WHOM PAID)

MORTGAGE LOAN

CLONEL/MTG

INSTALLMENT LOAN

FEDERAL & STATE

261268

MEDICARE

HOSPITAL

LABORATORY

BALANCE OF MEDICAL INSURANCE

NOT DEDUCTIBLE ON TOP LINE

TRAVEL FOR MEDICAL

AMBULANCE

GLASSES

HEARING AID

PROSTHETIC APPLIANCES

MEDICAL EXPENSES

LESS: REIMBURSED BY INSURANCE

6. TOTAL

7. LESS: 3% OF ADJ. GROSS INCOME

8. BALANCE (NOT LESS THAN ZERO)

9. TOTAL MEDICAL DEDUCTIONS

(LINE 1 PLUS LINE 8)

TAXES

AUTO LICENSE (LESS REG. FEE)

SALES TAX

SALES TAX AUTO

REAL ESTATE TAX

PERSONAL PROPERTY TAX

STATE INCOME TAX

GAS TAX /00% GAL @

c GAL.

150 100

FEDERAL

150%

STATE

100 00

TOTAL INTEREST

MISCELLANEOUS DEDUCTIONS

ALIMONY (EXPLAIN)

SAFE DEPOSIT BOX FEE

UNION DUES

SMALI. TOOLS (GOOD 1 YEAR)

TOOLS DEPRECIATION

SAFETY EQUIPMENT

UNIFORMS (NOT GEN. WEAR)

LAUNDRY & CLEANING

AUTO

' MILEAGE@

TELEPHONE EXPENSE (NOT REIMB.)

EMPLOYMENT AGENCY FEES

DUES & SUBSCRIPTIONS

INCOME TAX PREPARATION

OTHERS

167562

FEDERAL & STATE

57331

10000

033

2008

xxxx

7000

TOTAL MISC. DEDUCTIONS

CASUALTY LOSSES (EXPLAIN)

BORPNQUOKE

Lamess

FEDERAL & STATE

31000

DISABILITY INSURANCE

MISC. TAX

OTHERS:

• x*

SUB TOTAL

LESS REIMBURSED BY INS.

SUB TOTAL

LESS $100.00 FOR EACH CASUALTY

TOTAL CASUALTY LOSSES

7433 73

TOTAL DEDUCTIONS

3100 0

20 00 00

600.01

10000

5000

FEDERAL

4010991

TRO FORMe

TOTAL TAXES

NW88326 Rogld; 37245525 Page 25

STATE

401099

16633 VENTIIRA RAIlIFVARD

CIlITE K10

FNCING CAIIEADNIA Q121E

---

## Page 96

ULE C

Profit (or Loss) From Business or Profession

m

1040)

(Sole Proprietorship)

epartment of the Treasury

Partnerships, joint ventures, etc., must file on Form 1055.

Intornal Pevonuo Sarvico

Attach to

Form 1040.

Name(s) as shown on Form 1040

Samel and

Phyllls Ruby

Food Service

1971

Social security number

327

12 | 7097

A Principal business activity

(Sea separate instructions)

i product

(For example: retail-hordware; wholesaia--tobacco; services--legai; manufacturing--furniture; etc.)

B Business name ---..

Snack

• Bar

D Business address

5418 Van Nuvs

...

Van

C Employer Identification Number

California

91401

E Indicate method of accounting: (1) X cash; (2) Li accrua!;

(3) Cl other.

(ZIP code).

F Was there any substantial change in the manner o! determining quartities, costs, or valuations between the opening and closing inventories?

D YES I& NO.

If "Yes," attach explanation.

G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 1.971? (See "Item G"' in separate instructions for Schedule C.)

D YES & NO.

If "Yes," where were they filed? »

Gross receipts or gross sales $

... Less: Returns and allowances $

2 Invontory at beginning of ynar if ditferent trom last year's clone inventory

attach explanation)

3

Merchandise purchased $..

, less cost of any iteins

withdrawn from business for personal use $...

1

Cost of labor (do not include salary paid to yourself)

Material and supplies

6

Other costs (explain in

Schedule C-1)

Total of lines 2 through 6

8

Inventory at end of this year

9

Cost of goods sold and/or operations (subtract line 8 from line 7)

10 Gross profit (subtract line 9 from line 1)

OTHER BUSINESS DEDUCTIONS

11 Depreciation (explain in Schedule (-2)

12 Taxes on business and business property (explain in Schedule C-1) -

13 Rent on business property

14 Repairs (explain in Schedule C-1)

15 Salaries and wages not included on line 4 (exclude any paid to yourseif)

16 Insurance

-..•

17. Legal and professional fees

18. Commissions

19 Amortization (attach statement)

20 (a) Pension and profit-sharing plans (See Instructions).

(b) Employee benefit programs (See Instructions) .

21 Interest on business indebtedness

22

Bad debts arising from sales or services .

23 Depletion .:

24 Other business expenses (explain in Schedule C-1) •

25

Total of lines 11 through 24

26 Nat profit (or loss) (subtract ling 25 from ling 10). Enter hore and on line 34, Form 1040. ALSO enter on

Schedule SE, Part I, line 1

Line No.

Explanation

SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24

Amount

Lina No.

Explanation

$

SCHEDULE

ATTACHED

7.350 1

Amount

$.

$..

NW 88326 Docld:32245535 Page 96

---

## Page 97

Samuel and Phollis liby

SUPPLEMENT TO SCHEDULE C

Income

Less: Sales Tax

Cost of Conde sold

Berinning Inventor!

Purchases

Beverage/milk

Groceries

Meat

Bakerv./hread

Total Available

Less: Ending inventory

Adjusted Gross Profit

Expenser

Casual lahor

Rent

Payroll

Telephone

Insurance

Advertising

Accounting

Miscellaneous

Fquipment

Maintenance/repairs

Taxes/licenses

Hosiery

Alto

Linen

Donations

1es9: Depreclatlon

NET PROFTT

Fruipment

Covenant not

to Compete

Leasehold Imp.

(Bal, of Lease)

4/70

510,000.00

5.000.00

3,000.00

$43,479.18

174.63

043, 3014.55

800.00

4,980.70

15,16?.50

2,570.35

819.6

$26,336:17

800.00

25,536.17

$17,768:38

$

48.12

1,459.87

3, 640.03

148.00

190.50

43.70

175.00

27.04

74.03

136.19

558.06

130.04

317.14

17.83

24.00

DEPRECIATION

$2,000.00

1,000.00.

$28.50

5 "r. SL

5 TI.

7 Yr. al.

6,989.55

510,778.83

(3,429:50)

$ 7,350.33

52,000.00

1,000.00

428

50

$3,428.50

W 88326 Docld:32245535 Page 97

---

## Page 98

SCHEDULE SE

(Forn 1040)

Computation of Social Security Self-Employment Tax

Department of the Treasury

internal Revenue Service

→ Each self emmoved person must file a Schedule St.

Attach to Form 1040.

1971

• If you had wages,

Including tips, of $7.800 or more that vere subject to social security taxes, do not fill in this page.

• 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 sociai security record and used in figuring social security benefits:

Name of self-empioyed person (as shownion social security card)

Social

security • number

of self-employed person

322 : 12÷7997

Samuel Ruby

Business activities subject to self-employment tax (grocery store, restaurant, farm. etc.) »

Computation of Net Earnings from BUSINESS Self-Employment (other than farming)

1 Net profit (or loss) shown in Schedule C (Form 1040), line 26. (Enter combined amount if more than one

business.)

7,350|33

2 Net income (or loss) from excluder cervices or sources includder on late t

Specify excluded services or sources

3 Net earnings (or loss) from business self employment (Subtract line 2 from line 1. and enter here and

on line 8(a). Part I1l below.)

7,350, 33

Partillas Computation of Net Earnings from FARM Self-Employment

SE

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) inore 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

lines 4 and 5.

Computation under Regular Method

4 Net farm profit (or loss) from:

(a) Schedule F, line 52 (cash method), or line 71 (accrual method)

(b) Farm partnerships

5 Net carnings fron self-employment from farming.

Arld lines 4(i1) ind (b)

Computation under Optional Method

6 •ll gross profits froin farining are:*

(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

*Note.-Gross profits from farming are the total of the gross profits from Schedule F,

or line 69 (accrual method), plus the

distributive share of gross profit from farm

partnerships as explained in instructions tor Schedule SE.

7 Enter here and on line 8(b), Part Ill, below, the amount on line 5 for 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 line 3, Part I, above

(b) From farming (from line 7, Part I1, above)

(c) From partnerships, joint ventures, etc. (other than farming)

(d) From service as a minister, member of a religious order, or a Christian Science practitioner. 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.). Specity

9 Total net earnings (or loss) from self-employment reported on line 8

(If line 9 is less than $400, you are not subject to self-employment tax. Do not fill in rest of page.) :.

10 The largest amount of combined wages and self employment earnings subject

to social security tax is

$7,800

00

11 (a) Total "FICA" wages as indicated on Form W-2

(b) Unreported tips, if. any, subject to FICA tax from

Form 4137, line 9

•.•

(c) Total of lines 11(a) and 11(b) .

12 Balance (subtract line 11(c) from line 10).

13 Self-employment income-line 9 or 12, whichever is smaller

14 If line 13 is $7,800, enter $585.00; if less, multiply the amount on line 13 by .075

15 Railroad employee's and railroad employee representative's adjustinent for hospital insurance benefits

tax from Form 4469

16. Self-employment tax (subtract line 15 from line 14). Enter hore and on Form 1040, liac 55

7.350 33

7,350, 33

7,350

551

33

| 27

357. 27

NW 88326 Docld:32245535 Page 98

---

## Page 99

SCHEDULE D

(Form 1040)

Department of the Treasury

Internal Revenua Serace

Name(s) as shown on Form 1040

Samuel and

Phullis Rubv

Capital Gains and Losses

Attach to. Form 1040.

→ Examples of property to be reported on this Schedule are

gains and losses on stocks, bonds,

and similar investments, and gains (but nut losses)

on personal assets such as a home or jewelry.

1971

a social security number

Partit

Short-term Capital Gains and Losses-Assets Held Not More Than 6 Months

3. Kind of property and description.

(Esample, 100 shares of "'2" Co)

h. Hom

acquired.

Enter tetter

symbol (sen

insiructions)

Mo., day

yr.

dotted line and data

acquired brint

dotted line,

d. Gross sales price

a Cost or other basis,

as adjusted, cost of sub:

sequent improvements

fit not purchase f, altach

explanation) and ex.

ponse of sale

f: Gain or (loss)

(d less a)

SCHEDULE ATTACHED

(1,249 /092

2

3

4(a)

4(b)

5

Enter your share of net short term gain or (loss) from partnerships and fiduciaries .

Enter net gain or (loss), combine lines 1 and 2

Short term capital loss component carryover from years beginning before 1970 (see Instruction H)

Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction H)

Net short term gain or (loss), combine lines 3, 4(a) and 4(1)

art ll

Long-term Capital Gains and Losses- Assets Held More Than 6 Months

5

3

4(a)

4(b)

5

7

Capital gain distributions

8

Enter gain if applicable from line 4(a) (1), Form 4797 (see Instruction A) .

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)

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 H)

12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) :

Net long term gain or (loss), combine lines 11, 12(a) and 12(b)

EPärtilll

Summary of Parts I and Il

Combine the amounts shown on lines 5 and 13, and enter the net gain (loss) here

If line 14 shows a gain-

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

(b) Subtract line 15(a) from line 14. Enter here and on line 35, Form 1040

15

If line 14 shows a loss-See Instruction I.

= Omit lines 16(a) and 16(b) and go to Part IV if losses are shown on lines 12(a) and 13.

= 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;

(ií) If amount on line 13 is zero or a net gain, enter amount on line 14; or.

(ill) If amounts

on line 5 and line 13 are net losses, enter amount on line 5 added to

50% of amount on line 13.

(b) Enter here and on line 35, Form 1040, the smaller of:

(i) The amount on line 16(a);

(ii) $1,000 ($500 if married and filing a separate return-if losses are shown on lines

4(a) and 5, see Instruction K for a higher limit not to exceed $1.000); or,

(ili) Taxable income, as adjusted (see instruction J)

NW 88326 Docld:32245535 Page 99

7

8

9

10

11

12(a)

12(b)

13

14

15(a)

15(b)

114,274

nộ)

(14.274

00)

(15, 522 00)

16(a)

16(b) ( 1,200 100)

Carry yes. 11-1: ($14,522.00)

---

## Page 100

114411

SALESMAN BachE sCi

CUSTOMER

NAME

ТУРЕ

BUSINESS

Planned

Description

Decé

siqueited

213-13 -70

158/2-31-20

yer Corp

2casl-12-7i

110x (0x0, 501-6-74

LSAM Fletcer 7001-19-1

dusay EnC 300 2-4-74

2002-371

Lease 34508002-14-91

112Y SerV (XPx50.3-16=71

Heysery: 2002-16-12

ucky Frid(b 200 3-4-74

igtiger vn3-1271

bis Pic totar 3-11-71

aciciut503-11-14

LeclAir Gatt 300 3-26-911

"TALS

NW 88326 Docld:32245535 Page 100

WEEKLY WORK PLAN/ TIME REPORT

CONTRACT

APPLICATION

і-S41

ONE TIME

олії і

3/00

MONTHLY

2422-

3115 RiCO

1- 14-5/13,133 г

215÷1

1-19-11

277.

ZL5-

1. 22.01 10 7313,691

2:3-724,220/372-

262277224

2-1770,944-1,9.301

226:012,320-2,3:3

3-4-7144it-3,5.36

3-4-72.5/4-

521

3-9-11 2113-260-

3-10-1143 5-3274-

3-/27/4113-6156-

3-21 1/3,501 36.11

3-24-77%

253-

4-6-1/ 3.31-3,465-

corest raid dasin ta

CALI

HRS

HIR

COMMENTS AND

EXPENSE

NOTES

121-

27.5-

Eií-

479-

522-1

125-10

69-

35-

(123)

(24-)

68-

541-

(32-)

(5.57-)

(47-)

(76-)

---

## Page 101

=:

SALESMAN BACHENCÙ

CUSTOMER

NAME

TYPE

BUSINESS

D.124

25сіртом

ісції

IbsNati Geniste 3013-9-71

15 Nat (Ge, 16p 41:1003-5-71

Planned

5

VERKLY WORK

RE FLAR TIME REPORT

CONTRACT

APPLICATIÓN

REVENUE

BOOKED

CALL

HIRS

ONF TIME

MONTILY HIP

Print

354-4

3.35

COMMENTS AND

EXPENSE

NOTES

maintena

5. /4:21

AtsLacns Theat 100 4-301-121

its.NotleNstTing 2004-6-74

tis NethiNst Iix/ip0,5061-71

5-14-7/

486-

6-1-2 2EL2091

11L35751956

Aspublic Cor

-2004 - 4-79

salitrunDerices

Gescrts Tutratl 3a 6-4-94

4-1-71

457-

554-

5-2:193 2B2 114E

524-11 1031- 1615-

824744301-52

5-34-11143-5,422-

1-24-74-3,411-14,149

72-

(370-)

115-

552 -

42-

(95-)0

(171-)

: 3E6d

(648-)

5979)

(1037)

TOTALS

NW 88326 Docld:32245535 Page 101

---

## Page 102

CUSTOMER

NAME

Discription

Er May Sugar

TYPE

BUSINESS

Pal

Planned

WEEKLY WORK PIAN/TIME REPOR

CONTRACT

APPLICATION

AEL ELE

34121

WEEK ENDING

REVENUI

BOOKED

ONE TIME

2101

MONTHLY

1-14-71

123

it-12-74

15 la

1-10-17

71 -

5756

L

CALL

HRS

HR

• COMMENTS AND

EXPENSE

NOTES

/

11-12-71

1 11-10-71

Ly Mar Plyway

11-11-7:

LI. May Sugar 211. 23-31

FiT. Nay Sugar L443677

tx May Sugar

1/1-24-24

V2=23-74

ix Mayll Sugar /

12-3-74

L2-5=*

12-144

12-15-74

3 24

121-74 523

K11-71 22-

12572.525

12-1271 523

1260

234

5.35

12-15-292005

4025

Torsic SiT- LoT

-23=

34 -

(3, -)

(65):

(35/-)

248-

(222)

13417-

(7355. 00)

TOTALS

W_88326 Docld:32245535 Page 102

---

## Page 103

ente tenne1.

OVERLY WORK PLAN TIME REPORT

SALESMAN MesTill Lych

Mera maBm 220310:

L WEEK ENDING

CONTRACT

P.EVENUE

BOOKED

CUSTOMER

NAME

Planned

Lescription

ТУРЕ

BUSINESS

Da÷-

Liquiret

PREM

INTL

APPLICATION

2aT

ONE TIME

MONTHLY

mirano.

coll

tleH1174115419

CALI

HRS

HR

k-901

1023 - 202

COMMENTS AND

EXPENSE

NOTES

in (loca)

it'/ Gen'| (oxp s0cn 4-15-71

104-712293-3927-

31-

11V.546.93-452

5009-14-71

5°CE 10-8-71

186-45010

5x0914-71

14-8-1 3951-

3127

VC-2-112451-2446

16 15 27:13

1411.0

34-

213-

(38-)

156 4.590

cirer Coro

1-93- 50%0

5000

10-1371

3t! Gen'! Cora

4x 54093406

1g297

i1-19-71

11-18-223716- 2610

12177/1030-

TOTA

15?-

10,0

W.88326 Docld:32245535 Page 103

---

## Page 104

SCHEDULE

CALIFORNIA

FORM 540

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

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

Samuel and Phyllis Puby

SHORT-TERM-ASSETS HELD NOT MORE THAN & MONTHS

(Example,

Kind of to eyes neecrioto.)

snares ni

Co.)

b. Date acquired

(mo., day, yr.)

c. Date soid

(mo., day, yr.)

d. Gross sales price

e. Cost or other baits, a:

adjusted, cost oi

subsequent improvements

tif not purchased.

attach explanation)

and expense of sale

TAXABLE

1971

YEAR

322

Sccial Sacurity Number

:12

:7997

1.

Gain cr

loss

(u less e)

• SCHEDULE. ATTACHED

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. Enter unused short-term capital loss carryover from preceding taxable years (attach statement)

5. Net short-term gain (or loss), combine lines 3 and 4

LONG-TERM-ASSETS HELD MORE THAN 6 MONTHS

(0,248.009

7. Enter gain if applicable from line 4, Schedule D-1 (Form 540) (attach copy)

8. Enter your share of net long-term gain (or. loss) from partnerships and fiduciaries

9. Net gain (or loss), combine lines 6 through 8

10. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)

11. Net long-term gain (or loss), combine lines 9 and 10 :

(14.274,00)

12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here

13. If line 12 shows a gain

(a) Enter 50% of line 11 or 50% of line 12, whichever is smaller. Enter zero if there is a loss or no entry on line 11

(b) Subtract line 13(a) from line 12. Enter here and on line 32, Form 540 (line 33, Form 540NR)

14. If lina 12 shows a loss

(a) Add lines d and 10 (if lines 4 and 10 are blank, enter a zero here and on lines 14(b) and 14(c) and go to

line 14(d)).

(b) Combine lines 3 and 9-if gain, enter gain; if loss, enter zero.

(c) Enter smallest of. (i) line 14(a) less line 14(b); (ii) the amount of taxable income on Form 540 or 540NR,

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)

(e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital jains

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) and 14(e)-(Do not

enter an amount greater than $1,000)

(15, 522.00)

‹ 1,000.00)

Carriover (1-1). ($14,5:2.(0)

San Instructions on Back

NW 88326 Docld:32245535 Page 104

---

## Page 105

• FORN

540

PESIDENT

CALIFORNIA

TAXABLE

1971

INDIVIDUAL INCOME TAX RETURN

YEAR

DO NOT WRITE ON THIS LINE

For Calendar Year 1971

or Fiscal Year Begun

1971 and Ended

FIRST NAME(S) AND INITIAL(S)

SAMUEL AND PHYLLIS

Please

PRESENT HOME ADDRESS (Number and

street, or rural route)

Of

Print

16250 Bircher Street

CITY, TOWN OR POST OFFICE

Granada Hills

NAME AND ADDRESS OF EMPLOYER AT TIME OF FILING

Self Employed

FILING STATUS-Check Only Une:

Claim your appropriate

exemption on line 16

1. D Single

2. O Married, filing joint return

3. O Married, filing separate return-If this item checked, enter spouse's

security number in space above and enter.

first name

1972

LAST NAME

RURY

STATE

California

Yeur

social security number

322

: 1?.

7997

Your occupation

Self Emploved

COUNTY

Tos Anceles

Spouse's social security cumber

349

: 18

1420

Spouse's occupation

ZIP CODE

BLIND and/or DEPENDENT EXEMPTIONS:

5. Blind

I/ Yourself 1.f Your spouse -Enter number of boxes checked

6. Dependents--Do not list yourelf, your spouse, or person who qualities you

as head of houschold NAME tand adiess if diflerent from yours) . RELATIONSHIP

Fred, Brian Elis?, Thomas

Enter

number

5

here s

4. O Unmarried "head of household" -Complete Part I, page 2

7. Total blind and dependent exemptions (add lines 5 and 6)

8. Wages, salaries, tips, etc. (before payroll deductions) if more than two employers; attach list

Employer's name

Where employed (city and state)

Income

Do not write

in• this.col 3s

8

HERE

ATTACH REMITTANCE

9. Dividends. Enter total here (complete and attach Schedule B 1540), if total is over $100)

9

10. Interest. Enter total here (complete and attach Schedule B (540), if total is over $100)

10

11. Other income (from page 2, lins: 40)

11

12. Total (add lines 8, 9, 10 and 11)

12.

42

178

6,350

6.571

13. Adjustmonts to Income (rom page 2, lina 16)

13

14. Adjustad gross income (subtract line 13 from line 12)

14

6,571

• If you do not itemize deductions AND line 14 is under $10,000, find your tax in Tix Table in instructions.

Enter tax on line 15:

• If 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.

15. Tax from (check one): [ Tax. Table, La Tax Computation (page 2, Part IV) or EJ Schedule G (540): line 21

16. Personal Exemption. Single—$25. Married couple or head of household--$50

16

50.

17. Multiply total number. of exemptions on line 7 above, by $8

17

3:2

18. Total exemptions (add lines 16 and 17)

19. Tax liability (subtract line 18 from line 15-not less than zero)

20. Other credits (from page 2, line 62)

21. Net tax (subtract line 20 from line 19)

22. Tax forgiveness-20% of line 21 luse Part V on page 2; if reporting income on Schedule D (540))

00

100

18

19

20

21

22

NOTE: You must file your return and pay any tax due (line 27) by the due date to ba entitled to this forgireness

23. Net tax liability (subtract line 22 from line 21-if $1.00 or less, enter zerol

24. Tax on preference income (see instructions) check here , if Schedule P (540) is altached

25. Total tax liability (add lines 23 and 24)

23

24

25

50

86

33.

25.60

82.00

- None.

Balance:

Dus or

Refund

26. 1971 California estimated tax payment (include 1970 overpayment allowed as a credit)

27. Balance dug-if any (subtract line 26 from line 25)

28. Overpayment-if any (subtract line 25 from line 25)

29. Portion of line 28 you wish to apply on 1972 estimated tax

30. Refund-if any (subtract line 29 from line 28)

26

PAY IN FULL WITH RETURN

OVERPAYMENT

None

REFUND

28

29

30

Under

penalties of perjury,

I declare that I have examined this return. including accompanying schedules and stalements, and to the best of my knowledge and

seivef 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

Sign

M

knowiedge.

signature if fling jointly, BoTH must sign

Date

Signature of prepares other than taxpayer

here

SUITE 110

91÷16

signature

Date

Address

gate

Enter Your Social Socurity No. on Your Chock or Monay Order. Make Remittance Piyable 10

VW 88326 Docia:2295439 Page 105 FRANCHISE TAX BOARD, SACRAMENTO, CALFORMA 95001

•RANCHISE TAX

Do not write in these spacza

T

---

## Page 106

Form 540 1971 Page 2

PART, *-Head of Household-If claimed, answer the following questions (See Instructions)

Check

Never married

Legal separation (interlocutory decree does not qualify)

Dâte..

one:

[/ Widow(er) Date.

Final divorce/dissolution Date

Individual who qualified you as head of household:

Name.

Is this person married?

the calendar year 1971?.

Relationship

If yes, did he or she file a joint return with spouse?

Did this person reside in your home for the entire taxable. year?

Age..

Gross income $.

Did this person qualify as your dependent for

.If not, explain circumstances.

Total amount necessary ie maintain household $

How much did you contribute? $

PART IL Other Income

31. Business income (or loss) (attach Schedule C (540))

32. Net gain (or loss) from sale or exchange of capital assets (attach Schedule D (540))

33: Net gain (or loss) from Supplemental Schedule of Gains and Losses (attach Schedule D-1 (540))

34. Pensions and annuities

35. Rents and royalties

36. Partnerships

Attach

Schedule E

(Form 540)

37. Estates and trusts

38. Farm income (or loss) (attach Schedule F (540))

(a) Fully taxable pensions and annuities (not reported on Schedule 0

39. Miscel

laneous

Income

Alimony

(c)

Other (state nature and source)

31

32

33

34

35

36

37

38

...

(d). Total miscellaneous income add lines 39(a), (b) and (c)

40. Total (add lines 31 through 39). Enter here and on page 1, line 11

39

40

PART Ill- Adjustments to Income

41. "Sick pay" if included in line 8 (see instructions-attach statement)

42. Moving expenses (see instructions-attach statement)

43. Employee business expense (see instructions-attach statement)

44. Military exclusion (see instructions for line 8)

15. Payments as a self-employed person to a retirement plan, etc., (attach Federal Form 2950SE)

15. Total adjustments (add lines 41 through 45). Enter here and on page 1, line 13

41

42

43

44

45

46

.°

PART IV-Tax Computation-Do not use this part if you use the Tax Table to find your tax

47. Adjusted gross income (from page 1, line 14)

18. (a) If you itemize deductions, enter total from Schedule A (540), line 32, and attach Schedule A

(b) If you 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 line 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

47

48

49

PART V-Tax Forgiveness

Complete all lines below. However.

f you used the income averaging method to compute your lax on line 15. omit lines 50

51 and 52, enter on line

53 the

amount shown on. line 41 of Schedule G (540), and complete. lines. 54. 55 and 56

30. Taxable income from line 49 above, or page 1, line 14 if Tax Table used

31. Amcunt (if any) entered on Schedule D (540), line 13(a)

32. Adjusted taxable income (subtract line 51 from line 50)

S3. Adjusted tax (use same method. as used for determining tax on page 1, line 15)

§f. Add lines 18 and 20, page 1, and enter total here

§5. adjusted net tax (subtract line 54 from line 53)

56: 20% of line 55. Enter here and on page 1, line 22

PART VI-Credit for Net Income Tax Paid to Another State-Attach copy of "other state" return —and Retirement Income Credit

57. Income derived from sources within State of

and also taxable by California

38. California adjusted gross income (from page 1, line 14)

-3. California tax liability (from page 1, line 19)

=0: Credit limitation-line 57 ÷ line 58

% (100% maximum) x line 59 (cannot exceed tax paid other state)

51. Retirement income credit (attach Schedule R (540))

i2. Total dadd lines 60 and 611. Enter here and in page 1, line 20

50

51

52

53

54

55

56

57

58

59

60

61

62

1,350

11.000

33

00)

6

1, 350

33.

6,57.1

.69

4,010

1.919

2,560

70

ART VIl-Reconciliation to Federal Return-If adjusted gross income on Federal Return is different froni line 14, page 1, explain below

88326 Docld:32245535-Page 106

20121004112 COCH(1) ^ OBP

---

## Page 107

SCHEDULE

CALIFORNIA

FORM 540

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

19

71

YEAR

Nama as shown on Form 540

Samuel and Phyllis Ruby

itemized is. Standard Deduction You have a choice

two deduction

You can either itemize your deductions or take a standard deduction as

explained in the 540 Instructions. On separate returns of a husband and wife,

Social Security Number

32.2

12

:7992:

if one spouse itemizes deductions, the other may not use the Tax Table or cia;

the standard deduction. If you choose to itemize your deductions; complete ti

appropriate items below.

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 hali (but not more than $150) of insurance premiums for medical care

2. Medicina and drugs

3. Enter 1% of adjusted gross income shown on Form 540

4. Subiract line 3 from line 2. Enter difference (if less than zero, enter zero)

5. Enter balance of insurance premiums for medical care not entered on line 1

6. Other medical and dental expenses (attach itemized list)

7. Total-(Add lines 4, 5 and 6)

8. Enter 3% of adjusted gross income shown on form 540

9. Subtract line 8 from line 7. Enter difference (if less than zero, enter vero)

10. Tolal--(Add lines 1 and 9)

9

10

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 line 11-See instructions for maximum limitations

Taxes

14. Real estate

15. State and local gasoline

16. General sales

17. Auto license-Excess of registration and weight fees (see instructions)

18. Personal property

19. State disability insurance (SDI)-Employer private disability plans do not qualify

20. Other. (specify)

21. Total taxes-(Add lines 14 through 20)

Contributions

22. Cash-Including checks, money orders, etc. (itemize)

23. Total cash contributions

24. Other than cash (see instructions).

Enter total here

25. Total-Add lines 23 and 21-Maximum deduction may not exceed 20% of adjusted pross income

Intarest Expansa

28. Home morigage

27. Installment purchases

28. Other (itemize)

29. Total-lAdd lines 26, 27

and 28)

Miscollaneous Deductions

J0. For child care, alimony, union dues, casualty losses, etc.--See instructions (itemize)

150

p0

12

13

15

1€

17

18

19

20

21

743

•31

22

.23

24

25

26

27

28

29

2,617

30

31

.32

500 00

31. Total miscellaneous deductions

32. Total daductions-Add lines 10, 13, 21, 25, 29 and 31. Inter total here and on form 10, page 2: in space provided

(Ror. 1971)

Schodulo B on ravorso

NW 88326 Docld:32245535. Page 107

S/:

---

## Page 108

SCHEDULE

CALIFORNIA

TAXABLE

19

71

FORM. 540

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

YEAR

Astoch this schedule. to your income tax roturn, form 540 or 540NR

Name as shown on Form 540 or 540NR

Samuel and Phullls Ruhy

Food Service

A. Principal business activity

Parinerships, joini ventures, etc., must file on Form 505

Social Secuity Number

322

÷12

7997

; product

(For oxample: retail-hardwaro; wholosole-tobar.co; services-legal; manufacturing-furniture; etc.)

B. Business name...

D, Business location

Snack Bar

5418 Van Nuys Blvi.

van Wurs,

call fedia

Federal employer identification number.

(Number and ¿treat or rural routo)

(City-past offico!

(State)

(ZIP coda:

E. Indicate method of accounting: [ cash; 0 accrual; J other (describe)

F. Was there any substantial change in the manner of determining quantities, costs or valuations between the opening and closing

inventories? O Yes E No. If "yes," attach explanation.

G. Were Forms 591, 592, 586 and 599, for the calendar year filed (if required)? Yes a 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 citach

explanation) .

3. Merchandise purchased $

, less cost of any items with.

drawn from business for personal use $

4. Cost of labor (do not include salary paid to yourself)

5. Material and supplies

6. Other costs (explain in Schedule C-1)

7.

Total of lines 2 through 6

8. Inventory at end of this year.

9. Cost of goods sold and/or operations (subtract line 8 from line 7)

10. Gross profit (subtract line 9 from line 1)

OTHER BUSINESS DEDUCTIONS

11. Depreciation (explain in Schedule C-2)

12. Taxes on business and business property (explain in Schedule C-1)

13. Rent on business property

14. Repairs (explain in Schedule C-!)

15. Salaries and wages not included

on line 4 (exclude any: paid to yourself)

16. Insurance

17. Legal and professional fees

18. Commissions

19. Amorlization (attach statement)

20. (a) Pension and profit-sharing plans (see instructions)

(b) Employee benefit programs (see instructions)

21. Interest on business indebtedness

23. Bad debts arising from sales or services

23. Depletion of mines, oil and gas wells, timber, ete. (altach schedule)

24. Other business expenses (explain in Schedule C-l)

25.

Toral of lines 11 through 24

26. Net profit (or loss) (subiract line 25 from line 10). Enter here and on page 2, Form 540 or 540NR

S.

SCHEDILE

ATTACHED

$

7,350

33

Line No.

Explanation

SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24

Amount

Line No.

, Explanation

Amcunt

$

$

20y. 1971)

W 88326 Docld:32245535 Page 108

Page

---

## Page 109

9:..

1040

US

Department of the Treasury-Internal Revenue Service

Individual Income Tax Return

71973

For the year January 1-December 31, 1973, or other taxable year beginning

1973, ending

19..

Name (If joint return, give first names

and i

atials of both)

Last name

COUNTY OF

SAMUEL

HULLIS.

KuB!

RESIDENCE

Your social security number

32212 7989

resent home address (Number and street, including apartment number, or rural rou

16250

BIRCHERIT

Los

ANGELEI

Spouse's social security no:

City, town or post office, State and ZIP code

GRANADA

HILLS CALLE

Осси-

Yours D

349.18 1º20

pation

Spouse's

HIN

Filing

Status-check only one:

Exemptions

Regular / 65 or over / Blind

Single

6a Yourself . .

Married filing joint return (even if only one had income)

₴

Married filing separately. If spouse is also filing give

spouse's social security number in designated space above

4

5

8

of Forms W-2 here

Income

Please attach

Order. Attach here

Money

and Credits

Tax, Payments

c First names.of your dependent children who lived with

THOMA.

and enter full name here D

ELISA - FRED

number D

3

Unmarried Head of Household

d Number of other dependents (from line 27) . .

Widow(er) with dependent child (Year spouse died → 19

7

Total exemptions claimed

.D

Presidential Election Campaign Fund.-Check] if you wish to designate $1 of your taxes for this fund. If joint return,

check [ if spouse wishes to designate $1. Note:

This will not increase your tax or reduce your refund. See note below.

(Attach Forms W-2. If

9

Wages, salaries, tips, and other employee compensation.

unavailable, attach explanation)

9

Dividends (See instructions) s

on page 6.

4%0, 101 Less exclusion s.9

1od (Gross amount received, if different from line 10a

10c

$

11

Interest income

12

Income other than wages, dividends, and interest (from line 38) .

13

Total (add lines 9, 10c, 11, and 12)

14

' Adjustments to income (such as "sick pay," moving expenses, etc. from line 43)

-15

Subtract line 14 from line 13 (adjusted gross income) .

11

12

13

14

15

348

16196

16541.

16541

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.

CAUTION. If you have unearned income and can be claimed as a dependent on your parent's return, check here »

• and see instructions on page 7.

16

Tax, check if from:

Tax Tables 1-12

Tax Rate Schedule X, Y, or Z

Schedule D

Schedule G

Form 4726 OR

Form 4972

17

Total credits (from line 54)

18

Income tax (subtract line 17 from line 16).

19

Other taxes (from line 61)

20

Total (add lines 18 and 19)

16

17

18

19

20

1095

1095

396

149.1

21a Total Federal income tax withheld (attach Forms

W-2 or W-2P to front) :

b 1973 estimated tax payments (include amount

allowed as credit from 1972 return)

21a

b

c Amount paid with Form 4868, Application for Automatic

Extension of Time to File U.S. Individual Income Tax Return

• d Other payments (from line 65)

22

Total (add lines 21a, b, c, and d)

22

Check

5

Pay in full with return. Make

Due

Balance

or Refund

23

If line 20 is larger than line 22, enter BALANCE DUE IRS

check or money order payable

to Internal Revenue Service

23

14.91

(Check here → , if Form 2210, Form-2210F, or statement is attached. See instructions on page 8.)

24

If line 22 is larger than line 20, enter amount OVERPAID

25

' Amount of line 24 to. be REFUNDED TO YOU

24

25

26

Amount of line 24 to be credited on 1974 esti-

mated tax

26

Note: 1972 Presidential Election Campaign Fund Designation.-Check [ if you did not designate $1 of your taxes on your

1972 return, but now wish to do so. If joint return, check if spouse did not designate on 1972 return but now wishes to do so.

Under penalties of perjury, ! declare that I have examined this return,

including accompanying schedules and statements, and to the best of my knowledge and belief

It is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he has any knowledge.

Sign

here

Your signature

: Date

Preparer's signature (other than taxpayer)

Date

367-34-8729

Spouse's signature (if filing jointly, BOTH must sign even if only one had income)

Address (and ZIP Code)

Preparer's Emp. Ident. or Soc. Sec. No.

16-82337-2

03717 VANOIVEN STREET

¡NAN NUYS,

CA. 91403

367-34-8729

NW 88326• Docld:32245535 Page 109

---

## Page 110

Form 1040 (1973)

(a) NAME

(b) Relationship

Other

Dependents

(c) Months lived in your

home..If

born

died

during year, write BorD.

(d)

Did

"de-

pendent

have

of.

$750 or more?

(e)

Amount

YOU

furnished

for

de-

pendent's

port

sup

100%

write ALL.

$

27 Total number of dependents listed in column (a). Enter here and on line 6d

Partil 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 Supplementa! Schedule of Gains and Losses (attach Form 4797)

31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E).

32 Farm income or (loss) (attach Schedule F)

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)

35 State income tax refunds (standard

not. apply

instructions on took the

36 Alimony received

37 Other (state nature and source)

38 Total (add lines 28, 29, 30, 31, 32, 33, 34, 35; 36, and 37). Enter here and on line 12

28

29

30

31

32

33

34

35

36

37

38

SPart Wa3 Adjustments to Income

39 "Sick pay." (From Forms W-2 and W-2P. If not shown on Forms W-? or W-2P, attach Form 2440 or statement.)

40 Moving expense (attach Form 3903)

41 Employee business expense (attach Form 2106 or statement)

42 Payments as a self-employed person to a retirement plan, etc. (see Form 4848) :

43 Total adjustments (add lines 39, 40, 41, and 42). Enter here and on line 14

Tax Computation

(Do not use this part if you use Tax Tables 1-12 to find your tax.)

gross income (from line 15)

45 (a) If you itemize deductions, enter total from Schedule A, line 41 and attach Schedule A

39

40

41

42

43

44

45

(b) If you do not itemize deductions, enter 15% of line. 44, but do NOT enter more than

$2,000. ($1,000 if line 3 checked)

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

46

47

48

(Figure your tax on the amount on line 48 by using Tax Rate Schedule X, Y, or Z, or if

applicable, the alternative tax from Schedule D, income averaging from Schedule G, max-

imum tax from Form 4726, or special averaging from Form 4972.) Enter tax on line 16.

Pärtel!

Credits

49 Retirement income credit (attach Schedule R). . .

50 Investment credit (attach Form 3468)

51 Foreign tax credit (attach Form 1116)

52 Credit for contributions to candidates for public office-see instructions on page 9

53 Work Incentive (WIN) credit (attach Form 4874)

54 Total credits (add lines 49, 50, 51, 52, and 53). Enter here and on line 17

49

50

51

52

53

54

@Partive Other Taxes

55 Self-employment tax (attach Schedule SE)

56'Tax from recomputing prior-year investment credit (attach Form 4255)

57 Tax from recomputing prior-year Work Incentive (WIN) credit (attach schedule)

58 Minimum tax. Check here & , it form 4625 is attached

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

55

56

57

58

59

60

61

Part VIL Other Payments

62 Excess FICA tax withheld (two or more employers-see instructions on page 9)

62

63 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form

4136)

63

64 Credit from a Regulated Investment Company (attach Form 2439) .

65 Total (add lines 62, 63, and 64). Enter here and on line 21d

Forel

Accounts

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 U.S. financial institution)?

If "'Yes," attach Form 4683. (For definitions, see Form 4683.)

# U.S. GOVERNMENT PRINTING OFFICE: 1973-0-500-047

Page 2

(f)

Amount

nished by. OTHERS

including

dent.

depen-

$

4948

1000

12248

16196

16541

5165

11396

3580

9626

396

386

Yes.

16-82337-1

No

NW 88326 Docld:32245535 Page 110

---

## Page 111

SCHEDULE A

(Form

1040)

Itemized Deductions

Department of the Treasuty

Internal Revenue Service

• Attach to Form 1040.

1973

Name(s)

shown on Form 1040

AMnEL

& PHYLLIS

RuBy

Your social security number

322. 127997

Medical and Dental Expenses (not compensated by insurance

Contributions (See instructions on page 11 for examples.)

or otherwise) for medicine and drugs, doctors,

dentists,

21 a Cash contributions for which you

nurses, hospital care, insurance premiums for medical care,

have receipts, cancelled checks, etc.

150

b Other

cash

contributions.

List

1 One half (but not more than $150) of

donees and amounts. D

insurance premiums for medical care.

(Be sure to include in line 10 below)

150

2 Medicine and drugs

3 Enter 1% of line 15, Form 1040 :

4 Subtract line 3 from line 2. Enter dif-

ference (if less than zero, enter zero)

5

Enter

balance of insurance premiums

for medical care not entered on liné 1

475

6 Enter other medical and dental expenses:

a Doctors, dentists, etc.

730

b Hospitals

c Other (Itemize- include hearing aids,

dentures, eyeglasses, transportation,

etc.) D

60

7 Total (add lines 4, 5, 6a, 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 on line 35

Taxes

11 State and local 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) »

SCH

17 Total (add lines 11, 12, 13, 14, 15, and

16). Enter here and on line 36

Interest Expense

18 Home mortgage.

19 Other (Itemize) D

496

769

919

22 Other than cash (see instructions on

page 12 for required statement) .

23

24

Carryover from prior years

Total contributions (add lines 21a, b,

22, and 23). Enter here and on line

38

150

Casualty or Theft Loss(es) (See instructions on page 12.)

Note: If you had more than one loss, omit lines 25 through

28 and see instructions on page 12 for guidance.

25 Loss before insurance reimbursement

26

Insurance reimbursement

27

Subtract line 26 from

line 25.

difference (if less than

zero,

Enter

enter

zero) .

28 Enter $100 or amount

on line 27,

whichever is smaller

29 Casualty or theft loss (subtract line 28 from

line 27). Enter here and on line 39 . D

Miscellaneous Deductions (See instructions on page 12.)

30 Alimony paid

31 Union dues

32 Expenses for child and dependent care

services (attach Form 2441)

33 Other (Itemize) →..

ScH

20

Total (add lines 18 and 19). Enter here

and on line 37

927

34 Tota! (add lines 30, 31, 32, and 33).

Enter here and on line 40.

Summary of Itemized Deductions

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

41 Total deductions (add lines 35, 36, 37,

3169.

38, 39, and 40). Enter here and on

Form 1040, line 45

# U.S. GOVERNMENT PRINTING OFFICE: 1973-0-500-049

919

3169

150

5165

18-82343-3

* NW 88326 Docld:32245535 Page 111

---

## Page 112

SCHEDULE C

(Form 1040)

Department.of the Treasury

Internal Revenue Service'

Profit or (Loss) From

Business or Profession

(Sole Proprietorship)

Partnerships, joint ventures, etc., must file Form 1065.

1973

• Attach to Form 1040.

Name(s)

as shown on Form 10%

AMMEL

HYLLIS

NACEBAR i product D.

Social security number

3221217992

F000

A Principal busines activity N A C 6A R

B Business name D........

NACK

City, State and ZIP code b...

Nuy S

418 VAN Nays

E Indicate method of accounting:

(1) pA Cash

(2) [ Accrual (3) [ Other D

Yes

No

E Were you required to file Form W-S Form 1096 for 19737 (See Schedule C Instructions)

If "Yes," where filed D

SNO

H Mesad of inventory valuation ederal tax Return, Sailed for this business for any quarter i Was 97.

H Method of inventory valuation *...

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 $.

Less: returns and allowances $......

Balance D

2 Less: Cost of goods sold and /or operations (Schedule C-1, line 8)

3 Gross profit

4 Other income (attach schedule)

5 Total income (add lines 3 and 4)

6 Depreciation (explain in Schedule C-3)

7 Taxes on business and business property (explain in Schedule C-2) .

8 Rent on business property

9 Repairs (explain in Schedule C-2)

10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself)

11 Insurance

12. Legal and professional fees

13 Commissions

14 Amortization (attach statement)

15 (a) Pension and profit-sharing plans (see Schedule C Instructions) .

(b) Employee benefit programs (see Schedule C Instructions) •

Deductions

16 Interest on business indebtedness

17

Bad debts arising from sales or services

18

Depletion .

19 Other business expenses (specify):

(a) ..

(b)

(c)

(1)

(g)

(h)

(i)

(k) Total other business expenses (add lines 19(a) through 19(i))

20 Total deductions (add lines 6 through 19)

enter of che dus e, litra taline 20 from line 5). Enter here angon of 1ea, dire i Apro

enter on Schedule SE, line 5(a)

4948

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)

2 Purchases $

Less: cost of items withdrawn for personal use $..

Balance I

3 Cost of labor (do not include salary paid to yourself)

4 Materials and supplies

5 Other costs (attach schedule)

6 Total of lines 1 through 5.

7 Less: Inventory at end of year

8 Cost of goods sold and/or operations. Enter here and on line 2 above

10-82341-1

7100

V 88326 Doc|d 02245535 Page 112:

---

## Page 113

Schedule C (Form 1040) 1973

SCHEDULE C-2.-Explanation of Lines 7 and 9

Line No.

Explanation

Amount

$

Line No.

Explanation

Page 2

Amount

$

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 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)-11 (b)(5)(vi) and 1.16

(a)-12,; the provisions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970

Check box if you made an election this taxable year to use

Class Life (ADR) System and/or 5

Guideline Class Life System.

d. Depreciation

e. Method of

a. or description of property

Group and guideline class

b. Date

acquired

Cost or

other basis.

allowed or allowable

computing

" poor years

depreciation

f. Life or

rate

g. Depreciation for

this year

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

2 Depreciation from Form 4832. ( See Note)

3 Depreciation from Form 5006

4 Other depreciation:

Buildings.

Furniture. and fixtures

Transportation.

equipment

Machinery and other equipment

Other (specify).

5 Totals

6 Less amount of depreciation claimed in Schedule C-1, page 1

7 Balance-Enter here and on page 1, line 6

SUMMARY OF DEPRECIATION (Other Than Additional First-Year. Depreciation)

Straight line

Declining balance

Sum

of the :

years digits

Jnits of

production

Other (specify)

Total:

1

Depreciation from

Form 4832

2

Depreciation from

Form 5006

3 Other •

2000=

vю0г

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

Salaries and Wages

employees. In determining the five highest paid employees, expense

Owner

account allowances must be added to their salaries and wages. How-

ever, the information need not be submitted for any employee for

whom the combined amount is less than $10,000, or for yourself if

your expense account allowance plus line 21, page 1, is less than

$10,000.

2

3

4

5

Did you claim a deduction for expenses connected with:

(1) Entertainment facility (boat, resort, ranch, etc.)?

(2) Living accommodations (except employees on business)?

Yes

No (3) Employees' families at conventions or meetings?

Yes

$ No (4) Employee or family vacations not reported on Form W-2? • Yes LY No

# U.S. GOVERNMENT PRINTING OFFICE: 1973-0-500-050

• Yes

A No

16-82344-1

88376. Docld 32245535 Page 113

---

## Page 114

SCHEDULE D

Capital Gains and Losses

(Form 1040)

• Attach to Form 1040.

Examples of property to be reported on this Schedule are

Departmen't of the Treasury

gains and losses on stocks, bonds, and similar investments, and gains (but not losses)

Internal Revenue Service

on personal assets such as a home or jewelry.

Name(s) as shown on Form 1040

AMUEL

SPHYLLIS RUBY

Part I a

Short-term Capital Gains and Losses-Assets Held Not More Than 6 Months

b. How

acquired.

c. Mo.,

(Put date sold above

(E imple, 100 shy es of esp.)

Enter letter

dotted line and date

symbol (see

acquired

d. Gross sales price

instruction

e. Cost or other basis,

as adjusted (see

instruction

E)

and

expense of sale

dotted

line)

D)

400 INTERNATIONALPEL

100 LEVITE

100 POTTER / NST

100 ESSEXINTER

22223

1/17/73

113/23.

10/11/72

6/29/23.

A

3/19/23

4157/73

3618

1281

3У8

139 г

3729

2799

699

1259

1973

Social security number

322127997

f. Gain or (loss)

(d less e)

(511

1516

(343

)

367)

2

3

4(a)

4 (b)

5

Enter your share of net short term gain or (loss) from partnerships and fiduciaries . :

Enter net gain or (loss), combine lines 1 and 2

Short-term capital loss component carryover from years beginning before 1970 (see Instruction H)

Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction H)

Net short-term gain or (loss), combine lines 3, 4(a) and 4(b)

Partille. Long-term Capital Gains and Losses-Assets Held More Than 6 Months

2

3

4(a)

4(b)

5

[2941

2941

7

Capital gain distributions

8

Enter gain, if applicable, from line 4(a) (1), Form 4797 (see Instruction A)

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) :

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 H)

12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) .

13

Net long-term gain or (loss), combine lines 11, 12(a) and 12(b)

Part.lllk

Summary of Parts 1 and Il

14

15

Combine the amounts shown on lines 5 and 13, and enter the net gain or loss here .

If lirie 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.

(b) Subtract line 15(a) from line 14. Enter here and on line 29, Form 1040 :

16

If line d4 shows a loss~

Omit lines 16(a) and 16(bj and go to Part IV if losses are shown on BOTH lines 12(a) and 13.

