Transcript of 180-10073-10093.pdf
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JFK Assassination System Date: 10/1/201
Identification Form
Agency Information
AGENCY HSCA
RECORD NUMBER : 180-10073-10093
RECORD SERIES NUMBERED FILES
AGENCY FILE NUMBER 004876
Document Information
ORIGINATOR RUBY, SAMUEL
FROM: RUBY, SAMUEL
TO
TITLE :
DATE : 01/24/1978
PAGES : 118
SUBJCTS
RUBY, SAM
RUBY, JACK, BACKGROUND, ASSOCIATES AND RELATIVES
DOCUMENT TYPE : OTHER TEXTUAL
CLASSIFICATION Unclassified
RESTRICTIONS 3
CURRENT STATUS Redact
DATE OF LASTREVIEW 10/25/1995
OPENING CRITERIA
COMMENTS Wlcover letter. Box #.102_
Xeleased under the JohnF. Kennedy
Assassination Records Collection Act of
992 (44USC 2107 Note) Case#:Nw
33326Date; 2025
v9.1
NW 88326 Docld:32245535 1 Page
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For
5329 Returm for Individwal 1976
Depertmon? ottho Treesury
Retirement Savings Arrangement
Intornal Revenuo Servico
(Under . Sections 408 or 409 0f the Internal: Revenue Code) Only This Side of Fomm is
D Attach to Form1040. Open to 'Public Inspection
If you have established a retirement savings arrangement you must complete: Part and Part Il 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 Ill; (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 591/2
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: spoise
under a divorce-decree, you must complete Part V; (4) if you are 701/2 or older on the last of the year, see: in:
structions to determine if you are required to complete Part VI:
Name
SnmyeL
D Tub-
Address (Number and street)
1SD BesHa@
St
or tow, State and ZIP code
hnkDa HLLLS
SA
If you are not required to file a Form 1040 check here
Partfl; Individual and Retirement Savings Information
1 Type of individual retirement savings arrangement:
(0) 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 Persedtiobr3o3(haan; or stock boniis
plan, including a qualified Keogh (HR 10) plan, or were you covered under a 403(b) annuityOr custodial
account or under a government 'retirement plan other than the Social Security 84 Railroad Retirement Acts?
(Volunteer firemen and military reservists see specific instructions for line 2) Yes N8s
If "Yes; you are not allowed a deduction for your 1976 contributions to your individlak retirememeartangement
Under penalties of perjury, declare that have examined this return, including accompanying-scheduleszand-statuments andito the; best 0f my
knowledge and belief it is true, correct, and complete: If prepared by a person other than the taxpayer _this declardtiontis based on alfinformation
ot which the preparer has any knowledge:
Your signature Date
I-)lVLYY
Preparer'$ signature (other than taxpayer) Preparers identification number Date
(see General Instruction B)
'Preparer'$
2212
address'ard
VNwze_G_Vai_
ZIP code
Uays Ca_2!80
Form
5329
NW88326_Qocld 32245535_Page
day
city
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Form8329; (1976) This Page Is Not Open to Public Inspection
Pogo 3
EPant Attach BorForm 5493here
Your Social_Security Number 12_Z
2kfifiled by surviving spouse or beneficiary of an individual who created this retirement savings arrangement check here
Jand enter name and social security number of individual for whom the arrangement was established
4*Indicate-your age as of the end of the year (If you checked item 3 do not complete this item):
(a) Under age-594/2
(b) Age 591/2 to
(C) Over age (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 plan, 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 withini 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)2 Yes No
(c) If (b) was " Yes," complete lines (i) through (iii) below: Month Year
(i) Date of transfer to arrangement
(ii) Date distribution was made to you fror !e plan
(iii) Name of trustee or insurance comfany to wtiich the transfer was made (If bonds were purchased state "Bonds")
(d) ' (i) if"within" one taxabie year, YOu received a distribition"0f entire account from your empioyer'$ qualified' pension;,
profit-sharing or stock' bonus plan because the plan was terminated by your employer did you:
88, receive such amount On or after July 4, 1974 but prior to January 1, 1976,
transfer such amount, reduced Ly the amount of the income tax paid on the distribution on
your 1974 or 1975 income tax return; to an arrangement and
(C) tile a claim for refund of such tax paid? (Check "Yes" only if (A), (B) and (C) ALL apply-) Yes No
(i) If (d)(i) is "Yes," and you have received such refund or credit for such tax enter: Month 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 If, during the year, you transferred any funds from one retirement savings arrangement to another retire- Month Day Yeer
ment savings arrangement, enter the date of transfer here
Caution: Such & transter may be a taxable distribution.
7 If, during the tax year covered by this form, YOU have entered irto 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 ioan, check here
Note:_See instructions_tor the tax consequences of such transactions:
EParthl Computation of Allowable Deduction
(lf you have entered into 2 prohibited transaction under section 4975, do not complete Part III or Part
Iv tor the retirement savings arrangement with which you entered_into such prohibited transaction))
8 Wagesetips and other compensation from Form 104O (f a joint returm do not include compensation of spouse)
(See definition B in the instructions for the meaning of compensation )
9 of line 8 or $1,500, whichever is lesser (if you are or over or answered "Yes" to line 2, enter zero)
10 Amount paid by You or o 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 %f 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 4Oa)
Panliva] Tax on Excess Contributions
12 Tax on excess contributions (see Part IV of the Specific Instructions if Part Iil, line 10 exceeds line 11). Enter
tax trom worksheet here and on Form 1040,line 61
PantIE] 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 591/2). Enter tax from worksheet here and
on Form 1040, line 57.
EPanwi7 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 o 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
XU.S. GOVERNMENT PRINTING OFFICE 19760-218-176 EI 13.2687399
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Department of the Treasury _Internal Revenue Service
L
8 1040
U.S. Individual Income Tax Return
1976
This space tor IRS use only
For the year January ]~December 31, 1976, Or other taxable year beginning 1976 ending 19
Name (lf joint return, give first names and initials of both) Last name Your social security number
} Saml+PH Jba
Ruy 322EZTS
3 Present home address (Number and street, including apartment number, or rural route) For Pfivacy Act Notification, Spouse's social security no: 1 L2 S0 Bechin ST see page 5 of Instructions: 349/E1
1 City, town or post office, State and ZIP code Occu- Yours 5
@Qanad ltll pation Spouse'$ SEE
1 Single (Check only ONE box) 6a Regular Yourself Spouse Enter number of
boxes checked
2 Married filing joint return (even if only one had income)
b First names of your dependent children who
3 Married filing separately: If spouse is also give lived with you 24SA 1
spouse'$ social security number in designated space above IhomxS Enter
and enter full number
name here
J
c Number of other dependents (from line 7)
Unmarried Head of Household; See page 1 of instructions d Total (add lines 6a, b, and c)
to see if Enter
you qualify e Age 65 or older _ Yourself Spouse number
5 Qualifying widow(er) with dependent child (Year Blind Yourself Spouse checea
spouse died D 19 ). See page 7 of Instructions f TOTAL (add lines 6d and e)
Other dependents: (b) Relationship (c) Months lived in Your (d) Did dependent (e) Amount_furnished for dependent'$ support
home. If born or died have income of 5750 (a) Name during year, write B or D or more? By YOU_ If 1009 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 If box(es) it' will not increase your joint_retur,_does_your_spouse wish to designate S12 Yes No tax or reduce your refund_
9 Wages, salaries, tips, and other employee compensation (Attach Forms w-2 If unavail- 9 able, see page 6 of Instructions ) g
10a Dividends
'See_ Parstructiond _ and 10b less exclusion Balance 1Oc
(If gross dividends and other distributions are over $40O, list in Part of Schedule B.) Y
11 Interest income: If $400 or less, enter total without listing in Schedule B
If over $400, enter total and list in Part Il of Schedule B 11
Sl
12 Income other than wages, dividends, and interest (from line 37) 12
Y#
13 Total (add lines 9, 1Oc, 11 and 12) 13
59
14 Adjustments to income (such as moving expense, etc. from line 42) 14 76'
0 15a. Subtract line 14 from line 13 15a
b Disability income exclusion (sick pay) (attach Form 2440) 15b
224
c Adjusted gross income: Subtract line I5b from line I5a, then complete Part IIl on back
1 (If less than $8,000, see page 2 of Instructions on "'Earned Income Credit:") 15c
Zz44LL
Tax Table Tax Rate Schedule X, Y or Z Schedule D 16 check if from:
Schedule Form 2555 OR Form 4726 16 1
17a" Multiply $35.00 by the number of exemptions o line 6d 17a Enter (If box on line 3 is checked
larger see page 10 of Instryctions)
b Enter 2% of Iine 47 but not more than $180 (890 if box 3 is checked) 17b 8 8 17c H_
18 Balance: Subtract line 1Zc from line 16 and enter difference (but not less than zero) 18
19 Credits (from line 54) 19
3
20 Balance: Subtract line 19 from line 18 and enter difference (but not less than zero) 20
21 Other taxes (from line 62) 21 1
22 Total (add lines 20 and 21) 22
(attach- Forms W-2, 9 23a Total Federal income tax withheld. or W-2P to front) 23a
(include amount allowed Pay amount on line 25 in 4 b 1976 estimated tax payments a5 credit from 1975 return) 23b fuli with this return: Write 8
c Earned income credit offromstructiong) 2 23c social security number on
check or money order and
d Amount with Form 4868 23d make payable to Internal
Revenue Service. 1
e Other payments (from line 66) 23e
24 TOTAL (add Iines 23a through e) 24
6 25 If line 22 is larger than line enter BALANCE DUE IRS 25 1
(Check here 0 if Form 2210 or Form 2210F is attached. See page 10 of instructions:) 8
3 26 If line 24 is larger than line 22, enter amount OVERPAID 26
3221
2 27 Amount of line 26 to be REFUNDED TO YOU 27 1
28 Amount of line 26 to be credited on 1977 estimated tax 28 66
Under penalties 0l declare that have examined this return, including accompanying schedules and statements, and to the best 0f my knowledge and belief it is
true, correct, and complete. of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Ia
8 Your Signature Date Preparer' $ signature (and employer' $ name, if any) Date
9SAYXY
Spouse $ signature (f Miling jointly, BOTH must sign even if only one had income) Tdentifying number (see instructions) Address (and ZIP code)
218-052-2
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Pare 2
Form 104o (1976)
Paq Income other Than Wages,_Dividends and _Interest
29
29 Business income or (loss) (attach Schedule C)
Cg
30a Net
or (loss) from sale or exchange of capital assets (attach Schedule D) 30a
b 50% 0f capital gain distributions (not reported on Schedule D_see page 10 of Instructions)- 30b
31 Net
or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) 31
320
Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc (attach Schedule E) 32a
b Fully taxable pensions and annuities (not reported on Schedule E_~see page 10 of Instructions) 32b
33
33 Farm income or (loss) (attace Schedle F retund Is ior Year in #hich vou took the
34
34 State income tax refunds standard deduction _others see page 10 oi (nstructions
35
35 Alimony received
36 Other (state nature and source _see page 11 of Instructions)
36
37 Total (add lines 29 through 36) Enter here and On line 12 37
2ZY6
Parthi? Adjustments to Income
38
38 Moving expense (attach Form 3903)
39
39 Employee business expense (attach Form 2106)
40a Payments to an individual retirement arrangement from attached Form 5329, Part 40a
40b b Payments to a Keogh (H.R. 10) retirement plan
41
Forfeited interest penalty for premature withdrawal (see page' 12 of Instructions) 41
42 Total (add lines 38 through 41). Enter_here and on line14 42
lparitHilt Tax Computation
Adjusted.gross income (from line 15c). If you have unearned income and can be claimed as a 43
dependent on your parent's return, check here and see page 9 of Instructions 43
22Y1_
44a If you itemize deductions, check here D and enter total from Schedule A, line 40, and attach Schedule A
b Standard deduction--If you do not itemize deductions, check here and:
2 or 5, enter the greater of $2,100 OR 16% of line 43__but not more than $2,800 44
SGel_
If you checked
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 Iine 44 from line 43 ad enter difference (but not less than zero) 45
20s_
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) 4T
If line 47 is $20,000 or less and you did not average your income o Schedule G, or figure your tax on Form 2555, Exemption of Income Earned Abroad, findf
your tax in Tax Table Enter tax 0n line 16 and check appropriate box
If line 47 is more than $20,000, figure your tax on the amount o line 47 by using Tax Rate Schedule X, Y, Z, or if applicable; the alternative tax from Schedule
"N"D, income_averaging_from Schedule_G,_tax_irom Form 2555 or maximum tax from Form 4726. Enter tax on line_16_and_check_appropriate_box
PanIIV ] Credits
48
48 Credit for the elderly (attach Schedules R & RP)
49
49 Credit for child care expenses (attach Form 2441)
50
50 Investment credit (attach Form 3468)
51
51 Foreign tax credit (attach Form 1116)
52 Contributions to candidates for public office credit (see page 12 of Instructions) 52
53
53 Work Incentive (WIN) Credit (attach Form 4874)
54 Total (add Jines 48 through 53)Enter_here and on line 19 54
PartIVz Other Taxes
55 Tax from recomputing prior-year investment credit (attach Form 4255) 55
56 Minimum tax; Check here D and attach Form 4625 56
57
Tax on premature distributions from attached Form 5329, Part 57
58 Self-employment tax (attach Schedule SE) 58
270
59 Social security tax on tip income not reported to employer (attach Form 4137) 59
60 Uncollected employee social security tax on tips (from Forms W-2) 60
61 Excess contribution tax from attached Form 5329, Part IV 61
62 Total (add lines 55 through 61)_ Enter_here and on line 21 62
PantViE Other Payments
63 Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers__see page 13 of Instructions) 63
64 Credit for Federal tax on special fuels, nonhighway gasoline ad lubricating ojl (attach Form 4136) 64
65 Credit from a
Regulated Investment Company (attach Form 2439) 65
66 Total (add lines 63 through 65)- Enter_here and on line 23e _ 66
US_ GOVERNMENT PRINTING OFFICE : 1976-0-218-052 218-052-2
NW 88326 Docld:32245535 Page 6
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Sched ules A&B_Itemized Deductioms AnD
(Form 1040) Dividend and Interest Income
1978
'Department of the Treasury Attach to Form 1040. See Instructions for Schedules Aand B (Form _104O)
Intemal Rerenue Service Your social security number
Name(s) as shown on Form 1040 Stk Kuby 3212L2I4 "
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 5150) of [n" receipts, cancelled checks or other
surance premiums tor medical care: (Be
written evidence sure to include in line 10 below)
b Other cash contributions. List donees
2 Medicine and drugs
3 Enter 1 % of Iine 15c, Form' 1040 and amounts:
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. 22 Other than cash (see page 15 of instruc
tions for-required statement)
b Hospitals
Other (itemize ~include hearing aids, 23 Carryover from prior years
transportation, 24 Total contributions (add lines Z1a through
dentures, eyeglasses,
23) Enter here and on line 37
etc ) 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)
1 Total (add lines 4 through 6c) 28 Enter $100 or amount on line 27 , which-
ever is smaller
8 Enter 3% of line 15c, Form 1040
29 Casualty or theft loss (subtract line 28
9 Subtract line 8 from line 7 (if less than from line 27)_ Enter here and on line 38
zero, enter zero) Miscellaneous Deductions (See page 15 of Instructions:)
10 Total (add lines 1 and 9). Enter here and 144L
on line 34 30 Alimony
Taxes (See page 13 of Instructions ) 31 Union dues
11 State and Iocal income 32 Other (itemize)
12 Real estate
13 State and Iocal gasoline (see gas tables)
10 General sales (see sales tax tables)
15 Personal property
16 Other (itemize)
17 Total (add lines 11 through 16). Enter 33 Total (add lines 30 through 32). Enter
here and on line 35 here and on line 39
Interest Expense (See page 14 of Instructions ) Summary of Itemized Deductions
18 Home mortgage
34 Total medical and dental--line 10 19 Other (itemize)
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
20 Total (add lines 18 and 19). Enter here 39). Enter here and on Form 1040, line
88
and on line 36
2SL
44
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Schedules AeB (Form 1040) 1976 Schedule B_~Dividend and Interest Income Page 2
Name(s) as shown on Form 1040 (Do not enter name and social security number if shown on other side) Your social number
~p Euby 32212
Partl Dividend Income Pait Interest Income
Note: /f gross dividends (including capital gain distributions) &nd Notep If interest is $400 or less, do not complete this part: But
other distributions on stock are $400 or less, do not complete this enter lamgunt of interest_received on Form 1040, line 11.
part. But enter gross dividends less the sum of capital gain dls- 7 Interest includes earnings Trom savings and Toan associations,
tributions and non-taxable distributions, if on Form 1040, mutuai savings banks, cooperative banks, and credit unions
line 1Oa (see note below) ag Well as interest on bank deposits, bonds, tax refunds, etc_
Gross dividends (including capital gain distributions) and other interest also includes original issue discount on bonds and
distributions on stock: (List payers and amounts ~write (H); other evidences of indebtedness (see page 16 of Instructions).
(W), (J); for stock held by husband, wife,_or jointly) (List payers and amounts)
NATE 0 {ioo2 N
LA
TPAMRZ)
WIKE Q
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
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 1Oa Form 1040, line 11
SLIS
Note: If you received capital distributions and do not need Schedule D to report any other gains or or to compute
the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions o Form 1040,
line 30b.
PartIIIIOZ 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 No
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 No
If "Yes, attach Form 4683 (For definitions, see Form 4683.)
US: GOVERNMENT PRINTING OFFICE: 1976-0-218-054 218-054-1
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SCHEDULE C
Profit or (Loss) From Business or Profession
(Form 1040) Partnerships, JoinSolentreprietorshig} File Form 1065. 1976
Departmentvof the Treasury
Internal Revenue -Service Attach to Form 1040_ 6 See Instructions for Schedule € (Form 1040).
Name of proprietor Social security number
Sy P Eub 32212/7927
A Principal business activity (see Schedule C 5
ZERVaZ product nac 34 72
B Business name D
UMuccdeeShreta
0 CGEEZEzib
c Employer identification number D9S_
3fs78
D Business address (number ad street) LkeS gnfRibE_z
City, State and ZIP code
Encina
'Mi3ib
E Indicate method of accounting: (1) Cash (2) Accrual (3) Other Yes No
F Were you required to Form W-3 or Form 1096 for 1978 (see Schedule € Instructions)?
If "Yes; where filed
G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for thjs business for ay quarter in 19762
H Method of inventory valuation Was there any substantial change in
the manner of determining quantities_costs,%_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) 2 1
3 Gross profit 3
4 Other income (attach schedule)
5 Total income _(add lines 3 and 4) 5
6 Depreciation (explain in Schedule C-3)
7. Taxes on business and business property (explain in: Schedule C-2)
8 Rent on business property 8
9 9 Repairs (explain in Schedule C-2)
10 Salaries and wages not included on line 3, Schedule C-1 (exclude any to yourself) 10
11 Insurance 11
12 Legal and professional fees 12
13 Commissions 13
14 Amortization (attach statement) 14
15 (a) . Pension and profit-sharing plans (see Schedule C Instructions) 1502)
(6) Employee benefit programs (see Schedule C Instructions) (b)
16. Interest on business indebtedness 16
17 Bad debts arising from sales or services 17
1
18 Depletion 18
19 Other business expenses (specify):
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)_
(d)
(i)
(k) Total other business expenses (add lines 19(a) through 19(i)) 19(k)
20 Total deductions (add lines 6 through 19(k)) 20
21 Net profit or (loss) (subtract line 20 from Iine 5). Enter here and on Form 1040, line 29. ALSO
enter on Schedule SE, line 5() 21
3Sb
SCHEDULE C-13 Cost of Goods Sold and/or Operations (See Schedule C Instructions for Line 2)
1 Inventory at beginning of year (if different from last years closing inventory, attach explanation)
2 Purchases $. Less: cost of items withdrawn for personal use $_ Balance 2
3 Cost of labor (do not include salary to yourself) 3
4 Materials and supplies
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 operationsEnter here and on line 2 above_
Did you claim a deduction for expenses of an office in your home? Yes No
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Schedule' C (Form 1040) 1976 2
SCHEDULE C-2.-~Explanation of Lines 7 and 9
Line No. Explanation Amount Line No: Explanation Amount
$ $
SCHEDULE C-3. Depreciation (See Schedule C Instructions for Line 6)
If you need more space, use Form 4562.
d_ Depreciation e. Method of
D Date C. Cost or allowed or allowable computing Life &. Depreciation for
a. Description of property acquired other basis in prior years depreciation or rate this year
1 Total additional first-year depreciation (do not include in items below)
2 Other depreciation:
3 Totals
4 Less amount of depreciation claimed in Schedule C-l, 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 Salaries and Wages
Enter information with regard to yourself and your five
highest paid: employees In determining the five highest Owner
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 2
the combined amount is less-than $25,000, or for your-
3 self if your expense account allowance plus line 21; page
1,is less than 325,000.
Did you claim a deduction for expenses connected with: 5
(1) Entertainment facility (boat, resort, ranch, etc )? Yes No (3) Employees' families at conventions or meetings? Yes No
(2) Living accommodations (except employees on business)2_ Yes No (4) Employee_or famiiy vacations not reported on Form W-22 Yes No
U.S. GOVERNMENT PRINTING OFFICE 1976-0-218-055 218-055-2
NW 88326 Docld: 32245535 Page.10
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SCHEDULE 'D Capital Gains amd Losses (Examples %_propertveto be reported on this
(Form 1040) Schedule are gains and losses o stocks; bonds;and similar investments, and gains (but not 1976
losses) on personal assets such as a home Or jewelry.)
'Department 0t tho Trensury
Attach to Form 1040. See Instructions tor Schedule D (Fom 1040).
Internal Revonua Servico
Social security number Name(s) as shown on Form 104O
SxP Ru_ 3z2l212a9
jpadtiIe3 Short-term Capital Gains and Losses_Assets Held Not More Than 6 Months
0. Cost Or other basis,
b. Date c, Date 43 adjusted '(s00 Galn or (lose)
Klad 0 and description ecquirod sold Gross sales price Instruction p) and (d Ioss 0)
(Example,
Jo8*enbre
sheres 0t *'2' Co,) (Mo:, day, yr,) (Mo:, expense otsalo
2
2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries
3
3 Enter net' gain or (loss), combine lines 1 and 2
0
Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction I) 0
3TE
5 Net short-term gain or (loss)__combine lines 3_and 4_ 5
Partzll
Long-term Capital Gains and Losses_Assets Held More Than 6 Months
TSZELMEM
Fee
538 $
7 Capital distributions
8
8 Enter gain, if applicable, from Form 4797 , line 4(a)(1) (see Instruction A)
9
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) 10
11 11' Net gain or (loss), combine lines 6 through 10
12 Long-term capitai loss carryover attributable to years beginning after 1969 (see Instruction 12 5
13 Net long-term Or (loss) combine lines_12 and 12 13
"Partriii; Summary 0f Parts and II (If You Have Capital Loss Carryovers From Years Beginning Betore 1970, Do Not
Complete This Part. See Form 4798, Parts Ill, IV and V)
14 Combine lines 5 ad 13, and enter the net or (loss) here 14
15 If Iine 14 shows 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 15a
6 Subtract line 15a from line 14. Enter here and on Form 1040, line 30a 15b
16 If Iine 14 shows & loss
8
Enter one of the following amounts:
If iine 5 iS zero or a net gain, enter 50% of line 14;
If line 13 is zero or a net gain, enter line Or,
(iii) if iine 5 and iine 13 are net losses, enter amount on line 5 added to 50% 'of amount on
16a
line 13
b Enter here and enter as a (loss) on Form 1040, line 30a, the smallest of:
The amount on line 16a;
81,000 (3500 if married and filing a separate return); or, S25423
16b
LDD_ 1 Taxable_incomes as adjusted (see_Lnstruction_J)
218-056_1
R28926 Docid,922u55n5 paget41
day, Yt)
gain
gain
gain
gain
14;
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Schedule D (Forrn 1040) 1976 Page 2
(PamtTH Computation of Alternative Tax (See Instruction $ to See if the Alternative Tax Will Benefit You)
e4
17 Enter amount from Form 1040, line 47 17
18, Enter amount from line 15a (or Form 4798, Part !V, line 8(a)) 18
19 Subtract line 18 from Iine 17 (if line 18 exceeds line 17, do not complete the rest of this part; The Alter:
19 native Tax will not benefit you)
Note: If line 18 does not exceed $25,000 (512,500 if married filing separately) , lines 20 through
23 and enter zero on line 24.
20 Enter $25,000 (812,500 if married filing separately) 20
21 21 Add lines 19 and 20
22 Tax on amount on line 22
23 Tax on amount on line 21* 23
24 Subtract' line 23 from line 22 24
25 25 Tax on amount on line 19*
26 Enter S0% of line 18 but not more than $12,500 (86,250 if married filing separately) 26
27 Alternative Tax__add lines 24, 25,and 26. If smaller than the tax figured on thearnount on Form 1040,
line 47, enter this alternative tax o Form 1040, line 16. Also check the Schedule D box on Form 1040,
line 16 27
If the amount on which the tax is tv 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 !oss carryovers from 1976 to 1977: Pre-1970 Post-1969
Short-term (from Form 4798, Part Il or Part V)
Long-term (from Form 4798, Part II or Part V)
298
U.S. GOVZRNKENT PRINTING 0FFICE 197-0-218-058 218-056-1
ANwi88326_Decld;32245535 12
omit
178
Yr
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SCHEDULE SE Computation of Social Security Self-Employment Tax
Brrortmant 1O O2aury
Each selt-employed person must tile 0 Schedule SE: Attach to Form 1040.
1976
Internal Revanue Service See Instructions tor Schedule SE (Form 1040).
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 ad used in figuring social security benefits.
NAME OF SELF-EMPLOYED PERSON (AS_SHOWN ON SOCIAL SECURITY CARD) Social security number o SAmRA 8
selt-employed person
1322 zi 784
Business_activities_subject_to_self-employment_tax (grocery store,_restaurant,_farm,_ etc.)
If you have only farm income complete Parts and III; 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:
Parte | Computation of Net Earnings trom FARM Self-Employment
You may elect to compute your net Tarm 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) la
1 Net profit or (loss) from: b Farm partnerships 1b
2 Net earnings from farm self-employment (add lines la and b) 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 method), or line 70 (accrual method) 'Plus the' distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line 14)
as explained in instructions for Schedule SE
Enter here and on line 12a, the amount on line 2, or line 3 if you elect the farm optional method 4_
LlPartiii Computation of Net Earnings Trom NONFARM Self-Employment
a Schedule C, line 21. (Enter combined amount if more than one business ) 5a 3S,
b Partnerships, joint ventures, etc. (other than farming) 5b
Service as a minister, member of a religious order, or a Christian Science REGULAR METHOD practitioner _ (Include rental value of parsonage or rental allowance fur-
5 Net profit or nished:) If you filed 'Form 4361, check here and enter zero on this
(loss) from:_ line 5c
Service with a foreign government or international organization Sd
(See Form 1040 in-
8 Other structions for !ine 36.). Specify 5e
6 Total (add lines Sa through e) 6 35
T Enter adjustments if any (attach statement) 7
8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7) 8
35746
If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9
through 1l and enter amount from line 8 on line 1 Part IIL;
Note: You may use the nonfarm optional method (Iine 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 carnings from self-employment of
S400 or more for at least 2 of the 3 following years: 1973, 1974, and 1975. The nonfarm optionai 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) 9a 81,600 00
b Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero) 9b
C Balance (subtract line 9b from line 9a) 9c
10 Enter two-thirds of gross nonfarm profits or $1,600, whichever is smaller 10
11 Enter here and on line 12b, the amount o line 9c or line 10, whichever is smaller
11 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-l (Form 1065), line 14) as explained in instruc-
tions for Schedule SE. Also, include gross profits from services reported on line Sc, d and e, as adjusted
by line 7
RPartiie Computation of Social SecuritySelf-Employment Tax
12 Net earnings or (loss): a From farming (from line 4) 12a
b From nonfarm (from line 8, or line 1l if you elect to use the Nonfarm Optional Method) 12b 3S72
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
3Su6_
14 The largest amount of combined wages and self-employment earnings subject to social security or
railroad retirement taxes for 1976 is 14 815,300 00
15 a Total "FICA" wages and "RRTA" compensation 15a
b Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA 15b
c Total of lines 15a and b 15c
16 Balance (subtract line 15c from line 14) 16
17 Self-employment income__line 13 or 16, whichever is smaller 17 37Y6
18 Self-employment tax: (If Iine 17 is $15,300.00, enter $1,208.70; if less, multiply the amount on line
17 by 079) Enter here and on Form 1040,line 58 18
280
218-060-1
Nw.88326 Decld:32245535_Page13
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Form
4798 Capital Loss Carryover
(Computations of Capital Loss Carryovers and Summary of Capital 1976
Deportment of the Treasury Gains ' and Losses if 'Pre:1970 Capital Losses are Carried to 1976.)
Internal Revenuo Servlce Attach to Form 1040.
Name(s) a8 shown on Form 1040 Soclal Security Number 3+ Eyb 312 70
Note: Complete Only Page 1 of This Form to Compute Your Capital Loss Carryover if 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
Pantil; (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 Iine 7
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), iine.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, Iine 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 shown on your 1975 Schedule D (Form 1040), line 5. If that line is blank or shows
a loss, enter _ a zero 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 Excess of amount on line 10 over amount on line 11 12
Note: amount on line. 12 is your long-term capital loss carryover trom 1975 to 1976 that is attributable to years beginning
after 1969. Enter this amount on your 1976 Schedule D (Form 1040), line 12_
EPantiie
Post-1969 Capital Loss Carryovers from 1976 to 1977 (Complete this part f 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 Iine is blank or shows
a
loss, enter a zero 2
3 Reduce loss on line 1 to the extent of any on line 2 3
Enter amount shown on your 1976 Form 1040, line 30a 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 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 Iess line 5 (Note: If you ignored lines 2 through-6, enter amount from your 1976 Form 1040, line 30a)
'8 Enter loss:from your 1976 Schedule D (Form 1040), line 13; if none, enter zero and ignore lines
9 through 12 8
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 &,ly loss o line 8 to the extent of any 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 trom 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
gain
The'
any gain
gain
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Form `4798 (1976) Page 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 CS Part IV, Line 22 or 36.__If there Is a loss and 0 Gein on tha Ilnee
A, Who Should .File: mentioned in the instructions for Part IV line 22 or 36, enter the logs
your 1975 Schedule D (Form 1040) lines and 12(a) reduced by the amount of the gain: If the exceeds the loss enter
show 0 Iass: (1) use Part M, below, to determine your capital zero. If there is a loss and no gain, just enter the loss.
carryover ' to 1976; (2) complete your 1976 Schedule D (Form 1040)_ D. Married Taxpayers Filing Separate Returns ~ ~If you are marrled
lines 1 through 13 to reporticapital gains and losses for the current year and tiling a separate return the limitation for Part iv lines_9(b)(Ui)
and any post-1969 capitalzioss carryovers; and (3) complete Part IV and 27(6) is $500, increased by amounts attributable to pre-1970 Short:
to figure your net capital or (loss) for 1976 and the capital loss term capital loss components, but the combined total may not exceed
limitation if necessary_ Use Part V to figure capital loss carryover from S1,000. If there is a Ioss in Part IV line 2, complete Part IV, Section
1976 to 1977 for pre: 'i970 losses or &a combination of 1970 and post: E If there is a loss in Part IV line 5, complete Part Iv Section 0
1969 losses_ lines 14 through 22 (assuming all the lines in Section D were not other:
B. Part .IV , Line 19 or 33,-_If there is a gain and a on the lines wise required to be completed) ignoring the note under Iine 14.
mentioned in the instructions for Part IV_ line 19 or 33, enter the gain E Additional Information.__For information about capltal 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 Instructions for Schedule D (Form 1040).
Pre-1970 and Post-1969 Capital Loss Carryovers to 1976 (Complete this if the amount 0n your
Pantii 1975 Schedule D (Form 1040), line 16(a) or line 33, is larger than the loss deducted o 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 o your 1975 Schedule D (Form 1040) , line 13. If that line is blank or shows a ioss enter
a Zero 2
3 Reduce loss on line 1 to the extent of any gain o line 2 3
1
Note: It line 4(a) on your 1975 Schedule D (Form 1040) is blank, IGNORE lines 4 through 1l, enter
a zero on Iine 12-_ then go to line 13.
Combine lines 3 and 11 on your 1975 Schedule D (Form 1040).
Enter: the gain; if zero or a loss, enter a zero
SLoS
Note: It line 4 is zero IGNORE lines 5 through 11, enter on' line. 12
the loss from your 1975 Schedule D (Form
io4oer
line 4(a)
then go to line 13.
{5; Enter any gain from your 1975 Schedule D (Form 1040) , line 3 5 0
6 Enter smaller' of line 4 or 5 6 70
7 Enter excess of gain on line 4 over line 6 FOE
8 Enter .loss from your 1975 Schedule D (Form 1040), line 12(a);
otherwise, enter a zero 8
L32zz
9 Reduce any on line 7 to the extent of any loss line 8
10 Enter loss from your 1975. Schedule D (Form 1040), line 4(a); other-
wise enter .a zero 10
11 Add the gains on lines 6 and 9 11
12 Reduce the loss on line i0 to the extent of any on line 11 12
13 Pre-1970 short-term capital (Enter smaller of line 3 or 12) 13
T7
14 Short-te capital loss attributable to_years_beginning after 1969 (excess_of_line 3_over_line 134 14
15 Enter loss from line 13, above 15 17
16 Enter loss deducted on 1975 Form 1040, line 29a 16
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
Z(
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 Post:1969 short-term loss carryover to 1976 (excess of Iine 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
(Form 1040) , enter any loss from your 1975 Schedule D (Form
1040) , line 30; otherwise, enter 'ero 21
82 /ZI
22 Enter excess of line 19 over Iine 18-_if Iine 19 does not exceed Iine
18, enter zero. (Note: If_You, ignored Iines 2 through 20 above, enter
amount from your 1975 Form 1040, line 29a) 22
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
2
24 If you were required to complete Part IV of your 1975 Schedule
(Form 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 S8
25 Enter excess of line 22 over line 21 X 2 (If line 22
does not;exceed line 21, enter zero ) 25
26 Post-1969 long-term loss carryover to 1976 (excess of Iine 24 over line 25__if line 24 does not
exceed Iine 25,_enter_zero)Enter_here and on your 1976 Schedule D (Form 1040)line 12 26
5829
1NW88326,Docld;32245535 15
~:
galn 4(a)
loss
gain
pre-
loss
the
part
gain on
gain
loss
m
'any
your
(g2121
Page
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Page 16
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Form 4798 (1976)
PartiIV Capital Gains and Losses 3
Section A-_Short:term Capital Gains and Losses
1 Amount 1976 Schedule D (Form 1040) , line 5 2 Amount trom' Part IW, line 17
7]
3' Net short-term gain or (loss)_ combine 2
1 and 2
3
Section B-~Long-term Capital Gains and Losses
Amount from 1976 Schedule D (Form 1040), line 13
5' Amount from Part IlI,
line 23
6 Net term gain or_(loss) combine lines 4 and 5
5
%2
6 2
Section C_ -Summary of Sections A and B
'Combine lines 3 and 6 and enter the net gain or (loss) here
8 If 7 shows a gain _ ZYZ
(a) Enter 50% of line 6 or 50% of Iine 7, whichever is
IV , for computation of smaller (see Schedule D (Form 1040), Part
'(b) , Subtract;
alternative tax). Enter zero if there is
a loss or no entry on line 6 8(a) line 8(a) from line 7_ Enter here and on Form 9-If Iine 7 shows a loss 1040, line 30a (b)
If 'losses are. shown on BOTH lines 5 and 6, omit Otherwise; lines 9() and (b) and go` to Section D_ '(2) Enter %ne Of the following amounts;
If line 3 is Zero or a net gain, enter of line Hf line 6 is zero or a net gain, enter 7;
If,line 3 and line 6 are net
amount from line 7; or
on line 6
losses; enter amount on iine 3 'added to 50% of amount
(6) Enter"here and enter as a (loss) on Form 1040, line 9(a)
Theamount on line 9(a); the smallest of:
{1,000 (married taxpayers
separate Taxable Income, as adjusted (see
returns see Instruction D); or
1040)) - Instruction in Instructions for Schedule D (Form
Section D. ~Capital Loss Limitation __ (b) [O_
~Where Losses Are Shown on Both Lines 5 AND 6 of
Part IV
J0 Entef loss from line 3; if line 3 is zero or a gain, enter
a zero 12 Enter loss from line 6 '10
'12 Enter: gain, if {from line 3; if line 3 is zero or 11
13 a loss, enter a zero Reduce loss O lifie' 1i to the extent of the gain, if 12
14 'Combine" any, on line 12
13 amounts on 1976 Schedule D (Form 1040), lines 3 and
andzif gain,'enter gain; if zero or a loss, enter a zero
14
Note: ' If the entry on line 14 is zero, OMIT lines
enter on line 22 the loss shown on line 5 15 through 21 and
15, Enter' gain,-if 1976 Schedule D (Form
16 Enter smaller
1040) , line 11 15
of:amount on line 14 or line 15
17 Enter excess of gain on line i4 over 16
amount on line 16 17 18 Enter' loss from_ 2; if line 2 is blank, enter a zero 18 19 Reduce 'gain; -if. ay;: on line 17
to the extent of if any, on line 18 'Instruction B)
20 Enter: loss. from' iine 5
19
21 Add the gain(s) o line(s) 16 and
19
20
22' Reduce the loss on line 20 to the extent of the 21
23', Enter smaller %f aniount gain, if on line 21 (see Instruction GII 22 on line 22 or line 13 (f line 22 is zero, enter
24 Subtract amount on line 23 from the loss a zero)_ 23 on line 13 25 Enter 50% of the amount on line 24 24
26 'Add lines 10, 23, and 25 25
27 , Entef here-and enter as a (loss) on Form: 26 1040, line 30a, the smallest of: (2)" Amount,on 26;"
(b). $1,000 (Married taxpayers
separate returns
'(c) Taxable Incomle_ a5 adiusted
see Instruction D); or
(see Instruction J in Instructions for Scledule D (Form 1040)) 27
218-162-1
li.03326_Decld332245535 16
Pare
from
lines
'long:
line
50.%
30a,
filing
any;
any; froin
iine
loss, (sees
any,
line
filing
Page'
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Page 17
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NAME
St2_Qubl
CALENDAR YEAR 194
76_
SOC. SEC. NO_
322-42 4 729
'ADPRESS
DEDUCTION SCHEDULE
MEDICAL - STATE FEDERAL CONTRIBUTIONS STATE FEDERAL
2MEDICINEIDRUGS 21a CASH CONTRIBUTIONS
3Less % A.G.I. (Line 18 10401 21b PARTNERSHIP SHARE
ANET MEDIDRUGS GIRLIBOY SCOUTS
5h &A INS. (Ya + EXCESS)
ZOS KEART FUNDICANCER FUND
6a DR RED CROSS/UNITED FUND
dr: XMAS & EASTER SEALS
DR. MiSC _ ORGANIZED CHARITIES
DR_ POLITICAL coNTRIBUTiONS
Dr_ CHURCHES
dr_
DR:
DR.
22 OTHER THAN CASH
23 CARRY OVER FROM PRIOR YRS
6b HOSPITAL 24TOTAL CONTRIBUTIONS 1Q
PROSTHETIC APPLIANCES CASUALTY OR THEFT (LOSSES)
HEARING AID 25 Loss BEFORE ADJUSTMENT
26 INSURANCE REIMBURSEMENT
6c AMBULANCE 27
LABORATORIES 28 (8100 LIMITATION PER CAS )
TRAVEL FOR MED_ LezD 20 29 TOT,CASQR THEFTLOSS
MSCELLANEOUS DEDUCTINS
MEDICARE INS: 30 ALIMONY
GLASSES 31 UNIONIPROFESSIONAL DUES
1 MEDICAL EXPENSES
3273 32 INCOME TAX PREPARATION
LESS REIMBURSED BY INS UNIFORMSIPROTEC. CLOTHING
8 LESS 3% ADJ_GROSS INC: 2.32 SMALL TOOLS AND SUPPLIES
9 LAUNDRY AND CLEANING
I+:h(TO S150) QF H & A INS_
32
AUTO USEIDAMAGE
IO TOTALMEDICAL DED aY7 INVEST.COUNSEL & PUBS:(Sched)
TAXES EMPLOYMENT AGENCY FEES
I1STATE & LOCAL INCOME SAFE DEPOSIT BOX
12 REAL ESTATE TEL. REQ IN BUSINESS
13 STATE & LOCAL GASOLINE
987
POLITICAL CONTRIBUTIONS
14 GENERAL SALES TAX
15a PERSONAL PROPERTY
15b PERSONAL PROPERTY AUto
16 SALES TAX AUTO
33 TOTAL MISC_ DED_
SSUMMARY 0F ITEMZED DED; STATE FEDERAL
Tot. DEDUC TIBLE MEDICAL & DENTAL TOTAL TAXES
LIC B4 EGPENEDS
FROM INE 10)
WTEREST (TO WHOM PAID B5 ToTAL TAXES (From Line 171
18 MOR TGAGE 86 TOTAL INTEREST (Line 20)
37 TOTAL CONTR: (Line 24)
38 CAS. & THEFT LOSS(ES) (Line 29)
TOTAL MSCEL LANEOUS 19 INSTALLMENT LOANS 3 39 DEDALIlSS
(FROM LINE 33)
40 ESTER ONEFORED 3ED E INENS 56X6 362
ENTER ON FQRM 1040 LINE 44
REMARKS
20 TOTAL INTEREST 751Z 25n
N17+883ZGta Doold32245535NPageal| d6s Form 101
~Z
2487
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Page 18
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NAME -
Ssp
.D NO _ C ALENDAR YEA R 19
Z6
socORSEC _
NO .
322-12-14
ADDRES S F | SCAL XEAR END / NG
19
SCHEDULE OF PROF ! T (OR LOSS FROM BUS NESS OR PROFESS | ON
PRincipAL BUS INESS ActiviTy
BUS iESs NAME EMPLOYERS No
BUS INESS ADDRESS
TOTAL RECE | Pts
TQZ
"NVENTORY AT BEG INN ING 0F YEAR
MERCHAND SE PURCHASED B2s6
LABoR
TOTAL
NVENTORY AT END 0f YEAR
E
GROsS ProF iT'
74
GROsS INCOME
744
O THER BUS ! NES S DEDUCT ONS
ADVERTisiNG LOE
Auto AND Truck EXPENSE Ci12
BAD DEBTS
CASH ShoRt
CoMm SS |ONS
DEULVERY
DEPREC | AT | ON SCHEDULE ATTACHED
TZE
DUES AND SUBSCR !PT |ONS
ENTERTA INMENT AND PROMOT I ONAL
INSURANCE
INTEREST
JAN |ToR SERV ICE
LAUNDRY
LEGAL AND ACCOUNTiNG To
MA NTENANCE
JFF iCE SUPPLIES: AND EXPENSE
RENT
1boz
REPA |RS 2
SALAR ES AND WAGES
SALAR IES OFF ICERS
SUPPL I,ES
TAXES AND LICENSES
37
TAXES PAYROLL
TELEPHONE
T69
TRAVEL
UTILTTIES
NE T PR OF I.T:: OR LOSS FEDE RAL RETURN
3945
NET PROF | T OR LoSS S TA TE RE TURN SEE DEPREC. SCHEDULE FOR DIFF_
PROFESS ONAL STAT | ONERS INC . FORM 10 4
Los AN GELES CAL |F SCHEDULE
Nw 88326" Docld: 32245535 Page 18.
Zubk
7
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Page 19
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7
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NWN 88326 ' Docld:32245535 19 Page
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Page 20
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MEL2{Hy-tl!e
Or Calendar Yr. 19
NAME SOC. SEC. NO FIY/E 19
GAINS ON INSTALLMENT SALES
DESCRIPTION 'OF PROPERTY
DATE ACQUIRED
4fz,
DATE SOLD
37Z72Z
TYPE OF ASSET CAPITAL SEC, 1245 SEC. 1250
SELLING PRICE: CASH S
s2OLYA
$
2_ NOTES 4pLz
3 MORTGAGE TRANSFERRED
4 OTHER
5: GROSS SALES PRICE (1+2+3+4)
BE32D
63 COST OR BASIS S S 5S2H S
LESS ACCUMULATED DEPRECIATION
8 PRIOR' TO 1-1-62
9 PRIOR "TO.1x1-64
10. AFTER 12-31-61 2313
11_ ST. LINE AFTER 12-31-63
912 EXCESS OVER S/L 1-64/12-69
113 EXCESS OVER S/L AFTER 12-31-69
14 ADJUSTED BASIS (6-_7 THRU 13)
Y29L51
15,= EXPENSES OF SALE 222
16. TOTAL ADJUSTED BASIS (14 + 15) Y313
17.3 TOTAL GROSS_ PROFIT (5
47 16) $
18. TOTAL GROSS.PROFIT ORDINARY S 13J3 S
19. ToTAL GROSS:PROFIT OTHER
Eae
$22 84 S'
20: CONTRACT, PRICE (1 + 2 + 4) S $ be3r .S
21uGROSS PROFIT % % 36 2 * %
22. PAYMENTS RECEIVED YEAR.OF SALE
23; CASH (1) 2OLY?
'24 PRINCIPAL' COLLECTIONS
125, EXCESS MORTGAGE.OVER BASIS
226. OTHER (4)
27:" TOTAL PAYMENTS (23 THRU 26) Loll
28; RECOGNIZED GAIN
293 RECOGNIZED GAIN ORDINARY 2313
30 'RECOGNIZED GAIN OTHER ILDS
ORDINARY INCOME
TAX TO TAL LESS inT. SECTION 1245 SECTION 1250 CAPITAL GAIN
ABLE, PAYMENTS (To Pt. 2.
YR SEC. 3) REPORTED BALANCE REPORTED BALANCE REPORTED BALANCE
Fx 2o Moql TLR 1547
[2Z6LL9503 Mxq 2sS OLL
N1i2S8S82GNAp320iiSY21i5335 4BatGEzi . CALIF FORM 96 SCHEDULE
Ruel.m1
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Page 21
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INDIVIDUAL TAXABLE YEAR REOIDENT
540
CALIFORNIA 1976
INCOME TAX
PlacE PREADDRESSED LABEL HerE If available: (Correct' name and address, if necessary) Check Calendar Year
Enter social security numberls) oly if incorrect or not shown o label One; Fiscal Year Ending 1977
FoR PRIVAC Y NotifICA TiON
NAME (If iolnt return, give Arst name: and initials of both) LAST NAME SEE PAGE 2 0f NSTRUC TioNS
Your Social Security Number SemusL P#yLLLS Ruh
3zz
PRESENT HOME ADDRESS (Number and street, including aportment number, or al route) Spouse Socjal Security Number
1LZS Glab S7 2
CiTY, TOWN OR Post OFFICE STATE AND CODE OccU- Yours
Sanmpp H LLS CA PATion Spouse' $
Singlle (Check Only One 6 Personal If line or 3 checked, enter 525 00
Married filing joint return (even if only one had income) If line 2, 4 or 5 checked, enter 550
Separate return of married person_Enter spouse's
3
Bonodensf the person who qualifies
as head of household
social security number and full name here LLS2
1
Head of Household_Enter name of qualifying
7 tona_
Total Number 2X 58 7
individual 8 Blind (see tructions) Number of blind exemptions X 58 8 00
5 Widowler) with dependent child (Year spouse died 197 9 Total exemption credits (add lines 6, 7 and.8) Enter here and on `line 20 9 00
Attach copy 2 of Form(s) W-2 to face of this 10 10 Wages, salaries, tips and other employee compensation =
return_ If unavailable, see instructions, Page 10
11 Dividends_before federal exclusion; Enter total (if over $400, complete and attach Schedule B(540) ) 11
12 Interest: Enter total (if over $400, complete and attach Schedule B(540) 12 3
13 Income other than' wages , dividends and interest (from Iine 48) 13
25t
0
14 Total (add lines 10, 11, 12 and 13) 14 724LL
8 15 Adjustments to income (from line 55) 15
16 Adjusted gross income . (subtract line 15 from line 14) 16;
3Y|
2
If you do NOT itemize deductions AND Iine 16 is under $15,000, find tax in Tax Table and enter on" line 19
5
M
If you itemize' deductions OR line 16 is $15,000 or more, complete lines 17 and 18.
17 Deductions: Itemized (from line 63) OR STANDARD (S1,000 if line 1 or 3 checked__S2,000 if line 2 4 or 5 checked) 17
SbIe
3
18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule_Enter tax on line 19 18 265S
1
19 Tax from (check' one) Tax Table Tax Rate Schedule Income Averaging Schedule (G or G-l ) 19
20 Total exemption credits (from Iine 9, above) 20
21 Tax liability (subtract line 20.from line 19_if Iine 20 is greater than line 19, enter zero) 21
22 Other credits (from line 68-Including Specia/ Low Income Tax Credit) 22
23 Net tax liability (subtract Iine 22 from line 21-if Iine 22 is ' greater than Iine 21, enter zero) 23
24 Other taxes (from Iine 71 ) 24
25 Total tax Iiability (add Iines 23 and 24) 25
26 Total California income tax withheld (attach W-2 or W-ZP to face of this return) 26
1
27 Renter's credit_if you lived in rented property on March 1,1976, complete Part 1 o page 2 27
28 1976 California estimated tax payments 28 1
29 Excess California SDI tax withheld (see instructions) 29
30 Tota| Credits_ 30
1
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 PAY In FULL 37> 31 6
SACRAMENTO, CA 95867 Do not write in these spaces
32 If Iine 25 is smaller than line 30, enter amount OVERPAID 32 P 5
33 Amount of line 32 to be REFUNDED TO YQU. Allow at least six weeks_ E 1 Mail return to: FRANCHISE TAX BOARD 33
P.o. BOX 13.540 M
5 SACRAMENTO, CA 95813 A
1
34 Amount of line '32 to be credited on your 1977 ESTIMATED TAX 34 R
If you do NOT want State income tax forms and instructions mailed to you next yea{, check here See Instructions Pa ge 9 I
Under penalties of perjury , declare that have examined this return, including accompanying schedules and statements, and to thexbest of my know
and belief it is true;correct, and complete Declaration of preparer (other than taxpayer) is based on a/l information' of which preparer has any knowledge _
1
SIGN
Your signature Date Preparer' $ signatur? (other than taxpayer) Date 1
NI
BEQE TDoeld.32245533 Pageezi
return Date Address (and Zip code)
Zip
you
ins
_)
ledge
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Page 22
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2 Form 540 (1976)
PART | 3 Renter's Credit All questions must be answered
35 Did you , o March 1, 1976, live in rented property which was your principa| residence? Yes 1lo If you may not claim this credit
36 Was the property you rented exempt from property iax? Yes Q No If yes, you may not claim this credit
37 Did you live with any other person who claimed You as a dependent for income tax purposes? 0 Yes No If yes, you may not claim this credit
38. Did you or your spouse claim the homeowners property tax exemption Or receive public assistance?: Yes No If yes , see page 3 of instructions
PART |I L Other Income
39 Business income (or. loss) (attach Schedule C(540)) 39
34s
40 Net gain (or loss) sale or exchange of capita} assets (attach Schedule D0(540)) 40 1o00
41 Net gain (r Ioss) from supplementa schedule of gains and losses (attach Schedule 0-1(540)} 41
42 , Pensions and annuities 42
43 Rents and royalties ATTACH 43
SCHEDULE E 44 44 .Partnerships
FoRM (540)
45 Estates and trusts 45
46 Farm income (or loss) (attach Schedule F(540)) 46
47 Miscellaneous income
'(a) Fully taxable pensions and annuities (not reported o Schedule E(540)) 47a
(b) Alimony 47b
(c) Other (state nature and source) 4lc
Enter total of Iines 47(a), 47(b), and 47(c) 47
48 Tota| (add lines 39 thru 47). Enter here and 0 line 13. 48
254_
PART |li A Adjustments to Income
49 "Sick pay, if included in line 1 0 (see instructions attach Forin FTB 3805T) 49
50 Mving expenses (see instructions attach Form FTB 3805U) 50
51 Employee business expenses (See instructions attach Form FTB 3805N) 51
52Military exclusion (see instructions) 52
53(a) Payments to an individua irement arrangement (attach FTB 3805P) 53a
(b) Payments to a Keogh (H.R: 10) retirement plan 53b
(c) Payments to.a self-employed Defined Benefit Plan 53c
Enter total of lines 53(a) , 53(b) , and 53(c) 53
54 Forfeited interest penalty (see instructions_ 54
55 Total adjustments (add lines 49 thru 54). Enter here and 0n Iine 15 55
PART IV Itemized Deductions
0 Attach Schedule A(540) and enter,sub-totals o lines 56 thru 62, below
56 Total deductible medical and dental expenses (from Schedule A(540), Iine 10) 56
L94L
57 Total taxes (from Schedule A(540) , ine 57 LLX
58 ' Total interest expense (from Schedule A(540), Iine 20) 58
ZS11
59 Total contributions (from Schedule A(540), line 24) 59 01
60 Total casualty loss (from Schedule A(540) , Iine 29) _ 60
61 Total miscellaneous deductions (from Schedule A(540) , line 33) 61
62 ` Tota| child care and adoption expenses (from Schedule A(540),, line 37) 62
63 Total itemized deductions (add lines 56 thru 62). Enter here and o Iine 17 63 5686
PART V Other Credits: SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW
64 'Other State" net income credit (attach copy of other state return and Schedule S(540)) 64
65" Retirement income credit (attach Schedule R(540)) 65
66 Special low income tax credit (see special instructions) 66
67 , Solar energy credit (see special instructions) 67
68 TOTAL (add lines 64 thru 67). Enter here and 0n line 22 68
PART Vi Other Taxes
69 Tax on preference income (see instructions attach Schedule P(540) 69
70 Tax 0 premature distributions from attached Form FTB 3805P 70
71 Total (add lines 69 and 70) enter here and on Iine 24 71
PART VII Reconciliation to Federa Return If adjusted gross income o Federal Return is different from Iine 16, page 1 , explain below _
NW 88326 ` Docld;32245535 Page 22
Page
no,
from
ret
17)
tax
tax
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Page 23
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SCHERULE TAXABLE CALIFORMIA
1976
ITEMIzed DEDUCTIONS
YEAR FORM 840 Attach to Form 540
Soclal Security Number Name 03 shown on Form 540 S+8 Qub E2217429.1
A
Use Only If YOU D0 NoT "Use THe TaX Table Or TAKE' THE STANdARD DEOUCTION
Medlcal and dentel exponses (not compensated by Insurance or otherwise) for Contributions
medicine and doctors, dentists, nurses; 21(a). Cash contributions for which you have receipts,
hospital care; 'Insurance premiums for medical `
canceled checks_ etc.
care, etc. (6): Other cash contributions. List donees and
amounts
1. One half (but not More than S150) of Insurance
premiums for medical care _
2. Medicine ad drugs _
3. Enter 1 % of line 16, Form 540 _
Subtract line 3 from Iine 2_ Enter difference (if less 22, Other than cash _See instructions tor required state:
ment than zero, enter zero) _
23. Carryover from 1974 & subsequent vears See 5, Enter balance of insurance premiums for medical care
instructions not entered 0n Iine 1
6. Other medical and dental expenses: 24, Total _ (Add:lines 2la thru 23 _ Maximum de:
(a) Doctors, dentists,` nurses, etc; duction may not exceed 20% of adjusted 46o
income. Enter here and on Form 540, Iine 59) (6) Hospitals
(c) Other (itemize)
Casualty or Theft Loss(es)
NOTE: If you had more than oe loss, oit lines 25
through 28-See instructions for guidance
25. Loss before insurance reimbursement
26 . Insurance reimbursement
7 Total (Add lines 4, 5, 6a, b, and c) 27 . Subtract Iine 26 from Iine 25, Enter difference
8 Enter 3% of line 16, Form 540_
(If less than zero_ enter zero)
9. Subtract line 8 from line 7 Enter difference (if less 28. Enter S100 or amount on line 27, whichever is
than zero, enter zero)
smaller
10, Total_ (Add lines 1 and 9. Enter here and on Form 1q4 29 . Casualty or theft loss (subtract Iine 28 from
540, Iine 56) _ line 27 , Enter here and on Form 540, Iine 60)
Taxes
Miscellaneous Deductions
11. Auto license_Excess ;of registration a weight fees
(see instructions) _ 30 _ Alimony paid to
12. Real estate 31 _ Employment Education Expense:
13. State and local gasoline . 32 . Union dues
14,, General Sales Other (itemize)
15. Personal property (Boat and Aircraft) _
16. Other (itemize) _
33 . Total (Add Iines 30 through 32. Enter here and
on Form 540 , Iine 61 )
17. Total tares_ UAdd Vines 11 thru 16. Enter here and
on Form 540, Iine 57) Child Care and Adoption Expense
34_ Child care expenses Attach Form 3805X _
Interest Expense
35 . Tota | adoption expense
18.. Home mortgage
Less 3% of line 16 , Form 540
19. Other (itemize)
36 . Net adoption expenses 7 See instructions
for maximum limitations
37 _ Tota| child care and adoption expenses
(add lines 34 and 36. Enter here and on
20. Total__(Add lines 18 and 19. Enter here and on
Form 540, line 58)
2571
Form 540, line 62) .
Nw 88326 Docld:32245535 Page 23
drugs,
gross
Sek
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Page 24
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SCHEDLLE TAXABLE CALIFORMIA
B
1976
DiVidend AND INTEREST INCOME
Form 540 YEAR
Attach to Form 540
Soclal Securlty Number Name as shown on Form 540 SeLr_ Rubs 3227
PART 0~_DIVidenD INCOME
Linte 1 = Gross Divldends and Othet Distributions On tions) , less nontaxable portion; if any, on Form 540, page 1
Stock If gross dividends and other distributions (including capital Do NOT deduct the $100 federal exclusion:
""Capital dividends" are treated as ordinary dividends for
gain , dividends) on stock were Sa00 or)l0ss, do not complete State income tax purposes and nor as capital gains 99 permitted
9 this part; but enter gross dividends (including capital gain distribu- under the federal law.
Gross dividends and other distributions 0 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 0n line 11, form 540
PART II-_InTEREST INCOME
Interest on bonds,. debentures, loans, notes, tax refunds and all (6) Bonds (but not other obligations) of California and its
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 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 Note: If total taxable interest income was S400 Or |e8s, do
the United States. (Interest on Philippine Islands obligations not complete this part; but enter the total amount of , interest
issued on or after March 24, 1934 is not exempt:) received on Form 540, page 1.
1. Interest income -List payers and amounts_
NoZa_ON @eeRChy KLIIED 4
IUEC
TRINS W
WOKLL
2. Totel Interest Income. Enter here and on Iine 12, Form 540
NW 88326 Docld:32245535 Page 24
gain
polit-
prior
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Page 25
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TAXABLE
SCHEDULE
CALIFORNIA
19 22
PROFIT (OR LOSS) FROM-BUSINESS OR PROFESSION
YEAR
FORM 540 (Sole Proprietorships)
B4ONR Partnorehlpe; lolni ,vontores, ot6! muot Alo O1 Porm 963
Actach thts schodule t your Income tax roter, Form 800 or
Soclal Securlty Number
Name &s shown on 'Form 540 or 3E[EZ901 "2228Xub
Bs Federal Employer I.D. No.
A_ Name and Address of Business
Wboblty
Blso_CoFz ShEloss lnken E Znclnddn 9S_ E2zs
C. Principal business activity
retail-hardware; wholesale-tobacco; services-legal etc)_SzeQLCE iesh
D: Indicate method of accounting: 0 cash; Rraccrual; other_
E
Were Forms 591, 592, 596 ad 599, for the_calendar year filed (if required)? YES NO
{ Method of inventory valuation
Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening ad closing inventories?
0 YES NO If "Yes;" attach explanation.
Balance
Gross receipts, sales, or fees $ Less returns and allowances
2 Inventory at beginning of year (if different from last years closing inventory, attach explanation) .
3 Purchases $- Less cost of items withdrawn for personal use S
Cost of labor (do not include salary paid to yourself) .
5 Materials and supplies _
6 Other costs (explain in Schedule €2 or attach Schedule)
Total : of Iines 2 tn '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 Tetal Income (add lines 10 and 11) .
OTHER BUSINESS DEDUCTIONS
13 Depreciation (explain in Schedule C-1 or attach Schedule) _
14 Taxes on business ad 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 o ba ;is) _
25. Depletion ' (attach schedule) _
28 Other business expenses (explain in Schedule C-2 or attach Schedule) _
27 Total of Iines 13 thru 26 .
28 Net profit (or loss) (subtract line 27 from line 12), Enter here and O Page 2, Form 540 or 54NR
Zj
Depreciation Method of Life or Depreciation
Group and guideline class Date Cost or allowed (or allowable) computing Rate tor this year
2 or description of property Acquired other basis in prior years depreciation
3 1 U
8
]
LINE EXPLANATION AMOUNT LINE] EXPLANATION Amount
9 No: NO.
87
y
1
6
SCKEDULE 6 Om RiVerse W88828' Docld: 32245535 25
(i,e-
cash;
Page
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Page 26
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SCHEDULE
CALIFORMIa
TAXABLE
197,6
FoRm 540
CApItal GAins And LOSSES
YEAR
Attech to Form 540 Or 5408R
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.
S1i srcurlty Number Name as shown on Form 540 or 54ONR
Ruks [zii 797
PART Ky_Assofb Mold Ono Yoar Or Loos
Cort 0 owor Besl 4 djustod, eott 0t]subtt
Kind of property and descriptlon 6.. Date acquired Date sold 0_ Grets sales iadrorbeu (It Galn & loss
(Example, 100 shwres of "2" Co.) (mo. , day, Yr.) mo. , day, Yt, ) Pr ice not purthased otlcch (4_ lest 4) mplanatIan) a1d 6'
Danla 0 Llo
2 Enter (or loss), if applicable, 'from line 17 , Schedule D-} (540) (attach copy)
3_ Enter your share of net Or loss from partnerships and fiduciaries
4_ Not or loss, combine lines 1, 2 and 3
PART Ii_Assete Held More _Than One Year But Not_Moro Than Five_Years
53
tnstalwn
6. Enter (or loss), if applicable, from line 19, Schedule D-I (540) (attach copy)
7 Enter share of net gain or loss from partnerships and fiduciaries
8_ Net Or loss, combine lines 5, 6 and 7 (If gain, see 540 instructions, line 24a (Preference Income)) 3SS
PART I_Aseeto Held Moro Than Five_Years
IO. Entor (or loss) if applicable, from line 21, Schedule D-] (540) (attach copy)
11. Enter your share of net or loss from partnerships and fiduciaries
12. Net gain or loss, "combine lines 9, 10 and 11 (If gain, see 540 instructions Iine 24a (Preference Income))
PARI IV__Summary % Capital Gains 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 loss carryover from preceding taxable-
yeo? Guach compufation)
17. Combine the amounts shown on lines 13, 14, 15 ond 16
(L)
18. ' K line 17 shows gain, enter here and on page 2, Part Il of Form 540 or 54ONR
19. If line 17 ghows a loss, enter here and on page 2, Part Il of Form 540 or 54ONR 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) $1,000 (6500 in the case of a husband orwife filing a separate return) 6pp
NW 88326_Doeld:*32245535 Rage-26-
quont
gain
gain
gain
gain
Your
gain
gain
gain
and
capital
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Page 27
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Department of the Treasury-Internal Revenue Service 1040 US Pndividual income Tax Return
1975
Fur the year January [-Decemhcr J1, 1975, {i' vtlr (;uahle: yva beiinit; 1275, ene 19
Name (If joint return, give Iitst initials o hoth) Last name Your social security number For Privacy Act Notilication,
2 SaMLEL
ZEzX Rsg 322, 12922 see page 2 of Instructions:
6 Present home addtess (Nunber and steet 'ircluding: apaitmient number _ 0[ rural route) Spouse'$ social security no. For IRS use only
1 16z IQ_ BLRc*ER 3Y9_ 1elY2b
City, Xtwn or fust office State ami ZIP codc: Occu- Yos ZTe 1
KeANA
HLzs C#
pation Spouse' $
0 In wlal cly, village, 0 Ho yem live within thc levnl C Iu what county and State do Yuu live? D' In what lownship (o Requestcd hy
etc_, do live? limits o/ the city, town, elc.? State you live? (See page 4.) Census Bureau
for Revenue L
bHNgeial
Yes No Don't know
Lx Antele
Cx
Sharing
Enter number 0f
1 Single (check only ONE box) 6a Regular MYourself Spouse
boxes checked
2 Married tiling joint return (even if only one had income) b First names of dependent children who
3 Marricd liling scparately_ M sqwuse is also liling Wivc lived with you
TEnE
Enter
1
spouse' $ sucial secutity tumher in, designated `space above number
aaqe ere 'ull
L
Number of other dependents (from line 27)
Unmarried Head of_Household (See: page 5 of Instructions) d Total (add lines 6a b, and c)
Yourself Spouse Enter
e Age 65 or over numnber
of boxes
5 Qualifying widow(er) with dependent child (Year Btind Yourself Spouse: checked
spousc died 19 ) Sec Dzge 5 of Instructions_ 7 Total (add lines 6d and e) 4
8 Presidential Election [o you wish to designate $1 of your taxes tor this fund? Yes No Note: If Yoill chockincrease Yol
box(es) it not your 2 Campaign Fund I joint retutn, does your spouse wish to designate $12 Yes tax or reduce Your refund.
(Attach Forims W-2 If unavail- 9 9 Wages, salaries; tips, and olher employee compensation ablc, see pale 3 of Instructions.) ~
10a Dividends Sa" oPaiasuuctias $47 1ob Less exclusion $_
2
Balance 1Oc 2
(If gross dividends and other distributions are over $400, list in Part of Schedule 'B.)
If $400 or less, enter total without listing in Schedule B 11
3
L
11 Interest incotric M over %OO enter tolal ad list in Par Il o Schluile B
12 Incum othen uh WIk";, ilividlens, :d interest (Itm lin: 3G) . 12 8
0
13 Total (add lines 9, 1Oc, 1l, and 12) 13
31
14 Adjustments to income (such as "sick pay, moving expenses, etc from line 42) 14 7
(tf less than $8,000, sec page 8 of
15 Suhtract-line 14 fron line 13 (Adjusted Gross Income) structions on 'Earned Income Credit. 15 8s9.
1
you do not itemize deductions and line 15 is under $15,000, find tax in Tables and enter on line. 16a
you itemize deductions or line 15 is $15,000 or more, go to line 43 to figure tax:
CAUTION: If you-have uneamed income and can he claimed as a dependent o your parent'$ return, check here and see page 7 of instructions: 1
if from: Tax Tables Tax Rate Schedlule X_ Y, 0r Z
16a Tax, check
Schedule D Schedule G OR Form 4726 16a
b Credit for personal exetnptions (multiply line 6d by $30)
3
c Balance (subtract line 16b from line 16a)
17
17 Credits (froni line: 54)
18 8
18 Balance (subtract line 17 from line 16c)
19 Other taxes (Irom lite 63) 19
ZL
@
20 Total (add lincs 18 and 19) 20
(attach forms W-2 or 21a
L
21a Total Federal income tax withheld W 2p t0 front) amount on line 23 in 3
b 1975 estimated tax paymnents Siecludi,0mou;a afeowed 35 fuli with this return: Write
social secuirity number on
Earned incomn credit check or money order and
make payable 'to Internal 1
Amount paid with Form 4868 Revenue Service.
6 e Other payments (from line 67) 8ODQ
22 Total (add lines 21a through e) 22
8
23 If line 20 is larger than line 22, enter BALANCE DUE IRS 23
2
~(Check here if Form 2210_ Form 2210F , or statemcnt is attached. See page 8 of Instructions. Jei
24 V line 22 is Iargger than line 20, entcr amount OVERPAID 24
23}
25 Amount of line 24 to be REFUNDED TO YOU 25
3
6 26 Amount of line 24 to be cred: overhzyment (imne I5 i0 #ipe26. 1
refundled (line 25)_ make M10 emtry 0m1 ited on 1976 estimated tax_ 26 Y/ls 1r3ko_ ZL:liUIuLitHILIILIE
declare that navc examnined this return, including accompanying schedules and statements, and to the best 0f my knowledge and beliet it Under penalties of perjury,
Dcclaration of plepJiei (othcr than taxpayer) is based on all information of which pr eparer has any knowle
is truc_ cuttcct, and complete. Isign]
here
Date Preparer signature (other than taxpayer) Date
Your signatu
Spouse Giz5ture jointly, BOTA mnust sicn even if only one had incomne) Addtess " (and
261-3Y-&22
Zip Code)
16-.856-1
NW 88326 Docld:32245535 Page
Ionil;
1
the
No
Pay
4
edke.
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Form 1040 '(1975) Page 2
(a) NAME (b) Relationship (c) Months lived in your (d) Did de- (e) Amount You (t) Amount fur-
home. born or died pendent have furnished for de- nished by OTHERS
during year, write 8 or D income 0f pendent' $ sup including depend-
$750 or more? If 100 % ent. write ALL. 8
1
$
27 Total_number_of_depeudents 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) 28
F:5
29a Net or (loss) from sale or exchange of capital assets (attach Schedule D) 29a
29b 50% of capital distributions (not reported on Schedule D_~see page 9 of Instructions) 29b
30 Net or
(loss) fromn Supplemiental Schedule of Gains and Losses (attach Form 4797) 30 33L3
31a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) 3la
31b Fully taxablc pensions and anuitics (not rcported O Schedule E_~scc page 9 of Instructions) 31b
32 32 Farmn income Or (loss) (attach Schedule F)
dlues not #pply if refund is tor year in which you took the 33 33 State income tax refuinds stand:d dedliictionulhers sce page 9 01 Imstruction:; 34 34 Alimony received
35 Other (state nature and suurce -Sce pagc 9 ol Instructions)
35
36 Total (ada liucs "28 tlurough 35) Enter here and on line 12 36 522"
Pant II Adjustmnents to Income
37 "Sick pay: (attach Form 2440 or other required statement) 37
38 38 Moving expense (attach Form 3903)
39 Employee business expense (attach Form 2106 or statement) 39
40a Payments to a Keogh (H.R. 10) retiremert plan 40a
40b Payments to an individual retirement arrangement from attached Form 5329, Part 4ob 373
41 Forfeited interest penalty for premature withdrawal-~see page 10 of Instructions 41
42 Total (add lines 37 through 412. Enter here and 0n line 14 42 325
Part II Tax Computation (Do not use this part if you use the Tax Tables to lind tax.)
43 Adjusted gross income (from line 15) 43 8I22|
44 (a) If you itemize dledluctions, check here- and enter total (rom Schedlule ^_ Iine ^1
and attach Schedule A
(b) if you do not itemize deductions and line 15 is $15,000 or more, check here and: 44 $2c
if box on line 2 or 5 is checked, enter 16%, of Iine 15 but not more tham $2,600; box
'on line 1 or 4 is checked, enter $2,300; if box on line 3 is checkcd, entcr $1,300
45 Subtract line 44 from line 43 45
2852
46 Multiply total number of exemptions claimed on line 7, by $750 46 3263
47 Taxable income. Subtract line 46 from line 45 47
(Figure your tax on the amount on line 47 by using Tax Rate Schedule X Y, or 2, 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:
48 Retirement incomne credit (attach Schedule R) 48 3
49 Investment credit (attach Form 3468) 49
50 Foreign tax credit (attach Form 1116) 50
51 Contributions to candidates for public office credit-~see page 10 of Instructions 51
2
52 Work Incentive (WIN) credit (attach Form 4874) 52
2
53 Purchase of new principal residlence crcdit (attach Form 5405) 53
54 Total (add_lines 48 through 53). Enter_here and on line 17 54
55 Tax froni recomputing prior-year investmnent credit (attach Form 4255)'
Torue
55 2
56 Tax from) recomputing prior-ycar Work Incentive (WIN) credit (attach Schcdule) 56
57 Minimum tax. Check here if Forn 4625 is attached 57
8
58 Tax on premature distributions from attached 62 5329, Part 58
59 Self-employment tax (attach Schedule SE)
40 8
'Y@) /46
59 SE
60 Social security tax on tip income not reported to erployer (attach Form.4137) 60
61 Uncollected employee social security tax o tips (from Forms W-2) 61 2
62 Excess contrilution tax from attached Form 5329, Part IV 62
63 Total (k/ lines % Mhrouxh G) Euter here jd O line 19 63
ZQB
Pant Vl Othier Paymeuts
64 Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers--see page 10 of Instructions) 64
65 Credit for Federal tax 0 special fuels, nonhighway gasoline ad lubricating oil (attach Form 4136) 65
66 Credit from a Regulated Investment Companly (attach Form 2439) 66
67 Total (add lines 64 through 66) Enter here and on line 2le 67
U.S, GOVERMMENT /'Rinting OfficE 1975-0-575-050 Ju-4310-1
NW 88326 Docld: 32245535 Page 28
port:
gain
gain
gain
your
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Schedules A&B Itemized Deductions AND
(Form 1040) Dividend and Interest Income
1975
PDrerntaereven uheServicury Attach to Form 1040. See Instructions for Schedules A and B (Form 10402. Internal Revenue
Name(s as shown on Form 1040 Your social security
TamsC { 322 LY =
'5327
Schedule A--Itemized Deductions (Schedule B on back)
Medical and Dental Expenses (not compensated by insurance Contributions Sce page 12 of Instructions for examples )
Or otherwise) (See page 1l of Instructions:) 21 a Cash contributions for which you have
One half (but not more than $150) of in- receipls, cancelled checks or other
surance premiums for medical care. (Be
sure t0 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_
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:
Sce
a Doctors, dentists, nurses, ctc 22 Other than cash (sec page 12 of instruc-
tions for requirec statement)
b Hospitals
c Other (itemize include hearing aids, 23 Carryover from prior years
dentures, eyeglasses, transportation, 24 Total contributions (add lines Zla through
23). Enter here and on line 38
etc:)
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)
7 Total (add lines 4 through 6c) 28 Enter $1O0 or amount on line 27 , which-
8 Enter 3% of line 15, Form 1040 ever is smaller
29 Casualty or theft loss (subtract line 28
9 Subtract linc 8 {rom line 7 (if less than
(rom line 27) Enter hcre and on lino 39 ero, enter zcro) Miscellaneous Deductions (See page 13 0f Instructions )
10 Total (add lines 1 and 9). Enter here and IS21|
on line 35 30 Alimony paid
Taxes (See page.11 of Instructions_ 31 Union dues
11 State and Iocal incorne 32 Expenses for child and dependent care
12 Real estate services (attach Form 2441)
13 State and local gasoline (see gas tax tables) 33 Other (itemize)
14 General sales (see sales tax tables)
15 Personal property
16 Other (itemize)
17 Total (add lines 11 through 16). Enter 207 34 Total (add lines 30 through 33). Enter
here and on line 36 here and on line 40
Interest Expense (See page 12 of Instructions ) Summary of Itemized Deductions
18 Home mortgage
19 Other (itemize) 35 Total medical and dental_~line 10 Sz
36 Total taxes_~line 17 20z
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
20 Total (add lines 18 and 19). Enter here 28S 40). Enter here and on Form 1040, line 235L
and on line 37 44
16 82607-1
NWN 88326 Docld: 32245535 Page 29
T.yLLLS Ruey
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SCHEDULE C
Profit or (Loss) From Business or Profession
(Form 1040) Partnerships , JoirSolenfreprietorshig)
Must File Form 1065.
11975
Department of the Treasury
Internal Revenue Service Attach to Form 1040. See Instructions for Schedule € (Form 1040)-
Name(s) as shown on Form Social security number
322
Principal business activity (see Schedule C
6
product
INECc
7kz
B Business name WoODLEY
2e34%b
identilication number 626
K7S
D Business address (number and street)
LeoSI NI7
City, State and ZIP code NC(Ne CA 9 3L.6.
E Indicate method of accounting: (I) Cash (2) Accrual (3) Other Yes No
F Were you required to file Form W-3 or Form 1096 for 19752 (see Schedule C Instructions)
If "Yes; where filed
Was an Employer's Quarterly Federal Tax Return, Form 941, tiled for this business for ay quarter in 19752
H Method of inventory valuation Was there any substantial change in
the ,manner of dctermining: Quantities, cosls, or valuations belween the opening and closing inventories? (V "Yes, attach explanation)
1 Gross receipts or sales $_ Less: eturns and allowances $_ Balance
2 Less: Cost of goods sold and/or operations (Schcdule €-J, line 8) 1
3 Gross profit 3
4 4, Other incom: (atlach scheclulc)
5 Total income (add linies 3 id ^) 5
6 Depreciation (explain in Schedule C-3) 6
7 Taxcs 01 business Jd business property (explain in Schedulc C-2) 7
8 8 Rent on business property
9 Repairs (explain in Schedule €-2) 9
10 Salaries and wages not incluuded on line 3, Schedule C-l (exclude any paicl to yourself) 10
11 Insurarice 11
12 Legal and professional fees 12
13 13 Commissions
14 14 Amortization (attach statement)
15 (a) Pension and profit-sharing plans (see Schedule C Instructions) 15(a)
(b) Employee benefit programs (see Schedule C Instructions) (b)
16 Interest on business indebtedness 16
17 Bad debts arising from sales or services 17
|
18 Depletion 18
19 Other business expenses (specify):
(a)
(b)
(c)
8
4
(g)
(h)
(i)
JYUT
(i)
(k) Total other business expenses (add lines 19() through 19(i)) 19(k)
20 Total deductions (add lines 6 through 19(k))
Tza
20
21 Net profit or (loss) (subtract line 20 frorn line 5). Enter here and 0n Form 1040, line 28. ALSO
enter on Schedule SE, line 5(a) 21
2ssz
SCHEDULE €-1 Cost of Goods Sold and / or Operations (See Schedule C Instructions for Line 2)
1
Inventory at beginning of year (if different (rom last year's closing inventory, allach explanation)
2 Purchases $ Less: cost of items withdrawn for personal use $_ Balance 2
3 3 Cost of labor (do not include salary to yourself)
4 Materials and supplies
5 5 Other costs (attach schedule)
6 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
J0_82517-}
NW 88326 Docld: 32245535 Page 30
srUZEyLE# Ryien
Jez-84
"O8Employer
paid
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Schedule C (Form 1040) 1975 2
SCHEDULE C-2. Explanation of Lines 7 and 9
Line No Explanation Amount Line No Explanation Amount
$
SCHEDULE C-3. Deprecialion (See Schedule € Instructions lor Line 6) I you nced mnore space, you mnay use Form 4562.
Note: If dlepreciation is computed by using thc Class Lite (ADR) System Ior asscts placed in service atter December 31_ 1970, or the Guideline Class
Lifc Systetn for assts placed in service belorc Jatwary 1 1971, you must Iile Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline
Class Lile System). Excepl #$ Olherwisc expnessly provided in incomne tax rcgulations sections 1.167(a)-1l(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 a" elcction this taxable year fo usc Class Lile (ADR) System and/or Guideline Class Life Syslem.
Deprcciation Method o( Group and kuidelinc clas: b. Date c. Cost of allowed or alluwable computing Lifc Depreciation Ior
or descriptior of property acquircd other basis In pfior Ycats depreciatiun or rafc this year
1 Total additional first-year depreciation (do not includle in items below)
2 Depreciation from Form 4832 See Note
abuve 3 Depreciation from Form 5006
4 Other depreciation:
Buildings
Furniture and {ixtures
Transportation equipment
Machinery and other equipment
Other (specily)_
5 Totals
6 Less amount of depreciation claimed in Schedule C-l, page
7 Balance__~Enter here and on1 pagc 1 line 6
9ZY
SCHEDULE C-4_ Expense Account Information (See Schedule C Instructions {or Schedule C_4
Enter information wilh 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
2 whom the combined amount is less than $25,000, or for yourseli i
your expense account allowance plus line 21, page 1, is less than 3
$25,000.
Did you claim a deduction for expenses connected with: 5
(1) Entertainment facility (boat, resort, ranch, etc)? Yes No (3) Employees' families at conventions or meetings? Yes No
(2)_Living accommodations (cxccpt ciployecs 0 business)? Yes 1 mo (4) Emplvyec or Iamily vacalions nol reported on Form W-2? Yes No
U.S. GOVERNMENT ?RiniNG OFFICE 1915_0 575-053 M;361T-]
NW 88326 Docld:32245535 Page 31
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SCHEDULE D Capital Gains and Losses (Examples of property to be reported on this
(Form 1040) Schedule are and losses on stocks, bonds, and similar investments, and gains (but not 1975
losses) 0n personal assets such as a home or jewelry:)
Departmeat o tha Tcasuty
Intetnal Kovenue Setvice Attach to Forin 1040. See Instructions for Schcdulc D (Form 1040).
Naine(s) as shown 0u For 104u Social security number'
JamLEL [HYLLUS UBY
321 12
2992
Part | Short-term Capital Gains and Losses ~Assets Held Not More Than 6 Months D
Cost or other basis,
b.. Uate Date as adjusted (see Gain or (loss) Kind of property and description acquired sold d Gross sales price instruction F) and (Example, 100 shares of '2' Co.) (Mo., (Mo., day, yr.) expense ofsale
(d
2 Enter your share of nct short-teri or (loss) {rom partnerships and fiduciaries 2
3 3 Entcr nol or (loss), coibite lines 1 and 2
4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction !) 4(a)
(b) Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction !) (b)
E
5 Net_short-term gain_or_(loss)_combine lines 3, 4(a) and (b)_ 5
Part Long-term Capital Gains and Losses_
Assets Held More Than 6 Months
5
7
7 Capital distributions
8 Enter gain, if applicable, from Form 4797, line 4(a)(1) (see Instruction A) 8 5i 0S
9 Enter your share of net long-term or (loss) from partnerships and fiduciaries 9
10 Enter your share 0f net long-term gain from srnall business corporations (Subchapter S) 10
11 Net gain or (loss), combine lines 6 through 10 11' 3L07
12(a) Long-termn capital loss componcnt carryover from years beginning before 1970 (see Instruction !) 12(2) 1332
(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction 1) (b) 7a33
13 Net long-term or (loss), combine lines 1l, 12(a) and (b) 13
Part III Summary of Parts and Il
14 Combine the amounts shown on lines 5 and 13, and enter the net or (loss) here 14 S52Z1
15 If line 14 shows a
(a) Enter 50% of iine 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 15(a)
(b) Subtract line 15(a) fromn line 14. Enter herc and 0n Form 1040, line 29a (b)
16 line 14 shows a loss
If losses Jre shown 0n BOTH lines 12(a) and 13, omit lines 16(a) Jrd (b) Jnd &o to Part IV
(see Instruction J).
Otherwise,
(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;
If amount 0n1 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 16(a)
(D) Enter here and enter a5 a (loss) o Form 1040, line 29a, the smallest of:
The amount on line 16(a);
51,000 (S500 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,
(iii) Taxable income; as adjusted (see Instruction M) (b)
DO0L +
16--82514-[
NW 88326 Docld:32245535 Page 32
gains
less day , Yr.)
gain
guin
gain
gain
gain
gain
gain
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Schedule D (Form 1040) 1975 Pare 2
PartIV Capital Loss Limitation__Where Losses Are Shown o Both Lines 12(a) AND 13
17 Enter loss froni line 5; if line 5 is zero or a gain, entcr a zero 17
18
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 19
20 Reduce loss on line 18 to the extent of the gain, if any, o line 19 20
(6z6)
21 Combine liries 3 and 1l ard if gain, enter gain; if zero or a loss, enter a zero 21
sles
Note: If the 0n line 21 is zero, OMIT lines *2 through 28, and enter on line 29 the
loss shown 0n line 12(2).
22
22 Enter gain, if any, from line 11
f30E
23 Enter smaller of amount o line 21 or line 22 23
24 Enter excess of gain on line 21 over amount on line 23 24
25 Enter loss from line 4(a); if line 4(a) is blank, enter a zero 25
26 Reduce gain, if ay, on line 24 to the extent of loss, if any, o line 25 (see Instruction K) 26
27
27 Enter loss from line 12(a)
28 Add the gain(s) o line(s) 23 and 26 28
29 Reduce the loss o line 27 to the extent of the gain, if any, on line 28 (see Instruction 29 82
30 Enter smaller of amount o line 29 or line 20 (if line 29 is zero, enter a zero)
30
31
31 Subtract amount on line 30 from the loss on line 20
32
32 Enter 50% of the amount on line
33 222
33 Add lines 17, 30, and 32
34 Enter Iere ;d clter :8 & (loss) 0 Formm 10AU, Iine 29:, Uhc gmnallcst ol=
(a) Amount on line 33;
(b) $1,000 (S500 if matried and filing a separate return--see Instruction N for a higher limit not to exceed $1,000); 0r,
(c) Taxable Income_ as adjusted (see Instruction M) 34
LLozD
Complete Part V if You are Married Filing a Separate Return and Losses are Shown o Lines 4(a) and
Part V 14 (See Instruction N)
35 Combine lines 3 and 1l 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
36 Enter gain, if any, from line 3
37
37 Enter smaller of amount on line 35 or line 36
38
38 Enter excess of on line 35 over amount on line 37
39
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) 40
41
41 Enter loss from line 4(a)
42
42 Add the gain(s) o line(s) 37 and 40
43 Reduce the loss on line 4l to the extent of the gain, if any: on line 42 (see Instruction L) 43
Part VI
Computation of Alternative Tax (See Instruction W to See if the Alternative Tax Will Benefit You)
44
44 Enter amount from Form 1040, line 47
45
45 Enter amount from line 15(a)
46
46 Subtract amount on line 45 from amount 0n line 44 (but not less than zero)
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.
48 Enter share of certain long-term gains from partnerships, tiduciaries, and small business cor-
48 porations referred to as "certain subsection (d) gains' (sec Instruction W)
49
Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger 49
If line 49 is equal to or greater than line 47, check here and omit lines 50 through 54.
50
50 Multiply amount o line 49 by 50%
51
51 Add amounts on lines 46 and 50
52 Tax o line 44 or 45, whichever is greater (use Tax Rate Schedule in instructions) 52
53 Tax on the amount on lirie 51 (use Tax Rate Schedule in instructions) 53
54 54 Subtract amount on line 53 from amount o line 52
55 Tax on the amount o line 46 (use Tax Rate Schedule in instructions) 55
56 If the block o line 47 or 49 is checked, enter 5o% of line 45; otherwise enter 25% of line 49 56
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 4Z, enter _this alternative tax on Form 1040 linel6a 57
X U.S. GOVERNMENT PRINTING OFFICE 1975-0-575-054 10"82544-1
NW 88326 Docld: 32245535 Page 33
entry
31
gain
your
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SCHEDULE SE
(Form 1040)
Computation of Social Security Self-Employment Tax
Department of Treasury Each self-employed person must file 8 Schedule SE. Attach to Form 1040.
1975
Internal Revcnuc Scrvice See Earncd Income Credit Instructions on page 8 and Instructions tor 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 arc eligible for the Earned Income Credit. See Instructions
If you had more than onc business, combine profits and losses from all businesses and farms on this Schedule SE.
Important-The self-employment income reported below will be credited to your social securily record 'and used in figuring social security benefits.
NAME OF SELF-EMPLOYED PERSON (AS SHOWN ON SOCIAL SECLWRITY CARD) Social security number ot
SCAmuELKuB sclf-employed` porson [3z>
Business_activities_subject to_self-emplovment tax (grocery store, restaurant, Iarm, etc )
74i7yr2?z
If you have only farm income complete Parts and Ill. If you only nonfarm income complete Parts Il and Ili_
If_you have both_farm and nonfarm income complete Parts 4, Il, and IL.
Part Computation of Net Earnings from FARM Self-Employment
You may elect to compute your nct Tarm. earnings using the OPTIONAL METHOD, linc 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 farn self-employment (add lines 1(a) and (b))
FARM OPTIONAL METHOD (a) Not morc than $2,400, enter two-thirds of the gross profits 3 If gross profits
ftom farming arc: (b) More than $2,400 and (he net farm prolit is less than $1,600, enter $1,600
Gross protits Irom tamming wro the: tota1 gross profits Iroin Schedulo F Iine 28 (cush method), or line '72 ("ccrui
method), plus the distributive share 01 gross' prolits from tarm partnerships (Schedule K-I (Form 1065), Iine 14) a5 explained in instructions tor Schedule SE:
Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method
Part IL Computation of Net' Earnings Trom NONFARM Self-Employment
(a) Schedule C, line 21. (Enter combined amount if more than one business ) 552 1
(b) Partnerships, joint ventures, etc (other than farming)
REGULAR METHOD (c) Service as a minister, member of 3 religious order, or a Christian Science prac-
5 Net profit,or titioncr. (Include rental value of parsonage or rental allowance furnished:) If you
(loss) from: filed Form 4361_ check here and enter zero on this line
(d) Service with a foreign government or international organization
(See Form 1040 in- (e) Other structions for Iine 35.) Specify.
6 Total (add lines S(a) through (e)) 5q
7 Enter adjustments if any (attach statement)
8 Adjusted net earnings or (loss) {rom nonfarm sclf-employment (line 6, as adjusted .by line 7) 5
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 IlI.
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 nontarm profits; and you had actual net earnings from self-employment of $400 or more
tor at least 2 ot the 3 tollowing years: 1972 1973, and 1974. The nonfarm optional method can only be used tor 5 SE
taxable years:
NONFARM OPTIONAL METHOD
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) 81,800 0o
(b) Enter amount from line 3_ (If you' did not elect to use the farm optional mcthod, 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
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 14) as explained in instructions
for Schedule SE_ Also, include 8ross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7
Part Il 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 $4OO, you are not
subject to self-employment tax Do not fill in rest of schedule:)
14 The largest amount of combined wages and self-employment earnings subject to social security or railroad
retirement taxes for 1975 is 814.100
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
YoBL
U.5. GOVERNMENT PRIMTiNG OFFICE 195 0-575-058 18_82518-3
NW 88326 Docld:32245535 Page 34
the
your
have
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SOEDYOEC Y6E0SE Computation of Social Security Self-Employment Tax
Dcpartment ol tho Teosury Each self-cmployed person must file 0 Schcdule SE. Attach to Form 1040_
1975
Intarnal Revenuo Scrvico Sce Earncd Incomic Creclit Instructions on page 8 and Instructions tor Schcdulc SE (Formi 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 unlcss you arc eligible for thc Earned Income Credit. See Instructions.
If you had more than one business, combine profits and losses from all businesses and farms on this Schedule SE_
Important: The self-employment income reported below will be credited to your social security record and uscd in figuring social security benefits
NAME OF SELF-EMPLOYED (AS SHOWN ON SOCIAL SECURITY CARD) Social security number of "ZEyL o) FERRYA Ey
self-employed person
Business activities subject to_self-emploxmcnt_tax (grocery store, restaurant, farm, etc )
522Zalee_
If you have only farm income complete Parts and III: If you have only nonfarm income complete Parts Il and Iil:
If have both _tarm and nonfarm income_complete Parts 1, m,and Ill.
Part Computation of Net_Earnings from FARM Self-Employment
may elect to compute your net farm earnings using the OPTIONAL METHOD, line 33 instead 0f 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 linc 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 OPTIOMAL METHOD (a) Not more than $2,400, enter two-thirds of the gross profits 3 If gross profits
from farming are: (b) More than $2,400 and the net farm profit is less than $1,600, enter 81,600
Gross prolits from farming aro the total Kross profits Irom Schedule F Iine 28 (cash method), or Iine 72 (accrual
method), plus the distributive share of 8ross prolits Irom: farm partnerships (Schedulo K-l (Form 1065), line 14) a5 explained 'in instructions for Schedule SE
4 Enter here and 0n1 line 126), Ihc %uount 0n1 linc 2 or linc 3 if You elect thc farmn optionl mnothod
Part II Compufation of Net Eariings Trom NONFARM_Scli Emloymont
(a) Schedule C, line 21. (Enter combined amount if more than one business )
744Z1
(b) Partnerships, joint ventures, etc. (other than farming)
REGULAR METHOD (c) Service as a minister, member of a religious order, or a Christian Science prac-
5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished ) If you
(loss) from: filed Form 4361, check here and enter zero on this line
(d) Service with a foreign government or international organization
(See Form 1040 in. (e) Other structions Ior line 35.) Specify
6 Total (add lines 5(a) through (e))
261
7 Enter adjustments if any (attach statement)
8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted: by line 7)
ZYM0
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 IlI:
Note: You may use the nontarm optional method (line 9 through line 11) only it Iine 8 is less than 51,600 and less
than two-thirds ot your gross nonfatm prolits, and you had actual nct eamnings (romn scll-cmployment o 54O0 or moro
tor at least 2 ot the 3 tollowing ycars: 1972, 1973, and 1974. Thc nonfarm optional method can only be used tor 5 SE
taxable years:
NONFARM . OPTIONAL METHOD
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm)
81,600 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 f 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
Gross profits trom nonfarm business are the total of the gross profits Schedule C line 3, plus the distributive
share of gross profits from nomtarm partnerships (Schedule K-1 (Form 1065), linc 14) as explained in instructions
for Schedule SE_ include gross prolits trom services reported on Iines S(c), (d) and (e) as adjusted by line 7
Part II 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)
27
13 Total net earnings or (loss) from self-employment reported on line 12. (Il Line 13 is less than $400, you are not
subject to self-employment tax. Do not Iill in rest of schedule )
2Ylp
14 The largest amount of combined wages and self-employment earnings subject to social security or railroad
retirement taxes for 1975 is 814,100
15 () 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)
25
17 Self-employment income~line 13 or 16, whichever is smaller
18 Self-employment tax (lf 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
110
U.S, GOVERNMENT PRIKTiNG OFFICE 195 0-575-058 10--82518-3
NW 88326 Docld:32245535 35
your
you
You
from
Aiso,
TY
Page
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Page 36
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Supplemental Schedule % Gains and Losses_
Form
4797
Sales , Exchanges and Involuntary Conversions under 1975
Dopartment of tha Iroesury Sections 1231, 1245, 1250, 1251, and 1252
Intorntl Rovanue Servlco Tq be {iled with Form 1040, 1041, 1065, 1120, etc:-See Separate Instructions
Name(s) a5 shown on return Identlfying numbor
SAMLEL
YhyLLY
KMBY 3
2E1-2722
Part Sales or Exchanges Property Used in Trade or Business, and Involuntary Conversions
(Section 1231)
SECTION A. Involuntary Conversions Due to Casualty and Theft (See Instruction E)
Cost 0[ other besis
0. Kind of property (il necessaty, b Date acquired Date sold d Gross sales
iowedeRogciilionabie) provemontb 0l 0n4b569to' PiF; Gtin or(loss)
"decbilsddatiosho #deseiotive (mo . Yt.) (mo., YI. ) Price sinco acquisition chased _ attach explana. (d plus Iass details not shown tion) and expense 0l sale
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_
SECTION 0.~Sales (i
Exchanges 0 Property Used in Tradc or Business and Certuin Involuntary Conversions (Not Roportoble In Soc:
tion A) (See Instruction E)
NE
SLOI
Combine the amounts on line 3_ Enter here, and on the appropriate line as follows
(a) For all except partnership returns:
(1) If line 4 is a gain, enter such as a long-term capital on Schedule D (Form 1040, 1120, etc ) that is being filed. See
instructiori 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 II _ Ordinary Gains and Losses
Cost or other besis
Kind of property (if nccessaiy, Depreciation al cost of subsequent im Gain or(loss)
b Datc Jcquired Dato sold d_ Gross salcs lowed (or allowable) provemnents (if nol pul . (d plus Ioss attach additional dcscriptivc (mo., day, Yi.) (mo.. Yr.) prico sinco acquisition chascd _ attach explana details not shuwn below) tion) expense of sale
5 Amount; if any, from line 2()(2)
6 Amount, if any, from line 4(a)(2)
7 Gain, if any, from page 2, line 21
2zi3
8
9 Combine amounts on lines 5 through 8_ Enter here, and on the appropriate line as follows
3343
(a) For all except individual returns: Enter the or (loss) shown o 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 or (loss) on line 9, includes losses which are' to bc treated as an itemized (leduction on
Schedule A (Form 1040) (see instruction F), enter the total 0f such loss(es) here 'and include on
Schedule A (Form 1040) , line 29_~identify as 'loss from Form 4797, line 9(b)(1)'~
2.313'
(2) Redetermine the or (loss) on Iine 9, excluding the loss (if any) entered on line 9(b)(1). Enter here
and on Form 1040, line 30
16-~8250H- ] Form 4797 (1975)
NWV 88326 Docld:32245535 Page 36
im:
day , day.
gain' gain
day,
and
gain
@ain
gain
==================================================
Page 37
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Forni 4/9/ (1975) Page 2
Part IlI Gain From Disposition of Property Under Sections 1245, 1250_ 1251,
1252-_Assets Held More than Six Months (See Separate Instructions)
Disregard lines 18 and 19 if there are no dispositions of farm property or farmland, or if this form is filed by a partnership.