See Instruction I.

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,

(ili)

If amounts on line 5 and line 13 are net losses, enter amount on line 5 added to

50% of amount on line 13

(b)

Enter here and enter as a (loss) on line 29, Form 1040, the smallest of:

The amount on line 16(a);

(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 M for a higher limit not to exceed $1,000); or,

(ili) Taxable income, as adjusted (see Instruction L)

8

9

10

11

12(a)

13322

12(b)

13

(13322

14

16063

15(a)

15(b)

16(b)K 1000

16-82339-1

- 88326-Docld:32

245535-Page 114

---

## Page 115

Page 2

Schedule D' (Form 1040) 1973

PartIV

Capital Loss Limitation-Where Losses Are Shown on Both Lines 12(a) AND 13

17 Enter loss from line 5; if line 5 is zero or a gain, enter a zero .

18 Enter loss from line 13

19 Enter gain, if any, from line 5; if line 5 is zero or a loss, enter a zero

17

18

19

20

20 Reduce loss on line 18 to the extent of the gain, if any, on line 19

(2741)

13322

13322

21

Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero

21

-..

NOTE: If the entry on line 21 is zero, OMIT lines 22 through 28, and enter on line 29 the

loss shown on line 12(a).

22

22 Enter gain, if any, from line 11

23 Enter smaller of amount on line 21 or line 22

24 Enter excess of gain on line 21 over amount on line 23 .

25 Enter loss from line 4(a); if line 4(a) is blank, enter a zero

26

Reduce gain, if any, on line 24 to the extent of loss, if any, on line 25 (see Instruction J) .

27 Enter loss from line 12(a)

24

25

26

27

28

: 28 Add the gain(s) on line(s) 23 ard 26

29 Reduce the loss on line 27 to the extent of the gain, if any, on line 28 (see Instruction K) .

30 Enter smaller of amount on line 29 or line 20 (if line 29 is'zero, enter a zero) .

(13322

133227

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

16963)

34 Enter here and enter as a (loss) on line 29, Form 1040, the smallest of:

(a) Amount on line 33;

(b) $1,000 ($500 if married and filing a separate return-see Instruction M for a higher limit not to. exceed $1,000); or,

(c) Taxable Income, as adjusted (see Instruction L)

34

110020

Part V B

Complete Part V if You are Married Filing a Separate Return and Losses are Shown on Lines 4(a) and

14. (See Instruction M).

35 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero .

35

NOTE: If 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 line 3

37 Enter smaller of amount on line 35 or line 36

38 Enter excess of gain on line 35 over amount on line 37

39 Enter loss from line 12(a); if line 12(a) is blank, enter a zero

40 Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 (see Instruction d) .

41 Enter loss from line 4(a)

42 Add the gain(s) on line(s) 37 and 40

Reduce the loss on line 41 to the extent of the gain, if any, on line 42 (see Instruction K)

36

37

38

39

40

41

42

43

Part

Computation of Alternative Tax (See Instruction V to See if the Alternative Tax Will Benefit You)...

44. Enter amount from line 48, Form 1040

45 Enter amount from line 15(a)

46 Subtract amount on line 45 from amount on line 44 (but not less than zero) •

44

45

46

47

47 Enter smaller of amount on line 13 or line 14

If line 47 does not exceed $50,000 ($25,000 if married filing separately), check here &

• and

omit lines 48 through 54.

Enter long term gains from certain contracts and installment sales referred to as "certain subsec-

tion (d) gains"' (see Instruction V)

48

49

49 Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger .

If line 49 is equal to or greater than line 47, check here # and omit lines 50 through 54.

50 Multiply amount on line 49 by 50%

....

51 Add amounts on lines 46 and 50

52 Tax on line 44 or 45, whichever is greater (use Tax Rate Schedule in instructions) .

53 Tax on the amount on line 51 (use Tax Rate Schedule in instructions)

54 Subtract amount on line 53 from amount on line 52

55 Tax on the amount on line 46 (use Tax Rate Schedule in instructions)

56 lf the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 25% of line 49 .

50

51

52

53

54

55

56

57 Alternative Tax—add amounts on lines 54 (if applicable), 55, and 56. If smaller than the tax figured

on the amount on line 48, Form 1040, enter this alternative tax on line 16, Form 1040

57

# U.S. GOVERNMENT PRINTING OFFICE: 1973-0-500-051

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## Page 116

SCHEDULE G

(Form 1040)

Department of the Treasury.:

-Internal Revenue Service

Name(s) as shown on Form 1040

AMUEL

Taxable Income and Adjustments

Income Averaging

See instructions on pages 3 and 4.

Attach to Form 1040.

PHyLLIS

(a)

Computation year

RuBy

1973

(b)

lst preceding base

period year

1972

(c) *

2d preceding base

period year

1971

7626

-000

1973

Your social security number

322112.2997

(d)

3d preceding base

period year

• 1970

(e)

4th preceding base

period year

1969

1 Taxable income (see instruction 1)

2 Income earned

outside

of the

United

States or within U.S. possessions and ex-

cluded under sections 911 and 931

3 Excess community

income and certain

amounts

received

by

owner-employees

subject to a penalty under section 72(m)

(5). See instruction 3

4 Accumulation distributions subject to sec-

tion 668(a). See Form 4970

5 Adjusted taxable income or base period

income. (Line 1 plus line 2, less lines 3

and 4.) If less than zero, enter zero .

Computation of Averagable Income

7626

-0-

6

6 Adjusted taxable income from line 5, column (a) . •

7

7 30% of the sum of line 5, columns (b), (c), (d), and (e) •

8 Averagable income (line 6 less line 7)

8

Complete the remaining parts of this form only if line 8 is more than $3,000. If $3,000 or

less, you do not qualify for income averaging. Do not fill in rest of form.

Computation of Tax

9

9. Amount from line 7 .

10

10 20% of line 8

11

11 Total (add lines 9 and 10)

12 Amount from line 3, column (a), less any income subject to a penalty under section 72(m)(5)

which was. included in line 3

12

13

13 Total (add lines 11 and 12)

14

14 Tax on amount on line 13

15 Tax on amount on line

11

15

16

219

-0.

16 Tax on amount on line 9.

17 Difference (line 15 less line 16) .

17

219

18

18 Multiply the amount on line 17 by 4 .

19 Total (add lines 14 and 18) •

19

20 Tax on income subject to the penalty under section 72(m)(5) which was included in line 3

21 Tax (add lines 19 and 20). Enter here and on Form 1040, line 16. Also check Schedule G box on

Form 1040, line 16

20

21

7626-

7626

G

1525

1528

152S

219

826

1098

1098.

16-82358-1

- NW 88326 Docld:32245535 Page 116

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## Page 117

SCHEDULE SE

Computation of Social Security Self-Employment Tax

(Form 1040)

* Each self-employed person must file a Schedule SE.

Department of the Treasury

1973

Internal Revenue Service

• Attach to Form

1040.

• If you tiad wages, including tips, of $10,800 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 OF SELF-EMPLOYED PERSON (AS SHOWN

SOCIAL SECURITY CARD)

Social security number

of self-employed person

A MU

E'L

322167997

Business activities subject to self-employment tax (grocery store, restaurant, farm, etc.) → SNACKBAR

If you have only farm income complete Parts I and Ill.

If you have only nonfarm income complete Parts Il and III.

If you have both farm and nonfarm income complete Parts I, Il, and III.

Part Da Computation of Net Earnings from FARM Self-Employment

SE

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.

1 REGULAR METHOD Net profit or (loss) from:

(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 1(6)

3 FARM OPTIONAL METHOD- If gross profits from farming are: 1

(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

1 Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method),

or line 72 (accrual method), plus the distributive share of gross profits from farm partnerships

(Schedule K-1 (Form 1065), line 15) as explained in instructions for Schedule SE

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method

Part lIs

Computation of Net Earnings from NONFARM Self-Employment

5 REGULAR METHOD Net profit or (loss) from:

(a) Schedule C, line 21. (Enter combined amount if more than one business.) .

(b) Partnerships, joint ventures, etc. (other than farming)

(c) Service as a minister, member of a religious order, or a Christian Science practitioner. (Include

rental value of parsonage or rental allowance furnished.) If. you filed Form 4361, check here D

and enter zero on this line

(d) Service with a foreign government or international organization

(e) Other (director's fees, etc.). Specify D.

6 Total (add: lines 5(a), 5(b), 5(c), 5(d), and 5(e))

7 Enter other adjustments (attach statement) . . . :

8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 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 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 earn.

ings from self-employment of $400 or more for at least 2 of the 3 following years: 1970, 1971,

and 1972. 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 distributive 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), 5(d), and 5(e), as adjusted by line 7.

9 NONFARM: OPTIONAL METHOD:

(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)) . :

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

4948

4948

4948

$1,600

00

16-82342-1

iNW 88326 Docld:32245535 Page 117

778a07

---

## Page 118

Schedule SE (Form 1040) 1973

Part Ul

Computation of Social Security Self-Employment Tax

12 Net earnings or (loss):

(a) From farming (from line 4) . . .

(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 form.) .

14 The largest amount of combined wages and self-employment earnings sub-

ject to social security tax for 1973 is .

$10,800

00

• 15 (a) Total "FICA" wages as indicated on Forms W-2

(b) Unreported tips, if any, subject to FICA tax from

Form 4137, line 9

(c) Total of lines 15(a) and 15(b) :

10800

16 Balance (subtract line 15(c) from line 14) : .

17 Self-employment income line or or whichever whichever is smaller.

18 If line 17 is $10,800, enter $864.00; if less, multiply the amount on line 17 by .08

Railroad employee's and railroad employee representative's adjustment for hospital insurance bene-

fits tax from Form 4469 . . . . . .

... . . .....:

-...

20 Self-employment tax (subtract line 19 from line 18). Enter here and on Form 1040, line 55 .

You may use this space to

make any needed computations

Page 2

4948

1948

4948

396

396

# U.S. GOVERNMENT PRINTING OFFICE: 1979-0-500-055

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---

## Page 119

Form

4797

Department of the Treasury

Internal Revenue Service

Name

Suppiemental Schedule of Gains and Losses

Sales, Exchanges and Involuntary Conversions under Sections 1231, 1245, 1250, etc.

1973

To be filed with Form 1040, 1041, 1065, 1120, etc.—See Instruction A

MUEL

HYLLIS

RuB

Identifying number as shown on page 1

Part 1: al

Saletion 123 yes of Property Used in Trade or diness and /or Involuntary Conversions

32201207995

(Section 1231)

SECTION A.-

Involuntary

• Conversions

Due to Casualty and Theft (See Instruction D)

8.

Kind of property (if necessary,

attach statement of descriptive

details not shown below)

b. Date acquired

(mo.,

day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

e. Depreciation al.

lowed (or allowable)

since acquisition

f. Cost or other basis,

cost of subsequent im-

provements (if not pur-

chased, attach explana-

tion) and expense of sale

. Gain or (loss)

i plus e less t

2 Combine the amounts on line 1, enter here and also on the appropriate line as follows .

(1) If line 2 is zero or a gain, enter such amount in column g, line 3.

(2) If line 2 is a loss, enter the loss on line 5.

(b) For partnership returns: Enter the amount shown on line 2, on line 6, Schedule K (Form 1065).

-Sales or Exchanges of Property Used in Trade or Business and Certain Involuntary Conversions (Not Reportable

•in Section A) (See Instruction D)

3

4 Combine the amounts on line 3, enter here and also on the appropriate line as follows .

(a)

For all returns, except partnership returns:

(1) If line 4 is a gain,

enter such gain as a long-term capital gain on the Schedule D (Form 1040, 1120, etc.), that is

being filed-see instruction D.

(2) If line 4 is zero or a loss, enter such amount on line 6.

(b)

Part I8

For partnership returns: Enter the amount shown on line 4, on line 7, Schedule K (Form 1065).

Ordinary Gains and Losses

a. Kind of property and how acquired

(If necessary, attach statement of de-

scriptive details not shown below)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, уr.)

d. Gross sales

price

f. Cost or other basis,

e. Depreciation ai-

cost of subsequent

lowed (or allowable)

improvements and

since acquisition

expense of sale

¡ain or (lo.

I plus e less

5 Amount, if any, from line 2(a)(2)

6 Amount, if any, from line 4(a)(2)

7 Gain, if any, from line 21 .

8

12218

12Y6

9 Combine lines 5 through 8, enter here and also on the appropriate line as follows .

(a) For all returns, except individual returns: Enter the gain or (loss) shown on line 9, on the line provided

for on the return (Form 1120, etc.) being filed-see instruction E, for specific line reference.

(b) For individual returns:

(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 E), enter the total of such loss(es) here and include on

line 29, Schedule A (Form 1040)—identify as loss from line 9(b)(1), Form 4797 •

(2) Redetermine the gain or (loss) on line 9, excluding the loss (if any) entered on line 9(b) (1). Enter

here and on line 30, Form 1040

122Y8

16-82348-1

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## Page 120

Form 4797 (1973)

Part Ill

Page 2

Gain From Disposition of Property Under. Sections 1245, 1250,

1251, 1252—Assets Held More than Six Months (See Instruction F)

Lines 18 and 19 should be omitted if there are no dispositions of farm property or farmland; or, if this form is filed by a partnership.

10 Description of sections 1245, 1250, 1251, and 1252 property:

Date acquired

(тo..

day, уг.)

SNACK

BAR

4170

Date sold

(mo.,

day, уг.)

8/13/23

(A)

(8)

(C)

(D)

(E)

Correlate lines 10(A) through 10(E)

with 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 line 13

15 Total gain, subtract line 14 from line 11

16 If section 1245 property:

(a) Depreciation allowed (or allowable) after

applicable date (see instructions) .

(b) Line 15 or line 16(a), whichever is smaller

Property

(A)

28000-

28138-

12386-

15752

12248.

12386

12248

Property

(B)

Property

(C)

Property

(D)

Property

(E)

17 If section 1250 property:

Enter

additional

depreciation

after

12/31/63 and before 1/1/70 .

(b) Enter.

additional

12/31/69

depreciation after

(c) Enter line 15 or line 17(b), whichever is

smaller .

(d) Line 17(c) times applicable percentage

(see instruction F.4)

(e)

Enter excess, if any, of line 15 over

line 17(b)

(f)

Enter line 17(a) or line 17(e), whichever

is smaller

(g) Line 17(f) times applicable percentage

(see instruction F.4)

(h) Add line 17(d) and line 17(g)

18 If section 1251 property:

(a) If farmland, enter soil, water, and land

clearing expenses for current year and

the four preceding years

(b) If farm property, other than land, sub-

tract line 16(b) from line 15; OR, if farm-

land, enter line 15 or line 18(a), which-

ever is smaller (see instruction F.5)

(c)

Excess deductions account (see instruc-

tion F.5)

(d)

Enter line 18(b) or line 18(c), whichever

is smaller

19 If section 1252 property:

(a)

Enter soil, water, and land clearing ex-

penses made after 12/31/69 .

(b) Enter amount from line 18(d), if any;

- otherwise, enter a zero

(c) Enter excess, if any, of line 19(a) over

line 19(b)

(d)

Line 19(c) times applicable percentage

(see instruction F.5)

(e) Line 15 less line 19(b)

(f) Enter smaller of line 19(d) or line 19(e)

Summary of Part IllI Gains (Complete Property columns (A) through (E) up to line 19(f), before going to line 20)

20 Total of Property columns (A) through (E), line 15 .

12248

21 Total of Property columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter here and on line 7 .

12248

22 Subtract line 21 from line 20. Enter here and in appropriate Section in Part I (see instructions D and F.2)

I U.S. GOVERNMENT PRINTING OFFICE: 1973-0-500-154

16-82348-1

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---

## Page 121

Form

Department of the Treasury

Internal Revenue Service

Name(s) as shown on Form 1040

SAMUEL

Capital Loss Carryover

(From 1972 to 1973)

Attach to Form 1040.

1973

Social Security Number

322/27997

A. Who Should File.-You will need to complete

either Part I or Part Il of this form if you have a capital

loss to carryover to 1973.

You will have a capital loss carryover to 1973 if the

amount on line 16(a), or on line 33, of Schedule D

(Form 1040) for 1972 is LARGER THAN the loss de.

ducted on line 36, Form 1040 for 1972.

How to Compute Carryover.-If you have a cap.

ital loss carryover, complete either Part 1 or Part II, but

do not complete both.

1. Complete only Part 1 if lines 4(a) and 12(a),

Schedule D (Form 1040) for 1972, DO NOT SHOW

A LOSS.

2. Complete only Part Il if either (or both) line 4(a)

or 12(a), Schedule D (Form 1040) for 1972,

shows a loss.

Parties

Post-1969 Capital Loss. Carryovers

Section A.-Short-term Capital Loss Carryover

1 Enter loss from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows

a gain, check this block [J, and OMIT lines 1 through 6 (because no short-term capital loss carry-

over exists) and enter the amount from line 36, Form 1040 for 1972 on line 7— then go to line 8

2 Enter gain from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows

a loss, enter a zero . . . •

1

2

3 Reduce loss, if any, on line l to extent of gain, if any, on line 2

3

4

4 Enter amount from line 36, Form 1040 for 1972 . . :

5

5 Enter smaller of amount on line 3 or line 4 . . : ::.

6

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

1972 to 1973 that is attributable to years

beginning after 1969. Enter this amount on line 4(b), Schedule D (Form 1040) for 1973.

Section B.-Long-term Capital Loss Carryover

7 Line 4 less line 5 (unless you checked the block on line 1, and followed the line 1 instruction) .

8 Enter loss from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows

a gain, check this block , and OMIT lines 8 through 12, because no long-term capital loss carry.

over exists. .

9 Enter gain. from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows

a loss,

enter a zero

7

8

9

10

10 Reduce loss on line 8 to extent of gain, if any, on line 9

11

11 Multiply the amount on line. 7 by 2 .

12

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 1972 ta, 1973, that is attributable to years beginning

after 1969. Enter this amount on line 12(b), Schedule D (Form 1040) for 1973.

NW 88326 Docld:32245535 Page 121

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## Page 122

Form 4798 (1973)

Part W°.): Pre-1970 and Post-1969 Capital Loss Carryovers

Section A.—Short-term Capital Losses Identified

1 Enter loss from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows

a gain, check this block X; and OMIT lines 1 through 20 (because no short term capital loss carry:

over exists), complete line 21, enter loss from line 36, Form 1040 for 1972 on line 22— then go to

line 23

2 Enter gain from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows

a loss enter a zero

3 Reduce the loss on line 1 to the extent of the gain, if any, on line 2

Note: If line 4(a), Schedule D (Form 1040) for 1972 is blank, OMIT lines

4 through 11, enter a zero on line 12—then go to line 13

Combine lines 3 and 11, Schedule D (Form 1040) for 1972 and if gain,

enter gain; if zero or a loss, enter a zero .

4

Note: If line 4 is zero, OMIT lines 5 through 11, enter on line 12 the loss

from line 4(a), Schedule D (Form 1040) for 1972—then go to line

5 • Enter gain, if any, from line 3, Schedule D (Form 1040) for 1972

6 Enter smaller of amount on line 4 or line 5 .

7 Enter excess of gain on line 4 over amount on line 6

7

8 Enter loss from line 12(a), Schedule D (Form 1040) for 1972; otherwise,

enter a zero

8

9 Reduce the gain, if any, on line 7 to the extent of the loss, if any, on line 8

9

10 Enter loss from line 4(a), Schedule D (Form 1040) for 1972; otherwise,

enter a zero .

11 Add the gain(s) on line(s) 6 and 9

10

11

12 Reduce the loss on line 10 to the extent of the gain, if any, on line 11

13 Pre:1970 short-term capital loss (enter smaller of amount on line 3 or on line 12)

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 1973

15 Enter loss, if any, from line 13 above .

15

16. Enter loss deducted on line 36, Form 1040 for 1972

16

17 Loss carryover to 1973 (excess of line 15 over line 16-1f line 15 does not exceed line 16, enter

zero). Enter here and on line 4(a), Schedule D (Form 1040) for 1973

18 Enter loss, if any, from line 14 above

18

19 Enter excess of line 16 over line 15—if line 16 does not exceed line 15,

19

enter zero

20 Loss carryover to 1973 (excess of line 18 over line 19-If line 18 does not exceed line 19, enter

zero). Enter here and on line 4(b), Schedule D (Form 1040) for 1973

21 If you were required to complete Part IV, Schedule D (Form 1040) for

1972, enter loss, if any, from line 30, Schedule D (Form 1040) for 1972.

Otherwise,

enter

zero

21

19322

22 Enter excess of line 19 over line 18- if line 19 does not exceed line 18,

enter zero (unless you checked the block on line 1, and followed the

line 1 instructions)

22

1000

23 Loss carryover to 1973 (excess of line 21 over line 22-if line 21 does not exceed line 22, enter

zero). Enter here and on line 12(a), Schedule D (Form 1040) for 1973

24 If you were required to complete Part IV, Schedule D (Form 1040) for

1972, enter loss, if any, from line 31, Schedule D (Form 1040) for 1972.

Otherwise, enter loss, if any, from line 13, Schedule D (Form 1040) for 1972

24

25 Enter excess of line 22 over line 21 D

•X 2 (If line

22 does not exceed line 21, enter zero.)

25

--

26 Loss carryover to 1973 (excess of line 24 over line 25—if line 24 does not exceed line 25, enter

zero). Enter here and on line 12(b), Schedule D (Form 1040) for 1973

# US. GOVERNMENT PRINTING OFFICE: 1973-0-500-158

50-2003-097

13322)

- NW 88326 Docld:32245535 Page 122

1

2

•3

12

13

14

17

20

23

26

Page 2

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## Page 123

NAME -

ADDRESS

SAMUEL & PHYLLIS: RuBY

CALENDAR YEAR 19

322-18-7997

SOC. SEC. NO..

73

MEDICAL

MEDICINE/DRUGS

LESS 1% A.G.I. (Line 18 - 1040)

NET MED/DRUGS

H & A INS. (½ + EXCESS)

DR.

DR.

DR.

DR.

DR

DR.

DR.

, DR.:

PROSTHETIC APPLIANCES

HEARING AID

HOSPITAL

AMBULANCE

LABORATORIES

TRAVEL FOR MED. 1000

MEDICARE INS.

GLASSES

MEDICAL EXPENSES

LESS REIMBURSED BY INS.

LESS 3% ADJ. GROSS INC.

+: ½ (TO $150) OF H & A INS.

10 TOTAL MEDICAL DED.

TAXES

"REAL ESTATE

STATE & LOCAL GASOLINE

GENERAL SALES TAX

STATE & LOCAL INCOME

PERSONAL PROPERTY

PERSONAL PROPERTY AUTO

STATE DISABILITY INS.

SALES TAX AUTO

•I7 TOTAL TAXES

INTEREST (TO WHOM PAID)

MORTGAGE

FEDERAL

478

730

60

1265

496

769

I5Q

419

60

2570

157

DEDUCTION SCHEDULE

STATE

CONTRIBUTIONS

PARTNERSHIP SHARE

GIRL/BOY SCOUTS

HEART FUND/CANCER FUND

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

POLITICAL CONTRIBUTIONS.

CHURCHES

FEDERAL

750

OTHER THAN CASH

CARRY OVER FROM PRIOR YRS.

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT LOSS(ES)

LOSS BEFORE ADJUSTMENT

INSURANCE REIMBURSEMENT

$100 LIMITATION (PER CASUALTY)

DL

150

12608

109.9

766

130

916

29 TOT. CAS. OR THEFT LOSS

MISCELLANEOUS DEDUCTIONS

INCOME TAX PREPARATION

UNION/PROFESSIONAL DUES

UNIFORMS/PROTEC. CLOTHING

SMALL TOOLS AND SUPPLIES

LAUNDRY AND CLEANING

AUTO USE/DAMAGE

ALIMONY (SCHEDULE)

INVEST.COUNSEL & PUBS.(SCHED)

EMPLOYMENT AGENCY FEES

SAFE DEPOSIT BOX

TEL. REQ. IN BUSINESS

CHILD & DEP. CARE (Form 2441)

XXXXX

I3A TOTAL MISC. DED

92%

SUMMARY OF ITEMIZED DEDUCT.

35 EXPENSES (FROM MNE COL & DENTAL

36, TOTAL TAXES (FROM LINE 17)

37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. (Line 24)

39 CAS.& THEFT LOSS(ES) (Line 29)

40

TEDUC MONGEFROM LI

INE 34

FEDERAL

STATE

180

STATE

INSTALLMENT LOANS

ISTTHRIFT

RILL UNCH

WEIS VOiSIN

41

ITEMI:ZED DEDUCTIONS

ENTER ON

1040 LINE 45

REMARKS

A Y A!

5/69

13160

20 TOTAL INTEREST

B/ 3169.

NV-28325N Ros/d32845535nPagealades, Calif. Form 101

3/61

---

## Page 124

SAMUEL A PHyLLIS

RuBy

SEC. NO.

"ADDRESS

322-12-7997

SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION

PRINCIPAL BUSINESS

ACTIVITY

BUSINESS NAME

BUSINESS ADDRESS

TOTAL RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

LABOR

EMPLOYERS NO.

10331

TOTAL

INVENTORY AT END OF YEAR

20136

GROSS PROFIT

73

CALENDAR YEAR 19-

FISCAL YEAR ENDING

19

33636

20136

1350%

13.5000

'GROSS INCOME

ADVERTISING

AUTO AND TRUCK EXPENSE

BAD DEBTS

CASH SHORT

COMMISSIONS

DELIVERY

DEPRECIATION (. SCHEDULE ATTACHED)

DUES AND SUBSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR SERVICE

LAUNDRY

LEGAL AND ACCOUNTING

MAINTENANCE

JFFICE SUPPLIES. AND EXPENSE

RENT

REPAIRS

SALARIES AND WAGES

SALARIES OFFICERS

• SUPPLIES

TAXES AND LICENSES

TAXES • PAYROLL

TELEPHONE

TRAVEL

UTILITIES

SALES TAX INCLUDED

OTHER BUSINESS DEDUCTIONS

15

550

2.0050

25 2

120

60%

1668

2487

19₴

78,0

511

008

NET PROFIT:: OR (LOSS) - FEDERAL RETURN

NET PROFIT OR LOSS) • STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF. )

PROFESSIONAL STATIONERS INC. FORM 104

LOS

ANGELES.., CALIF.

NW 88326 Docld:32245535 Page 124

SCHEDULE

---

## Page 125

NAME.

SAMUELE PHYLLIS RUBY,

ADDRESS.

322-12-7997

NO.

SOC. SEC:

NO. -

KIND OF PROPERTY

GOODWILL

EQUIPMENT

CONENENT NoTTO

COMPETE

LEASEHOLD /MP.

SCHEDULE OF DEPRECIATION/ AMORTIZATION

COST OR

DATE

ACQUIRED

YR

SPEC 20%

DEP

DEPRECTABLE

BASIS

DEP ALLOWED

PRIOR

YEARS

OTHER BASIS

4/70.10000

-о-

4/70

110000

10000

6000

4/70

5000

5000

13000

Чпо 3000

3000

11386

CALENDAR YEA!

19 73

FISCAL. YEAR ENDING

REMAINING

COST

METHOD

RATE (%)

OR

LIFE

(YRS)

DEPRECIATION

FOR

THIS YEAR

40700

2000

SL.

SYR.

1167

S.L. SYR

583

16/Y

S. Li

7YR

35Q

TOTALS

128000

PROFESSIONAL STATIONERS INC. LOS ANGELES, CALIF. FORM NO 1O2A

110386

Add 20% Additional Depreciation on Items Purchased THIS Year.

TOTAL DEPRECIATION THIS YEAR

SCHEDULE

12000

NW 88326 Docld:32245535 Page 125

---

## Page 126

+ i-+133-84444499

INDIVIDUAL

RESIDENT

540

CALIFORNIA

INCOME TAX

For the year January 1-December 31,

, 1973, or other taxable year beginning

1973, ending-

FIRST NAME(S) AND INITIAL(S)

Please

Туре

or

Print

SAMUEL

ePHyLLIS

LAST NAME

КидУ

PRESENT HOME ADDRESS (Number

street, including apartment number

or rural route)

16250

BIRCHER

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

GRANADA

1661

CALIF

Yours

ULLU-

PATION

Spouse's

Filing Status - Check Only One

Exemption Credits

If line 1 or 3 checked,

enter $25

1. 0

Single

6.

Personal Exemption:

If line 2, 4 or 5 checked,

enter $50

•2. D Married filing joint return

7.

Dependents - Do not list person who qualifies you as head of household.

3. D

Married filing separate return—Enter spouse's full

Vame (include last name and/or address if different from

name

4. . Head of Household-Enter name of qualifying

ELISA

individual

X $8

X $8

5. • Widower) with dependent child. Enter year spouse

died 19.

8

9.

10

11

12

13

14

15

16

ATTACH COPY 2 OF FORM

Total Number».

Blind (refer to instructions) Number of blind exemptions

Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20 below

income

10. Wages, salaries, tips and other employee compensation

(it unavalay 2, affach explanati front, )

11. Dividends—-before federal exclusion. Capital gain dividends must be included at 100%

12.

Interest. (See instructions for taxability of federal, state and municipal bonds)

13.

Income other than wages, dividends and interest (from line 50)

14. Total (add lines 10, 11, 12 and 13)

15. Adjustments to income (from line 56)

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 line 19.

• If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.

17. 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

18

TAXABLE YEAR

1973

19

Your Social Security Number

322127997

Spouse's Social Security Number

349181420

HIeN

6

9

92

34 S

16/96

16633

16633

516%0

16771

240

ATTACH FORM DE1964 HERE

19. Tax-If an averaging method is used, check appropriate box Schedule G, or E Schedule G-1

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!

Your

Tax

and

Credits

22.

Other credits (from line 66)

23.

Net tax (subtract line 22 from line 21—if line 22 is greater than line 2k

enter zero)

24.

Special tax credit-from line 75 (see Instructions, page 2, for allowable credit)

... 25.

Net: Tax liability (subtract line 24 from line 29_if line 24 is greater than lite 23, enter zero)

26.

Tax on preference income (see instructions-attach Schedule P(540)):

27:

Total tax liability (add lines 25 and 26)

check or money order.

Pre-

ayment

28.

Renter's credit-if you lived in rented property on March I, 1973, Complete Pärt I on page 2

29.

Total California income tax withheld (attach Form(s) W-2 or W-2P to face of return).

30.

1973 California estimated tax payments (include amount allowable as a credit from 1972 return)

29

30

31

31.

Excess California SDI tax withheld (attach Form*DE 1964 to face of return) :

32.

Total prepayment credits (add lines 28 through 31)

33.,

If line 27 is equal to or larger than line 32, enter amount of BALANCE DUE

Pay in full and mail with return to: Franchise Tax Board, Sacramento, CA 95867

Balance

Due

.or

Refund

34. If line 32 is larger than line 27, enter amount OVERPAID

Mail return to: Franchise Tax Board, P.Ô. Box 13-540, Sacramento, CA 95813

35. • Amount of line 34 to be REFUNDED. (allow at least six weeks for your refund)

36.

34

35

36

Amount of line 34 to be credited on your 1974 estimated tax

social

Under penalties of perjury, I declare that I 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

axpayer, his declaration is based on all information of which he has any knowledge.

SI

GN

signature

HERE

gnature if fling a joint return

Date

Date

Preparer's signature (other than taxpayer)

Address (and Zip code)

19

20

21

22

23

24

25x

26

27

-28

125

125

3

1.220

122

32

33

=0

122

Do not write in these spaces

M

NW. 88326 Docld:32245535 Page 126

367-34-8729

Preparer's Employer

_ Identification (or SSA) Number

13717 VANOWEN STREET

VAN NUYS, CA. 91403

_7447-34-8-729

---

## Page 127

Page 2 Form 540 (1973)

PART 1: Renter's Credit - All questions must be answered

37: Did you, on March 1, 1973, live in rented property which was your principal residence?

38.

Was the property you rented exempt from property. tax?

:.39. Did you live with any other person who claimed you as a dependent for income tax purposes?

40. Did you or your spouse claim the homeowners' property tax exemption or receive public assistance?:

See Instructions, Page 2, for Allowable Credit

• Yes

Yes

Yes

Yes

No

• No

No

D No

If no, you may not claim this credit

If yes, you may not claim this credit

If yes, you may not claim this credit

If yes, see page 2 of instructions

PART Il - Other Income

41. Business income (or loss) (attach Schedule C(540))

42... Net gain (or loss) from sale of exchange of capital assets (attach Schedule D(540))

43. Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540))

44.

Pensions

and annuities

45.

Rents and royalties .

46.

Partnerships

Attach

Schedule E

Form (540)

47. Estates and trusts

48.

Farm income (or loss) (attach Schedule F(540))

(a) Fully taxable pensions and annuities (not reported on Schedule •E(540))

49.

Miscel-

laneous

income

(b) Alimony

(c) Other (state nature and source)..

Enter total of lines 49(a), (b) and (c)

50. Total (add lines 41 through 49). Enter here and on line 13 .

41

4948

42

43

1000

132018

44

45

46

47

48

(a)

(b)

(c)

49

50

16196

PART III - Adjustments to Income

51. "Sick pay", if included in line 10 (see instructions-attach statement)

52.

Moving expenses. (see instructions-attach statement)

53. Employee business expenses (see instructions-attach statement)

54. Military exclusion (see instructions)

55.. - Payment as a self-employed person to a retirement plan, etc. •

56.

Total adjustments (add lines 51 through 55). Enter here and on line 15

51

52

53

54

55

56

ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE

PART IV - Itemized Deductions - DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION.

Attach Schedule A(540) and enter sub-totals on lines 57 through 62, below

57.

Total deductible medical and dental expenses (from Schedule A(540), line 10)

58. Total child adoption expenses (from Schedule A(540), line 13) .

59.

Total taxes (from Schedule A(540), line 21)

60.

Total interest expense (from Schedule A(540), line 25)

61.

Total contributions.

(from Schedule A(540), line 29)

62.

Totals miscellaneous deductions (from Schedule A(540), line 40)

63.

Total itemized deductions (add lines 57 through 62). Enter here and on line 17.

57

58

59

60

61

62

63

9181

3927

150

3162

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 S(540))

65.

*Retirement income credit (attach Schedule R(540))

66.

Total (add lines 64 and 65). Enter here and on line 22

64

65

66

If you report net gains from capital assets held more than one year on Schedule D(540), complete all lines below.

PART VI - Special Tax Credit -

All other taxpayers enter "Net Tax" from line 23 on line 74 and complete line 75.

67. - Taxable income from line 18 (or line 16 if Tax Table used)

67

68.

Amount of gain or loss (if any) entered on Schedule D(540), line 14

69. Amount of gain or loss (if any) entered on Schedule D(540), line 15

68

69

11000

70. Combine lines 68 and 69 and enter total here. If zero or a loss, enter zero

7i.

Adjusted taxable income (subtract line 70 from line 67)

72. Adjusted tax (use same methed as used for determining tax on line 19)

73. Add lines 20 and 22, and enter total here

74. Adjusted net tax (subtract line 73 from line 72)

75.

Special tax credit-Determine allowable credit using Table on page 2 of instructions. Enter here and on line 24

7.0

71

72

73

74

75

=0

178

53

13714-400 5-73 10,000M O A OSP

# NW 88326-Doeld 32245535-Page-127.

---

## Page 128

SCHEDULE

FORM 540

CALIFORNIA

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

19 23

YEAR

Name as shown on Form 540

MuEL

PHYLLIS

Itemized

Standard Deduction-You have

a choice between two deduction

methods. You can either itemize your deductions or take a standard deduction as

explained in the 540 Instructions. On separate returns of a husband and wife,

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

2. Medicine and drugs

:3. Enter 1%

540.

of adjusted gross income shown on Form

4. Subtract line 3 from line 2. Enter difference lif line.

3. is greater than line: 2, enter zero)

5.

Enter balance of insurance premiums for medical

care not entered

on line 1

6. Other medical and dental expenses:

(a) Doctors, dentists, etc.

(b) Hospitals .

(c) Other (itemize)

150

RuBy

Social Security Number

322/27997

if one spouse itemizes deductions,

the other may not use the Tax Table or claim

the standard deduction. If you choose to itemize your deductions, complete the

appropriate items below.

Interest Expense

22.

Home mortgage

23.

Installment purchases

24. Other (itemize)

SCH

25. Total-lAdd lines 2L

23. and 24. Enter here and

on Form 540, - page 2)

3/69

Contributions

26. Cash contributions for which you have receipts, can-

celed checks,

etc.

27. Other cash contributions. List donees and amounts

150

425

730

60

1263

499

766

916

7.: Total-(Add lines 4, 5, 6a, b, and c)

of adjusted

gross income shown on

8. Enter

3%

Form 540

g.

Subtract line 8

from line

7.

line 8 is greater

than

Enter

difference (if

line 7;

enter zero)

10.

Total-(Add lines

Form

540, page

2)

and

9.

Enter here and on

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

line 11-See instructions

for maximum

limitations. (Enter here and on Form

540, page

2)

Taxes (See tables on reverse)

14. Real estate

15.

State and local gasoline

16. General sales

17.

Auto license-Excess of registration and weight fees

(see instructions)

18.

Personal property

19.

State disability

insurance (SDI)-Employer private

disability plans do not qualify

20. Other

21. Total taxes-(Add lines

14 through 20. Enter here

and on Form 540;

page 2)

Rev.

1973)

NW 88326

Docld:32245535 Page 128

28. Other than cash. - See instructions for required

statement

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)

. B.

Miscellaneous Deductions

Casualty or Theft Losses)-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 line 30. Enter difference. (if

line 31 is greater than line 30, enter zero)

33.

Enter $100 or amount on line 32,

whichever is

smaller

34:

Casualty or theft loss (line 32 less line 33) •

35.

Alimony paid

36.

Child care-See instructions

37. Union dues

38.

Employment education expense-See instructions

39.

Other-See instructions (itemize)

150

927

40.

Total-Add lines 34, 35, 36, 37, 38 and 39. (Enter

here and on Form 540, page 2)

---

## Page 129

"SCHEDULE

* FORM 540

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

TAXABLE

19 73

YEAR

Alrach this schedulo to your income sax rotur, Form 540 or 540NB

Partnerships, joins. vontures, ofc, must filo on Form 363

Name as shown on Form 540 or 52 ReY taba15

SAMMEL

SNACK

RuBy

Social Security Number

322/22882

A Principal business activity

See Instructions for "Item A."

(for exc

ple: retail-hardware; wholesale-tobacco; services-legal; manufacturing-furniture; etc.)

BAR

--; product.

Fo00

B. Business name...

NACK

AR

D.

Business address...

5418

DAN NuyS

- VAN NayS

(ZIP codo)

E. Indicate method

of accounting:

cash; D accrual;

%. Were d on 591, 592, 59o tin 599, for the colendor year filed (if required)? A Yes

• No

G. Method of inventory valuation b..

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

D YES

NO.

If "Yes," attach explanation.

IMPORTANT-All applicable lines and schedules must be filled in.

Gross receipts or sales $

Less returns and allowances $

Balance D

INCOME

2 Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) .

3 Gross profit

& Other income (attach

TOTAL income (add lines 3 and 4)

€ Depreciation (explain in Schedule C-3)

7 Taxes on business and business property (explain

ih Schedule C-2)

8 Rent on business property

9 Repairs (explain in Schedule C-2)

10 Salaries and wages not included

on line 24, Schedule C-! (exclude any paid to yourself)

li Insurance

12 Legal and professional fees . .

13

Commissions..

14

Amortization (attach statement)

15 (a) Pension and profit-sharing pl

ans (see Instructions for line 15(a))

(b) Employee benefit programs

Instructions for line 15(b))

Interest on business indebfedness

17

Bad debts arising from sales or services

18 Depletion

19

Other business expenses (specify):

(a).

(b).

(c)..

(d)

(e).

(f)

(g).

(h) Total other business expenses (add lines 19(a) through 19(g))

20

Total deductions (add lines 6 through 19)

•SCHEDULE

21 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR

4948

SCHEDULE C-I. 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 $.

Less cost of items withdrawn for personal use $.

Balance D

24 Cost of labor (do not include salary paid to yourself)

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

NV803,4gDocld:32245535 Page 129

Biting.

---

## Page 130

, Schedule C (Form 540) (Rev. 1973)

SCHEDULE C-2. Explanation of Lines 7 and 9

Explanation

$

Line No.

Explanation

Page 2

Amount

$

SCHEDULE C-3.

DEPRECIATION (See Schedule C Instructions for line 6).

IOTE: Depreciation may be computed b

sing the Asset Guideline Classes specified in Federal Revenue Procedure 72-10, regardless of when assets were

placed in service. If this method is used, do NOT use the lower Limit or the Upper Limit (ADR) Ranges. Attach

detailed statement of depreciation computation.

a. Group and guideline class

b. Date

or description of property

acquired

C.

Cost or

other basis

d. Depreciation

allowed or allowable

in prior years

e. Method of

computing

depreciation

f, Life or

8. Depreciation for

this year

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

2 Asset Guideline Class System

(See Note above)

3 Other depreciation

Buildings

Furniture and fixtures .

Transportation equipment.

Machinery and other equipment.

Other (specify)

4. Totals

5 Less: Amount of depreciation claimed elsewhere in Schedule C-1

@ Balance-Enter here and on page 1, line 6

Summary

Straight line

Declining balance

I Line 2, above

8. Other .

201

SCHEDULE C-d.

Expense Account Information

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. However, the infor-

mátion need not be submitted for any employee for

whom the combined amount is less than $10,000, or

for yourself if your expense

account allowance plus

line 21, page 1 is less than $10,000.

Did you claim a deduction for expenses connected with:

(1) Entertainment facility (boat, resort, ranch, etc.)?

• Yes

MI NO

(2) Living accommpdations (except employees on business)?

7 Yes

DE NO

NW 88326 Docld:32245535 Page 130

Sum of the

years-digits

Units of

production

Other (specify)

Total

(See Schedule C Instructions for Schedule C-4)

Name

Owner

3

Expense Account

Salaries and Wages

(3)

Employees' families at conventions or meetings?

• Yes

IT NO

(4) Employee or family vacations not réported on Form W-2?

• Yes

DA No

19719-400 5-73 2,000M O A OSP

---

## Page 131

SCHEDULE®

CALIFORNIA

FORM 540

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

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 SAD or S49 PHYLL IS

SAMUE

RuBy

PART I-Assets Held One Year or Less

a. Kind of property and description

(Example, 100 shares of "Z" Co.)

1400 INTER RECTIFIER

100650112

10.0

OTTERINST

100 ESSEX

INT

b. Date acquired

(mo., day, yr.)

1/17/73

10/11/72

3/19/23

413/73.

c. Date sold

(mo., day, yr.)

3/22/23

413/23

529123

6/29/23

d. Gross sales

price

3218

1281

348

1392

TAXABLE

1973

YEAR

Social Security Number

322122992

e. Cost or

other

basis as

adjusted, cost of subse-

quent

improvements

ne?

purchased,

(if

attach

explanation)

pense of sale

and

ex.

3229

301.7.1

3.95

1739

Gain or los

7316

8233

2. Enter gain (or loss), it 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

PART Il-Assets Held More Than One Year But Not More Than Five Years

5.

(2741)

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 Ill-Assets Held More Than Five Years

9.

10. Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)

11. Enter your share of 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

13. Enter amount from line 4

{741)

14: Enter 65% of the amount on line 8

15.

Enter 50% of the amount on line 12 19721053-19-322-10075

16. Enter unused capital loss carryover from preceding taxable years (attach computation)

13322)

17. Combine the amounts shown on lines 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

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 line 17;

(b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange

of capital assets; or

(c) $1,000 ($500. in the case of a husband or wife filing a separate return).

_NW 88326 Docld:32245535 Page 131

(16063,

(1000)

---

## Page 132

oof.

SCHEDULE

D-1

FORM 540

CALIFORNIA

TAXABLE

1973

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges Including Involuntary Conversions)

(Attach to Form 540, 540NR, 541 or 565)

YEAR

Name as shown on Tax Return

SAMUEL

PART I Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220

Identifying number as shown on return

322-12-7997

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

Description of Sections 18211, 18212-18, 18219, and 18220 property.

SNACK

1/20

8/13/33

(B)

(C)

(D)

Correlate lines. 1(A) through 1(D) with these columns a

2.

3.

4.

5.

6.

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

Property

(A)

28000

28138-

12386-

15752-

12248.

Property

(B)

Property

(C)

Property

(D)

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 :

12386

12248

8.

If Section 18212-18 property:

(a) Enter additional depreciation after 12-31-63 and before

1-1-71

(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 ó 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)

9.

If Section 18220 property:

(a) If farm land, enter soil

and water conservation expenses

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 line 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

10.

If Section 18219 property:

(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)

(t) Enter smaller of line 10(d) or line 10(e)

SUMMARY

OF

PART!

(Complete Property Columns (A) through (D) up to Line 10(f)

11.

Enter amounts. from line 6

12. Enter amounts from lines 7(b), 8(h), 9(d) and 10(f)

12248

before going to Line 11)

122Y8

13.

Subtract line 12 from line 11, enter here and in appropriate

Section in Part Il (see Instruction D-2)

Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part Ill

12ZY8=

(REV.

1973)

NW 88326 Docld:32245535 Page 132

---

## Page 133

Schedule D-1(540)

PART H

Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions

(Section 18181-82) see Instruction E

Section

A - INVOLUNTARY CONVERSIONS

DUE TO CASUALTY AND THEFT

a. Kind of property (if necessary,

attach statement of descriptive

details not shown below)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, ýr.)

d. Gross sales

price

e. Depreciation allowed

(or allowable).

since acquisition

1. Cost or other basis, cost of

subsequent improvements

• (if not purchased,

attach explanation) and

expense of sale

Page 2

id. plus cor

16. Combine the amounts on line 15, enter here and also on the appropriate line 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 111.

(b) For partnership returns: Enter gain(s) and losses) 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

17.

19.

21.

18. Combine the amounts on line 17, enter here

Section B-2 Property Held More Than One Year But Not More Than Five Years

20. Combine the amounts on line 19, enter here

Section B-3 Property Held More Than Five Years

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 as 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 541) that is being filed. (2) If line 23 is a loss, enter such amount on

line 26 of Part III.

(b) For partnership returns: Enter amounts on lines 18, 20 and 22, in Schedule K(565)— see Instruction E.

PART Ill Ordinary Gains and Losses

24.

25.

26.

27

a. Kind of property and how

acquired (if necessary,

attach statement of descriptive

details not shown below)

Gain, if any, from line 14

Loss, if any,. from line 16

Loss, if any, from line 23

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

price

e. Depreciation allowed

(or allowable)

since acquisition

f. Cost or other basis, cost of

subsequent improvements

and expense of sale

d. plus e. less f.

12248

28. Combine lines 24 through 27, enter here and also on the appropriate line as follows

(a) For fiduciary and partnership returns: 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:

on line 28 includes losses which are to be treated as an itemized deduction on

540 or 540NR) (see Instruction F), enter the total of such losses) here and

Schedule A (Form 540 or 540NR)- Identify 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(5)(1). Enter here

and on page 2 of Form 540 or Form 540NR, under "Other Income"

NW 88326 Docid:32245535 Page 133

12248

серж

122-4800

13722-400 5-73 2.500M Do OSP

---

## Page 134

1040

US

Department of the Treasury

/ Internal Revenue Service

Individual Income Tax Return

1970

For the year January 1-December 31, 1970, or other taxable year beginning

., 1970, ending

First name and initial (If Joint return, use firat names and middle initials of both)

Last name

SAMUEL AND PHYLLIS

RUBY

Present home address (Number and street or rural routo)

16250 Bircher

City, town or post office, State and ZIP code

Granada Hillge California

Filing Status—-check only one:

"10

Single;

2 X Married filing jointly (evead only one)

had income

Your social security number

322 18 2907

Spouse's social security number

3491

18 1420

Осси-

Yours SeLf-Emp.

pation

Spouse's Housewife

Regular / 65

or over / Blind

Enter

number

of boxes

checked 2

3 I Married filing

separately and spouse is

filing.

If this item checked give spouse's social security number in

space above and enter

first name here b

4 D Unmarried Head of Household

5

Surviving widow(er) with dependent child

6 [ Married filing separately and spouse is not filing

Exemptions

7 Yourself

& Spouse (applies only it item

or 6 is checked) #J

9 First names of your dependent children who lived with

you ._.

Fred,

Brian,

Elisa,

Thomas

10 Number of other dependents (from line 34) .

11 Total

exemptions claimed

Enter

number

6

Please attach Copy B of Form W-2 to back

12 Wages, salarles, tips, etc. (Attach Forms W-? to back. If unavailable, attach explanation) .

12

13a Dividends (and 08e.) $ 20.60

..... 136 Less exclusion $ 20.60

Balance

(Also list in Part I of Schedule B, if gross dividends and other distributions are over $100)

14 interest. Enter total here (also list in Part I| of Schedule B, if total is over $100) .

13c

Income

14

Please attach Check or Money Order here

15

15 Income other than wages, dividends, and interest (from line 40) -

7.284

- 92

16

16 Total (add lines 12,

nd 15) .

7,284

: 97

17 Adjustments to

moving expense, etc. from line 45)

17

18 Adjusted gross income

18

See page 2 of instructions for rules Ur

ur tax and surcharge.