Date acquired Dato 10 Description of sections 1245, 1250, 1251, and 1252 property: (mo Yr.) (mo:'duys
(A)
UOzMBTa C6 EEEEhor
2 2Y
Z1z
(B)
(C)
(D)
(E)
Relate lines 1O(A) through IO(E) to these Property Property Property Property Property
columns (A) (B) (C) (D) (E)
11 Gross sales price
12 Cost or other basis and expense of sale
13 Depreciation allowed (or allowable)
14 Adjusted basis, line 12 less Hine 13
15 Total gain, line ![ less line 14
16 ii section 1245 property:
(a) Depreciation allowed (or allowable) allcr ap
plicable date (see instructions)
(b) Enter smaller of line 15 or 16(a)
17 If section 1250 property:
(a) Enter additional depreciation alter 12/31/63
and befure 1/1/70
(b) Enter additional depeciation alter 12/31/69
(c) Enter smaller of line 15 or 1765)
(d) Line 17(c) . times applicablc 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() times applicable percentage . (see
instruction G.4)
(h) Add_lines 17(d) and
18 If section 1251 property:
(a) - If farmland, enter soil, water, and Iand 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 ay excess of line 19(a) over line 19(b)
(d) ine 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 0f Part T Gains (Complete Property columns (A through (E) through Tine T9() before going to line 202
20 Total gains for all properties (add columns (A) through (E), line 15)
2412
21 Add columns (A) through (E), lines 16(b), [7(h) , 18(d), and 19(f). Entcr here and 0n line 7
2213 _
22 Subtract line 21 from line 20. Enter here and in appropriate Section in Part (see instructions E and G.2)
51os:
#U.S. GOVERNMENT Printing Officc 1975_0-575-158 16-82;004-1
NW 88326 Docld:32245535 37
sold
day_
STAL
Medt
(ale
1Z(0)
Page
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Page 38
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4798 Capital Loss Carryover
Form (From 1974 to 1975)
1975
Deparlmont of tha Treaeury Attach to Form 1040.
Intornal Ravonuo Servlce
Social Security Number
Name(8) 98 ahown on Form 1040
SAMAEL
TEyLL) Raey 322 12222
A, Who Should File.-_You will need to complete either
B. How to Compute Carryover: ~lf you have a capital
Part or Part Il of this form if you have a loss to
loss carryover, complete either Part or Part Ii of this
form, but do not complete both:
carry over to 1975.
1. Complete only Part if lines 4(a) and 12(a) on
your 1974 Schedule D (Form 1040) DO NOT SHOW A
You will have a
capital loss to carry to 1975 if the LOSS.
amount on your 1974 Schedule D (Form 1040) , line 2. Complete only Part Il if either (or both) line 4(a) or
16(a) , or line 33, is LARGER THAN the loss deducted line 12(a) o your 1974 Schedule D (Form 1040) shows
on your 1974 Form 1040, line 29. a loss.
Part 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 shown on your 1974 Schedule D (Form 1040), line 13. If that Iine is blank or shows
2
a loss, enter a zero
3
3 Reduce any loss on line 1 to the extent of any on line 2
Enter amount shown on your 1974 Form 1040, line 29
5
5 Enter smaller of line 3 or 4
6
6 Excess of amount o 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
8
9 through 12
9 Enter shown on your 1974 Schedule D (Form 1040), line 5 If that line is blank or shows
9
a loss, enter a zero
10
10 Reduce any loss on line 8 to the extent of any on line 9
11
11 Multiply amount on line 7 by 2
12
12 Excess of amount on line 10 over amount on line 11
The amount on line 12 is your long-term loss carryover from 1974 to 1975 that is attributable to years beginning
Note:
after 1969.
Enter this amount on your 1975 Schedule D (Form 1040), Iine 12(b).
Form 4798 (1975)
NWN 88326 Docld: 32245535 Page 38
capital
gain
gain
gain
gain
capital
==================================================
Page 39
==================================================
Tlt
Form 4798 (4975)
Pago 2
Part Il Pre-1970 and Post-1969 Capital Loss Carryovers
Sectlon A._Short-term Capltal Losses Identlflod
1 Enter loss shown on your 1974 Schedule D (Form 1040),. Iine 5; if none, enter zero and Ignore
lines 2 through 20 ~then g0 to line 21
65
2 Enter gain shown on your 1974 Schedule D (Form 1040), line 13,_lf that Iine is blank Or shows
2
a loss enter a zero
3 Reduce loss on line 1 to the extent of any on line 2 3
3374Z
Note: It line 4(a) on 1974 Schedule D (Form 1040) is blank, IGNORE lines 4 through 11, enter
a zero on line 12--then go to line 13.
Combine lines 3 and 11 on your 1974 Schedule D (Form 1040).
Enter the gain; or if zero or a loss, enter a zeto
0
Note: If line 4 is zero IGNORE lines 5 through 11, enter on line 12
the loss from your 1974 Schcdule D (Form 104O), line 4(0)
thcn &o t0 lino 13.
5 Enter any gain fromn your 1974 Schedulo D (Formn 1040). lino 3 5
6 Enter smaller of line 4 or 5 6 D
1 Enter excess of gain on line 4 over line 6
8 Enter loss from your 1974 Schedule D (Form 1040) , line 12();
otherwise, enter a zero
62322
9 Reduce any gain on line 7 to the extent of any loss on line 8 9 W3zZ
10 Enter loss from your 1974 Schedule D (Form 1040), line 4(a); other-
10 ~0
wise enter a zero
11 Add the gains on lines 6 and 9 11
12 Reduce the loss on line 10 to the extent of any on line 11 12
13 Pre-1970 short-term capital loss (Enter smaller of line 3 or 12) 13
14 Short-term capital_loss attributable_to years_beginning_after_1969 (excess_of_line 3 over_line 13) _ 14
Section B:_Computation of Capital Loss Carryovers to 1975
15 Enter any loss from line 13, above 15
16 Enter loss deducted on your 1974 Form 1040, line 29 16
1070
17 Loss carryover to 1975 (excess of line 15 over line 16 ~If line 15 does not exceed Iine 16, enter
zero). Enter here and on your 1975 Schedule D (Form 1040), line 4(a)
LbD
18 Enter any loss from line 14, above 18
22
19 Enter excess of line 16 over line 15 ~if line 16 does not exceed line
15, enter zero 19
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 1975 Schedule D (Form 1040) , line 4(b) 20
(nYL)
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 21
(61222y
22 Enter excess of line 19 over line 18-~if line 19 does not exceed line
18, enter zero: (Note: If you ignored lines 2 through 20 above, enter
amount from your 1974 Form 1040, line 29.) 22 = 6
23 Loss carryover to 1975 (excess of line 21 over line 22_~if line 21 does not exceed Iine 22, enter 12322
zero). Enter here and on 1975 Schedule D (Form 1040), line 12(a) 23
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
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 Ilne 25, enter
~iz2
zero)_ Enter here and on your 1975 Schedule_D(Form_1040)_line_12(b) 26
NI 88326 Docld:32245535 Page 39
~0 _
gain
your
gain
your
83 3)
==================================================
Page 40
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NAME:
SaMuel LluyLlis
CALENDAR YEAR 19
2
ADDRESS
321 = /2-2222
SOC. SEC. NO
DEDUCTION SCHEDULE
ME OICAL STATE FEDERAL CONTRIBUTLONS STATE FEDERAL
2mEDICiNE/oruGs 21a CASH CONTAIBUTIONS
3LESS 1 % A.G.I. (Line 18 1040) 21b PARTNERSHIP SHARE
4NET MEDIDRUGS GirLiboy SCOUtS
50 & A INS. (Y EXCESS)
62 HEART FUNDICANCER FUND
6a DR_ RED CROSS/UNITED FUND
To
DR: XMAS & EASTER SEALS
DR_ MISC. ORGANIZED CHAAITIES
DR
377 CHURCHES
DR_
DA_
DR_
Dr
22 OTHEA THAN CASH
23CARRY OVER FROM PRIOR YRS_
6b HOSPITAL 24 TOTAL CONTRIBUTIONS TO
PROSTHETIC APPLIANCES
CASUALTY OR THEFT(OSSES)
heARiNG AID 25 Loss BEFORE ADJUSTMENT
26 INSURANCE IMBURSEMENT
6c AMBULANCEE 27
LABORATORIES 28 (S100 LimitATion PEI CAS'
TRAVEL FOR MED_ OPD 70 29 Tot.CAS. Or THEFTLOSS
MSCELLANOUS DEDUCTIONS
MEDICARE INS_ 30ALIMONY
GLASSES 31 UNION/PROFESSIONAL DUES
7MEDICAL EXPENSES
76Z4 762Z 32 CHILD & DEP.CARE (Form 2441)
LESS REIMBURSED BY INS 33INCOME TAX PAEPARATION
8 LESS 3% ADJ. GROSS INC 220 377 UNIFORMSIPROTEC. CLOTHING
9 132L SMALL TOOLS AND SUPPLIES
+Y(TO S150) OF H & A INS_
3
LAUNDRY AND CLEANING
MIOTAL MEDICAL DED
H
AUTO USEIDAMAGE
TAXES INVEST.COUNSEL & PUBS.(Schcd
11STATE & LOCAL INCOME EMPLOYMENT AGENCY FEES
12 REAL ESTATE SAFE DEPOsIT BOX
13 STATE & LOCAL GASOLINE YS TEL REQ.IN BUSINESS
14 GENERAL SALES TAX LLs POLITiCAL ContriBuTiONS
15a PERSONAL PROPERTY
15b PERSONAL PROPERTY AUTO 22
16 SALES TAX AUtu 50
34 TOTAL Misc_ DED
SUMMARY OF ITEMZED DED STATE FEDERAL
ZZ 35Fov DEDUC TI8LE MEDIcAL & DENTAL 17 TOTAL TAXES
77
EXPENSES FROMLINE 40
WNTEREST (TO WHOM PALDJL 36 TOTAL TAXES (From LINE 17)
18 MOR TGAGE
2ZL 37 TOAL INTEREST (Line 20)
38 TOTAL CoNtR: (Line 24)
39CAS. & THEFT LOSS(ES) (Line29)
19 INSTALLMENT LOANS MUY 40 B2B88T85SE{FRONVEQHEE 34)
WEEZ)
22|
Yi"
LoD 41 TOEH BiEFoRRR
Form
3EDuCTRN5 723 7STT5
REMAAKS
20 TOTAL INTEREST 02
572
Professional Stationers, Irc. PSI
7 JAO) Lalel CAnyrr: Eudevatd Form 101
Nuth Akdlywr)d, Calitcxt) 9160S, SCHEDULE
NW 88326 Docid: 32245535 Page 40
Kuey
RE
==================================================
Page 41
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NO CALENDAR YeaR 19_
2
NAME 0r
SOC SEC . NO _ 322- = F |SCAL YE AR End inG
ADD RE S $
9_
ScHEDULE OF PROFIT OR LoSS FROM BUS INESS OR PROFESS TON
PRINCIPAL Bus INESS AcTivity
[MfioyERS No BUS INESS NaME
RUS INESS ADoRESS
ToTAL RECE iPts
7322X4
inVENToRY At BE G inniNG 0F YEAR
E0O
MEncMAND / SE PUrckASED
LY3L
ToTAL
24232
LESS InVEnToRY At End 0F YEAR
b
GR oss Prof | T
GR oss Ncome
2092
othER BUS |NESS dEdUc T | ONS
ADVERTising
T7
AuTo AND Truck EXPENSE
Tgoo
BAO DE BT $
Comm SS |ONS
DEL |VERY
DEPRECiAtion SCHEDULE DELo#
3
OUES AmD SUTScR PT |OnS
ENTERTAINMENT AnD Pr omot | ONAL
INSURANCE
TE
iNTEREST
JANiTor AnD HAUL iNG
LE GAL AND Accounting
To
0f F |CE SUPPLIES AND EXPENSE
RENT
TDT
RE PA | R5 AnD MA INTENANCE
61<
SALAR |ES And #AGFS
7632
SUPPL IES
TAXES AND LICENSE S
ZO
TAXES PAYROLL Sz.
TELEPMONE AND UtilitiES
1Z4
ZE EXTAGT" Feae
7Y
NE T PRoF | T 0 R (oss FE OE RA l RETURN
L2
NE T PRoF | T OR (oss' S TA TE RE TIRN SEE DEPREC _ SCHEDUL E FOR
DTHZEZTWTY
SCHEDULE OF_DEPRECIATION
DATE YEARS cost OR PRIOR DEPRECTATION
NO_ KinD ANDd LOCATION OF PROPERTY ACQUIRED METH; OR % OTHER BASIS DEPREC. This YEAR
EUTPMEM zphxs2yjzozz4 12244 CY
73.6ZUZZL [Zix 3S67D L0
Pr 0fEss O#AL STAT | OnERS InC Form 1044 SCHEDULE
Los AMGELES CAL ! f
NW 88326 Docld: 32245535 Page 41
Stnuey2 {gulz' &
Kuey
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Page 42
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Sa
BMEL2{nxLhl!e
or
Kuey
Calendar Yr:
192
NAME SOC. SEC. NO_ FIYIE 19_
GAINS ON INSTALLMENT SALES
DESCRIPTION OF PROPERTY
4xz5}
~#EAP
DATE ACQUIRED DATE SOLD
973ZZ5
TYPE OF ASSET CAPITAL SEC. 1245 SEC. 1250
1,SELLING PRICE: CASH $
s2OLYG
S
2 NOTES 48isz
3 MORTGAGE TRANSFERRED
4. OTHER
5. GROSS SALES PRICE (1+2+3+4)
B22201
6_ COST OR BASIS S S528 S
7_ LESS ACCUMULATED DEPRECIATION
8_ PRIOR TO 1-1-62
9 PRIOR TO 1-1-64
10. AFTER 12-31-61 23/2
11 ST_ LINE AFTER 12-31-63
12. EXCESS OVER S/L 1-64/12-69
13. EXCESS OVER SIL AFTER 12-31-69
14 ADJUSTED BASIS (6_7 THRU 13) 429
15. EXPENSES OF SALE 2?2_
16. TOTAL ADJUSTED BASIS (14 + 15) Y3L3
17, TOTAL GROSS PROFIT (5 ~ 16) S
18. TOTAL GROSS PROFIT ORDINARY $ 1Z13 $
19. TOTAL GROSS PROFIT OTHER S228YI $
20. CONTRACT PRICE (1 + 2 + 4) S S B23D S
21 GROSS PROFIT % % 35_ 2% %
22. PAYMENTS RECEIVED YEAR OF SALE
23 CASH (1) 2OL?
24 PRINCIPAL COLLECTIONS 0
25. EXCESS MORTGAGE OVER BASIS
26_ OTHER (4)
27. TOTAL PAYMENTS (23 THRU 26) 2ol&
28. RECOGNIZED GAIN
29. RECOGNIZED GAIN ORDINARY 23L3
30 RECOGNZED GAIN OTHER SLD
ORDInARY iNcOME
TAX- TO TAL LESS INT SECTION 1245 SECTION 1250 CAPITAL GAIN
ABLE PAYMENTS (To PT. 2.
YR SEC_ 3) REPORTED BALANCE REPORTED BAL ANCE REPORTED BALANCE
02S None TE T5yl
NW 88326
=fe
Docld:
88
32245535
7s
Page.42
#NCFi Fc 04i IF FOpi 0f
CcHFOMF
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Page 43
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RESIDENT INDIVIDUAL
TAXABLE YEAR
540 @
CALIFORNA
INCOME TAX
1,915
PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) Check LCalendar Year Enter social security number(s) only if incorrect or not shown on label, One: LJ Fiscal Year Ending_ 1976
NAME (lf joint return, give first nd initials of both) LAST NAME FOR FEDERAL PRIVACY Act NOTIFT -
CATion SEE PAGE 2 OF inSTRUCTionS AnuEL LS Ruey
Your Social Security Number
PRESENT HOME ADDRESS (Number and' including apartment number/Zrrural route) 311 L 2222
Spouse $ Social Security Number
City, TOWN OR
L62 fo_
PosT OFFICE, STATE AND Zip
3Y2 Da
cop
Occu- Yours 6RANADA LL
Ca_
PATion Spouse'$
FILING STATUS Check Only One: EXEMPTION CREDITS
If line or 3 checked, enter $25
6 Personal If line 2, 4 or 5 checked, enter 550 00
2 Married joint return if only one had income) Dependents Do not list yoursell, youi spouse or the person who qualifies You
3 Separate return of married person_Enter spouse'$ as head of household. Enter name and relationship.
social security mmher and full name here
Ehomfa J
Head of Household- Entcr namc of qualilying Total Numher X S8 00
individual_
8 Blind (refer to instructions) Number of blind exemptions X $8 8 00
5 Widowler) with dependent child (Year spouse died i97_ 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20 9 00
10 salaries, tips and other employee compensation - Attach copy 2 of Form(s) w.2 to {ace 0f this return_ If unavailable, see instructions, Page 6 10 3
11 Dividends__before federal exclusion; Enter total (if over $400, complete ad attach Schedule B(540) ) 11
12 Interest Enter total (if over 5400, complete and attach Schedule 8(540) ) 12
13 Income other than wages, dividends and interest (from Iine 48) 0
14 Total (add lines 10, 11; 12 and 13)
13
14 8
8 15 Adjustments to income (from line 55)
15
16 Adjusted gross income (subtract line 15 from line 14) 2
If line or 3 is checked and 16 is $4,000 or enter zero tax 0n line 23. Do not complete
5 line 2_ 1 , 0r 5 is checked and line 16 is $8,000 or less, enter zeto tax on linc 23. lines 17 thru. 22
&a*y
16
0 you do NOT itemize deductions AND line 16 is under 515,000, tind tax in Tax Table and enter on line 19. 3
you itemize deductions OR Iine 16 is $15,000 or more, complete Vines 17 and 18.
17 Deductions: Itemized (from Iine 62) OR STANDARD ($1,000 if line
1 or 3 checked__$2,000 if line 2, or 5 checked) 17
5238 1
18 Taxable_income (subtract_line 47 Irom line 16) Compute tax fxm Tax Rate Schedule_Enter
tax 0n line 19 18 32
19 Tax from (check one) Table O Tax Rate Schedute Income Averaging Schedule (G or G-1) D 19
20 Total exemption credits (from line 9, above) 20
21 Tax liability (subtract line 20 from line 19_if line 20 is greater than line 19, enter zero) 21
22 Other credits (from line 65)
22
23 Net tax liability (subtract line 22 from line 21-if line 22 is greater than iine 21, enter zero) 23
24 Tax on preference income (see instructions-_attach Schedule P(540) ) 0
25 Total tax liability (add lines 23 and 24) 24
25
26 Total California income tax withheld (attach W-2 or W-ZP" to of this return) 26
1
27 Renter'$ credit _-if you lived in rented property 0n March 1, 1975, complete Part 1
0n page 2 27
28 1975 California estimated tax payments 28 1
29 Excess California SDI tax withheld (attach Form DE 1964 to face of this return) 59
30 Total prepayment credits (add lincs 26 (hru 29) #[
31 If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter
30
zero_ 2 6 in full and mail with return to: Franchise TaX BOARD
SACRAMENTO, CA 95867 PAY In FULL 31
5
1
32 If line 25 is smaller than Iine 30, enter amount OVERPAID Do not write in these spaces
32 2 5 33 Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks;
Mail return to: FRANCHISE TaX BoARD 33
'
[
P.O. BOX 13-540 1 SACRAMENTO, CA 95813
A 1 34 Amount of line 32 t be credited 0n your 1976 ESTIMATCD TAX
34 ESTIMATED TaX: R
Under Penalties of perjury , declare that have examined this return including accompanying schedules and
belief it is true, correct ond complete. If prepared by Person other than his
statements, ond to the best of my knowledge ond { taxpayer, declaration is based on oll informotion pf which he has any knowlodje.
ISIGN
Your sipnature Date Preparer'$ , signature (other than taxpayer) Date HErcid:378333"
Spouse'$ ureif @li73 Jint retura Date Address (and Zip code)
202-3Y36
NW 88326 Page
YYit
RELE;+EE
Single
filing (even
Wages,
334
linc less,
Tax
face
Pay
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Page 44
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2 Form 540 (1975)
PART ~ Renter's Credit - All questions must be answered
35 Did you, on March 1, 1975, live in rented property which was your principal residence? Yes No n0, you may not claim this credit
36 Was the property you.rented exempt from property tax? Yes No if yes, you may not claim this credit
37 Did you live with ay other person who claimed you as a dependent for income tax purposes? Yes No If yes, you may not claim this credit
38 Did you or your spouse claim the homeowners' property tax exemption or receive public assistance? Yes No If yes, see page 6 of Instructions
PART Il Other Income
39 Business income (or loss) (attach Schedule C(540) 39
40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule D(540) 40 U
41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule 0-1(540) 41
73131
42 Pensions and annuities 42
43 Rents and royalties Attach 43
SCHEdULE E 44 Partnerships Foam (540)
45
45 Estates and trusts
46 Farm income (or loss) (attach Schedule F(540) 46
47 Miscellaneous income
(a) Fully taxable pensions ad annuities (not reported on Schedule E(540) 47a]
(b) Alimony 47b
(c) Other (state nature.and source)_ 47c
Enter total of lines 476a) , 47(b), and 47(c) 47
48 Total (add lines 39 thru 47). Enter hcre and on line 13 48
[ezt
PART Ili Adjustments to Income
49 "Sick pay;' if included in line 10 (see instructions attach statement) 49
50 Moving expenses (see instructions attach statement 50
51 Employee business expenses (see instructions attach statement) 51
52 Military exclusion instructions) 52
53 Payment as a self-employed person to a retirement plan, etc. (see instructions) 53
54 Forfeited interest penalty (see instructions) 54
55 Total adjustments (add lines 49 thru 54). Enter here and on line 15 55
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) 56
57 Total child adoption expenses (from Schedule A(540}, Iine 13) 57
58 Total taxes (from Schedule A(540), line 20) 58
59 Total interest expense (from Schedule A(540), Iine 23) 59
60 Total contributions (from Schedule A(540), Iine 28) 60
61 Total miscellaneous deductions (from Schedule A(5401, 1 line 39) 61
62 Total itemized deductions (add lines 56 thru 61). Enter here and on line 17 62 73
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) ) 63
64 Retirement' income credit (attach Schedule R(540) ) 64
65 TOTAL (add lines 63 and 64). Enter here and on' line 22 65
PART Vi Reconciliation to Federal Return If adjusted gross income on Federal Return is different from Iine 16,page 1, explain below:
bKEX
R-A3
NW 88326 Docld:32245535 44
Page
(see
Page
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Page 45
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SCHEDULE TAXABLE
A
CALIFORNLA
41975
ITEMIZED DEDUCTIONS
YEAR FoRM 540 Attach to Form 540
Soclal Securlty Number Name as on Form 540 LYLLLS
Ruey
3421-2322
If your adjusted gross Income is $8,000 or less and your fillnz status Is "Married , Flling Jointly,' "Hcad of Household," or "Widowler) With Dependent Chlld,'
or $4,000 or less and your status Is "Slnglo;' or Karried, Separately," do not itemize, enter zero 00 Form 540, Iine 23, &nd check the tax
table box.
USE Only If YOU d0 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,
21 . Home mortgage hospital care, insurance premiums for medical
care, etc. 22. Other (itemize)
1 One half (but not more than S150) of insurance
premiums for medical care
Gt
2__ Medicine and drugs _
35 Enter 1 % of line 16, Form 540_ 23. Total-_(Add lines 221 and 22. Enter here and On
4. Subtract line 3 from line 2. Enter difference (if less Form 540, line 59)
than zero, enter zero)
5_ Enter balance of insurance ptemiums for medical care
not entered on line 1 Contributions
6. Other medical and dental expenses: 24. Cash contributions for which YOU have receipts,
(a) Doctors, dentists, nurses, etc_ canceled checks, etc:
(b} Hospitals 25. Other cash contributions, List donees and amounts
(c) Other (itemize)
26. Other than cash:--See instructions for required state-
7. Total__(Add lines 4, 5, 6a, b, and c) _ ment
0. Enter 3% of Iine 16, Form 540 _ 27 . Carryover from 1974__See instructions
9_ Subtract line 8 from line 7_ Enter difference (if less 28. Total-__(Add lines 24, 25, 26, and 27. Maximum de-
than zero, enter zero) duction may not exceed 20% of adjusted gross
10, Total_JAdd . lines 1 and 9. Enter here and, 0 Form income. Enter here and on Form 540, line 60)
540, line 56) _
Miscellaneous Deductions
Chiid Adoption Expense Casualty or Theft Lossles) See instructions
11. Total expenses paid or incurred__Attach itemized list NOTE: If you had more than .one loss, omit lines 29
through 33 ad follow instructions for guidance.
12. Enter 3% of line 16, Form 540_
13. Subtract line 12 from line 11-See instructions for 29. Loss before insurance reimbursement:
maximum limitations (Enter here `and on Form 540, 30. Insurance reimbursement
line 57) _ 31 . Subtract line. 30 from line 29. Enter difference (if line
30 is greater than line 29, enter zero)
Taxes 32. Enter $100 or amount on line 31, whichever is .smaller
14. Real estate 33. Casualty or theft loss (line 31 less line 32) _
15. State and local gasoline . 34 . Alimony
16. General Sales_ 35. Child care_ See instructions
17. Auto license-_Excess of registration and weight fees 36. Union dues
(see instructions) _ 37. Employment education expense_See instructions _
18. Personal property (Boat and Aircraft _ 38. Other__(itemize)
19. Other (itemize) .
Z
39. Total_Add lines` 33, 34, 35, 36, 37, and 38. (Enter
20. Total texes_(Add lines 14 thru 19. Enter here and 1262
here and on Form, 540, line 61) .
on Form 540, line 58) _
NW 88326 Docld: 32245535 Page 45
show3?ASiEL;
Flling flllng
285
o
paid ,
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Page 46
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SCHEDULE TAXABLE
C
BALIFORNIA
19 2
Form 340
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
(Solo Preprlotorshlps)
Attaeh thb ehodula' t0 your Incomo tar rten, Bormn j40 Or MONR Perteoreblet: Iolnt vontored, ete, Musf Alo 0a Form %
Soclal Security Number Name as shown on Form 540 or 54ONR
QAMnELX 322-12-222_
A Name and Address of B. Federal Employer |.D. No.
Waopl
EYEFTAoCEEEE
95-2651Z2
C, Principal business activity (i.e-, retail-hardware; wholesale-tobacco; services-legal; etc )
ZERMICE FNRLEBAR
D. Indicate method of accounting: 0 cash; Kaccrual; other_
E, Were Forms 591, 592, 596 ad 599, for the calendar_yeer-filed (f required)? YES No C
F Method of Inventory valuation
Was there &y substantial change in the manner of determining quantities, costs, or valuations between the opening &d closing Inventories?
YES NO If "Yes;' attach explanation.
Gross recelpts, sales, Or fees $- Less returns and allowances Balance
2 Inventory at beginning of year (if difterent from last year's closing inventory, attach explanation) .
3 Purchases $ Less cost of items `withdrawn tor personal use $
Cost of labor (do not include salary paid to yoursell) _
5 Materials and supplies .
6 Other costs (explain in Schedule €2 or attach Schedule)_
Total of Ilnes 2 tn 6
8 Inventory at end of this year .
9 Cost of goods sold (subtract line 8 from line 7)
10 Gross prolit (subtract Iine 9 Irom line 1).
11 Other income ' (attach schedule) .
12 Total Income (add lines 10 and 11)_
OTHER BUSINESS DEOUCTIONS
13 Depreciation (explain in Schedule C-1 or attach Schedule) _
14 Taxes on business ad business.property (explain in Schedule €-2 or attach Schedule) _
15 Rent on business property
16 Repairs (explain in Schedule €.2 or attach Schedule)
17 Salaries and wages not included on line (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 0n business indebtedness
24 Bad debts arising from sales or services (Not applicable if reporting o cash basis)_
25 Depletion (attach schedule) _
26 Other business expenses (explain in Schedule C2 Or attach Schedule}_
27 Total of Iines 13 thru 26 _
28 Net profit (or loss) (subtract line 27 from Iine 12), Enter here and on 2, Form 540 or 54ONR
SCl
25$ 9
Group and guideline class Date Cost or
Depreciation Method of Life or Depreciation
2 or description of property Acquired other basis
allowed (or allowable) computing Rate for this year
in prior years depreciation
3 4 U
5
]
LINE EXPLANATION AMOUNT LINE} EXPLANATION AmOUnT % NO. NO:
833
y
:
'6
NW 88326 Docld: 32245535 Page 46
Y+yLLLS Ruey
Stee
Page
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Page 47
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SCHEDULE
CALIFORMIA
TAXABLE
0 1975
Form 540
CAPITAL GAINS AND LOSSES
YEAR
Attach to Form 540 or S4ONR
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 fewelry.
Name as shown on Form 540 or 54ONR Iohi Scurlty Numbor
SaMMEL_
Zuey
B22[2i2292
PART |-_Assets Held Ono Year or Loss D
Cott 0r other bash
edlusted_ cost ot subIt- Kind of property and description 6 Date acquired Dale sld d Gross sales ~qutnt improrements (It Galn or Ioss
(Example, 100 shares of "2' Co. (mo., day, Yr.) (mo:, day, yr.) price not purchated attech (0. Iest 4) eplanat Ion) and
pente of gla
1424 Loss larGNavitt
Loi36.0)
Mee_l??Y 1o
2 Entor (or loss) , if applicable, from 18, Schedule D-1 (540) (alach copy)
3_ Enter your share of net or loss from partnerships and fiduciaries
4 Net or loss, combine 1, 2 and 3
PART II_Assets Held More Than One Year But Not More Than Flvo Yoars
5
6. Enter (or loss) if applicable, from line 20, Schedule D-I (540) (attach copy) Zoj
7 Enter share of net or loss from partnerships and fiduciaries
8. Net or loss, combine lines 5, 6 and 7 5VZ
PART III_Assets Held More Than Five Years
10. Enter (or loss), if applicable, from line 22, Schedule D-I (540) (attach copy)
11. Enter your share of net or loss from partnerships and fiduciaries
12. Net gain or loss,. combine lines 9, 10 and 11
PART IV_Summary % Capital Gains and Losses
13, Enter amount from line 4
14, Enter 65% of the amount on line 8
3372
15. Enter 50% of the amount on line 12
16. Enter unused capital loss carryover from preceding taxable years (attach compuation)
(9a6e
17 . Combine the amounts shown on lines 13, 14, 15 and 16
(Lexz)
18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or 54ONR
19. If 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 54ONR the smallest of:
(a) amount on lines 17;
(6) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
of capital assets; or
(166p
NW
',883Je) 0i8 9A3i708595the 688e4f a husband or wife filing 0 separate return)
YiYLLU
line gain
gain
lines gain
gain
gain Your
gain
gain
gain
Iine
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Page 48
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SCHEDULE TAXABLE
0-1
CALIFORNIA
19225
SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
YEAR FoRM 540
(Sales or Exchanges Including Involuntary Conversions)
(Attach to Form 540, 54ONR, 541 or 565)
Identifying number a9 shown 0n return Name as shown on Tax Return
SAMuE ! LLS
Ruey 322-12-2992
D:1
PART Gain From Disposition of Property Under Sections 18211, 18312-18, 18219, 18220
Lines 9 and 10 should be omitted if there are no dispositions_of_farm_property or farm land; 0r, if this form_is filed by a partnership:
Date acquired Date sold Description of Sections 18211, 18212-18, 18219, and 18220 property _ Mo:, Yr.) (mo , day, Yr.)
(A) D ~€EEzIR
9
(B)
(D)
Correlate lines I(A) through 1() wilh Ihese columns Property Property Property Property
(A) (8) (C) (d)
2 Gross sales price
3 Cost Or other basis and expense of sale
4_ Depreciation allowed (or allowable)
5. Adjusted basis, line 3 lcss line 4 45
6. Total_gainsubtract_line_5_from_line_2
If Section 182 1 1 property:
(a) Depreciation allowed (or allowable) after applicable date_
(See Instruction D-3)
(b) Line 6 or line Z(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 of line 6 over line 8(b)
(6) Enter line &(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
If Section 18220 property:
(a) If farm land, enter soil and water conservation expenses
for current Year and four preceding Years
(6) If farm property, other than land, subtract line 7(b) from
line 6; OR, if farm land, enter 6 or line %a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see Instruction D-5)
(d) Enter line 9(b) or line %(c)_whichever is smaller
10. If Section 18219 property:
(a) Soil and water conservation expenses made after 12-31-69
(6) Enter amount from line %d), if any; otherwise, enter a zero
(c) Enter excess; if any, of line IO(a) over IO(b)
(d) Line IO(c) times applicable percentage (Instruction D-5)
(e) Line 6 less line 10(b)
(f) Enter smaller of line IO(d) Or line IO(e)
SUMMARY OF PART (Complete_Property Columns (L)through (D) UP te Line 1O(H) betore_going to Line
11_ Enter amounts from line 6 7YX
12. Enter amounts from lines 7(6), 8h), %d) and 10(f) 3523_
13. Subtract line 12 from line 11, enter here and in appropriate
Section in Part Il (see Instruction D-2)
LS1Ds
14. Total of Property Columns (A) through (D) line 12. Enter here and on line 24, Pant Ill 2313
NW,883267 Docld: 32245535, Page 48
Psyl
day,
"WnTyy
SALE
any,
8(g)
line
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Page 49
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Schedule 0-1(540) Page 2
PART Ii Sales Or Exchanges % 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
Cost or other basis_ cost Of
Kind of property (it necessary , b. Date acquired c. Datesold d_ Gross sles Depreciation allowed 50b5e9 30f purcroageaents 0. Gain (or loss)
attach statement ofdescriptive (mo. yr.) (mo., dty, Yr.) price since AArquahifion
attach explanation) and (0. pius Ies
details not shown below) expense 0f_cale
15.
16. Combine the amounts on line 15, enter here and also on the appropriate line as follows
(a) For all returns, except partnership returnsc (1) If line 16 is zero Or a gain, enter amount of each Or loss,, above, in
column (g) of applicable Section B-1 , 8-2 or B-3; (2) If line 16 is a loss, enter such amount on line 25 of Part IlI.
(b) For_partnership returns: Enter_goin(s) and _lossles)_in_Schedule_K (Form 565). See Instruction E.
Sectlon B Mn 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
18_ Combine the amounts on line 17_ enter here
Section 82 Property Held More Than One Year But Not More Than Five Years
19_ LNE SLe
20. Combine the amounts on line .19, enter here
Section B-3 Property Held More Than Five Years
21
22. Combine the amounts on line 21, enter
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 & 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 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 JII Ordinary Gains and Losses
a. Kind %f property and how Deprtciation allowed Cost or other basis_ cost of acquired (it necessary Datt acquired c. Date sold d_ Gross mles orallowable) subsequent improvements Gain (or Iose)
attach statement o descriptive mo., day, yr.) mo., day, Yr.) price since arquisition and expense ofsale pius less
details not showm below)
24 Gain, if any, from line 14
2373
25. Loss, if from line 16
26. Loss, if any, from line 23
27
28 . Combine lines 24 through 27 , enter here and also on the appropriate line as follows
2Z7
(a) For fiduciary and partnership returns: Enter the (or loss) shown on line 28 on the line provided for on the
return filed_~see Instruction F for specific line reference.
(6) For individual returns:
(1) If the (or loss) on line 28 includes losses which are to be treated: as an itemized deduction on
Schedule A (Form 540 or S4ONR) (see Instruction F), enter the total of such loss(es) here and on
Schedule A (Form 540 or 54ONR)-Identify as loss from line 28(6)(1), Schedule D-I (Form 540) 23 D3
(2) Redetermine the (or loss) on line 28, excluding the loss (if any) entered on line 28(b)(1). Enter here
and 2 of Form 540 or Form S4ONR, under "Other_Income"
2NW
88326-Bocld:93d+21 3898.36
749
day ,
gain
here
filing
any,
gain
being
gain
gain
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Page 50
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NAME
SannEL
Lpay-LI
CALENDAR YEAR 19
2
'ADDRESS
322 = 2-2922
SOC. SEC. NO
DEDUCTION SCHEDULE
ME DIcAL STATE FEDERAL CONTRIBUTIONS STATE FEDEAAL
2MEDICINEIDRUGS 21a CASH CONTRIBUTIONS
3Less 1 % A.G.I (Line 18 1040) 21b PAR TNERSHIP SHARE
4NET MEDIDRUGS GIRLiBOY SCOUTS
5H & A INS. ( EXCESS) 622 HEART FUNDICANCER FUND
6a R_ RED CROSS/UNITED FUND
To
DR. XMAS & EASTER SEALS
MISC. ORGANIZED CHAAITIES OR.
DR
277 CHURCHES
DA_
DAJ
Dr.
DR
22 0THER THAN CASH
2JCAARY OVER FFROM PRIOR YRS
Gb HOSPITAL 24 TOTAL ConTRiBUTIONS
ProsthETic APPLIANCES CASUALTY OR THEFT (OSSES)
HEARiNG AID 25 Loss BEFORE ADJUSTMENT
26 INSURANCE REIMBURSEMENT
6c AMBULANCE 27
LABORATORIES 26 (S100 LImitATION PEA CAS
TRAVEL FOR MED_ Q 7 Q 29 IOT CAS, OR THEFTLOSS
MSCELANEOUS DEEDUCTIONS
MEDICARE INS 30 ALimONY
GLASSES 31UNION/PROFESSIONAL DUES
7MEDICAL EXPENSES
T4 T2z 32 CHILD & DEP_CARE (Form 2441)
LESS REIMBURSED BY iNS 33INCOME TAX PREPARATION
8 LESS 3% ADJ. GROSS INC_ 220_ 377 UNIFORMSIPROTEC. CLOTHING
1IZ 132 L SMALL TOOLS AND SUPPLIES
+% To $150) OF H & A INS_ LAUNDRY AND CLEANING
10 IOTALMEDICAL DED
8
TS
3
AUTO USE/DAMAGE
TAXES INVEST. COUNSEL & PUBS (Sched
ISTATE & LOCAL INCOME EMPLOYMENT AGENCY FEES
12 REAL ESTATE SAFE DEPOSIT BOX
13 STATE & LOCAL GASOLINE 4S TEL REQ_ IN BUSINESS
14 GENERAL SALES TAX LLs POLITICAL ContRibuTiONS
15a PERSONAL PROPERTY
15b PERSONAL PROPERTY Auto 22
16 SALES TAX Auto ~70
34 TOTAL Misc DED
SUMMARY 0F TEMZED DED_ STATE FEDERAL
TOZ 35 Tot_ OEDUctible MEDICAL 8 DENTAL 17 TOTAL TAXES EPENSES FROM LINE 4Q
WTEREST (TO WHOM PAIDL 36 TOTAL TAXES From LINE 17)
18 MOR TGAGE
2ZL 37 TOTAL INTEREST (Line 20)
38 TOTAL CONTR. (Line 24)
39 CAS. & THEFT LOSS(ES) (Line29)
19 INSTALLMENT LOANS MUY 40 82888TO5SEFRONEQUS
LINE 34)
MS WEEZ)
TP
3#
LAQ 41 ESTER ONETOEED 3EBUETO i5 723 77Z
REMARKS
20 TOTAL INTEREST
Profcssionil Statiuters, Iric. PSI
jmr[ JAI} Igsk Form 101 SCHEDULE
tkalh !k li/Ntxz), (ntihntu- "Mur, NW 88326 Docld: 32245535 Page 50
ruey
T2
2257 K5q
Mn
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Page 51
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NO _ CALENDAR YeaR 19_
NAME or
SOC SEC _ NO _
2 2- = F |SCAL YEAR End inG
ADD RE S 5
9
SCHEDULE OF PROFTT OR Loss FROM BUS INE SS OR PROFESSTON
PRINCIPA BUSinESS ACTiViTy EmpiOYERS Ho
BUs INESS NaME
BU S INESS AddrESs
TotAL RECE iPts
73424
invEnToRy AT BEG inniNG 0f YEAR
=OI
MERCHAND |SE PURchASED
5Y432
TOTAL
2 YKZZL
LESs invenTory AT End 0f YEAR
bzt
GR 0s $ Prof |T
Zq
Guoss NCOME
0TmER Hus incss dediict ONS
ADVERTising
4T
AUTo ANO Truck EXPENSE
PAD 0E BT $
Comm SS |OnS
DLiVERY
DEPreciAT |ON SCHEDULE UELUw
3
DUES And SUascR | P | Ons
EnTERTA iNMENT ANC Promot | ONAL
inSURANCE
3izp
iNTEREST
JaN Tor Anu HaUL iNi;
LE GAA AnU Accounting
To
OfF |CE SuppliES AND EXPENSE
RENT
4Z
RE PA | Rs Amd MA INTENANCE
6291
SALAR /ES AND #AGES
5s32
SUPPLIES
TAXES AND LICENSES
20
TAXES PAYROLL
#H
TELEPHONE AND UTiliTIES
EoACEFeOR #
NET PROF | T 0R (L 0S $ FEDE R, L RE TURN
12
NE T PR OF | T OR (Loss ) StA TE RE TURN SEE DEPREC SCHEDULE FOR DIFF .
(HETW)F
SCHEDULE_OF_DEPRECIATION
[EPRECTATTON
YEARS COsT OR PRIOR
DATE METH: OR % OTHER BASIS DEPREC. This YEAR
NO_ KIND AND LOCATION OF PROPERTY ACQUIRED
EAUIPMEMT ephsz/eykuozz4 1224 9ZY
LLLZY 3S672 LO O5 736O WZZL
Profess | OmAL STat |Oners inc Form 1044 SCHEDUL E
Los ANGELES CAL !F _
NWN 88326 Docld:32245535 Page 51
SAnusv 2 {yzlz >
Ku ey
28
TZQa
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NAME
Sn
WMELO{xtte
Calendar Yr. i9_
SOC. SEC. NO. F/YIE 19_
GAINS ON INSTALLMENT SALES
DESCRIPTION OF PROPERTY
Losess Cale
DATE ACQUIRED
2Z4
DATE 'SOLD
9731Z7
TYPE OF ASSET CAPITAL SEC 1245 SEC 1250
1SELLING PRICE: CASH
S
s2OLYE
S
2 NOTES 48isz
3_ MORTGAGE TRANSFERRED
4_ OTHER
5 GROSS SALES PRICE (1+2+3+4) 6336o[
6_ COST OR BASIS $ SY1228 S
7_ LESS ACCUMULATED DEPRECIATION
8 PRIOR TO 1-1-62
9 PRIOR TO ,1-1-64
10. AFTER 12-31-61 23/3
11. ST. LINE AFTER 12-31-63
12. EXCESS QVER S/L 1-64/12-69
13. EXCESS OVER S/L AFTER 12-31-69
14. ADJUSTED BASIS (6-7 THRU 13) 4z91
15. EXPENSES OF SALE 2.38
16, TOTAL ADJUSTED BASIS (14 + 15) YBLS
17. TOTAL GROSS PROFIT: (5 16) S
18. TQTAL GROSS PROFIT ORDINARY $ 1313 $
19. TOTAL GROSS PROFIT OTHER 5214 $
20. CONTRACT PRICE (1 + 2 + 4) $ S BrBum $
21 GROSS PROFIT % % 36_t 2 % %
22 PAYMENTS RECEIVED YEAR OF SALE
23 CASH (1) 2oy&
24_ PRINCIPAL COLLECTIONS
25. EXCESS MORTGAGE OVER BASIS
26, OTHER (4)
27. TOTAL PAYMENTS (23 THRU 26) LoME
28. RECOGNIZED GAIN
29. RECOGNIZED GAIN ORDINARY 2313
30 RECOGNIZED GAIN OTHER {LDS
ORDINARY INCOME
TAX TO TAL LESS INT SECTION 1245 SECTION 1250 CAPITAL GAIN
ABLE PAYMENTS (to PT. 2.
YR SEC. 3) REPORTED BALANCE REPORTED BALANCE REPORTED BALANCE
[2 NoNe TAI T59T
NW 88326Docld:32245535 52
Rn :Cii ;c;F Ir _
Kuey
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'Department ot the Treasury _Internal Revenue' Service 1040 UJS indtwidual Incometeraxveeturae 1974
For the year January 1-December 31, 1974, or other taxable year beginning 1974, ending 19_
Name (If joint return, give nae and initials of both) Last name COUNTY OF Your social securty numbor
1 AAmuEL
2"T_zz_ RuBy RESIDENCE 222 L2222
Present homo address (Number and including apartmont numbar or rural [OUke) Spouse's social security no 1 Lb)So_
"EEcHZ
P L
A 3Yelle_ LY22
City, town or post oftice, State and ZIP Occu- Yours EZlLy Ca
pation Spouse'$
If=
Status (check only one) Exemptions Regular 65 or over Blind
Enter 1 Single 6e Yourself number
2 Married filing joint return (even if only one had income) b Spouse checkeea
3 Married filing separately. If spouse is also filing give First names of your dependent children who lived with
spouse's social security number in designated space above E
and enter full you
Daf
name here Tio
Unmarried Head of Household (Sce instructlons on page 5) nurober 2
Number of other dependents (from line 27)
5 Widow(er) with dependent child (Year spouse died 19 Total exemptions claimed Z
8 Presidential Elcction Do you wish t0 designate S1 of your taxcs tor this fund? Yes No Moto: IiYou check tho 'Yes
box (es) it will not incredso 9 Campaign: Fund It joint return, does your spouse wish to designate $12 Yes No your_ tax or reduce your ` refund_
Y (Attach Forms W-2. If unavail
9 Wages, salaries, tips, and other employee compensation able, see instructions on pago 3.)
1
1Oa Dividends OnSoegestructians3
)s_126
10b Less exclusion $_
1b
Balance 1Oc
(If gross dividends and other distributions are over $400, list in Part of Schedule B.)
7
L
11 Interest income: If $400 or less, enter total without listing in Schedule B | 11
0 If over $400, enter total and list in Part Il of Schedule B
12 Income other than wages, dividends, and interest (from line 38) 12
341
3
13 Total (add lines 9_ 1Oc, 11, and 12) 13
14 Adjustments to income (such as 'sick pay," moving expenses, etc from line 43) 14
1
15 Subtract line 14 from line 13 (adjusted gross _income) 15 2923E
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 Iine 44,to figure tax 1
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 ]
16 Tax, check if from: Tax Tables 1-12 Tax Rate Schedule X, Y, or 2
Schedule D Schedule_G IoR] Form 4726 16 3
17 Total credits (from line 54)_ 17
18 Income tax (subtract line 17 from line 16) 18
19 Other taxes (from line 61) 19
3
20 Total (add lines 18 and 19) 20
21a Total Federal income tax withheld (attach Forms
W-2 or W-ZP to front) 21a amount on Ilne 23
!
1
b 1974 estimated tax payments (include amount
i#rite wociahis ectuft;
allowed as credit from 1973 return) number on check Or 8
Amount paid with Form 4868, Application for Automatic paoaBteorde anatarakae
4
Extension of Time to File U.S. Individual Income Tax Return Revenue Service: 1
d Other payments (from line 65)
22 Total (add lines 2la, b, C, and 22
3
Jz
23 If line 20 is larger than line 22, enter BALANCE DUE IRS 23
Z25
1
(Check here if Form 2210, Form 2210F, 'or statemeni is attached:' See instructions 0n poge 1
24 If line 22 is larger than line 20, enter amount OVERPAID 24 ]
25 Amount of line 24 to be REFUNDED TO YOU 25
6 /iiiiiiiiiiiiiiiiiitiiiitriiiiiitiii 0
26 Amount of line 24 to be cred- all of overpayment (line 24) 0 be retunded (line 25)_ make_ no entry on 'line 26_ ited on 1975 estimated tax: 26 IIMMIIIIILI /iiiiiiiiiiiiiiiiiii
Under penalties of perjury , declate that have examined this return, Including accompanying schedules end statements, and to the best.of my knowledze and-belief
iis true, correct, and complete. Declaration 0 preparer (other than taxpayer) (s based on all information of which he has &ny knowledge.
Sign]
here
Your Signaturo Date Proparer Jignature (other than taxpoyer) Dato
Spouse $ signature TH' Must]sign]Oven T only 0ne had Income) Address (and. ZIP Code) Proparor" ,
262472Y.49
Emp: Ident. %r Soc: 88
10-832w0-1 28717 VANOWEN STREET
WAW NUYS; CA 91403
367-34-8729
NW: 88326 ' Docid: 32245535 Page 53
1
Filing
Pay
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Form j04o (1974) Page 2
(0) NAME (b) Rclationship (c) Months lived in your (d) Did de- (0) Amount You Amount fur-
homo. If born or died have furnlshed for de- nished by OTHERS
during year, write B or D.