7,284

97

' It you do pot itemize deductions and liffe

• in Tables. Enter tax on line 19

If you itemize deductlons or line 18 is $10,00

19

Tax and

Surcharge

19 Tax (Check it from: Tax Tables 1-15 [J, Tax Rate"

Dedule D L, or Schedule G [!)

Tax surcharge. See Tax Surcharge Tables A

u claim retire:

ment income credit, use Schedule R to figure surch

20

Payments and Credits

CLENTS COPY.

117

53

21 Total (add lines 19 and 20) .

117. 53

22 Total credits (from line 55) .

23 Income tax (subtract line 22 from line 21) .

24 Other taxes (from line 61) . .

538

20

25

25 Total (add lines 23 and 24) .

*26 Total Federal income tax withheld (attach Forms W-2 to back)

27 1970 Estimated tax payments (include 1969 overpayment allowed as a credit)

• 28. Other payments (from line 65).

26

27

28

655

7

Make check or money

order payable to Inter-

nal Revenue

Service.

29 Total (add lines 26; 27, and 28)

29

Bal. Due

or Refund

30 If line 25 is larger than line 29, enter BALANCE DUE. Pay in full with return . .

30

655 23

31 If line 29 is larger than line 25, enter OVERPAYMENT .

31

32, Line 31 to be: (a) Credited on 1971 estimated tax b $

(b) Refunded D

$

Undor penalties of perjury, I declare that i have examined his roturn, including accompanying schedules and statements, and to the best of my knowledge and belief

It is true, correct, and complote.

Sign

here

Your signature

Date

Spouse's signature (If filing jointly, BOTH must sign oven if only one had income)

Signature of preparer other than taxpayer,

based on

Date

all information of which he has any knowledge.

Address

LAMBERT-MARKELL

16633 VENTURA BLVD.

10—X1168-1

ENCINO, CALIF. 91316

NW 88326 Docld:32245535 Page 134

---

## Page 135

Pago 2 Form 1040 (1970)

Foreign Accounts

(check

appropriate box)

Attach Copy B of Form W-2 here. D

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 U.S. financial institution)?.

• Yes

No.

If "Yes,"

attach Form 4683. (For definitions, see form 4683.)

PART I.-Additional Exemptions (Complete only for other dependents claimed

on line 10)

33 (9) NAME

ship olation-

(c) Months lived in your

home.

during

it born

died

(d)

Did depend-

ent have income

or

year write

"B'" I of $625 or more?

"D".

(e)

Amount YOU furnished

for dependent's support, if

100% write

*'ALL

(f)

Amount furnished

by

OTHERS includ-

ing dependent.

$

$

34 Total number of dependents listed above. Enter here and on line 10.

PART Il.-Income other than Wages, Dividends,

and Interest

35 Business income (or loss) (attach Schedule C) .

36 Sale or exchange of property (attach Schedule D).

37 Pensions and annuities, rents and royalties, partnerships, estates or trusts, etc. (attach Schedule E) •

38 Farm income (or loss) (attach Schedule F)

39 Miscellaneous income (state nature and source) ..

40 Total (add lines 35, 36, 37, 38, and 39). Enter here and on line 15

PART Ill.- Adjustments to income

41 "Sick pay" if included in line 12 (attach form 2440 or other required statement) .

42. Moving. expense (attach Form 3903) •

43 Employee business expense (attach Form 2106 or other statement) .

44 Payments as a self-employed person to a retirement plan, etc. (attach Form 2950SE)

45 Total adjustments (add lines 41, 42, 43, and 44). Enter here and on line 17

PART Ii-Tax. Computation

46 Adjusted gross income (from line 18) :

47 (a) .If you itemize deductions, enter total from Schedule A, line 22

(b) ' If jou do not itemize deductions, and line 46 is $10,000 or more, enter

$1,000 ($500 if married and filing separately)

48 Subtract line 47 fröm line 46

49 Multiply total number of exemptions claimed on line 11, by $625 .

50 Taxable income. Subtract line 49 from line 48. (Figure your tax on this amount by using Tax Rate

Schedule X, Y, or Z unless the alternative tax or income averaging is applicable.) Enter tax on line 51

51 Tax. Enter here and on line 19

PART V.- Credits

52. Retirement income credit (attach Schedule R) .

53 Investment credit (attach Form 3468) . . .

54 Foreign tax credit (attach Form 1116) .

55 Total credits (add lines 52, 53, and 54). Enter here and on line 22

PART VI. Other Taxes

56 Self-employment tax (attach Schedule SE)

57 Tax from recomputing prior-year investment credit (attach Form 4255) •

58 Minimum tax. See instructions on page 7. Check here D, if Form 4625 is attached .

59 Social security tax on unreported tip income (attach Form 4137):

60 Uncollected employee social security tax on tips (from Forms W-2)

61 Total (add lines 56, 57, 58, 59, and 60). Enter here and on line 24

PART VII.-Other Payments

62 Excess F.I.C.A. tax withheld (two or more employers-see instructions on page 7)

63 Credit for Federal tax on gasoline, special fuels, and lubricating oil (attach Form 4136) .

64 Regulated Investment Company Credit (attach Form 2439) •

65 Total (add lines 62, 63, and 64). Enter here and on line 28

FEET: U.S, GOVERNMENT PRINTING OFFICE: 1970-11-370-040

NW 88326 Docld:32245535 Page 135

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

8,284

- 97

(1,000

00)

2.284 97

7.284 97

2.745|44

4. 539

53

3.700

00

839

11?

53

538:20

538|20

1B~#1107-

---

## Page 136

(Form 1040)

Department of the Treasury

Internal Revenue Service

Schedules A&B-Itemized Deductions AND

Dividend and interest Income

• Attach to Form 1040.

1970

Name(s) as shown on Form 1040

Samuel and Phyllis Ruby

Your Social Security Number

322 | 12: 7997

Schedule A-—Itemized Deductions (Schedule B on back)

Medical and dental expenses (not compensated by insurance

Contributions.Cash-including checks, money orders, etc.

or otherwise) for medicine and drugs, doctors, dentists, nurses,

(Itemize-see instructions on page 8 for

hospital care, insurance premiums for medical care, etc.

examples)

1 One half (but not more than $150) of in-

surance premiums for medical care.

2 Medicine and drugs .

. . :

3 Enter 1% of line 18, Form 1040 .

4 Subtract line 3 from line 2. Enter differ.

ence (if less than zero, enter zero) .

5 Itemize other medical and dental ex-

penses. Include hearing aids, dentures,

eyeglasses, transportation, balance of in-

surance premiums for medical care not

entered on line 1, etc.

11 Total cash contributions .

12 Other than cash (see instructions on

page 8 for required statement). Enter

total for such items here.

13 Carryover from prior years (see in-

structions on page 8).

14 Total contributions (Add lines

11,

12, and 13. Enter here and on line

19, below. See instructions on page 8

for limitation)

Interest expense-Home mortgage

Installment purchases .

Other (Itemize)..

280. 00

6 Total (add lines 4 and 5) .

7 Enter 3% of line 18, Form 1040 .

8 Subtract line 7 from line 6. Enter differ-

ence (if less than zero, enter zero) .

9 Total deductible medical and dental ex-

penses (Add lines 1 and 8. Enter here and

on line 17, below.)

Taxes.-Real estate .

State and local gasoline (see gas tax tables)

General sales (see sales tax tables) .

State and local income .

Personal property.

150

00

15 Total Interest expense (Enter here and

on line 20, below.) .

Miscellaneous deductions for child care,

alimony, union dues, casualty losses, etc.

(see instructions on page 8).

1, 552; 18

10 Total taxes (Enter here and on line 18,

below.) .

663 26

Summary of Itemized Deductions

16 Total miscellaneous deductions (Enter

here and on line 21, below.) .

17 Total deductible medical and dental expenses (from line 9) .

18 Total taxes (from line 10)

19 Total contributions (from line 14)

20 Total interest expense (from line 15),.

21 Total miscellaneous deductions (from line 16) .

22 TOTAL ITEMIZED DEDUCTIONS. (Add lines 17 through 21. Enter here and on Form 1040, line 47)S/ A

100

00

150

663

00

26

280

00

1,552

18

100

00

2•745 44

10-81189-1

NW 88326 Docld:32245535 Page 136

---

## Page 137

NAME

ADDRESS

Samuel and Phyllis Ruby

16250 Bircher

_ IDENTIFICATION NO. 322-12-7992

SCHEDULE NO.

MEDICAL

1. ONE HALF OF MEDICAL INSURANCE

(NOT OVER $150.00)

2. DRUGS AND MEDICINES

3. LESS: 1% OF ADJ. GROSS INCOME

4. NET DRUGS AND MEDICINES

5. DOCTORS/DENTISTS

DR.

DR.

DR

DR.

DR.

DR.

DR.

DR.

DR.

FEDERAL

Granada Mills. California

SCHEDULE OF DEDUCTIONS

STATE

CONTRIBUTIONS

CHURCHES

YEAR ENDED

1970

FEDERAL & STATE

150|00

150

00

150 00

COMMUNITY CHEST/UNITED CRUSADE

SALVATION ARMY/GOODWILL INDUSTRIES

RED CROSS

XMAS & EASTER SEALS

HEART FUND/CANCER FUND

PARTNERSHIP RETURN

PAYROLL DEDUCTION

OTHER ORGANIZED CHARITIES:

Boy Scouts

Girl Scouts

100 00

15

700

15.00

TOTAL CONTRIBUTIONS

INTEREST (TO WHOM PAID)

MORTGAGE LOAN

Colonial Mtg. CO.

280,00

FEDERAL & STATE

1,133 10

MEDICARE

HOSPITAL

INSTALLMENT LOAN

Goodbody Co.

Bache Co.

First Thrift

Transworld

Revolving Charges (6%)

120

3₴

119

_12

8910

51.

_44

39.10

LABORATORY

* BALANCE OF MEDICAL INSURANCE

NOT DEDUCTIBLE ON TOP LINE

TRAVEL FOR MEDICAL

AMBULANCE

GLASSES

HEARING AID

• PROSTHETIC APPLIANCES

MEDICAL EXPENSES

LESS: REIMBURSED BY INSURANCE

6. TOTAL

7: LESS: 3% OF ADJ: GROSS INCOME

8. BALANCE (NOT LESS THAN ZERO)

9. TOTAL MEDICAL DEDUCTIONS

(LINE 1 PLUS LINE 8)

TAXES

AUTO LICENSE (LESS REG. FEE)

SALES TAX

+ Large Items

SALES TAX AUTO

REAL ESTATE TAX

PERSONAL PROPERTY TAX

STATE INCOME TAX

GAS TAX 2000GAL. ®

• 07 c GAL.

150 00

FEDERAL

42

00

170

100

150 00

STATE

42

00

120,00

TOTAL INTEREST 1,552

18

MISCELLANEOUS DEDUCTIONS

FEDERAL & STATE

ALIMONY (EXPLAIN)

SAFE DEPOSIT BOX FEE

UNION DUES

SMALL TOOLS (GOOD 1 YEAR)

TOOLS DEPRECIATION

SAFETY EQUIPMENT

UNIFORMS (NOT GEN. WEAR)

LAUNDRY & CLEANING

AUTO_

MILEAGE Mo

TELEPHONE EXPENSE (NOT REIMB.)

EMPLOYMENT AGENCY FEES

DUES & SUBSCRIPTIONS

INCOME TAX PREPARATION

OTHERS Financial Publ

50

00

50

00

311

26

311 26

TOTAL MISC. DEDUCTIONS

CASUALTY LOSSES (EXPLAIN)

100|00

FEDERAL & STATE

140

00

140|00

DISABILITY INSURANCE

MISC. TAX

OTHERS:

TOTAL TAXES

66}

26

663 26

----

SUB TOTAL

LESS REIMBURSED BY INS.

SUB TOTAL

LESS $100.00 FOR EACH CASUALTY

TOTAL CASUALTY LOSSES

FEDERAL

STATE

TOTAL DEDUCTIONS 2774577 20745744

LAMBERT-MARKEIL • 16633 VENTURABLVD. • ENCINO, CALIF. 98140

NW 88326 Docld:32245535 Page 137

---

## Page 138

SCHEDULE C

(Form" 1040)

Department of the Treasury

Internal Revonuo Sorvice

Profit (or Loss) From Business or Profession

(Sole Proprietorship)

• Partnerships, joint ventures, etc., must file on Form 1065.

• Attach to Form 1040.

1970

Name as shown on Form 1040

Samuel and

Phyllis Ruby

Social security number

322

112

17997

A Principal business activity

Food

(See separate instructions)

B Business name ...

Snack

Bar

D Business address

5418

Van Nuys Boulevard

product

(For exomple: retail-hardware; wholesale-tobacco; services--legal; manufacturing-furniture; etc.)

C Employer Identification Number 95-2651578

Van

NuyS,

California

E Indicate method of accounting: (1) ₽ cash;

(2) [ accrual;

(3) D other.

91401

(ZIP code)

F Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

O YES # NO.

If "Yes," attach explanation.

G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 1970? (See "Item G", in separate instructions for Schedule C.)

D YES

# NO. If "Yes," where were they filed? ...

.Gross receipts or gross sales $...

Less: Returns and allowances $

2 Inventory at beginning of year; (if different from last year's closing inventory

attach explanation)

→..

3 Merchandise purchased $.....

less cost of any items

withdrawn from business for personal use $.

4 Cost of labor (do not include salary paid to yourself)

Material and supplies

Other costs (explain in Schedule (-1)

7

Total of lines 2 through 6

Inventory at end of this year

9 Cost of goods sold and/or operations (subtract line 8 from line 7)

10 Gross profit (subtract line 9 from line 1)

OTHER BUSINESS DEDUCTIONS

11 Depreciation (explain in Schedule C-2).

12 Taxes on business and business property (explain in Schedule C-1)

13 Rent on business property

14 Repairs (explain in Schedule C-1)

15 Salaries and wages not included on line 4 (exclude any paid to yourself)

16 Insurance

17 Legal and professional fees

18 Commissions

19 Amortization (attach statement)

20 Retirement plans, etc. (other than contributions made on your behalf-see separate

instructions

21 Interest on business indebtedness

22 Bad debte arlsing from sales or services

23 Depletion

24 Other business expenses (explain in Schedule C-1)

25'

Total of lines 11 through 24

26 Net profit (or loss) (subtract line 25 from line 10). Enter here and on line 35, Form 1040. ALSO enter on

Schedule SE, Part I, line 1

SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24

Line No.

Explanation

Amount

Line No.

Explanation

$

SCHEDULE

ATTACHED

9.284

97

Amount

$_

18-81171-1

NW 88326 Docld:32245535 Page 138

---

## Page 139

SCHEDULE SE

Computation of Social Security Self-Employment Tax

(Form. 1040)

Department of the Treasury

Internal Rovenuo Sorvice

Atta to Form person must file a separate Schedule SE

1970

= If you had wages, including tips, of $7,800 or more that were subject to social security taxes, do not fill in this page.

* If you had more than one business, combine profits (or losses) from all of 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)

Samuel

Ruby

Social security number

Check applicable block

: 12

17997

1 D Male 2 [] Female

Business activities subject to self-employment tax (grocery store, restaurant, farm,

etc.)

Part le

Computation of Net Earnings from BUSINESS Self-Employment (other than farming)

1 • Net profit (or loss) shown in Schedule C (Form 1040), line 26. (Enter combined amount it more than one business.) .

8,284|97

2 Net'income (or loss) from excluded services or sources included on line 1

: Specify. excluded services or sources.

3 Net earnings (or loss) from business self-employment (Subtract line 2 from line 1, and enter here and on line 1(a),

Part Ill, below.) :

Computation of Net Earnings from FARM Self-Employment

...-

SE

A farmer may elect to compute net far.n earnings using the OPTIONAL METHOD (line 3, below) INSTEAD.OF THE REGULAR METHOD (line 2, 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 lines 1 and 2.

Computation under Regular Method

1 Net farm profit (or loss) from:

(a) Schedule F, line 52 (cash method), or line 69 (accrual method)

(b) Farm partnerships:.

2 Net earnings from self-employment from farming. Add lines 1(a) and (b)

Computation under Optional Method

3 If gross profits from farming are:*

(a) Not more than $2,400, enter two-thirds of the gross profits

(b) More than $2,400 and the net farni profit is less than $1,600, enter $1,600

•Note.-Gross profits trom farming are the total of the gross profits from Schedule f, line 28 (cash method), or line

67 (accrual method), plus the distributive share of gross profit from farm partnerships as explained in instruc-

tions for Schedule SE.

4 Enter here ánd on line 1(b), Part I11, below, the amount on line 2 (or line 3, if you use the optional nethod)

Parti

Computation of Social Security, Self-Employment Tax

Net earnings (or loss) from self-employment-

: (a) From business (other than farming-from line 3, Part 1, above) .

(b) From farming (from line 4, Part Il, above)

*(c) From partnerships, joint ventures, etc. (other than farming)

(d) From service as a minister, member of a religious order, or a Christian Science practitioner. If you filed Form

4361, check here ] and enter zero on this line

(e) From service with a foreign government or international organization

(1) Other (director's fees, etc.), Specity..

2

Total net.earnings (or loss) from self-employinent reported on line 1

(It line 2 is less than $400, you are not subject to self-employment tax. Do not fill in rest of page.)

3 The largest amount. Öf combined wages and self-employment earnings subject to social

security tax is

$7,800

00

4: (a) Total "FICA" wages as indicated on Form W-2 .

• (b) Unreported tips, if any, subject to FICA tax from Form 4137.

line 9:

(c) Total of lines 4(a) and 4(b)

5

Balance (subtract line 4(c) from line 3)

6.

Self-employment income-line 2 or 5, whichever is smaller

7

If line 6 is. $7,800, enter $538.20; if less, multiply the amount on lirie 6 by .069

8

Railroad employee's and railroad employee representative's adjustment for hospital insurance benefits tax from

Form 4469.

9

Self-employment tax (subtract line 8 from line 7). Enter here and on Form 1040, line 56

8.284

197

8,284 97

7,800

100

538

20

538120

10-91171-1

NW 88326 Docld:32245535 Page 139

---

## Page 140

Samuel and Phyllis Ruby

SUPPLEMENT TO SCHEDULE C

Income :

Less. Sales Tax

Beginning inventory

Purchases - Beverages/milk

Groceries

Meat

Bakery/bread

Lessi Ending inventory

Adjusted Gross

Profit

Expenses:

Rent

Payroll

Payroll taxes

Travel to employees

Miscellaneous expense

Interest.

Accounting

Telephone

Repairs

Insurance

Linen

Auto - 3,000 M.

Office

Cleaning/maintenance

Depreciation

Net Profit

Equipment

4/7.0

Covenant Not To

Compete

Leasehold Imp.

(? Yr. Balance Lease)

$32,657.34

153•39

$32,503.95

1,988.55

8.761.69

1,893.83

2,412.82

$15,056.89

_800.00

1,172.16

2,046.30

202.92

215.00

219.40

419.10

225.00

78.45

121.40

150.00

21.00

360.00

360.00

50.00

3.321.36

14,256.89

$18.247.06

( 8,962.02)

$9,284.97

DEPRECIATION

$10,000.00

5,000.00

3,000.00

April-December, 1970

5 Yr.

?

Yr.

Yr.

$2,000.00

1,000.00

428.50

$4,428.50

NW 88326. Docld:32245535 Page 140

---

## Page 141

SCHEDULE D

(Form

Sales or Exchanges of Property

1040)

Department of the Treasury

• Attach to Form 1040.

Internal Revenue Service

Name(s) as shown on Form 1040

Samuel and Phyllis Ruby

Part

Capital Assets-Short-term capital gains and losses— assets held not more than 6 months

1970

Social Security Number

322 | 12|

7997

D

a. Kind of prop.

arty, Indicate

security, real

astate,

or other

(specify)

b. Description

(Examples:

100 sh.

of

"'Z" Co.,

2 story brick,

etc.)

с. Нож

ac.

quired.

d. Date

8. Date sold

acquired

letter

(mo., day, yr.) (то.,

day, уr.)!

symbol

(888

Instr.)

f. Gross sales

price

B. Depreciation

allowed (or

allowable) since

acquisition

h. Cost or other

basis,

cost of

subsequent

improve-

ments (if not

purchased,

attach

explanation) and

expense of sale

i. Gain (or loss)

It plus

g less h)

•SCHEDULE ATTACHED

(15,274.00)

2. Enter your share of net short term gain (or loss) from partnerships and fiduciaries.

3

4

5

6

Enter net gain (or loss) from lines 1 and 2

Enter unused short-term capital loss carryover from preceding taxable years (attach statement)

Net short-term gain (or loss) from lines 3 and 4

Long-term capital gains and losses assets held more than 6 months

7.

Capital gain distributions

8. Enter gain from Part VII, line 47 or line 51(a), whichever applicable

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)

11 Net gain (or loss) from lines 6 through 10

12 Enter unused long term capital loss carryover from preceding taxable years (attach statement)

13 Net long-term gain (or loss) from lines 11 and 12.

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 IV for computation of alternative

tax). Enter zero: if there is a loss or no entry on line 13

(b) Subtract line 15(a) from line 14, Enter here and on line 17, Part 11

16 If line 14 shows a loss-

(a) Add lines 4 and 12 (if lines 4 and 12 are blank, enter a zero here and on lines 16(b) and 16(c) and go

to line 16(d))

(b) Combine lines 3 and 11—if gain, enter gain; if loss, enter zero

(c) Enter smallest of (i) line 16(a) less line 16(b); (ii) line 48, Form 1040 (line 18, Form 1040 if tax

table used) disregarding capital gains and/or losses-determine this figure via a side computation;

or (jii) $1,000

(d) Combine lines: 3 and 11-If loss, enter loss; if gain, enter zero here and on line 16(e),

and go to line 16(f)

(e)

Enter smallest of (i) line 48, Form 1040 (line 18, Form 1040 if tax table used) disregarding capital

gains and/or losses, less line 16(c)— determine this figure via a side computation; (il) $1,000 ($500

if married and filing separately); (lii) if line 3 is zero or shows a gain, 50% of line 16(d); (iv) if line

11 is zero or shows a gain, amount on line 16(d); or, (v) if lines 3 and 11 show losses, line 3 added

to 50% of line 11.

Enter here, and on line 17, Part ll, the sum of lines 16c and on tate and teter

$1,000)

APart. W

Summary of Schedule D Gains and Losses

17 Net gain (or loss) from line 15(b) or 16(f), Part !

18. Net gain (or loss) from line 22, Part III

19 Total net gain (or loss), combine lines 17 and 18. Enter here and on line 36, Form 1040

(15.274.00)

1,000.00)

070-14-104-1

370-016

NW 88326 Docld:32245535 Page 141

---

## Page 142

NW 88326

Docld:32245535

Samuel and Phyllis Ruby

SUPPLEMENT TO SCHEDULE D

Shares

Description

Sale Price

Purchase Price

200

200

100

100

100

200

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

3 Units

200

100

100

100

Trans America Inc.

Tool Research and Eng.

Nat'1 Health Ent.

Botany Ind.

Datatron Processing

Castleton Ind.

Computer Equipment

Computer Equipment

Computer Inv.

Computer Inv.

Adams Russell

Cinerama Inc.

Summit Org.

Summit Org.

Itel Corp.

Asamere 01l Co., Ltd.

Saxon Ind.

Saxon Ind.

Telex Corp.

Telex Corp.

Salem Corp.

Equity Funding Corp:

General Mtg. Invest.

Nat'1 Health Enterprises

Botany Industries

Computer Equip.

Technicolor Inc.

$1,738.00

3,147.00

615.00

541.00

336.00

814.00

492.00

984.00

857.00

830.00

492.00

432.00

358.00

480.00

1,685.00

1,512.00

2,078:00

2,078.00

1,980. 00

1,980. 00

1,193.00

2,250.00

3,301.00

1,107.00

517.00

456.00

1,403.00

$1,681.00

4,534.00

1,724.00

1,105.00

529.00

1,479.00

1,219.00

2,463.00

1,648.00

1,661.00

1,194.00

967.00

840.00

840.00

1,660.00

1,507.00

2,041.00

2,041.00

2,269.00

2,269.00

1,495.00

2,584.00

3,011.00

3,499.00

1,105.00

1,219.00

2,465.00

NET LOSS

Gain

(Loss)

58.00

1,387.00)

1,109.00

564.00)

193.00)

665.00)

727.00)

1,479.001

791.00)

831.00)

702.00)

535.00)

482.00)

361.00)

25.00

5.00

38.00

38.00

289.00)

289.00)

302.00)

334.00)

290.00

2,392.00)

589.00)

763.00)

1,062.00

($15,274.00)

---

## Page 143

-FORM

54.0

RESIDENT

CALIFORNIA

INDIVIDUAL INCOME TAX RETURN

TAXABLE

1970

YEAR

For Calendar Year 1970 or Fiscal Year Begun

1970 and Ended

1971

FIRST NAME(S) AND INITIAL(S)

LAST NAME

Your social security number

Please

SAMUEL AND PHYLLIS

RUBY

322: 12:7997

C

Typer PRESENT HOME ADDRESS (Number and streas, or rural route)

COUNTY

Spouse's social security number

or

• 16250 Bircher

Los Angeles

349 | 18;

1420

O Print CITY, TOWN OR POST OFFICE

STATE

ZIP CODE

Your occupation

B

Granada Hills.

California

91344

Self-Employed

P

Spouse's occupation

• NAME AND ADDRESS OF EMPLOYER AT TIME OF FILING

Self-Employed

Housewife

NAME AND ADDRESS ON 1969 CALIFORNIA RETURN. IF SAME AS ABOVE, WRITE "SAME". IF NONE FILED,

Adjusted gross income on 1970 Federal

GIVE REASON.

Return $-

8, 284. 97.

11346 Montgomery Avenue

Granada Hills, Calif.

If different from line 11, below,

explain

in Part VII, page 2.

Filing Status

1.

(check one)

2.

Single

3.

Married, filing separate return-spouse's name:

Married, filing joint return

Unmarried "head of household" —Complete Part I, page 2

5. Wages, salaries, tips, etc. (before payroll deductions) if more than two employers, attach schedule

Income

Employer's name

Where employed (city and state)

If joint return,

'Include all

income of

both husband

and wlfe

B. Dividends. Enter total here (also list. in Schedule B (540), Part 1, it total is over $100)

6

20

60

7. Interest. Enter total here (also list in Schedule B (540), Part Il, if total is over $100)

7

8. Other income (from page 2, line 30)

8,284

97

9. Total (add lines 5, 6, 7 and 8)

8,305

57

REM

10. Adjustments to Income (from page 2, line 35)

10

Your

Tax,

and

Credits

11. Adjusted gross income (subtract line 10 from line 9)

11

° 8,305

157

• Ií you do not itemize deductions AND line 11 is under $10,000, find your tax in Tax Table in instructions.

Enter tax on line 12.

• If: you itemize deductions OR line 11 is $10,000 or more, go to Part IV on page 2 to figure tax.

12. Tax from (check one): Tax Table , Tax Computation (page 2, Part IV) 0g, or Schedule G. (540)

13. Exemption credits (from page 2, line 43)

12

13

00

-T00

None

14. Tax liability (subtract line 13 'from line 12)

15. Total other credits (from page 2, line 49)

16. Net tax. liability (subtract line 15 from line 14-18 $1.00 or less, enter. "zero")

15

16

None

17: 1970 California estimated tax payment or credit from 1969 (if any). If none, enter "zero'

Balance

Due or

Rofund

18. Balance due—lf any (subtract line 17 from line 16)

10: Overpayment-if any (subtract IIne' 16 from line 17)

PAY IN FULL WITH RETURN

OVERPAYMENT

20. Portion of line 19 you wish to apply on 1971 estimated

tax

21. Refund-if any (subtract line 20 from line 19)

REFUND

17

18

19

20

21

None

beller it is true, correct and complete.

d' compete it prepared ay a person other than taxpayer, his declaration is based on all

Including accompanying schedules and statements, and to the best

of my knowledge and

Do not write in these spaces

information of which

he has any knowledge.

Sign

Your signature i filing jointly, BOTH must sign

Date

here to

Spouse's signature.

Date

O Make Remittance Payable to FRANCHISE TAX BOARD-Mall to

FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 9581%.

Signature of preparer other than taxpayer

Adred AMBERT-MARKEt Date

166.33 VENTURA BLVD.

ENCINO, CALIF:. 91316

NW 88326 Docld:32245535 Page 143

---

## Page 144

Form 540 1970 Page 2

-PART I-Head of Household-If claimed, answer the following questions

Check

Never married

[J Final divorce/ dissolution

one:ss.

Date

Individual who qualified you as head of household:

Name.

Is this person married?.

the calendar year 19707.

(See Instructions)

Separate maintenance

Date..

• Widow(er)

Date.

Relationship..

If yes, did he or she file a joint return with spouse?

Did this person reside in your home for the entire taxable year?

Gross income $...

Did this person quality as your dependent for

..If not, explain circumstances

Total amount necessary to maintain household $

How much did you contribute $

PART. I! Other Income

22. Business income (or loss) (attach Schedule C (540))

23.

Sale or exchange of property (attach Schedule D (540))

24. Pensions and annuities

25.

Rents and royalties

26.

Partnerships

Attach

Schedule E

•(Form 540)

27. Estates or trusts

28.

Farm income (or loss) (attach Schedule F (540))

29. Miscellaneous income (state nature and source)...

22

23

24

25

26

27

28

8.284

..9?

(1,000

00)

30. Total (add lines 22 through 29). Enter here and on page 1, line 8

29

30

7.284 97

PART IlI- Adjustments to Income

31. "Sick pay" if included on page 1, line 5 (attach statement)

32. Moving expenses (attach statement)

33. Employee business expense (attach statement)

34. Military exclusion (maximum $1,000-$500 if separate return of husband or wife)

35. Total adjustments (add lines 31 through 34). Enter here and on page 1, line 10

31

32

33

34

35

PART IV_Tax Computation-If you do not use Tax Table or Income Averaging (Schedule G (540))

38. Adjusted gross. income (from page 1, line 11)

37. If you itemize dedúctions, enter total from Schedule A (540), line 31

If you do not itemize deductions, and line 36 is $10,000 or more, enter

(a) $1,000, if single, or married person filing separate return

(b) $2,000, if head of household, or married couple filing joint return

38. Taxable income (subtract line 37 from line 36)

39. Tax from Tax Rate Schedule in Instructions. Enter here and on page 1, line 12

PART V-Exemption' Credits

40. Single-$25. Married couple or. head of household--$50

41. Blind

• Yourself • Your spouse--$8 for each box checked

42. Dependents-Do not list yourself, your spouse, or person who qualifies you as head of household

NAME (and address if diferent from yours).

Fred, Brian,

Elisa,

Thomas

36

37

7.305.57

2,74544

38

4,539

51

00

40

41

5.0

00

RELATIONSHIP

children

Number of dependents

Ilsted

$8

43. Total exemption credits (add lines 40, 41 and 42). Enter hore and on page 1, line 13

42

43

PART VI Credit for Net Income Tax Paid to Another State-Attach copy of "other state" return-and Retirement Income Credit

44. Income derived from sources within State of

• and also taxable by California

45. California adjusted gross income (from page 1, line 11)

46. California tax liability (from page 1, line 14)

47. Credit limitation-line 44 = line 45

% (100%* maximum) x line 46 (cannot exceed tax paid other state)

48. Retirement income credit (attach Schedule R (540))

49. Total (add lines 47 and 48). Enter here and on page 1, line 15

44

45

46

47

48

49

32

82

00

00

PART VII-Reconciliation to Federal Return-If adjusted gross income on Federal return is different from line 11, page 1, explain below

Dividend Exclusion

NW 88326 Docld:32245535 Page 144

15149-400 7-90 19,000M O A OSP

---

## Page 145

SCHEDULE

CALIFORNIA

FORM 540

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

19 20

YEAR

Name as shown on Form 540

Samuel and.

Phyllis Ruby

Itemized

Standard

Deduction--You have

a choice between two deduction

methods.

You can either itemize your deductions or take a standard deduction as

explained in the 540 Instructions. On separate returns of a husband and wife,

Social Security Number

322

112 | 7997

if one spouse itemizes deductions, the other may not use the Tax Table or claim

the standard deduction. If you choose to itemize your deductions, complete the

appropriale items below.

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 premiums for medical care

2. Medicine and drugs .

3. Enter 1% of adjusted

gross income shown on Form 540

3

. 4: Subtract line 3 from line 2 (if less than zero, enter zero)

5. Other medical and dental expenses. Include balance of insurance premiums for niedical care not •

deducted on line 1 (attach schedule)

6. Total-(Add lines 4 and 5)

7. Enter 3% of adjusted gross income shown on Form 540

5

6

7

8. Subtract line. 7. from line 6 (if less than zero, enter zero)

9. Total-(Add lines 1 and 8)

8

9

1.50

Child Adoption Expense

10. Total expenses paid or incurred Attach itemized list

11. Enter 3% of adjusted gross income shown on Form 540

12. Subtract line 11 from line 10-See instructions for maximum limitations

12

Taxes:

13. Real estate

14. State and local gasoline

15. General sales

18. Auto license-Excess of registration and weight tees (see instructions)

17. Personal property .

18. State disability insurance (SDI)-Employer private disability plans do not quality

19. Other (specify)

20. Total taxes-(Add lines 13 through 19)

13

14

15

16

17

18

19

20

663

Contributions

21. Cash-Including checks, money orders, etc. (itemize)

21

22. Total cash contributions

23. Other than cash (see instructions). Enter total here

24. Total-Add lines 22 and 23—Maximum deduction may not exceed 20% of adjusted gross income

22

23

24

280

Interest Expense

25. Home mortgage

26.

Instaliment purchases

21. Other (itemize)

25

26

27

28. Total-(Add lines 25, 26 and 27)

28

1,552

Miscellaneous Deductions .

29. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize).

29

00

26

00

18

30. Total miscellaneous deductions

31. Total deductions. (Add lines 9, 12, 20, 24, 28 and 30). Enter total here and on Form 540, page 2, in space provided S/.A

NW 88326 Docld:32245535 Page 145

Schedule B on

reverse

30

31

100

2, 745

00

11.4

---

## Page 146

TAXABLE

SCHEDULE

FORM 540

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

19.70

YEAR

Aftach this schedule to your income tax return, Form 540 or 540NR

=

Name as shown on Form 540 or 540NR

Samuel and Phyllis Ruby

Partnerships, joint ventures, etc., must file on Form 565

Social Security Number

322 12 2997

Food

A. Principal business activity........

i produt.......

(For examplo: rotail-hardwaro, wholosalo-tobacco; services-legal; manufacturing-furniture; etc.)

Snack Bar

B. Business name ....

C. Federal employer identification number. 2652.578

D. Business location 5418 Van Nuys Boulevard

Van Nuys, California

(Numbor and stroat or rural routo)

(City-post office)

(State)

91401

(ZIP code)

Indicate method of accounting: X cash; J accrual; J other (describe).

F. Was there any substantial change in the manner of determining quantities, costs or valuations between the opening and closing

inventories?

• 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

explanation)

3. Merchandise purchased

less cost of any items with-

drawn from business for personal use $.

4. Cost of labor (do not include salary paid to yourself)

5. Material and supplies

6. Other costs (explain in Schedule C-1)

7.

Total of lines 2 through 6 .

8. Inventory at end of this year .

9. Cost of goods sold and /or operations (subtract line 8 from line 7)

10. Gross profit (subtract. line 9 from line 1)

OTHER BUSINESS DEDUCTIONS

11. Depreciation (explain in Schedule C-2)

12.

Taxes on business and business property (explain in Schedule C-1)

13. Rent on business property

184.

Repairs (explain in Schedule C-1)

15.

Salaries and wages not included on line 4 (exclude any paid to yourself)

16

Insurance

17. Legal and professional fees.

18.

Commissions

19.

Amortization (attach statement)

20. Retirement plans, etc. (other than your share) . . .

21. Interest on business indebtedness .

22.

Bad debts arising from sales or service;

23.

Losses of business property (attach statement) :

24.

Depletion of mines, oil and gas wells, timber, etc. (attach schedule) .

25. Other business expenses (explain in Schedule C-l)

26.

Total of lines 11 through 25

27. Net profit (or loss) (subtract line 26 from line 10). Enter here and on page 2, Part II, Form 540 or 540NR

SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 25

Line No.

Explanation

Amount

Line No.

Explanation

$.

SCHEDULE

ATTACHED

$

9.284 97.

Amount

$.

$..

(Rev. 1970)

NW 88326 Docld:32245535 Page 146

Page 1

---

## Page 147

SCHEDULE

CALIFORNIA

SALES OR EXCHANGES OF PROPERTY

• Attach to Form 540 or 540MR

FORM 540

Name as shown on Form 540 or 540NR

Samuel and Phyllis Ruby

Part I-CAPITAL ASSETS

SHORT-TERM-ASSETS HELD NOT MORE THAN 6 MONTHS

a, Kind of property (if necessary,

attach statement of descriptive

details not shown below)

1. Date acquirer

(mo., day, yr.)

c. Date sold

(mo., day, уr.)

d. Gross sales price

SCHEDULE ATTACHED

TAXABLE

1970.

YEAR

Social Security Number.

322 | 121

7997

e. Depreciation allowed

(or allowable)

since acquisition

(attach schedule)

f. Cost or other basis,

cost of subsequent

improvements (if not

purchased, attach

explanation) and

expense of sale

(15,274.00)

2.: Enter your share of net short-term gain (or loss) from partnerships and fiduciaries

3. + Enter unused short-term capital loss carryover from preceding taxable years (attach statement)

4. Net short-term gain (or loss) from lines 1, 2 and 3

LONG-TERM-ASSETS HELD MORE THAN 6 MONTHS

5. Enter gain (if any) from line 16, Part Il

*Enter your share of net long-term gain (or loss) from partnerships and fiduciaries

7. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)

8. Net long-term gain (or loss) from lines 5, 6 and 7

9. Combine the amounts shown on lines 4 and 8 and enter the net gain (or loss) here

•10. If line 9 shows a GAIN, enter 50% of line 8 or 50% of line 9, whichever is smaller. (Enter zero if there is a

loss or no entry on line 8)

11.

Subtract line 10 from line 9, Enter here and on line 17, Part Ill

12. If line 9 shows a LOSS, enter here and on line 17, Part Ill the smallest of the following:

(a) the amount on line 9; (b) the amount of taxable income on Form 540 or 540NR, computed without capital

gains and losses; or (c) $1,000

Carryover Loss (14,274.00)

Part Il-SALE OR EXCHANGE OF PROPERTY UNDER SECTIONS 18181-82

13. Enter gain (if any) from line 22, Part IV

14. Enter gain (if any) from line 25, Part IV

(15.274.00)

( 1,000: 00)

15. Enter your share of gain (or loss) of Section

18181-82 items, from

partnerships and fiduciaries

16. Net gain (or loss). If GAIN; enter on line 5, Part I; if LOSS, enter on line 29, Part V

PART III-TOTAL NET GAIN OR LOSS FROM SALES OR EXCHANGES OF PROPERTY

17. Net gain (or loss) from line 10 of 11, Part !..;

18. Net gain (or loss) from line 31, Part IV

19. Total net gain (or loss)-Combine lines 17 and 18. Enter here and on Form 540 or Form 540NR, page 2, Part

Il, line 23

(Rev. 1970)

NW 88326 Docld:32245535 Page 147

(Schedule continued on reverse)

Page 1

---

## Page 148

IRS

1ior sepulvere

787-0211

US

11.0k

Combined

with Form

- 1040A

For the yéar Jänuary 1-December 31, 1969, or other taxable year beginning.

First namo and initial (if joint return, use first names and middle initials of both)

Departinent of the Treasury

Individual Income

989-2700

Internal Revenue Service

Tax Return

1969, ending

196

19..

Last name

Your social security numbar

print

Homo address (Number, and street or rural route)

Please

City, town or post office, State and ZIP code

Your occupation

Spouzo's social socurity number

Enter below name and address used on your return

for 1968 (if same as above

write "Same"). If none filed, give

Spouse's occupation

reason...lf changing from separate to joint or joint to separate returns,

enter 1968 names and addresses.

Your present employer and address

Your

1 D Single

Filing

Status

2 • Married filing joint return (even if only one had income)

(Check

30

Married filing separate return and spouse is also filing a return.

If this item checked give spouse's social security number in.space provided

only one

above and enter first name here Do

Check boxes for exemptions which apply

7a Yourself .

7b. Spouse (only if her (his) income is included in this return or she (he) had no income)

8 First names of your dependent children who lived with you

6 D

Unmarried Head of Household

Surviving widow(er) with dependent child

Married filing separate return and spouse

is not required to file

Renana 65 or over

D

Please attach Copy B of Form W-2 here

Your Exemptions

Blind

/ Enter

number

of boxes

checked

9

OTHER

DEPENDENTS

(a) NAME-Enter figure 1 in the last

column to right for each name listed

(if more space is needed,

use other side)

(b) Rolation

ship?

No Months lived

Inifour., home? See

page 3 of instr.

(d) $600

or more

income?

(0) Support

furnished. 11100%6

write "ALL."

•$

Enter number

(f) Support furnished

by dependent and

others

$

10 Total exemptions from lines 7, 8, and Sabove.

11 Wages, salaries, tips, etc. Attach Forms W-2. If unavailable, explain on back

•11

Your income

12a Dividends (Total botore $_-

exclusion)

- It Less Less Exclusion Exclusions 20O-Balancess

13

Interest (If over $100, list in Schedule B, Part Il)

12c

13

1,637

-

Please attach Check or Money Order hereF

•Your Tax and

Surcharge

Your Credits

Balance Duel.

or. Refund

14

Other income from Schedule C O, Schedule D , Schedule E •. Schedule FO

14

(Add lines 11 thru 14)

(see back)

15a Total $ /

1-

Less 15b Adjustments $

Adjusted Gross Income D

15c

90% -

A If line PSc is $5,000 or more, go to Schedule T, to figure tax and surcharge. (Omit lines 16a and 16b.)

B. Also go to Schedule T, to figure tax and surcharge if you itemize deductions; or claim retirement income credit, foreign tax credit, or

investment credit; or if you owe self:employment tax or. tax from recomputing prior year investment credit. (Omit lines 16a and 16b.)

C If neither A nor B applies use Tax Tables instead of Schedule T. Complete lines 16a, 16b, and 16c. See paragraph D on back for

rules under which the IRS will figure your tax and surcharge.

16a Tax from Tax Table: A D, B O. or C (check one)

16a

16b Tax surcharge on amount on line l6a (see Page 10 of instr.)

16b

16c Total add lines 16a and 16b OR enter amount from Schedule T (Form 1040), line 11

16c

17

Total Federal income tax withheld (attach Forms W-2) .

17

18

Excess F.I.C.A. tax withheld (two or more employers-see page 5 of instr.)

18

19

• Nonhighway Federal gasoline tax-Form 4136, D Reg. Inv.-Form 2439

19

20

1969 Estimated tax payments (include 1968 overpayment allowed as a credit)

20

90.

21

Total (add lines 17, 18, 19, and 20)

21

Make

check

or

money order pay.

able

to

Internal

Revenue Service.

90

22

If line 16c is larger than line 21,

-→ enter BALANCE DUE

22

23

If line 21 is larger than line 16c,

24

Line 23 to be: (a) Credited on 1970 estimated tax D $

-→ enter OVERPAYMENT

; (b) Refunded D $

23

10

Under pensities of perjury, I deciare that I have examined this return, including accompanying schedules and statements; and to tha best of my knowledge and belief it

is true, correct, and complote.

Sign

here

Your signature

Date

Signature of preparer other than taxpayer,

based on

all information of which he has any knowledge.

Date

Spouse

's signature (If filing jointly, BOTH must sign-even if. only one had income)

Addross

16-s-

acid

---

## Page 149

SCHEDULE D

(Form 1040)

U.S. Treasury Department

Internal Revenue Service

Name as shown on page 1 of Form 1040

Gains and Losses From Sales or Exchanges

of Property

Attach this schedule to your income tax return, Form 1040

1968

Social Security. Number

Part I- CAPITAL ASSETS-Short-term capital gains and iosses-assets held not more than 6 months

a.

Kind of

prop-

orty.

Indicate

security, real

estate,

or other

(Specify)

Hew

ac-

d. Description

(Examples:

100 sh. of

"iz." Co., 2 story brick,

stc.)

quired.

Enter

letter

symbol

(Seo

instr.)

See Schedule

d. Date

acquired

a. Date sold

(mo., day, sr.) | (mo:.

day, yr.)

E. Depreciation

t. Gross sales

price

allowed (or

silovable) since

acquisition

Attacher

h.

Cost or other

basis, east of

subsequent improve-

ments (if not

purchased, attach

explanation) and

expense of sale

Gain or 10s5

(f'plus g lesgh)

(1357-)

2 Enter your share of net short term gain or loss) from partnerships.

and fiduciaries

3: Enter unused short-term capital loss carryover from proceding taxable years (attach statement)

4 Net short-term gain (or loss) from lines 1, 2, and 3 .

Long-term capital gains and losses-assets heid more than 6 months (12 months or more for certain livestocks)

76,352

5 Enter gain from Part Il, line 3 .

Total long-term gross sales price .

ба

Enter your share of net long-term gain (or loss) from partnerships and fiduciaries.

6b Enter your share of net long-term gain from small business corporations (Subchapter S) .

7:

Enter. unused. long term capital loss carryover from preceding taxable years (attach statement)

8

Capital gain dividends (see Form 1040 Instructions, page 5) .

Net long term gain (or loss) from lines 5, 6a, 6b, 7, and 8.

10 Combine the amounts shown on lines 4 and 9, and enter the net gain (or loss) here

11 14 line 10 shows a GAIN-Enter 50% of line 9 or 50% of line 10, whichever is smaller.

(Enter zero if there is a loss or no

entry on line 9.) (See reverse side for computation of alternative tax.)

82 Subtract. line 11 from line 10. Entor here and in Part IV, line 1, on reverse

side

13 if line 10 shows a LOSS-Enter here and in Part IV, line 1, the smallest of the following: (a) the amount on line 10; (b)

the amount on Form 1040, page 1, toge- 1b, computed without regard to capital gains or lesses; or (C) $1,000 L141 6 36

Part I|-GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250-

assets held more than 6 months (see instructions for definitions)

Whera double headings appear, uss the first heading for section 1215 and the second heading for section 1250.

a. Kind of property

and how acquired fif necessary,

attach statement

of descriptive dotails not shown below write 1245 or 1250

to indicato type of asset)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, уr.)

d. Gross sales price

(6, 357=

6. Cost or other basis, cost of

subsequent improvements (it

not purchased, attach expia-

nation) and expense of sale

f. Depreciation allowed (or allowable) since acquisition

t-1. Prior to January 1, 1962

-OR-

-1-2 After Do ember 31, 1861

OR -

Prior to January 1, 1.964

After December 31, 1953

&. Adjusted basis

(o loss sum of 1-1 and t-2)

h. Total gain

(d less g)

:. Ordinary gain

(lesser of 1-2 or h)

(see instructions)

1. Other gain.

• (hi less i)

2 Total ordinary gain.

Enter here and in Part IV, line 2, on: reverse side .

3 Total other gain. Enter here and in Part I, line 5; however, if the gains do not exceed the losses when this amount is

combined with other gains and losses from section 1231 property enter the total et column Lin Part I. line. 1

88326 Dold 32245535 Page 149

---

## Page 150

SCHEDULE T

(Form 1040)

Department of the Treasury

Intemal Rovenue Service

Tax

‹ Computation

Attach this schedule to your income tax return, Form 1040

Name (as shown on Form 1040)

Tax Computation

1 Your adjusted gross income (from line

15c, Form 1040)

Note.--If your adjusted gross income is less than $5,000 and you choose to take the standard deduction

instead of itemizing your deductions, omit lines 2, 3, 4, and 5. Find your tax in the tables on pages 10-12

in the instructions and enter it in line 6a instead of making a percentage rate computation.

2

Enter on, the ine at the right the amount of your deduction tigured under one of the folowing

—If you itemize deductions, enter the total from Schedule A (Form 1040), line 14

'OR

-Figure your standard deduction as follows:

'Enter 10 percent of line 1 'but

PROO

not more than $1,000 ($500 if

married and

filing separately)

$

Enter the sum of: $200 ($100 if

ARY

(b)

married

and

filing

separately)

plus $100 for each exemption

ОГ

iter the larger of (a or b on the

line at the right. If your spouse files

separate

return,

determine

your

deduction in the same manner that

claimed in line, 10 of Form 1040,

she (he) has.

but do not enter

more

than

$1,000 ($500 if married

and

filing separately)

3

Subtract the amount on line 2 fro

4.: Enter number of exemptions claimed on line 10, Form 1040. :..

n the amount on line 1 and enter the balance here.

..Multiply this number by $600, and

enter the amount on this line

5

Subtract the amount on line 4 from the amount on line 3 and enter the balance here. This is your

taxable income .

6а Tax: Use the appropriate Tax Rate Schedule on page 9 of instructions to figure your tax on the amount on

line 5.

(Check if tax is from: Tax Table , Tax Rate Schedule J, Schedule D Q: or Schedule G )

6b Tax surcharge. If line 6a is less than $730, find surcharge from tables on page 10 of instructions. If line 6a

is $730 or more, multiply amount on line 6a by 05 and enter result. (If you claim retirement income

credit. use Schedule R (Form 1040) to figure surcharge.)