Pecceat
of pendent's sup- Including depend:
$750 or more? port: 100 % ent:
wrlto ALL. 8
|
27 Total number_of dependents listed_in_column () Enter_here and 0n line 6d
Part Income Other than Wages,Dividends; and Interest
28 Business income or (loss) (attach Schedule C) 28
35
29 Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) 29
30 Net or (loss) from Supplerental Schedule of Gains and Losses (attach Form 4797) 30
31 Pensions, annuities, rents, royaltics, partnerships, estates or trusts, etc. (altach Schedule E) 31
32 Farm income or (loss) (attach Schedule F) 32
33 Fully taxable pensions and annuities (not reported on Schedule E_~see instructions on page 8) 33
34 50% of capital distributions (not reported on Schedule D ~see instructions On page 8) 34
does not apply %f refund is for year in which you took the 35 35 State income tax refunds standard deduction__others s00 instructions on pago "8) _
36 Alimony received 36
37 Other (state nature and source see instructions on page 8)
37
38 Total (add lines 28,29, 30,31,32,33,34,35,36,and 37) Enter here and on line 12 38 {TL
Part II Adjustments to Income
39 "Sick pay_ (From Forms W-2 and W-ZP. If not shown 0 Forms W-2 or W-ZP, attach Form 2440 or statement ) 39
40 Moving expense (attach Form 3903) 40
41 Employec busincss exponse (allach Forin 2106 or staternent) 41
42 Payments a5 a self-employed pcrson to a retiremnent plan, etc -~see instructions on page 9 42
43 Total adjustments_(add lines 39,40,41,and 42).Enter_here and on line 14_ 43
Part IIL Tax Computation (Do_not_use_this_part if_YOu_use_Tax Tables_1-2? to find your_tax )
44 Adjusted gross income (from line 15) 44 22y
45 (a) If you itemize deductions, check here and enter total from Schedule A, line 41
and attach Schedule A 45 TQo
(b) If you do not itemize deductions;,check here and enter 15% of line 44, but do
NOT enter mnore than $2,000. (81,000 if Iine 3 checked)
46 Subtract linc 45 from line 44 46
47 Multiply total number of exemptions claimed on line 7, by $750 47
48 Taxable income. Subtract line 47 from line 46 48 3
(Figure 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) 49
50 Investment credit (attach Form 3468) 50 TB
51 Foreign tax credit (attach Form 1116) 51
52 Credit for contributions to candidates for public office_see instructions on page 9 52
53. Work Incentive (WIN) credit (attach Form 4874) 53
54 Total credits_(add_ lines 49,50, 51, 52, and 53) Enter here and 0n line 17 54
Part V Other Taxes
55 Self-employment tax (attach Schedule SE)
W) .7q0 55 282
56 Tax from recomputing prior-year investment credit (attach Form 4255) 56
57 Tax from recomputing prior-year Work Incentive (WIN) credit' (attach schedule) 57
58 Minimum tax: Check here if Form 4625 is attached 58
59 Social security tax on tip income not reported to employer (attach Form 4137) 59
60 Uncollected employee' social security tax on tips (from' Forms W-2) 60
61 Total (add lines 55,.56,57, 58,59,and 60)-Enter _here and On line 19 61 Z27
Pan VI Other Payments
62 Exccss FICA talx withheld (two or inore emnploycrs-~scc inslructions 0n page 9) 62
63 Credit for Federal tax o special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) 63
64 Credit from a Regulated Investment Company (attach Form 2439) 64
65 Total (add lines 62, 63,and 64)Enter_here and on line 21d 65
Did you, at any time during the taxabie year; have any interest in or signature or %ther authority over
a bank; securities, or other financial account in a foreign country (except in a U.S. military banking 9
facility operated by a U.S. financial institution)? Yes No
If "Yes, attach Form 4683. (For definitions, see Form 4683.)
U.5. GOVERNMENT PRINTING OFFICE : 1074-0-548-047 16--83220-1
NW 88326 Docld:32245535 54
gain
gain
your
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Schedules A&B--Itemized Deductions AND
(Form 1040) Dividend and Interest Income
1974
Department of the Treasury
Internal Revenue Service Attach to Form 1040. See Instructions Ior Schedules A and B (Form 1040).
Name(s) as shown on Form 104 Your social security number
SAMuEL HYLLL B2 2 12R2
Schedule A Itemized Deductions (Schedule B on back)
Medical and Dental Expenses (not compensated by insurance Contributions (See instructions on page 1 1 for examples )
or otherwise) (See instructions on page 10.)
21 a Cash contributions for which you One half (but not more than $150) 0f have receipts, cancelled checks,.etc_ insurance premiums medical care.
(Be sure to include in line 10 below) b Other cash contributions: List
2 Medicine and drugs donees and amounts:
3 Enter 1 % of line 15, Form 1040
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:
Ck
a Doctors, dentists, nurses, etc 22 Other than cash (see instructions on
b Hospitals page 11 for required statement)
c Other (Itemize_include hearing aids, 23 Carryover trom prior years
dentures, eyeglasses, transportation, 24 Total contributions (add lines 21a, b,
etc:) 22, and 23). Enter here and 0n line 38
Io
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 tor guidance
25 Loss before insurance reimbursement
26 Insurance reimbursement
27 Subtract line 26 from line 25. Enter
difference (if less than zero, enter
zero)
1 Total (add lines 4, 5, 6a, b, and c) 28 Enter $100 or amount on line 27 ,
8 Enter 3% of line 15, Form 1040 whichever is smaller
29 Casualty or theft loss (subtract line 28
9 Subtract line 8 from line 7 (if less than
zero, enter zero) trom line 27). Enter here and 0n Iine 39
Miscellaneous Deductions (See instructions on page 12.)
10 Total (add lines 1 and 9). Enter here U3rb
and on line 35 30 Alimony paid
Taxes (See instructions on page 10.) 31 Union dues
11 State and local income 32 Expenses for child and dependent care
12 Real estate services (attach Form 2441)
13 State and Iocal gasoline (see gas tax tables) 33 Other (Itemize)
14 General sales (see sales tax tables)
15 Personal property:
16 Other (Itemize)
17 Total (add lines 11 12, 13, 14, 15, and 34 Total (add lines 30, 31, 32, and 33)_
16). Enter here and on line 36
[0bz
Enter here and on line 40
Interest Expense (See instructions on page 11.) Summary of Itemized Deductions
18 Home mortgage
19 Other (Itemize) 35 Total medical and dental -line 10
36 Total taxes-line 17
37 Total intcrest-~linc 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,
20 Total (add lines 18 and 19). Enter here
29 94
38, 39, and 40): Enter here and on
5g90
andon line 37 Form 1040, line 45
10 83231-1
NW 88326 Docld:32245535 55
UBY
for
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spi 7r MRNt ulit~-A
Profit or (Loss) From Business or Profession
40)
Partnerships, JoirSolentpreprietorshig} File Form 1065. 1974
of the Treasury
Revenue: Service Attach to Form 1040. See Instructions for Schedule € (Form 1040)_
Name(s) as shown on Form Social security number 3E %2
322 1
22922
A Principal business activity (see Schedule
2 4260en08
C
JE product
NA7Z
B Business name
Woad
74g37zi2=
Employer Identitication number 265
D Business address (number and street)
L6
39ieSe
City, State ad ZIP code
ENCLM 4 91L6
E Indicate method of accounting: (1) Cash (2) Accrual (3) Other Yes
F Were you required to file Form W-3 or Form 1096 for 19742 (See Schedule C Instructions)
If "Yes;" where filed
G Was a Employer's Quarterly Federal Tax Return, Form 94 filed for this business for any quarter in 1974?
A Method of inventory valuation Was there any substantial change in
the manner of deicrmining quantitics, costs,or_valuations_between the opening and closing _inventories? (Vf "Yes, attach explanation)
L Gross receipts or sales $ Less: returns ad 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 Taxos on businoss and husiness proprty (uxplain in Scheculo C-?)
8 Rent 0n 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 (sec Schedule C Instructions)
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)
CW)ZYx
(i)
(i)
H)EI53
(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 993Y
enter on Schedule SE, line 5(a)
SCHEDULE C-1J Cost of Goods Sold and/or Operations (See Schedule C Instructions for Line 2)
1
Inventory at beginning of year (if difterent from last years closing inventory, attach cxplanation)
2 Purchases $ Less: cost of items withdrawn for personal use $_ Balance
3 Cost of labor (do not include salary to yourself)
Materials and supplies
5 Other costs (attach schedule)
6 Total of lincs 1 through 5
7 Less:. Inventory at end of year
8
Cost of goods sold and/or operationsEnter here and on line 2 above
NW 88326 Docld:. 32245535 Page 56
ENRsn8
No
paid
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Schedule C (Form 1040) 1974 Page 2
SCHEDULE C-2- Explanation of Lines 7 and 9
Line No. Explanation Amount LIno No: Explanatlon Amount
$ $
SCHEDULE C-3. Depreciation (See Schedule C Instructions Tor Line 6) Tfyou need more space, You may use Form 4562.
Note: 1f depreciation is comnputed by using thc Class Life (ADR) System for assets placcd/ in servicc aflcr Dccember 31 1970, or tho Guideline
Class Lite Systcm for assets placed in service before January 1. 1971 You must Iile Forrn 4832 (Class Life (ADR) Systcr) or Form 5006
(Guideline Class Life System): Except as otherwise expressly provided i income tax rcgulations 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 Class Life (ADR) System and /or Guideline Class Life System.
d. Depreciation Method of Group and guideline class b. Date Cost 0t allowed or allowable computing Life Or 8. Depreciation for
or description of property acquircd other basis in prior years depreciation ratc this year
1 Total additional first-year depreciation (do not include in items below)
2 Depreciation from Form 4832 Sce Note
above )
3 Depreciation from Form 5006
Other depreciation:
Buildings
Furniture and fixtures
Transportation equipment
Machinery and other equipment
Other (specify)_
337
5 Totals
6 Less amount of depreciation claimed in Schedule C-l, page 1
T Balance Enter here and on page 1, line 6 1224
SCHEDULE C4.~Expense Account Information (See Schedule Instructions for Schedule € Z)
Enter information with regard to yourself and your live highest paid Name Expense account Salarics 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
2 whom the combined amount is less than $25,000, or for yourself if
your expense account allowance plus Iine 21, page 1, is less than 3
525,000. 4
Did you claim a deduction for expenses connected with: 5
(1) Entertainment facility (boat, resort, ranch, etc)? Yes No (3) Employees' families at conventions or meetings? Yes No
(2) Living accommodations (except employees 0n business)2 Yes No (4) Employee or family vacations not reported on Form W-2? Yes No
US. COVERNMENT PRiNTiNG OFFICE 1974-0-548-050 16--83228-1
N088326 ~Qocld:32245535 Page 57
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SCHEDULE D Capital Gains and Losses
(Examples of property to be reported on
(Form 1040) this Schedule are and losses on stocks, bonds, and similar investments, and gains (but 1974
Department of the Treasury not losses) on personal assets such as a home or jewelry.)
Internal Revenue Service Attach to Form! 1040. See Instructions for Schedule D (Form . 1040).
Name(s) as on 1040 Social security number "eSa22
l322 L12292
Part Short-term Capital Gains and Losses_Assets Held Not More Than 6 Months D
Cost or other basis,
Klnd of propctty and doscription b_ Date Date 05 adjustod (see Goln or (loss)
(Example, 10O shares ot '2' Co.) acquired sold d. Gross salos instruction D) and (d Ioss 0) (Mo., day, Yc.) (Mo., day, Yc.) expense of Sale
ZoAN ToSumJTE#EEE ZKEbrizzezz
2 2 Enter your share of net short-term or (loss) from partnerships and fiduciaries
3 Enter net gain or (loss), combine lines 1 and 2 3
(z
4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction G) 4(a)
Uzz
(b) Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction G) (b)
5 Net short-terni or (loss), combine lines 3, 4(a) and (b) 5
Part Long-term_Capital_Gains_and_Losses Assets Held More Than 6 Months
54OULHEE Hz S3 132z ~21
4o2
%2
Exe) 628 LL
Loz DET 2h2z 2/ izl 7622 23Y2 =
@
1U Lan ZeE
22 3& LEL
4ECA 73377 1Sf= 3202
7 Capital distributions
8 Enter gain, if applicable, from Form 4797, line (see Instruction A) 8
9 Enter share of net long term gain or (loss) from partnerships and fiduciaries 9
10 Enter your share of nct long-term gain from srall business corporations (Subchapter S) 10
11 Net gain or (loss), combine lines 6 through 10 11
33Z
12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction G) 12(a)
(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction G) (b)
13 Net long-term gain or_(loss) combine_lines 1l, 1Z(a) and (b) 13
5TL-
Part IIL Summary of Parts and II
14 Cornbine the amounts shown on lines 5 and 13, and enter the net or loss here 14 2QTT
15 If line 14 shows a
(a) Enter 50% of Iine 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 15()
(b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29 (b)
16 If Iine 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
See Instruction H:
Otherwise,
(a) Enter one of the following amounts:
If amourt on linc 5 is zero or a net gain, enter 50% of amount on" Iine 14;
ainount 0# lite 13 is zoro or 2 net gain; enter amount or Iine 14; Or_
If amounts 0n line 5 and linc 13 aro net losscs, enler umount 0n1 linc 5.added to 16(a
523
2
50% of amount on line 13
(b) Enter here and enter aS a (loss) on Form 1040, line 29, the smallest of:
The amount on line 16(a);
S1,000 (S500 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,
(iii) Taxable income_ as adjusted (see_Instruction K) (b)
Low_
16_R3232-1
NW 88326 Docid:32245535 Page 58 ,
gains
PA)Lil Ruey
prIco
gain
gain
gain
4()(1)
your
gain
gain
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SCHEDULE SE Computation of Social Security Self-Employment Tax
(Form 1040)
Each self-employed person must file a Schedule SE:
1974
Peernaeevenub Sereisury Attach to Form 1040. See Instructions for Schedule SE (Form 1040).
Internal Revenue
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 trom 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 (AS SHOWN ON SOCIAL SECURITY CARD) Social security number 0t
PnyLLHI
"s 825
selt-employed person 2YLELY)2
Business activities subject to ~emloyment_tax_ (grocery_store_restaurant,_farm, etc ) EFMZEEZR
If you have only farm incomie complcte Parts and I. If you have only nonfarm income complete Parts Il and Ill_
If youl have hoth farin and nonfarm income complete Parts 1 II; and I:
Part Computation of Net Earnings from FARM Self-Employment
A farmer rnay elect t0 compute net farm carnings 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 52,400 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 (a) Not more than $2,400, enter two-thirds of the gross profits
3 If gross profits
from farming are: (b) More Ihan $2,400 and the net farm profit is less than $1,600, enter $1,600_
Gross profits from farming are the total gross prolits from Schedule F_ line 28 (cash method), or line 72 (accrual
method), plus the distributive share of gross profits from farm partnerships (Schedule K-] (Form 1065), line
15) as explained in instructions-for Schedule SE_
4 Enter here and 0n1 line 12(a) the auount on line 2, or line 3 if elect the farm optional method
Part II Computation of Net Earnings from NONFARM Self-Employment
(a) Schedule C, iine 21. (Enter combined amount if more than one business ) 2Yo
(b) Partnerships, joint ventures, etc. (other than farming)
REGULAR METHOD (c) Service as a minister memiber of a religious order, or a Christian Science prac-
5 Net profit or titioner, (Include rental value of parsonage or rental allowance furnished:) If
(loss) from: you filed Form 4361, check here and enter zero on this line
(d) Service with a foreign government or international organization
(See Form 1040 in- (e) Other structions for Iine 37.) Specify
Total (add: lines 5(), (b), (c) (d), ana (e)) 5Y63
Enter adjustments if any (attach statement)
8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7)
76
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 IlI:
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-cmployment of
S400 or morc for at least 2 of thc 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
adjusted by line 7.
NONFARM OPTIONAL METHOD
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) 81 ,600 00
(b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.)
(c) Balancc (subtract line 9(b) from Iine 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 1O,_whichever_is smaller_
Part IlI Computation O Social Security Self-Employment Tax
12 Net earnings or (loss): (a) From farming (from line 4)
(b) From nonfarm (from line 8 or line 1l if you elect to use the Nonfarm Optional Method) XoD
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 )
2Yoz
14 The largest amount of combined: wages ad self-employment earnings subject t social security_tax_for_1974 is 813,200 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
X@
18 If line 17 is $13,200, enter $1,042.80; if less, multiply the amount o line 17 by.079
19 Railroad employee's and railroad employee representative's adjustment from Form 4469, line 10
20_Selt-employment tax (subtract_line_19 trom _line_18)Enter_here and on Form 1040 _line_55
4 U5. GOVERNMENT PRINTING OFFICE 184-0-548-055 16-83234-1
NW 88326 Docld:32245535 Page 59
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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 Attach to Form 1040. See Instructions for Schedule SE (Form 1040).
Internal Revenue Service
you had wages, including tips, Of $13,200 or more that were subject to social security taxes do not fill in this form.
you had more than one business, coinbine profits and losses trom all your_businesses and farms on this Schedule SE
Important: The sclf-cmployment incomc reported below will be credited to your social security record and used in_figuring_social security_benefits
NAME OF SELF-EMPLOYED SHOWN ON SOCIAL SECURITY CARD) Social security number o
SAMuEL
TESok , 07,
self-employed parson 1323
Business activities subject to self-employment tax (grocery store,_restaurant,_farm,etc: ENACC
42222
If you have only farm income complete Parts and IlI. If you have only nonfarm income compiete Parts Il and III.
If you have both farm and nonfarn income complete Parts II, and II.
Part 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) niore than $2,400 and net profits are less than $1,600. However, lines 1 and
2 must be_completed even it You_clect to use the FARM OPTIONAL METHQD
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 (a) Not mnore than $2,400, enter two-thirds of the gross profits
3 If gross prolits
from farining are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,60@
Gross protits farming arc thc total gross profits fromn Schedule F, line 28 (cash method) or Iine 72 (accrual
method), plus thc distributivc share of gross profits trom (arm partnerships (Schedule K-[ (Form 1065), line
15) as explaincd in instructions for Schedule SE
Enter here and on line 12(a), the auount on line 2, or_ line 3 if You_ elect the farm Optional method
Part II Computation of Net Earnings from NONFARM Self-Employment
(a) Schedule C, iine 21_ (Enter combined amount if more than one business )
3sX|
(b) Partnerships, joint ventures, etc: (other than farming)
REGULAR METHOD (c) Service as a minister, member of a religious order, or a Christian Science prac-
5 Net profit or titioner. (Include rental valuc of parsonage or rental allowance furnished ) If
(loss) from: you filed Form 4361, check here and enter zero on this line
(d) Service with a foreign government or international organization
(See Form 1040 in- (e) Other structions tor Iine 3I.) Specify
6 Total (add: lines 5(a), (b), (c) (d), ana (e))
ZL
T Enter adjustments if any (attach statement)
8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7)
37Y
If line 8 is $1,600 or more OR if do not elect to use the Nonfarm Optional Method, omit lines 9
through 11 and enter amount {rom line 8 on line 12(b), Part IlI:
Note: You may use the nontarm 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
S400 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-l (Form 1065), line 15) as explained in
instructions for Schedule SE. Also, include gross protits from services reported on lines 5(c) , (d), ad' (e), as
adjusted by line 7_
NONFARM OPTIONAL METHOD
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) S1,600 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 1O,_whichever_is_smaller
Part III Computation Of Social Security Self-Employment
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)
ZZxl
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 o form:)
Z45z
14 The largest amount of combined wages and self-employment earnings subject t social security_tax _for_1974_is 513 , 200
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)
BZ4
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 _Selt-employment tax (subtract_line_!9 trom line 18)Enter_here_and on Form 1040, line 55
U.S. GOVERNMENT PRWNTING OfFIC 1974-0-548-055 10-R3234-j
NW 88326 Docld:32245535 Page 60
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Tax
232
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3468
Computation of Investment Credit
Deeertment % the_Tradwury
Intertl Revonua Servico Attach to your tax return.
1974
Namo
MenskS5g cumber %achown on SIA
Poro 1 0ryour tax roturn
1 Qualltied Investment
Mwen! nevena uLl HYLLUS 222712772422
NOTE: Include your share of Property. (See Instructions C ana for ellglble property:) investment in property made by @ partnership, estategtrus_rsall
Type of
(1)
business corporation, or lessor:
property Line (2) (3) Life years Cost or basis Applicable (4) (See instruction G) Percentage (samed * coitmant
2 * column 3) (0) 3 or more but less than 5
331/3
New
Property (b) 5 or more but less than 7
(c) 7 Or more 100
(d) 3 or more but than 5 Used
(Sep Insoperions
(0) 5 or more but less thar 7 tor
dollar Ilmltation)
7 or more ioll?
100
2 Total quallfied investment__Add lines 1(a)
1022&
3 Tentative investment
through 1(f)
credit _7% %f line 2 (4% for public utility property)
7376
Carryback and carryover of unused credit(s). (See instruction F and
5_Total_Add lines 3 and 4 instructicn for line 4-attach computation )
6 82 Individuals -Enter amount from line Limitation
7Z
Estates and trusts ~Enter amount 16,,page 1, Form 1040
Corporations- ~Enter amount lirom line.24 Or 25,page z, Form i041
Ys
7
line 5, Schedule J, Form 1120
Less: (a) Foreign tax credit
(6) Retirement income credit (individuals only)
(c) Tax o lump-sum distributions. (See instruction 7.)
8 Total_~Add lines 7(a), (b), ad, (c)
9 Line 6 Iess line 8
10 (a) Enter amount on line 9 or $25,000, whichever is
trolled corporate
lesser. (Married persons
separately, con- groups, estates, and trusts, see instruction for line
10.)
(b) If line 9 exceeds line 1O(a), enter 50% of the excess
11 Total_Add lines 1O(@)and (b)
12 FoestiGend; fredil (LAmount from line 5 or line 1l, Whichever Yg
Form 1040;_line 6(b)Schedule J Form_0l20,eor is lesser (enter here and o line 50,
the appropriate_line on other returns)
!f_any part of your investment in line
1 above
Schedule A
was made by 3 partnership, estate, trust, small Name
business_corporation,or_lesso complete the
(Partnership, estate, trust, etc ) Address Property
New Used Life years
S
If _property_is_disposed Of_prior to the life years used in
10~83238-1
computing the investment credit, see instruction E
Form 3468 (19
NW:88326 . Docld: 32245535 Page 61
Kue
662/3
less
33 /3
662/3
from
filing
following:
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4798 Capital Loss Carryover
Form (From 1973 to 1974)
1974
Dopertmant of the Tretsury Attach to Form 1040.
Intorntl Revanuo Sorvica
Name(s) a5 shown on Form Social Socurlty Number HNoE% [KYLLUS Rue_y
827 12 2212
A. Who Should File. _You will need to complete B: How to Compute Carryover: ~If you have a capi:
either Part or Part Il of this form if you have a capital tal loss carryover, complete either Part or Part Il of
this form, but do not complete both_
loss to carry over to 1974.
1. Complete only Part if lines 4(a) and 12(a) on
your 1973 Schedule D (Form 1040) DO NOT SHOW A
You will have a capital loss to carry to 1974 if the LOSS.
amount 0n your 1973 Schedule D (Form 1040), line 2. Complete only Part Il if either (or both) line
16(a) , or line 33, is LARGER THAN the loss deduct- 4(a) or line 12(a) on your 1973 Schedule D (Form
ed on your 1973 Form 1040, line 29. 1040) shows a loss_
Part 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
27y 1
2 Enter shown on your 1973 Schedule D (Form 1040), line 13. If that Jine is blank or shows
2 0
a loss, enter a zero
3 Reduce any loss on line 1 to the extent of any gain on line 2 3
22Y1
Enter amount shown on your 1973 Form 1040, line 29
L0.D
5 Enter smaller of line 3 or 4 5 Loz2
6 Excess of anount 0n line 3 over amount on line 5 6
(17y1
Note: The amount 0n line 6 is your short-term capital loss carryover trom 1973 to 1974 that is attributable to years beginning
after 1969. Enter this amount on your [974 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
8 9 through 12
9 Enter gain shown on your 1973 Schedule D (Form 1040), line 5. If that line is blank or shows
9
a loss, enter a zero
10 Reduce any loss on line 8 to the extent of any on line 9 10
11 Multiply amount on line 7 by 2
11
12
12 Excess of lime 10 over amount on line 11
Note: The amount on line 12 is your long-term capital Ioss 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
gain
gain
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Re% tijiueteg74d E+ Wnrn
Form 4798 (1974)
2
Part 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 i040), line 5; if none, enter zero and ignore
lines 2 through 20 ~then go to line 21
2 Enter" shown 0n jour 1973 Schedule D (Form 1040), line 13." If that line is blank or shows
2
a loss enter a zero
3 Reduce loss wn line 1 to the extent of any gain on line 2 3
Note: If Iine 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.
Combine lines 3 and 11 on your 1973 Schedule D (Form 1040). Enter
the gain; or if zero or a loss, enter a zero
Note: If line 4 is zero IGNORE lines 5 through 11 enter on line 12. the
loss trom your 1973 Schedule D (Form 1040). line 4(a)-_then go
to line 13
5 Enter any {rom your 1973 Schedule D (Form 1040), line 3 5
6 Enter smaller of line 4 or 5 6
7 Enter excess of on line 4 over line 6
8 Enter loss from your 1973 Schedule D (Form 1040), line 12(a); other-
8 wise, enter a zero
9 Reduce any on linc 7 to the extent of any Ioss on line 8 9
10 Enter loss from your 1973 Schedule D (Form 1040) , line 4(a); other-
wise enter a ero 10
11 Add the gains on lines 6 and 9 11
12 Reduce the loss on line 10 to the extent of any on line 11 12
13 Pre-1970 short-term capital loss (Enter smaller of line 3 or 12) 13
14 Short-term ca pital_loss attributable_to years beginning_atter_l969 (excess_of line 3 over line_13) 14
Section B.eComputation of Capital Loss Carryovers to 1974
15 Enter any loss from line 13, above 15
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) 17
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 Iine 19 _if line 18 does not exceed line 19, enter
zero) _ Enter here and on your 1974 Schedule D (Form 1040), line 4(b) 20
21 If you were required to complete Part IV of your 1973 Schedule 0
(Form 1040), enter any loss from your 1973 Schedule D (Form 1040) ,
line 30; otherwise, enter zero 21
13 2
22 Enter excess of line 19 over line 18~if line 19 does not exceed line
18, enter zero: (Note: It you ignored lines 2 through 20 above, enter 6
amount trom 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) 23
1xLL )
24 If 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 Iine 25, enter
zero) Enter hcre and on your 1974 Schedule D (Form 1040) line 12(b) 26
{ UJS. GOVERNMENT Printing Office 1974-0-548-157 52-0701621
NWV 88326 Docld: 32245535 Page 63
Pabe
gain
gain
gain
gain
gain
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NAME
kue%
NO _ CALENDA R YEA R 19
2Y
0R
32 2FD_2992 SOC SEC NO
F |SCAL YEAR END iNG ADDRES S
19
SCHEDULE OF PROF |T (OR LOSS FROM BUS INESS OfR PROFESS | ON
PRINCIPAL BUS INESS AcTiViTy
BUs NESS NAME EMPLOYERS No
BUS iNESS ADDRESS
TOTAL RECE |Pts
Tear
INVENToRY AT BEGINNING OF YEAR
MERCHAND [ SE PURCHASED
37072
LABOR
TOTAL
NvENToRY AT END 0F YE AR
Egzz
352
GRoss PRoF | T
31 B0S
GRoss INCOME
351
OTHEr BUs NESS DEDUctiOnS
ADVERTis |NG
337
AUTo AND TRuck EXPENSF LETTT
AITY
TLO
BAD DE BTS
CASH SHORT
COMM SS | ONS
DEL /VERY
DEPREC | AT | ON SCHEDULE ATTACHED
132
DUES AND SUbSCR | PT | ONS Lb_
ENTERTA INMENT AND PRomot | ONAL
inSURANCE
INTEREST
RB
JAN itor SERV ICE
LAUNDRY
LEGAL AND ACCOUNTiNG
32
MAINTENANCE
JFF |CE SUPPLIES AND EXPENSE
RENT
REPA |RS
344
SALAR ES AND WAGES
SALARIES OF F ICERS
SUPPLiES
TAXES AND LICENSES
TAXES PAYROLL
322
TELEPHONE
TRAVEL
UTilitiES
TARKLNG
NE T PRof | T O R Loss FED E RAL R E TUrn
210
73Y
NE T PRoF | T OR Loss STATE RE TURN_ SEE DEPREC . SCHEDULE FOR DIFF
014C
PR OFESS | ONAL STAT | ONERS InC FORM 104
SCHEDULE NW:88326 ^DGSe[d;32245535 Page 64_
Sml
YayLLL
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2
17
1
2
5
{
3
27
M N
3
Ie
0
1
1
V 8
2
1
8
2
9
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8:
8 1
2 <
3 1 8
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8 8
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1 1 L
NW 88326. Docld: 32245535 Page 65,
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RESIDENT
INDIVIDUAL
TAXABLE YEAR
5403
CALIFORNIA
1.9747
INCOME TAX
PLACE PREADDRESSED LABEL KERE, if available: (Correct name and address, if necessary) For calendar year Or
Enter social security number(s) only if incorrect or not shown on label. Taxable year ending 197_
NAME (Wrioint return, give first initials of both) LAST YMMe Your Social Security Number
MuEl
"EEEY-;
LBY 322 2
2292
PRESENT HOME ADDRESS (Number and including aportmont numbor, 0rtural routo) Spouse $Sociai Security Number
Lby{Q
KKi&LFZ
8 Vylo
CitY, TowNOr PosT OFFICE STATE AND; Zip CODE OccU- Yours
JE
GRaNADA L(a_
Patiom Spouse
FILING STATUS Check Only One: EXEMPTION CREDITS If line 1 or 3 checked, enter $25
Single 6 Personal If line 2, or 5 checked, enter 550
2 Married filing joint return (even if only one had income) Dependents Do not Iist yourself; your spouse or the person whu qualifies you
as head of household: Enter name and relationship;
3 Q Separate return of married person -Enter spouse'$
social security number and full name here
Ella
TAIMA=
Head of Household-_Enter name O qualifying Total Number X 88 7 16
individual_ Blind (refer to instructions) Number of blind exemptions X 88 8
5 Widowler) with dependent child (Year spouse died 197_) 9 Total exemption credlb (add lines 6_ 7 and 8) Enter here and 0n line 20 9 KG
Attach cody 2 of Form(1) W-Z t face ofthls 10 10 Wages, salarles, tips and other employee compensation return. If unavallablo. attach exelanation_
11 Dividends_before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540) ) 11 3
12 Interest: Enter total (if over S400, complete and attach Schedule B(540) ) 12
13 Income other than wages, dlvidends and Interest (from line 48) 13
2FzY
0
14 Total (add lines 10, 11, 12 and 13) 14 5070
8 15 Adjustments to income (from line 54) 15
16 Adjusted gross income (subtract line 15 from line 14) So2d
2
you do NOT itemize deductions AND Iine 16 is under $10,000, find tax in Tar Table and enter on Iine 19.
3
4 you itemize deductions OR Iine 16 is $10,000 or more, com plete Iines 17 &nd 18.
3 17 Deductions: Itemized (from Iine 61) OR Standard (51,000 if line 1 or 3 checked _ $2,000 if line 2, 4 or 5 checked) 17
SYkr
18 Tarable income (subtract line 17 from line 16) 'Compute tax from Tax Rate Schedule_Enter tax on line 19 18
1
19 Tar trom (check one) Tax Table CI Tax Rate Schedule Income Averaging Schedule (G 0i G-1) 0 19
20 Total exemption credits (from line 9, above) 20
2
21 Tar liabllity (subtract line 20 line 19__if line 20 is greater than Iine 19, enter zero) 21
22 Other credits (from line 65~Includes special low income tax credit) 22
23 Net tax liability (subtract Iine 22 from Iine 21-if line 22 is greater than Iine 21, enter zero) 23
24 Tax on preference income instructions-__attach Schedule P(540) ) 24
25 Total tax liability (add lines 23 and 24) 25
1
26 Total California income tax withheld (attach Form(s) W-2 Or W-ZP to face of this return) 26
27 Renter'$ credit_if you lived in rented property on March -1, 1974, complete Part 1 on page 2 27 1
28 1974 Callfornia estimated tax payments
29 Excess California SDI tax withheld (attach Form DE 1964 to face of this return) 1
30 Total prepayment credits (add iines 26 thru 29)_ 30
W
31 If line 25 is larger than Iine 30, enter BALANCE DUE If it is equal to line 30, enter zero.
Pay in full and mail with reture to: FRANCHISE TAXBOARD Pay In FULL 31 : 5 SACRAMENTO, CA 95867 Do not write in thee spaces
3
1
32 If Iine 25. is smaller than line 30, enter amount OVERPAID P
Mail return to: FRANCHISE TNX BOARD 32
E ! 8 P.O: BOX 13-540
SACRAMENTO, cA 95813 M 1
33 Amount of line 32 to be REFUNDED. (Allow at' least six weeks) REFUND TO YOU 33 1
34 Amount of line 32 to be credited 0n your 1975 ESTIMATED TaX 34 01mtn} 1
Under penalties of periury , doclare that hove exominad this roturn, including occomponying schedule: and statemonts, and to Iho bost of my knowledgo and
beliof is true, correct and complete. If prepared by Peron]othor than . toxpever, hit doclaration it based on all information of which ho hat any knowlodga
1
SIGN
Your sipnature Dato Preparer' $ signature (other than texpayer ) Date 1
03717 VANOWEN STREET
3623Y229
HERE
Spouse '$ signature _if filing Joint return Dab Address (and Zip code)
Menttrs; CA: 714Preparer $ Fein (or SSA) No_
367-34-8729
NW 88326 Docld:32245535 Page 66
SA
3Y9
3007a]
from
(see
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2 Form 540 (1974)
PART Renter'$ Credit AII questions must be_anstvered See Instructions, Page 3, for Allowable Credit
35 Did you, 0n March 1, 1974, live in rented property which was your principal residence? Yes No If you may not claim this credit
35 Was the property YOU rented exempt from property tax? Yes No If yes, you may not claim this credit
37 Did you live with any other person who claimed you as a dependent for income tax purposes? Yes No yes, you may not claim this credit
30 Did you or your spouse claim the homeowners' property tax 'exemption or receive public ssistance? Yes No yes, see . page 3 of instructions
PART Il Other Incone
39 Business income (or Ioss) (attach Schedule C(540) ) 39
40 Net (or loss) trom sale or exchange of capital assets (attach Schedule D(540) ) 40
41 Net gain (or Ioss) from supplemental schedule of gains and losses (attach Schedule 0-1(540) ) 41
42 Pensions and annuities
43 Rents and royalties ATTACH
44 Partnerships
SOEDUsEc US40}
0
45 Estates and trusts
46 Farm income (r loss) (attach Schedule F(540) ) 46
47 Miscellaneous income
(a) 'Fully taxable pensions and annuities (not reported on Schedule E(540) ) 47a
(b) . Alimony 476
(c) Other (state nature and source) 47cE
Enter total of Iines 47(a), 47(b), and 47(c) 47
48 Total (add Iines 39 thru 471. Enter here and o line 13 48
gTZYL
PART JII Adjustments to Income
49 "Sick pay;' if included in line 10 (see instructions attach statement) 49
50 Moving expenses (see instructions attach statement 50
51 Employee business expenses (see instructions attach statement) 51
52 Military exclusion (see instructions) 52
59 Payment as a self-employed pcrson to a retirement plan, etc 53
54 Total adjustments (add lines 49 thru 53). Enter here and on line 15 54
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`' Iines 55 tru 60, belov
55 Total deductible medical &nd dental expenses (from Schedule A(540), line 10) 55
1326
56 Total child adoption expenses (from Schedule A(540), ` line 13) 56
57 Total taxes (from Schedule A(540), Iine 21) 57 0
58 Total interest expense (from Schedule A(540), line 25) 58
59 Total contribuiions (from Schedule A(540) , line 29) 59
60 Total miscellaneous deductions (from Schedule A(540), line 40) 60
61 Total itemized deductions (add lines 55 thru 60). Enter here and on line 17 61 78
PART V S Other Credits SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW:
62 "Other State" net income tax credit (attach copy of other state return and Schedule S(540) ) 62
63 Retirement income credit (attach Schedule R(540) ) 63
64 (a) Special Low Income Tax Credit If Adjusted Gross Income does not include net capital from assets held more than one
Year and is $8,000 or less (joint return of married couple; head of household or widowler) with dependent child) or $4,000 o
less (single Or separate return of married person) enter the amount from ` Iine 21. If Adjusted Gross Income includes Capital
Gains, complete Schedule B1. See 3 of Instructions 64a]
(b) Enter total here from Iine 4, Schedule B-1. If zero Or a enter zero 64b
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 _L,_explain_below_
DUEEXZZC
NW 88326 , Docld:32245535 Page 67
Page
no,
gain
26
gains
Page
loss,
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Page 68
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SCHEDULE
CALIFORNIA
TAXABLE
A
974
ITEMIZED DEDUCTIONS
YEAR FORM 540 Attach to Form 540
Soclal Securlty Number Name as shown on Form 540
SmunL
Ku e_
p2 2
2222
Use only it you do not use the Tar Table or take the standard deduction: A
Medicaland 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
24. Other (itemize) premiums for medical care
2 Medicine and drugs
32 Enter 1% of adjusted gross income shown on Form
540.
4_ Subtract Iine 3 from line 2 Enter difference (if Iine
3 is greater . than Iine 2, enter zero)
Sct
5. Enter, balance of insurance premiums for medical
care not entered 0n line 1 25. Total (Add lines 22 , 23 and 24. Enter here and
on Form 540, page 2 Iine 58) 2292
6. Other medical and dental expenses:
(a) Doctors, dentists, nurses, etc_ Contrlbutlong
(b) Hospitals 26. Cash contributions for which you have receipts, can:
(c) Other (itemize) celed checks, etc:
21 . Other cash contributions. List donees and amounts
Scl
1 . Total_(Add lines 4, 5, 6a, b, and c)
8. Enter 3% of adjusted gross income shown on
Form 540 28. Other than cash See instructions for required
9 Subtract line 8 from line 7_ Enter difference (if statement
line 8 is greater . than line 7 enter zero) 29. Total (Add Iines 26,27 and 28. Maximum deduction
10. Total_ (Add lines 1 and 9_ Enter here and on may not exceed 20% of adjusted gross income _
1fa
Form 540, page 2, line 55)
URL Enter here and on Form 540, page 2, Iine 59)
Child_Adoption Expense Miscellaneous Deductions
Casualty or Theft Lossles) _ See Instructions
11. Total expenses Or incurred__Attach itemized NOTE: If You had more than one loss, omit lines . 30
list through 34 and follow instructions for guidance.
12. Enter 3% of adjusted gross income shown on Form 30. Loss before insurance reimbursement
540 31 . Insurance reimbursement
13. Subtract line 12 line 11-See instructions 32. Subtract line 31 Irom line 30. Enter difference
for maximum limitations. (Enter here and on Form 'line 31 is greater than Iine 30, enter zero)
540, page 2, line 56) 33. Enter 5100 or amount on line 32 , whichever is
smaller
Taxes 34. Casualty or thett Ioss (line 32 less Iine 331
14. Real estate 35. Alimony pald
15. State and local gasoline 36. child care_See instructions
31. Union dues 16. General sales
38. Employment education expense__See instructions
11. Auto license-_Excess of registration and weight fees
(see instructions) 39. Other_See instructions (itemize)
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 0 40, Total_Add lines 34, 35, 36, 37, 38 and 39. (Enter
and on Form 540, page 2, line 57)
Qx
here and o Form 540, page 2, 'Iine 60)
(Rov., 1974)
NW 88326 Docld:32245535 68
PeylLU
Sctt
paid
from
Page
==================================================
Page 69
==================================================
SCHEDULE TAXABLE
c
CALIFORNIA
192&
FORM 540
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
(Sole Proprlatorships)
Attach thls schodulo to Incomo tax roturn, Form s00 or s4ONR Partnorohlps, lolnt voaturod, otc, must alo on Form 305
Name as shown on Form 549or Social Security Number
Cam
T4v4
2322
A Principal buiiness activity: RVLc e
product_
KNaccbar
(Sao Inttruction, for 'Ilem A:'= (For examplo; rotail_hordworo ftobocco; torvicos-logal; manufocturing_furnituro; ac )
B. Business name_
"V;:2+5284r3 GE55
'Hederalpaployw;' identification 95-26S1[zf
D. Business address_ 1L.04$_ NTURA BLvD_ 0 9..316.
E. Indicate method of accounting: C cash; K accrual; other (Zip'codo)
F Were Forms 591, 592, 596 and 599, for the calendar_year filed (if required)? Yes No
G. Method of inventory valuation 8 _S7
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.
IMPORTANT_Aii applicable Iinos and schodulos mubt bo Alled In.
Gross receipts or sales $ Less returns and allowances Balance
2 Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule)
3 Gross
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 24, Schedule C-1 (exclude any 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 IS(a))
(6) Employee benefit programs (see Instructions for line 15(b))
1
16 Interest on business indebtedness
17 Bad debts arising from sales or services
18 Depletion
19 Other business expenses (specify):
(a)_
(6)
(e)
(9)
(h) Total other business expenses (add lines I%a) through I9g))
20 Total deductions (add lines 6 through 19)
isi
21 Net profit (or loss) (subtract line 20 from line 5). Enter here.and on page 2, Form 540 or Form 54ONR
993Y
SCHEDULE C-I. COST OF GOODS SOLD (See Schodula C Instructions forIlno 2)
22 Inventory at beginning of year (if different from last years closing inventory, attach explanation)
23 Purchases $ Less cost of items withdrawn for personal use Balance
24 Cost of labor (do not include salary 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 sold. Enter here and on line 2, above
NP832720 Docld:32245535 Page 69
Your
RuBy 3221z -
€
"4mbea
profit
paid
paid
goods
==================================================
Page 70
==================================================
Schedule (Form 540) (Rev. 1974) Page 2
SCHEDULE C-2. Explanation of Lines 7 and 9
LIne No. Explanation 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 guldellne class b. Date Cost or Depreciation Method 0f Llfe or B. Depreclatlon Ior
or descriptlon of property acquired omher basis allowed or allowable computing rate 'thls year in prior years depreciation
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)
(35.9
Totals
5 Less: Amount of depreciation claimed elsewhere in Schedule C-1
Balance-Enter here and on page 1, line 6
7337
SCHEDULE C-4. Expense Account Information (See Schedule € Instructions for Schedule C-4)
Enter information with regard to yourself and your five Name Expense Account Salarles and Wages
highest employees In determining the five highest Owner
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 Ihe combined amount is less than s10,000, Ot
for yourself if Your expense account allowance plus
line 21, page is less than $10,000. 5
Did you claim a deduction for expenses connected with:
(1) Entertainment fgcility (boat, resort, ranch, etc )? (3) Employees' families at conventions or meetings?
Yes No Yes No
(2) Living accommodations (except employees on business)? (4) Employee or family vacations not reported on Form W-2?
No Yes No
NM88326-Docid 37745535-Page 70
paid
paid
Yes
==================================================
Page 71
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SCHEDULE
CALIFORNA
TAXABLE
D
1914
FORM 540
CAPITAL GAINS AND LOSSES
YEAR
Attach to Form 540 or 54ONR
Use this schedule to report and losses On stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as 0 home or jewelry:
~Sorlal Securiity Number Name shown on Form 540pr
Smuel
Pix-4X
b2zz 2327
PART I~_Assets Held One Year %r Less
Cost Or other basIs as adJusted; cost ofsubse-
a. Kind of property and descriotion D Date acquired Date tld d_ Gross sales quent improvements (if Gain or loss
(Example, 1CO shares of "Z" Co.) (mo: day, yr. ) (mo: , day, yr.) price not purchased_ attach (d. less 6. explanation) and ex -
pense of sale
LDANTaSEMMITEACL-cokhoeariort
ioz
ORCHIEr@nOExeC Thka_ 6 3 81 22.7
0uCHLEETAMNDexe V?3 6
H5
28 E.RL
2 Enter (or loss) if applicablc, (rom line 18, Schodulo D-1 (540) (altach copy)
3. Enter your share of net or loss from partnerships and fiduciaries
4 Net or loss, combine lines 1, 2 and 3
233
PART II_Assets Held More Than One_Year But _Not_More_Than Flve_Years
52
TETE CR?ZET 5 47 (6l1 26yT 2z
DIJ
NLIRO2: 5 L32 ZLZY
Ul
30
63 Enter (or loss), if applicable, from line 20, Schedule D-I (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
YYOG
PART]III__Assots Held More_Than Five Years
4.7s8
GRRyovek
16.0.63
LESsI0DD
10. Enter gain (or loss), if applicable, from line 22, Schedule D-I (540) (attach copy)
11. Enter your share of net gain or loss from partnerships and fiduciaries
12. Net Or loss, combine lines 9, 10 and 11
PART_IV__Summary %f Capitel Gains_gnd _Losses __
13. Enter amount from line 4
2
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)
(L<063 202602
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 S4ONR
19. If line 17 shows @ loss, enter here and on page 2, Part Il of Form 540 or 54ONR the smallest of:
(a) amount on lines 17;
(6) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
of capital assets; or
(30)
(c) $1,000 (S500 in the case of 0 husband or wife filing 0 separate return)
NW 88326 Docld:32245535 Page 71
gains
Ruey
gain
gain
gain
37
gain
gain
==================================================
Page 72
==================================================
NAME
SAM4EL
LlhyLyu
CALENDAR YEAR 19
7.4.
ADDRESS
322312-2297
SOC. SEC: NO
DEDUCTION SCHEDULE
ME DICAL STATE FEDERAL contRibutions STATE FEDERAL
2 MEDICINE/ORUGS 21PAR TNERSHIP SHARE
3 LESS 1 % A.G.I. (Linc 18 1040) GIRLIBOY SCOUTS
4NET MEDIDRUGS HEART FUNDICANCER FUN
SH & A INS. (Yz EXCESS)
30Y
RED CROSSIUNITED FUND
6a DR_ XMAS & EASTER SEALS
T56
DR_ MISC. ORGANIZED CHARITIES
DR. POLITICAL CONTRIBUTIONS
DR.
53I CHURCHES
DR
DRJ
DR_
DR_
22 OTHER THAN CASH
23 CARRY OVER FROM PRIOR YRSI
6b HOSPITAL 24 TOTAL CONTRIBUTIONS LSO
PROSTHETIC APPLIANCES CASUALTY OR THEFT LOSSES)
HEARING AID 25 LoSS BEFORE ADJUSTMENT
26 INSURANCE REIMBURSEMEN T
6c AMBULANCE 21 Difference (not less than zero)
LABORATORIES 28 (S100 LimitATion PER CAS )
TRAVEL FOR MED_ DE5 20 29 TOT. CAS. OR THEFT LOSS
MSCELLANE QUS DEDUCTIONS
MEDICARE INS_ 30 ALIMONY
GLASSES 31UNION/PROFESSIONAL DUES
MEDICAL EXPENSES 1SY 32 CHILD & DEP. CARE (Form 2441)
LESS REIMBURSED BY INS 33INCOME TAX PREPARATION
8 LESS 3% ADJ. GROSS INC 268 UNIFORMSIPROTEC. CLOTHING
9 SMALL TOOLS AND SUPPLIES
#Y (TO $150) OF H & A INS_ LAUNDRY AND CLEANING
10TOTAL MEDICAL DED
TEE EEZL
Auto Use Mi
TAXES INVEST.COUNSEL & PUBS (Schcd
I1STATE & LOCAL INCOME EMPLOYMENT AGENCY FEES
12 REAL ESTATE 27 SAFE DEPOSIT BOX
13 STATE & LOCAL GASOLINE 8 TEL REQ_ IN BUSINESS
14GENERAL SALES TAX
15a PERSONAL PROPERTY
15b PERSONAL PROPERTY AUTO 2H
16 STATE DIS_ INS. H W
SALES TAX AUTO 34 TOTAL MISC_ DED
SUMMARY OF ITEMZED DED STATE FEDERAL
17 TOTAL TAXES THO 1T5 35 Fop DEDUCTIBLE MEDICAL & DENTAL
EXPENSES ERQM LINE 10
WTEREST (TO WHOM PAID) 36 TOTAL TAXES (From LINE 17)
18 MOR TGAGE 24B 37 TOTAL INTEREST (Line 20)
38 TOTAL CONTR. (Line 24)
39 CAS. & THEFT LOSS(ES) (Line29)
19 INSTALLMENT LOANS 40 B2DUETi8;SETRONEQHSE 34)
TerrL
263
TbA 41 BRTER ONT8FE? B OUEWENSS SSBS S
REMARKS
20 TOTAL INTEREST 99 L2
NVreBa2BoDecld: 82245685, (Ragesingeles , Calif_ Form 101
Kuey
473
==================================================
Page 73
==================================================
Rvesb 74i
NAME
SAmueL
LeyLy"y
CALENDAR YEAR 19
24
ADDRESS
322_1222992
SOC. SEC. NO.
DEDUCTION SCHEDULE
MEDICAL STATE FEDERAL conTRiButions STATE FEDERAL
2MEDICINE/DRUGS 21'ARTNERSHIT' SHARE
3LESS_ % A.G.I. (Line 18 1040) GIRLIBOY SCOUTS
4NET MED/ORUGS HEART FUNDICANCER FUN
5H & AINS. (Yz + EXCESS)
30Y
RED CROSSIUNITED FUND
6a DR_ XMAS & EASTER SEALS
T76
DR_ MISC. ORGANIZED CHARITIES
DR_ POLITICAL CONTRIBUTIONS
DR.