6c Total (add lines 6a and 6b)

Special credits

7a Retirement income credit .

?b Investment credit.

7c Foreign tax credit .

7d Total (add lines 7a, 7b, and 7c) .

8

Income tax (subtract line 7d from line 6c) : . .

9

Self-employment tax (from Schedule SE (Form 1040), line 13)

10 Tax from recomputing prior-year investment credit (attach statement) .

11 Total tax (add lines 8, 9, and 10). Enter here and on line 16c, Form 1040 (make no entries on line 16a

or 16b, Form 1040)

# U.S. GOVERNMENT PRINTING OFFICE: 1985-0-337-051

SS

1969

Social Sacurity Numbar

907

1392=

:0

3600

20

12

rocId:32

---

## Page 151

SCHEDULE B

(Forra 1040)

Department of the Treasury

Intomal Revonua Servico

Name (as shown on page 1 of Form 1040)

Dividends and Interest

Income Schedule

Attach this schedule to your Income tax return, Form 1040

1969

Social Security

Number

PART I-Dividends Income

1 Gross dividends and other distributions on stock (list payers and amounts--write (H), (W), (J), for stock

held by husband, wife, or jointly)

PR

RELIM

Total line 1 .

2 Capital gain distributions (see

page 5 of instructions)

3 Nontaxable distributions (see

page 5 of instructions)

4. Total (add lines 2 and 3) .

5 Dividends before exclusion (line 1 less 4-not

less than zero). Enter here and on Form 1040;

line 12, in space provided

PART Il-Interest Income (list payers and amounts below)

Earnings from savings and loan associations and credit unions

-X.X

525-

395

-

158

40-

Other Interest (on bank deposits, bonds, tax refunds, etc.)

AV Contral Narayal Bank

11410281

513 -

Total interest income. Enter here and on line 13 .

4637=

--151.

---

## Page 152

SCHEDULE A

(Form 1040)

Department of the Trossury

Internal Rovanuo Service

Name (as shown on Form 1040)

Itemized Deductions

1969

Attach this schedule to your income tax return, Form 1040

Social Security Number

itemized DeductiongYou have a choice between two

deduction methods. You can either itemize your actual

deductions or take a standard deduction. Deductions may be

itemized for charitable and other contributions, interest ex-

pense, medical expense, certain taxes, casualty losses, child

care, and other items described in the instructions on

back. If you take the standard deduction, you will get an

Medical and dental expense (not compensated by insurance

or otherwise) for medicine and drugs, doctors, dentists, nurses,

hospital care, medical insurance premiums, etc.

1 One half of insurance premiums for medi-

cal care (but not more than $150).

2 Medicine and drugs

48

3 Enter 1% of line 15c, Form 1040

4 Subtract line 3 from line 2 (not less than

zero)

39

5 Itemize other medical, dental expenses

(Include balance of insurance premiums

not deducted on line 1) .

amount equal to 10 percent of the income you report on line

15c of Form 1040, but not less than $200 plus $100 for

each exemption claimed on line 10 of Form 1040 (subtract

$100 if married and filing

separately). The maximum

standard deduction is $1,000 ($500 if married and filing

separately). If you choose to itemize your deductions, fill

' in the appropriate spaces below.

Contributions. Cash-including checks, money orders, etc.

12 Scouts FAmAT

15

15

Cathole C:016a

PROOF

Hosp, Ins Pr

Dr. Reis

De, Straiss

Dr. Mendet

BELMINARY

1la Total cash contributions .

11b Other than cash (see instructions for

required statement). Enter total of

such items here .

200

1lc Carryover from prior years (see in.

structions on back) .

1ld Total contributions (add lines lla,

1lb, and 11c-see instructions for

limitation)

42

nem.

406

Interest expense-Home mortgage

Installment purchases

Other (Itemize) :

Auto Loan Derin, BA

Di. Fox Exe

75=

53m2

Sacres

tica

BILLY OPALS)

92=

939

6 Total (add lines 4 and 5) .

7 Enter 3% of line 15c, Form 1040:

8 Subtract ine 7 from line 6

9 Total (line 1 plus line 8) .

Taxes. —Real estate.

State and local gasoline

General sales (See page 15 of instructions)

State and local income

Personal property.

4002

22

108

12 Total interest expense

Miscellaneous deductions for child care,

alimony, union dues, casualty losses, etc.

See instructions. / 91c

Incone Tax Pieparationt

10 Total taxes

130

14 Total deductions (add lines 9, 10, 1ld, 12, and 13-

-

13 Total miscellaneous

enter on Schedule T (Form 1040), line 2) .

ENW 88326 Doclar45335 Page: 192

40

-

-

42-

120

1,5

135=

25

-

25 -

92-

-1

---

## Page 153

969

Samuel and thyllis tumy

.

11 346 MONTGOMERY

Granada Nices, dALIs

o be attached to and made

part of

: U.s. Individual

Sincome

FORM

1040,

1969

SNARES

DESCRIPTION

DATE

ACQUIRED

3016

PURCHAS

PRiCe

E: F. HuTToN and Co.

40055

4000

200

200

200

200

MERCANTRE INDUSTRIES

BOTANY INDUSTRIES

MIQWESTERN FiNANCIAL

MOLESTERN FINANGIAL

VTR. INC.

10-68

11-68

10-68

10-68

3-69

1-49

2:69

2-6.9

2:68

5-68

3303-

2994-

4,010-

1, 466-

3,726

1,832

1, 416

1,832

5,3257

4, 458

309-1

284

(366 →

<416-)

" 867-

MCDONNELL + CO

100

100

WEST BURY FASHIONS

IMPERIAL CURe FAMER

8-68

8-68

2-69

6-68

943-

853-

1,672-1,749-

90-

(72)

GOODBODY 4 Co

VOLUME MERCHANDISE.

300

200-

200

6200

200

100

H00

11-68

PENNSILVANIA ENG. CORP.

1-69

BOTANY INDUSTRiES

12-68

1-67

11-68

2-69

CAMERAMA, INC.

1-19

HENRYS DeiVE-IN

2:69

2-6.9:

10-6.9

ENTRON ELECTRONIAS

Co.

10-69

10.69

POLYCHROME CORe

3-69

10:169

NITRONIOS, INC.

1-69

11-10.9

COGAN- BERLIND WEILL.

LEVI

100

100

100

HELENE CURTIS INDUSTRE

12-68

10-62

ELLIED ARTISTS PICTS

3-69

10-6.9

VANGUARD INT., INC

9-68

10•69

ELEVISION Mfg. AMER

12-68

10-69

APRONiES, INC.

6.69

DIVERSIEIEO IND

6-19

11-69

12-69

2,563 2,645

82-

4, 6426-3,809

837-

4,010 - 3,726

284-

2,627-2,428

189-

2, 1403°

828-

,635)

875-

1, 672-

873

1 2-

2,002

(330.)

3,320-

4,66.0

(1,340-

1, 338-

2,1531

(8130)

1,078-1,257

(179

671-

1,219

(548)

362-

739-

(377)

1647-1,982-1

(3420)

1,722-2,431

(709)

SACHE " CO

100

UNITED PIECE + DIE WIS.

100

DIBONEY O

SORt

1oo

SIBONEY CORR

4во

MIDWESTERN FINANCIAL

100

GENERAL BATTERY + CERAMIL

9/00

GSC ENTERPRISES, INC.

100

IMPERIAL CORP & AMER

GENERAL BATTERY + CERAMiC

100

hon

TooL RESEACEN & ENG.

NITRONKS

8.68

1-69

169

2-68

1.69

2-49

868

2-162

1-69

2.69

5.109

568

8-68

6-69

6-68

66-669

10-10 9.

10-109

2-69

12-109

TOTA

2,3,4 - 2,343

609-

(29)

588-

21-

609-

l000

9-

2,932-

4,220

6,2881

1,623- 1,H87

139-

979-

739-

2 40-

1,5730

7494

(176)

3,3940

2,893

501-

2,464-2,267-

197-

1276-

3059

20301

64, 902 - 66, 138-

(6,3557)

AIl StOCKs

Required Ai

8326-Docld*

5535-Page 153

---

## Page 154

MEE MONTERMERY

Obe attached and

GRANADA MILES, CALiC

made a part af h.S: Individual Income Tai Foem ia4o

1969

he below listed expenses are in connection with Scheduled

INTEREST PAID ON MARGiN ACCOUNTS

BACHÉ + Co,

MEDONNELL + Co

COGAN-BERLIND - WEILL-LEVITT

CroopboDy a Co.

HUTTON + CO

TONAL INTEREST

137-

145

7÷

176

5/

583

BOars PERIODiCALS GaSERVICES

AUTO EXPENSE LOne MILES

ERSONAL

.5000

Mués

at 107/001.000

MiLES

47 -

TOTAL EXpENSES.

1.00

230

88326 Docld:32245535 Page 154

---

## Page 155

"" :

11040

Combined

with Form

US

Department of the Treasury

Internal Revenue Service

Individual Income Tax

Return

For the year January 1-December 31, 1969, or other taxable year beginning

1939,

C0322÷2-7497

ending

344-18-1420

Planse print or typa

D036

SAMUEL I PAULIS RUBAVE

13IG MUNT GONERY.

GRANADA HIS, CALiP GIV

196

Your social security number

322/27997

Your occupation

§If - EMFLOVED

Spouse's sociai security number

349 18 1 4020

Enter below name and address used on your return for 1968 (if same as above write

"Samo!"): If. none filed, give

reason. If changing from separate to joint or joint to separate returns.

Spouse's occupation

Hscuit

Please attach Copy B of Form W-2 to back

Name and address of employer at time ci filing

Your

1

Filing

Single

Married filing joint return (even if only one had income)

Status,

(Check

•3 0

Married filing separate return and spouse is also filing a retura..

If this item checked give spouss's social security number in space providad

only one)

above and enter first name here bo

Check boxes for exemptions which apply

Your Exemptions

7a Yourself .

7b Spouse (applies only if line 2 or line 6 is checked)

8 First names of your dependent children who lived with you

FRED- BRIAN- ELiSA- THOMAS

9 OTHER

(a) MAME- Enter figure 1 in tho last

DEPENDENTS

column to right for each name listed

(b)

(if more space is needed, use other side)

Relationship

(c) Months lived

in your nome. See

instructions,

B-2.

5

L

6

Unmarried Head if Household

Surviving widow(er) with dependent child

Married filing separate return and spouse

is not filing a return

Regular

65 or over

...A

Blind

: 0'1

Enter

number

of boxes

checked b

2

4

(d) $600

or inora

income?

(a) Support you

furnished. If 100%

write "'ALL.'

$

Enter number

(f) Support furnished

by dependent and

others

$

10 Total exemptions from lines 7, 8, and 9 above .

11 Wages, salaries, tips, etc. (Attach Form W-2 to back. If unavailable, explain on back)

11

Your Income

12a Dividends (exalberone] S-fo

SE -a-- Balance B-

12c

C

13

interest (Enter total here and if over $100, also list in Schedule B, Part !)

13

16570-

Please attach Check or Money Order here

Your Tax and

Surcharge

Your Credits

Balance Due

or. Refund

14 Other income: Total from attached schedules (check schedules used- O, PA, ED, FO).

14

Adjusted

15á Total

Add lines 11

15b Less Adjustments / 1010-1] $

Gross

© if line i5c is 55,000 or mbye E 6 Scheuie. T, to figure tax and surenarge. (OmitTes 16 and 17

income s

15c

907-0

Go to Sch. T'to figure tax and surcharge it you itemize deductions; or claim retirement income credit, foreign tax credit, or invest

ment credit; or if you owe self-employment tax.or tax from recomputing prior year investment credit.

@ It neither of above two items applies, go to Tax Tables instead of Sch. T. Complete lines 16, 17, & 18.

Somit lines tara Mil

16

See 1040-

1 for rules under

Tax from Tax Table (see tables on T-2 and T-3) •

which the IRS will figure

your tax and surcharge.

Tax surcharge on line 16 (see T-1 for tax surcharge tables) •

18

Enter total of lines 16 and 17 OR amount from Schedule T, line 18, if applicable (check

if from Tax Table A Q,

BO. COI

Tax Rate Sch. D,

•19

Total Federal income tax withheld (attach Forms W-2 to back)

20

*Excess: F.I.C.A. tax withheld (two or more employers--see R-2) .

21

• Nonhighway Federal gasoline tax, Form 4136; [] Reg. Inv., Form 2439

22

1969 Estimated tax payments (include 1968 overpayment allowed as a credit)

20

21

22

Make

Check

or

money order pay-

able

to

Internal

Revenue Service.

23

Total (add lines 19, 20, 21, and 22)

70

23

2.4

If line 18 is larger than line 23, enter BALANCE DUE. Pay in full with return

24

: 25

If line 23 is larger than line 18, enter OVERPAYMENT

26

25

Line 25 to be: (a) Credited on 1970 estimated tax 3 $

; (b) Refunded D- $

90.

Under penalties of perjury, I declare that i have examined this returni, including accumpanying schedules and statements, and to the best of my knowledge f relia t

Is true, correct, and complete.

Sign

here

Your signature

Date

Signature of preparer other than taxpayer,

based on

all information of which he has any knowledge.

Uate

Spouse's signature (If filing jointly, BOTH must sign even if only one had income)

Address

locld:32245535 Page 155

---

## Page 156

SCHEDULE A

(Form 1040)

Department of the Treasury

internal Revenue Service

Name as shown on Form 1040

Samuel a Pira

uềy

Medical and dental expenses (not compensated by insurance

or otherwise) for medicine and drugs, doctors, dentists, nurses,

hospital care, insurance premiums for redical care, etc.

& Ona half of Insurance premiums for mock

cal care (but not more than $150) . .

150

2' Medicine and drugs .

48

3 Enter 1% of line 15c, Form 1040

9

4. Subtract line 3 from line 2. Enter differ.

ence, (if less than zero, enter zero)

39 -

5 Itemize other medical and dental ax.

penses (include balance

of insurance

premiums for medical care not deducted

on line 1) . .

Itemized

Deductions

= See instructions on A-1 and Au2.

e Il you use ints schedute, attach i to Ferm 1090.

1969

Social Security Number

322/12/7992

Contributions,--Cash--Inciuding checks, money

orders, etc,

(itemize).

BY SEE 7AMER

GIRL SEOUS F AMER

15-

Hosp. INs PRams

De: REis

De STRAUSS

De MENDEL

De RoBINSON

De. FOX (EVE EXAM)

(FRED BRIAN, JAMIEL

WEINER OPTICAL

4 pair GLESsES)

6 Total (add lines, 4 and 5)

7 Enter 3% of line 15c, Form 1040 .

8 Subtract line 7 from line 6. Enter differ.

ence (if less than zero, enter zero)

9 Total deductible medical anó dental ex-

penses (add lines 1 and 8) .

Taxes, - Real 'estate :

State

and local gasoline

General sales (see sales tax tables)

State and local income

Personal property.

10 Total taxes

W 88326

Docld:32245535. Page 156

CATHOLIC CHARITIES

200

600.-

42-

406

25-

75-

92

11 Total cash

contributions

12. Other than cash (see instructions on

A-l for required statement). Enter

total for such items here

13 Carryover from prior years (see in-

structions on A-2)

14 Total contributions

(add lines 11,

12, and 13.--see instructions on A-2

for limitation)

Interest expense Home mortgage

Installinent purchases

Other (Itemize)

AUTO LOAN DEVON BANE

STEARES

15 Total interest expense

931

912-

#discellaneous deductions

for child care,

alimony, union dues, casualty losses, etc.

(see instructions on A-2).

1968 INIOME TAR

TREFARATION

1,0607 =

22-

108+

I6 Total miscollaneous deductions ..

17 TOTAL ITEMIZED DEDUCTIONS (add

tines 9, 10, 14,

15, and 16-enter

here and on Schedule T, line 2) .

10

40

=

40-.

T

120 20

1500

735-

25-

130

4,312 -

---

## Page 157

SCHEDULE B

(Form 1040)

Department of the Treasury

Internal Revenue Service

Name as shown on Form 190

SAMUEL + THYLLIS

SURY

PART I-Dividend Income

Dividend and interest Income

# See instructions on B1

I it you use this schedule, attach it to Form 1040

1 Gross dividends and other distributions on stock (list payers

and amounts--write (H), (W), (J, for stock held by tus.

band, wife, or jointly)

196

Social Security Number

32212

7947

PART I Interest Income

3. Earnings from savings and

loan

associations and credit

unions (list payers and amounts)

(WILLECT FEDERAL SAVINGS

F CHGO

525

= 20

152,6

if

2 Other interest

tax there is dist payers and amounts

(W) CENTRAL NAT'L BX F CHIGO

513.

2 Total of line 1

3 Capita!

gain

distri-

#'butions (see instruc-

tions on B-1) .

4 Nontaxable distribu-

tions. (see

instruc

tions on B-1) .

5, Total (add lines 3 and 4) . . : •

6 Dividends betore

exclusion

(subtract

line

5 from line 2). Enter here and ori

• Form 1040, line 12a

3 Total interest income. Enter here and

On Form 1040, line 13

1,637 =

NW 88626 Docld:32245535 Page 157

---

## Page 158

SCHEDULE D

Sales or Exchanges of Property

(Form 1040)

See instructions on D-1 and D-?.

Department of the Treasury

Internal Revenue Service

It you use this schedule, attach it to Form 1040.

Name as shown on Form 1010 SAMUEL + PHYLLIS

1969

Secial Security Numker

322

121

7992

Part I-CAPITAL ASSETS-Short-term capital gains and loges-assets heid not inore than 6 months

c. How

ac:

a. Kind of prop-

erty." Indicate

security, real

Tale.

other

b.

Description

(Examples: 100 sh, of

'"?""

Co.,

2 story brick,

aic.)

quired.

•Enter

121121

symbol

(Specify)

(Se:

instr.)

SEE

SCHEDULE

d. Date

acquired

(rno., day, уr.)

e. Date sold

(mo., day, jr.)

1. Gress sales

price

&. Depreciation

allowed for

allewable) since

acquisition

h. Cost or other

basis, cost of

subsequent improve.

menis (if nut

purchased, attach

expianation) and

expense of sale

i. Gain or los

if plús g'less h

ATTACHED

(6,359→

2 Enter your share of net short term gain (or loss) from partnerships

and fiduciaries;

3 Enter unused short-terin capital luss carryover from preceding taxabie years (attach statement)

4 Net short-term gain (or loss) from lines 1, 2, and 3.

• 16,3670

Long-term capital gains and losses-assets held more than 6 months (12 months or more foi certain livestock)

5 Enter gain from Part I1, line 3

Total long-term gross sales price.

6a Enter your share of net long-term gain (or loss) from partnerships and fiduciaries .

6b Enter your share of net long-term gain from small business corporations (Subchapter S) .

7 Enter unused long-term, capital loss carryover from preceding taxable years (attach statement)

8 Capital gain dividends

9 Net long-term gain (or loss) from lines 5, 6a, 60, 7, and 8

10 Combine the amounts shown on lines 4 and 9, and enter the net gain. (or loss) here

11 IF LINE 10 SHOWS A GAIN-Enter 50% of line 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a loss

or no entry on line 9.) (See reverse side for computation of alternative tax.) .

i2 Subtract line 11 from line 10. Enter here and in Part IV, line 1, on reverse side

13 IF LINÉ 10 SHOWS A LOSS Enter here and in Part. IV, line 1, the smallest of: (a) line 10:

One 3 SCh

., (tine 15c,

Form 1040, if tax table used) computed without capital gains or losses; or (c). $1,000

Part I-GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250-

assets held more than 6 months (see instructions on D-1 for definitions)

Where double headings appear, use the first haading for section 1245 and the second heading for section 1250.

16,3590

[6,3570

<015

a Kindes roper delai no shuire dion cessar 1 245 or 12550

attach statement

of descriptive details not shown balow-write

to indicato type of asset)

b. Date acquired

(mo., day, yi.).

c. Date sold

(mo:, day, y:.)

d, Gross sales price

o. Cost or othur basis, cost of

subsequent improvamants (if

not purchased, attach expla

nation) and exponse of sale

f. Depreciation allowed (or ailowable) since acquisition

f-1. Prior to January 1, 1962

I-2. After December 31; 1961

-- OR

--.i-OR--

Prior to January 1, 1964

After December 31, 1963

8. Adjusted basis

(e less sum of t-1 and 1-2)

h. Total gain

(i less g)

i. Ordinary gain

(lesser of 1-2 u: h)

--OR---__-

(set instructions)

j. Other gain

(h less i)

2 Total ordinary gain.

Enter here and in Part IV, line 2, on reverse side .

3 Total other gain..

Enter here and in Part I, line 5; however, if the gains do not exceed the losses when this amount is

combined' with other gains and losses from section 1231 property enter the total of column j in Part IIl, line 1

NW 88326 Docid: 32245535 Page 158

---

## Page 159

ULE T

1040)

of the Treasury

enue Service

Tax

Computation

If no entry is made on line 14, line 16, or line 17, keep this for your records

If entry is made on line 14, line 16, or line 17, attach to form 1040

shown on Form 1040

SAMUEL + PHILLIS

RuBY

adjusted gross income (from line 15c,

Form 1040)

-If your adjusted gross income is less than $5,000 and you cheose to take the standard deduction

ad of itemizing your deductions, omit lines 2, 3, 4, and 5.

Find your tax in the appropriate table

r. B on .T-2 or C on T-3). Enter tax on line 6 below.

r on the line. at the right the amount of your deduction figured under one of the following

jods:

you itemize deductions, enter the total from Schedule A, line 17

OR

gure your standard deduction as follows:

(1) Enter 10 percent of line 1 but do not

enter more than $1,000 ($500 if

married and filing separately)

(2) Enter the sum

of: $200 ($100 if

married and filing separately) plus

$100 for each exemption claimed in

#line 10 of Form: 1040, but do not

enter more than. $1,000 ($500 if

married and filing: separately) .

$

Enter the larger of b(1)

or b(2) on the line at the

right. It your spouse files

a separate return, deter-

mine your deduction in

the same

manner that

she (he) has.

1969

Social

Security

Number

372

1i/2

7997

907

-то

1,372-

tract the amount on line 2 from the amount on line 1 and enter the balance here .

er number of exemptions claimed on line 10, Form 1040,

.. Multiply this number by $600, and

er the amount here

stract the amount on line 4 from the amount on line 3 and enter the balance here. This is your

able income. Figure tax on this amount by using the appropriate Tax Rate Schedule (1, 11, or 111) 012

Enter tax on line 6 below

3,600 -

=

öu claim the retirement income credit, enter amount from Schedule R, line 12, here

stract line 7 from line 6

‹ surcharge. If line 8 is less than $735, find surcharge from tax surcharge tables on T-1. If line 8 is

35 or more, multiply amount on line 8 by .10 and enter result here

tal (Add lines 6 and 9) •

tirement income credit from Schedule R, line 17 (attach Schedule R).

vestment credit (attach Form 3468).

..

reign tax credit (attach Form 1116) • • • •

tal credits (add lines 11, 12, and 13)

come tax (subtract line 14 from line 10) . .

elf-employment tax (attach Schedule SE)

..

-

ax from recomputing prior-year investment credit (attach Form 4255)

stäl tax' (add lines 15, 16, and 17). Enter here and on line 18, Form 1040 (make no entry on line 16

r:17, Form 1040). Attach Sch. T to Form 1040 only if you made an entry on line 14, 15, or 17 above .

le 'Averaging. —If your income has ' (b) a joint return, or as a surviving hus-

To claim tax-free covenant bonds credit,

ised substantially this year, it may

band or wife,

with taxable income ex-

enter the amount of

credit

above line

your advantage to figure your tax

ceeding

$52,000,

or (c) as a head of

14,

and write "covenant bonds" to left

e surcharge under the

"averaging

household with taxable incorne exceeding

of the entry,

Schedule G from

$38,000.

al "Revenue Service office for full

Line 16--Self-Employment Tax.-Enter

IS.,

Line 9-Tax Surcharge. -The

rate for

amount shown on line 9, Part Ill, Schedule

the calendar year 1969 is

10 percent.

native: Tax.-It will usually be to

The tax surcharge is an addition to the

SE.

advantage to use the alternative tax

regular income tax.

See the Tax Sur-

Line 17-Tax From Recomputing Prior

ir net long-term capital gain exceeds

charge Tables on T-1.

Year

Investment

Credit... Enter

the

amount by which the credit taken in a

net short-term.capital loss,.or if you

a net long-term capital gain only, and

Credit for Foreign Taxes and Tax-Free

prior year or years exceeds the credit as

are filing (a) a separate return with

Covenant Bonds.-You may claim these

recomputed due to early disposition of

ale income exceeding '$26,000, or

credits only if you itemize deductions.

property. Attach Form 4255.

ENW 88326 Docld;32245535 Page 159

INS

ded by the

ins. This is

dule T. Also

1f8 or more

there isnotax

• Mini-

mum

10%

$0

6000

0000

0006

0000

0000

0000

0000

000

0000

0500

5000

0000

0000

14

26

20|

2.61

331

39

0000

2000

0000

0000

0000

0000

0000

0000

0000!

000o

32

39

T-3

---

## Page 160

Good Doa yo co

1940

ia dàu,

D

vIdends

20.100

Int erest

8,24

37

17 A

2.6 %

1/00

3g.

5. Page 160

---

## Page 161

ENW 88326 Dold 32245535 Page 1614

3602586182

The StanleyoOliver Migo Coo

1001 So California

Ave o

Chicago,

Il1. 60612

Type or print EMPLOYRR'S identification number, name, and address above.:

FEDERAL INCOME TAX INFORMATION

Federal income tax

withheld

Wording id tier to with-

Other compensa-

tion paid in 19682

156.00

2,250.00

EMPLOYEE'S social security number DD

322 12 7997

WAGE AND TAX STATENENT 1968

Copy C- For employee's records

SOCIAL SECURITY INFORMATION

paid in 19684

97.00

2, 250000

or sick pade tus seported by employee.

Amount is before payroll deductions

2 Add this item to wages in figuring the amount to be reported as wages

and salaries on your income tax return.

Samuel D. Ruby

6123 N. Hoyne Ave.

Chicago, Illo 60645

Type or print EMPLOYEE'S name and address (including ZIP code) above.

FORM V-2-V.3. Treasury Department, Internal Revenue Service

Uncollected Employee Tax on Tips

---

## Page 162

1040

U.S. Treasufy Department, Internal Revenue Service

Income Tax Return

for the year January 1-December 31, 1968,

or other taxable year beginning

1968, ending ......

................., 19......

Firat nato and Initial (If joint retum, use first names and middle initials of both)

Last name

1968

Your social security number

print of

amiel

Home address. (Number and street or rural route)

and Phyllis

ll.23 iV.

Ruby

City, towm or post office, and State

•Hoyne

ZIP code

Chicago

60645

i changing from separate to joint or found to separate returns, enho is ine sa" addresnes.

322/12|7847

Your occupation

Se/femployed

Spouse's social security number

3441/811420

If none filed, give

Housewife

Your present employer and address

Seif-employee

Your Filing Status —check only one:

Your Exemptions

Regular

65 or over

Blind

la • Single

2a Yourself . .

Enter

number

1b A

Married filing joint return (even i only one had income)

2b Spouse

of boxes

checked b

1c 0

Married filing separately. If spouse is also filing a return,

За First names of your dependent children who lived with

enter her (his) social security number in space provided above

you -

freu

L Bricin

and give first name here

Thomas

Enter

1d D Unmarried Head of Household

numbor»

3b Number of other dependents (from page 2, Part I, line 3)

le Surviving widow(er) with dependent child

4 Total exemptions claimed

Income

5

Wages, salaries, tips, etc.

If not shown on attached Forms W-2 attach explanation

5

Please. attach.Copy B of Form W-2 here

If joint re-

turn include

6

Other income (from page 2, Part II, line 8),

all income

7

:Total (add lines 5 and 6)

of both

8

husband

Adjustments to income (from page 2, Part Ill, line 5)

and wife

9

Total income ("adjusted gross income") (subtract line 8 from line 7)

9

350

2, 250

111

40

2162

2402

15

Find tax

10

from table

If you do not itemize deductions and line 9 is under $5,000, find tax in tables on

pages 12-14 of instructions. Omit lines 11a, b, c, or d.

Enter tax on line 12a.

Ila If you itemize deductions, enter total from page 2, Part IV, line 17

If you do not itemize deductions, and line 9 is $5,000 or more enter the larger of:

(1) 10 percent of line 9;

(2) $200 ($100 if married and filing separate return)

1la

7401226

plus $100 for each exemption claimed on line 4.

Figure tax

Deduction under (1) or (2) limited to $1,000 ($500 if married and filing separately).

using tay

rate

1lb Subtract line 11a from line 9. Enter balance on this line

schedules

116: Multiply total number of exemptions on line 4, above, by $600

Jid

Subtract line 11c from line 11b.

11b

11c

11d

3, 100/20

amount by using tax rate schedule on page 11 of instructions.) Enter tax on line 12a.

12a

12b

Tax (Check if from: Tax Table [, Tax Rate Schedule (A, Sch. D J, or Sch. G [J)

12a

Tax surcharge. If line 12a is less than $734, find surcharge from tables on page 10 of instruc-

3, 0/2.31

46031

tions. If line

12a is $734 or more, multiply amount on line 12a by .075 and enter result. (If

12b

you claim retirement income credit, use Schedule B (Form 1040) to figure surcharge.)

L

12c

Total (add lines 12a and 12b)

26.C0)

456

54

13-.

Total credits (from page 2, Part V, line 4)

Your

Tax,

Credits,

and

Pay-

ments

14a Income tax (subtract line 13 from line 12c)

14b Tax from recomputing prior year investment credit (attach statement)

15

Self-employment tax (Schedule C-3 or F-1)

16

Total tax (add lines 14a, 14b, and 15)

12c

13

14a

14b

15

16

475-04

-

I-d

7)

04+

17

Total Federal income tax withheld (attach Forms W-2)

18

Excess F.I.C.A. tax withheld (two or more employers-see page 5 of instr.)

19

• Nonhighway Federal gasoline tax-Form 4136, DJ Reg. Inv.--Form 2439

20

1968 Estimated tax payments (include 1967 overpayment allowed as a credit)

17

18

19

20

157-00

Make

check

or

money order pay-

able

to

Internal

Revenue Service.

Total (add lines 17, 18, 19, and 20)

21

If payments (line 21) are less than tax (line 16), enter Balance Due. Pay in full with this return

22

Balance

23

Due or

If payments (line 21) are larger than tax (line 16), enter Overpayment

23

314

- 14

Refund

24

Amount of line 23 you wish credited to 1969 Estimated Tax

24

25

Subtract line 24 from 23. Apply to: [ U.S. Savings Bonds, with excess refunded or [ Refund only

25

ponaltios of perjury, I doclaro that I have examined thio return,

ncluding accompanying schedules and statements

corract, and complote.

i ord by ton othrthn taxpayer, i declaration is base on i normatin an a one ma note de beiot le le

Sign

Your signaturo

Dato

Signaturo of proparor othor than texpayor

Doto

here

Addroos

088-18-30189-1

ENW 88326 Docld 32245535 Page 162

---

## Page 163

-AREA 10

&xemptions

Complete sniy for dependents claimedon line at page i

(D) NAME (If more space is needed attach schedule)

(b) Relationship

(c) Months tived in your

home. If born or

died dur-

ing year write

or "D"

(d) Did depend-

ent have income

of $600 or more?

(e) Amount YOU furnished

for

pendent's suppo

100% write "ALL'

$:

Form 1010-1968--Fago 2

(t) Amount furnished

by OTHERS includ.

ing dependent.

$

2

3 Total number of dependents listed above.

Enter here and on page 1, line 3b .

Part Is Incomefrom sources other than wages, etc.

Part iVe Itemized deductions-Use only if you do notuse

tax table or standard deduction.

Ja Gross dividends and other distributions on stock (list payers

Medical and dental expense (not compensated by insurance or

and amounts--write (H), (W), (J), for stock held by husband, wife, or

otherwise)-Attach itemized list.

ointly) ..

1 One half of insurance premiums for medi-

Sun Elect

Cuburn.

20,00

cal care (but not more than $150) .

52.52

2 Total cost of medicine and drugs .

Atlas

10.00

3 Enter 1% of line 9, page 1

Diversified Metals

6:00

4 Subtract line 3 from line 2 (not less than zero)

5

Other medical, dental expenses (include

ATI (7)

balance of insurance premiums for medi•

cal care not deductible on line 1)

Total line la

6253

Ib Exclusion (see instructions).

160j00

6 Total (add lines 4 and 5)

7

Enter 3% of line 9, page 1

• Ic Capital gain

distributions

8

Subtract line 7 from line 6 (not less than zero

9

Total (add lines 1 and 8) .

(see page 5 of instructions).

Contributions.-Cash—including checks, money. orders, etc.

Id Nontaxable distributions

(see page 5 of instructions).

(itemize)

1e Total (add lines 1b, 1c, and 1d) •

100|000

If Taxable dividends (line la less line 10-

not less than zero)

6758

Interest (list payers and amounts below)

Earnings from savings and loan assoc. and credit unions.

Other interest (on bank deposits, bonds, tax refunds, etc.)...

veron

15..

60

2 Total Interest income

3. Pensions and annuities, rents and royalties, part-

nerships, estates or trusts, etc. (attach Sch. B) •

4 Business income or loss (attach Schedule C) .

5 Sale or exchange of property (attach Schedule D) .

6 Farm income or loss (attach Schedule F) •

Miscellaneous income (state nature and source)

Business

0612.

Chiver

scubery

IS L

5,036:22

250.00

7

Total

misce

come

8 TOTAL (add lines 1f, 2, 3, 4, 5, 6, and 7)

Enter here and on page 1, line 6.

Adjustments to income

"Sick pay" if included in line 5, page 1 (at-

tach Form 2440 or other required statement) .

2 Moving expenses (attach, Form 3903) •

3

Employée business expense-(attach-Form

2106 or other statement)

Payments by self-employed persons to re-

tirement plans, etc. (attach Form 2950SE)

752 0C

5549140

Enter here and on page 1, line 8

10 Total cash contributions

11 Other than cash (see instructions for required

statement). Enter total of such items here.

12 Carryover from prior years (see page 7 of instr.)

13 Total contributions (add lines 10, 11,

and 12—see instructions for limitation) &

Taxes.—Real estate .

State and local gasoline

General sales (see page 15 of instructions) •

State and local income .

Personal property

14 Total taxes .

Interest expense.—Home Mortgage

Installment purchases

Other (Itemize) ..

A

15 Total interest expense

Miscellaneous deductions.—(see page 8 of instructions)

16 Total miscellaneous

17 TOTAL DEDUCTIONS (add lines 9, 13, 14,

15, and 16). Enter here and on page 1, line 11a. D

Erärva Credits

716,83

1

Retirement income credit (Schedule

B)

2 Investment credit (Form 3468) .

1251

3

Foreign tax credit (Form 1116) :

4

TOTAL CREDITS (for page 1, line 13) •

11

716

83

EXPENSE ACCOUNTS if you had an

expense allowance

or charged

MEHT U.S. GOVERNMENT PRINTING OFFICE: 1868-0-290-001

expenses to your employer, check here a and see page of instructions

080-18-4018001

MNWC88326-Docld:32245535: Page:163

---

## Page 164

PREPARED BY.

DATE...

CHECKED:

FOOTINGS BY...

EXTENSIONS BY..

SENIOR...

Samuel and this luby

→.:

To be attached to

Income

and made a part of US. Individual

Tax Form 1040, 1968

PartIn

The below listed

expenses are

iniconnection

with

my Schedule

Interest paid on margin accounts

McDonald

EF, HuHan

Lothschild

Sache

131.07

1538

2884

29.29

Total Interest

25453

Book, Periodiat and Services

1273

Auto

Miles Travelled

Less Persona

Business

at 10d

Telephone

Pent - Use of 14 of room

Deski and Book Case

$165.00 at 1oyeurs

6000

4500

1500

i5000

16 Co

72.00

Total, Expenses

16S0

14:83.

1149020141

26 Docld 32245535 Page 164

---

## Page 165

PREPARED BY..

DATE..

CHECKED:

FOOTINGS BY.

EXTENSIONS BY.

SENIOR.

Samuel and Phyllis Kub,

0123N. Hoyne

Illinoi

To be attached to

and made a part of U.S. Individual

Income Tax Form 1040, 1968.

Part In

The below listed

expenses

are

connection

with

my Schedule D

Interest paid on margin accounts!

McDonald

EF. Hutton,

Lothschild

Bache

13107

15'38

2884

2434

Total Interest

Book, Periodiat and Services

25433

1275

Auto

Miles Travelled

Less. Persona

Business

at 10d

Telephone

- Rent - Use of 14 of room

Desk and Bouk Cuse

$165.00

at coyears

6.000

4500

1500

iSOCo

16 Co

72000

16SO

Total Expenses

- 74.83

Mustunts to maine)

age 165

---

## Page 166

SCHEDULE D

(Form 1040)

U.S. Treasury Department

Internal Revenue Service

Samuel

Mama as shown on pago grAyllis

and

Part I- CAPITAL ASSETS-Short-term

Gains and Losses From Sales or Exchanges

of Property

Attach this schedule to your income tax return, Form 1040

196

ub

Social Security Number

32021

12

1Z9G)

capital gains and losses-assets held not more than 6 months

o. Kind of

prop.

erty.

Indicate

security,

estate,

real

or other

(Specity)

b. Description

(Examples: 100 sh. of

iz"' Co.,

2 story brick,

etc.)

c. How

quired.

letter

symbol

(See

instr.)

d. Date

acquired

8. Date sold

(mo., day, yr.) | (mo., day, yr.)

f. Gross sales

g. Depreciation

allowed (or

allowable) since

acquisition

h. Cost or other

basis, cost of

subsequent improve-

ments (if not

purchased, attach

explanation) and

expense of sale

i. Gain or loss

(f plus & less h)

ses

Schedule

AttacheT

5, 036.22

2 Enter your share of net short-term gain (or loss) from partnerships

and

fiduciaries

3 Enter unused short-term capital loss carryover from preceding taxable years (attach statement) .

4 Net short-term gain (or loss) from lines 1, 2, and 3 .

Long-term capital gains and losses-assets held more than 6 months (12 months or more for certain livestock)

5 Enter gain from Part Il, line 3 .

5, 0.36.012

Total long-term gross sales price.

6a Enter your share of net long-term gain (or loss) from partnerships and fiduciaries

6b Enter your share of net long-term gain from small business corporations (Subchapter S)

7 Enter unused long-term capital loss carryover from preceding taxable years (attach statement)

8

Capital gain dividends (see Form 1040 Instructions, page 5) •

9

Net long-term gain (or loss) from lines 5, 6a, 6b, 7, and 8 .

10 Combine the amounts shown on lines 4 and 9, and enter the net gain (or loss) here .

11 If line 10 shows a GAIN-Enter 50% of line 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a loss or no

entry on line 9.) (See reverse side for computation of alternative tax.) .

12. Subtract line 11 from line 10. Enter here and in Part IV, line 1, on reverse side.

13 lf line 10 shows a LOSS-Enter here and in Part IV, line 1, the smallest of the following: (a) the amount on line 10; (b)

the amount on Form 1040, page 1, line 1lb, computed without regard to capital gains or losses; or (c) $1,000 .

Part I|-GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250—

assets held more than 6 months (see instructions for definitions)

Where double headings appear, use the first heading for section 1245 and the second heading for section 1250.

5,036.22

5036.

a. Kind of property and how acquired (if necessary.

attach statement

of descriptive details not shown below-write 1245 or 1250

to Indicate type of asset)

b. Date acquired

(mo., day, уr.)

c. Date sold

(mo., day, yr.)

d. Gross sales price

o. Cost or other basis, cost of

subsequent improvements if

not purchased, attach expla-

nation) and expense of sale

f. Dopreciation allowed (or allowable) since acquisition

I-1. Prior to January 1, 1962

1-2. After December 31, 1961

OR -

_ OR -

Prior to January 1, 1964

After December 31, 1963

g, Adjusted basis

(a less sum of f-l and f-2)

h. Total gain

(d less 8)

1. Ordinary

(lesser of t-2 or h)

- OR -

(see instructions)

• Other gai

h loss i

2 Total ordinary gain.

Enter here and in Part IV, line 2, on reverse side

3 Total other gain. Enter here and In Part I, line 5; however, if the gains do not exceed the losses when this amount is.

combined with other gains and losses from section 1231 property enter the total of column j in Part Ill, line 1 . .

WNW 88326cDocld:82245535 "Page 166

E.?.

---

## Page 167

1040

u.S. Individual

U.S. Treasur popmentlinternal Revenue Service

Income Tax heturn for the year January i-December 31, 1967,

• 1967, ending --.

19.....

or other taxable year beginning

First namo and initial (if joint roturn, use first names and middle initials of both)

Last name

19

Your social security. number

samuel and chulli.

Ruby

32212|2997

Your occupation

ome address (Number and street or rural loute

Enqineer

•123 N. Houne

ZIP code

Spouse's/social socurity number

ity, town or post office, and State

349 18:1430

Chicago

Linois

Enter below namoond address used on your return for 1966 (if same as above, write "Same")., If none filed, give reason.

If changing

Spouse's occupation

trom separate to joint or joint to separate returns, enter 1966 names and addresses.

Your present employer and address

Souse present empayer an ades an e- Diver a Chicage tellinos.

Housemiti

Your Exemptions

Regular

65 or over

Blind

Your Filing Status —check only one:

Enter

Za Yourself .

number

of

boxes

la B. Single

checked &

Married filing joint return (even if only one had income)

2b Spouse

ic Married filing separately, If spouse is also filing a return,

За First names of your dependent children who lived with

enter tier (his) social security numbar in space provided above

you stred!

Brians.

and give first name here...

• Elisa

Thomas.

number D

4.

1d O

Unmarried Head of Household

3b Number of other dependents (from page 2, Part I, line 3)

le [ Surviving widow(er) with dependent child

Total exemptions claimed

Income

Wages, salaries, tips, etc.

If not shown on attached Forms W-2 attach explanation

5

W. 2 herc

# joint re-

6

Other income (from page 2, Part Il, line 8)

6, 733.38

turn include

6.74664

all income

Total (add lines 5 and 6)

8

of both

Adjustments to income (from page 2, Part Ill, line 5)

husband

6,74464

of Form

and wife

Total income (subtract line 8 from line 7)

Find tax

10

If you do not itemize deductions and line 9 is less than $5,000, find your tax from

from table

tables in instructions.

Do not use lines 11a, b,.c, or d.

Enter tax on line 12.

Picase attach Copy B

—OR

1la

If you itemize deductions, enter total from page 2, Part IV, line 17

If you do not itemize deductions, and line 9 is $5,000 or more enter the larger of:

(1) 10 percent of line 9;

(2) $200 ($100 if married and filing separate return)

Ila

186/28.

plus $100 for each exemption claimed on line 4, above.

Figure tax

Deduction under (1) or (2) limited to $1,000 ($500 if married and filing separately).

using tax

11b

rata

1lb Subtract line lla from line 9

554036

schedules

11c Multiply total number of exemptions on line 4, above, by $600

11c

3.60000

11d Subtract line. 11c from line 11b.

Enter balance on this line.

(Figure your tax on this

amount by using tax rate schedule on page 11 of instructions.) Enter tax on line 12.

1ld

L

96036

Tax (from either Tax Table, see line 10, or Tax Rate Schedule, see lines 1la-jid)

12

288 05:

Total credits (from page 2, Part V, line 4)

13

14a

Income tax (subtract line 13 from line 12)

14a

288. 05

LYour

14b

Tax from recomputing prior year investment credit (attach statement)

14b

Tax,

15

Self-employment tax (Schedule C-3 or F-1)

15

Credits,

16

288105

15

Total tax (add lines 14a, 14b, and 15)

Please, attach Check or Money Order here

and

17

Total Federal income tax withheld (attach Forms W-2)

17

344.60

Pay-

ments

18

Excess F.I.C.A. tax withheld (two or more employers-see page 5 of instr.)

19

• Nonhighway Federal gasoline tax-Form 4136, DJ Reg. Inv.-Form 2439

20

1967 Estimated tax payments (include 1966 overpayment allowed as a credit)

20

21

21

Total (add lines 17, 18, 19, and 20)

349k0

22

If payments (line 21) are less than tax (line 16); enter Balance Due.

Pay in full with this return

22

Balance

23

If payments (line 21) are larger than tax (line 16), enter Overpayment

23

6/53

Due or

24

Amount of line 23 you wish credited to 1968 Estimated Tax

24

Refund

Subtract line 24 from 23. Apply to: [J U.S. Savings Bonds, with excess refunded or & Refund only

25

6/155

Urider ponalties.

of porjury, I declare that l' have examined this return,

including, accompanying schedules and statements,

and to the best of my knowiedgo and bolief it is

true, corrèct; and complete.

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

Sign

Signatura of preparer other than texpayer

S/a

here

gnature if tiling Jointly, BOTH mu

had Income)

226 Adie

089-10-79828-1

NW 88326. Docld:32245535 Page 167

19

---

## Page 168

SCHEDULE. D

(Form 1040)

U.S. Treasury Department

Internal Revenue Service

Gains and Losses From Sales or Exchanges

of Property

Attach this schedule to your income tax return, Form 1040

Name and address as shown on page 1 of Form 1040

amuel and

Part I-CAPITAL ASSETS Short term capital gains and losses-

6/23 N. Hayne, Chicago,

Illinois

-assets held not more than 6 months

с. Нож

AC-

a. Kind of prop.

orty. Indicate

security, real

estate,

other

(Specity)

b. Description

(Examples:

100 sh. of

'iz' Co.,

2 story brick,

stc.)

quired.

letter

Symbol

d. Date

a. Date sold

8e4U1re0

(mo., day, yr.) (mo., day, yr.)

1. Gross sales

• price

(See

Depreclation

allowed (or

allowable) since

acquisition

instr.)

h. Cost or other

basis,

cost of

subsequent improve-

ments (if not

purchased,

attach

explanation) and

expense of sale

1967

1. Gain or loss

(f plus g less h)

tock

StocK

2-29-67 10-16-67 3,93592

7-22-62 18-16-672

60025

4483.26

2694.81

(54734

94. 56

2 Enter your share of net short term gain (or loss) from partnerships and fiduciaries •

3 Enter unused short-term capital loss carryover from preceding taxable years (attach statement)

4 Net short-term gain (or loss) from lines 1, 2, and 3

Long-term capital gains and losses.-assets heid more than 6 months (12 months or more for certain livestock)

5 Enter gain from Part 11, line 3

Steck

Beth Steel

Stes

AMP

StacK

Jupiter

12-65

9-62

6a-10.-

21-63 1-6)

10-62

553856

2,269.95

554.23

5564.02

1ep3.50

$ 32.021

(641.902

34.44

316,48

Total long-term gross sales price .

6 Enter the full amount of your share of net long-term gain for loss) from partnerships and fiduciaries

7 Enter unused long-term capital loss carryover from preceding taxable years (attach statement)

8 Capital gain dividends (see Form 1040 Instructions, page 6)

9 Net long-term' gain (or loss) from lines 5, 6, 7, and 8.

10 Combine the amounts shown

on lines 4 and 9, and enter the net gain (or loss) here

11 If line 10 shows a GAIN-Enter 50% of line 9 or 50% of line 10, whichever is smaller.

(Enter zero if there is a loss or no

entry on line: 9.)

(See reverse side for computation of alternative tax.) .

12 Subtract line 11 from line 10.

Enter here and in Part IV; line 1, on reverse side

13 I line 10 shows a LOSS Enter here and in Part IV, line 1, the smallest of the following: (a) the amount on line 10; (b)

the amount on page 1, line 1lb, Form 1040, computed without regard to capital.gains and losses; or (c)-$1,000

Part II-GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250-

assets held more than 6 months (see instructions for definitions)

Where double headings appear, use the first heading for section 1245 and the second heading for section 1250.

453.42

188.451

188.48)

&. Kit descripive eld not shui below esse it or i12tamen!

to indicate type of asset)

b. Date acquired.

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales price

e. Cost or other basis, cost of

subsequent improvements (if

not purchased, attach expla

nation) and expense of sale

f. Depreciation allowed (or allowable) since acquisition

1-1. Prior to January 1, 1962

• OR -

Prior to January 1, 1964

f-2. After December 31, 1961

- OR -

After December 31, 1963

• Adjusted basi

e less sum of f-l and f-2

h.

Total gain

(d less g)

lossel 0

lesser of ry or h

- OR.

(see instructions)

1. Other rain

(h less i)

2 Total ordinary gain.

Enter here and in Part IV, line 2, on reverse side .

3 Total other gain.

Enter here and in Part I, line 5; however, if the gains do not exceed the losses when this amount is

combined with other gains and losses from section 1231 property enter the total of column j in Part Ill, line 1 .

10-79725-1

NW 88326-Doeld 32245535-Page 168

---

## Page 169

Partal Exemptions Complote only for dopondonts claimod on lina 3b, page 1

(c) Months livod in your

(d) Did depond-

(a) NAME (ilmore space, is needed allach schedule)

(b) Relationship

home. If born or

died

the year woe of or du-

ent have Income

of $500 or morel

(8) Amount YoU turnished

for dependents

to roomin" support,

$..

Form 1040-1967—Page 2

(f) Amount furnisheu

by OTHERS includ

Ing dependeat

$.

3

Total number of dependents listed above.