73D CHURCHES
R.
DR_
DR_
DR_
22 OTHER THAN CASH
23 CARRY OVER FROM PRIOR YRSI
6b HOSPITAL 24 TOTAL CONTRIBUTIONS LO
PROSTHETIC APPLIANCES CASUALTY OR THEFT LOSS(ES)
HEARING AID 25 LOSS IEFORE ADJUSTMENT
226 INSUIRANCE REIMIURSEMEN /
6c AMBULANCE 27 Difference (not less than zero)
LABORATORIES 28 (S100 LIMITATiON PER CASJ
TRAVEL FOR MED_ TEz 26 29 TOT CAS OR THEFTLOSS
MSCELLANEOUS DEDUCTIONS
MEDICARE INS; 30 ALIMONY
GLASSES 31 UNION/PROFESSIONAL DUES
1 MEDICAL EXPENSES
1ZY 32 CHILD & DEP. CARE (Form 2441)
LESS REIMBURSED BY INS 33INCOME TAX PREPARATION
8LESS 3% ADJ: GROSS INC 268 UNIFORMS/PROTEC. CLOTHING
9 173 SMALL TOOLS AND SUPPLIES
Y (TO S150) OF H & A INS 5 LAUNDRY AND CLEANING
1 TOTAL MEDICAL DED_
DEELLEEbL
Aufo Ust Mi
TAXES INVEST. COUNSEL & PUBS (Schec/
I1STATE & LOCAL INCQME EMPLOYMENT AGENCY FEES
12 REAL ESTATE 22 SAFE DEPOSIT BOX
13 STATE & LOCAL GASOLINE TEL. REQ_ IN BUSINESS
14GENERAL SALES TAX
15a PERSONAL PROPERTY
15b PERSONAL PROPERTY AUTo 21
16 STATE DIS_ INS_H W
SALES TAX AUTO 34 TOTAL MISC DED_
SUMMARY OFTTEMIZED DED . STATE FEDERAL
17 TOTAL TAXES
ZL 15 35 Fop DEDUC TIbLE MEOCAL 8 DENTAL
EXPENSE S FROM LINE 4O)
WNTEREST (TO WHOM PAID) 36 TOTAL TAXES (From LINE 17)
18 MOR TGAGE
2543 37 TOTAL INTEREST (Line 20)
38 TOTAL CONTR_ (Line 24)
39CAS. & THEFT LOSS(ES) (Line29)
19 INSTALLMENT LOANS 40 82D88Ti8ESEFRONEQHSE 34)
TEx;+
263
TA 4ETE OTETFBZED Foze DEDUCTNONS5 Ssb ? 150
REMARKS
20 TOTAL INTEREST 22 2922
NiR883261CD6el8t32245535. Page?7gngeles , Calif . Form 101
Kuey
18
==================================================
Page 74
==================================================
NAME
LLUS
Ruey
NO CALENDAR YEAR 19
2Y :
OR
SOC SEC _ NO
ADD RESS
32 2_0=2972
F |SCAL;YEAR END /NG
19
SCHEDULE OF PROF | T (ORR LOSS FROM BUS INESS OR PROFESS | ON
PRincipAL BUS (NESS ActiviTy
BUS INESS NAME EMPLOYERS No
AUS INESS ADDRESS
TOTAL RECE |PTS
707
INVENTORY AT BEGINNING 0F YEAR C0 X
MERCHAND |SE PURCHASED
33272
LABOR
TotAL
Ergzz
INVENTORY AT END OF YEAR
3122
GRoss PRofiT
31 XOL
GRoss inCOME
32
OTHER BUS INESS DEdUctions
ADVERTiSiNG
387
Auto AND TRUck EXPENSE
LATDHL ATTI BLb
BAD DEBTS
CAsH Short
COMM |SS |ONS
DEL /VERY
DEPREC | AT |ON SCHEDULE ATTACHED
EEZ
DUES AND SUBSCR |PT |ONS LE
ENTERTA |NMENT AND PR OMOT) ONAL
NSUR ANCE
INTEREST
Ba
JAN{Tor SERV ICE
LAUNDRY
2477
LEGAL And Accounting
270
MA NTENANCE
JfF |CE SUPPL IES AnD EXPENSE
RENT
REPA |RS
38
SALAR |ES AND WAGES
SALAR ES 0f F (CERS
SUPPLIES
TAXES AND LICENSES
1ob3
TAXES PAYROLL
32
TELEPHONE
TRAVEL
UTil'TIES
TARETNG
NET PR of | T 0K Loss f EDERAL 1E TiiN
281
73Y
NET PROF | T OR Loss STA TE RE TURN SEE DEPREC. SCHEDULE FOR DIFF
W2c
PROFESS | ONAL STAT |ONERS INC FORM 104 SCHEDULE NW 88326 'DG8i.37245535 Page 74
Sanl Iay
==================================================
Page 75
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N
0
2
1
7
'11
0
17
1 N
8
Je
1 d
1
1
8 8
8
1 1
2
2
8 :2
8
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NW 88326 Docld:32245535 75
3
4
Page
==================================================
Page 76
==================================================
226.78 93
Lzi-Jlavcl;e CR tiio Tre Oury Intcrnol Qovonuo Sorulco US
Ug_c lkuc_I Uncotc Tax Bo uri 7
19772
1 moE=l!'Euml %1 X-Dcccs JF 31, 1972, or Otfior C ioblo your bezlfning 1972, onding 89 Jt-
Fs (I; Icln: "fil, W") flrs? fEmc? cnd flddlo Inl?lcla 6} Loti) Lost nomo Vczz Czsial Te 2id'0
L +XvLKXS RUBY 522 I2M,
, tcludlig cr [2t?, C7 neicl scuto) CC'0 Gucc^ 7o 47 Icla6 Ic~~T
(" XJ- 369 18 11020
C~3 Ns
"SoIT WSptoyod
Gel{ uzt; ..0 Cxo (o "HC_Uowzo
fi_
~Cu Jily Ofle: Excmpliong Rogular 65 Or ovor Cle4 Entc?
Evieot Yoursoif 64 Bomoo
caoctca
Sinz3 FRurn (GvJn iC fxly cna hcd iccomo) 7 Wifo (husband)
x; (M- I7 wifc (fuceisnd) ts Olco First nomcc 0X your @cpondor? chilarcn who Ilvod tvilm
Lc;nymnbor ond Efof you Frad 0_Bzlono_ELLOa Tomo
ecn
'OC
'3lS; id WubtsAC
4 idci: chlld (Lmi' K YJUK 08 @leh 9 Numbar 0f othor dopondonto (Irom Ilno 32)
ewik 19 10 Totol_oxomptiong_cloimcd
~Ce 'Ia, %ip3, Lrik) &icr cmploycu compoiioagion. M UnGvoricUG, @ icc 00501 11 on,onution)
%ic' Gcrd 8
'861.9 €0 226 Loog occluolon $
70 , O0
Bulonce 12c
6u
7ol Juundo und 0866? (Ytrlbutionj CrO Ovop S2OO, Ilo? In Porc / 0? Schedulo 8
{6c;
I} {zz) 0f I:ug, Gnrc? Corcl wirhour Iloting in Schcdulo 22 00
;) 13 I8 cEcr {3", Ontor &o*cI cnd Ilo? In crt Il 0f Schcdulo
in' } 7 WiCC , Ct'ccilds, &nal ilkoros? (Arom ling 45) 14 5,90 2
'ii'"h #321, 12e,,42 2e' 1) 15
31227-6
32652 (J1 Ifcomio (c 1. {,3 "cich [% Tcoving oxponsos, otc. Srom Iino 50) 16
U: %om Wup E!; fedluorcg_ kncomo) 17 51493170,
cotuc {wul 19 you do To} Iromize
doducriong
I8 you Ikomizo , dozuezl :7p
:u; ~VL- YC Url, ond Ilmo 87_Is undor Slo,ouo, Iloo 17 Ip S1O,C3I 0r W,4
i <_ 'Af:} vilnd J In Vi;alcc ond unibor @7 80 Illn? B8 & 6_2HrO 60zl,
Zk; ("w0
Tcn : {k_J 136" Y_To#_Qoto_Schcculg % Vo or 2
{k 4d Schcdulo G O7 Formn 4726 10
te_ 6;, kum Iino 61) 19
EF Io %': ("inzac? Ilno 19 {om Iino 18) 20_
Zs ( (Grem lina 67) 21 5224
Te; (2 03 and 28) 22 52 7 ,
[6c.4 Fc; Inicomo fax (ylthliold (ofsh Formg WI-2 j
2p ( ) {Ung) 23
32' Ecil;, , &14 pcymCtlo (include cmount allowod 2
3 ZC p m,1671 roturn) 20
Gif (jForm 4868, [cpllceelon for Guromatic Extension
"io l0 R1 !4.8." Individual Ipvomp Tax Return 25
fJ Au Grom lino 78) 26
2( 1: 23, 24,29, and 20) 21
Pcv In Iull ,lth rrum: Lioto 52270
Vin? 22i%17 nun Iino 27 , onrer BALANCE DUE IRS ehzch or mongy ordct Eyiblo
(J Inlcznoi AcvAL {cTvco
K#)# # Xcmon limo 22, onter Omoum? OVEQPAiD 29
{5 hcf = 'EDi,)YCWU 20
90- "udon 1C2Jcielmaxcd @ vi 31
87 3, Ci yai:during C'} (Jutable blorcodi hovo any intoroo? In or oignorura or othor ourhorily
%l . iilus , Cr 6 {p Occoun? in 0 Soroign country (Olcep? in 0 U.S,
} S"y 0F~ A by 0 U.S. Mnoncicl inogirurion)? Yc?_ 'No
3,' cLAf 7 GCu3: (Lor definiriong, Bee Form 4683.)
0 Cifq * cfinplete Ruvcaua Sharinr; (lines 33 and 34) on_ naxt page.
WJle' 63n; ';ca| dkm thct Ev? ~omincd Alilg 7 1.1, Including cccompcnying schcdulod cnd ctoromonto; ond % Aho Doat 0f Gy lczlcJco ond Ejllc
(, {nuj V Yfuc?, Cla, (ploc h Daclorution CP Jruporsi (olnce Qazn Io*poyrt) 10 boscd Ca 0f mnlormotion 0} cMlch he onv (no;lcdgo
"CVi
Your nlen uto Doto Ptouct0i
EDWARD
Iuiq Wss L LyapeRT
Dorz) L~cro "NAX"? ENsutorAN
17835 VENTURRA SUiTE 106_
#ife' J (huabund"5) @ignalure (07 filing jointly, HOTH (nust sign ovon only one hod income) Address (lnGINVEdCAI Ik-nt;sl6. Id:8, 67 fc5573[5;
TEL, (213) 881.7310
S.S- 568.40.9627
NW:88326 Docld: 32245535. 76
Cid
hod
BLVD L
Page:
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Page 77
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Pogo 2
Fozr;? 20,0 (1072}
(o) Na;, (6) Rolczionollp (c) Mon?ho livod In your (d) Did do: {grnAoant You B eso4erdu01chcc
howio. IF Dorn or dlod Pendont hovo Ior da: 0
durind yoor, wvrito 8 Ot Incoma 0p RT8S% 87it3A82 ing dopznasnt
; 0 5750or moro7 JoO % writo ALL_ 8
S
; (
1
6
6z7cJ? J €. Zidgn g Ilcc- 1 [ Goluzm (9): Entcr horo ond on Iln?
6iJ €
Sox, 0m {hyou pi_Si DlCG) CITcRe ) a Gild ol vadr (oi nacc9c7lly U) CJmo Gu Lou7 P9Si, Odc) Eldrczo)
( ) Courty (() 6 Ila: I9 vcJ Ilezd Inoldo Iho boundorlc? 0 @ Incore?: (d) Tozncblp (cc? Icctrucziono
63U60, Cac7 ilo nomj; IP 658, chzzt hcro 5 pjgo 0
Jleg
Loo_Awceleg
EL,[ r6:? pJOnd inc uccd on Iin? 10 Kor GT Cvo
370 %l:: {) ngutn 0f Rkr Gwin; Oq, (2)
Ive [ncipal PIcc? @8 rccildo7i3?
6' WA
La
ic c;1W762G_C3
Usatorost
Z0
C"ihw (6, "H8, c.2 xgh Cek_5 €)
26 (1 Oo0
J A 3c* FrCwa . J €7 (choi) 6i copIol CcCE?g (Okich Schcdulo D)
6X,€
,1) Avon? J pulmiontol Cslk Julo 0f @lno OJ Lojcoo (otroch Form 4797) 87
RESGGnulcco Ionzo Gnd royollcs parrnorchlpJ, cororog or krusts, ec. (uttach Schcdul 29
29
0 Fcim tn (2 loc:) {ursah Bchodul F)
C@
C) Ftlly €xazls :Jlono :d annul?loo (not poporcg on Cchodulo € ~coo Inserucriong on pogo 8)
01 J1 "ES? '{} exz" W Goln Cnlutlono (Tc? rczz7cd ca Cshcdulo D)
42
12 Trgia Izcomo fritt Delunc" } (eoutlon ~3CJ lnolzucUomj CJ [2G?
03
~ €"nne3V
04
C73 {ctz"g 6 7kuro 0r] Coutgo)
4s
5196917
Tilc 5
35 Orzinh 4A). Entcz Ecn ond_0Mz244
)cJl~ ') Liiijo
iic" Husc "J
Huck;nJ (otznsh (orm 24.40 OF Ozhor roquircd ckoremone) Cs
05
)uk (uc' Vcy7c.4 %XCD)
C)
3J U "J
_uch Vczuw 280J € cxr ororomone)
"Hkc X :JFcew 6J) '? rOiciOiil : AJ@, CRC, (LOO Form 4840) CO
n 03,4n,3 C9). (XC ? Gvo fnJ @ _Ino 1G_ 5@
1fbue:)Glo KSzJ LJ Voz Tobico !-12 (@ InJ youv &ox,)
LJ 5} 50
[:Jjuc;: 'J3 'ncOw? ' (fwsha %imo 17) Schcdu? 4, Ilna 40 ond otach Schodulo A 52 0 62
8' 1C~C; Ibcc;" 4; onzor &o&n1 IzCm _
03 lina 51, bur do NOT enter mora jc" ) R IE 0 ( Zucrong, ontor 15%
~ (C1,cJWE13 i8 chce_c-i) 5a 1 5681 60
0 {"} E8t . # E? ivorn Ul? 51: _ 50250
0 Nuiti;sj (2~4 numblv C oxomptiong cllnad on Iino 10, by S750
55
ictcbo - : ZQa Subazuek lino 54 from Iina 53
(guc yor / <" on C2 omount on lino 55 by using Tor Roze Schedulo Xayor Z_% Wopolicablez She alkernativo &ax from Sched:
3
D,E_JUJnoGi;;Izom Schedulc G, or maximum tax {rom Form 4726.) Enter tx 0n lino 18.
53
'Mvo (; (ck ch Schcdeilo R)
87
JU
I3 (Cv" m Veriz, 4C)
CJ
Lyvck "13 {uc'. MVlckim 10XG)
Li e: ( tdussl 6 gu.lldalos (ev publlc Ofllcc _OO Inorrucelono on poto C2
9 c j%ril:~l-Lc_ CiZc (Uctoch Fonv 4874)
61 jlc (~cJ linod {3,57: 58, 59,ond CQ2.Entcy bozo ond 0n_Ilm2 12
Viir Va 33 TiL_C
522
02 Solf-er__AlcJizink &ax (cSJ ch Schedulo SG)
73 ax (roc: rocorinutlng prlci-yoar inveotmon? crcdlt (cGzch Form 4255)
( MJinimie x (e: ,3 ingrsctlonf on pOgo JC): Chock horo O, Iq Form 4625 io attachod
3 "xclci m2.." 1 (K Cm Olp iicoma nox rCeortod t0 omployor (attach Form 4137)
3 (acoi:; cd crployc? ( eel:l s-zurity CO 03 &ips (from Fozmo W-2)
i;nc" I:j Ulmog 62, 63;CA, GS,_and 68): Lvtcy Wom_C.2 c: lino 21
L Lcv: ui_rifu; NJvl
CJ Excoof (iS' 1; wiehhc^ 4 (,/0 *r moro Olwoloyoro__C Inotrucrions on page 10) C3
CJ tvodie Gr ?ccKwul Qon OfN OpOcILI Quolo, nonhkyhwoy gocollno ond lubricaring oil (ottach Form 41.36)
79 (rodic {vum Wocgulured Itivo tmone Cokdpxiny (atzjch Fonm 2439) 70
"4 Tclc! (udd Ino Gx, 69, Wfid 702; Enlor hru_ond @6 Ulwo 2C 71
I ft0 ' (uvtmnmemi Pmituine {#11(6 10I / ( 4*, U4 G;Pc) 70" (xml
NW 88326 Docld: 32245535: Page 77_
8
Ajl;
6 'Jul
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elaee'ulcs AGL } _Itc mllzzod DDoductlono AND
(E'cr io 1vo)
"1
Dividond Jnd luxerest Income
19772
Dcportmcnt of' &lo Tronoury
Intarnol Roveni) Scivlc? D Attach to Form 104O:
Vour czclol CCTUrQ '[IE:^
Name(o) as . hoil} Cn /orm 1040
'c
322 12 ~2922
Jn_Benlys
dechJ %cmiizc: )] CxJuctiong (Schodule 8 on back)
33+4-5 (J InzzTJzCJ Con&rlburlong, Cash-~including chceko, Monoy OrCc73,' Cte;
7u' 3, dociorjy donriseo, nunoo, (Itomize-_Boe inotructiono on paga 1J {or examploo )
a1wiayl Cl n ic' : A %o: For mcdie; % CcFo, C*c
Xro lx 'O) €? Ina
4Jfd. (Lo
30 Torel cash contriburlono
19 Orhar than cosh (0oo
ingrructlong' on
I: MGib dljop: pago 12 Tor rcquirod starament). Entor
2 ; Ror zuro) total for such iters hora
20 Carryover from prior years
Ts J7 & Xon_ }X
or #surJnij ; premlumo Ior
21 Totol contriburlons (Add lineg 18, 19, &nd
Drdice;' C37( n10 ontcrsd on Ilne 1
20. Enter hera and on Iino 35, bolow ) 200
Jzamizr; 02J; Vncile )| ond dantal Ox"_
Foncc:, Ifx Ouping; oldu, donkuroo,
Intoroor Okponbo:
avoult:' 33i} 'kVorki:), Okc;"
22 Homo morteoga
28 Inorollmont puirchocoo
24 Ornor (Iromiizo)
29 Totol incoroot O#p3nCO (Add Ilncz 22,
23 and 24. Entor hero and on lino 96,
bzlow_
232 0o
Cosuolly @ &hett loso(c3)
Sco instructions on page 12. NOTE:' I$
you had morc ghan One casualty 0r
thom loss occurrence, Omit lines 26
through 29 and so2 page 12 0/ &ha
instrucrions for guidanco_
23 Lojo before odjusemonto
'7otcl" 3 /, 8, ci /) 27 Inouronca rolmburcomont "B1oo_
{nber (f %, 17 Mtrm 3040, 28 S1OO Ilmitatlon
29 Add Ilnes 27 and 28
juberi Xi;y_ 6,.m Ilt, 3 ; Enor dlfar: 30 Cogualty Or than iosg ' (Excess 0{ ilno
:Hec 'I:c;; Zh'&1 ZOF0; Jkkon zaF0) 26 ovor line 29. Entar here and on Iina
'vcwl 6ub7s @untol QEZa 37_ below.
2 Eater kioro
iid a:: Ili, ',locs} JSM CQ
31 Chlld and dopndont cara oxpanoos
Irom Forin 241. (Enter horo and on
lino 38, below.) Wkjol X
J2 %:0. lu;) tIsollnuk; ((6" *e% tox tobloo) Mioculloncous dcducrlong tor olimony,
umon dues_ etc (300 instructions on
3) Conert. sl:} (Gwe calG;, a* tesblos) page 13)_
46; Sratc _] loecI incomo_
Z Porso.t Xoxtrty
26 (sner .
17 Tctol Jej {Add Ilncr ` ! J ` ehzouch 16. 861 32 Tolol mlocelloncoud CcJucrlono (Enror
Enkci {oro € Q1 |inc '8 bclow ) horo ond ( Iino 39, bolow:-
Summon 0l Itomizod Lxducliono
29)" Totol ( 2644371' J mcdic' urid '(lontel Qxcxncog (from Iino 10)
%, Torol &oKc"} 61il Ilno' 4')
2;} 'Yotol (wonaruiuelems (roin Ilnc 21)
3 23
26 Total Inpro)FOG& cxpenso (Orum Ilno 25)
37 Cosuulty and thoft loso/os) (from Iina 30)
29 Child and dopcident Gure expenses (from line 31)
39 Total miscellaneous deductions (f1om line 32) 52.S/A D 3742 00 40 TOLAL QUEMIZED DEDUCTIOVS: (Add lines 33 through 39Enter_here andon_Form _1040_line
NW 88328;- Docld: 32245535.Page-78_
126;
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Page 79
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NA;e
IL Spyu
C_R
ideNtifica , JN NO.
ZxVzh_RZ
AWJDWJESS_
141* NO
SGLIEDULE_QF_deductions YEaR ENDED
VCDEQAL STATC Contributions FEzeoal & STATe
~] C;*3^ , InjCC__IAi -7 churcwes J60
"ZQ 0.3
902K6_8 CormunitychestiuNITED CRUSade
80.6.3103 ;AIE SaLvATiON Armyigooowill industries
'2t c NJ €Icife QED cROSS
Sig_ntisth) XMAS & Easter S[ ALS
Heart FUNDicANCER FunD
partnership RETURN
PavRoLl Deduction
city Or Mopi 8t
OtmeR OrgaNiZeo chaRities:
Too
Total CoNTRIbutions 20
INTEREST (oWVOY PAID) FBOEQAL & SPATE
MORTGAGE_LOANL HLONIL 341Y42
instaLLMENT LOAN
DW
76z_TpvaTb
wtv
W6z,-Ur ale
56
LK: I:HlG JGL
"ZLE 16(9 TOTAL inteREST
Jedicc MISCELLANEQUs DEDUCTIONS FELEdAL & StapE
Alimony (EXPLAIN)
24 SAFE Deposit_Box FeE
[5 Oues
#lil CS SMALL TOOLS (COOD ! YEAR)
Excen_c ToOls DEPRECIATION
~El Y BrranGE SAFETY Equipme #T
Umiforms (NoT GEN_ WEAR)
Gny; &;.",:#"s5 (AunOAy C ci EAtiing
GcC {01 'n ampo Mii €acf (@
Xs;lel';U; {I0G TilephonC Wxpitisl (NoF Oimb.)
AJ Lin Wi
hjo Joo | po
Empi OymeNT Agi Ncy FCCO
VLJLna_ ovazl DU@? C Quoscriptiong
(LGIL € (IE6 i VIs income Tan Paef'aaation
Cmild CARE
~JTO OHERS;
TQ bfLk_ {0? TotaL MSC; deductions
30 Tc CAsualm LOSSES_(ExPLAIN) FEDEQal & SRARE
70 " W |0 *
'Lea; 0 c €L Jlo >po hcXL
SUb TOTAL
ZI; 4,7 INsuRANCC" Less REimbursed By iNS
3*X A R Sub TOTAL
oyacns; fss 6100 (, Om ACh casuri Ty
Tutal ca_uAltv Losses
FEdERAL satc
ToV40 , Taxis 02,77,@0/ Total deductions 0 LIL_ 704
z rah
NW_B8322Voc342555 gai 4 17835 VENTURA BOULL VAKL, ME I66 ENCINO , CALIFORNIA 91316
Docld;.
uNioN
8EL
Ll#
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SCHEDULE C profit (or Loss) From Busimess o Professiom
((orm 1040)
(Sole Proprietorship)
19772
Dopartmon? 0f tho Trcocury Atach %0 Form 1040.
Intornol Rovanua Sorulc) Partnerchipo, Jolnk venturcs, olc-, muct {ile Fcrm 1065.
RGinj(s) &3 snetvi 0f4 [orm %040 Social sccurity numezr
Soscl cnd Fhyllls_Ruby 322 12 7997
1 "@S Servgco
{elncl; pu;Jici; (icrlvty; produc?
monufocturing_furnituro; atc ) (Ucj } Dv; C7uc;" (For Qwamplo; rotoll_ hordworo; wholaalo_Robocco; porvlcos--ogal;
Osausele Ro?
0; 'Juolnc; :) 'fltetl) 0t6
C Emplcyor Idontifcotion Number '562C"78""NUsd"Blva _
0 { (Juslnc. V2 'atnE % UJnd cru2t) 'Vil
cutrgornsa "IxuYo,
Clty, i /2 :#;1 Z8' (ado
B' Indlcce i Jn ,iie 67 Cccsl;;dlng; (8) @J cooh; (2) Q accrual; (3) [7 orhor_
F Wera Yejulvcd to fll) Fonrm,1096 for 19727 (See Schedula C Instructions) YES NO. If "Yeo, where filed?
@), s Mlt ` 3iclng Q locnted (eln' Gno boundarlcz 0? ho city, Rowvn, Ctc , indicoted? 0 YES 0 NO.
Dld yoW {;"(j buolng G} 8h3' ond 0} 19787 CVEB No
( "M1on 6.J63o6.a'Ia 1034} dIld YAU own ehlo buolacjo? 12,
Wro ai: Cmtloyor'u Quoicrly Fcdorol (n Roxura, Form 044, Ilod I_Rhlo buoltoog for_Ony quaror_In_19727 YE8 No
MZS;Ar ~ ll Lplicoblo ilricJ ond ochadulca mug? De {illod in
3 Grczo rccclpto or oclcj $ Loco rorurna ond a/lowancod Balanca "sciiEdiuyz
{ 2 LCjs: Cciz 0f [oc-J ocld and/or oparalono (Schedulo C-J, line 8)
ATTACHED
9 0 Grgos DFo7t ;
eoF lftici;j: , (cor ~hodulo)
;JC, Ineam Racd Ilnkmn 3 ond 4)
L-,c' i Jpli Ji 'In Ochlaulo C-Z)
9o1;+"_bly,hooa 01+} LuclncJo proppry (oxploln In Echadula €-3)
foot W? prb,Jry
Aczciv_ Ioxpluln In fcnodula €-3)
xj0 Ecnricj L} 1JOgc] !otoe Inicluded on Iina 3, Cchedulo C-J (oxclude any paid to yoursel?
J1 Incurone?: X1v
42 Lcicl 6,22 proicooldic} Icpc
8i Comrlcle;s;
2} Gzrtlzrlon '(urcch cecromcn?)
JE (c); Fpncicz and prore-sherlng plano (cc? Bchadula C Incerucrions)
(6) Enli d bonaf? progremo (ue3 Bchodule C Instructlons)
26 insz: an' [usinocc, Indobrodnoso
87 EiJ drz,2n crlclng Irci7 Cleg Or oarvlcco
z3 Dsltcn"
40 G |"lce) oxpjncJ (opelly):
prar#enuaue 4p0 4o*p0
(6)
9 (c)
3
()_
(0)
8
noo
ny
4r
(0) _
0oujn 046 40 p8 00 (p) " Totol oxhor buolnoco oxpances (add Ilnoc 19(a) Ghrough 19(0))
20 Tokal dcductionc (add Iinoc 6 through 19)
22 Ne? profit (or loss) (suberoct line 20 from Ilne 5). Enter hore ard on line 35, Form 1040. ALSO enter on
Schedula SE, line 1 6 969 60
NW 88326--Qeeld;32245535" "'80. Page
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Sofcol Qud Phyllgo
1972
SUPPLEMZNT To SCHEDULE
Zaei 699072
LGi ,C; 8 Solos 3cz 383241 s65,116.25
Gooc; ( 6( do ` Gold
Eor34on? ' ; Iov(Jkozy S 800 . 00
0 Qr?@lxcvx : >
Tlc. 70X {s8#; 60491.98
@LOcX JSE LcJ 160663.08
Fc'&;
20 923.29
BckorS Ipocf' 34102244
361} Avalzoblo 780 , 79
Louo?_ Zodin ; Jnvenco5y 8009 00 264980 22
Gzood Income S180135. 66
Ecp_J3
Rcs:
$ 1,728. 82
Lgr"w su 200 . 0o
Pczz" ; 1 3, 877. 93
Vc;,543' Cn3do 323.62
ZCu{s}Bc 190 .00
2o8p; Loa( J 127.65
LNcz ul:C 25.00
MZccc Jccowolzopalzo 2540 15
Ecu?eZLC 382 . 2.5
Toz"uol:ecuuad' 216
0
52
Honzc:y. 12 15
Avco 625.29
Linca 50-
Dona@Louo' 61.94
'Newupuporo 1ue65 2237
0
56
NET XNCOME s1O,397.90
@coq8 Depreeloglon 8,989,58
NTT INCOMF '$ 6 0
DEPRECIATZQN
Lc p lcnone 6-70; ,9106000
0 Oo '84 o QQO,. 00 5 SL s2,000 .00
Gv JGsil nok (0
Ce_pacc 5, 000 , 00 20 000 . 00 2 Yro SL 1,000 . 00
Leanehold
0
(Biilance of Leage) 3 , 000. 00 957 . 00 7 Yz0 SL 628250
s30628. 50
NW 88326 'Dpcld:32245535 Page.81
Ruby
S45p
s27 ,
Yr 0
Imp.
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Page 82
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SCBJLDULe SE Computation 0f Sccial Sccurity Sell-Employment Tax
(Fortwt 1CC0)
Lcch scli-omzloyca porson muot 94*3 0 Schcdulo SE.
1972
@-porimun? 0? Iho Ircocury
Intornol Acvcnuo Scrvlc) Artnch &c Form 1CAO.
IP you (wd wcc2o, Includlng Qipo, 0f $9,000 or moro ehcr woro gubjoc? %o Bocial security &axos, do no? SIII in &hl8 pago
0? you cd moFj Man 63.3 Dujlnooo, combln? proflko ana Iooooc {rom oll buclnesseg &nd farmg on thls Schodulo SE:
Imnportan:, ~Ia celk-amplovi ciig ncomg roportod Ealow Iill ba crcdlked ko your soclol szcurity record and used In figuring soclol securlly bangrloo
[ C: Z 31U} nJaCS Eoj ] CJ CEZML CZCUQM CAQ@) Caclcl cocuzlt numbz?
01 c2lI-omploy-d pJrcon
Sylij9el Rehy 322 12 7997
uciness ccc "ic?"subjz t €? Eol-omploymca? Cox (@rcOT Io7e;_restaurant ferm etc )
Novz Qi _.ic;i) 07 Not [zrnings irom DUSINESS Sell-Employment (other tham farming)
Net Dzcii %0; iu3o) shcwn in Schedulo C (Form 1040), line 21. (Enter combinad omount M @ore thon oe 69.969 60
(;iczz)
@' '#ck Inik)hz , lezo) Or Tn Urciudod corvlcos or coureon Includod on Ilna
{clwygs Izulg,u,tp uuurC o ~ooQoba: 07, NNor orule"g" !4' Iooo) Gozi budlnadg cOll-cinploymonc (Gubrroc? Ilno 2 Irom Ilna 1, ond onter horo &nd
in Ik:x) 'o) ;llow=
969 40
Coc_u_oel;., 01 Nc LLorniaczg Ircww CARM Soll-Employmon? Sl
Irmor moy' Olcz? t0 comburo not {ari STGirGS szing3 tha OPTIONAL METhOd (lino 6 below) INSTEAD' OF THE RCGULAG
CETCOD Qlino $,/ iluw) I? flj Grocs proflko Qra; S2 , Or 1oss, or (2) more than $2,400 and ner profiks are legs &hon SL,600.
wour_@rcjJJ p7oit S (rom lming ara not mo7o &han $2,400 and you oloct to use the optional method, neod not complcto linco
anj 5.
Camoutotion undoz Rofular Moticd
Nct icvm pzo € (Or lojo) Iron:
(0) Semcduilo F, lina 54 (caoh mechod) or Ilne 74 (accrual method)
(6) Form Darrershlpo
'ts Not camin : 'Irom sc sfaployment Irom (orming: Add Ilnoo &(0) ond (6)
Cs "satlow uor : @glionol Mczhcd
8 C7C-J[ Won Icki #iC OrQ:?
(0) Nc;t 0 RJM 1ycno, cntor ewo-Ghlrlo 0? tho Crooo profito
(0) Mero Ci:,wv{/!C00 LikG &rq nox form fzefle Io Iocz &hon $1,600, onror $1,600
#
~J; 7Ico Qve;}_ nrming oro G62 koknl 01 &ho @COJ0 prorro Srom Schodulo F_ Ilno 28 (cooh
6z3J,or KO. 74 ((scriul moczcd)' Dlug %h2 "dluGelbutivo ohoro 0 8rooo prorl? trom Iorm
0 Ep3 CJ omplolfcg In Inskrugalorg Yor Schcdulo S2.
7 Enlar hXo Onc on Ilno .8(6), below, &ho amount on Ilna 5 (or Iina 6, i8 you us0 (he oprlonal
mcthod)
ICEFuGc.o; 01 Social Sccurily Szll-Employmont Tax
Not esrniaizo (or losc) Irom self-employmone _
(0) Fren buciness (08hor than farming) irom line 3, above
(@) From Iarmlng (Irom Ino 7, above)
(c) Fram Lipanorshipo, joint vonturos, crc; (other thon Sorming)
{d) Frufi,crj:o 98 & @lncror; membor 09 a religlous ordor, or a Christian Science prectitioner. If you
Illex} Gowj 4361, chock horo [ | ond Ofltor zoro on &nio Iina
(c)) Fress Jik") wlkh () Vorclt Govornfipne or Inrornoelonal orGenizerlon
'(0) O6l.7 (ellrcn;eor'0 A(k56, 0xc,). #poclly
0 , votal 638 ' prtvlfe (or Ioro) Srom 60l/ omployinant roporod on Iino 8
7691 60
(07 Ilt.o 6) ix KjU Ion C2cJ, you Ore noQ Cubjoc? Ro col/-omploymnon? &ou. Do no? YIll Ia roor @8 pogo.)
10 The lorjuur omoun? 0? comblnod waroo and colf-employmon? oarningo oubjece
Ro soclol gcurlky %ax Sor 1972 is 89,000 00
12 (a) Toznl "FICA" wagoc 0$ indicated on Form W-2 _
(6) Unrczorted ,tips, I @ny, Oubject to FICA tax Irom
Form ' 4137 ,, lino 9
(c) Total 0} Jines 1J(0) and i1(b)
12 Calanco (cuberact Iino !1(C) Irom line j0)
13 ' Self-emplcymon? incomc 'line 9 or 12, whichover Io smallcr 969 40
10 I line 13 Io $9,Q00, onkor 8675.00; if leso, multiply %he amount on Iine 13 by .075 522 70
85 Rullroud €Iuploye 'u ond rallrend amplo)yoo reprosonrarivo'0 odjustmont Ior hospital inguronco hcnalllo
Cux Irom FtWtfd 4469
JG_Ugll erpluvmonk %ua _(uberuce Iing !@ Irom line 1f)_Entar_haro nnd QEO L04G_Ilng 62 522170
NWL88326. Docld:32245535,Page 82
your
you
WCF
==================================================
Page 83
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SCHEDULE D Capital (ains and Losses
(Fort? 1040) Atach tc Form 10CO. Exomplcs 0l propanyy to ba reported on thlo Schedule ore
1972
Department of the Troosury going and losses @ stocks, bondj, ond simiior investments, &nd (but no? losses)
Interna/ Revenuo Sarvico 0n personal aosel ouch Js 0 homa Or jewelry:
Name(s) aj shown on Form 1040 Social security numbar
Sciue % 4 CC' : Phylllo Ruby 322 121 7997
46"GP6] (uifpllzi Galno 0d Looooc ~Asooto Hold Not Moro Than 6 Montho
b. Hort
0 Do., 8oy, VT. Cost or othar boslo
U' Kli:) 3 dnd d arlprion
EG6ou Caor (Put dotq ooid obowj 08 odfuatod (000 1. doln (or Ioos)
(Gh3lj,
!APorsr
Ohjfcj 6 rz @22 oymibol (CC? dottcd Iino ond doto 6to0g aplod prIco inciruction E) (d Ioco 0)
incirucrion ocgulrcd biloz Oxponco 01 00lo doztcd Ilno) 0)
SCHLLZULE AZTACHED (40 496_/o)
D
296 bo
3 Encor % uV Cfiaro & no? chorz-Rurm @Oln (or Iooo) Arom porenorohipg ond liduiclarios 2
3 Enror, @'J (or . Joro) ; eomiblno Ilnoo 4 0nd 2
(Q) Shor: c%n €'Wlrol Ioo componont carryovor Iroin yoaro boginning boloro J970 (0o Ingtruclion H) AKo)
Shor RcYm @!;)Rol Iocg garryovor 062 Jurabla f YJOro bozlnning omtor 1969 (cG Ingtrucllon H) (b)
Noe : lioss8*986r4.Eoln""(or_ locs);comblin linog 3,4o) ond @(b) _ 57 z00 "o
Le;g:vm CUi ita} Gaing_ond LoscocZLoocls !old More_Than 6 Montho
7 Caprpy Iln @lore zuclono
Eucc? (Zli WV opplleabio' Arom Iino 4(o)(!) ' Form 4797 (coo Instructlon A)
Enzor Your ch JFO @8 fO& long-tem goln (or logg) Irom partnerohipg ad fduciorioo
10 Enkor Your @hcro 0l mak 'Iong-&orm coln Irom srall bucinoss corporatlong (Subchapler S) - 10
12 Nok (cr Iccs), comblna linag 6 &hrough 1O 11
12(o) Lonti trrm Capitol loco component corryover from yoars beginning before 1970 (sae Instructlon H) 12(02 TIE
d
322bo5
12(6) Long-term capital loc carryover attriburable to yoaro boginning Oltor 1969 (sec Instruction H) 12(b)
13 Net_long-term gain (or_loss), combine lines 11_ 12(a) and 12(b) 13
A; IIeummavy_ol Perts 0 and Ii
16 Combine the amounts shown On lines 5 and 13, and enter the ner or loss hera 18
7T6o322 W0)
15 IF litt? 3Acs;jo 0
(a) Etor 50% Iino 13 or 50% 0f Ilno 14, whichcvor is Smaller (see Part VI for computatlon
of altornativo Ram). Entor zero 18 &hC?o is a losg Or no ontry On lino 13 _ 15()
(b) Sulerace Ilne 15k0) Srom line 16. Enzor here and on line 36, Form 1040 15(6)
46 Uv Agno Clcio 0 kczc
Omit linoo 16(0) tinid 46(b) and @0 &o Part IV if lodoeg arc shown o BOTH lines 12(0) and 13.
Sou Inc?zul;Blon I=
Ozhorwlcu,-
(o) Enor Gno 08 0h2 {ollowlng omounlo:
4q amouc;? on Iino 5 Io ZCro Or 0 nor gOln, onter so% 08 omoum on Ilno 16;
9 omoung on Ilno 13 I0 zor0 Or & not @aln; enter omount on Iine 14; O_
iI0) , 4 amoun?s on line 5 and Ulno 13 aro nG? losses, onor amount on Iine 5 added to
s0% of amount on line 13 16(0)
(b) Enter here and enker as a (loss) on Iine 36, Form 1040, the smaller of;
The amount on line 16(a);
S1,000 (S500 if married and a soparate return _i} 3 loss is shown on line
4(a) or 12(a), see instruction M for a higher limit nor to exceed $1,000); 0r, 1 000 0o
0 (iii) Taxable income a9 adjusted (sec Inskruction 16(6)
Carrvover (130322.O0)
NW 88326-Docld; 32245535_Rage.83
gains
ond
Cln
Mb) .
Cain
gain
of,p55
filing
==================================================
Page 84
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Ov
{ 'e062 D 0^ Phyccis TrJ &y {rce
WIkKLY WO)RK PL.AN/ MI MhPOR|
SALESMAN
Vess Koisi
a
(6
NIMIF WIKK EN{AINo ;
CONTRACT Met |
COMMENTS ANI
Te
H8
4 K8w36 265 Nez z Sie Be
EXPENSE
xlfies '(o Un ICCV HR
(LosioTil S Ga
'YJycl
'Mlve@ (tncC 64Yz
'93-05 % 'Ig1l;e1a 8
21 215.22 L-L_2l31o3.% (l (3382
12 : InA"*2
68 < 4 4 629 Z44A 'Ii 45xn6el L'2Z-ls6%k99 {74
0r-
25'_017ESIl: .2lwll1l21 112144L"11 2353.93
MD c5 ,1_TuLa_(Onil_
5 92925244275%
E5.022 56V klkee 7L 2 R8EsLea.2 35
bs; 0
sA Ekaelz 5.93* 1-[zz2lLfstee est ikk
(Jaeelz(eae Sket}8I1A-L-l-2z_ % S3o] 232 4114z GV 29 372
CL" (2B WVs; Sh hs I-la 3 3-2 3287 Jdzh 70
S2 [oo' S6, 2344417-1.214437 A91k
SleasSi JL,lelzhr 234ze ZlZL?elea 37020
tx Zu1IzIg_ 3-/3-2L924V2Yi
laocSce la Jz 387-782 637l/%2 3-/3-73 37-J91 0llg
4o
Slllkla sh 363% 3-1-21316&8 4.22)
'{oe SxL|ur_l-Ja-Yal 3-2 g A632
'60' S
(03722 ncua
TOTALS
NW; 88326, Qecld: 32245535_Page 84
APPLE
(sE
9As6R
Iye
Sh
474*
==================================================
Page 85
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S0jc; D,8+ [ylets Ruoy
WEEKIY WOKK PLAN/ TMF K#POR'[
SALESMAN
Eis VelSyN_ Qz_TNc
NUMKER WEEK ENDING
IacgZ
CONTRACT REVENUE
COMMENFS A^
CUSTOMER HASY BOOKED
NAME
U
A
DeTe i48 Ees4 EXPENSE
7i6: hlarcs
2 Kkkc Rid
HR
kpS)oTBS
")
HrM Jlys X43.672 Ts-Sku4 4_2E ZLEJS: Ul
'43
Issx H} 6 ] G5 CS 5-2 94 (,ez
I1'
'75h 6z,00@ skhle-RkFR 11612 53 Zla
@erQn
5,76 62 156 4-1271 s6.s3t"e 5-37 4334 5} 34of
JSYZA 381342L3s2322 24Z-ZA 30432
he 934 J-Y -12= Il3E S-24Zl Jyseliola
" & Kc? B3 82k-Jz LX3s R:ZL.EL_32032
0
Fc3 ISE 2.3864
8
36s] %6-7 37.322
^( c 5
'8nws Iag
3xlshdzL Z8ase 9-K-Z2 [922|elyk (D8s2
KfcesJz (le Jzzlleh2x 3(ef % 9-1-Zzl L3.3 21?VA 896
teNX_Is 'So 1433 |L:J LLLe [5.Zx Hs S2 Vsdz 4472
'0; ho0 VeSS hlzzL 14019 Lo-WL 2512 e Is1
7m fez_ 17- 48io-I-Zzl 1suels
EScecM hap Jozl_ S-bLlllc2 LI-2 Io
(29
(37
Cis_ 2z4
WW,88326, Docld; 32245535 Page-852 703004
BT
79
TION'
caa
ie32 18472
JAk
Ws
Je
96;
Iysr
30 (Vph:
==================================================
Page 86
==================================================
SAmVeL D.aAL PHyicis RuBy
WEEKLY WORK PLAN/ TJME RFPOR [
SALESMAN
Rackks
0
ALG
1272 NIJMBEk
KLlsl:-ies TeA8A
CONTRACT REVENUE CALI.
COMMI
~USTOMER BOOKED HR S
NAMF
3
1
af
UFT1
p 8eicc
D:ED
Fzice
HR
(Losxyha
'000 7 6; #k
2-/ 7 3214.4.7 3,k1
1t} 92.21-78 LaZ 782
Meh 133 LEK Lzh (Gz S32
h:02222 CSLss L-I8z4 275@ 5234
TEnEiA (1es Je-R LL:elk-8ZI 1o42
1-3.73
7Ub51z-3-2 254ISL
nlx
36327 243 222 R56
F.k7 341313-2 5s10
2
46-74 [33c2 7-x-2 131.90
32k27e 3S40 3-'7-7 3SJ8 3o.
877/-NE R-k_TL [ZI 3-1-2 1a:ES] 3
Y Lzf '50.:7z ISyd 3371_ 35.Zz 2M:
Wobs ":3829:74 372L3-6221 4735 Tna
SY,izi_ '13L Sla By 84.0c 324.21 34s.0
C
"*3-3 26-4#l-i2 35.10 Hzac_
7 eioL
(K92
5 ; @
EnAnkth tiilesaltc ATiokkr
SL0a F0l BalSL VEZIAe
2.00 1nl NeE;
TOTALS
NW 88326 |Docld32245531 Page863
Afb"o
3621
ks.2"JL
0G420
==================================================
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DLUB)nt
ONbiviJAL YAXADLE YoJ
3 / 3j
CALIFORNIA 11972
[NCOOl TAX
3J7 ( 77 19/2, 03 @lor Carcbla year boginning 1972, cnding 1973
T Nac(G) An) 6740(o) #i;k} LAST NAAL Your @zlol a~cwlly nL COr
'SN @1 ;46- Pt,.n RUDY 322 12 7997
0 @I OM WiCE(MG n, hcuz1j C-JICm nUGC37 , Cr Qurel FeurJ) Wipo 0 CuOt:7, 1n IonII d
6z: 5S- Jo5 _/ {'203 "7' 369 Il 1620
366} "3 CJCu ] Zip code Occu: Yourd Selz Eplo
'C;c Uoc A,g&o50@_ Patiom Wilo' 0 Howac1?i@0
LJ
0, LScJG Joax-05 K68 licq vourcol?;, yGur !pouso or pzreon wno quaillca you e hoad 07 Rcyoohold
[IOCJC (Iccleda b:czcVa CCCJ I? dlfcren? Ira3) Voero) Ollationiomip
0e Ezad,- Bzsdg, EllaaoThomaw
8' 2 % UKG 'nkcz €/7X0I'9 ceclel
6V . J4T (z9L 4,cm horo_ Enter
Number 5
0 Clic: (refer %o Instrucrlons) Aumber 0f blind exemptions claimed 6
Wczic". {Xe ritl Pcr? !; 03o 2 1. Tokc} dopondonl ca LIlnd ouorplono (add lines 5 &nd 6) 7
RGoch Copy 2 0 Forg(0) 0-2 W 1_;;c c L7,C)o or orplovo) eczc~cogllea; Xcic
1? Guvolloblc; czch explcnollcn) 0
1 Etz C;ijI folcl ( 'ovor: 9500, comlobo ond aticch) Schcdule 9(540) 9
22
{2 (:~c+ol Cz? flcl (Iq G2r $500, complal cad attach Echodulo (8(500) = 10
11. Bzz?om Ca 'Cccdo 0cJ] Icc31oo8 (from pago 2 Iing 41) 80
56 969 TB0"
C2 Tc^ 1 (c ] ;;0 0, 80 cad.LD); 12
Jc {jOlnjGnny 2, Ilno 4@ 13
3 @ Ji.) bjsi_J (euerjc8 Ilno 13 Areta V? LZ) 14 062
0:.[i [ JuLJOESEsoro gv0 IE3 40 I LeJor S10C_J, Lnc W Icv Icalo ocJ oclor 0n Ilno 91.
0 [Jn_ Cdrjulc J Ci? Ilng 14 Ib GIO,C J o GJro eczzlsa ILso 19 c7 80. 20 000
iU:" Ikr"] Alzg C? Q-cudord dcccett-a (rom pago 2, Iina 58) 15
10" Bc; 33 (cucarccu Aln?' JS Arom Izg' 14L, Figuro ycur @ 0 {lb czoun? by t1o cpproprlata Tox Rero
mBL_ZJ Zxcv QOK o Vnj 8v 10 061 50
" Wciiui 'ORR= 1J SGr Toblo; Tox @cRo Cchcaula 03 Schodulo 'C(5c0) 8Z 52
#
6 9t
I3, Cciii_ZEo Sz3l3-825. Marricd couple or hecd 09 Rcuschold_C50 ne
f0 €C _ En: 3cC__Total on ,Iina ' 7 above; X SB 19 "32 00
z, Icz ] Cr;,C3 (edg Ilu29 18 and 19) 20
a, Ic. '1,) ( ibGrecd Ilej '20 Irom Ilno 87 21
12. Cx__i Gc"Yz} (irom DOEu 2, Ilna '50) 22
2; E & (..sJ (subarac? Ilna 22 Irom Iino 28) 23
24, Ton CJ 670.56* iRE: (see instructlons__azrach Schedul P(540) ) 26
25. Tctc] % Ec__J (ad Iincs 23 ad 24) 25
1 26. Icc} Cc_ic_g (nccc) @I [li old (attcch Form(s) W2 C7 CE-ZR to front) 26
27. 1002 @c"a OcCLCk ] @o" Puyi,ionro 27
23. Erccc? "cilarcloSOI Cxt cGhold (attoch Fozm DE 1964 @ Icco 0f rotura) 28
{} 29. Ictc] OGjoc (udd Ilnog 26, 27 end 20) 29
8, | Il,J 25 /o hurger Ilng 29, entor CALCLJCR CUE. Poy In full Meil oyaceat= wirh rorura Ro 30 Fronchlse Tak Board, amonto, CA 95367.