Enter here and on

page 1,

line 3b

Income from sources other than wages, etc.

Deart 2l Itemized deductions-Use only If you do not use

tax table or standard deduction.

la. Gross dividends and other distributions on stock (list payers

Medical and dental expense (not compensated by insurance or

and amounts write (H), (W), (J), for stock held by husband, wife, or

othenviso) - Attach itemized list.

jointly)

Bethlehem.

Steel

(H)

168.

75°

1 One-half (but not more than $150) of In-

surance premiums for medical care

72

Hmer.

rich. a Found CHi

67.50

2 Total cost of medicine and drugs .

3 Enter 1% of line 9, page 1

4 Subtract line 3 from line 2 (not less than zero)

5

Other medical,

dental expenses (include

balance of insurance premiums for medi-

cal care not deductible on line 1) .

23625

168672

6 Total (add lines 4 and 5)

Total

686112

line la

2024.

7 Enter 3% of line 9, page 1

lb Exclusion (see instructions).

100/00

8

Subtract line 7 from line 6 (not less than zero)

Ic Capital gain

484.31

distributions

Total (add lines 1 and 8) :

544103

(see page 6 of instructions).

Contributions.—Cash—including checks, money

orders,

stc.

ld Nontaxable distributions

(see page 6 of instructions).

le Total (add lines lb, 1c, and 1d)

100,00

iss. Charities

• 25700

16: 00

1f Taxable dividends (line la less line 16

not less than zero)

136 2]

U.SY

20:00

Interest (list payers and amounts below)

Earnings from savings and loan assoc. and

credit unions.

bonds, tax refunds, etc.)

Lincolnuves

2 Total interest income

3 Pensions and annuities, rents and royalties,

part-

nerships, estatos or trusts, etc. (attach Sch. B)

4 Business income or loss (attach Schedule G) •

5 Sale or exchange of property. (attach Schodule D)

6 Farm income or loss (attach Schedule F) .

Miscellaneous income (state nature and source)

10 Total cash contributions

11 Other than cash (see instructions for required

statoment). Enter total of such items here.

12 Carryover from prior years (200 page 8 of Instr.)

13. Total contributions (add lines 10,

48.87

and 12- see instructions for limitation

Taxes, — Real estate •

State and local gasoline

General Sates (see page 15 of Instructions) .

4582

State and local income .

Personal property

14 Total taxes .

Interest expense.- Home Mortgage

188 48 0ther (itemize

Aey nold.

Frechling

MIsc.

6/00

40.00

175.40

2/5.00

37.00

15 Total interest expense

25425

7 Total miscellaneous income

Miscellaneous deductions.— (see page 9 of Instructions)

8 TOTAL (add lines 1f, 2, 3, 4, 5, 6, and 7)

Enter here and on page 1, line 6.

( 3130)

• WooK Tools

5200

Parall

Adjustments to income

"Sick pay" if included in line 5, page 1 (at.

tach Form 2440 or other required statement) .

„....¿Il'

16 Total miscellaneous

17 TOTAL DEDUCTIONS (add lines 9, 13, 14,

15, and 16). Enter hore and on page 1, line 11a. P

5200

1,1.8628

2 Moving expenses (attach Form 3903) •

3 Employee business expense (attach Form

2106

other statement)

4 Payments by self-employed persons to re-

tirement plans, etc. (attach Form 2950SE) •

5 TOTAL ADJUSTMENTS (lines 1 through 4);

Enter here and on page 1, line 8

# Credits

1 Retirement income credit (Schedule B) .

2 Investment credit (Form 3468) •

3 Foreign tax credit (Form 1116).

4 TOTAL CREDITS (for page 1, line 13) •

EXPENSE

ACCOUNTS-If you

had

an

expense

allowanco

or

charged

expensos to your employer, check here .and see page 7 of Instructions.

#U.S. GOVERNHENT PRINTING OFFICE: 1957-0-280-001

080-10-70877-1

-NW 88326-Doeld 32245535-Page 169

---

## Page 170

36-2586182

The Stanley-Oliver Migo Coo

1001 So California Ave.

Chiongo, Ill. 60612

Type. or print. EMPLOYER'S identification number, name, and address above.

FEDERAL INCOME TAX INFORMATION

Federal income

tax

Wages' paid subject to with-

withheld

holding in 1967

Other compensa!

tion* paid in 1967

349.60.

6,750.00.

Type or print EMPLOYEE'S social security number

322 12. 7997

Samuel D. Ruby

6123 N. Hoyne Ave.

Chicago, Ill. 60645

Type or print EMPLOYEE'S name and address (including ZIP code) above:

FORM W-2--U.S. Treasury.Department, Internal Revenue Service

WAGE AND TAX STATEMENT 1967

Copy C-For employee's: records

SOCIAL SECURITY INFORMATION

F.I.C.A. employee

Total F.I.C.A: wages '

tax withheld 3

paid in 1967.

290.40

6,600.00

This amount is before payroll-deduc-

tions or

exclusion:

Add this item to wages in figuring the amount to:be-reported"as wages

and salaries on your income tax return.

(F.I.C.A.)

rate of 4.4% includes

for Hospital

Insurance cal sec and 35% Co oldate, survivors and disability insurance.

much des tip rene send ese Was are the same bet to social

security. federal Income Tax Intormation,

under

but not more than $6,600.

Uncollected Employee Tax on Tips .

---

## Page 171

Reference copy, JFK Collection: BSCA

(RG 233)

JEE ASSASSINATION COLMECTION

IDENTITICATION FORM

jeency: ESCA

record Number: 7310093

decord Series: NULBERDD FILES

Ageney File Number: 004876

Fricinator: Eitizen Ruby, Sanuel

Frei: Reby Samuel.:

To:

- Ii

- -K

Title:

Date:

1-24-78

Wages:

169

Subjecte:

1...

2.

3...

Rule, sam.

_..R

Tap Rottens

Ruby Jach. Bockg round Associate sn Relates

-.R

5.

_..-R

6.

.-

R

Inciment Type : Other Textual

Clascification:

Restrictions:

Upen

19 1E 10 2

4

15

D

Current Status:

Date of last Rerien:

1 193

(peninE Criteria:

Comments: l cover leter

Bas 1: 102

FDider Title=

NW 88326 Docld:32245535 Page 171

---

## Page 172

Reference copy, JFK Collection: ESCA (RG 233)

INDIVIDJAL

RESIDENT

540

CALIFORNIA

INCOME TAX

LACE PREADDRESSED LABEL HERE, If available.

(Correct name and address, if necessary)

nter social security numbers) only if incorrect or not shown on label.

NAME (If joint return, giro first names and initials of both)

LAST NAME

SAmUEL+ PHYLUS

PRESENT HOME ADDRESS (Number and street, including apartment number, or

162

-50

BIRCHER

ST

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

GRANADA

LUSION

• Single

(Check Only One)

6

2,81

Married filing joint return (even if only one had income)

• Separate return of married person-Enter spouse's

social security number and full name here

TAXABLE

YEAR

1976

Check A Calendar Year

One:

D Fiscal Year Ending

FOR

SEE

PRIVACY

NOTIFICATION

PAGE 2

OF INSTRUCTIONS

Your Social Security Nunhar

1977

OCCU.

PATION

Yours

Spouse's

Personal

§ If line 1 or 3 checked, enter $25

If line 2, 4 or 5 checked, enter $50.

Dependents

-

Do not list the person who qualifies you as head of household

ELISA

THomas

6

00

HERE

W-2

5

Head of Household-Enter name of qualifying

individual

Widow(er) with dependent child (Year spouse died 197.

Total Number A1

Blind (see instructions) Number of blind exemptions

Total exemption credits (add lines 6, 7 and 8) Enter here and on line

Attach copy 2 of Form(s) W-2 to

face of this

10

Wages, salaries, tips and other employee compensation; return.

unavailable, see instructions, Page 1oh

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

14)

Z×$80

$8

10

11

€ 12

13

14

15

• EX 16

• If you do NOT itemize deductions AND line 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 lines 17 and 18.

17

18

Deductions: Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked)

Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule-Enter tax on line 19

Tax Rate Schedule

Income Averaging Schedule (G or G-1)

122.00

00

00

9

Ista

5195

2546

7741

2241

number on check or money order. ATTACH

Tax from (check one)

_ Tax Table

20

Total exemption credits (from line 9, above)

Tax liability (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) .

Net tax liability (subtract line 22 from line 21-if line 22 is greater than line 21, enter zero)

24

25

26

27

28

29

30

31

Other taxes (from line 71)

Total tax liability (add lines 23 and 24)

Total California income tax withheld (attach W-2 or W-2P to face of this return)

Renter's credit-it you lived in rented property on March 1, 1976, complete Part 1 on page 2

1976 California estimated tax payments

Excess California SDI tax withheld (see instructions)

Total Credits.

If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30,

enter zero.

Mail return to:

FRANCHISE TAX BOARD

SACRAMENTO, CA

95867

If line 25 is smaller than line 30, enter amount OVERPAID

Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks.

Mail return to:

FRANCHISE TAX BOARD

P.O. BOX 13-540

SACRAMENTO, CA

95813

€ 17

18

₫ 19

20

21

22

23

24

25

5686

2055

73

: 27

28

* 29

PAY IN FULL → 31

30

-0=

-0-

Do not write in these spaces

a 32

→ 5: 33

-0-

Amount of line 32 to be credited on your 1977 ESTIMATED TAX

34

If you do NOT want State income tax forms and instructions mailed to you next year, check here

See Instructions, Page 9

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best 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.

SIGN

Your signature

NEV 88326 Docld:32245535 Page 172

Date

Presar

Date

---

## Page 173

Reference copy, JFK Collection: ESCA (RG 233)

= = Page-2-Form 540 (1.976).

PART I - Renter's Credit - All questions must be answered

35 Did you, on March 1, 1976, live in rented property which was your principal residence?

36 Was the property you rented exempt from property tax?.

37 Did you live with any other person who claimed you as a dependent for income tax purposes?

38 Did you or your spouse claim the homeowners' property tax exemption or receive public assistance?.

• Yes TAlo

• Yes

• No

• Yes

• No

• Yes

• No

PART Il - Other Income

39 Business income (or loss) (attach Schedule C,540)) .

40 Net gain (or loss) from sale er exchange of capital assets (attach Schedule D:540)) .

41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-](540)) .

42 Pensions and annuities

43 Rents and royalties

44

Partnerships

ATTACH

SCHEDULE E

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 E(540))

(b) Alimony .

(c) Other (state nature and source)

Enter total of lines 47(a), 47(b), and 47(c)

48 Total (add lines 39 thru 47). Enter here and on line 13.

PART III - Adjustments to Income

49 "Sick pay," if included in line 10 (see instructions - attach Form FTB 3805T)

50 Moving expenses (see instructions - attach Form FTB 3805U)

51 Employee business expenses (See instructions - attach Form FTB 3805N)

52 Military exclusion (see instructions)

53(a) Payments to an individual retirement arrangement (attach FTB 3805P)

(b) Payments to a Keogh (H.R. 10) retirement plan

(c) Payments to a self-employed "Defined Benefit Plan'

Enter total of lines 53(a), 53(b), and 53(c)

54 Forfeited interest penalty (see instructions).

55 Total adjustments (add lines 49 thru 54). Enter here and on line 15

PART IV - Itemized Deductions

o Attach Schedule A(540) and enter sub-totals on lines 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) •

58 Total interest expense (from Schedule A(540), line 20)

59 Total contributions (from Schedule A(540), line 24)

60 Total casualty loss (from Schedule A(540), line 29).

61

Total miscellaneous deductions (from Schedule A(540), line 33)

62 Total child care and adoption expenses (from Schedule A(540), line 37) .

63 Total itemized deductions (add lines 56 thru 62). Enter here and on line 17

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 S(540)).

65 Retirement income credit (attach Schedule R(540))

66 Special low income tax credit (see special instructions).

67 Solar energy tax credit (see special instructions) .

68 TOTAL (add lines 64 thru 67). Enter here and on line 22

PART VI - Other Taxes

47a

47b

47G

53 a

53b

536

56

57

58

59

60

61

62

63

64

66

67

68

69 Tax on preference income (see instructions - attach Schedule P(540)

70 Tax on premature distributions from attached Form FTB 3805P

71 Total (add lines 69 and 70) enter here and on line 24 .

69

70

71

PART VII - Reconciliation to Federal Return - If adjusted gross income on Federal Return is different from line 16, page 1, explain below.

If no, you may not claim this credit

If yes, you may not claim this credit

If yes, you may not claim this credit

If yes, see page 3 of instructions

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

55

3546

1000)

2546

194/

112x

2917

.100

565€

NW 88326 Docld:32245535 Page 173

---

## Page 174

Reference copy, JFK Collection: ESCA (RG 233)

SCHEDULE

FORM 340

CALIFORNIA

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

1976

YEAR

Name as shown on Form 540

SXP Ruby

USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION

Soclal Security Numbor

3444 788

Modical and dental expenses (not compensated by insurance or otherwise) for

medicine

doctors,

dentists, nurses,

hospital care, Insurance premiums for medical

care, etc.

Contributions

21(a). Cash contributions for which you have receipts,

canceled checks, etc.

(b). Other cash contributions. List donees and

amounts ...

1. One half (but

not more than $150) of insurance

premiums for medical care...

2. Medicine and drugs

3. Enter 1% of line 16, Form 540

4. Subtract line 3 from line 2. Enter difference (if less

than zero, enter zero)

5. Enter balance of insurance premiums for medical care

not entered on line 1

6. Other medical and dental expenses:

(a) Doctors, dentists, nurses, etc..

(b) Hospitals

(c) Other (itemize)

sH

22. Other than cash.-See instructions for required state-

ment

23. Carryover from 1974 & subsequent years - See

instructions

24. Total- (Add lines 21a thru 23.

Maximum de-

duction may

not

exceed 20% of adjusted gross

income. Enter here and on Form 540, line 59) ....

scH

Casualty or Theft Loss(es)

NOTE: If you had more than one loss, omit lines 25

through 28-See instructions for guidance

7. Total-(Add lines 4, 5, 6a, b, and c)

8. Enter 3% of line 16, Form 540.

9. Subtract line 8 from line 7. Enter difference (if less

than zero, enter zero)

10. Total-lAdd lines 1 and 9. Enter here and on Form

540, line 56)

1941

25. Loss before insurance reimbursement.

26. Insurance reimbursement

27. Subtract line 26 from line 25, Enter difference

(If less than zero, enter zero)

28. Enter $100 or amount on line 27, whichever is

smaller

29. Casualty or theft loss (subtract line 28 from

line 27. Enter here and on Form 540, line 60)

Taxes

11. Auto license-Excess of registration and weight fees

(see

instructions).

12. Real

estate

13. State and local gasoline.

14. General Sales.

15. Personal property (Boat and Aircraft)

18. Other (itemize)..

Miscellaneous Deductions

30. Alimony paid to: .

31. Employment Education Expense..

32. Union dues

Other (itemize)

100

SCH

17. Total taxes (Add lines 11 thru 16. Enter here and

on Form 540, line 57)

Interest Expense

18. Home mortgage.

19. Other (itemize).

1128

33. Total (Add lines 30 through 32. Enter here and

on Form 540, line 61)

Child Care and Adoption Expense

34. Child care expenses - Attach Form 3805X. . . .

35.

Total adoption expense..

Less 3%0 of line 16, Form 540.

36. Net adoption expenses- See instructions

for maximum limitations.

37. Total child care and adoption expenses

(add lines 34 and 36. Enter here and on

Form 540, line 62).

20. Total-(Add

Form

540,

lines

18

line 58)

and

19.

Enter here and

on

NW 88326 Docld:32245535 Page 174

25,7

---

## Page 175

Reference copy, JFK Collection: ESCA (RG 233)

SCHEDL.LE

ті 216071420

FORM 340

CALIFORNIA

DIVIDEND AND INTEREST INCOME

Attach to Form 540

TAXABLE

1976

YEAR

lame as shown on Form 540

Soclal Security, Number

SXP Ruby

PART

I-DIVIDEND INCOME

Line I-Gross Dividends and Other Distributions on

tions),

less nontaxable portion, if any, on Form 540, page 1.

rockelf gross dividends and other distributions (including capital

Do NOT deduct the $100 federal exclusion.

"Capital gain dividends" are treated as ordinary dividends for

ain dividends) on stock were $900 or less, do not complete

State income tax purposes and not as capital gains as permitted

is part; but enter gross dividends (including capital gain distribu-

under the federal law.

Gross dividends and other distributions on stock-List payers and amounts-Write (H), (W), (J), for stock held by husband, wife, jointly.

Total dividends

Nontaxable distributions

• Taxable dividendsSubtract line 3 from line 2. Enter here and on line 11, form

540

PART II INTEREST INCOME

Interest on bonds, debentures, loans, notes, tax refunds and all

(b) Bonds (but not other obligations) of California and its polit-

pes of savings accounts including banks, credit unions and postal

ical subdivisions issued after November 4, 1902.

vings is taxable.

(c) Interest on bonds of Alaska and Hawaii issued prior to their

Interest on the following obligations is exempt from tax:

achieving statehood.

(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.)

Note: If total taxable interest income was $400 or lass,

do

not complete this part; but enter the total amount of interest

received on Form 540, page 1.

Interest income—List payers and amounts.

NOTE ON

WOODLEY

ить

TRANS WORLD

BIST2O

WOrD

4.95%

17

71

147

17

. Total Interest Income. Enter here and on line 12, Form 540

NW 88326

Docld:32245535 Page 175

5195

---

## Page 176

Reference copy, JFK Collection: ASCA (RG 233)

SCHEDULE®

CALIFORNIA

- TAXABLE

1976

YEAR

FORM 540

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Propriotorships)

tach this schedulo to your income fax return, Form 540 or 340NR

me as shown on Form 540 or 540NR

Ruby

Parinershlps, lolnt ventures, ofe, must file on, Form 363

Social Securlty Number.

B. Federal Employer I.D. No.

Name and Address of Business

DOODLEY BISTRO COFFEE

SHOP, 1055 VENTURA BLUD SiRINACA, 95-26515-78

Principal business activity li.e., retail-hardware;

wholesale-tobacco; services-legal; etc.) SERVIeS -

snach BAiL

Indicate method of accounting:

se accrual;

• other....

Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)?

Method of inventory valuation b-.....

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

• YES

• NO If."Yes," attach explanation.

Balance D

1 Gross receipts, sales, or fees $.

Less returns and allowances

$...

2 Inventory at beginning of year fif different from last year's closing inventory, attach explanation).

3 Purchases $.

Less cost of items withdrawn for personal use $..

A Cost of labor (do not include salary paid to yourself).

5 Materials and supplies.

6 Other costs (explain in Schedule C-2 or attach Schedule)

7

Total of lines 2 thru 6

& Inventory at end of this year.

9 Cost of goods sold (subtract line 8 from line 7)

D Gross profit (subtract line 9 from line 1).

1 Other income (attach schedule)

2 Total Income (add lines 10 and 11)

OTHER BUSINESS DEDUCTIONS

'3 Depreciation (explain in Schedule C-1 or attach Schedule)

4 Taxes on business and business property (explain in Schedule C-2 or attach Schedule)

15 Rent on business property..

6 Repairs (explain in Schedule C-2 or attach Schedule)

i7 Salaries and wages not included on line 4 (exclude any paid to yourself)

18 Insurance

19 Legal and professional fees

20 Commissions

?1 Amortization (attach statement

32 Retirement plans, etc. (other than your share, see instructions)

:3 Interest on business indebtedness.

34 Bad debts arising from sales or services (Not applicable it reporting on cast, bais).

25 Depletion (attach schedule)...

26 Other business expenses (explain in Schedule C-2 or attach Schedule).

27

Total of lines 13 thru 26

28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or 540NR

Schedule C-1

Depreciation

Claimed on line 13.

Group and guideline class

or description of property

Date

Acquired

Cost or

other basis

Depreciation

allowed (or allowable)

in prior years

5ct

Method of

computing

depreciation

Life or

Rate

3546

Depreciation

for this year

sett

Schedule G2

Explanation of Lines

6, 14, 16, and 26.

LINE

NO.

EXPLANATION

NW-88326-Doeld:32245535-Page 176

AMOUNT

LINE

NO.

EXPLANATION

AMOUNT

---

## Page 177

Reference copy, JFK Collection:

ESCA (RG 233)

411181432

SCHEDWEE

CALIFORNIA

"TAXABLE

1976

Зной

FORM 540

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

YEAR

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 340 or 540Ng

Ruby

PART I Assets Hold Ona Year or Loss

soen security Humber

D

8. Kind of property and description

(Example,

100 shares of "Z" Co.)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

price

8. Cost of

adjusted

other

basis

• cost of subse

quent Impromments

not

surchased,

(11

sttach

expianation)

and

pense of sala

1. Gain or loss

(d.1088 8.)

1.

2.

Enter gain (or loss), if applicable, from line 17, 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 . .

PART If Assets Hold More Than One Year But Not Moro Than Five Years

5355

6. Enter gain (or loss), if applicable, from line 19, 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 (If gain, see 540 instructions, line 24a (Preference Income))

PART Ill-- Assots Held Moro Than Five Yoars

9

5355

10. Enter gain (or loss), if applicable, from line 21, Schedule D-1 (540) (attach copy) .

11. Enter your share of net gain or loss from partnerships and fiduciaries

12. Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a (Preference Income))

PART IV-Summary of Capital Gains and Losses

13. Enter amount from line

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 yeals fallach computation)

17. Combine the amounts shown on lines 13, 14, 15 and 16 .

3481

(150÷2)

18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or 540NR

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

(c) $1,000 ($500 in the case of a husband or wife filing a separate return)

NW 88326 Docld:32245535 Page 177

(1561)

(1000 )

---

## Page 178

Reference Copy, JFK Collection: ESCA (RG 233)

RESIDENT

540

INDIVIDUAL

CALIFORNIA

INCOME TAX

TAXAbLE YEAR

1975

PLACE

PREADDRESSED LABEL HERE, if available.

(Correct name and address, it necessary)

Enter social security numbers) only it incorrect or not shown on label.

Check

One:

NAME Ilf joint return, give first

LAST NAME

AMMEL

Кив

I Calendar Year

Fiscal Year Ending-

- 1976

FOR

FEDERAL

PRIVACY

CATION SEE

PAGE

ACT

NOTIFI-

2 OF INSTRUCTIONS

a Ygur

Social Security Num

PRESENT HOME ADDRESS (Number and Str

16250

CITY, TOWN

BIRCHER

rural route)

OE POST OFRICE, STATE AND LIP CP ILLUS

RANALA

CA

Spouse's Social Security Number

349

18146

Yours

oCcU.

PATION

Spouse's J/C

FILING STATUS Check Only One:

EXEMPTION CREDITS

/ 0 Single

§ If line 1 or 3 checked, enter $25

6 Personal

i If line 2, 4 or 5 checked, enter $50/

650

00

Married filing joint return (even if only one had income)

1 Dependents - Do not list yourself, your spouse or the person who qualifies you

3 O Separate return of married person -Enter spouse's

as head of household. Enter name and relationship.

social security number and full name here

ELISA

THOMAS

4 D Head of Household Enter name of qualifying

Iotal Number 0 .

.20.

individual.......

x.$80

8

16

00

Blind (refer to instructions) Number of blind exemptions a

× $8

00

5 0 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

10 Wages, salaries, tips and other employee compensation;

1 Attach copy 2 of

Formis) W-? to lace of this

66

00

return. If unavailable,

see instructions,

Page 6

10

11 Dividends-before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540) )

17

A 12 Interest. Enter total lif over $400, complete and attach Schedule B(540))

12

95

13 Income other than wages, dividends and interest (from line 48)

14

Total (add lines 10, 11, 12 and 13)

13

88.22

14

15

8.984

Adjustments to income (from line 55)

15

16

Adjusted gross income (subtract line 15 from line 14)

• If line 1 or 3 is checked and line 16 is $4.000 or less, enter zero tax on line: 23

Do not complete

• If line 2. 1, or 5 is checked and line 16 is $8.000 or less, enter zero tax on lime 23.

lines 17 thru 22

16

8984

• If you do NOT itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on line 19.

• Il you itemize deductions OR line 16 is $15,000 or more, complete lines 17 and 18.

17

Deductions: Itemized (from Ime 62) OR STANDARD ($1,000 if line 1 or 3 checked-$2,000 it line 2, 4 or 5 checked)

17

18

5735

Taxable income (subtract line 17 from line 16) Compute tax f

rom

Tax Rate Schedule-Enter tax on line 19

18

19

Tax from (check one) Tax Table O

3249

Tax Rate Schedul

Income Averaging Schedule (G or G.1) O

19

20

Total exemption credits (from line 9, above)

20

21

Tax liability (subtract line 20 from line 19-if line 20 is greater than line 19, enter zero)

21

22

Other credits (from line 65)

23 Net tax liability (subtract line 22 from line 21-if line 22 is greater than line 21, enter zero)

22

HERE

23

24

Tax on preference income (see instructions-attach Schedule P(540) )

25

Total tax liability (add lines 23 and 24)

24

25

- 0

ATTACH

26

Total California income tax withheld (attach W.2 or W.2P to face of this return)

— 26

27

Renter's credit-if you lived in rented property on March 1, 1975, complete Part 1 on page 2

a 27

money order.

28

1975 California estimated tax payments

29

28

Excess California SDI tax withheld (attach Form DE 1964 to face of this return)

DE 1964 HERE

30

29

Total prepayment credits (add lines 26 thru 29)

30

- O

If line 25 is larger than line 30. enter BALANCE DUE. If it is equal to line 30, enter zero.

Pay in full and mail with return to: FRANCHISE TAX BOARD

ATTACH FORM

Write social security number on check

SACRAMENTO, CA 95867

PAY IN FULL -

31

0

32

If line 25 is smaller than line 30, enter amount OVERPAID

Do not write in these spaces

33

• 32

Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks.

Mail return to:

FRANCHISE TAX BOARD

→ La 33

P.O. BOX 13-540

SACRAMENTO, CA 95813

Amount of line 32 to be credited on your 1976 ESTIMAILD TAX

.34

_ ESTIMATED TAX

Under penalties of perjury, I declare

belief

that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and

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

SIGN

Your signature

Date

Preparer's signature (other than taxpayer)

NW 88326 B0C1

Docld: 32245535' Page 1/goint return

Date

---

## Page 179

Reference copy, JER Collection:

ESCA (RG 233)

SCHEDULE

FORM 540

CALIFORNIA

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

1975

YEAR

Social Security Number

Name as shown on form 540

AMUEL

THYLLIS KUBY

If your adjusted gross Income is $8,000 or less and your filing status is "Married, Filing Jointly." "Hear

of Household," or "Widowler) With Dependent Child,"

or $4.000 or less and your filing status Is "Single," or "Married, Filing Separately,"

do not itemize, enter zero on Form 540, line 23, and check the tax

USE ONLY IF YOU DO MOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION

Medical and dental expenses (not compensated by insurance or otherwise) for

medicine and

hospital care, insurance premiums for

care, etc.

Interest Expense

21. Home mortgage

22. Other (itemize).

1. One half (but not more than $150) of insurance

premiums for medical care

• 2. Medicine and druRs

3. Enter 1% of line 16. Form 540

4. Subtract line 3 from line 2. Enter difference lif less

than zero, enter zero)

5. Enter balance of insurance premiums for medical care

not entered on line 1

6. Other medical and dental expenses:

(a) Doctors, dentists, nurses, etc.

(b) Hospitals

(c) Other (itemize)

SCH

23. Total-(Add Iines

21 and 22. Enter here and on

Form 540.

line

59)

2857

Contributions

24. Cash contributions for which you have receipts,

canceled checks, etc.

25. Other cash contributions. List donees and amounts

7. Total-Add lines

4, 5, 6a, b, and c)

8. Enter 3% of line 16, Form 540

9. Subtract line 8 from line 7. Enter difference (if less

than zero, enter zero)

10. To line Solines 1 and 9. Enter here and of Form

540, line 56)

SCa

Child Adoption Expense

11. Total expenses paid or incurred-Attach itemized list

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)

Taxes

14. Real estate

15. State and local gasoline

16. General Sales.

17. Auto license-Excess of registration and weight fees

(see instructions)

18. Personal property (Boat and Aircraft).

19. Other (itemize).

SCH

20. Total taxes-(Add lines 14 thru 19. Enter here and

NW 88326D62la:32245535 Page 179

1509

SLH

26. Other than cash.-See instructions for required state.

ment

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 Lossles)-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. Insurance reimbursement

31. Subtract line 30 from line 29. Enter difference (if line

30 is greater than line 29, enter zero)

32. Enter $100 or amount on line 31, whichever is smaller

33. Casualty or theft loss (line 31 less line 32)

34. Alimony paid.

35. Child care-See instructions

36. Union dues.

37. Employment education expense-See instructions

38. Other-(itemize)

150

1207

39. Total-Add lines 33, 34, 35, 36, 37, and

38.

(Enter

here and on Form 540, line

61).

---

## Page 180

Reference copy, JFK Collection: ESCA (RG 233)

SCHEDÜLE

CALIFORNIA

TAXABLE

19 25

C.

FORM 540

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Solo Proprlororships)

YEAR

Attach this schodulo to your incomo tax roturn, Porm 340 or 340NR

Name as shown on Form 540 or 540NR

Parmorsalps, folni vonturos, ofe, musi flo da form 368

Soclal Security Number

АМИ

EL

A. Name and Address of Business

PHyLL's RuBy

WOODLEY

ISTRO

COFFEESHOR

C. Principal business activity fi.e.,

retail-hardware;

wholesale-tobacco; services-legal; etc.)....

B. Federal Employer I.D. No.

95-2651878

SERVICE -NACKBAR

D. Indicate method of accounting:

EXaccrual;

F Mered of inventory valuation e, to cdS oer lee it require)?

*YES

F. Method of inventory valuation s

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

• YES

• NO If "Yes," attach explanation.

1 Gross receipts, sales, or fees $......................

...Less returns and allowances $.........

Balance D

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 $

& Cost of labor (do not include salary paid to yourself)

5 Materials and supplies

6 Other costs (explain in Schedule C-2 or attach Schedule).

7. Total of lines 2 thru 6

8 Inventory at end of this year

9 Cost of goods sold (subtract line 8 from line 7)

10 Gross profit (subtract line 9 from line 1)

11 Other income (attach schedule)

12

Total Income (add lines 10 and 11).

OTHER BUSINESS DEDUCTIONS

13 Depreciation (explain in Schedule C-1 or attach Schedule)

14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule)

15 Rent on business property

16 Repairs (explain in Schedule C.2 or attach Schedule)

17 Salaries and wages not included on line 4 (exclude any paid to yourself)

18 Insurance

19 Legal and professional fees

20 Commissions

21 Amortization (attach statement)

22 Retirement plans, etc. (other than your share, see instructions)

23 Interest on business indebtedness..

24 Bad debts arising from sales or services (Not applicable if reporting on cash basis)

25 Depletion (attach schedule)...

26 Other business expenses (explain in Schedule C-2 or attach Schedule)...

27

Total of lines 13 thru 26

28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or 540NR

Schedule C.1

Depreciation

Claimed on line 13.

Group and guideline class

or description of property

Date

Acquired

Cost or

other basis

SCH

Depreciation

Method of

allowed (or allowable)

computing

in prior years

depreciation

Life or

Rate

2559

Depreciation

for this year

Schedule G2

Explanation of Lines

6, 14, 16, and 26.

LINE

NO.

EXPLANATION

AMOUNT

LINE

NO.

EXPLANATION

AMOUNT

NW 88326 Docld:32245535 Page 180

---

## Page 181

SCHEDULE

D

FORM 540

Reference copy, JFK Collection:

ESCA (RG 233)

CALIFORNIA

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540MR

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.

TAXABLE

1975

YEAR

soeial security Number

SAMUEL

PART |- Assets Held One Year or Loss

8. Kind of property and description

(Example, 100 shares of "'7" Co.)

b. Dale acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

price

1924 LOSS CARENOVER

20,3607

USED19 410D

2. Entor gain (or loss), it applicoble, from line 18, Schedule D-I (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

PART Il- Assets Held More Than One Year But Not Moro Than Fivo Years

e. Cost

other

basis as

adjusted, cost of subse.

quent

improrements

not

purchased,

(it

attach

explanation)

and

ex.

pense

of sala

P. Gain or loss

(d. less e.)

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 Ill- Assets Held More Than Five Years

9.

5105

5105

10. Enter gain (or loss), it applicable, from line 22, Schedule D-1 (540) (attach copy)

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

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 (attach compuation)

17. Combine the amounts shown on lines 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

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

NW 88320

ĐbĐN:32245535hPage 18ts hushand or wite filines e sonarate return!

3318

(1936 8)

(6042)

(1000)

---

## Page 182

Reference copy, JFK Collection:

ESCA (RG 233)

SCHEDULE

D-1

FORM 540

CALIFORNIA

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges Including involuntary Conversions)

(Attach to Form 540, 540MR, 541 or 565)

TAXABLE

1925

YEAR

Name as shown on Tax Return

Identifying number as shown on relurn

D 1.

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.

Date acquired

Date sold

1.

(A)

(B)

Description of Sections 18211, 18212-18, 18219, and 18220 property.

WOOFLEY BISTRO COFFEESROP

(mo., day, yr.)

(mo., day, уr.)

21/54

9/2/75

(D)

Correlate lines 1(A) through 1(D; with these columns c

Property

(A)

Property

(B)

Property

(C)

Property

(D)

2. Gross sales price

3. Cost or other basis. and

expense of sale

4. Depreciation allowed (or allowable)

5. Adjusted basis, line 3 less line 4

6.

Total gain, subtract line 5 from line 2

INSTALMENT

7.

If Section 18211

property:

(a) Depreciation allowed (or allowable) after applicable date.

(See Instruction D-3)

SALE

(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

1-1-71

(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)

If Section 18220 property:

(a) If farm land, inter soil and, water conservation expenses

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 line 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

10.

If Section 18219 property:

(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)

(f) Enter smaller of line 10(d) or line 10(e)

SUMMARY OF PART I (Complete Property Columns (A) through (D) up to Line 10(f) before going to Line 11)

11.

Enter amounts from line 6

.74.18

12. Enter amounts from lines 7(b), 8(h), 9(d) and 10(f) .

13. Subtract line 12 from line 11, enter here and in appropriate

Section in Part Il (see Instruction D-2)

SIOS

14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part Ill

2313.

NW 88326-Dockd:32245535-Page 182-

---

## Page 183

Reference copy, JFK Collection: ESCA (RG 233)

MME SAMUEL & PHYLLIS RU

- CALENDAR YEAR 19-

25.

"ADDRESS

MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A.G.l. (Line 18 - 1010)

4 NET MED/DRUGS

5 M & A INS. (% + EXCESS)

6a DR.

DR.

DR.

DR.

DR

DR.

DR.

DR.

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

6C AMBULANCE

LABORATORIES

TRAVEL FOR MED

MEDICARE INS

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED EY INS

8 LESS 3% ADJ. GROSS INC

1+:½ (TO $150) OF H & A INS

10 TOTAL MEDICAL DED

TAXES

11 STATE & LOCAL INCUME

12 REAL ESTATE

13 STATE & LOCAI. GASOLINE

14 GENERAL SALES TAX

15a PERSONAL PROPERTY

156 PERSONAL PROPERTY AUTO

16 SALES TAX AUTO

17 TOTAL TAXES

INTEREST (TO WHOM PAID)

18 MORTGAGE

STA.TE

162.9

329

150

ВІ а

107

19 INSTALLMENT LOANS

MISC

TRANSWORER

SBA

FEDCG

20 TOTAL INTEREST

PSI

Pete send stationers i'

1: 311

NW 88326 Docld:32245535 Page 183

2809

Form 101

- SOC. SEC. NO. -

DEDUCTION SCHEDULE

FEDERAL

CONTRIBUTIONS

21a CASH CONTRIBUTIONS

21b PARTNERSHIP SHARE

GIRL/BOY SCOUTS

682

HEART FUNU/CANCER FUND

RED CRUSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

8?7

CHURCHES

STATE

70

7629

258

1321

150

IS2!

4.3

48

215

22

251Y

100

2852

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT (LOSS(ES)

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT

27

26 ($100 LIMITATION PER. CAS.)

29 TOr. CAS OR THEFTLOSS

MISCELLANEOUS DEDUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Form 2441)

33 INCOME TAX PREPARATION

UNIFORMS/PROTEC. CLOTHING

SMALL TOOLS AND SUPPLIES

LAUNDRY AND CLEANING

AUTO USE/DAMAGE

INVEST. COUNSEL & PUBS. (Sched

EMPLUYMENT AGENCY FEES

SAFE DEPOSIT BOX

TEL. REO. IN BUSINESS

POLITICAL CONTRIBUTIONS

1501

34 TOTAL MISC. DED

SUMMARY OF ITEMIZED DED.

35 TO S CAR MEPIT

& DENTAL

36 TOTAL TAXES (From LINE 17)

37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. (Line 24)

39 CAS. & THEFT LOSS(ES) (Line 29)

40

ГОГА

DEDUC TONS THROM LING 341

STATE

¡TEMIZED DEDUCTIONS

41 ENTER ON FORE 1O4O LINE 45

REMARKS

1503

FEDERAL

150

150

FEDERAL

5235

SCHEDULE

------+--

---

## Page 184

Reference

Copy, JER collection:

ESCA (RG 233)

МВУ

CALENDAR YEAR 19.

SEC.

NO.

FISCAL YEAR ENDING

_19

SCHEDULE OF PROFIT

I OR LOSS ) FROM BUSINESS OR PROFESSTON

PRISCINAL BUSINESS ACTIVITY

BUSINESS NAME

BUSINESS

ADDRESS

TOTAL

RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

EMPLOYERS NO.

48924

800

2Y03L.

TOTAL

2Y831

L55

-0-

INVENTORY

AT END

OF

YEAR

GROSS PROFIT

2Y83L

24093

24093

OTHER BUSINESS

AOVERTISING

1. ?

TRUCK EXPENSI

8A0. 1. B7.5

COMMISSIONS

99

1800

DEMHECIATION I SOMEDULE.

BL1.09

DUFS

AND

SURSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTERES!

DANIIOR AND HAUL IN..

LI GAI.

AND ACCOUN!INI.

MICE SUPPLE

AND MAPLESL

HEN!

REPAIRS AND MAINTINANCI

SALARIES AND MAGES

SUPPLIES

TAXES

AND

LICENSES

TAYES PAYROLL

TELEPHONE AND UTILITIES

LINEN

CONTRACTLABOR

92%

285

1107

150

4181

525

5632

240

57.

128

158

49 У

16834

2559

NET

NE!

PROFIT

PROFIT

PE iLOSS I FEDERAL RETUEN

OF 11055) STATE RETURN

NO.

KIND AND LOCATION OF PROPERTY

EQUIPMENT

SEC. DEPREC.

SCHEDULE OF DEPRECIATION

DATE

YEARS

COST OR

ACQUIRED

METH

OTHER BASIS

2YR 10228

PRIOR

DEPREC.

1339.

TDEPRECTATTON

THIS YEAR

974

6000 WILL

4134

35000

-0-

-0.

PROFESSIONAL STATIONEHS INC FORM IORA

1.05

ANGELES.

CALIF

NW 88326 Docld:32245535 Page 184

SCHEDULE

---

## Page 185

Reference Copy, JFK Collection: ESCA (RG 233)

trist is test

REBIDENT

540

INDIVIDUAL

CALIFORNIA

INCOME TAX

TAXABLE YEAR

1974

PLACE PREADDRESSED LABEL HERE, if available.

(Correct name and address, if necessary)

Enter social security numbers) only if incorrect or not shown on label.

NAME (lipint return, give first

and initials of both)

AMUEL

PMYLLIS

LAST NAME

КиВУ

PRESENT HOME ADDRESS INUNDrON DIRCHER

1, including aportment number, or tural route)

16250

TOWN OR POST OFFICE, STATE AND ZIP CODE

TRINABL

HILL

FILING STATUS Check Only One:

1 0 Single

o Married filing joint return (even it only one had income)

3 • Separate return of married person Enter spouse's

social security number and full name here

For calendar year or

Taxable year ending

Your Social Security Number

197.

Spouse's Social

"Security Number

PATION

Yours

Spouse

EXEMPTION CREDITS

6 Personal

§ 11 line 1 or 3 checked. enter $25

If line 2. 4 or 5 checked, enter sSo s

7 Dependents - Do not list yourself, your spouse or the

person who qualities you

as head of household. Enter name and relationship.

THIMAS

4 I Head of Household-Enter name of qualifying

individual.

5 [ Widow(er) with dependent child (Year spouse died & 197-)

10 Wages, salaries, tips and other employee compensation

attach explanation.

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 54)

16

Adjusted gross income (subtract line 15 from line 14)

Total Number #

8

Blind (refer to instructions) Number of blind exemptions a

Total exemption credits (add lines 6, 7 and 8) Enter here and on line

20

10

11

12

13

14

15

18

• Il you do NOT itemize deductions AND line 16 is under $10,000, find tax in Tax Table and enter on line 19.

• If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.

17

18

Deductions: Itemized (from line 61) OR Standard ($1,000 if line 1 or 3 checked-$2,000 if line 2, 4 or 5 checked)

Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule-Enter tax on line 19

Income Averaging Schedule (G or G-1) D

× $8

× $8

16

8

° 66

136

8934

1070

9020

DE 1964 HERE

ATTACH FORM

17

5468

18

360г

19

Tax from (check one) Tax Table M Tax Rate Schedul

19

36

20

Total exemption credits (from line 9, above)

20

Tax liabllity (subtract line 20 from line 19-if line 20 is greater

than line 19, enter zero)

21

22 Other credits (from line 65-Includes special low income tax credit)

22

23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter zero)

23

-0

24 Tax on preference income (see instructions-attach Schedule P(540))

24

25 Total tax liability (add lines 23 and 24)

25

26

Total California income tax withheld (attach Form(s) W.2 or W.2P to face of this return)

26

27

Renter's credit-if you lived in rented property on March 1, 1974, complete Part 1 on page 2

27

28

1974 California estimated tax payments

29

Excess California SDI tax withheld (attach Form DE 1964 to face of this return)

30

Total prepayment credits (add lines 26 thru 29).

30

' money

31

If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero.

Pay in full and mail with retura to:

FRANCHISE TAX BOARD

PAY IN FULL →

31

- 0.

SACRAMENTO, CA

95887

social security nuraber on check

Do not write in these spaces

32

If line 25. is smaller than line 30, enter amount OVERPAID

Mail return to:

FRANCHISE TAX BOARD

P.O. BOX 13-540

32

SACRAMENTO, CA 95813

33

Amount of line 32 to be REFUNDÉD. (Allow at least six weeks) -

- REFUND TO YOU -

33

34

Amount of line 32 to be credited on your 1975 ESTIMATEO TAX .

34

Undor penalties of porjury, I doclare that I havo examined this roturn, including accompanying schedulos and statements, and to the bost of my knowlodge and

baliot

is true, correct and complore. If prepared by a parson othor than taxpayer, his doclaration is based on all information of which ho has any knowadge.

SIGN

Your signature

Data

VW 88320

Id02245585-Page 185 return

Date

Preparer's signature (other than taxpayer)

89717 VANOWEN STREFL

Address (and Zip code)

-HaN BUYs, CA. 917prparer"

757.94.0770

Date

EIN (Or SSA)

No.

---

## Page 186

=.1.16:

Reference COpy, JFK Collection: ESCA (RG 233) BUDdi

SCHEDULE

CALIFORNIA

FORM 540

ITEMIZED DEDUCTIONS

Attach to Form 540

Name as shown on Form 540

AMUEL.

Rusy

Use only it you do not use the Tax Table or take the standard deduction.

Medical and dental expenses

(not compensated by insurance or otherwise) for

Interest Expense

medicine and drugs, doctors, dentists, nurses, hospi-

tal care, insurance premiums for medical care, etc.

22. Home mortgage.

. 23. Installment purchases

1. One half (but not more than $150) of insurance

premiums for medical care

24.

Other (itemize)

2. Medicine and drugs

3.

Enter 1% of adjusted gross income shown on Form

540.

4. Subtract line 3 from line 2. Enter difference (if line

3 is greater than line 2, enter zero)

5.

Enter. balance of insurance

premiums for medical

care not entered on

line

6. Other medical and dental expenses:

(a) Doctors, dentists, nurses,

eic.

(b) Hospitals

(c) Other (itemize)

SCH

25.

Total/Add lines 22, 23 and 24. Enter here

and

on Form 540, page 2, line 58)

Contributions

26.

Cash contributions for which you have receipts, can.

celed

checks,

etc.

27.

Other cash contributions. List donees and amounts

TAXABLE

1974

YEAR

Social Security Number

2992

CH

7. Total-(Add lines 4, 5, 6a, b, and c)

8. Enter

3% of

adjusted

gross

income

shown on

Form 540

9. Subtract line 8 from

line

7.

Enter

difference (if

line 8 is greater than line

7, enter zero)

10.

Total-(Add

lines

and

Form 540, page 2, line 55)

9.

Enter here

and

on

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

line 11-See instructions

for maximum limitations. (Enter here and on Form

540, page 2, line 56)

. B

Taxes

14. Real estate

15. State and local

gasoline

16. General sales

17. Auto license-Excess of registration and weight fees

(see instructions)

18. Personal property

19. State

disability

insurance

(SDI)-Employer private

disability plans do not qualify

20.

Other

SCH

21. Total taxes (Add

lines 14 through 20. Enter here

and on form 540,

page 2, line 57

NW.98376

Docld:32245535 Page 186

1386

ScH

28. Other than

cash. — See instructions for required

statement

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)

. H

Miscellaneous Deductions

Casualty or Theft Loss(es)-See Instructions

If you had more than

one loss, omit lines 30

through 34 and follow instructions for guidance.

30. Loss before insurance reimbursement

Insurance reimbursement

32.

Subtract line 31 from line 30. Enter difference (if

line 31 is greater than line 30, enter zero)

38.

Enter $100 or amount on line 32, whichever is

smaller

34.

Casualty or theft loss (line 32 less line 33).

35.

Alimony paid

36.

Child care-See instructions

37.

Union dues

38.

Employment education expense-See instructions

39.

Other-See instructions (itemize)

150

9y0

40.

Total Add lines 34, 35,

36,

37,

38 and 39. (Enter

here and on Form 540, page 2, line 60)

---

## Page 187

• Reference copy, JFK Collection:

ASCA (RG 233)

SCHEDULE

CALIFORNIA

FORM 540

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Solo Proprietorships)

TAXABLE

1924

YEAR

Artach this schedule to your income tax roturn, form SA0 or SAOMR

Name as shown on for A PAy, LIS RuBy

Partnorships, joint ventures, ore, must flo on Form 365

Sociai Security Number

LAM

•. Principal business activity

SERVICE

SNACKBAR..

B.

Business name..

DOODLEY DISTRO COFFEE

for probacco; services-lood; manufacturing-furnitura; atc.)

D. Business address 14 DIS VENTURABLUL

Foderal peployer identification number 25-2651578.

9131 6

E. Indicate method of accounting:

Lj cash;

Dy accrual;

• other

(ZIP code)

6. Method of inventory valoion 599, for te cos a year filed fit required)?!

AYes

C

G. Method of inventory valuation b

Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

7 YES

SNO. If "Yes," attach explanation.

IMPORTANT-All applicable lines and sehedulos must bo Allad in.

1

Gross receipts or sales $

Less returns and allowances $

Balance o

2 Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) .

3

Gross profit

& Other income (attach

schedule)

5

TOTAL income (add lines 3 and 4)

6 Depreciation (explain in Schedule C-3)

7 Taxes on business and business property (explain in Schedule C-2)

8 Rent on business property

9 Repairs (explain in Schedule C-2)

10 Salaries and wages not included

on line 24, Schedule C-l (exclude any paid to yourself)

11

Insurance

12 Legal and professional fees.

13 Commissions.

Amortization (attach statement)

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 (specify):

(a).....

(b).

(c)

(d)

(e)

(f)

(g)

(h) Total other business expenses (add lines 19(a) through 19(g)) .

20

Total deductions (add lines 6 through 19)

21 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR

9934

SCHEDULE C-I. 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 $

Less cost of items withdrawn for personal use $

24 Cost of labor (do not include salary paid to yourself)

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, abore

Nw 88326 Docld:32245535 Page 187

Balance D

---

## Page 188

Reference copy, JFX Collection: ESCA (RG 233) Mi

SCHEDULE

D

CALIFORNIA

FORM 540

TAXABLE

1974

YEAR

Name af shown on form 540g

AMWEL

PART I Assets Held One Year or Less

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540HR

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.

PHYLLIs RuBy

Social Security Humber

a. Kind of property and description

(Example, 100 shares of "Z" Co.)

b. Date acquired

(mo., day, yr.)

c. Date sold

(mo., day, yr.)

d. Gross sales

price

e. Cost

or other

adjusted,

basis

as

cost of subse.

quent improvements

not

purchased,

(if

explanation)

attach

and

-x-

pense of sale

1. Gain or los

(d. less e.

LOANTASUMMIT

100 CHIEFTAINDEXEL

100CHIEFTAIN DEVEL

EAGLE

131m3

1201>3

COR

PORATION

6/00/21

119.

1000)

2. Enter gain (or loss), il applicable, from line 18, Schedulo D-I (540) (attach copy) .

3. Enter your share of net gain or loss from partnerships and fiduciaries

4. Net gair or loss, combine lines 1, 2 and 3

PART I!-Asseis Held More Than One Year But Nor More Than Five Years

54332

5.

100 TESORO

100K c

PET

5/22/22

515/22

7/1600Y

3/2374

1622

258

105;

2817

1532

3252

82353

200.

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 Ill-Assets Hold More Than Five Years

1973. LOSS CARRYOUER.

16063)

LE55:000 -

(yy06 )

10. Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)

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

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 (attach computation)

21205

286

(15063)

17. Combine the amounts shown on lines 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

19. If line 17 shows a loss, enter here and on page 2, Part ll 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

(c) $1,000 ($500 in the case of a husband or wife filing a separate return)

NW-88326-Đoeld:32245535-Page-188

(20360)

(000)

---

## Page 189

NAME..

-SAMUEL

ADDRESS -

MEDICAL

2 MEDICINE/DRUGS

3 LESS 1% A. G.I. (Line 18 - 1010)

4 NET MED/DRUGS

5 H & A INS. (½ + EXCESS)

fa DR.

DR.

DR.

DR.

DR.

DR.

DR.

DR.

6b HOSPITAL

PROSTHETIC APPLIANCES

HEARING AID

6c AMBULANCE

LABORATORIES

TRAVEL FOR MED. 10UD

MEDICARE INS.

GLASSES

7 MEDICAL EXPENSES

LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.

9

+:½ (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 STATE DIS. INS. H

W

SALES TAX AUTO

17 TOTAL TAXES

NTE REST (TO WHOM PAID)

18 MORTGAGE

19 INSTALLMENT LOANS

MERKILL

-6

SBA

STATE

138%

940

20

1304

268

30

1386

727

24

TOER

2343

263.

170

16

NW8đ3261568f.32245535_Page-18992

12997

Reference copy, JFK Collection: ESCA (RG 233) 10. 11.

HYLLIS R

иву

_ CALENDAR YEAR

119 74.

SOC. SEC. NO.

DEDUCTION SCHEDULE

FEDERAL

CONTRIBUTIONS

21 PARTNERSHIP SHARE

GIRL/BOY SCOUTS

HEART FUND/CANCER FUND

30Y

RED CROSS/UNITED FUND

XMAS & EASTER SEALS

MISC. ORGANIZED CHARITIES

POLITICAL CONTRIBUTIONS

930

CHURCHES

STATE

130

FEDERAL

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS,

24 TOTAL CONTRIBUTIONS

CASUALTY OR THEFT LOSS(ES)

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT

27 Difference (not less than zero)

28 ($100 LIMITATION PER CAS.)

29 TOr. CAS. OR THEFT LOSS

MISCELLANEOUS DEDUCTIONS

30 ALIMONY

31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Furm 2441)

33 INCOME TAX PREPARATION

UNIFORMS/PROTEC. CLOTHING

SMALL TOOLS AND SUPPLIES

LAUNDRY AND CLEANING

Auto Use

MI

INVEST. COUNSEL & PUBS.(Sched

EMPLUYMENT AGENCY FLES

SAFE DEPOSIT BOX

TEL. REQ. IN BUSINESS

34 TOTAL MISC. DED.

SUMMARY OF ITEMIZED DED.

35 тот.

EXPENSES IFROM LINE

DEDUCTIBLE MEDICAL & DENTAL

36 TOTAL TAXES (From LINE 17)

37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. (Line 24)

39 CAS. & THEFT LOSS(ES) (Line29)

40 ĐẸDÚC HONG (TOM QUE 34)

11 TOTAL ITEMIZED DEDUCITON:

NTER ON FORM 1040 LINE 4

REMARKS

150

150

STATE

FEDERAL

346 %

5590

---

## Page 190

Reference copy, JFK Collection: ESCA (RG 233) eiMSNE."

SAMe PAYLLIS RA8%

SEC. NO.

SCHEDULE OF PROFIT TOR LOSS ) FROM BUSINESS OR PROFESSION

EMPLOYERS NO.

CALENDAR YEAR 19? Y

FISCAL YEAR ENDING

19

PRINCIPAL BUSINESS ACTIVITY

BUSINESS NAME

BUSINESS ADDRESS

TOTAL RECEIPTS

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

LABOR

68084

36079

TOTAL

INVENTORY AT END OF YEAR

GROSS PROFIT

36932

3527

32805

37.805

GRUSS INCOME

OTHER BUSINESS DEDUCTIONS

ADVERTISING

AUTO AND TRUCK EXPENSE 1200O MI AT 13%

BAD DEBTS

CASH SHORT

COMMISSIONS

DELIVERY

DEPRECIATION

SCHEDULE ATTACHED)

DUES AND SUBSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

INSURANCE

INTEREST

JANITOR

SERVICE

LAUNDRY

LEGAL AND ACCOUNTING

MAINTENANCE

JFFICE SUPPLIES AND EXPENSE

RENT

REPAIRS

SALARIES AND WAGES

SALARIES OFFICERS

SUPPLIES

TAXES AND LICENSES

TAXES

PAYROLL

TELEPHONE

TRAVEL

UTILITIES

TARKING

33"

1339

16

T814

34!

47

10. 4

5912

2282

1935

NET PROFIT

OR ( LOSS) .

FEDEKAL

RETURN

NET PROFIT

OR

LOSS)

• STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF

733Y

W/ 2Y00

NW 88326s-Dacld:32245535s Page 190m 104

SCHEDULE

---

## Page 191

NW 88326

Docld:32245535

Page

191

NAME AND 'YELL ANOT

ADDRESS

1. DoR

NO.

SOC. SEC. NO. _

CALENDAR YEAR 19 ' 1.

FISCAL YEAR ENDING

19:

SCHEDULE OF DEPRECIATION/ AMORTIZATION

COST OR

KIND OF PROPERTY

EQUIPMENI

GOOQWILL

DATE

ACQUIREO

MO

YR

OTHER BASIS

2/1174/10228

41/2435000

SPEC 20%

DEP

DEPRECIABLE

BASIS

10222

DEP ALLOWED

PRIOR YEARS

REMAINING

COST

RATE (%)

OR LIFE

(URS)

DEPRECIATION

FOR

THIS

YEAR

=0t 10228 5L. TYR 133%

Reference Copy, JFR Collection: ESCA (RG 233)

TOTALS

PROFESSIONAL STATIONERS INC.

LOS ANGELES. CALIF.

FORM NO

1339

102A

SCHEDULE

---

## Page 192

Reference copy, JFK Collection: ESCA (RG 233)

KIDDENT

INDIVIDUAL

CALIFORNIA

LIONS TAX

TANABLE YEAR

1972

year 1972, or othor tamablo yeur dog taina

, 1972, cnding

, 1973

150) AND 111A1(5)

LAST NAINS

Your social

PANT TE

RUDY

i :

MA CORD, teddy charmant numbs, or rural reuta)

14 1L7

221/2023

Gi, plaid

ZIP CODE

OCCU.

Yours

Selt

PATION

1c120. 601180.n1d

Wife's

Hounci

J. BepandonigDo not list yourself, your spouse or person who qualifies you as head of houschold

MARE (Includo lett carto and/er address if Gifferent freal yours)

RELATIONSHI?

Exed, Betan, Ellas, Thoman.

04

it, Sling Jolse retum!

1, filing copiedo return -Enter epcuse's social

if nandor and first nema hero....

0. Elled (refer to instructions)

7. Totel dependent and blind oxomations (add lines 5 and 6)

• Enter

.....Number D 5

Number of blind exemptions claimed @ 6-

7

r3i: sl K3.0h04d-Com2lte Part 2, n932 2

telected preced ds.

49122292

: 33

Pi.20k Eat it (li over $500, compite and attach Schedule (B540)) .

"Ca come Cutters and tHis! (ion pago 2, line 41)

15:50sas30o2001826008

229 16.

3. tea.

ta Ci cantard Codredito tirom pago 2, ling 55)

9 (subtreet line 15 droat To 14), Figure your tea on this cmcunt by using the appropriato Tex Rato

/,::

[ Tox Rate Schodule C.

[ Schedula 'G(540)

id fined m30. 8095-925. Married couple or head of heuschold-cuo

=3--Totel on lino 7 abova, -1.. x $8

20, Toal Cannotind (odd lines 18 and 19) .:. :

15

19

50700

32100

Milan hicc

wind Cabarack lia 20 from line 171

22. Card er "es (rom page 2, line 59)

23. Not in% Frankey (subtract line 22 from line 21).

24. Tan on proference income (see instructions-attach Schedule P(540))

25, Told! tex licklity (add lines 23 and 24).

26. Total Californio income tax withhold (attach Formis) W-2 or DE-2P to front)

27, 1972 Callionle estimatsd tar payments

23. Lucers Collierio SBI Rax withhold fattach Form DE 1964 do face of roturn)

28. Totai pagmonts (add linos 26, 27 and 28)

26

27

28

30. 18 line 25 Is larger thun line 29, entor CALANCE DUE.

E: 9 03

31. 18 line 29 is larges than line 25, enter GVERPAYMENT.

anchise Tax Board, Sac americ

return

to

sacramento, CA 95867

Mail return to P.O. Box 13.540,

Sacramento, CA 95313.

: 3a. Line 3l to to (a) nErUNDeD. (Allow at least six weeks for your refund)

(b) Credited on 1973 estimated tax

I, read cooth preday a per veter, let een in tibeduer and catients to ot

the best of my browings ena

which he hes any knowledge

EDWARD L. LAMBERT

TAX. COMSL

LANT

rent thing Jointly, Both must sion

Dita

49

taxpayer

NW 88326 Docld:32245535 Page 192

10

1!

12

13

14

15

10

17

20

21

22

23

24

25

29

30

31

5,9

2,2

6,05?

2,060

4,031)

yie:

Do not we in too te

---

## Page 193

SOMSUULE

TO 32

form 240 :.

: 77510, c.i

..!t

And Bitto% did Croice

jai said fies is

11134*

540, -pgs0 2)

in liest estate

Cute and loeel Gerara

13

Caroral salas

Auto licenss- Bious of regisbation and welgit

ross (see Instrugtiong)

Fersonal property

Stute Cisability

dise

anco 031-1

Juty pens so not Cually

-Other

41.

Total taries--0gd linas 14 through 20, Entor

tiero and on fond 040, pego 2)

NW 88326 Docld:32245535 Page 193

Reference copy, JFK Collection: ESCA (RG 233)

CALIFORNIA

MECIZED BEDUCTIONS

Raises to fero 5:9

AMANARLE

19

72

YEAH

Soriz

2-55-137

- Gates

Trind as

a Cut Fade

and tale,

it one spousa itemizes ducuctions, tha other may not use tho Tox TeSta co cla

the standard duduction. It you choose to itemiza your deductions, completo 1

appropriate liems below.

227777

i treate to real cars, es

Cc. bibulleas

22. Cash-Including

checks, money orders, etc.

(itomize)

2

3

3

3

13

11

12

13

14

15

16

17

10

19

20

150,00

21

841.00

23. Totol coch contributiens

€?. Other thon casi (sco instructione). Enter total

43. Total died lines 23 and 24. flaximum doduction

cy sat excect 2u% of causica

or toro end on for 540 pea gross incons.

27. Iont purchdeos

21. Othor (Itamize)

32.

Totel-LAdd lines 26

27 and 28. Enter here and

on Form 540,

page

2)

ces Bodec

1133

Casually or Theft Losslest ate instructions

NOTE: If you had moie than one casually or thoft

le:, Occuriches, omit lines 30 through 33 and follow

insmucions for guidanco.

29. Loss buforo adjustmenta

31. Insuranco reimbursement

32.

$100 limitation

33. Add lines 31 and 32

21. Casualty or thaft loss. (Line 30 less lina 33)

35.

Chi's Gora-See instructions

39.

Ochapa-for education, alimony, union dues, ete

_Seo Instructions

37.

Total miscollancous doductlons-Add lInes 34. 35

and 36. (Enter horo and on form 540, pago 21 D

22

23

24

25

23

27

281

29

30

31

33

34

35

36

209,0?

3,232.00

$100.00

---

## Page 194

SCHEDULE

to ee # +49544 1074-455-1900

Reference copy, JFK Collection: ESCA (RG 233)

CALIFORNIA

PROFIT (ON LOSS) FROM BUSINESS OR PROFESSION

(Salo Pieprictorships)

19

72

YEA?

Portagrabias, (olar vostorea, cão, touca dio co fona de.

14548240-

2ª Servieg

i product

(Tor champlar retail-hordmaro; volclasalo-tobacco, survices - legul, manulesiuring-furnituro: cls.)

Busin

Snark Hur

G.

Fodoral omployor idontification numbor...

Canes address.

5420 Van

Nuva Blud.

Van Nuypa Callfornin

Inatin: method ef accounting: - EJ cash; [ accrual;

• other.

Viceo cums 591, 992, 636 and C7u, for the calendar year filcd (if required)?

• Yes

@ No

is t'': biciness locared ithla to toundaries of the city, town, etc. indicated?

15e Dia you own this busine. at the end ci the tarable year?

How any months of. the tascible your did you cin this businoes?

12

(213 0012).

N

- Calancs D

P: of crudge a (Celedulo Col, lino C) caller operaitons (chiach echedulo)

Lan

Vos

Yes

hirrorse

i:.35.91

14)

3.?

i.s-.

-1n: Co

1313

tinto Schedude C-3)

indule C-3)

-juare, include i en line 3, Schedula C-l (cudlad, any poid do yourself)

• foes.

action (girl diatomcad):

¡an ap raporan ond grant-anorine piuns (see inviructions for ino 15(a))

ju, analoyed donato pragrama deca intruciiona for lina 150))

•Stones

"I douis ariang from colta ar sorvices

lye paration

(c)

(d)

: (0).

(0)

(0)

(i)

(m).

(0).

20

(p) Total oiher business expanses (add lines 19(a) through 19(o))

•Toral deductions (add lines 6 through 19)

28. Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR

6,969

4;0

NW 88326 Docld:32245535 Page 194

---

## Page 195

SCHERILE

CALIFORNIA

FORM 540

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540MR

Use this ichedule to report gains and losses on stocks, bords and similar investments,

=== gains (but not losses) on personal assets such as a home or jewelry.

Name as shown on Form 540 or 5÷0918

Samuel and shvili= Puhy

SHORT-TERM-ASSETS HELD NOT MORE THAN 6 MONTHS

Kind oi

(Example

arnperty and tess:==un

100 shares of "Z"

b. Dale arquired

(mo.. day. gr.)

Dat: soid

(mo.. day, yr.)

1 G: ss sales price

e. Cost or other b::is, as

ajjusted. cost of

subiequent improvements

fif not purchased.

attach explanation)

and expense of saie

TAXABLE

1971

YEAR

Sociai Security Numbe:

1.

Gain er loss

(J less e)

•SCHEDULE. ATTACHE

Enter your share of net short-term gain (or loss) from partnerships and fiduciaries

3. Enter net gain (or loss), compire lines l and 2 .

4. Enter unused short-term capites loss carryover from preceding taxable years (attach statement)

5. Net short-term gain (or loss), combine lines 3 and 4.

LONG-TERM-ASSETS HELD MORE THAN 6 MONTHS

6.

(1,249.00)

7.

Enter gain if applicable from line 4, Schedule D-I (Form 540) (attach copy)

8. Enter your share of net long-ierm gain (or loss) from partnerships and fiduciaries

9. Net gain (or loss), combine lines 6. through 8

10. Enter unused long-term copite! ioss carryover from preceding taxable years (otlach statement)

11. Net long-term gain (or loss), combine lines 9 and 10 .

(14,274.00)

12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here

13, If line 12 shows a gain

(a) Enter 50% of line 11 or 50% of line 12, whichever is smaller. Enter zero if there is a lass or no entry on line 11

(b) Subiract line 13(a) from line 12. Enter here and on line 32, Form 540 (line 33, Form 540NR)

14. If line 12 shows a loss

(a) Add lines d and 10 (if lines 4 and 10 are blank, enter a zero here and on lines 14(b) and 14(c) and go to

line 14(d))

(b) Combine lines 3 and 9-if gain, enter gain; if loss, enter

zero

(c) Enter smallest of (i) line 14(a) less line 14(b); (ii) the amount of taxable income on Form 540 or 540NR,

computed without capital gains and or losses determine this figure via a side computation; or (iii) $1,000

(d) Combine lines 3 and 9_i: loss, enter loss; if gain, enter zero here and on line 14(e) and go to line 14(f)

(e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital ‹jains

and or losses, less line 14'c! determine this figure via a side computation; (il) $1,000 ($500 if married and

filing separately); (ili) if line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows o

gain, amount on line 1418,; or (v) if lines 3 and 9 show losses, line 3 added to 50% of line 9

(f) Enter here, and on lina 32, Form 540 (line 33, Form 540NR), the sum of lines 14(c) and 14(e)-(Do not

enter an amount greeter than $1,000) .

(15, 522.00)

(1,000.00)

Carriover (1-1) (514, 52.10)

NW 88326 Docld:32245535 Page 195

son Instructions

on Back

---

## Page 196

SCHEDULE

CALIFORNIA

FORM 540

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

19 г

YEAR

Social Securily Number

Nama as shown on Form 540

sanuel and Phullis Ruby

Standard Deduction You have a choice belween tro deduction

methods. You can either itemize your deductions or take a standard deduction as

explained in the 510 Instructions. On separale retures of a husband and wife,

il one spouse ilemizes deductions. the other may not use the Tax Table cris

the standard deduction. If you choose lo itemize your deductions, complete r

appropriate items below.

Medical and dental expenses (rot compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospital cire, insurance

premiums for medical care,

1. One haif (but not more than $150) of insurance premiums for medical care

2. Medicing and drugs

3. Enter 1% of adjusted gross income shown on Form 540

3

4. Subtract line 3 from line 2. Enter difference lif less than zero, enter zero)

5. Enter talance of insurance premiums for medical care not entered on line 1

6. Other medical and dental expenses (attach itemized list)

6

7. Total-lAdd lines 4, 5 and 6)

8. Enter 3% of adjusted gross income shown on Form 510

9. Subtrart line 8 from line 7. Enter difference lif less than sern, enter sern)

10. Tolal-_(Add lines 1 and 9)

150 00

Child Adoption Expense

11. Total expenses paid or incurred--Altach itemized list

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 local gasoline

18. General sales

17. Auto license-Excess of registration and weight fees (see instructions)

18. Personal property .

19. State disability insurance (SDI)-Employer private disability plans do not qualify

20. Other (specify)

21. Total taxes-(Add lines 14 through 20)

743

31

Contributions

22. Cash-Including checks, money orders, etc. (itemize)

23. Total cash

contributions

24. Other than cash (see instructions). Enter total here

25. Total Add lines 23 and 21--Maximum deduction may

not exceed 20% ol adjusted pross income

Interest Expense

28. Home

morigage

27. Installment purchases

28. Other (itemize)

29: Total-lAdd lines 26. 27 and 28)

Miscellaneous Deductions

30. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize)

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

29

30

31

32

2,617

5010

31. Total miscellaneous deductions

12. Total deductions Add lines 10, 13, 21, 25. 29 and 311. Inter total here and on form 110, pare 2, in space provided

NW 88326-Rocld:32245535 Page 196

ichadula A on ravorsa

S/.

---

## Page 197

SCHEDULE

) GALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

TAXABLE

19 71

YEAR

Partnerships, joing ventures, ets, must filo on form 56:

FORM. 540

Attach this schedulo to your income tax roturn, form 340 or 540NR

Name as shown on Form 540 or 540NR

Samuel and shollla Ruby

Fond

A. Principal business activity

Service

; product

foraxamplo: retail-hordwore: wholesola-toborsoiservices.leonl;manufocturing-furniture;ofc.)

B. Business name

D. Business location

Snack Bar

5418 Van Nuus Blvi.

:Numbor and streat or rural routo)

M's,

call Federa empires

identification number.

(City-post offico!

(State

(ZIP coco

E. Indicate method of accounting: G cash; [ accrual;

• other (describe)

F. Was there any substantial change in the

manner of determining quantities, costs or valuations between the opening and closina

inventories?

D Yes I No. If "yes," attach explanation.

G. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? LYes

& No

1. Gross receipts or gross sales $

Less: Returns and allowances $

2. Inveniory at beginning of year lif different than last year's closing inventory attach

explanation)

3. Merchandise purchased

$

, less cost of any items with.

drawn from business for personal use $

4. Cost o! labor (do not include salary paid to yourself)

5. Material and supplies

6. Other costs (explain in Schedule C-1)

7.

Total of lines 2 through 6 .

8. Inventory at end of this year

9. Cost of goods sold and /or operations (subtract line 8 from line 7) .

10. Gross profit (subtract line 9 from

line 1)

OTHER BUSINESS DEDUCTIONS

18. Depreciation (explain in Schedule C-2)

12.

Taxes on business and business property (explain in Schedule C-1)

13. Rent on business property

14.

Repairs (explain in Schedule C-1)

15.

Salaries and wages not included on line 4 (exclude any, paid to yourself)

16. Insurance.

17. Legal and professional fees .

18. Commissions.

19. Amortization (attach statement)

20. (a) Pension and profit-sharing plans (see instructions)

(b) Employee benefit programs (see instructions)

21. Interest on business indebiedness

22.

Bad debts arising from sales or services

23. Depletion of mines, oil and gas wells, timber, cic. (altach schedule)

24. O1her business expenses (explain in Schedule C-l) . .

25.

Toral of lines 11 through 24

26. Net profit (or loss) (subiract line 25 from line 10). Enter here and on pag.: 2, Form 540 or 540NR

$

SCHEDi LE

ATTACHED

$

7,350|33

Lina Ms.

Explanation

SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24

Amount

Line No.

Exclanation

Amount

$

$

Nw 88328 Docld:32245535 Page 197

Page

---

## Page 198

SOYEDULE

CALIFORNIA

FORM 540

CAPITAL GAINS AND LOSSES

Altach to Form 510 or 540H2

Use this schedule to report guins 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 54CNR

Samuel and phyllis Puhy

SHORT-TERM-ASSETS HELD NOT MORE THAN 6 MONTHS

¿ Kinder 20a erdy and deriation

b. Date arquired

(mo.. day. yr.)

Da!: sold

(mo., day.

yr.)

1 G: as sales. price

e. Cost or other t. is. a

adjusted. cost ol

subsequent inera-ements

dii not purchases.

attach expianation)

and expense of sale

TAXABLE

1971

YEAR

Secial Security Humbe:

1. Gain or loss

(j less e)

SCHEDULF. ATTACHED

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. Enter unused short-term capital loss carryover from preceding taxable years (ottach statement)

5. Net short-term gain (or loss), combine lines 3 and 4

LONG-TERM- ASSETS HELD MORE THAN 6 MONTHS

6

11,248.00)

7. Enter gain if applicable from line 4, Schedule D-I (Form 540) (attach copy)

8. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries

9. Net gain (or loss), combine lines & through 8

10. Enter unused long-term capital loss carryover from preceding taxable years (ottach statement)

11. Net long-term gain (or loss), combine lines 9 and 10 .

(14,274200).

12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here. : .

13. If line 12 shows a gain

(a) Enter 50% of line 11 or 50% of line 12, whichever is smaller. Enter zero if there is a loss or no entry on line 11

(b) Subiract line 13(a) from line 12. Enter here and on line 32, Form 540 (line 33, Form 540NR)

14.

If lino 12 shows a loss

(a) Add lines d and 10 (if lines 4 and 10 are blank, enter a zero here and on lines 14(b) and 14(c) and sjo 10

line 14(d))

(b) Combine lines 3 and 9-if gain, enter gain; if loss, enter zero .

(c) Enter smallest of (i) line 14(a) less line 14(b); (ii) the amount of taxable income on Form 540 or 540NR,

computed without capital gains and or losses— determine this figure via a side computation; or (ili) $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 141f)

(e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital ‹jains

and or losses, less line 14(c)- determine this figure via a side computation; (ii) $1,000 ($500 if married and

filing separately); (ii) if line 3 is zero or shows a gain, 50% of line 14(d); (ir) 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

Enter here, and on line 32, Form 540 (line 33, Form 540NR), the sum of lines 14(c) and 14(e)—(Do not

enter an amount greater shan $1,000) : .

(15, 522:00).

(1,000.00)

Carriover (1-i) (514, 3:2.00)

Son Instructions on Buck

NW 88326 Docld:32245535 Page 198

---

## Page 199

neierence copy, Jok

LOLLECTION:

RESIDENT

540

INDIVIDUAL

CALIFORNIA

INCOME TAX

TAXABLE YEAR

1973,

19

or the year January 1-December 31, 1973, or other taxable year beginning

1973, ending

FIRST NAME(S) AND INITIAL(S)

BaSe

АМЧЕ

L PHyLLis

LAST NAME

КиДУ

PRESENT HOME ADDRESS (Number

street, including apartment number

or rural route)

16.250

int

IRCHER

S

CITY, TOWN OR POST OFFICE, STATE

ZIP CODE

oCCU.

Yours

GRANADA

LALIE

PATION

Spouse's

ling Status - Check Only One

Exemption Credits

If line 1 or 3 checked, enter $25

1.

Single

6.

Personal Exemption:

If line 2, 4 or 5 checked. enter $50

?.

Masried filing joint return

7.

Dependents - Do not list person who qualifies you as head of household.

3.

Married filing separate return-Enter spouse's full

Name (include last name and/or address if different from

name

THOMAS -

% 0

Head of Household-Enter name of qualifying

ELISA

individual

Total Number b

3

X $8

5.

Widow(er) with dependent child. Enter year spouse

8. Blind (refer to instructions) Number of blind exemptions » ..

X $8

died 19

9.

Total exemption credits (add lines 6, 7 and 8) Enter here and on line

20 below

Income

10.

Wages, salaries, tips and other employee compensation

Attach copy 2 of Form(s) W.2 to front, )

\if unavailable, attach explanation

10

• ATTACH COPY 2 OF FORM W-2 HERE D

11.

Dividends-before federal exclusion. Capital gain dividends must be included at 100%

11

12.

Interest. (See instructions for taxability of federal, state and municipal bonds)

12

13.

Income other than wages, dividends and interest (from line 50)

13

14

14. Total (add lines 10, 11, 12 and 13)

15. Adjustments to income (from line 56)

15

16. Adjusted gross income (subtract line 15 from line 14)

16

• If you do NOT itemize deductions AND line 16 is under 10,000, find tax in Tax Table and enter.on. line 19.

• If you itémize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.

17. Deductions: Itemized (from line 63) OR Standard ($1,000 if line 1 or 3 checked-$2,000 if line 2, 4 or 5 checked)

17

• 18. Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule-Enter tax on line 19

18

Your Social Security Number

Spouse's Social security" vumber

6

ZY

92

34 S

16196

16.633

16633

5162

Your

Tax

ATTACH HERE D

and

Credits

on check or money order.

security number

19. Tax—if an averaging method is used, check appropriate box

• Schedule G, or • Schedule G-1

20. Total exemption credits (from line 9, above)

21. Tax liability (subtract line 20 from line 19—if line 20 if greater than line 19, enter zerol

22.

Other credits (from line 66)

23.

Net tax (subtract line 22 from line 21-if line 22 is greater than line 2k enter zero)

24.

Special tax credit-from line 75 (see Instructions, page 2, for allowable credit)

25.

Net Tax liability (subtract line 24 from line 29-if line 24 is greater than lilier 23, enter zero)

26.

Tax on preference income (see instructions-attach Schedule P(540))

27. Total tax liability (add lines 25 and 26)

1.

28.

Renter's credit-if you lived in rented property on March 1, 1973, Complete Part I on page 2

Pre-

cayment

Credits

29.

Total California income tax withheld (attach Form(s) W-2 or W-2P to face of return).

30.

1973 California estimated tax payments (include amount allowable as a credit from 1972 return)

29

30

31

31. Excess California SDI tax withheld (attach Form DE 1964 to face of return) .

32..

Total prepayment credits (add lines 28 through 31)

33. If line 27 is equal to or lärger than line 32, enter amount of BALANCE DUE

Pay in full and mail with return to: Franchise Tax Board,

Sacramento, CA 95867

Balance

Due

34.. If line 32 is larger than line 27, enter amount OVERPAID

34

Mail return to: Franchise Tax Board, P.O. Box 13-540, Sacramento, CA 95813

Refund

35.

Amount of line 34 to be REFUNDED. (allow at least;

fix weeks for your refund)

35

36.

Amount of line 34 to be credited on your 1974 estimated tax

36

Under

enalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge an

elief it is true, correct and complete.

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

SIGN

signature

NW 88 ERE

Öate

Date

Preparer's signature (other than taxpayer)

Address (and Zip code)

19

20

21

22

23

24 !

25

26

27

122

28

32

33

_0

122

Do not write in these spaces

P

E

M

Preparer's Employer

- Identification (or SSA)

Number

---

## Page 200

Reference copy, JER Collection:

ESCA (RG 233) sto

SCHEDULE

CALIFORNIA

TAXABLE

19 73

FORM 540

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges Including Involuntary Conversions)

(Attach to Form 540, 540NR, 541 or 565)

YEAR

Identifying number as shown on return

Name as shown on Tax Return

SAMUEL SPHYLLIS RuBY

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, ут.)

(A)

SNACK

BAR

4/20

8113/33.

(B)

(C)

(D)

Correlate lines 1(A) through 1(D) with these columns ma

2.

3.

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

Property

(A)

28.000 -

28138

12386-

15752-

12248

Property

(B)

Property

(C)

Property

(D)

If Section 18211 property:

(a) Depreciation allowed (or allowable) after applicable date.

(See Instruction D-3)

(b) Line ó or line 7(a), whichever is smaller

12386

12248

8.

If Section 18212-18 property:

(a) Enter additional depreciation after 12-31-63 and before

1-1-71

(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)

9.

If Section 18220 property:

(a) If farm land, enter soil and water conservation expenses

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 line 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

If Section 18219 property:

(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, it any, of line 10(a) over 10(b)

(d) Line 10(c) times applicable percentage (Instruction D-5)

(e) Line & less line 10(b)

(f) Enter smaller of line 10(d) or line 10(e)

SUMMARY OF PART 1

(Complete Property Columns (A) through (D) up to Line 10(f)

before going to Line 11)

11. Enter amounts from line 6

12248

12. Enter amounts from lines 7(b), 8(h), 9(d) and 10(f)

12248

Subtract line 12 from line 11, enter here and in appropriate

Section in Part Il (see Instruction D-2)

14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part Ill

122Y8-

NW-88326-Docld:32245535-Page 200

---

## Page 201

Reference copy, JFK Collection:

ESCA (RG 233)

FORM

540

RESIDENT

CALIFORNIA

TAXABLE

INDIVIDUAL INCOME TAX RETURN

1970

YEAR

For Calendar Year 1970 or Fiscal Year Begun

1970 and Ended

FIRST NAME(S) AND INITIAL(S)

SAMUEL AND PHYLLIS

LAST NAME

RUBY

Please

Typa

of

Print

PRESENT HOME ADDRESS (Number and streat, or rural route)

• 16250 Bircher

CITY, TOWN OR POST OFFICE

STATE

Granada Hills

California

COUNTY

Los Angeles

ZIP CODE

91344

NAME AND

ADDRESS OF EMPLOYER AT TIME OF FILING

Self-Employed

NAME AND ADDRESS ON 1969 CALIFORNIA RETURN. IF SAME AS ABOVE, WRITE "SAME". IF NONE FILED,

GIVE REASON.

1971

Your social

security number

$

Spouse's

social security number

Your occupation

Self-Employed

P

Spouse's occunation

Housewife

Adjusted gross income on 1970 Federal

Return S...

3.284.0.97

11346 Montgomery Avenue

Granada Hills, Calif.

If different from line 11, below, explain

in Part VI. page 2.

Filing Status

Single

3.

Married, filing separate return-spouse's name:

(check one)

2.

Married, filing joint return

Unmarried "head of household" —Complete Part I, page 2

5. Wages, salarles, tips, etc. (before payroll deductions) if more than two employers, attach schedule

Income

Employer's name

Where employed (city and state)

It Jolnt return,

5

Include all

Income of

both husband

and wlfe

8. Dividends. Enter total here (also list in Schedule 8 (540), Part I, if total is over $100)

20

..60.

ATTACH. REMITTANCE HERE

7. Interest. Enter total here (also list in Schedule B (540), Part 11, if total is over $100)

7

8. Other income (from page 2, line 30)

8

8,2.84

9. Total (add lines 5, 6, 7 and 8)

9

8.305

5?

10. Adjustments to Income (from page 2, line 35)

10

11. Adjusted gross Income (subtract line 10 from line 9)

11

9.305 57

Your

Tax,

and

Credits

• It you do not itemize deductions AND line 11 is under $10,000, find your tax in Tax Table in instructions. Enter tax on line 12.

• If you itemize deductions OR line 11 is $10,000 or more, go to Part IV on page 2 to figure tax.

12. Tax from (check one): Tax Table J, Tax Computation (page 2, Part IV) Rg, or Schedule G (540)

13. Exemption credits (from page 2, line 43)

14. Tax liability (subtract line 13 from line 12)

15. Total other credits (from page 2, line 49) .

16. Net tax liability (subtract line 15 from line 14-lf $1.00 or less, enter "zero")

12

13

14

15

16

51 110

82

00

None

None

Balance

Due or

Rofund

17, 1970 California estimated tax payment or credit from 1969 (if any). If none, enter "zero"

18. Balance due—11 any (subtract line 17 from line 16)

18. Overpayment-if any (subtract line 16 from line 17)

20. Portion of line 19 you wish to apply on 1971 estimated tax

21. Refund-if any (subtract line 20 from line 19) .

PAY IN FULL WITH RETURN

OVERPAYMENT

REFUND

17

18

19

20

21

None

Do not write in these spaces

Under penalties of perlury, l declare that leared ama derson other than taxpayer, his declaration

Including accompanying schedules and

statements, and to

the best of my knowledge and

is true, correct and complete.

prepared by a person other

on all information of which he has any knowledge

Sign

Your signature if fling Jointly, BOTH must sign

Date

Signature

here b

Spouse's signature

"Dale".

• Make Remittance Payable to FRANCHISE TAX BOARD-Mail to

FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814.

pres

parer other than taxpayer

Adred AMBERT-MARKEl bate

16633 VENTURA BLVD.

ENCINO, CALIF, 91316

NW 88326 Docld:32245535 Page 201

---

## Page 202

SCHEDULE

Reference copy, JFK Collection:

GALILORNIA

ESCA (RG 233)

FORM 540

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

19 70

YEAR

Name as shown on Form 540

Samuel and Phyllis Ruby

Standard Deduction--You have a choice between two deduction

can either itemize your deductions or take a standard deduction as

explained in the 540 Instructions. On separate returns of a husband and wife,

Social Security Number

if one spouse itemies deductions, the other may not use the Tax Table or claim

the standard deduction. If you choose to itemize your deductions, crimplete the

appropriale items below.

Medical and dental expenses (not compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospital care, insurance

premiums for medical care,

1. One half (but not more than $150) of insurance premiums for medical care

2. Medicine and drugs

2

3. Enter 1% of adjusted gross income shown on Form 540

4. Subtract line 3 from line 2 (if less than zero, enter zero)

5. Other medical and dental expenses. Include balance of insurance premiums for medical care not

deducted on line 1 (attach schedule)

6. Total-(Add lines 4 and 5)

6

7. Enter 3% of adjusted gross income shown on Form 540

B. Subtract line 7 from line 6 (if less than zero, enter zero)

8

9

9. Total-(Add lines 1 and 8)

Child Adoption Expense

10. Total expenses paid or incurred--Attach itemized list

11. Enter 3% of adjusted gross income shown on Form 540

12. Subtract line 11 from line 10-See instructions for maximum limitations

10

11

12

Taxes

13. Real estate

14. State and local gasoline

15. General sales

18. Auto license-Excess of registration and weight fees (see instructions)

17. Personal property

18. State disability insurance (SDI)-Employer private disability plans do not qualify

19. Other (specify)

20. Total taxes--(Add lines 13 through 19)

13

14

15

16

17

20

Contributions

21. Cash-Including checks, money orders, etc. (itemize)

21

22. Total

cash

contributions

23. Other than cash (see instructions). Enter total here

24. Total-Add lines 22 and 23-Maximum deduction may not exceed 20% of adjusted gross income

23

24

Interest Expense

25. Home mortgage

26. Installment purchases

27. Other (itemize)

25

26

27

28. Total-(Add lines 25, 26 and 27)

28

Miscellaneous Deductions

29. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize).

29

1.50

163

280

1,552

00

26

00

18

30. Total miscellaneous deductions

31. Total deductions- (Add lines 9, 12, 20, 24, 28 and 301. Enter Intal here and on Form 540. page 2. i spare provided S/A

NW. 88326, Docld:32245535 Page 202

Celerala dr.

30

31

100

,745

00

7:4

---

## Page 203

SCMEDULE

FORM 540

Reference copy, JFK Collection:

ESCA (RG 233)

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

AXABLE

19

-70

YEAR

Partnorships, joint ventures, etc., must file on Form 565

Social Security Number

Attach this schedule to your income tax raturn, Form 540 or 540NR

Name as shown on Form 540 or 540NR

Samuel and Phyllis Ruby

Food

A. Principal business activity...

; product...

(For oxample: rotail-hardwaro, mlioleralo-tobacco; services--legal; manufacturing-furnituro; orc.)

B. Business namo ....

Snack Bar

C. Federal employer identification number. 263

05.578

D. Business location. 5418 Van Nuys Boulevard

van

NuyS,

California

91401

(Number and stroat or rural route)

(CIty-post offico)

(State)

(ZIP codo)

E. Indicate method of accounting: X] cash; ] accrual; other (describe)....

F. Was there any substantial change in the manner of determining quantities, costs or valuations between the opening and closing

inventories?

• Yes

XI No. If "yes," attach explanation.

G. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? Yes

X 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

explanation)

3. Merchandise purchased $

...., less cost of any items with.

drawn from business for personal use $

a. Cost of labor (do not include salary paid to yourself)

5. Material and supplies

6. Other costs (explain in Schedule C-1)

7.

Total of lines 2 through 6 .

8. Inventory at end of this year .

9. Cost of goods sold and /or operations (subtract line 8 from line 7)

10. Gross profit (subtract line 9 from line 1)

OTHER BUSINESS DEDUCTIONS

11. Depreciation (explain in Schedule C-2)

12.

Taxes on business and business property (explain in Schedule C-1)

13.

Rent on business property

14.

Repairs (explain in Schedule C-1)

15.

Salaries and wages not included on line 4 (exclude any paid to yourself)

16. Insurance .

17, Legal and professional fees .

18.

Commissions

19.

Amortization (attach statement)

20.

Retirement plans, etc. (other than your share) .

21. Interest on business indebtedness . .

22.

Bad debts arising from sales or service.

23. Losses of business property (attach statement)

24.

Depletion of mines, oil and gas wells, timber, etc. (attach schedule) .

25. Other business expenses (explain in Schedule C-l) .

26.

Total of lines 11 through 25

27. Net profit (or loss) (subtract line 26 from line 10). Enter here and on page 2, Part II, Form 540 or 540NR

Line Ha

Explanation

SCHEDULE C-1. EXPLANATION OF LINES 6,

Amount

Line No.

12, 14, AND 25

Explanation

$.

SCHEDULE

ATTACHED

$

9,284

18?

Amount

$..

NW. 88326

Docld:32245535 Page 203

Raan !

---

## Page 204

SCHEDULE

Reference copy, JFK Collection:

CALIFORNIA

ESCA (RG 233)

SALES OR EXCHANGES OF PROPERTY

Attach to Form 540 or 540NR

TAXABLE

1970

YEAR

Social Security Numb

FORM 540

Name as shown on Form 540 or 540NR

Samuel and Phyllis Ruby

Part I-CAPITAL ASSETS

SHORT-TERM-ASSETS HELD NOT MORE THAN & MONTHS

s. Kind of

property

(If necessary,

attach statement of descriptive

details not shown below)

b. Date acquired

(mo., day, уr.)

c. Date sold

(то., day, ут.)

d. Gross sales price

e. Depreciation allowed

(or allowable)

since acquisition

(attach schedule)

f. Cost or other basis,

cost of subsequent

improvements (if not

purchased, attach

explanation) and

expense of sale

1.

SCHEDULE ATTACHED

(15,274.00)

2. Enter your share of net short-term gain (or loss) from partnerships and fiduciaries

3. Enter unused short-term capital loss carryover from preceding taxable years (attach statement)

4. Net short-term gain (or loss) from lines 1, 2 and 3

LONG-TERM-ASSETS HELD MORE THAN 6 MONTHS

5. Enter gain (if any) from line 16, Part It .

6. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries

7. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)

8. Net long-term gain (or loss) from lines 5, 6 and 7

9. Combine the amounts shown on lines 4 and 8 and enter the net gain (or loss) here

10. If line & shows a GAIN, enter 50% of line 8 or 50% of line 9, whichever is smaller. (Enter zero if there is a

loss or no entry on line 8)

11. Subtract line 10 from line 9, Enter here and on line 17, Part Ill

12.

If line 9 shows a LOSS, enter here and on line 17, Part Ill the smallest of the following:

(a) the amount on line 9; (b) the amount of taxable income on Form 540 or 540NR, computed without capital

gains and losses; or (c) $1,000

Carryover Loss (14,274.00)

Part II-SALE OR EXCHANGE OF PROPERTY UNDER SECTIONS 18181-82

13.

Enter gain (if any) from line 22, Part IV

14. Enter gain (if any) from line 25, Part IV

(15,274.00)

( 1,000.00)

15. Enter your share of gain (or loss) of Section 18181-82 items from partnerships and fiduciaries

16. Net gain (or loss). If GAIN, enter on line 5, Part 1; if LOSS, enter on line 29, Part V

PART Ill-TOTAL NET GAIN OR LOSS FROM SALES OR EXCHANGES OF PROPERTY

17. Net gain (or loss) from line 10 or 11, Part 1

18. Net gain (or loss) from line 31, Part IV

19. Total net gain (or loss) -Combine lines 17 and 18. Enter here and on Form 540 or Form 540NR, page 2, Part

Il, line 23 .

NW 88026) Docld:32245535 Page 204

/Schedula continiradnnravo.co)

Paro 1

---

## Page 205

PAGE 4

SCHEDULE E -- SHAREHOLDERS SHARE OF INCOME AND CREDITS

(It additional space is needed, attach schedule)

(1)

Name and Addresa of Each Shareholder

(2). 77

So i earity

. (3)

Number of

Shares:'

(a)

(b)

(c)

.(d)

GEORGE.

MARCUS.

130/

MIAm, GARDENS DR, NiMIAMI, (LA, 33/6V

EARL RUBY

4380 STONeY RIVER DR, BIRMINgHAM, MUCH 48010

7500

71.00

JFK

Collection:

ESCA

(RG

233)

Reference

(i)

M1-10

(a) $4:32

036139

(b)2

32. 036.38

580.28

34, 380,38

3 380-28

32380 38

(d

(ax

(t)

(g

Docid-

---

## Page 206

PAGE 4

SCHEDULE E - SHAREHOLDERS SHARE OF INCOME AND CREDITS

(It additional space is needed, attach schedule)

(1)

Name and Address of Each Shareholder

(2)

Social Security

Number

eterence

copy,

JFK

• Collection:

ESCA (RG 233)

master di

(a)

(b)

(c)

(d)

GEGRGE...

MARCUS

130/

MIAMI GARDENS DR, N. MIAMI, FLA, SSIGN

EARL RUBY

4380 STONEY RIVeR DR, BIRMINgHAm, MIli 48010

.(3)

Number of

Shares

7500

7500

(g)

(hi)

(i)

•Amouni taxi

incorra (ectiod

U:8: 1120-8)

(a) 8: 32, 036.39

32,036.38

3.8038

32 380.38

$

3 1 360.28

32380.38

(c).

(d)

(e)

(t)

(g

(h)

(D)

Lodd

---

## Page 207

SOREDULE F- SCAREGOLDERS SHARE ÜE INCOiVE ANO GRENirO

(ii acidicional space is reeded, attach schedule)

(1)

Name and Address of Each Shareholder

(2)

Social Security

Number

(3)

Number of

Shares

(4)

Amount taxable

as ordinary

income (schedule K, total of

lines 4

and 8, U.S.

1120-S)

(a) .

URCE STORY RICS DR BirMMI

LE DE ENC INGTON 71150 CHICAGO, =1L. 110202

(c) .

(d) . .

(e)

(f)

(g)

(h)

(i)

(i)

2:500

7,500

46,840.01

46,040.05

JFK Collection:

ESCA

(RG 233)

Reference

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share-

holder

on Ml-1040 (enter on

page 2, schedule 1, line 34 or

on page 2, schedule 2, line 43)

difference between column 4

and column 5

(See instructions)

(7)

Enter here and on form

MI-1040, page 1, line 22

each

shareholder's pro-

portionate share of per-

sonal

property

taxes

paid on

inventories or

the credit for

franchise

fees paid.

(See instructions)

Enter

(8)

here

and

on

form

MI-1040,

each shareholder's

proportionate share of Single

business tax paid.

(See instructions)

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

46, £40.04

76,850.05

NW 88326 Docld:32245535 Page 207

DA0E 3 075

---

## Page 208

scheduLa r-stAncHoLDERs SriARE OF iNCOME ANO CRaOris

(If additional space is needed, attach schedule)

(1)

Name and Address of Each Shareholder

(2)

Social Security

Number

(3)

Number of

Shares

(4)

Amount taxable

as ordinary

income (schedule K, total of

lines 4 and 8, U.S. 1120S)

(a). EACH. RUB!

43EO STONEY RIVER BIRM., MI

ESTATE

SE GEORGE

MARCUS

LI'N. WASHINCTON VICEO CHICAGO LL. 60602

(c) .

(d)

(e)

(f)

(g)

(h) .

(i)

(i)

500

500

19,730.16

19.230.15

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share

solder on MI-1040 (enter or

page 2, schedule 1, line 34 or

on page 2, schedule 2, line 43)

difference between column 4

and column 5

(See instructions)

(7)

Enter here and on form

MI-1040, page 1, line 22

each

sharehoider's pro-

portionate share of per-

sonal

property

taxes

paid

on

inventories

or

the credit for. franchise

fees paid.

(See instructions)

Enter here

(8).

and

on

form

MI-1040,

each

shareholder's

proportionate share

of Single

business tax paid.

(See instructions)

(a)

(b)

19,730.16

19,730.15

(6)

(d)

(e)

(f)

(g)

(h)

(i)

(1)

NW 88326 Docld:32245535 Page 208

46.61

46.61

Reference copy,

JFK Collection:

ESCA

(RG

233)

---

## Page 209

PLEASE

PRINT

OR

TYPE

D- 1040 (NR)

CITY OF

DETROIT

CITY OF DETROIT INCOME TAX

INDIVIDUAL RETURN - NONRESIDENT

or other laxable year beginning

1976, ending

First Nome and Initial

Earl R. and Marge

Last Name

Ruby

(If joint return of husband and wife, use first names and middle initials of both)

Home Address (Number and Street or Rural Route)

18135 Livernois

City, Town or Post Office

Detroit,

State

Michigan

Postal Zip Code

48221

1976

19

233)

EXTENSION NUMBEI

Your Occupation

Sales

Spouse's Social Security Number

If you

are

an

EMPICI

enter your Federal EN:PLO

Identification No. her:

ESCA

Spouse's Occupation

Housewife

FP

APP.

OA.

• A. If married, is spouse filing a separate return? O YES

L NO. If yes, enter spouse's first name.

B.

Enter the name and

address

used on your return for 1975 (If the same as above write "Same". If different, indicate date

moved.) If none filed, give reason.

Same

Collection

JFK

Regular

65 or over

Auditor

Blind

SCHEDULE A - EXEMPTIONS.

1. YOURSELF

SPOUSE

2.

Enter first names of each of your DEPENDENT CHILDREN who lived with you:

Enter

number of

exemptions

checked

Enter

Attach Copy of Form DW-2 or W-2 Here

NAME

Enter figure l in the last column to

right for each name listed

Relationship

OTHER

DEPENDENTS

Months lived in

your home

during

1976

Reference

4.

Total exemptions from lines 1, 2 and 3; enter here and on line 15 below.

INCOME (If joint return, include all income of both husband and wife)

5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. - indicate (W) for wife

2

Total wages reported

Detroit Income Tax

WAGES, ETC.. EARNED

Employer's Name

Where employed (City and State)

on DW-2 or W.2

Withheld

IN DETROIT

COBO CLEANERS

•INC. DETROIT,

MICH.

s...

164200/00

92000

821100,00

COBO - RUMAR SALES, INC. DETROIT, MIN.

500100

110:00

250100

TOTALS

180, 700 jou

4080,00

7.

90,

350100

Rental income (or loss) from tangible property in the City of Detroit - from page 2, Schedule B, line 4

63172

8.

Other income (or loss) from partnerships, etc. - from page 2, Schedule F, line 4

9.

4,481100

Gain (or loss) from sale or exchange of tangible property in the City of Detroit - from page 3, Schedule E, line 10...

10.

Net profit (or loss) from business - from page 3, Schedule C, line 8

11. Income (or loss) - TRUSTS AND ESTATES ONLY - from page 4,. Schedule G, line 7 (see instructions for exemption to enter on line 15)

12.

Total (add lines 6 through 11 of last column).