S1. I9 Ilnj 29 Id |yrger Gil2j1 Ilng 25, entor CUZGQAVCAENT. Moll Rcrurn Ro P.o, Box 13.540, 31 Sscramento, CA 95013.
E2. Lino H1 '@9 6j ( Ac_" (Allow a& Iccze ' cl woeks (r vour relund)
() Creditcd ,on 3973 estimorod Rax
Unsc? Ccc"l-z o8 I dc3iczo &hat htj @rOmlnad thig Izsldlag cScoQczmvlng ucheduled onJ otolcocnts, ond %0 06n Law? 0R Cy 0} Do cot Urit 67hcej Mcz
Elz? 6i @ 671,
"Cci7e.73nd 0130 'h31 4o528i$
0 pcreon
3k+
othcz QoxpayeF , hic @ccIcration I boocd 0 0ll Informatlon 0 rmalch ho hos ofy
5E3&
R 3 EDWARD L, LAMBERT
SEgjn
Your SignaQure-iq"diing foinviy," BOrH "Rust cign Dito
gys58 VIAr8fC 8ok5LY AVye
8
E
~Ie ENCANO. CALIE_ 9L3i6
Spouzo' 5`@lynalevo Dclo Tze 7213) 881-7%.() Dol
S.S. 'tb 4u.'9 2i
NW88326;,Docld:32245635-Eaqe Bf":
yzar
~d_
43
(5
a4
Cc7i
Ro1
ucing
Egn
>1
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Page 88
==================================================
i 2 Feriwl 54J (19d2)
[x4Lauci_dlLoucohcl__If_claimed_ answer_the_following quostlom
'Soo Inaruchiong)
Clsl} Novor marrlod Logol wopararlon (inlorloculory ekeroa dooo nof quellly) Daie
0noi Widowilor) _ Dato Final ellvozco/ dlooolutlon Daxa_
Avice l who quclilcd Jou @J hcad @f hougehold (Do nol Iio? Ihib individual a8 a dopondon? o pago 1, Ilno 5):
Dolalionchip Ago Did ,his parson qualiky a your dopondomt (ov
Ycac:'I6n? , Did *Gs porcon gcclzo in your hezx for 'ho onrire farabla Year? Ik noc; '&tolain cizcumo?cr j
{#
{X6)
(or 381 1_4 Jchc,. ^ ) '0(6461) S9 61,969 Jo
3 'lozd)" 7Z 3)ik okch330' i1 copltal 089c.) (Cilcch Schazulj 04540))
~ADDLjoos"
1in (cr losg} 6 iil xi ,Higmental Czncduia 0/ Galns tnd Lcxscg (artcch) Schsdule 0-1(5401)
:28 Cln (or , lose" 7 lineo 3/ () an (1 30 (lo@@0_ @2=
J #uillmn 35
41;#)Gflo 36
C Arxn:: J5 (PCi'l 37
'Ec" 23 Baus3es 38
"anu*t; ,9644"tur'" Iosc' " (ortiZVi ~@chedulo* V(s L01) 39
(a) Fully Qoxabla ponsions gnd cnnuitles (nok rcgortod o Schzdulb
'Alimony
Oihar (52283 (ure Cag zource)
"'%or) {0uI Inso7? (sdd Ilnes Gtek () ond (c) ) Q0
4j "A ( Enkor 6Tvo (J 0 pogo 4,' Ilng 84 01 50969
3C( ) L3 2
kaudc:s i Alj U Igoo Iratzitlonc --ortach StCRcMon: 02
"30z3 (scr {ns; ~al2e) 9lotomont} 03
*1? 4 nr 968 Gui; In3a;5 38ceh Se ~ 04
kcrz_C3Cn pov orlv (c23 , no ructiong Gz {no &, pcgo Dp" 45
rliccnr? Jon R0 0 '6 alrcmon? plon, Clc;,` 43
31m (3" (c y}OGCUZ cXimc7 horo 063' 0 pcJo 1, Ikcj !J 07
LzEs
Lulal
5c S:j Doju:ilcn 0n' cxcarato relrzcj c1 Czrlcd (oncjyczJ tj8 @us? Ikalzo (ode-?Ic7o cr both Quse talc thc btondord dadueelon
(zz3c CJ , 8o c).Ex:) Ssnodulo 4(;0) cd encr &e) (lcis 0n Ilcoo ^9 &hrough 53, boloiz
ic 74671 mC 6,' 3 ic) CpCGco; (rox Schedulo 4 (E40), Iing 1C) 08
Voc; 'Gt:' . lon {," Jlk Jm Sszcl 0(5.40), Iino 15) 49
(irr%ul SshY uls' A(/01, Ilnp P3) _ 50
;ucikn$ (; rAa A (5C0),;' Il;) 25) 51
""0,78 (EpCnSJ (ron) Cs tdule A (00l" Ilna 29) 52
G Aious (-uikh;! ` (irom Schcsulo A (5401, lina 37) 53
(ducUons (&c;: , ines 4B;: Iirouzh 53) 54
(fineGED (gdC__ olc7 ,0 !lzJcid deduelcn cl 98oo
2
5JW yiigle or marric:] p2rs03 fillng coparate rerurn 55
k:d 0f G,Uundho' or mcirld J 'coupl filing join€ rokurn
Xuci_ SpGA) 03 5_1L4 duductlon (o 55). Enkor 631o @d 0n pczo 4,_Iine 15 56
F {z7 [ LZ) Wov Cc") t3 Anottijr Stc ~_Attach CSZJL ol ""other state' return _and Qctiremont Inconq Credit
~rvcd from} Gourcs9 'cvikhin SLN3 07 cnd also taxable by California 0
#ctdcjbeWooR J; lic) [4) 0
I lirjilkz) @;e). 7,1, Ila RH): C
'hi_V; S 0
0i 1ilm6ite
S5 (b00% Iln? (scnnot oucocd l paid olhor 0Pr91 57
CV: ';scylo W(},)) pte 98
~fjjU 03 AUh Ezzy horo cn:)] c pego 1, Iln? 22 59
~clEolicn ' {9' Focwzal DowE _Ii adjusted Gross incoma 0 Federal Return is different from Iine 14, page 1, explain bolowy
04750 Mo 0-72 ID.CoDtJ] 4 oQp
NWB8326-Docl332245335*Pag2 88
qMozkk:
"3,
==================================================
Page 89
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TAXAOLI
R42
CALIFORMIA
19 12
Iulcied _<NUculorJS
YEALZ
K) LSc^ @ Icij &.J
C-zlci TC
FJC:? G80
8Lnzhl rlylJla Ruby 322 12 7997
"J 1, esw 6t; + &-tis 0Q 0n? ccouse Ikemizog C~cuctlons, %o odor MoV CJl uc? te Tcx Tcblo c €'
3C Icb 0 S{ ~3czct:: 0 M3 clciJord Ozduction | You cnoose ko Itemiza Czductloms, complela L'
~cs;_ C*3rzii ) rcummiz 0l 0 S7icrd cnd [kz approprinto Items bolotz
670";
C37F W Icgurcaca 'c7' ocjico) (7 Co @ Jublns
'16, C-at3rs, €= Facs %c ;?
[ZAkJ T^ 2zz} Ccro, 63 22. Cczh~Includinz checho, monoy ordz7s, etc.
(Irocizo) 23
)c Wnz) And 8
3o 2
L? ycJ (~lzJ C: 6w
3
Ic) Ic;) 1J 2 Ewor dKJczorco
33Ej, Lis7 ZjT) L 23. Totol cash contributions 23
Ej 39 ( I637Cz2'! [Ctumg Icr Esdlcol
C^ 46
'Cndol 5 24. Oxncr Man cash (see Instructions) Entor total
Rero 20
~ecedorritzca"
29. Toli_JAdd lines 23 &d 24, Maximum dzduction
nwy not excecd 20S 0f cdjusted gross Income 200 . 00
Entcr hero and 0 Fom 540, paze 2) 25
Ictorogl_Lxczcc?
22 Kom) morkeoo 26
30. Inolicoab durehccoo 27
auaea
GQadoor*D" U # 02005 20 Owvor (Ircmlza) 20
Gtt 0od9
LS) 77
3 0' 6c_) [. Eatc? CZszons?
fo 'Cst)
E l (o Ercr Kzo Cd 6 250.00
C2 10 0
2 Takzy AAcd lines 26227 cnd 28; Entor hore %d 3 ,232 . 00
on Form 540, poge 29
Tr LZacollczz~E3 Cadczlcng
i4 ica uzcd Ccjec7w cr ToCk Looclco} Soo (nctruelJcn?
12
00 Note: 19 you hcd moro &ca %n2 cocualty Or, Mhefe
G
Iojb occurzonce, oml? Ilnoo 39 Rhrougn 33 &nd follow
Cw
82 instruerlond Por Guidonco;
22 Loza Dcloro odlustmonkq 29
J0, lncNrczso rolmzyrcomo6t 98
Oo 1000
J0 32. S8C: Imllelion 32 Sic.Cd
J8. Add Ilnga 31 0nJ 32 39
34. Cacuolly or thaft loes. (LIna 30 Iosa Iin? 33) 30
[c)c- ) 14
29. CnE] ~Seo instructlong 35
E (3jel] @Cs_' 15
6 "c 16 3 O@or_For educatlon, ellmony, union Cuos, olc.
~Szo Instructlons 38
RS-{3 6 VC{ .Z1 Fp0k38
4 721a5,4 , 17
18
ra
EZ3
5} 8e
9c0*io Dodeoooo*o0
20 0o P#jo09ooadodar
Alantrin
Tc~J IJ Ilms) ^10 Gcovah 20, Lxior_ J1, Tolcl @lecollanoouo Caducelonc_~Add Ilnoo 34, 35
hzzo € c VCzim 641,, PcJO *2} 21 862
0
00 ond D8, (Enlor Moro ond on Form 500, DOio 'Z)D 37
C_v ISva} Sozjlo 0 C rovoruo
Nw-88326 Docld 32245536_Rage-89
cd
TU5 Your
Cco
Cid
Ti_
(lvolj
==================================================
Page 90
==================================================
ECWJEDLLE TAXADLG CALIFORNIA
19 72
L
iClji] 840
PROFit (0n LOSS) FROC ? LUSIEzSS OR PROFESSIOR
YEAQ
(Solo Pzcprlovorchlpo)
cc czt;b 521c; fxj5acrzalona CjJC? CXO
PancorcM- blcv VCC;jnC; Cls, Coc10clzzC'
Toclol docurlly (Julc ?
v Um 2577140)_ Rogby 322 121 3907
Sirx " iz-=_ 0
J#L
ferv:
4akt
Jcq produer
3o~ een
'%Iht wp Fur: "Jdtai (Por onOni loi rolall-harc6vaio, w holocalo_tobocso} Borvlcoo -Iogul, manulacturlng-furnlluro, ol.)
C6,
08*6"
@nnal;_Be
Ve 144s4
Ga Fcdorol omployor idoniinearion numbor
ecJrest
525 Nuyg EIvd=
0
Wom 0_Califorala
(Zir Geco)
nac ~C_~nting: {Ieczh; Czgrual; CinCT .
J8r; 391,jii24 1> Jnd {o3 Mo calc"cz eor {od 0f [zqiired)? Yoo No
EGs Icc; ash 6poeiliazzies 0 63' Giy, 1o1n %e: inc zakd? Yoc No
cis {eedine lonoblh Ycon? Yeg
} herih: c_%€' # ablo icdr &id you Cn Iis buclnoti? 12
~wJ "czzic_c: Ozbp Or] c"~lcicu Gouop CrfcJ iq.
#=r) rG%oip;; "Gv 0lcj Locg rorurno @r}} ollowoncod Balanea JCEDUle
c Gooel; cil (Sanodula C-I, Iino C) @d/or opczatlong (awach ochadulo) ArfkCrto
Rq
"Df ,$ (of^ 5,2czkul))
(cJd Ez_J : @;J 4
jz, on 6 36861€2)
k bur_c;n) '= J ' rlc;z*J Dfoporty (onplzin' Ia Schadulo C-3)
cri ' seiix}o (7xiay
Jar } m Ezlodulo" €-3)
9O): ici J54 Uczvj CC? inclyz-;| on lilne 3, Sehcdlulo C-I (onclde any i yourself)
L7
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J€ ~ikng
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BC; Riv zot crid 'prO -sharinJ] 'Plong (uee Inoiruetiong for Ilnp-IS(a))
83"' n (#01CM (c5,3 Inofruciiong Vor lino 1SC)))
4c ,6n bescincw; E_Ibicsn:j-
'3l Cc, ali] 6onw falcj "&.7 crvigog
Aon
' X: } Lkic_657, ia (op;
(o):
"L)_
17pt;o
One
Toral other bucinoss expznsos (add lines IOa) chrough IGlo))
20 Toral deductions (add lines 6 shrough 19)
2 1 Nei (or loss) (subiract line 20 from line 5). Enter horo and on page 2, Form 540 or Form 54ONR 969 60
IQuv. 0672) Pecp 11
NW-88326-Docld: 322451352Page-90_
7"
Vpu Nuye
14:
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'Jl
paid
~Coyou
profit
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Page 91
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TAXALJLE
Liiil;UL
CALIFORMIA
119 T2
CEHL #xal CNES' ' @KJ LOSSES
YEAn
ViriJ Jco
ASrcah WJ Iozo CcJ o LACIO X1 "
ilo ( popon @nd Icanmn @ Dockg, bondo @n clmller lavoolmclio;
C,*z, (ur non Izccg) @ Fjric cl ACC?J Duzh @ @ Icino 67 Icwolzy.
"ilcoby 322 12
23501033260202 Ycay
0, Cast 07 ] Guncz Lacl G cdluskcz, Etzl c7 Cx
Czlnc0} 037 b. Dabo 6z7ca c. @oro cot: 0. Grcss sales quent Wijpzotz30 ( "%" Gat1,4, long
C Ja
71 (Qa , dzy, 5.) prIco 03t puzckiaccd, Cxec3h ( (4, &)
Lo} < 7L7 €7 (a) ew (39.} aplonattu,)) Cd 0t -
C-nS 67 5
Cro JL"ux"p 'L6 96 Jcd 40 Gixeputii"^TKACHE5 0.@0
Sd^
(in
Sabo,l kooec );'- Adcr" 46 '204_ OZIEc@G.
94rop
0a; Cu
63
cz 4 #a Wca peztic-chips @rJ @duciorioo
3zz;] che; Aci) tc"al: (~;;; cozjover fchh (zocoding]' Ianable yoan (owach slalomom)
'cv' Iqz9, Pa", (ncz 0= '3 @r 3 200 . 00
CC
Socz Cz)lca Mzzo_Wzn Dvo_ Ycarg
XA.1
Cle ade "8ge
94 90 Kiodulq [| (540) (@rckh cxor)
3?0 '7 Fardi: ttej 0d Gcuclarlav
V6c $
J4
'@n 1
Sc 5L' Vkvo' cczo
8 ii %3c: 2 'Op Szlsdulo Dof*(M4O) (@nach copv) 9006--Q0
66 Xnorchl;;S & Glduelaadllog
P4*0
'J bn s__ ~iy,c YrVOvor, kuc; proeodlng Iarc slo yooro (@waeh Oalomon) CL522
Cz { /c C '3o, 01 crJ :14
~C JL_
Jo'Qnd Laci
C?"
7 AC iej 3,h
@m,x} "m 'Jnc "14, 15 oc} B6
1z3 ~bc @ CCw; Crtc7 haio @Ed on pcgo 2, Fen Il of [xzm 540 o S40NR
W lin3' 17 shows @' loco, CAler lcko &nd on page 2;' Pam I! of Fozm 540 or SONR Ie smallesd of:
(c) CE;? on lic?'. 17
(6) alic Faxoble ingomo Ror"ahe lnabla yoar (compulod withour ragard @ going or lossos from cgle Or enchonge
0k capiial asscvo)
(c) $1,@0o (8560 Im 'Vho cdk) 6h @ huohand o vllu @ Coparalo rolurn) (15000.2 00)
rryovar (153
9
322.00)
NW:-88326: Docld;; 32245535 91
Cng
'7907
(Cz
09o
i14
'(nd
6
Aline)
Page:
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Page 92
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775-728
Department of the Treasury Internal Reventrr-Service 41040 US
Individual Income Tax Return
"m 1974_
For the year January 1-December 31, 1971. or Ofher taxable year beginning 1971, ending 4;
First njge initial (If join: retura. uge fi:st names and micdlo initials o/ bpt} Last fama Your sociaf security: numtar 2
SA TUEL AND PHYI IIS RURY 322 12 7997
6
Present homa Jddress {Mumber ard street, includinz aartment nurnber _ or {Ural route) Spouse'$ social security numbor 18
16250 Bircher Street 349 18 1420
City. tcwn 0r pot} ollico_ Stalo and Zl? zodo Occu. Yours Self Enplozed 1
Gran,!da Wills, Ca l{fornl; patlon Spoune' $ ousewife
Filing Status__check only one: Exemptions Regular Cs 0r over {Xlind Entcr
1 Singla 7 Yourself ntmber
of boeg 2 Married filing jointly (even if only one had incot:) 8 Spouse: #pplic; only i checked
#6 6 is' checkcd 3 Married separately and spouse: is also filin;?
9 First nanes of your dependent children whio lived with
Give sp' '150'3 social sccurity sumber in 3 space ai nva and enter ti;st nama hera Ered Brian ELsa
Unmarried Head of Household honas Enter
number 2 5 Surviving widow(er) with dependent child
10 Number of other dependents (from line 33) 3 Marrind filing separately 2nd spouse is not filing 11 Total exemptions claitned
1
12 Wages, salaries, tips, etc (Attach Forms W-2 to back If unavallable, attach expianation) 12
a
0
13a Dividends (and 520 pazes 6 ) $ 42,50 13b.Less exclusion $ 4 50_ Balance 13c
Hol,nstr
(It gross dividends and other distributions are over $IOO. list in Part / of Schedule B._
14 Interest: If S1OO or less, enter total without listing in Schedule B 14 178 36
Jl
If over S100, enter total and hst in Part MI of Schedule 8
15 Income other than' wages, dividends, and interest (fron) line: 40} 15 6.350 1
16 ' Total (add lines 12, 13c, 14 and 15)- 16 62522H2
17 Adjustments to income (such as "sick pay, moving expense, etc: from line 45) 17.
18,Adjusted gross income (subtract Iine 17 from line 16) 1B 6.529419
See page 3 of Instructions for rules under which the IRS will figure your tax:
you do not itemize deductions and line 18 is under $10,000, find tax in Tables and enter on line 19.
you itemize deductions or line 18 is $10,000 or more, go to line 46 t0 figure tax
19 Tax (Check if from:-O] Tax Tables 1-13, [J Tax Rale Sch X, Y, or 7, Q Schi D, C7 Sch: G o Form 4726) 19
3
20 Total credits (from line 54) 20
21 Income tax (subtract line 20 frorn line 19) 21 3
22 55127
22 Other taxes (from line 60)
9
1
23 Total (add lines 21 and 22) 23
55122,
24 Total Federal income tax withheld (attach Forms W-2 0r W-ZP to back) 24
1
25 1971 Estimated tax payments (include 1970 overpayment allowed a5 a credit) 25
26 Other payments (from line 64) 26
27 Total (add lines 24, 25,and 26) 27 8
28 If line 23 is larger than line 27, enter BALANCE DUE D= in tull with !eturn. Make checi or money 551 21
ouler pa t-le to Internal Revenuo Service 28 93 1
29 If line 27 is larger than line 23, enter OVERPAYMENT 29
6
3
30 Line 29 to be: (a) REFUNDED Allow at Ieas/ si, meoks
6 tor Yuur rclunt check
(b) Credited on.1972 estirnated tax 1
31 Did you, at any time during the taxable year_ have any interest I Or Signature Or Other author.
ity over a bank, securities or othier financial account In 4 foreign country (except in a U.S. 8
01
military banking facility operated by a U.S. financial institution)? Yes No
8 If "Yes; attach Form 4683. (For definitions, see Form 4633.
Under penalries of pe:jury. declare that have eramined this return, including accompafyinz schedules and statements_ to the best of my knorledgs 68et {
it is true, correct_ and compiete
EDWARD L, LAMBERI_
{
Your 5ignature Date Signature 0f preparer othef A,n (ta34a3r)Qareri 9q Dat
here a/1 informatiqi867hcnt,PTUNA o3_vf;
1_
SUITE si0 1
LNcinU_CALik_91316
Spouso " 5i2na7u7 (6f tilinz jointly, BOTH mwst Jigo evan if unly oe h34 in"me) 'Aidtes: M:i. {2131+1 42U
IMWv 88326 Docld:32245535 Page 92
2nd
item
filing
you
8
A
4n and
Sign"
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Page 2 Form 1040 (1971) Attach Copy 8 of Form W-2 here.
PART I._Additional Exemptions (Coniplete only for other' dependents claimed on line 10)
MME (6) Relationshi? c} #m; lived in your haie: (d) Qid de: (e} Amount mi fUr - (f) Amoint "Tiutnisted
32 (3) -0 0f dicc Cninz {t3n Pen;len: have nished ibr dep: :ent'$ bv OTKERS includ-
{Jf{ D ncW{m 2 support. # 100 6 '#ite ing deperdent
37S 0} More ALLJ
S 5
33 Total numher 0f dcependents listed above:_ Ente:r here ad on Iime: 1 0
PART Il.-~Income other than Wages, Dividends, and Interest
34 Business income or (loss) (attach Schedule C) 34 7 3507 33
35 Net or (loss) from sale or exchange of capital assets (attach Schi dule D) 35 (1,00Q 00)
36 Net or (loss) from Supplemental Schedule of Gains anc/ Losses (attach,Form 4797) 36
37 37 Pensions and annuities, rents and royalties, partnerships, estates or trusts, etc. (attach Schedule E)_
38 38 Farm income or (loss) (attach Schedule .F)
39 Miscel: (a} Fully taxable rensions and aninuities nc; 74; )red an Schadele
c0 {ifuctins 0%,Dave
laneous (b) 50% of capit;l distrbutions (not rej orted on Sche Iule D)
income (c) State income tax refunds (caution_~see instructions on {age 7)
(d) Alimony
(e) Other (state nature and source)
(f) Tutal miscellaneous incomne (adc lines : 9(a), (h), (c), (d),Ard (e)) 39
40 Total' (add iines 34, 35, 36, 37, 38, ard 39). Enter here and on Iine 15 40 6 350/ 00
PART M.ZAdjustments to Income
41 "Sick pay' if included in line 12 (attach Form 2440 Gr other recjuired stalemnerit) 41
42 Moving expense (attach Form 3903) 42
43 Etnployee business cxpense (attach Form 2106 or othier statemnem) 43
44 Payments a$ a self-erployed person to 3 retirement plani , etc. (altach Form 2950SE) 44
45 Total adjustments (add lines 41, 42, and 44) Enter here and on line' 17 45
PART IV ~Tax Computation (Do not use this if you use Tax Tables 1-13 t0 find your tax:)
46 Adjusted gross income (from line 18) 46 529 19
47 (a) If you iternize deductions, enter total frorn Schedule A, line 32.and attach Schedule A
(b) If you do mot iternize deductions, and line 46 is: 47 4 010 99
(1) S10,000 or more but less than $11,538.43, enter 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 48 2;518 20
49 Multiply total number of exeniptiors claimed.on Iine 11;, by $675 49 4 050 O0;
50, Taxable income. Subtract line 49 from line 48 50
(Figure tax on the amount on Iine 50 by usin;; Tax Rale Scheclule X, Y or Z, or if applicabie, the alternative.
tax from Schedule D, income averaging frorm) Sched:ile G, or maxirmm tax from Form 4726.) Enter tax 0n line 19.
PART V:~Credits
51 Retirement income credit (attach Schedule R) 51
52 Investment credit (attach Form 3468) '52
53 Foreign tax credit (attach Form 1116) 53
54 Total credits (add lines 51, 52, and 532 Enter here and on line: 20 54
PART Vi: ~Other Taxes
55 Self-employment tax (attach Schedule SE) 55 551 27
56 Tax from . recomputing. prior-year investment credit (attach Form 4255) 56
57 Minimum tax (see instructions on page 8). Check here @l, if Form 4625 is attached 57
58 Social security tax on unreported tip income (attach Form 4137) 58
59 Uncollected employee social security tax on (fron} Formis W-2) 59
60 Total (add lines 55, 56, 57, 58, and 59). Enter here and on line 22 60 551 27
PART VIOther Payments
61 Excess FICA tax withheld (two or more employers__see instructions ( page 8), 61
62 Credit for Fi;rleral tax On special fuels, nonlighway gasol:ne anrd Iutic::ting Oil (attach Form 4136) 62
63 Regulated Investment Company Credit (attach Forrn ?439) 63
64_Total (add lincs 61, 62,and 633) Enter herc and on line 26 64
'4'146524
QWN 88326 Docld:32245535 93
gain
gain
gain
43,
part
13%
your
tips
Page
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Schedules AeB-Itemized Deductions AND
(Form 1040) Dividend and Interest Income
1971
Depjrimen: of {he Trejsury'
Internal Revene Service Attach to Form 1040.
Name(s} as Shown 0n Form 1040 Your social security number
Samuel and Phyllis Ruby 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, (Itcmize-_see instruictions on page 10 for
hospital care, insurance premiums for medical care, etc_
examples)
1 One half (but not more than S150) of in-
surance premiums for medical care: (Be
sure to include in line 10 below)
2 Medicine and drugs
3 Enter 1% of Iine 18, Form 1040
4 Subtract line 3 trom 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 Tolal contributions (Add lines 18,
19, and 20. Enter here and on line 29,
Jweiow.)
Interest expense-
22 Home mortgage
23 Installment purchases
24 Other (Itemize)
7 Total (add lines 4, 5, and 6)
8 Enter 3% of line 18, Form 1040
9 Subtract Iine 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 25 Total interest expense (Add lines 22,
and on line 27, below:) 150 23, and 24. Enter here and on line 30,
below.) 2 ,617 68
Taxes:
11 Real estate Miscellaneous deductions for child care;
12 State and local gasoline (see gas tables)
alimony, union dues, casualty losses, etc__
(see instructions on page 10):
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. 26 Total miscellaneous dleductions (Enter
Enter here and on line 28, below ) 743 31 here ;ind on line 31, below:) 500) po
Summary of Itemized Deductions
27 Total deductible medical and dental expenses (from line 10) 1507o0
28 Total taxes (from line 17) 7G3 3T
29 Total contributions (from line 21)
30 Total interest expense (from line 25) 2,617/78
31 Total miscellaneous deductions (from line 26) 500 79
32 TOTAL ITEMIZED DEUCTIONS (Add lines 27 through 31, Enter hereaud Qn Form 104 1, line 47.) S/1
NW 88326 Docld: 32245535 Page 94
tax
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Page 95
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NAME
(Luli 4 KYYo
Riv
IDENTIFICATION 'NO.
31-Z-272
ADiRESS_
SCHEDULE NQ SCHEDULE OF DEDUCITIONS YEAR ENDED
mEdICAL FEDERAL STATE CONTRIBUTIONS FEDERAL +& STATE
1. ONE HALF Of MEDICAL INSURANCE CHURCHES
(Not Oyz? S130.00)
ko Foo |
2 DRUGS AND MEDICINES Community CHESTiuNiTEd CRUSADE
3_ LESS; 1% OF ADJ. GROSS INCOME SALVATION ARMYIGOODWILL INDUSTRIES
4_ NET DRUGS AND MEDicines RED CROSS
5_ DOCTORSI DENTiSTS XMAS & EASTER SEALS
DR_ HEART FUNDICANCER FUND
DR_ PARTNERSHiP RETURN
DR_ PAYROLL DEDUCTICN
DR_ Other ORGANIZED CHARiTiES:
DR_
DR_
DR
DR_
DR_ TOTAL CONTRIBUTIONS
WTEREST (TO WHOM PAID) FEDERAL & STATE
MORTGAGE LOAN
3L4ol-[k 1Z11E4
INSTALLMENT LOAN
MEDICARE
HOSPiTAL
LABORATORY
BALANCE OF MEDICAL INSURANCE
NOT DEDUCTIBLE ON TOP LINE TOTAL WNTEREST 5 A2
TRAVEL For MEDICAL MSCELLANEOUS_DEDUCTIONS FEDERAL & STAE
AMBULANCE ALIMONY (EXPLAIN)
GLASSES SAFE DEPOSIT BOX FEE
HEARING AID UniON DUES
PRosTHETIC APPLIANCES SMALI: TOOLs (GOOD 1 YEAR}
MEDICAL EXpensEs TOOLS DEPRECIATION
LESS: REIMBURSEO BY INSURANCE SAFETY EQUiPmENT
6_ TOTAL UnifoRMs (Not GEN _ WEAR)
7. LESS: 39 OF ADJ: GROSS INCOME LAUNDRY & CLEANING
8. BALANCE (NoT LESS THAN ZERO) AUto MILEAGE @
9. TOTAL MEDICAL` DEDUCTIONS TELEPKONE EXPENSE (NoT Reimb )
(LINe 1 PLUS LINE 8)
Lia l No;
EMPLOYMENT AGENCY FEES'
TAXES FEDERAL STATE DUES & SUBSCRIPTIONS
Auto LICENSE (Less REG FE2 INCOME TAX PREPARATION
SALES TAX 16 W OTKERS
SALES TAX AUTO
REAL ESTATE TAX 443 DZ) TOTAL MSC_DEDUCTIONS
PERSONAL Property TAX CASUALTY LOSSES (EXPLAIN) FEQERAL & STATE
STATE InCOME TAX X * * *
ZlezvQUAKE LeMEiz 3ho0
GAS TAX 1ozy GAL @ C GAL_ 221 Zdo
SUB TOTAL Joo
DISABILITY INSURANCE LESS REIMBURSED BY INS 72 @o TP
Tolvtaa'
Misc_ TAX X * `* * SUB TOTAL
Otheas: LESS $10O.00 For EACH CASUALTY 0
TOTAL CASUALTY LOSSES
FEDERAL STATE
TOTAL TAXES 2E31OW TOTAL DEdUctions Ualos Clale
NW28326v Realg; 2245535Rege 35
16633 VFNTMRA ROMi FVARD cmitf 51n Fncino CmlIFornia 01316
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UULE C Profit (or Loss) From Business or Profession
1040) (Sole Proprietorship)
1971
cpattmnent of Ihg Traasury Partnerships, joint ventures, etc , must file cn Form 1065.
Iatatnal Pevanuu Servico p Attach to Form 1040_
Name(s) as stlown On Forin 104o Sicial security numbar
Samel Phyllis
322 12 7997
Foodl Service prodhict Principal business activity
instructiong) (ror examplo: retsil hard; holesalo tobJcco; serulces _~E ~leza; mnafufactuting_furnlture; etc.) (See separate
B Business name
Snck_Ber Employer Identification Number
5418_Van_Nuys _ Blvdl an WS mliforni? 91'01
D Busincss address
E Indicate method of accounting: (1) X cash; (2) CI accrual_ (3) Ci othe; (ZIP code)
F Wias there any substantial change in the manner of determining quantities, costs, or,valuatiors between the cpening and closing inventories?
0'YES NO. If "Yes; attach explanation:
Were you required to tile Forms 1096 ad 1099 or 1087 for the calendar year 19717 (See "Item G" in separate instructions tor Schedule C.)
0 YES @ If "'Yes; where: were filed?
1 Gross receipts Or gross sales $ Less; Rcturns and allowances 5 S
2 Invontory ut beginning 0i ymmi (it clitterent Itin Ius/ yeii closnK invi:nlory
attach explanation)
3 Merchandise purchased $. less cost of a"y itetns
withdrawn from business for personal use $_ SCHEDULE
1 Cost of labor (do not include salary to yourself) AT'TA CHEI)_
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 Ilne 9 Irom line 1)
OTHER BUSINESS DEDUCTIONS
11 Deprecilation (explaini: In Schedule €-2)
12 Taxes on business and business property (explin In Schedule C-1)
13 Rent on business property
14 Repairs (explain In Schedule C-1)
15 Salaries and wazes not Included on-line 4 (exclude any to yoursclf)
'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 0f linas 11 through 24
26 Net protlt (or loso) (aubtract Iino 25 Irom Iina 10). Enter hora ana Or lime 34 _ Form 1040_ ALSO enter on
Schedule SE; Part 1 line 7 350)
SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24
Lino No. Explanation Amount Lina No Explanation Rmount
S $
NW 88326 Docld: 32245535" Page 96
and Ruhy
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they NO.
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Sanuel and Thvllis
SIPPLEAINT' To) "CIFLF C
Income
I,ess: Sales Tax
443,479.18_
174.63
843,34.55
Cost of Goods Sold
Besinn Inventory
800) . ()_
Purchases
Beverare{nilk
980.70
Groceries
15 ,162. 50
Meat
2,570.35
Bakerylbread
2,815.62
Tota] Avaflahle 826 336.17
Less: Endinz Inventory
800,02 25,536.17
Adjusted Gross Profit 817,76,8.38
Exnenses
Gasual lahor 68. 12
Rent 1,659 . 87
Payroll
3,640 .(3
Telephone
148. O()
Insurance
190 .5;) Advertising
43.70
Accounting
175.00
Mliscellaneous
27.04 Fquipment
74.03 Maintenance/repatrs
136.19 Taxes /l1censes
558.06' Hosiery
130 . 04
Auto
317.14 Linen
17.83 Donat tons
24.00 6,989.55
Iess: Deprectat Ion
S10,778..83
(3,429:50)
NFT PROftt
S 7 350 33
DEPRECIATION
Equipnent 4/70 S10,020.02 S2,00n,oc 5 SL Covenant not
s2,000.00
to Compete 5,000 . 00 1,o00 no 5 {r. SL
Leasehold 1,0o0.00
3,900 . 00 128. 50) 7 Yr . SI (Ral of I.ease)
428,.50
53 628 .50
AW 88326 Docld:32245535 Page 97
Wuhy
inc
4 ,
Yr.
Inp.
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SCHEDULE SE Computation 0f Social Security Self-Empioyment Tax
(Forrn 1040)
Each self-employed person must file a Schedule SH.
1971
[epatiten} %f Ite T e#sury
interaal Revenee Serece Attach t0 Form 1040.
> If you had Wiges, includim: tips_ of 57.800 or more that were suhyect to socialsecurity taxes, do not fill in this page_
D If you had more than one husiness, combine profits ari! losses fromn &i your businesses and farms on this Schedule SE.
Important_ ~ ~The self-employment income reported below will be credited to your sociai security recoid 2nd,used in figuring social security benefits
Name of self-empioyed person (as Shori on social security carc) Social security number
of self-employed person
Samue] 322 12- 7997
Business activities subject to self-employmeril !Ax (grocery store restaurant, 'farm, etc
PadiL Computation of Net Earnings from BUSINESS Self-Employment (other than farming)
1 Net profit (or loss) shown' in Scheduile C (Forin 1040) _ hnc 26. (Enter combined amount if more than une 7 3501 33 husiness )
2 Net income (or loss) (rom exchle| sTvices (,%'r:" iuclcdee| (I Itm:
Specify excludled services or Soufces
3 Net earnings (or Ioss) from business self-emplyment (Subtract Iine ?2 froi line 1, and enter here and
on_line_8(a):_Part Il below.)
7,350 33
Patdlla Computation of Net Earnings from FARM Self-Employment SE
A farmer may elect to compute net farm earnings using the. OPTIONAI 'METHOD (line 6, below) INSTEAD OF THE REGULAR_
METHOD (line 5 below) if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 ad net profits are less than $1,600.
If your gross profits from farming are not more than $2,400 and ycu elect to use the optional method, you need not complete
lines 4 and 5.
putation under Regular Method
4 Net farm profit (or loss) from:
(a) Schedule F, line 52 (cash method), or line 71 (accrual method)
(h) Farm. partnerships
5 Net carnings (roin sclf-employrient fromn farming: Acld Imes 4(.) ad (h)
Computation under Optional Method
6 'If gross profits froin farining are:
(a) Not more than $2,400, enter two-thirds 0f the gross prolits
(b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600
#Note. Gross profits from_tarming are the total of the gross profils from Schedule F, 28 (cash method), or line 69 (accrual method), plus the distribulive share of" gross' profit trom farm partnerships as explained in instructions for Schedule SE.
7 Enter here and on line 8(b), Part III, below, the amount on line 5 (or line 6, if you use; the optional
method)
Partill; 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 1; abovc 7 3501 33
(b) From farming (from,line 7_ Part Il, above)
'(c) From partnerships, joint ventures, etc (other than farning)
(d) From servicc a5 a minister, memiher 0f J relisius ordler, (jr # Christian Scierce practitioner. If YOu filed Form 4361, check here LJ ad enter zero on this linc
(e) From service with a foreign government or international organization
(f) Other. (director's fees, etc.). Specify
9 Total net earnings (or loss) from self-employment reported on line 8 7 350, 33
(If 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 vages and self-employment earnings subject
to social security tax is S7 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 1l(a) and 11(b)
12 Balance (subtract Iine 11(c) from line 10).
13 Self-employment income ~line 9 or 12 whichever is smaller 7,350 33
14 If linc 13 is $7,800, enter $535.00; if Icss, multiply the ariotmt on Iinc 13 by .075 551 27
15 Railroad employee's and railroad employce represenlative 5 adljustanent hospital insur:ince bencfits
tax fram Form 4469
16 _Self-ernployment_tax_(subfract line _] 5 trom Iine 14). Enter hcre al Oii Fonm -1J4O, Iine 55 55T!
NWV 88326 Docld:32245535 98
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SCHEDULE D Capital Gains and Losses
(Form 1040) Attach to.Form 1040_ D Examples of property to be reported on this Schedule ara 1974-
caparmen: cf tre Tfesury gains and iosses on stocks, bonds, ard similar investments, and gains (but not losses)
Intern:/ Reyenua 'Serrica on personal assets such a5 3 home or jewelry_
Name(s) 23 shown on Forrn 1040 Social security_number
Saruel and lis Rubv 2 997
JPattli Short-term Capital Gains and Losses-_Assets Held Not More Than 6 Months
Cost or Oihe; basis_
h Kow Mo_ day_ YI _ as adljusted, cost cf suh
Rind cf proparty and descfiption acquired Pw:tata sold above sequent improverants Gain or (loss}
(BJmalo, 100 shares of 2 Co Enter (etter dotted] fine and ca:n Gross sales Wice {ilnot purchascd, attach (d less 0 symboi (sc9 Jsquiredl belnx explanation) ?nd ex-
insiructions) doticc Iine) ponse of Sale
SCUETIJIE ATTACIIED (1 269 [oo)
2 Enter share of net" short-term or (loss) from partnerships and fiduciaries 2
3 Enter net gain or (loss), combine lines 1 and 2 3
4(a) Short:term capital loss component carryover from years beginning before 1970 (see Instruction H) 4(a)
4(b) Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) 4(b)
5 Net shont-term Or (loss)_combine lines 3_4(a) _and_ ^(b) 5
[partIIE Long-term Capital Gains and Losses _~Assets Held More Than 6 Months
6
7 Capital distributions
8 Enter if applicable from line 4(a)(1), Forrn 4797 (sec Iristruction A)
9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries 9
10 Enter your share of net long-term from small business corporations (Subchapter S) 10
11 Net gain or (loss), combine lines 6 through 10 11
12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction H) 12(a)
716,27i Jooj
12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) 12(b).
13 Net_long term or (loss), combine lines 11_ 12(a) and 12(6) 13 (14 274 40)
EPartll Summary 0f Parts I and II
14 Combine the amounts shown on lines 5 and 13, and enter the net (loss) here 14 (15 522 i00)
15 It line 14 shows a
(a) Enter 50% of iine 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 15()
(b) Subtract line 15(a) from line 14. Enter here and on line 35, Form 1040 15(b)
16 If line 14 shows a loss See Instruction I
Omit lines 16(a) and 16(b) and g0 to Part IV if losses are shown on lines 12(a) and 13:
Otherwise ,
(a) Enter ona ol the followinz amounts:
(i) If amourit on Ilna 5 is zero Or a net enter 50% of amount on line 14;
(li) Ifamount on line 13 is zerd) or a net gain, enter #Wunt ( line 14; Or
(iii) If amounts on line 5 and line 13 are net losses, enter amount on Iine 5 added to"
50% of amount on line 13 16(a)
(b) Enter here and on line 35, Form 1040,the smalier of:
The amount on line 16(a);
S1,000 (5500 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 51,000); or,
(iii) Taxable income as adjusted (see instruction J) 6() ~1o2 QQ)
arrvver (1~1' (614,522 . (J):
NW 88326 Docld:32245535 Page 99
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WEEKL Y WoRK FLANLTIAE REPORT
Bech_Y S PhyirS vuMVILsE &
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SALESMAN"
CONTRACT REVENUE CALL
BOOKED HRS
COMAIENTS AND
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NW 88326 Docld:32245535 Page 101
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SALESMAN,
Rach C NuMBFR'
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CUSTOMER TYPE BOOKED HRS
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NAME
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S(HZDULE
CALIFORNA
TAXABLE
1 971
FoRm s40
CAPITAL GAHNS AND LOSSES
YEAR
Attach to Form 540 or 548mR
Use this schedule to report goins and losses 'on stocks, bonds and" similar investments,
and gains (but nof losses) on personal assets such as a home Or_ jewelry .
Scciai Szcu ity Mumbe:
Name as shown on Form 540 or 540NR
Samuel and Phyllis Pubv 322 12 7997
SHORT-TERM__ASSETS HELD NOT MORE THAN 6 MONTHS
Cost or Otker ba5is as
adjusted cost 01
Kind o ornderty and degcription b Dale acquired Date sold d Ge.xs' salts price- subsequent improvements Gain 0 loss
Example, iod mhares at "2' Co. (mo,, day, Yr.) (mo . day, Yr ; ) (if not perchased d less
atlach explanation)
and expense o/ sale
SCHRNU.F ATTACTEN 248,(0)
2. Enter your share of net short-term (or loss) partnerships and fiduciaries
3.' Enter net (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
7. Enter if applicable from line 4, Schedule D1 (Form 540) (attach copy)
8 . Enter your share of net long-term (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 (atlach statement) (14 274_00)
M1_ Net long-term gain (or loss), combine lines 9 and 10
12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here (15,522.Q02
13. If line 12 shows O
(a) Enter 50% of line 11 or 50% of line 12, whichever is smaller. Enter zero if Ihere is & loss or no entry on line 11
(6) Subtract line 13(a) from line 12. Enter herc and on line '32, Form 540 (line 33, Form S4ONR):
14. If Iina 12 shows 0
(a} Add lines 4 and 10 (if lines 4 and 10 are blank, enter 0 zero here and or1 lines I4(b) and ]A(c) and go to
line I4(d) ):
(6) Combine lines 3 and 9-_if gain, enter gain; if loss, enter zcro
(c) Enter smallest of (i) ` line I4(a) less line 14(b); (ii) the amount of laxoble income on Form 540 or S4ONR,
computed without capital and or losses__determine this figure via a side computation; or. (iij) $1,000
(d) Combine lines 3 and 9__if loss, enter loss; if gain, enter zero here and on line I4(e) and go to line 14(f)
(e) Enter smallest of (i) the amount of taxable income on Form 540 or 54ONR, computed without capital ijains
and or losses, Iess line I4(c) _~determine this figure via @ side computation; (ii) $1,000 (S500 if married and
filing separately); (ii) if line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows
gain, amount on line I4(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 S4ONR), the sum of lines I4(c) and I4(e) -(Do not
enter an amount greater than $},000) 1,0nn.0Q)
Carrvover (1-()_ (S14,5:2.10)
Son Instrurtions on Back
NW 88326 Docld:32245535 104
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FORN TAXABLZ
540 :
CALIFORMIA
1971
RESIDENT
INDIvIduaL INCOME TAX RETURN
YEAR
oq Not WRItE 0m Tmis Lime
For Calendar Year 1971
cr Fiscal Year Begun 1971 and Ended 1972
LAST NAME Yeur {orial security number Spouse' $ sjciai secerily C5;C FIRST NAME(S) AND INIiIAL(S)
SAMUEL AND PHIYLLIS RWRY 322 12 7997 349 18 1420
Plzase
You occupation Spause occucaticn PRESENT HOME ADDRESS (Number and street, or rural route) Type
0f 16250 Rircher Street Se lf Enploved
Print CiTy, TOWN OR PoST OfFIcE STATE COUNTY Zip CODE
Granada Aflls Californi? T.os Anceles:
NAME AND ADDRESS Of EMPLOYER AT TImE Of Filing 5 M 8
Self Employed
FITMG STATUS__Check Only Une: Clnim yrur ;pproprial: BLIND and /or OEPEMDEMT EXEMPTIOMS:
cxesilion Un lina: 16
5. Hlirc) [ Youtsell '4Yer #puse ~ Fnkcr. numher of boxes checked 5
1 0 Sirgle
relurn 6_ Dependnts _ UJu mot I:st yur,elf, Ycut :pousc Or person wha" qualiics Y(Ju
2 Married , filing joint
a5 head of hou;cchold mamE (wd Jddress if 'diferent Irom yqurs) RelaTionship
3. 0 Married, filing separate return ~If this item checked; enter spouse'$
social security number in space above and enter first name Fred Rrinn' Flisa Thomas
Enter
number
here
Unmarried "head of household" Complete Part L, page 2 7_ Total-blind ad dependent exemptions (add lines 5 and 6}
dj nol #ife
8. Wages, salaries, tips, etc (before payroll deductions) if mofe than two. employers; attach 'list in' this, cok;57
Employer'$ name Where employed (city and sIate)
Income
8
9. Dividends, Enter total (complete and attach Schedule R (540), if folal is uvei SL00} 9 42 50
10." Interest Enter total here (complete and a/tach Schedule B (540}, if total is (vet Sioo) 10 178 86
@
11. Other incoma (from. page 2_ lino:` 4O) H' 6 350 33
12. Total (add: Iines #, 9_ 410 ;d H) 12 6..52.1 69
13. Adjustmonts to Income (Irom pape *, line 46) 1J
]
14. Adjustad gross Income (sublract 'Iine 13 trom line 12) 14 69
If you do not itemize deductions AND line 14 is under $10,000, find your tax in T;x Table in instructions. Enter 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 onel: C Tax: Table, @ Tax Computation (page 2, Part IV or Schedule G (540), Jine 21 15 25,60 1
16. Personal Exemption. Single =525.: Married couple or head of ' household_-550 16 50_-Joo
17. Multiply total number . of exemptions on line 7 above, by $8 17 32 00
Your
Tax, 18. Total exemptions (add lines 16 and 17) 18 82 [0n
and 19. Tax liability (subtract line 18 from line 15-not less than zero) 19 None
Credits 20 . Other credits (from page 2, line 62) 20
21. Net tax (subtract line 20 from line 19) 21
22. Tax forgiveness _20% of line 21 (use Part V on page 2, if reporting income on Schedule D (540)) 22
NOTE: You must Iile your return and pay any tx due (line 27) bJ the due dale to be: cntitled ta thie' torgipencss
23 . Met tax Ilabillty (subtract Iine 22 line 21_if $1.00 or less, enter zero} 23
24. Tax 0 preference income (see instructions) check here O if Schedule P (50) is altached 24
25 , Total tar liability (add' lines 23 and 24) 25
26 . 1971 California estimated. tax payment (include 1970, overpayment allowed as a 'credit)" 26
Balance: 27 . Balance due_if any (suhtrac/ lina *6 Icom Iine 225) PAX.im FULl With Returm 27 Ndne
Due 0r 28. Overpayment-if any (subtract Iine 25 line 28) OVERPAYMENT '28
Refund 29. Portion of line 28 you wish to apply; o 1972 estimaled tax 29
30. Refund_if any (subtract line 29 from line 28) REFUND 30
Yader Renallies of perjury, declare that have examined this It turn including accampanyina schedeles and stalements. and to the best of my knorledge and Do not Krife in {REt sp2c*3
#iitt il js cOr{ect and camplete. If prerared by person olhcr than taxpayer, his declaratian is based 0n1 all infcrmation 0} #hich 6e has any knorledge_
~A3O L NBERT
Sign
wr
Your Signatura ~ii-niing joinily," BoTif `"musi Date Sicnaiure 0i prepai giher Ahan; 6fayer SE:o
here 91 ;16
Spo5s; sigujiue Oate ~Addfes; Qaie
Sociol Socurity No. on Your Chock or Monoy Order. Makc Rcmittance Pgyable t0
84N2;"Soc43.28338 Mail 10 FRANCHISE TAX BOARD, SACRAMENTO, CALIFORMIA 95867
NW 88326 Page 105
here
6,571
tax"
{rom
from
{rue,
Entcr Your
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Form 540 1971 2
PARI '_ead 0f Household_If claimed,answer_the_following_guestions_ (See Instructions)
Check LI Never married Legal separation (inlerlocutory decree doe; nof qualify) Date_
cne: Widlow(er) Date Final divorce/ dissolution Date
Individual who qualified you as head of household:
Name Relationship Age_ Gross income S
Is this person married? f yes, did he or she file a joint return with spouse? Did this person. qualify as Your dependent for
the calendar year 1971?_ Did this person reside in home for the entire taxable_ If not, explain circumstances
Totcl amount: necessary tc maintain household $ How did you contribute? $_
PART IL_Other Income
31. Business income (or loss) (attach Schedule C (540) ) 31 7 350.133
32.' Net gain (or loss) from sale or exchange of capital assets (attach Schedule d (540) ) 32 L1 QQ
33. Net gain (or loss) Supplemental Schedule of 'Cains and Losses (attach Schedule 0:} (540} 33
34. Persions and annuities 34
35. Perts and royalties Attach 35
Schedule 36. Parinerships (Form 540) 36
37 . Estefes ad trusts 37
38. Farm income (or loss) (attach Schedule F (540) 38
(a) Fully taxable pensicns ad anuities (not reported o Schedule 0
39. Miscel
(b) Alimony
laneous (c) Other (state nature ad source)_
locome
(d) . Total miscellaneous income add lines. 39a), (b) and (c) 39
40. Total (add lines 31 through.39). Enter here ad 0n page 1, line 1l 40 6 350 33
PART_WVI_Adjustments to Income
41. "Sick pay' if included in line 8 (see instructions__attach : statement) 41
42. Hoving expenses (see instructions_attach statement) 42
43. {mployee business expense: (see instruclions__attach stalement) 43
Military exclusion (see instructions ` for line 8)
45. Payments as a self-employed person to a retirement plan; etc,, (attach Federal: Form 2950SE)
4
45. Totzl adjustments (add lines 41: through 451. Enter' here and on page 1, line 13 46
PARV_IV_Tax Computation_Do not use this part if you use the Tax Table to find your tax
Adjusted gross income (from page 1, line 14) 47 6 ,571/69
4.. (a} If you itemize deductions; enter total from Schedule A (5401, 'line 32, ad attach Schedule A
(b} If you do not itemize deductions, and line 14 is $10,000 or more, enter
(W) $L,000, if single, or married person filing separate return 48 4,010493
(21 $2,000, if head of household; or married couple joint return
'9. Tarable income (subtract line 48 from line 47). _ Figure your tax on (his amount by using 2 , 560 70'
appropriate Tax Rate Schedule in instructions. Enter tax on page 1 line 15 49
PART V_Tax Comvlete all lints below_ However _ if Yuu used income aycraging method to: compule Yqur {af on Xine 15 omit lines 50_ Forgiveness 51 and 52 , enter on Iine 53 the amount shomo 0n line 41 oi Schedule G (5u) and campltte . lines 54 55 and 56_
5Q. Tarable income from line 49 above, Or page 1, line 14 if Tax Table used 50
51. Amcunt (if ay) entered on Schedule 0 (540), line 13(a) 51
52. Adjusted taxable income (subtract line 51 from line 50) 52
51. Adjusted tax (use same method.as used for determining tax 0 page 1, line 15) 53
54. Add 18 and 20, page 1; and enter Iotal here 54
S5. Adjested net tax (subtract line 54 from line 53) 55
6: 20% 0/ line 55. Enter here ad 0 page 1, line 22 56
PART VI_Credit for Het Income Tax Paid to Another State_Attach cOpY of "other state' return ~and Retirement Income Credit
57 . Inc:me derived sources within State of and also taxable by California 57
39. Calitoraia adjusted gross income (from page 1, line 14) 58
99. Calitornia liability (from paze 1, line 19) 59
#: limitation_line 57 line 58 % (100 % maximum) X line 59 (cannot exceed' taz paid other state) 60
51, Reirrement incnme credit (attach Schedule R (540) ) 61
52 (add lines 60 ad 611. Enter here and on page 1, line 20 62
M'ART VII_Reconciliation to Federal Return_If adjusted goss income on Federal Return is diiferent troni 'line. 14,pag 1, explain below
WW 88326 Docir-32245535-Page 106
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SCHEDULE
@ALIFORMIA
TAXAaLE
A. 19
71
itehized DEDUcTIONS
FoRM 540 YEAR Attach to Form 540
Nama as shown on Form 540 Sociji Security Nusber
Samuel Lhllis_Rubv 322 12 2992.
itenized Y;_ Standard Deduction__You have a choice belween {wio deductinn one spruse itemizes dcductions, the other may not use the Tax Table or clai
methcds. Ygu can either itemize your deductions or take a standard deduction 35 Xhc standard deduction. if You. choosc to itemize your deductions; complele
explained in fha 540 Instructions_ On separate ' returns of a husband and wiie; appropriale items below_
Medical ad dental expenses (cot compensated by insurance 0r otherwise) for medicine &d doctors, dentists, nurses, hospital cre, insurance
premiums for medical care, etc.
Ona hali (but not more than $150) of insurance premiums for medical care
2. Medicina and drugs 2
3. Enfer 1 % of adjusted gross income shown on Form 540 3
4 Subtrac: line 3 from line 2. Enter difference (if less than zero, enter zero) 4
5, Enter balance of insurance' premiums for medical care not entered on line 1 5
6. Other medical and dental expenses (attach itemized list) 6
1 Totsl_(Add lines 4, 5 and 6) 7
8.. Enter 3% o/ adjusled Gtoss income shown on foim 540 x
9_ Subfract line 8 from line 7 Enter diffcrence (il less Ihan IeTO, cmer Ito) 9
10. Tolal-_(Add lines / and 9) 10 150 KhC)
Child Adoption Expense
11_ Total expenses paid or incurred_Attach itemized list 11
12, Enter 3% of adjusted gross income shown 0 Form 540 12
13. Subtract` Iine 12 Iine 11-See instructions for raximum limitations 13
Tares
14. Real estate 14
15. State and local gasoline 15
16. General sales ie
11. Aulo license_Excess o registration and' welght fees (see instructions) 17
18, Personal property 18
19. State disability insurance (SDI) _Employer private disability plans: d not qualily 19
20. Other. (specify) 20
21, Total taxes_-(Add lines .14 through 20) 21 143 p1
Contributions
22. Cash_Including checks, money orders; etc. (itemize) 22
23. Total . cash contributions 23
24. Other than cash (see instruclions) Enter total here 24
25,Total_Add, lines 23 and 24_Maximum deduction may not exceed 20% of adjustcd Poss income 25
Interest Expente
28. Home morlzage 26
21. Installment purchases 27
28. Other (itemize) 28
29. Total_ {Add lines 26, 27 ad 28) 29 2,617 68
Hiscollaneous Deductions
JO. For child care, alimony, union dues, casualty losses, etc "See instructions (itemize) 30
J_Total_miscellaneous deductions 31 500 bo
12. daductions _(Add Ilnes 10, 13, 21, 25,29 and 31). fnter total here and] on frrm 4410, Dave 2; in space pravided S/t 32 5, 'Qg
1971) Sthodulo B on rovor{o
Nwv 88326 Docld:32245535 107
and
drugs,
from
Total
!Ro7.
Page
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SCHEDULE TAXABLE CALIFORMIA
19_
71
PROFIT (OR LOSS) FROM ' BUSINESS OR PROFESSION
YEAR FopM,540
(Sole Proprietorships)
Amoch #his schedule to Your Income tox roturn, Form 540 or 54onR Partnerahips, join? ventures, etc-, must fle on Form s65
Social Secu: ity Mzmbc: Name as shown on Form 540 or S4ONR
Sarel and Phvllts Rnhv 322 12 7997
A. Principal business activity_ Food Service product
(For oxample: hordworo; wholosalt -lobarco; services ~legal; monufacturing-furniture; etc )
B. Business name
Snack Bar Federal emBl;Yeficentification number
5418 Van Nnys Biva Jn Wvs Cali ornia
D; Business location_
(Numbor and atreet or rural routo) (City-post offico} (Stote {ZI? ccde
E Indicate method of accounting: cash; accrual; other (describe)
8. Was there any substantial change in the manner of determining quantilics, costs or valuations between the opening and clasirc
inventories? Yes No. If yes; attach explanation.
G Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? CYes No
1 Grojs receipts or gross sales $ Less: Returns ond allowances $
2. Invenfory Gf beginning of year (If different than last year's closing inventory attach
explanation) SCHEDILE
3. Merchandise purchased $ kess cosf of any items ATTACIIED
drawn from business for personal use $
4_ Cost of labor (do not include salary t0 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 0f goods sold and/or operations (subtract line 8 from line 7)
10 Gross profit (subtract line 9 from linc 1)
OTHER BUSINESS DEDUCTIONS
I1. 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 Schedulc €V)
15.. Salaries and wages nof included on line 4 (exclude any to yoursclf)
16. Insurance
17. Legal and professional fees
183 Commissions
19: Amortization (attach statement)
20. (a) Pension and profit-sharing plans (see instructions)
(6) Employee benefit programs (see instructions)
21. Interest on business indebtedness
22. Bad debts arising from sales or services
23. Depletion of mines, oil and gas wells, timbcr, ctc. (alach schedule)
24. Othcr busincss expenses (explain in Schedule €-1)
25 . Tolal of lines 11 through 24
26. Net profit (or loss) (subtract line 25 from line 10). and on pagi 2 , Form 540 or 540NR 7 350 33
SCHEDULE C-1, EXPLANATION Of LINES 6, 12, 14, AND 24
Lint Mo. Explanztlon Amount Line Ko, Explanalion Amcual
R87,
Page
NW 88326 Docld: 32245535 Page 108
Gx
retail-
with-
paid
paid
Enter here
1971)
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Page 109
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Department of the Treasury_Internal Revenue Service 1040 US Badiwiduali ImcometeTax Retwrue 71973
For _the year January 1-December 31,1973, or other taxable year beginning 1973, ending 19.
Name (If joint return , give first namesfind of both) Last name COUNTY OF Your social security number
8 AMAEL
"pyyL-LRy z
RESIDENCE 322/2L7222
3 Present home address (Number and street, including apartment number, or rural Iouts; Spouse's social sec urity no: 1 62 52 BLRSHE
LH+aL377622
1 City, tm or post office, State and ZIP code Occu- Yours "ZANAD Hs_(ALLE_
pation Spouse's
Filing Status_check only one: Exemptions Regular 65 'or over Blind
Enter
1 Single 6a Yourself number
of boxes 2 Married filing joint return (even if oly oe had income) b Spouse checked
3 Married filing separately. If spouse is also filing give c First names of your dependent children who lived with
spouse's social security number in designated space above
you
Th MA
and enter full name here D
#Zi4
FREI fureber 3
4 Unmarried Head of Household d Number of other dependents (from line 27)
5 Widow(er) with dependent child (Year spouse died D 19 7 Total_exemptions claimed
8 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 $l_ 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
10a Dividends 'Seon ipstgections )s. 10b Less exclusion
S2
Balance 10c
~ 10d (Gross amount received, if different from line 10a
11 Interest income 11
12 Income other than wages, dividends, and interest (from line 38) 12 1
13 Total (add lines 9, IOc, 11, and 12) 13
3 14 Adjustments to income (such as "sick pay, moving expenses, etc: from line 43) 14
0 15 Subtract Iine 14 from line 13 (adjusted_gross_income) 15
TEZIY
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_ 1
16 Tax, check if from: Tax Tables 1-12 Tax Rate Schedule X; Y, or 2
Schedule D Schedule G Form 4726 IOR Form 4972 16
4oqs
W
17 Total credits (from' line 54) 17
18 Income tax (subtract line 17 from line 16) 18 7DS
19 Other taxes (from line 61) 19
3
20 Total (add lines 18 and 19) 20
21a: Total Federal income tax withheld (attach Forms
W-2 or W-ZP to 'front) 21a
2
1
b 1973 estimated tax payments (include amount
allowed as credit from 1972 return)
1
Amount paid with Form 4868, Application for Automatic
Extension of Time to File U.S. Individual Income Tax Return
Other payments (from line 65) 8
22 Total (add lines Zla, b, C, and d) 22 Z
in full with return. Make
check or money order payable 23
S1 ` Ja
23 If line 20 is larger than line 22, enter BALANCE DUE IRS to Internal Revenue" Service 1
(Check here if Form 2210_ Form-2210F, or statement is attached_ See instructions 0n page 8.)
& 24 If line 22 is larger than line 20,enter amount OVERPAID 24 1
25 Amount of line 24 to.be REFUNDED TO YOU 25 J
6
26 Amount of line 24 to be credited on 1974 esti-
mated tax 26 8 Note: 1972 Presidential Election Campaign Fund Designation: Check if you did not designate $l of your taxes on your
8 1972 return, but now wish to do sO. If joint return, check if spouse did not designate on 1972 return but nOw wishes to do so
Under penalties of perjury, declare that have examined this return, including accompanying schedules and statements and to the best of my knowledge and beliel 4
is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on ali information f which he has any knowledge. Sign
8 here
Your Signature Date Preparer '$ signature (other than taxpayer) Date
1
Spouse"s signature (f filing jointly, BOTH must sign even if only one income). Address (and ZIP Code) Preparer"s
2622Y-2
Emp: Ident: or Soc. Sec.
249
No.
168 -82337-2
[3717 VANOIYEN: 9treet
VEN Nuys CA_ 91403
367.34.8729 Yw 88326 ' Docld;32245535 Page 109
{
8
4
Pay
had
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Form 1040 (1973) Page 2
(a) NAME (6) Relationship (c)" Months lived in your (d) Did de- (e) Amount YoU (f) Amount fur-
home: If 'born or died pendent have furnished for de: nished by. OTHERS
during year: write B or D. income of pendent' $ sup- including depen:
5750 or more? port 100 % dent.
write ALL. 3
]
27 Total number of dependents listed in column (a). Enter here and on line 6d
Parth Income other than Wages, Dividends, and Interest
28 Business income or (loss) (attach Schedule C) 28
29 Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) 29
454
30 Net or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) 30
31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) . 31
32 Farm income or (loss) (attach Schedule F) 32
33 Fully taxable pensions and annuities (not reported on Schedule E= see instructions on page 8) 33
34 50% of capital gain distributions (not reported %n Schedule D), 34
does not apply Tf refund:is for year in which you' took the )' 35 35 State income tax refunds standard deduction-_others see instructions on page 8'
36 Alimony received 36
37 Other (state nature and source) 37
38 Total (add lines 28,29,30, 31,32, 33, 34,35, 36,and 37). Enter and on line 12 38
TZZ6
EPartill Adjustments to Income
39 "Sick pay; (From Forms W-2 and W-ZP. If not shown on Forms W-2 or W-2P, attach Form 2440 or statement.) 39
40 Moving expense (attach Form 3903) 40
41 Employee business expense (attach Form 2106 or statement) 41
42 Payments as a self-employed person to a retirement plan, (see Form 4848) 42
43 Total adjustments (add lines 39, 40, 41, and 42). Enter here and on line 14 43
EPartiia] 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) 44
TrT
45 (a) If you itemize deductions, enter total from Schedule A Iine 41 and attach Schedule A 45
(6) If you do not itemize deductions, enter 15% of:line 44, but do NOT enter more than
S2,000. (S1,000 if:line 3 checked)
46 Subtract line 45 from line 44 46 [L32 6
47 Multiply_total number of exemptions claimed on line 7, by $750 47
48 Taxable income. Subtract line 47 from line 46 48
32?
(Figure tax on the amount on line 48 using Tax Rate Schedule X, Y, or Z, or if
applicable, the alternative tax from Schedule income averaging from Schedule G, max-
imum tax from Form 4726, or special averaging from Form 4972. _ Enter tax on line 16.
Pant?IVi Credits
49 Retirement income credit (attach Schedule R) 49
50 Investment credit (attach Form 3468) 50
51 Foreign tax credit (attach Form 1116) 51
52 Credit for contributions to candidates for public office ~see instructions on page 9 52
53 Work Incentive (WIN) credit (attach Form 4374) 53
54 Total credits (add lines 49, 50, 51,.52, and 53) Enter here and o line 17 54
EPantIa Other Taxes
55 Self-employment (attach Schedule SE) 55 296
56 ' Tax from-recomputing prior-year investment credit (attach Form 4255) 56
57 Tax from recomputing prior-year Work Incentive (WIN) credit (attach schedule) 57
58 Minimum tax: Check here Dif Form 4625 is attached: 58
59 Social security tax on tip income not reported to employer (attach Form 4137) 59
60 Uncollected employee social security tax on tips (from Forms W-2) 60
61 Total (add lines 55, 56 57 , 58, 59,and 60). Enter here and on line 19 61 322
JPartIi 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 Compeny (attach Form 2439) 64
65 Total (add lines 62, 63, and 64). Enter and on line 21d 65
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 1
facility operated by a U.S. financial institution)? Yes No
If "Yes, attach Form 4683. (For definitions, see Form 4683.
U,S. GOVERNMENT PRINTING OFFICE : 1973-0-500-047 16-82337-1
NW 88326 Docld: 32245535 Page 110
gain
here
etc:
bx your
tax
here
1
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SGHEDULE A
(Form 1040)
Itemized Deductions 1973
Department of the Treasuky Attach to Form 1040.
Internal Revenue Service
Name(s) shown on Form 1040 Your social security number 'Simafz
L 4B 32LLI2Iz2wZ
Medical and Dental Expenses (not compensated by insurance Contributions (See instructions on page 1 1 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.
Iso
etc. b Other cash contributions: List
1 One half (but not more than 51SO) of donees and amounts:
insurance premiums for medical care.
(Be sure to include in line 10 below) 2
2 Medicine and drugs
3 Enter 1 % of line 15, Form 1040
Subtract line 3 from line 2_ Enter dif
ference (if less than zero, enter zero)
5 Enter ` balance of insurance premiums 425
for medical care not entered on line 1
6 Enter other medical and dental expenses:
a Doctors, dentists, etc:
73 .0
b Hospitals 22 Other than cash (see instructions on
Other (Itemize ~include hearing aids, page 12 for required statement)
dentures, eyeglasses, transportation, 23 Carryover from prior years_
6 0 24 Total contributions (add iines 21a, b,
etc ) 22, and 23) _ Enter here and on line 0
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 Insurance reimbursement
27 Subtract line 26 from line 25. Enter
difference (if less than zero, enter
zero)
28 Enter S100 or amount on line 27
whichever is smaller
29 Casualty or theft loss (subtract Iine 28 from
7 Total (add lines 4, 5, 6a, b, and c) line 27). Enter here and on line 39
8 Enter 3% of line 15, Form 1040
52b
Miscellaneous Deductions (See instructions on page 12)
9 Subtract line 8 from line 7 (if less than 30 Alimony paid
zero, enter zero)
269
31 Union dues
10 Total (add lines 1 and 9). Enter here 32 Expenses for child and dependent care
and on line 35
Q9L
services (attach Form 2441)
Taxes 33 Other (Itemize)
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) 34 Total (add lines 30, 31, 32, and 33)
Enter here and on line 40
Summary of Itemized Deductions
17 Total (add lines 1l, 12, 13, 14, 15,and
16). Enter _here and on line 36
922
35 Total medical and dental-~line 10
Interest_Expense 36. Total taxes_ line 17
33
18 Home mortgage 37 Total interest-~line 20
19 Other (Itemize) 38 Total contributions ~line 24 LfO
39 Casualty or theft loss(es) ~line 29
40 Total miscellaneous ~line 34
41 Total deductions (add lines 35, 36, 37_
20 Total (add lines 18 and 19). Enter here 38, 39, and 40). Enter here and on
fi6s
and on line 37
2161L
Form 1040, line 45
US: GOVERNKENT PRINTING OFFICE 1973-O-500-049 16-82343-3
NW 88326 Docld: 32245535 Page 111
KILLS
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SCHEDULE C Profit or (Loss) From Business or Professiom
(Form ' 1040) (Sole Proprietorship)
1973
Peernteeten.beservicary Attach to Form 1040. Partnerships, joint ventures, etc-, must file Form 1065.
Name(s) as shown on Form Social security number ZE77444//kn8262
322 L/z22z
A Principal business (see Schedule C D
2 product 0.0_
B Business name D
Ck
(structiog &
c identification number
D Business address (number and street)
NENESI
Empbyer '
City, State and ZIP code D
IAN CA
E Indicate method of accounting: (1) Cash (2) Accrual (3) Other Yes No
Were you required to file Form W-3_or Form 2096 for 19732 (See Schedule C Instructions )
If "Yes; where filed
EREINQ
Was & Employer's Quarterly Federal Tax Return, Form 941 tiled for this business for ay quarter in 19732
H Method of inventory valuation L 251 Was there any substantial change in
the manner of determining guantities,costs,_or valuations_between the_opening and closing _inventories? (lf '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) L
3 Gross profit
4 Other income: (attach schedule)
5 Total income (add lines 3 and 4)
6 Depreciation (explain in Schedule C-3)
T 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 () Pension and profit-sharing plans (see Schedule C Instructions)
(b) Employee benefit programs (see Schedule C Instructions)
16 Interest on business indebtedness
17 Bad : debts arising from sales or services
|
18 Depletion
19 Other business expenses (specify):
(a)
(b)
(c)
(d)
(
(g)
(h)
()
(i)
(k) Total other business expenses (add lines 19() through 19())
20 Total deductions_(add_lines 6 through 19)
21 Net profit or (loss) (subtract line 20 from line 5). Enter here a7 Forgt: 1040, dne3t #0 Yay&
enter on Schedule SE, _line_5(a) L
SCHEDULE C-1 Cost 0f Goods Sold and/or Operations. (See_Schedule C Instructions for Line 2)
1 Inventory at beginning of year (f different from last years closing inventory, attach explanation)
2 Purchases $._ Less: cost of items withdrawn for personal use $ Balance
3 Cost of Iabor (do not include salary 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_
16 82344-1
{NW883262 Do5ld332245535-Page 112
activity(IA
TYKA
Sci
paid
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Schedule C (Form 1040) 1973 Pabo 2
SCHEDULE c-2. ~Explanation_of Lines 7 and 9
Line Mo. Explanation Amount Line No. Explanation Amount
$
SCHEDULE c3 Depreciation (See Schedule C Instructions for Line 6) 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)-1i(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.
Check box if you made an election this taxable year to use Class Life (ADR) System and/or Guideline Class Life System:
d Depreciation 0. Method of
8 . Group and guideline class b. Date C. Cost or allowed or allowable computing Life or &. Depreciation for
or description of property acquired other basis in prior years depreciation rate this year
1 Total additional first-year depreciation (do not include in items below)
2 Depreciation from Form 4832 See Note
3 Depreciation Form 5006 above
) '
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
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 Units of Other (specify) Total:
years-digits production
1 Depreciation from
Form 4832
2 Depreciation from
Form 5006
3 Other 1zm
SCHEDULE C 4.~Expense Account Information (See Schedule Instructions for Schedule C_4)
Name Expense account Salaries and Wages Enter information with regard to yourself and your five highest paid
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
2 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 3
S10,000.
Did you claim a deduction for expenses connected with: 5
(1) Entertainment facility (boat, resort, ranch, etc )? Yes No (3) Employees' families at conventions or meetings? Yes No
(2) Living accommodations_(except employees on business) _ Yes No (4) Employee or family vacations not reported on Form W-2? Yes No
U,S. GOVERNMENT PRINTING OFFICE 1973 0-500-050 18-82344-1
0i488326-Qoclrl 32245535 Page-113
from
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SCHEDULE- D _ Capital Gains and Losses
(Form 1040) Attach to Form 1040. Examples of property to be reported on this Schedule are
1973
Department of the Treasury gains and iosses 0n 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 Social security number
SamUeL LBy 3+21/2 ' 7
Partll Short-term Capital Gains and Losses_Assets Held Not More Than 6 Months D
b:' How
acquired yr . Cost or other basis
8. Kind of property and description Enter letter (Put date sold above
d_ Gross as 8djusted ` (see Gain or (loss)
(Example , 100 shares of *2' Co.) symbol (see dotted 'Iine and date sales price instruction E) (d less e)
instiuction acquired below expense of sale dotted line) D)
40D
ITERNATIONALked li
3118 3222 su
4Z2l3
-102
LEvLT
A [Juzz
J12 81 2292 Is46 2
27x7133
Lop
DTTER InfT
A 2LLi1z3 342 625_ (2Y3-
Ioz NE_
HB3
[39 2 125 36-
2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries 2
3 Enter net gain or (loss), combine lines 1 and 2 3 2ZZ
4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction H) 4(a)
4(b) Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) 4(b)
5 Net short-term or (loss) combine lines 3 4ka) and 4(b) 5
624D
EPantuiza Long:term Capital Gains and Losses Assets Held More Than 6 Months
6
7
7 Capital gain distributions
8 Enter gain, if applicable, from Iine 4(a)(1), Form 4797 (see Instruction A) 8
9 Enter your share of net long-term or (loss) from partnerships and fiduciaries 9
10 Enter your share of net long-term gain from small business corporations (Subchapter S) 10
11 Net gain or (loss), combine lines 6 through 10 11
12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction H) 126)
(ez
12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) 12(b)
13 Net long-term or (loss), combine lines 11 12(a) and 12(b) 13
(2zl
BPant Summary _Of Parts and II
14 Combine the amounts shown on lines 5 and 13, and enter the net or loss here 14
(10z3
15 If line-14 shows a
(a) Enter 50% 0f line 13 or 5o% 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 15()
(b) Subtract line 15(a) from line 14_ Enter here and on line 29, Form 1040 15(6)
16 if line 14 shows a loss
Omit lines 16(a) and 16(b) 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:
If amount on line 5 is zero or a net gain, enter 50% of amount on line 14;
If 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 o line 5 added to 16(a)"
Kab62]
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);
S1,000 (S500 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
(iii) Taxable_income, as adjusted (see Instruction L)
16(bk Iuvze
7
16-82339-1
A4j4- 88326-Docld;32245535_Page-114
PiyLLLse 229
day, Mo:,
and
EseX
gain
gain
gain
gain
gain
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Schedule D (Form 1040) 1973
Pege 2
HPantwva Capital Loss Limitation_ Where Losses Are Shown on' Both Lines 12(a) AND 13
17
17 Enter loss from line 5; if line 5 is zero or a gain, enter a zero
18 1133
18 Enter loss from line 13
19 6
19 Enter gain, if any, from line 5; if line 5 is zero or a loss, enter a zero
20 Reduce loss on line 18 to the extent of the gain, if any, on line 19 20 13a2
21 Combine lines 3 and 1l and if gain; enter gain; if zere or a loss, enter azero 21
NOTE: If the entry 0n 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 12
23
23 Enter smaller of amount on line 21 or line 22
24 Enter excess of on line 21 over amount on line 23 24
25
25 Enter loss from line 4(a); if Iine 4(a) is blank, enter a zero
26 26 Reduce gain, if ay, o line 24 to the extent of loss, if any, on line 25 (see Instruction
27
27 Enter loss from line 12(a)
28 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 K) 29
83.3}
30 Enter smaller of amount on line 29 or iine 20 (if line 29 is zero, enter a zero) 30 033
31
31 Subtract amount o line 30 from the loss on line 20
32
32 Enter 50% of the amount on line 31
33
33 Add lines 17, 30, and 32
34 Enter here and enter as a (loss) on line 29, Form 1040, the smallest of:
(a) Amount on line 33;
(b) $1,000 (S500 if married ad filing a separate return __see Instruction M for a higher limit not to exceed $1,000); 0
(C) Taxable_Income as adjusted_ (see_Instruction L) 34
1025
Complete Part Vif You are Married Filing a Separate Return and Losses are Shown on Lines A(a) and
CPartV?
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, ad enter on line 43 the loss shown on %ine 4()
36
36 Enter gain, 'if any, from line 3
37
37 Enter smaller of amount on line 35 or line 36
38' Enter excess of gain on line 35 over amount on line 37 38
39 Enter loss from line 12a); if line 12(a) is blank, enter a zero 39
40
Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 (see Instruction J) 40
41
41 Enter loss from line 4(a)
42
42 Add the gain(s)' on line(s) 37 and 40
43 Reduce the loss 0n line 41 to theextent of the_gain,if any on line 42 (see_Instruction K) 43
EPanVz
Computation of Alternative Tax (See Instruction V to See if the Alternative Tax Will Benefit You)
44
44; Enter amount from line 48, Form 1040
45
45 Enter amount from line 15(a)
46 Subtract amount o line 45 from amount o line 44 (but not less than zero)
47 Enter smaller of amount on line 13 or line 14 47
If line 47 does not exceed $50,000 (825,000 if married filing separately), check here and
omit lines 48 through 54.
48 Enter long-term gains from certain contracts and installment sales referred to as "certain subsec-
48
tion (d) (see Instruction V)
49
Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger 49
If line 49 is equal to or greater than line 47, check here and omit lines 50 through 54.
50
50 Multiply amount on line 49 by 50%
51
51 Add amounts on' lines 46 and 50
52 Tax on line 44 or 45, whichever is greater (use Tax Rate Schedule in instructions) 52
53 Tax on the amount o line 51 (use Tax Rate Schedule in instructions) 53
54 Subtract amount o line 53 from amount on line 52 54
55 Tax 0n the amount o line 46 (use Tax Rate Schedule in instructions) 55
56 If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 25% of line 49 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 : 1973-0-500-05f 16- 82339-1
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gain
46
gains"'
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SCHEDULE G Income Averaging
(Form 1040) See instructions on pages 3 and 4:
1973
Department of the Treasury: Attach to Form 1040.
Internal Revenue Service
Name(s) as shown on Form 1040 Your social security number
SAMUEL
pue
6z2 '11222
Taxable Income and Adjustments
(a) (b) (c) (d) (e)
Computation year Ist preceding base 2d preceding base 3d preceding base Ath preceding base
period year period *year period year period year
1973 1972 1971 1970 1969
1 Taxable income (see instruction 1)
2626
2 Income earned outside of the United
States or within U.S. possessions ad ex:
cluded under_sections 911 and 931
3 Excess community income and certain
amounts received by owner-emplovees
subject to a penalty under section 72(m)
(52 ' See_instruction 3
4 Accumulatioh 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 3 761
and 4,) If less than zero, enter Zero
Computation Of Averagable Income_
Adjusted taxable' income from line 5, column (a)
2616_
~ 0_
1 30% of the sum of line 5, columns (b), (c), (d), and (e)
8 Averagable income (line 6 less lineZ) 8
7626
Complete the remaining parts of this form only if line 8 is more than $3,000. If $3,000 or
less, you do not qualify for income averaging: Do not fill in rest of form:_
Computation of Tax
0
9 Amount from line 7
10
15) S
10 20% of line 8
11
12{
11 Total (add lines 9 and 10)
12 Amount from line 3, column (), less any income subject to a penalty under section 72(m)(5)
12
which was: included in line 3
13
Kzf
13 Total (add lines 11 and 12)
14
2l7
14 Tax on amount on line 13
15 Tax on amount on line 11 15
2Lz
16 Tax on amount on line 9 16
17
1 9
17 Difference (line 15 less line 16)
18 Multiply the; amount on line 17 by 4 18
826
19
Lpzc
19 Total (add lines 14 and 18)
20 Tax on income subject to the penalty under section 72(m)(5) which was included in line 3 20
21 Tax (add lines 19 and 20). Enter here and: on Form 1040, line 16. Also check Schedule G box on
709$
Form 1040, line 16 21
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SCHEDULE' SE Computation
of Social Security Self-Employment Tax
1973
(Form 1040) Each self-employed person must file a Schedule SE:
Department of the Treasury Attach to Form 1040."
Internal Revenue Service
If
hiad Wages, including tips, of $10,800 or more that were subject to social security taxes; do not fihi inSchiedolers-
lf you had mogestha oerbusiess, combine profits and losses_from all your businesses and farms o_this Schedule SE
you
The self-employment income reported below will be credited to your social security record and used in figuring social security_benefits:
Important:
Social security number
NAME OF SELF-EMPLOYED PERSON' (AS SHOWN ON SOCIAL SECURITY CARD) ot self-employed person
SAMueL LB b322 12 2922
Business activities subject to self-employment tax (grocer_store_restaurant_farm etc = D
STAZE EZE
fyou have only farm income complete Parts and IIl
ifyou have only nonfarm income complete Parts Il and !II_
Wiyou have both_farm and nonfarm income complete Parts_L_Il and
Partf: Computation of Net Earnings from FARM Self-Employment
SE
A farmer
elect to compute net farm earnings using the OPTIONAL, METHOD line 3 instead fthsingtboRedoleverethods
er Miaygelect profompre
(1).$2,400 'or less, 01/82) more than 52,400 and net profits are less than $1,600. However, lines
Iinend' 2 mhistetescoPpfeteareven"{ you @leofte
use the FARM OPTIONAL METHOD:
J REGULAR METHOD ~Net profit or (loss) from:
(a) Schedule E, 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(b))
3
FARM OPTIONAL METHOD 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 farm profit is less than $1,600, enter $1,600
Gross profits from farming are the total gross profits from Schedule F, Jine 28 (cash methods
Orrfine P2 (accrual method); plus the distributive share %f gross protitsEfrom tarm partnerships
OSchedule k-1 (Form 1065), iine 15) as explained in instructions for Schedule SE
Enter here and on line 12() the amount on line 2,or line 3 if you elect the_farm optional method_
Partle Computation of Net Earnings from NONFARM Self-Employment
5 REGULAR METHOD Net profit or (loss) from: Yayel
(0) 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
and enter zero on this line
(d) Service with a
foreign government or international organization
(e) Other (director's fees, etc.). Specify FE7P
Total. (add lines 5(a), 5(b), 5(c): 5(d), and 5(e))
Enter other adjustments (attach statement)
8
Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line 7)
Yayr
If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method; omit lines 9 through 1l and enter
amount from line 8 on line 12(b), Part III.
Note: , You may
use the nonfarm optional method (line 9 through 'Jine 11) only if line 8 is less than
Si,600 and iess than two-thirds %f your gross nonfarm Profits; and you had actual net earn":
from self-employment of 5400 or more for at least 2 0f the 3 tollowing years: 1970, 1971,
ia is7z The nonfarm optional method can only be used for 5 taxable years
Gross profits from nontarm business are the total of the gross profits from Schedule G line 3,
the distributive share of gross profits from nonfarm partnerships (Schedule K-l (Form
Roostheirestfbutsvexpiaieed' {grosst Picions Tor Scheduie SE'Aiso; include gross profits from
services reported on lines 5(c), 5(d), and 5(e), as adjusted by line 7.
9 NONFARM: OPTIONAL METHOD: S1,600' 00
(a)
Maximum amount reportable, under both optional methods combined (farm and nonfarm)
(b)
Enter amount from Iine 3. (If you did not elect to use the farm optional method; enter zero )
(C) Balance (subtract line 9(b) from line 9a))
10' Enter: two-thirds of gross nonfarm profits Or $1,600, whichever is smaller
11
Enter_bere and on line 12(b)the amount on line 9c) or_line_lO_whichever_is_smaller
16-82342-1
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Schedule' SE (Form 1040) 1973 Page 2
PagW Computation of Social Security Self-Employment
12 Net earnings or (loss):
(a) From farming (from line 4)
(b) From nonfarm (from line 8, or line 11 ifyou elect to use the Nonfarm Optional Method)
YaYk
13 Total net earnings or (loss) from self-employment reported on line 12. (lf Iine 13 is less than $400,
are not subject to self-employment tax: Do not fill in rest of form )
Yayel
14 The largest amount of combined wages and self-employment earnings sub
ject to social security tax for 1973 is
810,800 00
15 () 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)
{0e0d[
16 Balance (subtract line 15(c) from line 14)
17" Self-employment income line 13 or 16, whichever is smaller
Y9Y8
18 If line 17 is $10,800, enter $864.00; if less, multiply the amount on line 17 by .08
19 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_204O _line 55
390
You may use this space to make any needed computations
Us: GOVERNMENT PRINTING OFFICE ; IIs-O-s0x-055 16-82342-1
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Tax
you
3261
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4797' Supplemental Schedule of Cains and Losses
Form Sales, Exchanges and Involuntary; Conversions under Sections 1231, 1245, 1250, etc
11973
Deecnaz eeventheServicary To be filed with Form 1040, 1041, 1065,1120,etc: See Instruction A
Identifying number as shown on page Name of your return SAMuEL HYLLIS LR 3 Z2 0
1272222
Sales or Exchanges of Property Used in Trade or Brsiness and/or Involuntary Conversions
Partl 0 (Section 1231)
SECTION A;_Involuntary Conversions Due to Casualty _ Theft (See Instruction D)
f_ Cost or other basis_
8 . Kind of property (if necessary, e Depreciation al. cost of subsequent im- Gain or (loss)
attach statement of descriptive b: Date acquired Date sold d Gross sales lowed (or aflowable) provements (if not pur- plus 0 less f)
details not shown below)' (mo. yr.) (mo , day, yr.) price since acquisition chased, attach explana-
tion) and expense of sale
2 Combine the amounts on line 1, enter here and also on the appropriate line as follows
(a) For all returns; 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, on line 6, Schedule K (Form 1065).
SECTION B.~~Sales Or
Exchanges of Property_Used in Trade or Business and Certain Involuntary Conversions (Not Reportable
in Section A) (See Instruction D)
4 Combine the amounts on line 3, enter here and also on the appropriate line as follows
(a) For all returns, except partnership returns:
is (1) If line 4 is a gain, enter such as a long-term capital on the Schedule D (Form 1040, 1120, etc ) that
being filed-_see instruction D.
(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, on line 7, Schedule K (Form 1065).
Pantli Ordinary Gains and Losses
Cost or other basis,
0 _ Kind of property ad how acquired Date acquired Date sold d_ Gross sales Iowea Baxociatoonable) cost of subsequent 8 Gain or (loss)
(if necessary, attach statement of de- (mo., Yr.) (mo., day, yr.) price since acquisition improvements and plus less
scriptive details not shown below) ~expense of sale
5 Amount, if,any, from line 2(a)(2)
6 Amount; if any, from line 4()(2)
Gain, if any, from line 21
ZZZ2
8
9 Combine lines 5 through 8, enter here and also on the appropriate Iine 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 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 or (loss) on line 9, excluding the loss (if any) entered on line 9(b)(1). Enter 122Y8
here and on line 30, Form 1040
10 82348-1
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and
day,
gain gain
"day,
gain
gain
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Form 4797 (1973) Page 2
Pantl 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 n0 dispositions of farm property or farmland; 0r, if this form is filed by a partnership
10 Description of sections 1245, 1250, 1251, and 1252 property: Date acquired Date sold
(mo day:_YG ) (mo., day,
(A) SNACK Bar 4Zzo
27223_
(B)
(C)
(D)_
(E)
Corelate lines IO(A) through 1O(E) Property Property Property Property Property
with' these columns (A) (B) (C) (D) (E)
11 Gross sales price
2eore
12 Cost or other basis ad expense of sale Z8
13 Depreciation allowed (or allowable)
yez
14 Adjusted basis, line 12 less Iine 13
15 Total_gain subtract line 14 from line 11
16 If section 1245 property:
(@) Depreciation allowed (or allowable) after 12286
applicable date (see instructions)
(b) Line 15 or line 16(2), whichever is smaller 4
17 Tf section 1250 property:
(a) Enter additional depreciation after
12/31/63 ad before 1/1/70
(b) Enter additional depreciation after
12/31/69
(c) Enter Iine 15 or line 17(b), whichever is
smaller
(d) Line 47(c) times applicable percentage
(see 'instruction F.4)
(e) Enter excess, if any, of line 15 over
line 17(b)
Enter Iine 17(a) or line 17(e) , whichever
is smaller
(e) Line 17(f) times applicable percentage
(see instruction' F.4)
(h)Add line_1Z(d)_and line_1Z(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 Iine 16(b) from line 15; OR, if farm-
land, enter Iine 15 or line 18() , 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 iand 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 Iine 19(a) over
line 19(b)
(d) Line 19(c) times applicable percentage
(see instruction F.5)
(e) Line 15 less line 19(b)
() Enter smaller of line 19(d) or lino 19(e)
Summany 0f Pant TII Gains (Complete Property columns (H through (E) upto line T9(0) before going to line Z02
20 Total of Property columns (A) through (E), line 15 22 YX
21 Total of Property columns (A) through (E), lines 16(b), 17(h); 18(d), and 19(). Enter here and on line 7 223
22 Subtract Iine 21 from line 20. Enter_here and_in_appropriate Section _in Part_ (see instructions D and F.2)
# U.S. GOVERNMENT PRINTING OFFICE :1973-0-500-154 10 82348-1
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Form
4798 Capital Loss Carryover 1973
(From 1972 to 1973)
Department of the Treasury Attach to Form 1040
Internal Revenue Service Social Security Number
Name(s) as shown on Form 1040 322 2 2222
MwEL 4 B
File:-_You will need to complete B. How to Compute Carryover. ~If you have a cap-
A Who Should ital loss carryover, complete either Part or Part Il, but
either Part | or Part Il of this form if you have a capital
do not complete both:
loss to carryover to 1973.
1_ Complete only Part if lines 4@) and 12(a),
Schedule D (Form 1040) for 1972, DO NOT SHOW
You will have a capital loss carryover to 1973 if the A LOSS.
amount on line 16(a), or on line 33, of Schedule D 2. Complete only Part Il if either (or both) line 4(a)
(Form' 1040) for 1972 is LARGER THAN the loss de or 12(a), Schedule D (Form 1040) for 1972,
ducted on line 36, Form 1040 for 1972. shows a loss.
EPartHe 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 and QMIT Iines 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
from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
2
loss, enter a zero
3
3 Reduce loss, if any, on line 1 to extent of gain, if any, on Iine 2
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 short-term capital loss carryover from 1972 to 1973 that is attributable to
beginning after 1969. Enter this amount on Iine 4(b), Schedule D (Form 1O40) tor 1973.
Section B:_Long-term Capital Loss Carryover
T
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-
8
over exists
9 Enter from line 5, Schedule 0 (Form 1040) for 1972; however, if such line is blank Or shows
9
a loss, enter a zero
10 Reduce loss on line 8 to extent of gain, if any, on line 9 10
11
11 Multiply the amount on Iine 7 by 2
12
12 Excess of amount on line 10 over amount on line 11
NCessThezamounton line 12 i5 your long-term capital loss carryover trom 1972 t94973*that is attributable to years beginning
after 1969. Enter this amount on line 12(b), Schedule D (Form 1040) tor
NWvi 88326' Docld:32245535 Page 121
PKLLL
Sa [
gain
years
your
gain:
1973
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Form 4798 (1973) "Page 2
Parm: 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 Ki; and OMIT lines 1 through 20 (because no short-term capital loss carry:
over exists), complete line 21, enter loss from Iine 36, Form 1040 for 1972 on line 22--then go to
line 23
2 Enter from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
a loss enter a zero 2
3 Reduce the loss on line 1 to the extent of the gain, if any, on line 2 3
Note: If line 4(a), Schedule D (Form 1040) tor 1972 is blank, OMIT lines
4 through 11, enter a zero on line 12--then go to line 13.
4 Combine lines 3 and 11, Schedule D (Form 1040) for 1972 and if gain,
enter gain; if zero or a loss, enter a zero
Note: If line 4 is zero, OMIT lines 5 through 11, enter_on line 12 the loss
trom line 4(a), Schedule D (Form 1040) tor 1972--then go to line
13.
5 Enter gain, if any, from line 3, Schedule D (Form 1040) for 1972 5
6 Enter smaller of amount on line 4 or line 5 6
7 Enter excess of gain on 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 on line 8 9
10 Enter loss from line 4(a), Schedule D (Form 1040) for 1972; otherwise,
enter a zero 10
11 Add the gain(s) on line(s) 6 and 9 11
12 Reduce the loss on line 10 to the'extent of the gajn, if any, on line 11 12
13 Pre:1970 short-term capital loss (enter smaller of amount on line 3 or on line 12) 13
14 Short-term capital loss attributable to_years beginning after 1969 (excess_of line 3 over line 13) 14
Section B.yComputation of Capital Loss Carryovers to 1973
15 Enter Ioss, if from line 13 above 15
16, Enter Ioss deducted on line 36, Form 1040 for 1972 16
17 Loss carryover to 1973 (excess of Iine 15 over line 16-~If Iine 15 does not exceed Iine 16, enter
zero). Enter here and on line 4(a), Schedule D (Form 1040) for 1973 17
18 Enter loss, if any, from line 14 above 18
19 Enter excess of line 16 over Iine 15 ~if line 16 does not exceed line 15,
enter zero 19
20 Loss carryover to 1973 (excess of line 18 over Iine 19 _If line 18 does not exceed line 19, enter
zero)- Enter here and on line 4(b), Schedule D (Form 1040) for 1973 20
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
N32 2
22 Enter excess of line 19 over line 18 ~if Iine 19 does not exceed line 18,
enter zero (unless you checked the block 0n line 1, and followed the
line 1 instructions) 22
OP
23 Loss carryover to 1973 (excess of line 21 over line 22 ~if line 21 does not exceed Iine 22, enter
zero): Enter here and on' Iine 12(), Schedule D (Form .1040) for 1973 23
(2222 )
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 Iine 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 Iine 24 does not exceed line 25, enter
zero) Enter here and on line 12(b)_Schedule_ D (Form 1040) for 1973 26
US: GOVERNMENT PRINTING OFFICE 1973-0-500-158 36-2603-697
N1-88326_Docld: 32245535_Page_122
gain
line
any,
any,
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SAmuEL
2
CALENDAR YEAR 19
23
NAME 32L~E2922
SOC . SEC; NO_
ADDRESS
DEDUCTION SCHEDULE
FEDERAL STATE CONTRIBUTIONS FEDERAL STATE
MEDICAL
MEDICINE/DRUGS PARTNERSHIP SHARE
LESS 19 A.G.I. (Line 18 1040) GIRLIBOY SCOUTS
NET MED DRUGS HEART FUNDICANCER_FUND
92 RED CROSS/UNITED FUND
H & A inS (Y + EXCESS)
XMAS & EASTER SEALS TO
DR MISC. ORGANIZED CHARITIES
DR_
POLITICAL CONTRIBUTIONS
DR_
DR_ 730 CHURCHES
DR_
DR_
'DR
DR
OTHER THAN CASH:
CARRY OVER FROM PRIOR YRS_
24 TOTAL CONTRIBUTIONS PROSTHETIC_APPLIANCES
CASUALTY OR THEFT LOSS(ES)
HEARING AID
HOSPITAL Loss BEFORE_ADJUSTMENT_
INSURANCE REIMBURSEMENT
AMBULANCE S100 LIMITATION (PER CASUALTY)
LABORATORIES
TRAVEL FOR MED: T2Z 6O 29 TOT, CAS. OR THEFT LOSS
MISCELLANEOUS DEDUCTIONS
MEDICARE INS: INCOME TAX PREPARATION
GLASSES UNIONZPROFESSIONAL_DUES
MEDICAL_EXPENSES 26.0 UNIFORMSZPRQTEC_CLOTHING
LESS REIMBURSED BY_INS SMALL TOOLS AND SUPPLIES
LESS 3% ADJ. GROSS INC. YZZ LAUNDRY AND CLEANING
769 26 Auto USEIDAMAGE
Y (TO S150) OF H & A INS 3 0 ALIMONY (SCHEDULE
10 TOTAL MEDICAL DED:
71
LS INVEST CQUNSEL & PUBS (SCHED=
TAXES EMPLOYMENT AGENCY FEES
REAL ESTATE SAFEEDEPOSIT BOX
STATE & LOCAL GASOLINE TELREQ IN BUSINESS
GENERAL SALES TAX
%]
CHILD & DEP. CARE Form 2441)
STATE & LOCAL INCOME XXXX X
PERSONAL PROPERTY
PERSONAL PROPERTY AUTO
STATE DISABILITY INS
SALES TAX AUTO TOTAL MSC: DED;
SUMMARY OF ITEMZED DEDUCI FEDERAL STATE
Tot DEDUC TIBLE MEDTCAL & DENTAL
JZTOTAL TAXES
2T7 7ZT B5 ESFzPSR9 FROM LINE 10
INTEREST (TO WHOMPAD 836 TOTAL TAXES (FROM LINE 17)
MORTGAGE
2570 BhiQTAL INTEREST Line 20)
Sg Ll 38 OTAL CONTR (Line_24)
39CAS & THEFT LOSS(ES) (Line 29)
INSTALLMENT LOANS
40 BeB gTESE E#RBNEQHEE 34)
LST 7
Y
LNCR
22
QBATH YEoxar bucNS 767 S1 -
3rn
REMARKS
G1w
20 TOTAL INTEREST
EEzL
MuF883RGN.Doeld:3224553ncF ageAl zaes, Callf. Form 101
py_yLLLS KuBH
3767
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CALENPAR YEAR 19
72
NAME
CamueL
1.D NO
6 R'
SOC SEC NO _
F ISCAL YE AR END |NG
ADDRESS
322-2=7997
19
SCHEDULE OF PROF T (OR Loss FROM BUS INESS OR PROFESS ON
PRINCIPAL BUS INESS AcTivi Ty
EMPLoyERS N.o BUS INESS NAME
BUs INESS ADDRESS
TOTAL RECE iPtS
33B34L
INVENTORY AT BEG | NNinG OF YEAR
731
MERCHAND ISE PURCHASED
LABOR
TOTAL
203
INVENTORY AT END OF YEAR
2 036
13502
Gross PROF |T
GRoss inCOME
B3T62
OTHER BUS INESS DEDUCT|OnS
ADVERTiSinG
T5 7
AUto AND TRUCK EXPENSE
8(2
BAD DEBTS
CASH SHORT
CommiSS |OnS
DEL /VERY
DEPREC AT | ON SCHEDULE ATTACHED 202
DUES AND SUBSCR |PT | ONS
ENTERTA |NMENT AND PRomoti ONAL
inSURANCE 25Z
INTEREST L2-0
JANitoR SERV ICE
LAUNDRY
LEGAL AND ACCOUNTING
32z
MAINTENANCE
JFF ICE SUPPLIES AND EXPENSE 3
RENT
70z-
REPA IRS
SALAR ES AND WAGES
3Z
SALAR IES OFF ICERS
SUPPLIES
TAXES AND LICENSES
792
TAXES PAYROLL
753
TELEPHONE
TRAVEL
UTlities
STLESTAXTNCEUE P STL
NET PR OF | T: OR LOSS FEDERAL RE TURN
%it
NET PRoF | T OR LOSS STA TE RETURN SEE DEPREC . SCHEDULE FOR DIFF
PROFESS ONAL STAT | ONERS INC . FORM 104
Los AN GELES CAL [ F
SCHEDULE
NW 88326 Docld:32245535 Page 124
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INDIVIDUAL TAXABLE YEAR REBIDENT
540
CALIFORNIA 1973
INCOME TAX
For the year January 1-December 31, 1973,or other _taxable_year beginning_ 1973, ending- 19
Your Social Security Number
FIRST NAME(S) AND INITIAL(S) LAST NAME
Please"
fAMLEL UA 327
Spouse'$ Social
7ar 5027 2222
Number
PRESENT HOME ADDRESS (Number street, including apartment number or rural route) Type
or [ZSo
Zi2;
ER 3Y9 le1Y22
Prlnt CITY, TOWN OR "POST OFFICE, STATE AND ZIp CODE OccU- Yours
PaTion Spouse' $ LpANALA CALLE
Status Check Only One Exemption Credits flf line 1 or 3 checked, enter 325
Single 63 Personal Exemption: If line 2, 4 or 5 checked, enter S50
2" Married joint return 1 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 an/or address il different from Lour Rclativiship
name
TomAJ
Head of Household-__Enter name of qualifying
ELIIA
individual Total Number X $8 Ixn
5J 0 Widowler) with dependent child. Enter year spouse 8. Blind (refer to instructions) Number of blind exemptions X $8 8
died 19_ 9_ Total `'exemption credits (add lines 6, 7 and 8) Enter here and on line 20' below 9
Attach copy 2 of Formls) W2 to front;
Income 10. Wages, salaries, tips and other employee compensation if unavailable, attach explanation 10
4 11. Dividends__before federal exclusion. Capital dividends must be included at 100% 11
0 12. Interest (See instructions for taxability of federal, state and municipal bonds) 12 375
13. Income other than wages, dividends and interest (from line 50) 13
7zzb
8
14. Total (add lines 10, 11, 12 and 13) 14
76.K33
3
15. Adjustments to income (from Iine 56) 15
5; 16. Adjusted gross income (subtract line 15 from Iine 14) 16 Lz
M If,you do NOT itemize deductions AND line 16 is under 10,000, find tax in Tax Table and enter on line 19
3
If you itemize deductions OR line 16 is $10,000 or more, co mplete 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
Sill
1
18. Taxable income (subtract Iine 17 from line 16) Compute tax from Tax Rate Schedule_Enter tax on line 19 18 KXZl
19. Tax _If an averaging method is used, check appropriate box Schedule G, Or Schedule G-1 19
20. Total exemption credits (from Iine 9, above) 20
21. Tax liability (subtract line 20 from line 19_if line 20 i3 greater than line 19, enter 21
Your 22. Other credits (from line 66) 22
Tax
23.