95, 462172

Attach Check or Money Order Here

13. Less:

Deductions from page 2, Schedule M, line 5 (if none, enter zero)

14.

Total (line 12 less line 13)

95.462'72

15.

Less Amount for Exemptions: Enter number of exemptions from line 4 above

2

and multiply by $600,

11200,00

16.

TOTAL INCOME SUBJECT TO TAX

94.202172

17.

CITY OF DETROIT TAX: Multiply line 16 by .005 (½%)

471,31

PAYMENTS AND CREDITS

18. a. Tax withheld by employer - from line 6 above - ATTACH Forms DW-2 or W.2

$..

1,080,00

b. 'Payments and credits on 1976 Declaration of Estimated Detroit Income Tax

c. Other Credits - explain in attached statement (See Instructions)

19.

TOTAL - Add Lines 18a, b, and c

$.

TAX DUE OR REFUND

20. If your payments (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT

S..

608169

21. Check box if you wish overpayment on line 20 to be: (A) Credited on 1977 Estimated Tax or (B) I Refunded.

22. If your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return..

.

$...

Make check payable to: "TREASURER, CITY OF DETROIT." A balance due of less than one dollar ($1.00) need not be paid.

I declare that I have examined this return fincluding accompanying schedules and statements). and to the best of my knowledge and belief it is true, correct and

SIGN

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

SIGN HERE

HERE

(Taxpayer's signature and date)

(Signature of

preparer other

than

taxpayer)

(Date)

SIGN HERE.

GORDON L HOLLANDER, P.C.

(Spouse's signature and date) (if joint return, BOTH HUSBAND AND WIFE MUST SIGN)

CERTIFIED PUBLIC ACCOUNTANT

WW 88326 Dold: 32245595ee partment son inis on, City Count loSe SeEN

---

## Page 210

inion. Dapt.;, of Treasury

C-3000K •

Schedule

of Partners or Shareholders-

Parinership, Subchapter S Cory., Professional Corp.

See instructions on reverse side

1976

1

Name:

2 Account Number:

Cobo-Rumar Sales, Inc.

SUMMARY

3

Total Number of Partners or Shareholders.

Total Number of Qualified Partners or Shareholders from Part Il-enter here and on C-8000, line 60a

AVnI Di QUALIFIED PARTNERS OR SHAREHOLDERS

NAME AND ADDRESS

B SOCIAL

c %

SECURITY NO.

Time

38-1812707

D SHAREHOLDER'S

SALARY

LE %

PARTNER'S or SHAREHOLDER'S

Own. F Share of Bus. Inc. | G Share of SBT Paid

Earl Ruby

4380 Stoney River;Birm.

100%

18,000 / 00 100%

|00

100

%

100

%

1 00

100

%

100

|00

%

1 00

%

100

%

|00

%

|00

• 100

%

| 00

%

100

100

%

| 00

%

| 00

100

%

100

%

|00

100

%

|00

%

| 00

100

РАВИ МІ!

%

100

%

00

100

NON-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is neoded submit separate schedule and enter totals on line 7.

|00

00

100

| 00

%

00

100

00

%

00

00

00

%

÷ 00

|00

100

| 00

100

00

%

|00

00

| 00

%

|00

100

100

%

1 00

100

|00

%

|00

00

00

100

100

NW 88326Y Doold:82245535 1Page>0m)

7

00

00

| 00

100

00

1nn1

collection:

Referen

ce

---

## Page 211

INUILLO

Calendar Year

OR FISCAL YEAR

1976

THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONI

:!

Beginning

Ending

X INDIVIDUAL (Check

• FIDUCIARY One)

19

19

FOR OFFICE USE ONLY

RUBY EARL & MARGIE

18135 LIVERNOIS AVE

DETROIT MI

6 9 8

5

"in

3)

m

(RG

SCA

48221

Husband's Social Security No.

Mo.

09

Day

-

30

Yr.

76

Retroactive Date

If this return is for an Estate, give Probate.

File No.

County

Wife's Social Security No.

698855

Intangible Account Number

x—

County

City

POSTED:

176112

File Date

AUDITED:

Employer Identification No.

Collect

FK

Date of Death

LINE

NO.

Computation of Tax Due

AMOUNT

LINE

NO.

TAX

1. Accounts and Notes Receivable (non-income producing only) -

2. Less Accounts and Notes Payable

3. Balance Taxable @ 1/10th of 1%

2.

3.

4. Accounts and Notes Receivable (income producing only)

Reference copy

5. Less Accounts and Notes Payable (use onty that portion, if any, not used in Line 2) _

6. Balance Taxable

7. Income applicable to balance

6.

7.

8. Tax @ 3½2% of income (Line 7) or 1/10th of 1% of Balance (Line 6), whichever is greater.

9. Stocks and Bonds - - . . - Schedule A, Column 9.

2:37623

10. Mortgages and Land Contrarts - . . . - Schedule B, Column 8. -

11. Annuities - - - - - Schedule C, Column 9.

12. Beneficiary Return (attach copy hereto) .

13.

TOTAL

14.

Less Statutory deduction (S175.00 or S350.00 by husbands and wives filing joint return)

15.

BALANCE DUE -

16. Cash on Hand or in Transit as of retroactive date (include cash in safety deposit boxes)

17. Bank Deposits in Banks Located Outside of Michigan

18. Savings in Building and Loan Ass'ns. Located Outside of Michigan -

or Withdrawn from Mich.

Banks or Ass'ns. atter

RETROACTIVE DATE.

19. TOTAL .

20. TAX @ 20c per $1000.00 of Line 19

21.

TOTAL TAX DUE (Line 15 plus Line 20) -

22.

Less Advance Payment of Tax

23.

TOTAL TAX DUE

24.

Penalties & Interest; Penalty

- %, S.

; Interest

- %

Months, S.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

J24.

2,376.23

350.10

2.026.23

2,02623

2,026.23

25. TOTAL AMOUNT DUE WITH THIS RETURN (Due on or before April 30)

. 25.

Or Four Months after End of Authorized Fiscal Year

2,02623

Make Remittance Payable To: STATE OF MICHIGAN' Write your Intangible Account No. on your check.

Mail To: MICHIGAN DEPARTMENT OF TREASURY, TREASURY BUILDING, LANSING, MICHIGAN 48922

Business or Profession of Taxpayer:

Amount Single Business Tax Paid:

Single Business Tex Account No.:

SALES

Telephone Number:

863.0400

Year of Last Return Filed:

1975

Address of Last Return:

SAME

Check which Method your return is Computed by.

RETROACTIVE DATE

MONTHLY AVERAGE

NOTE: If this return is from a Trustee, attach a list of Names and

Addresses of Beneficiaries and Date of Creation of Trust.

I declare under the panaiting imposed by Art No. 301 P.A. of 1939, as Amendied,

selertulao and alalaranto lino

1180011

anand by the and 10 the bood of any knowledurs and belief is a true, correct

and complete return.

Signaltro

Prepared By:

GORDON L HOLLANDER, P.C.

CERTIFIED PUBLIC ACCOUNTANT

NWX88325-DacId:332425 AXPSge-EM MILE ROAD

Signature

Title: (State whether Individuel, Owner, Executor, Administrator, Trustee, otc.)

---

## Page 212

ruddero

MICHIGAN INDIVIDUAL INCOME TAX RETURN

for 1975, or taxable year beginning

-, 1975, ending

19

Your social security number,

First name and initial (if joint return, use first names and initials of both)

Earl R. and Marge

• Last name

Ruby

Home address (number and street or rural route)

18135 Livernois

City, town or post office. and State

ZIP code

Your occupation

Sales

Spouse's social security no.

48221

Please Print or

Detroit, Michigan

Spouse's occupation

Residency Status during tax year:

X Resident

Non-resident

- to

O Filing Status:

A • Single

B L& Married, filing jointly

C L Married,

, filing separately (see instructions, page 2)

Name of Spouse

(Give spouse's Soc. Sec. No. in the space provided)

2.

STATE

Do you wish to designate $2.00 of your taxes for this fund?

CAMPAIGN FUND

If joint return, does your spouse wish to designate $2.00?

_Part-year resident, from

1. Exemptions:

(a) Enter here the number of exemptions claimed on your

federal income tax return..

(b) Special exemption for paraplegics & quadriplegics. Insiructions)

(c) TOTAL EXEMPTIONS, add lines 1(a) and 1(b).

YES

XI NO

YES

XI NO

4

4

NOTE: Il you check the YES boxes

it will

not increase your

tax

or

reduce your refund.

3. Adjusted gross income as defined in the Internal Revenue Code and which should be reported on Federal Form 1040,

Attach copies of any Federal schedules that indicate a loss or deduction

line 15, or 1040 A, line 12 from gross income. (See page 5 of the instructions)

63.

178

3, 0 36 18

Attach State Copy of Form W-2 Here

4. Additions to adjusted gross income, (from page 2, line 35)

178,

036

5. Total, add lines 3 and 4

6. Subtractions from adjusted gross income, (from page 2, line 44).

7. Subtract line 6 from line 5

8. Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48)

9. Income subject to tax (subtract line 8 from line 7)

9

10.

178,

6

036

18÷

•000

172,

036

18

7,51198

10. Tax: multiply line 9 by 4.37% (.0437)

CREDITS (See instructions - pages 7-10)

AMOUNT PAID

11. Income tax paid to Michigan cities.

10089

_ lla.

CREDIT

2009

12. Contributions to Michigan colleges & universities (attach receipts).

12a.

13. Income tax paid to another state (attach copy of return)

13.

13%

14. Total credits (add lines 11a, 12a, and 13a), enter total here

14.

2009

2,497/89

15. Income tax, subtract line 14 from line 10 (if line 14 is greater than line 10, enter 'NONE")

16. Credits from any MI-1040 CR form. (see page 9 of instructions).

16

Do not complete lines 17 thru 21 if you have claimed a credit on line 16.

17. Household income from line 56

18. Enter 1975 homestead property tax or amount from line 59

19. Tax not eligible for credit, enter 3.5% (.035) of line 17..

20. Subtract line 19 from line 18, if line 19 is greater, enter 'NONE'

18-

19.

20

Attach Check or Money Order Here

21. Property tax credit, 60% (.60) of line 20, ($500.00 maximum) .

22.

Personal property tax paid on inventory. 22

X 39% (39).

21.

22.

PAYMENTS

23.

Michigan tax withheld (attach State copy of W-2)

2,157/50

000

00

24.

Michigan estimated tax payments

25.

1974 overpayment credited to 1975

26. Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25

26

27

PAY

6,15750

1340 39

If line 26 is less than line 15, enter BALANCE OF TAX DUE HERE...

28. If line 26 is greater than line 15, enter AMOUNT OVERPAID

28.

29. Amount of line 28 to be REFUNDED TO YOU

30. Amount of line 28 to be credited to 1976 estimated tax.

(30

REFUND

NOTE: If all of overpayment (line 28) is to be

refunded (line 29), make no entry on line 30.

OFFICE USE

This return is due April 15, 1976 or on the 15th day of the fourth month after the close of your tax year.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and

statements, and to the best of my knowledge and belief it is true, correct and complete. It prepared by a person

other than the taxpayer, his declaration is baged on all information of which he has any knowledge

Sign

NW 88926

Your signature

Date

Docld:32245535. Page 217 в0тH must sign even it only one had incomei

GORDON O FOLLANDER, PIC.

anese

CERTIFIED PUBLIC ACCOUNTANT

pral dill

MAIn

Date

Reference

COPY, JFK Collection:

ESCA

• (RG

233)

---

## Page 213

2. Exemptions (number of allowable exemptions times $1.500.00)

3. Subtract line 2 from line 1. (This is your estimated taxabie income).

4. Estimated tax (line 3 times .046 or 4.6%)..

5. LESS: Total estimated tax credit for Michigan City income taxes, personal property tax on inventories.

Michigan homestead property taxes and contributions to Michigan colleges and universities..

6. Subtract line 5 from line 4. Enter here and on line 1 below

MICHIGAN

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS - 1.976

For calendar year 1976 or fiscal year ending —

-. 19-_

STATE OF MICHIGAN

Department of Treasury

FORM

MI-1040-ES

81618

First name and initial (if joint declaration, use names and initials of both)

Last name

Your social security number

Please

or type

Address (number and stree!)

Spouse's social security number

City, State, and ZIP code

1. Your estimate of 1976 income lax

2. Estimated income tax withheld and to be withheld during entire year of 1976

3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)

4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.

If this declaration is CJ April 15, 1976, enter 1/4 of line 3; September 15, 1976, enter 1/2 of line 3

due to be filed on:

/ June 15, 1976, enter 1/3 of line 3: Jan. 15, 1977, enter amount on line 3

5. If you had an overpayment on your 1975 income tax return which you elected to have applied as a

credit against your 1976 estimated tax, enter the amount here.

6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To spread

credit evenly.lo each installment, divide it by number of installments and enter results here

7. Amount to be paid with this declaration at time of filing (line 4 less line 6)

8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing of

quarterly estimates. Enter lump sum payment here

I have examined this declaration and to the best of my knowledge it is correct.

Signature(s)

Date.

19

MICHTG AIN

joint estimate, both husband and wife must sign

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS- 1976

For calendar year 1976 or fiscal year ending.

-, 19—

STATE OF MICHIGAN

Department of Treasury

FORM

MI-1040-ES

Your social securily number

First name and initial (if joint declaration, use names and initials of both)!

Last name

Earl R. and Marge

Ruby

Please

or type

Address (number and street)

18135 Livernois

City, State, and ZIP code

Detroit, Michigan

48221

1. Your estimate of 1976 income tax

2. Estimated income tax withheld and to be withheld during entire year of 1976

3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)

4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated

If this declaration is

EX April 15, 1976, enter 1/4 of line 3;

due to be filed on:

•June 15, 1976, enter 1/3 of line 3;

• September 15, 1976, enter 1/2 of line 3

• Jan. 15, 1977, enter amount on line 3

5. If you had an overpayment on your 1975 income tax return which you elected to have applied as a

credit against your 1976 estimated tax, enter the amount here.

6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To

spread credit evenly to each instalment, divide it by number of installments and enter results here....

7. Amount to be paid with this deciaration at time of filing (line 4 less line 6)...

8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing

of quarterly estimates. Enter lump sum payment here

NW 88328e BYEiA:S 22455 graparge f3ihe best of my knowiedge it is correct.

nata

Spouse's social security number

5,600.00

5,600.00

11700.00

1,4.00.00

19...

JFK Collection:

ESCA

(RG

233)

---

## Page 214

PLEASE

PRINT

OR

TYPE

D-1040 (NR)

CITY OF

DETROIT

CITY OF DETROIT INCOME TAX

INDIVIDUAL RETURN -NONRESIDENT

or other taxable year beginning.

, 1975, ending

First Name and Initial

Earl R. and Marge

Last Name

Ruby

(If joint return of husband and wife, use first names and middle initials of both)

Home Address (Number and Street or Rural Route)

18135 Livernois

City, Town or Post Office

State

Detroit, Michigan

Postal Zip Code

48221

1975

233)

19

Your Social Security

Number

32.0м

Your Occupation

Sales

Spouse's Social Security Number

EXTENSION NUMBEI

If

an

EMSIO

enter your Federal EMPL

Identification No. here:

Spouse's Occupation

IP

FP

APP.

OA.

A. If married, is spouse filing a separate return? J YES

IX NO. If yes, enter spouse's first name..

B. Enter the name and address used on your return for 1974 (If the same as above write "Same". If different, indicate date

moved.) If none filed, give reason.

Same

Regular

65 or over

Auditor

Blind

Enter

number of

exemptions

checked

Enter

Months lived in

your home

during

1975

copy,

Reference

or W-2 Here

DW-2

Attach Copy of Form

SCHEDULE A - EXEMPTIONS

1. YOURSELF

SPOUSE

2.

Enter first names of each of your DEPENDENT CHILDREN who lived with you:

Denise,

Joyce

NAME

Enter figure I in the last column to

3.

right for each name listed

Relationship

OTHER

DEPENDENTS

4.

Total exemptions from lines 1, 2 and 3; enter here and on line 15 below.

INCOME (If joint return, include all income of both husband and wife)

5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. - indicate (W) for wife

Total wages reported

Detroit Income Tax

WAGES, ETC. EARNED

Employer's Name

Where employed (City and State)

on DW-2 or W-2

Withheld

IN DETROIT

COBO CLEANERS, INS.

DET, MICH.

$.....

70,

0000

•tou

$

22900

000

'oa

35,000/00

16.500

110,03

8,25080

son

TOTALS

339:

43,250100

7.

Rental income (or loss) from tangible property in the City of Detroit - from page 2, Schedule B, line 4.

39613

8. Other income (or loss) from partnerships, etc. - from page 2, Schedule F, line 4

3,508100

9. Gain (or loss) from sale or exchange of tangible property in the City of Detroit — from page 3, Schedule E, line 10

•''

10. Net profit (or loss) from business - from page 3, Schedule C, line 8

11. Income (or loss) - TRUSTS AND ESTATES ONLY - from page 4, Schedule G, line 7 (see instructions for exemption to enter on line 15)

12.

Total (add lines 6 through 11 of last column) ..

46, 154113

13.

Less: Deductions from page 2, Schedule M, line 5 (if none, enter zero).

14.

Total (line 12 less line 13)

46.154,13

15.

Less Amount for Exemptions: Enter number of exemptions from line 4 above

and multiply. by $600.

2,400,00

16.

TOTAL INCOME SUBJECT TO TAX

43,254.113

218

17. CITY OF DETROIT TAX: Multiply line 16 by .005 (½%).

177

PAYMENTS AND CREDITS

18. a. Tax withheld by employer - from line 6 above - ATTACH Forms DW-2 or W-2..

$.

339,00

b. Payments and credits on 1975 Declaration of Estimated Detroit Income Tax

c. Other Credits - explain in attached statement (See Instructions)

19.

TOTAL - Add Lines 13a, b, and c

339,00

TAX DUE OR REFUND

20. If your payments (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT

120123

21. 'Check box if you wish overpayment on line 20 to be: (A) Credited on 1976 Estimated Tax or (B) I Refunded.

22. If your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return..

Make check payable to: "TREASURER, CITY OF DETROIT." A balance due of less than one dollar ($1.00) need not be paid

I declare that l have examined this return,(including accompanying schedules and statements) and to the best.of my knowledge and belief it is true, correct and

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

SIGN

SIGN HERE

HERE

(Taxpayer

signature and date)

/eignatura of preparer other shan taxpayer)

(Dato)

GORDON L HOLLANDER. P.C.

NW 88326

Bocid:32245535 igfkager21re) if join return,

BOTH HUSBAND AND WIFE MUST SIGN) CERTIFIED PUBLIC ACCOUNTANT)

---

## Page 215

Revenue Division

INTANGIBLES TAX RETURN

Calendar Year 19.

OR FISCAL YEAR

Beginning-

Ending-

19

19

Individual

THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONG.

---DO NOT WRITE ABOVE THIS LINE. -

Partnership-

Michigan Corporation

Foreign Corporation

Fiduciary

Check

One

RUBY EARL & MARGIE

18135 LIVERNOIS AVE

DETROIT MI

5,5

48221

POSTED

FILED

IF THIS RETURN IS FOI

ESTATE GIVE PROBA

-

MONTH

DAY

11

30

RETROACTIVE DATE

YEAR

75

698955

ACCOUNT NO.

TYPE

82

COUNTY

CITY

• K

151

FILE DATE

12

County_

File No.

Date of Death.

-

Line Computation of Tax Due

=

AMOUNT

Line

No.

TA

1. Accounts and Notes Receivable (non-income producing only)_

2. Less Accounts and Notes Payable.

3. Balance Taxable @ 1/10th of 1%-

4. Accounts and Notes Receivable (income producing only).

5. Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2)_

6. Balance Taxable

7. Income applicable to balance.

8. Tax @ 3½2% of Income (Line 7) or 1/10 of 1% of Balance (Line 6), whichever is greater..

9. Stocks and Bonds..... Schedule A, Column 9.

10. Mortgages and Land Contracis..... Schedule B, Column 8.

11. Annuities .-.. - Schedule C, Column 9.

12. Beneficiary Return (attach copy hereto)

13.

TOTAL

14.

Lost Statutory deduction (S175.00 or $350.00 by husbands and wives filing ioint return) _

15.

BALANCE DUE

16. Cash on Hand or in Transit as of retroactive date (include cash in safety deposit boxes) -

17. Bank Deposits in Banks Located Outside of Michigan.

18. Savings in Building and Loan Ass'ns. Located Outside of Michigan_

or Withdrawn from Mich.

Banks or Ass'ns. after

RETROACTIVE DATE.

19. TOTAL

20. TAX @ 408 por $1000.00 of Line 19.

21.

TOTAL TAX DUE (Line 15 plus line 20)

22.

Less Advance Payment of Tax

23.

TOTAL TAX DUE.

24.

Penalties & Interest; Penalty

_%, $.

_; Interest_

_%_

_Months, $_

25.

TOTAL AMOUNT DUE

2.

Coll

JFK

copy,

Reference

295267

10.

11.

12.

13

14.

15.

16.

17

18.

19.

20.

21 .L

22.

23

24.

25.

2952

3500

260a8

=60287

260267

260285

MAKE REMITTANCE PAYABLE TO STATE OF MICHIGAN

Please forward Remittance for Amount Shown Here on or belore April 30.

To: MICHIGAN DEPARTMENT OF TREASURY, LANSING, MICH, 48922

(or tour months attor and of authorized fiscal year)

IMPORTANT-Be Sure to Answer the following Question When Applicable.

SALES

863-0400

1. Business or Profession of Taxpayer.

_Phone No.

2. Give year of last return filed..

1974

_Address of Last Return_

SAME

3. Check here if return is computed on a Retroactive Date Method.

or Monthly Average Method'

4. If taxpayer is a corporation give State and Dare of Incorporation.

Federal Employers Identification Number_

5. If this is the return of a Trustee attach list of nämes and addresses of beneficiaries and date of creation of trust.

6. If this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.

I derlare unrter the nonaldine lepreart loy Are No. 201 P. A. nf 1979, a Amenelord, that Ihle return, Inclurtino any arcompanylnu acherules ans

anel lo lle beat of my knowledye and baliot la a live, corrert and complero rolurn.

S0rtnl Rocurily Number --

n oxamined by i

Return Prepared by-

GORDON L. HOLLANDER, P.C.

CERTIFTED PUBLIC ACCOUNTANT

NW 88326, Docld:32245535 Page 21BEST TEN MILE ROAD

Signed -

signed.

Trat-

---

## Page 216

(1)

Name and Address of Each Shareholder

(ii acidizionai space is reeded, atiach schedule)

(2)

Social Security

Number

(3)

Number of

Shares

(a) .

1?69

RICO DO.

7:500

7,000

(c)

(d) .

(e)

(f)

(g)

(h) .

(i)

(0)

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6 .

(6)

Amount to be used by share-

holder on MI-1040 (enter on

page 2, schedule

1, line 34 or

on page 2, schedule 2, line 43)

difference

between

column 4

and column 5

(See instructions)

(7)

Enter here and

on form

MI-1040, page 1, line 22

each

shareholder's

pro-

portionate share of per-

sonal

paid

property

taxes

on

inventories or

the credit for franchise

fees paid.

(See instructions)

(a)

46, 840.04

(b)

16. 840.05

(0)

(d)

(e)

(f)

(g)

(h)

(i)

(i)

NW 88326 Docld:32245535 Page 216

(4)

Amount taxable

as ordinary

income (schedule K,

total of

lines 4 and 8, U.S. 1120-S)

46, 840,01

46,870.05

JFK Collection:

ESCA

(RG

233)

(8)

Enter

here

and

on form

MI-1040,

each

shareholder's

proportionate share of Single

business tax paid.

(See instructions)

DOGE 3 075.

---

## Page 217

MICHIGAN INDIVIDUAL INCOME TAX RETURN

for 1975, or taxable year beginning

• First name and initial fif joint return, use first names and initiais of both)

Earl R.

and Marge

Home address (number and street or rural route)

-, 1975, ending

19

Last name

Ruby

Your social security number

ZIP code

Your occupation

Sales

Spouse's social security no.

48221

Detroit, Michigan

Spouse's occupation

Residency Status during tax year:

X Resident

Non-resident

to .

Filing Status:

J Single

4

B

C

& Married, filing Jointly

• Married, filing separately (see instructions, page 2)

Name of Spouse

Give spouse's Soc. Sec. No. in the space provided)

2.

STATE

Do you wish to designate $2.00 of your taxes for this fund?

CAMPAIGN FUND

If joint return, does your spouse wish to designate $2.00?

_Part-year resident, from -

1. Exemptions:

(a) Enter here the number of exemptions claimed on your

federal income tax return..

(6) Special exemption for paraplegios & quadriplegics. nstructions)

(c) TOTAL EXEMPTIONS, add lines 1(a) and 1(0)

•YES

XI NO

NOTE: It you check the YES boxes

will

not increase your tax

or

YES

XI NO

reduce your retund.

3. Adjusted gross income as defined in the Internal Revenue Code and which should be reported on Federal Form 1040,

Attach copies of any Federal schedules that indicate a loss or deduction

line 15, or 1040 A, line 12 from gross income. (See page 5 of the instructions)

178

3, 03618

4. Additions to adjusted gross income, (from page 2, line 35).

5.

178,036

5. Total, add lines 3 and 4

6. Subtractions from adjusted gross income, (from page 2, line 44).

7

7. Subtract line 6 from line 5

8. Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48)

9. Income subject to tax (subtract line 8 from line 7)

9.

10.

178

; 036

181

,0 00

0 U

172,036

18

7,51798

10. Tax: multiply line 9 by 4.37% (.0437)

CREDITS (See instructions - pages 7-10)

AMOUNT PAID

100|89

CREDIT

2009

11. Income tax paid to Michigan cities.

12. Contributions to Michigan colleges & universities (attach receipts).

13. Income tax paid to another state (attach copy of return).

- lla.

12a.

03a

14. Total credits (add lines 11a, 12a, and 13a), enter total here.

14.

2009

2,49789

15. Income tax, subtract line 14 from line 10 (if line 14 is greater than line 10, enter 'NONE')

16. Credits from any MI-1040 CR form. (see page 9 of instructions)

16

Do not complete lines 17 thru 21 if you have claimed a credit on line 16.

17. Household income from line 56

18. Enter 1975 homestead property tax or amount from line 59

19. Tax not eligible for credit, enter 3.5% (.035) of line 17

20. Subtract line 19 from line 18, if line 19 is greater, enter 'NONE'

19.

20.

Attach Check or Money Order Here

21. Property tax credit, 60% (.60) of line 20, ($500.00 maximum)

22. Personal property tax paid on inventory. 22

_X 39% (.39).

21.

22.

PAYMENTS

23.

Michigan tax withheld (attach State copy of W-2)

23

2,157|50

000!

0

24.

Michigan estimated tax payments

25. 1974 overpayment credited to 1975

Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25

26.

PAY

6,15750

1,340 39

27. If line 26 is less than line 15, enter BALANCE OF TAX DUE HERE.

28. If line 26 is greater than line 15, enter AMOUNT OVERPAID

29. Amount of line 28 to be REFUNDED TO YOU

30. Amount of line 28 to be credited to 1976 estimated tax.

(30

28.

REFUND

29

NOTE: if all of overpayment (line 28) is to be

refunded (line 29), make no entry on line 30.

OFFICE USE

This return is due April 15, 1976 or on the 15th day of the fourth month after the close of your tax year.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and

statements, and lo the best of my knowledge and belief il is true, correct and complete. If prepared by a person

other than the taxpayer, his declaration is based on all information of which he has any knowledge.

Sign

Here

NW 88326

Your signature

Date

d:3224559greaie i2fky. BOTH must sign even if only one had income)

Hail ratan

GORDON C. POL LANDER, FC.

Date

CERTIFIED PUBLIC ACGQUNTANT

19675 WESTATHEAN AChE BOAR. Dramer H, Lansing 43906

Reference

copy,

JFK

Collection:

(RG

233)

---

## Page 218

PLEASE

PRINT

OR

TYPE

D- 1040 (NR)

CITY OF

DETROIT

CITY OF DETROIT INCOME TAX

INDIVIDUAL RETURN - NONRESIDENT

or other taxable year beginning

1975, ending

First Name and Initial

Earl R. and Marge

Last Name

Ruby

If joint return of husband and wife, use first names and middle initials of both)

Home Address (Number and Street or Rural Route)

18135 Livernois

City, Town or Post Office

State

Detroit, Michigan

Postal Zip Code

48221

1975

19.

Your Social

Security Number

EXTENSION NUKABE:

Your Occupation

Sales

Spouse's Social Security Number

If you

are

an

enter

your Federal EliPlO

Identification No. here:

CA

Spouse's Occupation

IP

FP

APP.

OA.

A. If married, is spouse filing a separate return?

• YES

[ NO. If yes, enter spouse's first name.

B.

Enter the name and address used on your return for 1974 (if the same as above write "Same". If different, indicate date

mored.) If none filed, give reason.

Same

Auditor

Blind

Regular

65 or over

Enter

SCHEDULE A - EXEMPTIONS 1. YOURSELF

number of

exemptions

SPOUSE .

checked

Attach Copy of Form DW-2 or W-2 Here

2.

Enter first names of each of your DEPENDENT CHILDREN who lived with you:

Enter

Denise,

Joyce

NAME

Relationship

Months lived in

Enter figure 1 in the last column to

during

3.

your home

OTHER

right for each name listed

1975

Reference

DEPENDENTS

4.

Total exemptions from lines 1, 2 and 3; enter here and on line 15 below. -

INCOME (If joint return, include all income of both husband and wife)

5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife

Total wages reported

Detroit Income Tax

WAGES, ETC. EARNED

Employer's Name

Where employed (City and State) •

on DW-2 or W.2

Withheld

IN DETROIT

COBO CLEANERS. INS.

DET.

MICH

$.

70,0

0d'0s

$.

229,00

$.

33, 00

000

100

........d........

16.500

110

Sonia.

339;00

8,250

10

43, 250100

396a1-

7. Rental income (or loss) from tangible property in the City of Detroit - from page 2, Schedule B, line 4 .

8. Other income (or loss) from partnerships, etc. - from page 2, Schedule F, line 4.

2,508,00

9. Gain. (or loss) from sale or exchange of tangible property in the City of Detroit - from page 3, Schedule E, line 10.

10.

Net profit (or loss) from business - from page 3, Schedule C, line 8

11. Income (or loss) - TRUSTS AND ESTATES ONLY - from page 4, Schedule G, line 7 (see instructions for exemption to enter on line 15)

12.

Total (add lines 6 through 11 of last column)

46, 154113

Attach Check or Money Order Here

13.

Less:

Deductions from page 2, Schedule M, line 5 (if none, enter zero).

14.

Total (line 12 less line 13)

46.154,13

15.

Less Amount for Exemptions: Enter number of exemptions from line 4 above

and multiply. by $600.

2,400,00

16.

TOTAL INCOME SUBJECT TO TAX

43,

.754113

17. CITY OF DETROIT TAX: Multiply line 16 by .005 (½%)

$_

218|77

PAYMENTS AND CREDITS

18. a. Tax withheld by employer - from line & above - ATTACH Forms DW.2 or W.2.

339,00

b. Payments and credits on 1975 Declaration of Estimated Detroit Income Tax

c. Other Credits - explain in attached statement (See Instructions)

19.

TOTAL - Add Lines 13a, b, and e

339,00

TAX DUE OR REFUND

20. If your payments (line 19) are. larger than your tax (line 17), enter amount of OVERPAYMENT

120/23

21.'Check Check box if you wish overpayment on line to to be: (A)[J Credited on 1976 Estimated Tax or (B) A Refunded.

22. If your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return..

Make check payable to: "TREASURER, CITY OF DETROIT." A balance due of less than one dollar ($1.00) need not be paid.

I declare that I have examined this return (including accompanying schedules and statements) and to the best.of my knowledge and belief it is true, correct and

SIGN

complera. It prepared by a porson other than taxpayer, his declaration is based on all information of which he has any kramledge

HERE

(Taxpayer's signature and date)

(Signature of preparer other than taxpayer)

(Dato)

SIGN HERE

GORDON L HOLLANDER. P.C.

(Spouse's signature and date) (if joint return, BOTH HUSBAND AND WIFE MUST SIGN CERTIFIED PUBLIC ACCOUANANT)

NW 88326

Docid:377A5535: Faga 18epartment, Treasury Division, 104 City-Col067BUWEBT,TEN MILEiRUAgn 4822515

.

---

## Page 219

cape to! 1 19!6

2. Exemptións (number of allowable exemptions times 51. 500.00).

3. Subtract line 2 from line 1. (This is your estimated taxable income)..

4. Estimated tax (line 3 times .046 or 4.6%).

5. LESS: Total estimated tax credit for Michigan City income taxes, personal property tax on inventories,

Michigan homestead property taxes and contributions to Michigan colleges and universities

6. Subtract line 5 from line 4. Enter here and on line 1 below

MICHIGAIN

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS- 1976

For calendar year 1976 or fiscal year ending

-, 19--

STATE OF MICHIGAN

Department of Treasury

FORM

MI-1040-ES

First name and initial (if. joint declaration, use names and initials of both)

Last name

Your social security number

Please

print

of fyoe

Address (number and street)

Spouse's social security number

City, State, and ZIP code

1. Your estimate of 1976 income tax

2. Estimated income tax withheld and to be withheld during entire year of 1976

3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)

4. COMPUTATION OF INSTALLMENT. Check proper box below and. enter amount indicated

If this declaration is April 15, 1976, enter 1/4 of line 3;

due to be fied on:

0 June 15, 1976, enter 1/3 of line 3;

• September 15, 1976, enter 1/2 of line 3(

• Jan. 15, 1977, enter amount on line 3

5. If you had an overpayment on your 1975 income tax return which you elected to have applied as a

credit against your 1976 estimated tax, enter the amount here

6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To spread

credit evenly to each installment, divide it by number of installments and enter results here

7. Amount to be paid with this declaration at time of filing (line 4 less line 6).

8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing of

quarterly estimates. Enter lump sum payment here

I have examined.this declaration and to the best of my knowledge it is correct.

Signature(s)

Date..

19

-—

MICHIGAN

It joint estimate, both husband and wife must sign

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS- 1976

For calendar year 1976 or fiscal year ending

-, 19-

STATE OF MICHIGAN

Department of Treasury

FORM

MI-1040-ES

1111

First name and initial (if joint declaration, use names and initials of both)!

Last name

Earl R. and Marge

Ruby

Please

prin!

or type

Address (number and street)

18135 Livernois

City, State, and ZIP code

Detroit, Michigan

48221

1. Your estimate of 1976 income tax

2. Estimated income tax withheld and to be withheld during entire year of 1976

3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)

4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated

If this declaration is

X April 15, 1976, enter 1/4 of line 3;

due to be filed on:

#June 15, 1976, enter 1/3 of line 3;

• September 15, 1976, enter 1/2 of line 31

@Jan. 15, 1977, enter amount on line 3

5. If you had an overpayment on your 1975 income tax return which you elected to have applied as a

credit against your 1976 estimated tax, enter the amount here...

6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To

spread credit evenly to each instaliment, divide it by number of installments and enter results here.

7. Amount to be paid with this declaration at time of filing (line 4 less line 6)

8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing

-

of quarterly estimates. Enter lump sum payment here

I have examined this declaration and to the best of my knowledge it is correct.

NW 88326tDocld:32245535. Page 219.

Date..

Your social security number

Spouse's social security number

5,600.00

51600.00

11400.00

1,400.00

... 19..

Reference

copy,

JFK

Collection:

ESCA

(RG

233)

---

## Page 220

THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONE

Revenue Division

INTANGIBLES TAX RETURN

Calendar Year 19

OR FISCAL YEAR

Beginning-

Ending-

Individual

.19.

19.

---DO NOT WRITE ABOVE THIS LINE -

233)

(RG

Partnership.

Michigan Corporation

Foreign Corporation

Fiduciary

Check

One

KURY EARL & MARGIE

18135 LIVERNOIS AVE

DETROIT MI

5

4A221

POSTED

FILED

IF THIS RETURN iS

fOi

ESTATE GIVE PROBA

MONTH

DAY

11

30

RETROACTIVE DATE

YEAR

75

698855

ACCOUNT NO.

007

TYPE

8?

COUNTY

75

12

FILE DATE

AMOUNT

County-

File No.

Date of Death.

Linel

No.

-

CITY

• K

Lin. Computation of Tax Due

1. Accounts and Notes Receivable (non-income producing only)-

2. Less Accounts and Notes Payable.

3. Balance Taxable @ 1/10th of 1%.

4. Accounts and Notes Receivable (income producing only).

5. Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2)

6. Balance Taxable

7. Income applicable to balance.

8. Tax @ 3½% of Income (Line 7) or 1/10 of 1% of Balance (Line 6), whichever is greater.

9. Stocks and Bonds .... - Schedule A, Column 9.

10. Mortgages and Land Contracts.... • Schedule B, Column 8.

11. Annuities ..

- Schedule C, Column 9.

12. Beneficiary Return (attach copy hereto)

13.

TOTAL

14.

Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return) _.

15.

BALANCE DUE.

16. Cash on Hand or in Transit as of retroactive date (include cash in safety deposit boxes)

17. Bank Deposits in Banks Located Outside of Michigan.

18. Savings in Building and Loan Ass'ns. Located Outside of Michigan_

or Withdrawn from Mich.

Banks or Ass'ns. after

RETROACTIVE DATE.

19. TOTAL

20. TAX @ 408 per $1000.00 of Line 19.

21.

22.

23.

24.

25.

Less Advance Payment of Tax

TOTAL TAX DUE -

Penalties & Interest;

Penalty

TOTAL AMOUNT DUE

_%, $_

Interest__%_ Months, $.

5.

=

TA:'

JF

copy,

Reference

255

9.

10.

11

12

13.

14.

15.

16

17

18.

19.

20.

21.

22.

23.

24.

25.

2552

35015

2:02

2602,87

260287

26028-

MAKE REMITTANCE PAYABLE TO STATE OF MICHIGAN

Please forward Remittance for Amount Shown Here on or belore April 30.

To: MICHIGAN DEPARTMENT OF TREASURY, LANSING, MICH. 48922

(or four months ailer and at authoriod lscal yous)

IMPORTANT-Be Sure to Answer the following Question When Applicable.

SALES

_Phone No...

863-0400

1. Business or Profession of Taxpayer.

2. Give yeur of last return filed. _

1974

_Address of Last Return_

SAME

3. Check here if return is computed on a Retroactive Date Method

_or Monthly Average Methodi

4. If taxpayer is a corporation give State and Date of Incorporation_

Federal Employers Identification Number_

5. If this is the return of a Trustee attach list of námes and addresses of beneficiaries and dale of creation of trust.

6. If this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.

I declare under the penaltine imposer by Art No. 301 P. A. of 1970, no Ameneterd, that thie rosuen, includina any accompanyinu

anel lo lle beat of my knowlerue dur lialied le a true, corsert and complete return.

30c1nl docurlly Number -

on aramined by ,

Return Prepared by.

GORDON L. HOLLANDER, P.C.

CERTIFIED PUBLIC ACCOUNTANT

19675 WEST TEN MILE ROAD

1W 8320e Sold:32243309994020, MIAN A

Signed

Signed

Title

---

## Page 221

SÜTEÜULE F- SCARENOLDERS SHARE Ü INCOME MÜ GAEÜIO

(li acidicionai space is needed, atiach schedule)

(1)

Name and Address of Each Shareholder

(2)

Social Security

Number

(3)

Number of

Shares

(4)

Amount taxable as ordinary

income (schedule K, total of

lines 4 and

8, U.S. 1120-S)

IRG

233)

11269

2:500

7,500

$ 6,840.01

46,040.05

(c)

(d)

(e)

(f)

(g)

(h) .

(i)

(;)

Reference

copy,

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share-

holder on MI-1040 (enter on

page 2,

schedule 1, line 34 or

on page 2, schedule 2, line 43)

difference

between column 4

and column 5

(See instructions)

(7)

Enter here and on form

MI-1040, page 1, line 22

each

shareholder's

pro-

portionate share of per-

sonal

property

taxes

paid

on

inventories or

the credit for franchise

fees paid.

(See instructions)

(8)

Enter

here

and

on

form

MI-1040,

each

shareholder's

proportionate share of Single

business tax paid.

(See instructions)

(a)

(b)

$6,$40.04

46,840.05

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(i)

NW 88326 Docld:32245535 Page 221

PAGE 3 07S

---

## Page 222

SCITEDULE F - SHAREHOLDERS SMARE OF INCOME ANO CREÜITS

(If additional space is needed, attach schedule)

(1)

Name and Address of Each Shareholder :

(2)

Social Security

Number

(3)

Number of

Shares

(4)

Amount taxable

as ordinary

income (schedule K, total of

lines 4 and 8, U.S. 1120S)

(a) ..

CART RUB!

"ISO STONEY RIVER BIRM. MI

ESTATE..

SE GENREE

MARÇUS

LIN. WACHNVCTON LITO CHICAGO -ELL. 60602

(c) ..

(d)

(e)

(f)

(g)

(h)

(i)

500

500

19,730.16

19.230.15

Reference

copy,

JFK Collection:

(RG

233)

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share.

holder on Mi-1040 (enter on

page 2, schedule 1, line 34 or

on page 2, schedule 2, line 43)

difference between column 4

and column 5

(See instructions)

(a)

•(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

19,730.16

19.730.18

(7)

Enter here and on form

MI-1040, page 1, line 22

each

shareholder's

pro-

portionate share of per-

sonal

property

taxes

paid on

inventories or

the credit for franchise

fees paid.

(See instructions)

46.61

46.61

(8).

Enter

here

and

on• form

MI-1040,

each

shareholder's

proportionate share of Single

business tax paid.

(See instructions)

NW 88326 Docld:32245535 Page 222

---

## Page 223

mien, Dept, or freasury.

Schedule of Partners or Shareholders-

Partnership, Subchapter S Cory., Professional Corp.

See instructions on reverse side

2 Account Number:

38-1812707

1976

3

Name:

Cobo-Rumar Sales, Inc.

SURIMARY

Total Number of Partners or Shareholders

Total Number of Qualified Partners or Shareholders from Part Il-enter here and on C-8000, line 60a

QUALIFIED PARTNERS OR SHAREHOLDERS

NAME AND ADDRESS

B SOCIAL

SECURITY NO

Earl Ruby

4380 Stoney River;Birm.

41851

C

Time

D SHAREHOLDER'S E

SALARY

Own.

PARTNER'S or SHAREHOLDER'S

F Share of Bus. Inc. | G Share of SBT Paid

100%

18,000

100 100%

|00

100

%

| 00

%

1 00

100

%

|00

%

100

%

00

%

1 00

00

%

100

%

100

: 1 00

%

|00

%

| 00

| 00

%

00

%

100

/ 00

%

1 00

%

| 00

| 00

%

| 00

%

100

100•

%

100

%

00

100

PAh: | NON-QUALIFIED PARTNERS OR SHAREHOLDERS. It more space is neoded submit separate schedule and enter totals on line 7.

100

%

| 00

1 00

| 00

%

|00

100

| 00

%

| 00*

| 00

100

%

00

00

00

%

00

/00

00

%

00

00

100

%

| 00

| 00

00

%

00

00

00

%

100

100

00

%

100

00

Nw 8826-0002 5245535 Page 2,1)

00

00

%

%

100

00

1 00

Reference

JFK. Collection:

ESCA (RG

---

## Page 224

in, dept. of treasury

C-0000N O

i. =

Schedule of Pariners or Shercholders-

Parinership, Subchapter S Cory., Professional Corp.

See instructions on reverse side

1976

1

Name:

2 Account Number:

Cobo Cleaners, Inc.

38-1806433

SUMMARY

3

Total Number of Partners or Shareholders.

4

Total Number of Qualified Partners or Shareholders from Part I|- enter here and on C-8000, line 60a

14::: 111!

QUALIFIED PARTNERS OR SHAREHOLDERS

NAME AND ADDRESS

B SOCIAL

6 %

SECURITY NO.

Time

D SHAREHOLDER'S E %

SALARY

Own.

PARTNER'S or SHAREHOLDER'S

F Share of Bus. Inc. | G Share of SBT Paid

4380

Earl Ruby

Stoney River; Birm.

100

144,600 / 00

10%

100

. 00

%

00

%

100

|00

|00

%

100

00

%

100

%

| 00

00

%

100

%

1 00

7 00%

%

| 00

100

%

|00

100

00

%

|00

%

|00

|00

%

100

%

100

100

%

| 00

%

100

100

/liti r NON-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is needed submit separate schedule and enter totals on line 7.

00

%

100

1.00

100

%

| 00

100

100

|00

00

00

100

100

100

%

00

• | 00

00

00

| 00

00

%

100

| 00

|00

%

00

| 00

| 00

%

100

| 00

| 00

%

100

100

7

00

00

%

%

00

100

00

| 00

i dr TOTaLS (Part Il and Part Ill)

: NW-88326-Docld:32245535 Page 224

233;

JFK

collection:

---

## Page 225

risen, dept, oi treasury

?.?.

Schedule of Partners or Shareholders-

Parinersing, Subchapter S Corp., Professional Corp.

See instructions on reverse side

1976

1

Name:

2 Account Number:

Cobo Cleaners,

Inc.

SUMMARY

3

Total Number of Partners or Shareholders.

4

Total Number of Qualified Partners or Shareholders from Part I/- enter here and on C-8000, line 60a

HURT 111

QUALIFIED PARTNERS OR SHAREHOLDERS

NAME AND ADDRESS

B SOCIAL

c %

SECURITY. NO.

Time

D SHAREHOLDER'S E %

SALARY

Own.

38-1806433

4

PARTNER'S or SHAREHOLDER'S

F Share of Bus. Inc. | G Share of SBT Paid

Earl Ruby

4380 Stoney River; Birm.

100

144,600 / 00

100

| 00

%

100

.100

1 00

|00

100

-%

100

00

%

•00

%

| 00

00

%

|00

%

1 00

'00%

|00

%

1 00

%

100

%

100

00

%

100

%

| 00

00

00

%

100

| 00

%

00

%

100

100

SiLhi l NON-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is needed submit separate schedule and enter totals on line 7.

100

100

100

| 00

100

00

| 00

%

| 00

100

| 00

%

100

|00

00

%

00

|00

100

%

00

|00

100

%

|00

100

| 00

%

|00

100

|00

%

100

100

|00

%

1 00

100

NW 88826-Bocid:5224835 Page 2I)

7

00

100

%

%

| 00

100

: 00

| 00

copyr

JFK

Collection:

---

## Page 226

me. Wept, of ireasury

NO

Seltedule

Partners or Shercholders-

Parinersinp,

Subchapter S Cory., Professional Corp.

See instructions on reverse side

1976

1 Name:

2 Account Number:

Cobo Cleaners, Inc.

38-1806433

* N51!

SUMMARY

3 Total Number of Partners or Shareholders.

4 Total Number of Qualified Partners or Shareholders from Part I/-enter here and on C-8000, line 60a

HATh: :01

QUALIFIED PARTNERS OR SHAREHOLDERS

NAME AND ADDRESS

B SOCIAL

SECURITY NO.

c %

Time

D SHAREHOLDER'S

SALARY

E

%

Own.

4

PARTNER'S or SHAREHOLDER'S

F Share of Bus. Inc. | G Share of SBT Paid

Earl Ruby

4380 Stoney River; Birm.

# 100.

144,600 / 00

100

100

/ 00

%

| 00

%

|00

| 00

| 00

%

|00

|00

%

00

%

100

| 00

%.

1.00

100

%

|00

%

| 00

100)

00

00

%

100

100

%

100

%

|00

00

%

100

%

1.00

00

%

| 00

%

100

00

NON-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is needed submit separate schedule and enter totals on line 7.

100

%

100

100

| 00

%

1 00

00

100

| 00

00

100

%

100

00

00

%

00

100

100

%

|00

00

100

%

/ 00

100

00

%

|00

00

|00

%

100

00

00

%

00

00

NW. 88326 DoEid:32545335 4pange 2261)

7

00

100

%

%

00

100

00

00

Reference

copyr

JFK Collection:

ESCA (RG

233)

---

## Page 227

sixte

Departmeni oi Treasury

.=

for 1973, or taxable year beginning

First name and nual di join reiard. use irst names and intals of both)

MARGE

Home address (number and sired; or rural route)

1973. ending

19

Lasi name

RUBY

Your social security number

Please Print or

Your occupation

54÷25

coma or sosi oftice, and Sidie

ZIP code

spouse's sociai security no.

19161/64N

482=:

1. Exemptions-Enter nere total number of exemptions claimed on your

Were you a Michigan resident prior to July 1, 1972? EYes -No

1973 Federal income tax return

2. Fling status - check one.

& Married Filing Jointly.

L Single

Resident (fuli year)

_ Married Filing Separately - Name of Spouse

•Part-year from

10

Give spouse's social security no. in space provided

•Nonresicient

* Attach State Copy of Form W-2 Here &

3. Adjusied gross income as defined in the Internal Revenue Code and which should be reported on Federal Form 1040,

Attaci copies of any Federal schedules that indicale a loss or deduction

Line 15 or 104UA, Line 12 from gross income. (See page 5 of the instructions)

4. Additions (irom page 2, line 36).

5. Add lines 3 and 4

6. Subtractions (irom page 2, line 44)

7. Balance line(5 less line 6)

S.

Residents multiply exemptions claimed on line i by $1200.00

Part-year and nonresident allowance irom line 48

9.

Income subjeci to tax (line 7 less line 8)

10.

Tax: multiply line 9 by .039 (3.9%)

CREDITS

5.

120. 608137

2.0107

133.71

105

7.

130,70032

10.

3, 500/00

127

j08oa

4. 307=F

li. Income tax paid io Michigan cities

12. Contributions ic Michigan colleges and universities (attach receipts).

13. Income tax paid to another staie (attach copy of return).

13.

AMOUNT PAID

CREDIT

(See pages 8, 9, and 10 of the instructions)

192|59

•11a.

12a.

13 a.

14. Total credits (add lines lla, 12a, and 13a,) enter total here

15. Subtract line 14 from line 10 (li line 14 is greater than line 10, enter NONE)

• 14.

• 15.

$92977

Homesiead properiy tox relief - lines 16 thru 20 - senior citizens, veterans and blind persons see form MI-1040CR.

16. Enter 1973 homestead property tax or line 51

16

17.

Household Income from line 58

17

18.

Enter 3.5% (.035) di Household Income shown on line 17

19.

18.

Difference between line 16 and line 18 (lf line 18 is greater

than line 16, enter NONE).

19.

20

Enter 60% of line 19 (Maximum $500.00)

20.

21. Credit from MI-1040CR (attach form MI-1040CR)

22.

Personal property tax paid on inventory

23

Inventory tax credit - 25% of line 22

23.

PAYMENTS

24.

Michigan tax withheld (attach State copy of W-2)

Michigan estimated tax payments

226610

695/00

26. 1972 overpayment credited to 1973

26

27. Add line 20 or 21 to lines 23, 24, 25, and 26

28. if line 27 is less than line 15, enter BALANCE OF TAX DUE HERE PAY IN FULL WITH RETURN

27

2

flai

Eyí-.

29. lí line 27 is greaier than line 15, enter OVERPAYMENT HERE.

30. Amount of line 29 you wish to apply to your estimated tax payments

31. Amount to be REFUNDED (subtract line 30 from line 29)

29.

30

3)

This return is due April 15, 1974 or on the 15th day of the fourth month after the close of your tax year.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belier it

is irue, correct and compiete.

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

Sign

Here

Your signature

Date

Signature of preparer other than taxpayer

Daie

Spouse's signature (if filing jointly, BOTH must sign even it only one had income)

GORDON L HOLLANDER, P.C

Make checks payable to "State of Michigan." Mail return and payment to - MichgERTIED PUBE@ ACCUNTARsing, Michigan 48904

17350 TEN MILE ROAD

NW 88326 Docld:32245535 Page 227

SOUTHFIELD, MICHIGAN 42075,

072

---

## Page 228

Generoud in 15i"

2. Exemplong (üumber of aliowable examptors times 5i.500.00;

3.

Submac: line 2 from line 1. (This is your estimaied taxable income)

4. Estimated iax fine 3 times .039 or 3.9%)

5. LESS: Total estimated tax credit for Micnigan City income taxes, personai property tax on inventories,

Michigan homesiead property taxes and contributions io Michigan colleges and universities.

6. Subtraci line 5 from line 4. Enter here and on line i below

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS- 1974

NICH

For calendar year 1974 or fiscal year ending —

, 19.

FORM

MI-1040-ES

STATE OF MICHIGAN

Department of Treasury

First name and initial (if joint declaration, use names and initials of both)

Lasi name

Your social security number

Please

| Address (number and sireet)

prin:

Spouse's social security number

City, State, and ZIP code

1. Your estimaie of 1974 income tax.

2. Estimated income tax withheld and to be withheld during entire year of 1974

3. ESTIMATED TAX (line 1 less.line 2). (li less than $100, no declaration is required).

4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.

§CApril 15, 1974, enter 1/4 of line 3;

[ September 16, 1974, enter 1/2 of line 3(

(L June 17, 1974, enter 1/3 of line 3;

• Jan. 15, 1975, enter amount on line 3

5. If you had an overpayment on your 1973 income tax return which you elected to have applied as a

credit against your 1974 estimated tax, enter the amount here

ô. To apply entire overpayment credit to this installment and any excess to the nexi,

enter here the amount on line 5. To spread

credit evenly to each installment, divide it by number of installments and enter results here..

7. Amount to be paid with this declaration at time of filing (line 4 less line 6).

3. Note: The paymeni of the estimated tax (line 3 less any 1973 overpayment credit) with this return eliminates the filing of

quarterly estimates. Enter lump sum payment here

i have examined this declaration and to the besi of my knowledge it is correct.

Signature(s).

Date...

19 ...

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS- 2 W 7 4

MICH

For calendar year 1974 or fiscal year ending —

-, 19_

FORM

MI-1O40-ES

STATE OF MICHIGAN

Department of Treasury

Piease

print

or type

First name and initial (if joint declaration, use names and initials of both).

EARL

AND

MARGE

Address (number and street)

15I35 LUERNOIS

City, State, and ZIP code.

RUBY

Last name

Your social security number

Spouse's social security number

MICHIGAN

48221

1. Your estimate of 1974 income tax

2. Estimated income tax withheld and to be withheid during entire year of 1974

3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)

4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.

If this declaration is

SCApril 15, 1974, enter 1/4 of line 3;

7 September 16, 1974, enter 1/2 of line 3)

cue to be filed on:

June 17, 1974, enter 1/3 of line 3;

Jan. 15, 1975, enter amount on line 3

5. If you had an overpayment on your 1973 income tax return which you elected to have applied as a

credit against your 1974 estimated tax, enter the amount here....

6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To

spread credit evenly to each instaliment, divide it by number of installments and enter results here...

7. Amount to be paid with this declaration at time of filing (line 4 less line 6)..

8. Note: The payment of the estimated tax (line 3 less any 1973 overpayment credit) with this return eliminates the filing

of quarterly estimates. Enter lump sum payment here.

I have examined this declaration and to the best of my knowledge it is correct.

Signature(s)...

Date..

NW 88326 Docld:32245535sPage 228 hus

must sign

2.000.00

2.000.00

500.00

500-00

, 19....

---

## Page 229

..:-

we other rexaiie year beginning

: 1973, unding..

19

last ilome

Your Social Security iumber

45704293

Your Occupation

i: point resur

in you are

citt

dentificarion rio. here:

Cry,

Tomi oi Posi

RUEY

EARL

&MARGE

15135

LIVERNOIS

CETROIT,

MI

43221

Spouse's Social Security Number

Spouse's Occupation

ip?

.

• Од.

is. If married, is spouse filing a separate return? O YES

¡E NO. li yes, enter spouse's first name...

Eter the nomo end. address used on your return for 1972

(li the same as above write

"Same"', li diferent, indicate date

moved.) If none filed, give raason.

Regular

65 or over

Audio:

Blind

or Vid Here

Atlod: Copy of Forma UV/e

SCHEDULE A - EXEMPTIONS

1. YOURSELF

SPOUSE

2.

Enter first names of each of your DEPENDENT CHiLDREN who lived with you:

?:..

+...

inter

number of

exemptions

crecked

Enlei No.

3.

NAME

Enter figure 1 in the last column to

right for each name listed

Reiationship

Monins lived in

your home curing

7973

OTHER

DEPENDENTS

Toial exemptions from lines 1, 2 and 3; enter here and on line 15 balow.

INCOME (If joint return, include all income of both husband and wife)

Enier GROSS income from employers for wages, salaries, commissions, tips, etc. — indicare (W) for wife

Total wages reported

Detroit Income Tax

Employer's Name

Where employed (City and Siate)

Withheld

2.22

€182Va

..?...

221

on DW-2 or W-2

$..

INa

50

259

A0128

=.0191

1a0

130

TOTALS

=

7.

Rentai ircome (or loss) from tangible property in the City of Detroit - from page 2, Schedule 8, line 4

3.

Other income (or loss) irom partnerships, etc. - from page 2, Schedule F, line 4.

9.

Gain for loss) from sale or exchange of tangible property in the City of Detroit - from page 3, Schedule E, line 10

i0.

Net profi for loss) from business - from page 3, Schedule C, line 8

11.

Income (or ioss) - TRUSTS AND ESTATES ONLY - from page 4, Schedule G, line 7 (see instructions for exemption to enter on line 15)

12.

Total jadd lines 6 through 11 of last column)..

13.

less:

Deductions irom page 2, Schedule M, line 5 (if none, enter zero).

14.

Total (line 12 less line 13)

15.

Less Amount for Exemptions: Enter number of exemptions from line 4 above

3

and multiply by $600

1ó.

TOTAL INCOME SUBJECT TO TAX

17.

CiTY OF DETROIT TAX: Multiply line 16 by .005 (½%)

15.

PAYMENTS AND CREDITS

a. Tax withheld by employer - from line 6 above - ATTACH Forms DW-2 or W-2

b. Payments and credits on 1973 Declaration of Estimated Detroit Income Tax

c. Other Credits - explain in attached statement (See Instructions)

19.

TOTAL - Add Lines i8a, b, and e

WAGES, ETC. EARNED

S.

..:!

TAX DUE OR REFUND

20. your payments (line 19) are. larger than your tax (line 17), enter amount of

OVERPAYMENT

13

SiON

51.2

22. Ii your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this raturn..e e?

Maise circá payable to: "TREASURER, CITY OF DETROIT." A balance due of less than one collar ($1.00) need not bu paid.

i ceclare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belier it is irue, correct and

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

SIGN HERE.

SIGN MERE

(Taxpayer's signature and date)

(Signature of preparer other than taxpayer)

(Date)

GORDON L HOLLANDER, P.C..

(spouse's signature and date) (If joint relurn, BOTH HUSBAND AND WIFE MUST SIGN)

CERTIFIED PUBLIC ACCOUNTANT

MAIL TO: City Treasurer, 104 City-County Building,

RETURNS MUST BE FILED BY APRIL BOSOUYAFIELD, MICHIGAN 1607E

NW 88326 Docld:32245535 Page 229

---

## Page 230

-

idlonde Divisior.

THIS NUMBER WEEN SUDNNTTING PAYMENT, OR IN CORN

Cuisador Your 19.75

On 2.30ÃL YEAR

.19

iS

i---DO NOT WRITE ABOVE THIS LINE. -

EnGlag

individuai.

Farmership.

Michigan Corporation

Foreign Corporation

Fiduciary

Check

One

RUBY EARL &

MARGIE

18135 LIVERNOIS

AVE

DETROIT MI

3

3

5

5

48221

POSTED

FILED

IF THIS

RETURN iS

FOR

AN

ESTATE

GIVE PROBATE

MONTH

DAY

30

RETROACTIVE DATE

YEAR

73

598855

ACCOUNT NO.

00?

TYPE

8-2

COUNTY

CITY

Line

No.

Coraputation of Tax Due

73

12

FILE

DATE

AMOUNT

County.

File No.

Date of Deaih..

Line!

No.

TAX

1. Accounis and Notes Receivable (non-income producing only)-

2. Less Accounts and Notes Payable...

3. Balance Taxable @ i/10in of 1%-

i, Micounis and Notes Receivable (income producing only).

5. Less Accounts and Notes Payabie juse only that portion, if any, not used in Line 2)_

ó. Salance Taxable

7. income appiicable to balance.

ô. Tax @ 3½2% of Income (Line 7) or 1/10 of 1% of Balance (Line 6), whichever is greater.

%. Stocks and bonds...

... Schedule A, Column

10. Morigages and Land Contracis.... • Schedule B, Column 8.

11. Annuities .... - Schedule C, Column 9.

18. Geneticine Return fattach copy herero)

is.

is.

Luss Slatulory doduction ($175.00 or $350.00 by husbande and wivus filing joins ruturn)

15.

BALANCE DUE

16. Cash on Hund or in Transit as of retroactive date (include cash in safery deposit boxes) -

17. Bank Deposits in Sanks Located Outside of Michigan.

16. Savings in Building and Loan Ass'ns. Located Outside of Michigan

or Wighdrawn from Mich.

Banks or Ass'ns. after

RETROACTIVE DATE.

19. TOTAL

20.

TAX I@ 409 per $1000.00 of Line 19.

21.

•TOTAL TAX DUE (Line 15 plus Line 20) _

22.

Less Advance Payment of Tax

23.

TOTAL TAX DUE _

24.

Penalties &, interest; Penalty -

_%, $_

i Interest %_

Months, $_

25.

TOTAL AMOUNT DUE

2.

192016

10.

11.

19.Д

20.1

21.

22.

23.

24.

25.1

MARE REMITTANCE PAYABLE TO STATE OF MICHIGAN

Pleasa forward Remittance for Amount Shown Flere on or before April 30.

To: VICHICAN DEPARTMENT OF TREASURY, LENSING, MICH. 42922

(or four months aiter end of authorizca fiscal yeaz)

IMPORTANT-Be Sure to Answer the following Question When Applicable.

i. Business or Profession of Taxpayer.

SALES

_Phone No.

912-9799

2. Give your of last roturn filed. 14172

- Address of Last Return_

SAME

3. Check here if reiurn is computed on a Retroactive Date Method

_or Monthly Average Method.

4. if taxpayer is a corporation give State and Date of Incorporation_

Federal Employers Identification Number_

5. li this is the return of a Trustee attach list of names and addresses of beneficiaries and date of creation of trust.

6. If ihis is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.

I declare under the penalties imposed by Acr No. 301 P. A. of 1939, as Amended, that this return, including any accompan

and to the best of my knowledge and belief is a true, correct and complete return.

Social Security Number

GORDON L HOLLANDER, P.C.

Signed

Reiurn Prepared by_

CERTIFIED PUBLIC ACCOUNTANT

Signed

17350 TEN MILE ROAD

Address.

SOUTHFIELD, MIGHIGAN 48075

NW 88326 Docld:32245535: Rage 230N REVERSE SIDE

Title -

Administrator,

Sial Me ed individual Dunes Morni

been examined by .

---

## Page 231

.....

Thi CONPOIAIION

-i-i

= oi üni5-018-d, nov. 2.73;

À. IOTAL DETROIT INCOME EXPECTED IN 1974

3. EXEMPTIONS 1$600.00 FOR EACH EXEMPTION)

C.

ECTUAMTED DETROIT TAXABLE INCOME (LINE A LESS LINE 8)

ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIQUALS ENTER ½ OF 1% OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE ID OF DECLARATION BELOW

2-7040-85

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1974 or Fiscal Year Ending

NAME(S)

(PRINT OR TYPE)

ADDRESS

CiTY

STATE

POSTAL ZIP CODE

19

1974

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

• INDIVISUAL

SPOUSE'S SOCIAL SECURITY NUMBERI

¡ CORPORATION

PARTNERSH!?

O OTHER

1222

TEAS

COPY

FOR

1a. Your 1973 Detroit Income Tax S.

... ..,

1b. Your Estimate of 1974 Detroit Income Tax

2. Amount of Detroir Income Tax to be withheld or other credit expected in 1974.

3. ESTIMATED TAX (line lb less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicaied:

Apr. 30, 1974-1/4; [J June 30, 1974-1/3; Sept. 30, 1974-1/2; Jan. 31, 1275-100%

5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit

S. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

S..

YOUR

RECORDS

iF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAiL WITH DECLARATION TO:

This declaration of estimated tax is not a Tax Roturn.

CARICE OF THE CITY TREASURER - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

9-1040-95

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1974 or Fiscal Year Ending

NAME(S)

Coco.

ADDRESS

HING.

10UE5 LIVERNOIS

CITY -

Da то.?".

STATE

POSTAL ZIP

1.??

CODE

ia. Your 1973 Detroit Income Tax s. 1, SEO-S 3

LOCATOR NUMBER

DOCUMENT

1b. Your Estimate of 1974 Detroit Income Tax

Amount of Detroit Income Tax to be withheld or other credit expecied in 1974

ESTIMATED TAX (line Ib less line 2)

Computation of installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

# Apr. 30, 1974-1/4; [. June 30, 1974-1/3; Sapt. 30, 1974-1/2;

Less: Amount of overpayment on 1973 return which you elected to claim as a credit

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)..

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER -

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

19

397.

ti d

YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION

O INDIVIDUA!

SPOUSE'S SOCIAL SECURITY NUMBER L CORPORATION

I PARTNERSHIP

OTHER

S....

1, 60

$

400130

This declaration of estimated tax is not a Tex Return.

signoluro oi juxpajor. Spouse dino if joine declarasion.

DATE

NW 88326 Docld:32245535 Page 231

---

## Page 232

Tora

7 Cored:

¿stion 12)

3. Tille

boring:

mandrit-s

care fonger dere and on tire 12, page 1).

129íees instruction

Maguns adder is recorre

3. Saics on account

4. Cument year's

Monision

3. Marsveria:

÷.

amous dark

…лій v. :

13:9

ASTO

127.

4072

Eithod

ENPRECIATION (Sca instruction 24)

Note: If depreciation is

wer 4970, or ihe Guidelina Class Life Systara

usiar the Ciaor Lie KAOR)

for

assets placed in

cardice Setore 1671

7500d59 C

USS

Lift Systory with

you must

tie form

cunt, sucion i.1671a)-i2,

your return. Excopt as cherwice expressly provided in regulations section

ine provisions or Feverdo Procedures 62-21 and 66-13 are not applerbio for coresto years crui

Danet comedy li pou made on section this taxabla year to use _

Class Life (AD?) Systars and/or Ma Guideline Gaso Lite Statom. Sis tal

S22-60123 6225

propery

Dato

1. Coprociation

Cost or

other

basis

ailowed

3. irathod e:

or steadto complete a satori

5. the

in pao; Years

Totai additionei fist year depreciation (do not include in items below)

Depraciation from Form 4322.

Supreciation tor. Form 5006.

i Gior angreciation:

wit and fixtures

misperiadion codipment

actinary and cines ecstaniant

, Stais

• boss amount oi depreciation claimed in Schedule a .

Z1e00ce-emder here and on line 21, Duge

SUMMARY OF BAPRECIACION (oner than acuitional Arseyear deprecia

Straight line

Declining esianco

Hold 1. 41%

yearo-cia.is

Uris di

= Supreciotion from Form: 4832.

2 sopreciation from Foom 5005 .

ditt

.-.-

TAX CONGUTATION (See instructions)

1 Texacts income (line 28, page 1).

2 10) Enter 40% di line 1 (members of controlled groups, see instructions)

(ü) Subiraci $5,500 and enter difference

3 Not long tem capital gain reduced by not short-torm capital loss (irom line 3(ü), page 1)

•, Subtract, $25,000. (Siatutory minimum.) . . .

Sularice (ine 3 less line 4) (see instructions) .

Ender 30% of line 5 (see instructions)

7 Income tar (line 2 or line 6, whichever is lesser). Enter here and on line 29, page 1

Other (saccify)

6,500.00

8ô.

NW 88326 Docld:32245535 Page 232

---

## Page 233

find and cotter et

2. Soci

educa adtd diesseudono dexablo as crdinar insumo (Do not Include ameunto chowa ca lino 0) e

Morel sividard distabudoão daxbta ao tonetorm capital Gaine (after tar) "

eind divicaná elutabutiono exable ds Ordinary income and qualitging fe: dividend excluston

tondividend connottions

Janem rated tarabis moome-taxabie as ordinary income or flost,

tributed torable inceme-texablo as long-tor capital gain faiter taxy*

ind ca le wach amount dá die ero cana chora dif

in capital Solco158 6 6202.22.SW82 002 (82 22103. 52322233 8

• 1222312721803:

(2) Doitrond rolling saock

13) On the-job training foode

' doctavasterond incore or floss).

4i) Chid core iccilieise

dej Reservas tor lossos on bad desto oi

ances auer tondal income

bucasie to ne: loose property

Sinancial institutions

coss oi actiong dom digital gains

(c; Excess parcentage copiction

nu:

sion-tern capitel losses

minerabla to invecinent property .

(%) tot long tom copitel goin (riter tax) .

3.2

11068,372:

Sopreciation oi:

(-; Lowincome rental cousing .

Dadio ci

(a) 3or more but less than & teure.

(2) Ciner roal proparty .

investorant

3) ö more cut lees thar thar gears .

(3) Posconul proporty subjeci to a

properiy

noticase.

Gosẻ ci

40) 3 or mona but leso then & youro .

imortaatior os

invest.

(a) 5 or more but dons that 7 years.

Entiad pollution control iccilittes

proper

COMPLETE A SEPARATE SCHEDULE KN1 GOR SACH SHARRHOLSZa TIe CODy d Vind dGan

sr, ond doss Copy eter geur cocorãs.

i Date incorporate

1.16a

O sie iso decportion di the end of the taxable year own, directly ce in-

dructig, 80% or more of the voting stück of a comasue corpora-

in 5t0o Sto. (Foi mules di attribution, see section 25710).)

wie dasucris "les," atlach a scheduie showing:

si mune, address, and employer identification number; and

(S) jersantone owned.

• Eid duo corpora don during the tuxable year have any contradis er sub-

contrado subjec: to the Menegutiation Act of 1951? O Yes ENo

li "'Ves," entei die aggregate gross dollar amount billed during the

16..07

¿ Amount oi taxabie incomo or (loss) iur: 1970

414

i Wore you a member di a controlled nono surier to

the provisions of sectiono 158% or 13022 .

....÷=.

L Dul you clein a deduction dor exponses carmeetid titt dig:

(2) Entortalamont facility (Cout, rasori, conch, elc.)?e Clu te

(2) Livias eccommodations isxopt cmdlogoes ou aut-

iners)?.

(5) Empioycas' familles at conventions e: mestru? 0:0

j:) Empioreo o: family vacations not reporied en

Oid you ile ai reruled forms 1609, 1000 and iber? You

N Die ine corporation, ai any ume during ine tarise

jan, hove any interest in or signature or other autorty

over a bank, securities, or other Anancial account ta

1971

¿ Aufer to page 7 di insisuerions and stato the principal;

'.?:

Fusiose activity

Product of corvice

to de dontod as a small batres comaton cal est

was in existence for the taxable year prior io ine elecion dac

Was en agreement filed under section 1.47-1(b) cita

Regulations?

NW 88326 Docld:32245535 Page 233

.....

---

## Page 234

1.....-.

..

So.

... =.

..-

TOTA: DETRON INCOME EXPECTED IN 1974

C. EXBAPTIONS (6600.00 FOR EACH EXEMPTION)

c.

ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 3)

ESTUNATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C

ALL OFFER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Ib OF DECLARATION BELOW

N-:020-29

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1074 or Sisoul Year Ending

(PRINT OR TYPE)

ADDRESS

CITY

STATE

POSTAL ZIP CODE

YOUR SOCIAL

SECURITY NUMBER

CHECK TYPE OF DECLARATION

J INDIViDUAL

SPOUSE'S SOCIAL SECURITY NUMBERI

CORPORATION

PARTNERSHIP

OTHER

KEEP

TrAS

CO?!

FOR

la. Your 1973 Detroit income Tax S.

2.

Amount ai Detroit income Tax to be withheld or other credit expected in 1974.

1b. Your Estimate of 1974 Detroit Income Tax

3. ESTIMATED TAX (line lo less line 2)

4. Compuiation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicatod:

I Api: 30, 1874-1/4: 1] June 30, 1974-1/3; I Sept. 30, 1974-1/2; Jan. 31, 1975-100%

5. Less: amoun: of overpayment on 1973 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

$

$.

YOU?

RECOROS

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

MAKE REMITANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATICN TO:

This declaration of estimated tax is not a Tax futurn

OFFICE OF THE CITY TREASURER - INCOME TAX DIVISION

704 CITY-COUNTY BUIlDING

DETROIT, MICHIGAN 49225

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

3-7040-55

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1974 or Fiscal Year Ending

(PRINT OR TYPE)

JAMESO BRN ORTY) : SALES, IKE.

YOUR SOCIAL

SECURITY NUMBER

ADDRESSA/S LIVERNSIS

STATE

- MICHIGAN

POSTAL ZIR-CODE

19

1974

CHECK TYPE OF DECIARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER

I CORPORATION

• PARTNERSHIP

OTHER

LOCATOR NUMBER

DOCUMENT

1a. Your 1973 Detroit Income Tax S....

21904

'Ib. Your Estimate of 1974 Detroit Income Tax

3.

Amount of Detroit Income Tax to be withheld or other credit expected in 1974

S....

229

ESTIMATED TAX (line 1b less line 2)

4.

Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

I Apr. 30, 1974-1/4; [J June 30, 1974-1/3; I Sept. 30, 1974-1/2; . Jan. 31, 1975-100%

5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

This declaration of estimated tax is rot a Tax Poiura.

Signalura of Taxpayor. Spouse also if joint declaration.

DATE

NW 88326 Docld:32245535 Page 234

---

## Page 235

itwtüinne

-.

jd cacidione, apede te dosdbse mnneh deidduigt

41)

Name and Addiass of Eaca Snaranürder

2:

Sociai Socurity

numee?

Ntirkor ui

Snores

ia)

......

tiirle...

1296928

hny "

MrAng FinEi

(d)

(e)

(7)

(g)

(h)

(i)

income

(schedule k.

1108.

of lines 4 and

8.

U.S.

1120-S)

lines, or page 2, schedule ü.

line ô

(6)

Amount to bu usod üy shorcholdor on

IInd

line

uit

sehoiries

431

diffurence

betwean column

4 and column 5 (sae instructions)

(a) $

10)

36 707. 35

36: 009.24

(c)

(d)

(e)

(1)

(9)

(h)

(1)

(i)

NW 88326 Docld:32245535 Page 235

$

2G, 797.21

3S: 307.22

$

---

## Page 236

we..u..

oiamonn..ai

=.

= oi Dri5-017-j pror. d-73)

TOTAL GETRON INCOME EXPECTED IN 1974

EXBAAPTIONNS 1$600.00 FOR EACH EXEMPTIONN)

C.

ESTRAMTED DETROIT TANABLE INCOME (LINE A LESS LINE 8)

ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIOUALS ENTER ½

OF i% OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Ib OF DECLARATION BELOW

C-. 040-E5

CITY OF DETROIT DECIARATION OF ESTIMATED INCOME TAX

Fo: Calenda: Year 1974 or Fiscal Year Ending

NAME(S)

(PRINT OR TYPE)

ADDRESS

CiTY

STATE

POSTAL ZIP CODE

19

1973

YOUR SOCIAL

SECURITY NUMBER

CHECK TYPE OF DECLAZATION

O INDIV:SUAL

SPOUSE'S SOCIAL SECURITY NUMBER O

! CONPORATION

PARTNERSH!?

O OTHER

K22?

This

COPY

FOR

ia. Your 1973 Detroit Iacome Tex'$..

2.

1b. Your Estimate of 1974 Detroit Income Tax

Amount of Detroir Income Tax to be withheld or other credit expected in 1974

3. ESTIMATED TAX (line lb less line 2)

4. Computation of Installment: Check Due Daie of declaration below and enter portion of line 3 as indicaied:

D. Apr. 30, 1974-1/4; [3 June 30, 1974-1/3; Sept. 30,1874-1/2;

Jan. 31, 1975-100%

5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit

S. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

$.

$.

$

YOUR

RECORDS

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

MAKE REMITTANCE PAYABLE TO

"TREASURER, CITY OF DETROIT"

AND MAiL WITH DECLARATION TO:

This declaration of estimated tax is not a Tax Roturn.

OFFICE OF THE CITY TREASURER - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 43226

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-1040-85

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1974 or Fiscal Year Ending

NAME(S)

(PRINT OR TYPE)

COCO CLEANGES

INC

YOUR

SOCIA

NUMBER

ADDRESS

CITY -

STATE

POSTAL ZIP CODE

19

CHECK TYPE OF DECLARATION

• INDIVIDUA!

SPOUSE'S SOCIAL SECURITY NUMBERI

L CORPORATION

• PARTNERSHIP

• OTHER

LOCATOR NUMBER

DOCUMENT

ia. Your 1973 Detroit Income Tax 5. 1, 580-53

1b. Your Estimate of 1974 Detroit Income Tax

2.

Amount of Detroit Income Tax to be withheld or other credit expected in 1974

3.

ESTIMATED TAX. (line 1b less line 2)

4.

Computation of installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

y: Apr. 30, 1974-1/4; [7 June 30, 1974-1/3;

Sept. 30, 1974-1/2; LJ

5. Less: Amount of overpayment on 1973 return which you elecied to claim as a credit

6.

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

S...

1, 60=100

10050

tools

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

1. CERTIFY THAT THIS IS A CORRECT DECLARATION.

signuuro of tuxauyur, spouso uido it joint declararion.

This declaration of estimated tax is not a Tax Return.

ChiE

NW 88326 Docld:32245535 Page 236

---

## Page 237

_....--

iü.

Tom. DarROT ANCOME EXPECTED iN 1974

ARMPIONS 1$600.00 FOR EACH EXEMPTION)

C. EDINGÜLO DETROIT TAXMBLE INCOME iLINE A LESS LINE 9)

ESTIMATEO DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 16 OF DECLARATION 3ELOW

--.w-Ü-L5

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendor Year 1974 or Focai Year Ending

19

-...

(PRINT OR TYPE;

YOUR SOCIAL SECURITY NUMBER

A5ORESS

CHECK TYPE OF DECLASATION

J INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER E CORPORATION

CITY

STATE

POSTAL ZIP CODE

1O OTHER

CHIP

ThiS

CC?!

FoR

ia. Your 1973 Detroi: Income Tax S...

ib. Your Estimate of 1974 Detroit Ircome Tax

2. Amouni oi Detroit income Tax to be withheld or other credit expecied in 1974.

S. ESTiMMED TAX (ine lo less line 2) ..

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

= Api. 30, 187÷-1/61 17 June 30, 1974-1/3:

Sept. 30, 1974-i/2; Jan. 31, 1975-100%

5. Less: Amoun: of overpayment on 1973 return which you elected

to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

$

$

RECORDS

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

MAKE REMITANCE PAYAGLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATICN TO:

This declaration of estimated tax is not a Tax futuri.

OFFICE OF THE CITY TREASURER - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48225

DATa

Y DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

N-70-0-25

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Cuiendar Year 1974 or Fiscal Year Ending

MANESI

10

TPRINT OR TYPE!: SALES

-M0/.

File

YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION

ADDRESSIT LIVERENAIS

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER

!..

CORPORATICN

CiT:

STATE

POSTAL: IP. CODE

PARTNERSHIP

OTHER

1a. Your 1973 Detroit Income Tax S......

219.0, Ib. Your Estimate of 177: Detroit Income Tax

2.

s 2250

amount oi Detroit Income Tax to be withheld or other credit expected in 1974

3.

ESTiMATED TAX (line Ib less line 2)

LOCATON

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

7 Aar. 30, 1974-1/4; (7 June 30, 1974-1/3; Sept. 30, 1974-1/2: . Jan. 31, 1975-100%

5.

Less: Amount of overpayment on 1973 return which you elected to claim as a credit

$

$

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

DOCUMENT

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

This declaration of estimated tax is not a Tax folura.

Signaturo of Taxpayor. Spouse also if joint declaration.

DATE

NW 88326 Docld:32245535 Page 237

---

## Page 238

screwurs

(li aciditional space is needed, attaci schedure)

(1)

Name and Address of Each Shareholder

i2)

Social Security

Number

(3)

Numüor oi

Shares

(a)

4222

RUBY

MICH

Marcus

19W. WASHINGTON →150 CHICAGO, TEL. 60252

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(i)

2,500

(4)

Amount taxable

as

income

(schedule

of

lines

4

and

1120S)

ordinary

K.

8,

total

U.S.

(5)

Distributive income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share-

holder on Mil-1040 (enter on

page 2, schedule 1, line 37 or

on page 2, schedule 2, line 46)

difference

between

column 4

and column 5 (see instructions)

(7)

Enter here and on forin

Ml-1040, page

i, line 25

each

sharehoider's

portionate

share

pro.

of per-

sonal

paid

pioperty

taxes

On

inventories

or

the credit for franchise

fees

pald.

(see instructions)

i? "

(a) $

(b)

9,169.69

9. 1109. 052

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(i)

NW 88326 Docld:32245535 Page 238

9,169.69

9,169.69

---

## Page 239

TAX COMPUTATION SCHEDULE

C of D- iS-DIT.J (Rew. 8.74)

A.

TOTAL DETROIT INCOME EXPECTED IN 1975

EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B)

D.

ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW

D- 1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

NAME(5)

(PRINT OR TYPE)

YOUR SOCIAL SECURITY NUMBER

ADDRESS

SPOUSE'S SOCIAL SECURITY NUMBER

CITY

STATE

POSTAL ZIP CODE

KEEP

THIS

COPY

FOR

la. Your 1974 Detroit Income Tax $.

1b. Your Estimate of 1975 Detroit Income Tax

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975

3.

ESTIMATED TAX (line lb less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

I Apr. 30, 1975-1/4; [] June 30, 1975-1/3: . Sept. 30, 1975-1/2;

Jan. 31, 1976-100%

5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

YOUR

RECORDS

$

$

$

1975

CHECK TYPE OF DECLARATION

O INDIVIDUAL

CORPORATION

PARTNERSHIP

OTHER

$

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATION TO:

This declaration of estimated tax is not a Tax Return.

FINANCE DEPARIMENT - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

19

NAME(S)

(PRINT OR TYPE)

YOUR SOCIAL

NUMBER

ADDRESS

COSO - RUMAR SALES, INS.

18135 LIVENUIS

CITY

STATE

POSTAL ZIP CODE

ETPOiT

MICHIGAN

4820

1975

CHECK TYPE OF DECLARATION

E INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER

EL CORPORATION

• PARTNERSHIP

• OTHER

DOCUMENT LOCATOR NUMBER

1a. Your 1974 Detroit Income Tax s. 367.39;

Ib. Your Estimate of 1975 Detroit Income Tax

$...

4001

Amount of Detroit Income Tax to be withheld or other credit expected in 1975

3.

ESTIMATED TAX (line 1b less line 2)

400100

Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

Xi Apr. 30, 1975-1/1; [] June 30, 1975-1/3: 0

Sept. 30, 1975-1/2: 7 Jan. 31, 1978-100%

100

10U

Less: Amount of overpayment on 1974 return which you elected to claim as a credit

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

sipproarare of Texprayer.

Spouse also it joint decluration.

This declaration of estimated tax is not a Tax Return.

DAIE

NW 88326 Docld:32245535 Page 239

---

## Page 240

SCHEDULE F - SHAREHOLDERS SHARE OF INCOME MNS GNEDITS

(If additional space is needed, attaci schecule)

Name and Address of Each Shareholder

(2)

Socidi Socurity

Number

13)

Numbar of

Shares

(a)

FANG

RUBY

4380

STONEY RIVER DR BiRM. MI 43010

(b). ESTATE OF GEORGE

- MARCUS

69W. WASTINGTON #ISO

CHICAGO

ILL LoGot

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(1)

7,560

7000

(4)

Amount taxable

as

income

(schedule

of

lines

4

and

1120-S)

ordinary

K,

total

8,

U.S.

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share-

holder on Mi-1040 (enter on

page 2, schedule 1, line 37 or

on page 2, schedule 2, line 46)

difference between column 4

and column 5 (see instructions)

(7)

Enter here and on forn

MI-1040, page 1, line 25

each shareholder's

pro-

portionate share of por-

sonal

property

taxes

paid

on

inventories or

the credit for franchise

fees paid.

(see instructions)

(a) $

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i).

(j)

34, 331.38

34, 331.37

36,331.30

36

,331.37

91.94

NW 88326 Docld:32245535 Page 240

DEAT

---

## Page 241

-'..

-. *.

TAX COMPUTATION SCHEDULE

c.or0-15-D1T..Rev. 8-74:

TOTAi DETROIT iNCOME EXPECTED iN 1975

8 EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

E. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B)

s.

STIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C

•LL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 16 OF DECLARATION BELOW

D-1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year. 1975 or Fiscal Year Ending

, 19

1975

NAME(S;

(PRINT OR TYPE)

ADDRESS

CITY

STATE

POSTAL ZIP CODE

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

O INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER I CORPORATION

• PARTNERSHIP

• OTHER

KEEP

This

COPY

¡a. Your 1974 Deiroit Income Tax S...

1b. Your Estimate of 1975 Detroit Income Tax

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975

3. ESTIMATED TAX (line Ib less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

= Apr. 30, 1975-1/4; [j June 30, 1975-1/3: Sept. 30, 1975-1/2;

Jan, 31, 1976-100%

5. Lass: Amount of overpayment on 1974 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

$....

$...

$

FOR

YOUR

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

RECORDS

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATION TO:

This declaration of estimated tax is not a Tax Return.

FINANCE DEPARTMENT - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

C-,040-E5

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending.

(PRINT OR TYPE)

-.--

ELEANESH, INC-

ADDRESS $135 LIVERNOIS

CiTY ..

STATE

POSTAL ZIP CODE

MICHIGAN

1a. Your 1974 Detroit Income Tax s...1, 46).26;

LOCATOR NUMBER

1b. Your Estimate of 1975 Detroit Income Tax

Amount of Detroit Income Tax to be withheld or other credit expected in 1975

ESTIMATED TAX (line 1b less line 2)

Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

7. Apr. 30, 1975-1/4; C. June 30, 1975-1/3;

Sept. 30, 1875-1/2; / Jan. 31, 1976-100%

Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6.

AMOUNT TO BE PAID WITH THIS DECLARATION. (line 4 less line 5).

DOCUMENT

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

CERTIFY THAT THIS IS A CORRECT DECLARATION.

..., 19

1975

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

Tria ?

= INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBERI

E CORPORATION

• PARTNERSHIP

OTHER

S..

1,00203

i!:"

$...

$

26926

This declaration of estimated lax is not a Tax Return.

jignuiura of Taxpayor.

spouse also it joint declararion.

ON'E

NW 88326 Docld:32245535 Page 241

---

## Page 242

ilf aciditional space is needed, acracia scheduiel

Name and Address of Each Shareholder

i2)

Social Security

Number

(3)

Numboi of

Shares

AUS!

ЗIRM.

1b) ..52a6

Marsia

69W. WASHINGTO! →/150 CHICAGO, = LL. 60252

(c)

(d)

(e)

(f)

(9)

(h)

(i)

(j)

ZE022

7,500

(4)

Amount taxable

as

income

(schedule

of

lines

4

and

1120S)

ordinary

K.

total

8,

U.S.

(5)

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

difference

between column 4

and column 5 (see instructions)

(a) $

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(0)

7, 1609.69

9, 149.69

9,169.69

9,169.69

Enter here and on form

Nl-1040, page 1, line 25

each sharenoider's pro-

soral ate pere of pers

taxes

raid on

the credit for franchise

es par

ee instruction

!."!

1.?:

NW 88326 Docld:32245535 Page 242

na 19.t7 199

---

## Page 243

TAX COMPUTATION SCHEDULE

1975

C of D- 15-01T-J (REN. 8.74)

A. TOTAL DETROIT INCOME EXPECTED IN 1975

$

B.

EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

$

C.

ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 8)

$

D.

ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE I6 OF DECLARATION BELOW

$

D- 1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

19

1975

NAME(S)

(PRINT OR TYPE)

ADDRESS

CITY

STATE

POSTAL ZIP CODE

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER

• CORPORATION

• PARTNERSHIP

OTHER

KEEP

. THIS

COPY

la: Your 1974 Detroit Income Tax S...

....;

1b. Your Estimate of 1975 Detroit Income Tax.

Amount of Detroit Income Tax to be withheld or other credit expected in 1975..

3. ESTIMATED TAX (line 1b less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

[ Apr. 30, 1975-1/4; [ June 30, 1975-1/3; I Sept. 30, 1975-1/2; 0

Jan. 31, 1976-100%

5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5) .

FOR

YOUR

RECORDS

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATION TO:

FINANCE DEPARTMENT - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

This declaration of estimated tax is not a Tax Return.

DATE

Y DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

NAMES CORIN RUMAR SALES, INC.

ADDRESS

18I35 LIVERMOIS

CITY

STATE

POSTAL ZIP CODE

ETPOI

MICHIGAN

48201

19

1975

YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER I CORPORATION

• PARTNERSHIP

OTHER

1a. Your 1974 Detroit Income Tax 5. 367.39;

NUMBER

DOCUMENT LOCATOR

1b. Your Estimate of 1975 Detroit Income Tax.

400,00

2.

Amount of Detroit Income Tax to be withheld or other credit expected in 1975.

3.

ESTIMATED TAX (line lb less line 2)

100100

4.

Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

Xi Apr. 30, 1975-1/4;

[7 June 30, 1975-1/3;0

Sept. 30, 1975-1/2; 0

100,00

Jan. 31, 1976-100%

5.

Less: Amount of overpayment on 1974 return which you elected to claim as a credit

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

10000

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

CERTIFY THAT THIS IS A CORRECT DECLARATION.

siriura of lexpayer, Spouse alto it joine declurarion.

This declaration of estimated tax is not a Tax feturn.

DAlE

NW 88326 Docld:32245535 Page 243

---

## Page 244

SCHEDULE F - SHAREHOLDERS SHARE OF INCOME ANS CASUITS

(If additionai space is needed, attaci schreciule)

(1)

Name and Address of Each Shareholder

(2)

Social Socurity

Number

Nuriour of

Shares

RUBY

STONEY RIVER DR. BIRM.

G4W. WASHINGTON AlISO CHICAGO,

7,500

7,500

(c)

(d)

(e)

(f)

(g)

(h)

(1)

(j)

(4)

Amount taxable

as

income

(schedula

of

lines

4

and

1120S)

ordinary

K.

total

8,

U.S.

Distributive Income from

page 1, line 5, or page 2,

schedule B, line 6

(6)

Amount to be used by share-

holder on Ml-1040 (enter on

page 2, schedule 1, line 37 or

on page 2, schedule 2, line 46)

difference

column 4

and column 5 (see instructions)

(a) $

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

3, 331.36

36. 331.37

36,331.38

36.331.37

(7)

inter here and on forr

11-1040, page 1, line 2:

each

sharenolder's pro-

portionate share of por-

sonal

property

taxes

paid on

phe credit nor torins is

fees

paid.

(see instructions)

S1.94

91.94

NW 88326 Docld:32245535 Page 244

---

## Page 245

r v

TAX COMPUTATION SCHEDULE

c of D-15-DIT., ReN. 8.74:

TOTAi DETROIT iNCOME EXPECTED IN 1975

EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B)

D. ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 16 OF DECLARATION BELOW

$

D-1040-E5

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

19

1975

NAME(S)

(PRINT OR TYPE)

YOUR SOCIAL SECURITY NUMBER

ADDRESS

SPOUSE'S SOCIAL SECURITY NUMBER

•CITY

STATE

POSTAL ZIP CODE

CHECK TYPE OF DECLARATION

• INDIVIDUAL

• CORPORATION

PARTNERSHIP

OTHER

KEEP

THiS

COPY

FOR

la. Your 1974 Detroit Income Tax S...

.....

1b. Your Estimate of 1975 Detroit Income Tax.

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975.

3. ESTIMATED TAX (line 1b less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

= Apr. 30, 1975-1/4; [j June 30, 1975-1/3; Sept. 30, 1975-1/2;

Jan. 31, 1976-100%

5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

$.

$

YOUR

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER.

RECORDS

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATION TO:

FINANCE DEPARTMENT - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

This declaration of estimated tax is not a Tax Return.

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-i040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

(PRINT OR TYPE)

CLEANES:

, INc.

ADDRESS, E 135

LIVERNOIS

STATI

POSTAL ZIP.

CODE

MICHIGAN

1a. Your 1974 Detroit Income Tax s 1, 469.26;

LOCATOR NUMBER

DOCUMENT

1b. Your Estimate of 1975 Detroit Income Tax

2.

Amount of Detroit Income Tax to be withheld or other credit expected in 1975

ESTIMATED TAX (line lb less line 2)

Computation of Instailment: Check Due Date of declaration below and enter portion of line 3 as indicated:

X. Apr. 30, 1975-1/4; C. June 30, 1975-1/3; Sept. 30,1975-1/2; / Jan. 31, 1976-100%

Less: Amount of overpayment on 1974 return which you elected to claim as a credit

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

19

1975

YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER.

E CORPORATION

PARTNERSHIP

OTHER

$..

i20a

i!.3

1507t

2690

This declaration of estimared tax is not a Tax Return.

signuiura of Taxpoyer, Spouse also it joint declararion.

DATE

NW 88326 Docld:32245535 Page 245

---

## Page 246

=

TAX COMPUTATION SCHEDULE

1975

C of D-15-DIT.J (Rev. 8.74)

A.

TOTAL DETROIT INCOME EXPECTED IN 1975

B.

EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

C.

ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B)

D.

ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER ½ OF 1% OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW

D-1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

19

1975

NAME(S)

(PRINT OR TYPE)

ADDRESS

CITY

STATE

POSTAL ZIP CODE

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER J CORPORATION

• PARTNERSHIP

• OTHER

KEEP

THIS

COPY

la. Your 1974 Detroit Income Tax $.

1b. Your Estimate of 1975 Detroit Income Tax

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975

3. ESTIMATED TAX (line 1b less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

0 Apr. 30, 1975-1/4; [] June 30, 1975-1/3: Sept. 30, 1975-1/2;

Jan. 31, 1976-100%

5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

$.

$.

FOR

YOUR

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER.

RECORDS_

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

AND MAIL WITH DECLARATION TO:

FINANCE DEPARTMENT - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

This declaration of estimated tax is not a Tax Return.

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending:

NAME(S)

(PRINT OR TYPE)

MARUE!

, INC.

ADDRESS

18135 LIVERNOIS

CITY

DETROIT, MICHIGAN

POSTAL ZIP CODE

48221

1a. Your 1974 Detroit Income Tax 5 98:22;

DOCUMENT. LOCATOR NUMBER

Ib. Your Estimate of 1975 Detroit Income Tax.

2.

Amount of Detroit Income Tax to be withheld or other credit expected in 1975

3.

ESTIMATED TAX (line lb less line 2) ...

4.

Computation of Instaliment: Check Due Date of declaration below and enter portion of line 3 as indicated:

[ Apr. 30, 1975-1/4; [7 June 30,1975-1/3: I Sept. 30, 1975-1/2;

I Jan. 31, 1976-100%

5.

Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6.

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

19

1975

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER & CORPORATION

• PARTNERSHIP

• OTHER

100

100

$...

100

100

$

39117

This declaration of estimated tax is not a Tax Return.

jiunulure of Taxpayor.

Spouse aiso it joint declaration.

DAIE

NW 88326 Docld:32245535 Page 246

---

## Page 247

TAX COMPUTATION SCHEDULE

1975

C of D- 15-DIT-J (Rev, 8-74)

A. TOTAL DETROIT INCOME EXPECTED IN 1975

EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

C.

ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B)

$

ESTIMATED DETROIT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER

OF LINE C.

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 16 OF DECLARATION BELOW

$

D-1040-ES

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending

19

1975

NAME(S)

(PRINT OR TYPE)

YOUR SOCIAL SECURITY NUMBER

ADDRESS

SPOUSE'S SOCIAL SECURITY NUMBER

CITY

STATE

POSTAL ZIP CODE

CHECK TYPE OF DECLARATION

• INDIVIDUAL

CORPORATION

PARTNERSHIP

OTHER

KEEP

THIS

COPY

ia. Your 1974 Detroit Income Tax $.

1b. Your Estimate of 1975 Detroit Income Tax.

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975.

3. ESTIMATED TAX (line 1b less line 2)

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:

0 Apr. 30, 1975-1/4; 7 June 30, 1975-1/3; 1

Sept. 30, 1975-1/2;

Jan. 31, 1976-100%

5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)

$

FOR

YOUR

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

RECORDS

MAKE REMITTANCE PAYABLE TO "TREASURER, CITY OF DETROIT"

• AND MAIL WITH DECLARATION TO:

FINANCE DEPARTMENT - INCOME TAX DIVISION

104 CITY-COUNTY BUILDING

DETROIT, MICHIGAN 48226

This declaration of estimated tax is not a Tax Return.

DATE

DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-1040-E5

CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

For Calendar Year 1975 or Fiscal Year Ending:

VAME(S)

(PRINT OR TYPE)

MARUE!

INe.

ADDRESS

18135 LIVERNOIS

CITY

DETRAT

POSTAL ZIP CODE

4.

19

1975

YOUR SOCIAL SECURITY NUMBER

CHECK TYPE OF DECLARATION

• INDIVIDUAL

SPOUSE'S SOCIAL SECURITY NUMBER EE CORPORATION

• PARTNERSHIP

OTHER

DOCUMENT LOCATOR NUMBER

1a. Your 1974 Detroit Income Tax $.....

98:22;

1b. Your Estimate of 1975 Detroit Income Tax.

Amount of Detroit Income Tax to be withheld or other credit expected in 1975

ESTIMATED TAX (line 1b less line 2)

Computation of Instailment: Check Due Dote of declaration below and enter portion of line 3 as indicated:

[J Apr. 30, 1975-1/4; L June 30, 1975-1/3; 1

Sept. 30, 1975-1/2; C

Jan. 31, 1976-100%

Less: Amount of overpayment on 1974 return which you elected to claim as a credit

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

$.

100

i00

100

61

3817

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

I CERTIFY THAT THIS IS A CORRECT DECLARATION.

This declaration of estimated tax is not a Tax Return.

siunulure oí Taxpayor, Spouso also it joini declaration.

DAIt

NW 88326 Docld:32245535 Page 247

---