Net tax (subtract line 22 from line 21-if line 22 is greater than Iine 24 enter zero) 23
and
24. Special tax credit--from line 75 (see Instructions, page 2, for allowable | credit) 24
0 Credits
25. Net Tax liability (subtract line 24 from line 23__if line 24 is greater than" Inaxpg; enter zero) 25t
26. Tax-0 preference income (see instructions-__attach Schedule P540)): 26 1
27. Total ` tax liability (add Iines 25 and 26) 27 127
0
3
28. Renter's credit_if you lived in rented property on March 1, 1973, Complete Part on page 2 28 3
Your 29., Total ' California income tax withheld (attach Form(s) W-2 o W-2P to face of return). 29
1
Pre- 30. 1973 California estimated tax payments (include amount allowable as a credit from 1972 return) 30
2
6
Brvdient
31. Excess California SDI tax withheld (attach Form DE 1964 :to face of return) 31
32. Total prepayment credits (add lines 28 through 31) 32 W
33.` If line 27 is equal to or larger than line 32, enter amount of BALANCE DUE 33 22
8 Pay in full ad mail with return to: Franchise Tax Board, Sacramento; CA 95867 Do not write in these spaces Balance
34 P 1
Due 34. if line 32 is larger than line 27, enter amount OVERPAID
nor Maii 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` Alx weeks for your refund) 35 1
36. Amount of line 34 to be credited o your 1974 estiMated tax 36 M
Under . penalties of perJury, 1 declare that have examined this return, including accompanying schedules ad statements, and to the best %f my knowledeerind 1
belief 'it is true; correct and 'complete: If prepared by a person other ihar {expayer , his declaration Ts based on all information of which he has any knowledpe_
1 SIGN
signature Date Preparer's .signature (other than" taxpayer) Date
HERE
fiing joint return Date Address" (and Zip code) Preparer' $ Employer Tdentification
867.3*-8724
"(0F SSA) Number
Wife s Signature~if 13717 VANOWEN STREET
YAN NUYS; CA. 91403
Mw 88326 Docld:32245535 Page 126_ 377234.8729_
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Ib
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Page 2 Form 540 (1973)
PART Renter'$ Credit AII questions must be answered See Instructions, Page 2, for Allowable Credit
37: Did you, on March 1, 2973, live in rented property which was your principal residence? Yes No If no, you may not claim this credit
38. Was the property you rented exempt from property . tax? Yes No If yes, you may not claim this credit
39. Did you live with any other person who claimed you as a dependent for income tax purposes? Yes No If yes, you may not claim this credit
40 . Did you or your spouse claim the homeowners' property tax exemption or receive public assistance? Yes No If yes, see page 2 of instructions
PART II Other Income
41: Business income (or loss) (attach Schedule C(540)) 41
42. Net gain (or. loss) from sale or exchange %f capital assets (attach Schedule D(540)) 42
7EZ1
43. Net (or loss) from supplemental schedule of gains and losses (attach Schedule 0-1(540)) 43
AL42
44. Pensions and annuities 44
45. Rents and royalties Attach 45
Schedule €
46. Partnerships Form (540) 46
47 . Estates and trusts 47
48. Farm income (or ioss) (attach Schedule F(540)) 48
(a) Fully taxable pensions ad annuities (not reported o Schedule E(540)) (a)
Miscel: (b) Alimony (b)
49. laneous
income (c) Other (state nature and source)_ (c)
Enter total of lines 49a), (b)and (c) 49
50. Total (add lines 41 through 49). Enter here and o line 13 50
15T21
PART Adjustments to Income
51 . "Sick pay" , if included in line 10 (see instructions attach statement) 51
52. Moving expenses; (see instructions_attach statement) 52
53. Employee business expenses (see instructions_~attach statement) 53
54. Military exclusion (see instructions) 54
55.. Payment as a self-employed person to a retirement plan, etc; 55
56. Total adjustments (add lines 51 through 55). Enter here and on line 15 56
ON SEPARATE RETURNS OF MARRIED TAXPAYERS , BOTH MUST ITEMIZE
PART, IV Itemized Deductions
DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDU CTION:
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), Iine 10) 57
%8
58. Total: child , adoption expenses (from Schedule A(540) , line 13) 58
59." Total taxes (from Schedule A(540) , line 21) 59
927
60 . Total interest expense (from Schedule A(540), line 25) 60
3156
61 . Total contributions (from Schedule A(540), line 29) 61 15
62. Totals miscellaneous deductions (from Schedule A(540), line 40) 62
63. Total itemized deductions (add lines 57 through 62). Enter here and on line 17 63 56
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)) 64
65. 'Retirement income credit (attach Schedule R(540)) 65
66. Total (add lines 64 :and 65). Enter here and on" line 22 66
Credit
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 AIl other_taxpayers_enter "Net Tax" from line_23_@n line_74 and complete_line ' 75.
67 Taxable income from' Iine 18 (or Iine 16 if Tax Table used) 67
68. Amount of gain ,or loss (if any) entered on Schedule 0(540), line, 14 68
69. Amount of or" loss (if any) entered on Schedule 0(540), line 15 69 lod
70. Combine lines 68.and 69 and enter total here. 'If zero or a enter zero 70
71. Adjusted taxable income (subtract line 70 from line 67) 71
72. Adjusted (use . same methcd as used for determining tax o line 19) 72
73. Add lines ` 20 and .22, and enter total here 73
74. Adjusted net tax" (subtract line 73 line 72) 74
75. Special tax credit_Determine allowable credit using Table on page 2 of instructions. Enter here and on line 24 75 53
137[4-400 5-78 IQ,ODOM osP
NW88326,-Doeldi2245535-Page-127
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loss,
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TAXABLE
SCHEPULE
CALIFORNIa
192
ITEMIZED DEDUCTIONS
YEAR
FORM 540 Attach to Form 540
Social Security Number
Name as shown on Form 540
SAMAEL
{nLLII 327 Z222
Itemized VS . Standard Deduction_You have a choice between two deduction if one spouse itemizes deductions, the other may not use the Tax Table or claim
methods You can either itemize your deductions or take a standard deduction as the standard deduction If you. choose to itemize your deductions, complete the
explained in the 540 Instructions. On separate returns" of a husband and wife, appropriate items below
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
One half (but not more than S150) of insurance LTo 24, Other (itemize)
premiums for medical , care
2 Medicine ad drugs
3. Enter 1% of adjusted gross income shown o Form
540. ICH
Subtract Iine 3 from Jine 2. Enter difference (if line
25. Total_(Add lines 22, 23, ad 24. Enter here and 3. is greater `than line : 2, enter zero)
on Form 540,- 2)
3/69
page
5 Enter balance of insurance premiums for medical 4zs
care not entered on line 1 Contributions
62 Other medical and dental expenses:
26. Cash contributions for which you have receipts, can-
(a) Doctors, . dentists, etc_
72.0_
celed checks; etc.
4SO
(b) Hospitals 27. Other cash contributions. List donees and amounts
(c) Other . (itemize).
66_
Total (Add lines `4, 5, 6a, b, and c)
8.: Enter 3% of adjusted gross income shown on 4Q9
Form 540 28 . Other than cash, See instructions for required
statement
9 Subtract line 8 from - line 7 Enter difference (f 766
line 8 is greater than line 7, enter zero) 29, Total_(Add lines 26,27 and 28. Maximum deduction
'10. Total_ (Add : lines 1 and 9. Enter here and on may not exceed 20%:" of adjusted gross income:
Uo,
946
Enter 'here and on Form 540, page 2)
Form 540, page 2)
Miscellaneous Deductions
Child Adoption Expense
Casualty or Theft Lossles) _See Instructions
11. Total expenses - paid or incurred_Attach itemized NOTE: f you had more than one omit lines 30
list through 34 ad follow instructions for guidance.
12. Enter 3% of adjusted gross income shown on Form 30: Loss before insurance reimbursement
540 31 . Insurance reimbursement
13. Subtract line 12 from line 11-See instructions 32. Subtract line 31 from line 30. Enter difference.
for maximum limitations. (Enter here and on Form line 31 is greater than line 30, enter zero)
540 , page 2) 33, Enter $100 or amount on line 32 , whichever is
smaller
Taxes (See tables on reverse)
34; Casualty or theft loss (line 32 Iess line 33)
35. Alimony paid
14 Real estate
36. Child care_See instructions
15. State and local gasoline
37. Union dues
16. General sales
38. Employment education expense _-See instructions
17. Auto license-~Excess of registration and weight fees
39. Other_See instructions (itemize)
(see instructions)
18. Personal property
19. , State disability insurance (SDI) ZEmployer private
disability plans do not qualify
20. Other
21. Total taxes_(Add lines 14 through 20. Enter here 40. Total_Add lines 34, 35, 36, 37, 38 and 39. (Enter
and 0n Form 540, page 2)
927-
here and o Form 540, page 2)
(Rev. 1973)
NW 88326 Docld:32245535 128
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TAXABLE
SCHEDULE
CALIFOrnIA
1972
FoRM 540
PROfit (or LOSS) FROM BUSINESS OR PROFESSION
YEAR
(Sole Proprietorships)
aneck phs schedulo 10 your Inroma tax [oturTr; Form 540 or saone Partnerahips, loln:: vontwres, 6t6, Mudf @lo On Forra 9C5
Social Security Mumber
Name as shown on Form 540 or
SAMMEL
322[2222
A' Principal business activity
SnALk Bae
product
Eo60
(See Instructions for "Item A. (For example: retail-hardware; wholesale tobacco; services_legal; manufacturing-furniture; etc )
B Business name_
I~aslg 843
Bly sderal ezpicye; idezufcgtion "@beCIE
Da Business address 5
(ZIP codo)
E. Indicate method of]accounting: cash; accrual; other.
F. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? Yes No
6. Method of inventory valuation 6
Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
YES NO_ Jf "Yes; attach explanation:
Important_AII opplicable lines and schedules Must be flled in.
1 Gross receipts or sales Less returns and allowances Balance
2
Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) 1
3 Gross
0 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 (explaid 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-1 (exclude any to yourself)
1 0 Insurance
12 Legal and professional fees
13 Commissions
1 @ Amortization '(attach statement)
15 (a) Pension and profit-sharing; Rlaii (see Instructions for line iS(a))
(6) Employee benefit progigms (seeklnstructions for line 15())
16 Interest on business
indebfedness
I
17 Bad debts arising from sales or services
18 Depletion
19 Other business expenses (specify):
(a)
(6)
(c)
(d)_
(e)
(g)
(h) Total other business expenses (add lines 1%a) through 19g))
20 Total deductions (add lines 6: through 19)
~tEPLL E_
21 Net (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 54ONR
Yaye
SCHEDULE C-I . cOst Of GGOODS SOLD (See Schedule € Instructions tor line 2)
22 Inventory af beginning of year (f different from last years closing inventory: attach explanation),
23 Purchases $_ Less cost of irems withdrawn for Personal use $ Balance
20 Cost of labor (do not include salary to yourself)
25 . Materials and
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
NWER b3ppocid.32245535 Page 29
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Muy{
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profit
paid
supplies
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Schedule C (Form 540) (Rev. 1973) 2
'SCHEDULE C-2. Explanation %f Lines 7 and 9
Line No. Explanation Amount Line No Explanation Amount
$
SCHEDULE C-3. DEPRECIATION (See Schedule C Instructions for line 6). NOTE: Depreciation may be computed by
using che 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 sbe Lower Limit Or the Upper Limit (ADR) Ranges: Attach
detailed' statement of depreciation computation:
a. Group and guldeline class b Date Cost or d_ Depreciation e Method 0f f, life or 8 Depreciation for
or description 0f property acquifed other basis allowed or allowable computing rate this year in prior years depreciation
8 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)
8 Totals
5 Less: Amount of depreciation claimed elsewhere in Schedule C-1
Balance_Enter here and on page 1, line 6
Straight line Declining balance Sum-of the Units of Other (specify) Total Summary years-digits production
7 Line 2, above
8 Other
2 572
SCHEDULE C-a. Expense Account Information (See Schedule C Instructions for Schedule C-4)
Enter information with regard to yourself and your five Name Expense Account Salaries and Wages
highest employees: In determining the five highest Owner
paid employees expense account allowances must be
0 added to their salaries and wages However, the infor-
2
mation need not be submitted for any employee for
whom the combined amount is less than $10,000, Or
3
for yourself if expense account allowance plus 0
line 21, page 1a is less than $10,000_ 5
Did' you claim a deduction for expenses connected with:
(1) Entertainment facility (boat, resort, ranch, etc )? (3) Employees' families at conventions or meetings?
Yes M No Yes No
(2) Living accommoaations (except employees on business)? (4) Employee or family vacations not reported on w-2?
Yes No Yes No
NWV 88326 Docld:32245535 Page 130 1J719.400 5-71 2 ,OooM 0 4 osp
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paid
Your
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SCHEDULE-
CALIFORNIA
TAXABLE
D)
'1973
FORM 540
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 540 or 54QNR Social Security Number
Samuel
Zuyl_ If
LB 322/2 2222,
ParT 1__Assets Held_One_Year or Less
Cost Or other basis as
adJusted cost of subse-
Kind of property and description b. Date acquired c_ Date sold d_ Gross sales quent improvements (if Gain or loss
(Example, 10O shares of "Z' Co.) (mo., day, yr.)" (mo. day, yyr.) price not purchased _ attach (d. ` less e. explanation) and ex
pense of sale
EUGD TNTERRECT[EiR 177IZ3 2.7,73 3218 "3.2
0?_ i2li8z7 4/3/23 12.81 222.7
i3
22237x42
2Lcnz3_ 371135 E% & 525 347
[Gp ESIES 41e7n3. 6/x1/35- 732.3 1332 3.67
2_ Enter (or loss) if applicable, from line 18, Schedule D:1 (540) (attach copy)
3_ Enter share of net gain or loss from partnerships and fiduciaries
4. Net Or loss, combine lines 1, 2 and 3
27YZ
PART IiAssets Held More Than One Year But Not More_Than Five_Years
5.
6. Enter (or loss) , if applicable, from line 20, Schedule D-1 (540) (attach copy)
7_ Enter your share of net Or loss 'from partnerships and fiduciaries
8. Net Or loss, combine lines 5, 6 and 7
Part III_Assets Held More Than Five Years
10. Enter (or loss) ' if applicable, from line 22, Schedule D-I (540) (attach copy)
11. Enter 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
2777
14: Enter 65% of the amount on line 8
15. Enter 50% of the amount on line 12 1471.Lj3,,/8322
16.' Enter unused capital loss carryover from preceding taxable years (attach
compafation} (i23zz)
17. Combine the amounts shown on lines 13, 14, 15 and 16
(1L06z)
18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or 54ONR
19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 54ONR the smallest of:
(a) amount on Jine 17;
(6) the taxable income for the taxable year (computed without regard to or losses from sale or exchange
of capital assets; or
'(c) $1,000 (S500.in the case of a husband or wife a separate return) 16vv
NI88326_Qocld:32245535_Page 131
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Your
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gain
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gain
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'SCHEDULE TAXABLE CALIFORNIA
D-} 19z
SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
YEAR FORM 540
(Sales or Exchanges Including Involuntary Conversions)
(Attach to Form 540, 54ONR, 541 or 565)
Identifying number as shown 0n return Name as shown on Tax Return
SAmuEL
ALiyLL__KukY_ 322-22-7207
PART 1 Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220
Lines 9 and 1O should be_omitted if there are no dispositions of_ farm property _ or farm land; 0r, if this form is filed' by a partnership:
Date acquired Date sld
1 Description of Sections 18211, 18212-18, 18219, and 18220 property (mo.. day, (mo:_ day, Yt.)
(A) SMACK Za Y1Z0 27.3733
(B)
(C)
'(D)
Correlate lines. I(A) through I(D) with these columns Property Property Property Property
(A) (B) (C) (D)
2_ Gross sales price 280r2
3 Cost or other basis and expense of sale 28132
4 Depreciation allowed (or allowable) [23.86
5 Adjusted basis, line 3 less line 4 LZZ
6. Total_gainsubtract _line 5 from line 2 12zY ?
7. If Section 18211' property:
(a) Depreciation allowed (or allowable) after applicable date-
(See-Instruction D-3)
12386
(b) Line 6 or line Zlo) whichever_is_smaller LZYe
8_ If Section 18212-18 property:
(a) Enter additional depreciation after 12-31-63 and before
1-1-71
(6) 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)
(6) Enter line 8a) or line 8e), whichever is smaller
(g) Line 8(f) times applicable percentage (Instruction D-4)
(h) Add line '8d) and line 8g)
If Section 18220 property:
(a) If farm land, enter soil and water conservation expenses
for current Year and preceding years
(6) If farm property, other than land, subtract 7(6) from
line 6; OR, if farm land, enter line 6 or line %a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see Instruction D-5)
(d) Enter line. 9(b) or line %(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 %d), if any; otherwise, enter zero
(c) Enter excess, if any, of line IO(a) over 10(b)
(d) Line IO(c) times applicable percentage (Instruction D-5)
(e) Line 6 less line IO(b)
(6) Enter_smaller_of line 10d)
Or
line 1O(e)
SUMMARY Of PART 8 (Complete PropertyColumns (Ahrough () UP to Line [O() berore_going to Line 1)
11. Enter amounts. from line 6 122.%6
12. Enter amounts from lines 7(b), 8(h), %d) and 10(f) LLY&
13. Subtract line 12 from line 1/, 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 IlI DEYE
REV. 1973 ) [88326 Docld:32245535_Page 132
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Schedule p-I(540) Page 2
Part 88 Sales or Exchanges of Property Used in Trade or Business and/ or Involuntary Conversions
(Section 1818 0-82) see Instruction E
Section A INVOLUNTARY CONVERSIONS DUE To CASUALTY AND THEFT
Cost or other basis_ cost of
a, Kind of property (it necessary, 0 Date acquired Date sold d. Gross sales Depreciation allowed subSe9ueot Bureroeeaents Gain (or loss)
attach statement of descriptive (mo., day, yr.) (mo., day;yr ) price (or' allowable) attach o planathaned and plus less
details not shown below) since acquisition
expense of sale
15.
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 or loss, above, in
column (9) of applicable Section; B-1, B.2 or B-3; (2) :If line 16 is a loss, enter such amount on line 25 of Part Ill:
(b) For_partnership returns: Entergain(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
18. Combine the amounts on line 17 , enter here
Section B2 Property Held More Than One Year But Not More Than Five Years
9
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 enter here and also on the appropriate line as follows
(a) For all returns, except partnership returns:
(I) If line 23 [s & gain, enter the amounts from lines 18, 20 and 22, on Tines 2, 6
and 10, respectively, of the Schedule D (Form 540 or 541) that is filed. (2) If line 23 is a loss, enter such amount o
line 26 of Part Ill.
(6)For_partnership returns: Enter amounts on lines 1820 and 22, in Schedule K(565) -see Instruction E
PART bb? Ordinary Gains and Losses
a. Kind of property and how Gross sales Depreciation allowed Cost or other basis. cost of 'Gain (or loss) acquired (if necessary b_ Date acquired Date sold (or allowable) subsequent improvements g
attach statement of descriptive (mo., day, Yr. (mo., day, yr.) price since acquisition and expense of sale (d_ plus less
details not shown below)
24. Gain, if any, from line 14 [22Y
25. Loss, if from line 16
26. Loss, if any, from line 23
27 _
28. Combine lines .24 through 27, enter here and also on the appropriate line as follows
2272
(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:
(6) For individual returns:
(1) If the (or loss) on line 28 includes losses which are to be treated as itemized deduction on
Schedule A (Form 540 or 54ONR) (see Instruction F), enter the total of such loss(es) here and on
Schedule A (Form 540,or 54ONR) Identify as loss from line 28(6)(1), Schedule D-1 (Form-540)+
(2) Redetermine .the (or loss) on line 28, excluding the loss (if any) entered on line 28(6)(1). Enter here
and on page 2 of_Form 540 Or Form S4ONR, under "Other Income"
12Y?_
NW 88326 Tocid:3ZZ45535 Page 133 19727-po' $,79 2,s00M Op OsP
gain
22;
being
any,
an gain
gain
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Department ot the Treasury Internal Revenue Service
1
1040 US
Individual Inconte Tax Return
~20 1970
For ihe year January ]-December 31, 1970, Or othor taxable year beginning 1970, ending 19
Firet neme end initial (If Joint roturn , u8e firet names and middle initials of both) Last name 'Your_social-tecurity number 8
SAMUEL AND_PHYLLIS RUBY 322 14 2927
Presant home address (Number and street Or rurel routo) Spouse's goclal gecurlty number 1L
16250 Bircher 349 18 1420
City, town or post office, State and ZIP code Occu- Yours Self-Enp: L
Granada Hillex California pation Spouse '$ Housewife
Status_check only one: Exemptions Regular 65 or over Blind Enter
Single; 2 09 Married filing jointly revead' ,ocomone= 7 Yourself Kl ouroees
applies only i1 item checked 2
3 Married filing separately and spouse is also filing: 8 Spouse 2 01 6 is checked
If this item checked give spouse's social security number in 9 First names of your dependent children who lived with
space above and enter Fred Brian, Elisa 3
first name here you
Thomas Enter
Unmarried Head of Household number 8
5 Surviving widow(er) with dependent child 10 Number of other dependents (from line 34)
6 Married_filing separately_and spouse_is not filing_ 11 Total exemptions claimed
L
12 Wages, salarles, tips, etc (Attach Forms W-2 to back_ If unavailable, attach explanation) 12
3
@
13a Dividends (anaeg"8xen 5 83
20.60 13b Less exclusion $ 20.60 Balance 13c
9 of instr 8
(Also list in Part of Schedule B, if gross dividends and other distributions are over $100)
14 Interest_ Enter total here (also list in Part Il of Schedule B_ if total is over $1O0) 14 II
15 Income other than Wages, dividends, and interest (from line 40) 15 2.284/92
1
16 Total (add lines 12 d 15)
16
2.284 |92
17 Adjustments to moving expense, etc; from line 45) 17
18 Adjusted gross income btrad fr 18 2,284 |92
See page 2 of instructions tor rules the ur tax and surcharge_
If you do not itemize deductions and ung in Tables. Enter tax on line 19.
you Itemize deductlons or line 18 Is S1O,0 tax_
19 ,Tax (Check if (rom: Tax Tables 1-15 [J, Tax Rate f {ned Or dule D [I; or Schedule G LI) 19 1l2/53
20 Tax surcharge See Tax Surcharge Tables C in in juctions_ claim 3
]
ment income credit, use Schedule R to figure surchae 20
4
21Total_(add_lines 19 and_20)_ 21 112 53
22 Total credits (from Iina 55)
1J
23 Income tax (subtract line 22 trom line 21) 23
1
8 24 Other taxes (from line 61) 24 538/20
6
25 Total (add lines 23 and 24) 25 655123
8
L
26 Total Federal income tax withheld (attach Forms W-2 to back) 26 Make check or money
27 1970 Estimated tax payments (include 1969 overpayment allowed as a credit) 27 order payable to Inter-
nal Revenue Servlce: 1
28 Other payments (from line 65) 28 {IIIILIIIKIIIMMI
29_Total (add_lines_26.27,_and 28)_ 29 1a
1
30 If line' 25' is larger than line 29, enter BALANCE DUE. in full with return 30 655123
3 31 If Iine 29'is larger than line 25, enter OVERPAYMENT 31
6 32,Line_31_to be:_(e) Credited on 1971 estimated_tax $ (b) Refunded $
Undor penaiiies 07" perjury, declare that have examined ihia roturn , including eccompanying schedulos and statements, and to the best of my Rnowicdge and belfe7
It i truo, correct, and complote.
g
Your Bignature Date Signature 0l preparer other than (axpayer, based on Date all information of Which he has any knowledge.
LMBERL MARKELL
Spouse & signature (0 Tointly, BOTH must clgn oven Tf only Ono hid Tncome) Addrass 16633 VENTURA JO=x1168-] BLVD
ENCINO, CALIF . 91316
NW 88326 Docld:32245535 134
Filing
retire;
COPY
@
Pay
6
iling
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Page"2 Form 1040 (1970) Attach Copy B of Form W-2 here:
Did you; at any time during the taxable year, have any interest in or signature or other authority over
Forelgn Accounts a bank; securities , or other financial account in 3 foreign country (except in a U.S. military banking
(check: facility operated by a U.S. financial institution)? Yes No.
appropriate box) If Yes, attach Form 4683. (For definitions, see Form 4683.)
PART |.-_Additional Exemptions (Complete oly for other dependents claimed o line 10)
(6) Relation- (c) Months lived in your (d) Did depend: (e) Amount YOU furnished Amount furnlshed 33` (0) NAME
ship home. born OI died ent have income for dependent '$ support, if by OTHERS includ-
during year write 'B of 5625 or more? 100% write ALL ing depondont_
0r "D W9m1C
$ $
34 Total number of dependents Ilsted above: Enter here and on line 10
PART Il. ~Income other than Wages, Dividends, and Interest
35 Business income (or loss) (attach Schedule C) 35 8,284 88
36 Sale or exchange of: property (attach Schedule D) 36 (1 000
37 Pensions and annuities, rents and royalties, partnerships, estates or trusts, etc: (attach Schedule E) 37
38 38 Farm income (or Io89) (attach Schedule F)
39 Miscellaneous income (state nature nd source)
39
40 Total (add lines 35,36,37,38and 39) Enter_here and on line 15_ 40 2284 197
PART Ili._'Adjustments to Income
41
41 """Sick pay'~ if included in line 12 (attach Form 2440 or other required statement)
42 42 Moving, expense (ettach Form 3903)
43 Employee business expense (attach Form 2106 or other statement) 43
44 Payments as a self-employed person to a retirement plan, etc. (attach Form 2950SE) 44
45 Total adjustments (add lines 41, 42, 43_and 44)Enter here and on line 47 45
PART IV;-Tax. Computation
46 Adjusted gross income (from Iine 18) 46 7,284/92
47 () If you itemize deductions, enter total from Schedule A, line 22
(b) If you do not itemize deductions, and Iine 46 is $1O,000 or more, enter 47 2,745.144
S1,000 (S500 if married and filing separately)
48 Subtract Ilne 47 from line 46 48 lk,539 53
49 Multiply total number of exemptions claimed on line 11, by $625 49 3,200 0Q
50 Taxable income. Subtract Iine 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 50 839 53
51 Tax Enter here and on line 19 51 12153
PART V:_Credits
52
52 Retirement income credit (attach Schedule R)
53 investment credit (attach Form 3468) 53
54 . Foreign_ tax credit (attach Forin 1116) 54
55 Total credits (add lines 52,53,and 54) Enter here and on line 22 55
PART VI:__ Other , Taxes
56 Self-employment tax (attach Schedule SE) 56 20
57 Tax from recomputing prior-year investment credit (attach Form 4255) 57
58 Minimum tax: See instructions on page 7 Check here QJ; if Form 4625 is attached 58
59 Social security tax On unreported tip income (attach Form 4137)- 59
60 Uncoilected employee social security tax on tips (from Forms W-2) 60
61 Total (add lines 5657,58,_59_end.60)Enter hereand on line 24 61
338120
PART V;SOther Peyments
62 Excess F.I.C.A. tax withheld (two or more employers-see instructions Or page 7) 62
63 Credit for Federal tax on gasoline, special fuels, and lubricating oil (attach Form 4136) 63
64 Regulated Investment Company Credlt (attach Form 2439) 64
65 Total (add lines 62, 63,and 64) Enter here and On line 28 65
00kXUS, GOVERNMENT PRinting OFFICE :1970 _ 1-370-040 94.1149624 16_1i0-[
NW 88326 Docld;32245535 135
538
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Schedules AeB_Itemized Deductions AND
(Form 1040) Divldend and Anterest Income
1970
Department of tho Treasury
Internal Revenuo Sorvico Attach to Form 1040.
Name(8) a8 shown on Form 1040 Your Social Securty Number
Samuel and_Phyllig Ruby 322 1212997
Schedule A-_Itemized Deductions (Schedule B on back)
Medlcal end dental expenses (not compensated by Insurance Contrlbutlons. Cash ~including checks, money orders, , etc_
Or otherwlse) 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 helf (but not more than $150) ot In"
surance premtums tor medical care
2 Mediclne `and drugs
3 Enter 1 % ot line 18, Form 1040
Subtract line 3 from line 2_ Enter difter:
ence (if less than zero, enter zero)
5 Itemize other medical and dental OX:
penses. Include hearing aids, dentures,
eyeglasses, transportation, balance ot in:
surance premiums tor 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 years (see in-
structions on page 8)
14 Total contrlbutions (Add lines 11,
12, and 13. Enter here and on line
19, below. See instructions on page 8
for limitation)
280/
Interest expense _ Home mortgage
Installment purchases
Other (Itemize)
6 Total (add lines 4 and 5)
7 Enter 3%' of line 18, Form 1040
8 . Subtract Iine 7 from' line 6. Enter difter:
ence (if less than zero, enter zero)
9 Total deductlble medical and dental ex- 15 Total Interest expense (Enter here and
penses (Add lines 1 and 8. Enter here and on line 20, below:) 1552; 18
on Jine 17 below ) 150 00 Miscellaneous deductlons for child care,
Taxes: Real estate alimony, union dues, casualty losses, etc:
State and local gasoline (see gas tax tables) (see instructions on page 8).
General sales (see sales tax tables)
State and Iocal income
Personal property
10 Total taxes (Enter here and on line 18, 16 Total miscellaneous deductlons (Enter
below:) 663126 here and on line 21, below:) 100 00
Summary ot Itemized Deductions A
17 Total deductible medical and dental expenses (from 'line 9) 150 00
18 Total taxes (from line 10) 6631726
19 Total contributions (from Iine 14) 280 70
20 Total interest expense (from line 15); 15521 78
21 Totel miscellaneous deductions (from line 16) 10d 00
22 TOTAL ITEMIZED DEDUCTIONS(Add lines 1Z through 21, Enter here and on_Form 104O,_line 4ZS/A 24745 44
16--816D -
NW.88326 Docld: 32245535 Page 136
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NAME Samuel and Phyllig_Ruby
IDENTIFICATION NO_
322-12-2992
ADDRESS_ 16250_Bircher Granada Hills California
SCHEDULE NQ: A SCHEDULE_QF_DEDUCTIONS YEAR_ENDED
1970
MEDICAL FEDERAL STATE CONTRIBUTIONS FEDERAL & STATE
1. ONE HALF OF MEDICAL INSURANCE CHURCHES 150_ 00
(Not OVER $150.00) 150 00 150 00
2 DRUGS AND MEDICINES Community chEST/iNiTED CRUSADE
3, LESS; 1% OF ADJ. GROSS INCOME SALVATION ARMYIGOODWILL INDUSTRIES
NET DRUGS AND MEDICINES RED CROSS
5. DOCTORSIDENTISTS XMAS & EASTER SEALS
DR_ HEART FUNDICANCER FUND
DR; PARTNERSHIP RETURN
DR_ PAYROLL DEDUCTION
OR_ OTHER ORGANIZED ChARitiES: T00 To
DR. Scouts 15 Too
DR. Giri Scouts 15 700
DR_
DR;
DR_ TOTAL CONTRIBUTIONS 280_[Q0_
WNTEREST_ (To WhOM PAID) FEDERAL & STATE
MORTGAGE LOAN
Colonial Mtg. Co 1,l33 1LO
INSTALLMENT LOAN
Goodbody_Ca: 120432
Bache Co_ 119 12
MEDICARE Firat Thrift_ 89 1O_
KOSPITAL Transworld_ 51 44
Re volving_Charges (61) 39 10
LABORATORY
BALANCE OF MEDICAL INSURANCE
NOT DEDUCTIBLE ON TOP LINE TQTAL_INTERESLL, 552 18
TRAVEL For MEDICAL MISCELLANEOUS DEDUCTIONS FEDERAL & STATE
AMBULANCE ALIMONY (EXPLAIN)
GLASSES SAFE DEPOSIT BOX FEE
HEARING.AID UNION DUES
PROSTHETIC APPLIANCES SMALL TOOLS (GOOD 1 YEAR)
MEDICAL EXPENSES TOOLS DEPRECIATION
LESS; REIMBURSED BY INSURANCE SAFETY EQUIPMENT
6 TOTAL UNIFORMS (NOT GEN WEAR)
2LESS: %%_QF ADJ: GROSS INCOME LAUNDRY & CLEANINC
0. BALANCE (NOT LESS THAN ZERO) AUto MILEAGE (G0
9,' IQTALMEDICAL_DEDUCTIONS TELEPHONE EXPTNSE (Not REiMB)
(LINE 1 PLUS LINE 8) 150 00 150 00 EMPLOYMENT AGENCY FEES
IAXES FEDERAL STATE DUES & SUBSCRiPTiONS
AUTO LiCENSE (LESS REG, FEE) 42 00 42 00 INCOME TAX PREPARATION 50 00
SALES TAX Large Itemb 170 00 120 00 OTHERS Financial Publ 50 00
SALES TAX AUTO
REAL ESTATE TAX 31 26 3T726 TOTAL MSC_DEDUCTIONS 100 /o
PERSONAL PROPERTY TAX CASUALTY LOSSES (EXPLAIN) FEOERAL & STATE
STATE INCOME TAX X X X X
GAS TAX 2 00OGAL 07 C GAL. i4o 00 140 00
SUB TOTAL
DisABiLiTY INSURANCE LESS REIMBURSED BY INS_
misc_ TAX X * X * Sub TOTAL
otheas: LESS $10.00 FOR EACH CASUALTY
TOTAL CASUALTY LOSSES
FEDERAL STATE
TOTAL TAXES 763 [26 TOTAL DEDUCTIONS 75IE 2TTTITM
LAMBERT-MARKELL 166.3 VENTURA BLVD_ ENCINO, CALIf. 98140
NW 88326 Docld:32245535 Page 137
Boy
663 126
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SCHEDULE C Profit (or Loss) From Business or Profession
(Form' 1040) (Sole Proprietorship)
1970
Dopartmont ot the Treasury
Interna} Rovonuo'Sorvice Partnerghlps, lolnt ventures, etc-, must tile on Form 1065.
Attach to Form 1040_
Name as shown on Form 1040 Social security number
Sanuel and Phyllis Ruby 322 12 2997
Princlpal business activity Food product
(See:separate instructions) (Fot exomple: retail__hardware; whoiesale ~tobacco; services-_legal; manulacturing_furniture; etc.)
B Business name Snack Bar Employer Identification Number
95-2651528
D Business address
5418 Van_Nuys Boulevard Van Nuys California "91401
E Indicate method of accounting: (1) @ cash; (2) accrual; (3) other _ (ZIP code)
Was there any substantlal chango In the manner of determining quantities, costs, or valuations between the opening and closing inventories?
' YES: 0 NO. If "Yes,' attach explanotlon.
Were you required to Ille Forms 1096 ad 1099 or 1087 tor the calendar year 1970? (Seo Item G' in separate instructions for Schedule C)
YES & NO: I/ "Yes, where were they filed?
1 Gross receipts or gross sales $_ Less: Returns and allowances $ $
2 Inventory at beginning of year ; (if different trom 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 yoursell)
5 Material .and supplies
6 Other costs (explain In Schedule C-J) SCHEDULE
T7 Total .of lineb 2 through 6 A TACHED
8 Inventory at end ot this year
9 Cost ot goods sold and/or operatlons (subtract line &8 from line 7)
10 Gross profit (subtract Iine 9 trom Iine 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-J)
15 Salaries and wages not included on line 4 (exclude any to yourself)
16 Insurance
17 Legal and protessional tees
18 Commissions
19 Amortlzation (attach statement)
20 Retirement plans, etc. (other than contributions made on your behalf__see separate
instructions)
21 Interest on buslness Indebtedness
22 Bed debte erleing trom oal08 'or gervlces
23 Depletlon
24 Other buglness expenges (explain In Schedulo C-1)
25 Total of lines '11 through 24_
26 Net profit (or loss) (subtract Iine 25 trom Iine 10). Enter here and on line 35, Form 1040. ALSO enter on
Schedule SE, Part 1, line 1
9,284 97
SCHEDULE C-1._ EXPLANATION OF LINES 6, 12, 14, AND 24 C
Line No. Explanetion Amount Line No_ Explanation Amount
$ S
16--81471-}
NW 88326 Docld:32245535 138
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SCHEDULE SE Computation of Social Security Self-Employment Tax
(Form, 1040)=
Each self-employed person must file a geparate Schedule SE
1970
Dopartment ot the Treasury
Intornal Rovenuo Sorvlce Attach to Form 1040.
If you had wage9,' Including tips, 01 $7,800 or moro that were subject to soclal security taxes, do not fill In this page:
If you had more than one business, combine profits (or losses) trom 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 eelt-employed person (as shown on social security card) Social security number Check applicable block
Samuel Ruby 322_ 12 2997 1 M Male 2 Q' Female
Business_activities_subject to self-employment tax (grocery store restaurant, farm, etc )
Partul: Computation of Net Earnings (rom BUSINESS Self-Employment (other than farming)
1 Net profit (or loss) shown in Schedule C (Form 1040) , Iine 26. (Enter combined amount it more than one business )
8,284.197
2 Net ' income (or loss) from excluded services or sources included on line L
Specify excluded services Or sources.
3 Net earnings (or loss) trom business self-employment (Subtract line 2 from line 1 , and enter here and on line I(a),
Part)Ill;, below:)
Pant I Computation of Net Earnings from FARM_Self-Employment SE
A farmcr may elect to compute ret (ar.n earnings using the OPTIONAL METHOD (line 3, below) INSTEAD OF THE REGULAR METHOD (line 2, below)
If hls gross profits are: (1) $2,400 or le8s, or (2) more than $2,400 ard net protits are less than $1,600. If your gross profits from farming are
not more than $2,400 and you elect to use the optional mnethod, you need not complete lines and 2
Computation under Regular Method
1 Net farm profit (or loss) from:
(0) Schedule F, line 52 (cash method), or Iine 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 It gross profits from farming are:
(0) Not more than $2,400, enter two-thirds of the gross prolits
(b) More then $2,400 and the net farni profit is less than '$1,600, enter $1,600
'Note -_Gross profits trom {arming are the total of the &ross profits from Schedule /, line 28 (cash method), or line
67 (accrual method), plus the distributive share 0 gr08s protit tarm partnerships as explained: In instruc:
tions 'Ior: Schedulo SE:
Enter here ond ori lino 1 (b) Part IIl, below, the amount 0n line 2 (or: Iine 3, if you use the optional rnethod)
Part III Computation of Social Security , Self-Employment Tax
Net earnings (or loss) from self-employment _=
(a) From business (other than tarming trom line 3, Part 1,,above)
8 ,284" 92_
(b) From farming (from line 4, Part Il, above)
(c) . From' partnerships, joint ventures, etc. (other than farming)
(d) From ' service' a$ a minister , member of a religious order, Or a Christian Scierice practitioner. If you filed Form
4361,'check here and enter zero on this line
(0) From service with a foreign government or international organization
Other (director'$ foes, etc:). Specity
2 Total net_earnings (or loss) from employinent reported on Iine 1
8,284 972
(If Iine 2 is less than $400, you ar not subject to self-employment tax: Do not till in rest ot page.)
3 The largest amount .of combined wages and self-employment earnings subject to social
security tax is 87 ,800 00
(a) Total "FICA" wages as indicated on Form W-2
(b) Unreported tips, it: any, sublect to FICA tax: trom Form 4137_
Ilme 9
(c) Total of lineg 4(a) and 4(0)
5 Balance (oubtract line 4(c) from line 3)
6 Self-employment income line 2 or 5, whichever' is smaller
2.80.0 00
If line .6*is. $7,800 , enter $538.20; if less, multiply the amount on line 6 by .069 538 20
8 Railroad employee's. and railroad employee representative'$ adjustment tor hospital insurance benefits tax from
Form 4469_
9 Selt-employment tax (subtract Iine 8 from Iine 7). Enter here and on Form 1040, line 56 538l2o
16-81I71-1 0po
NW 88326 Docld:32245535 139
trom
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Samue1 and Phyllig Ruby
SUPPLEMENT TO_SCHEDULE C
Income 832,657.34
Le8s , Sale8 Tax 153.39 432,503.95
Beginning inventory
Purchageg, Be verages/milk 1,988.55
Grocerieg 8,761.69
Mea t 1,893.83
Bakery/bread 2412 . 82
815,056.89
Lesg i Ending inventory 800_ 00 14,256 .
Ad jugted Gross Profit
013,356.88
Expenses ,
Rent $ 1,172.16
Payroll 2 , 046.30
Payroll taxe8 2 02 92
Trave l to employee8 215.00
Miecellaneoug e xpense 219.40
Intereet_ 419.10
Accounting 22 00
Telephone
28:
45
Repairg 121.40
Ingurance 150.00
Linen 21.00
Auto 3,000 M. 360.00
Office 360= 00
Cleaningc maintenance 50 _ 00
Depreciation 3,321.36 8,962,02)
Ne t Profit $ 9,284.92
DEPRECIATI ON
Equipment 4/70 810,000.00 5 Yr . 42 ,000.00
Covenant Not To
Compe te 5, 000 :00 5 Yr . 1,000, 00
Leasehold Imp. 3 000.00 7 Yr . 428 , 50
(7 Yr . Ba lance Lease )
April-December, 1970 84,428,50
NW_88326 Docld:32245535 .Page 140
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SCHEDULE D Sales or Exchanges of Property
(Form 1040)
1970
Department of the Treasury Attach to Form 1040.
Internal Revenuo Sorvice
Social Security Number Name(s) &s shown on Form 1040
Samue1 and Phyl2is Ruby 322 12 7997
Part} Capital Assets Short-term capital gains and losses_assets held not more than 6 months 0
c. Hom h.. Cost or other
8 . Kind of prop- 0c: Depreciation basis , cost ' of
orty. Indicate b. Describaon quirod _ d_ Oate &. subsequent improve- Gain (or loss)
(Examples; sh_ ot Enter acquired Date sold Gross sales allowed (or ments (ifnot plus Securi to; Odner '2' Co:, 2 story brick , letter (mocquayc yr:) /(mo Yr.) price allowable) since purchased_ attach g less h) estate, or 0tc.) symbol acquisition explanation) and (specify) (s80 expense of sale Inatr.)
"SCHEDULE KTTACHEDI 115,275 ..00 )
2 Enter your share of,net short-term (or loss) from partnerships and fiduciarles_
3 Enter net gain (or loss) from lines 1 and 2
4 Enter unused short-term capital loss carryover from preceding taxable years (attach statement)
5 Net short-term (or Ioss) from lines 3 and 4
Long-term capital and losse8 assets held more han 6 months
6
7 Capital gain distributions_
8 Enter gain from, Part VII, line 47 or line 51(a), whichever applicable
9 Enter your share of net lang-term gain (or loss) from partnerships and fiduciaries
10 Enter your share %f net: long-term from small business corporations (Subchapter 8)
11 Net (or loss) from lines 6 through -10
12 Enter unused long;term capital lo8s cerryover from preceding taxable years (attach statement) 715,27*.700 )
13 Net long term gain (or loss) from lines 1 2 and 12
14 Combine the amounts shown on Iines 5 and 13, and enter the net (or loss) here
15 If Ilne 14 8hows &
(a) Enter 50% of Ilne 13 or 50% of Ilne 14, whichever is smaller (see Part IV for computation of alternative
tax): Enter zero; if there is a loss or no entry on Iine 13
(b) Subtract 'Iine 15(e) from Iine 14, Enter here and on Iine 17, Part' Il
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 1l _if gain, enter gain; if Ioss, enter zero
(c) Enter smallest ,of (0) 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 (iii) $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 () Iine 48, Form 1040 (line 18,, Form 1040 if tax table used) disregarding capital
and /or losses, less Iine 16(c)_ determine this figure via a side computation; (ii) ,81,000 (S500
married and filing separately); (lli) if Iine 3 is zero or shows a gain, 50% of Iine 16(d); (iv) if Iine
11 is zero or shows a gain, amount on Iine 16(d); or (v) if lines 3 and 11 show losses, Iine 3 added
to s0% ot Ilno 11 .
Enter here, and on Ilne 17, Part Il, the sum of Ilnes 16(c) an848evJPie72t enteL; 3 228unbffeater
1,000.00 ) than52,OO0)
Pait W Summary ot Schedule D Gains and Losses
17 Net gain (or loss) 'from Iine 15(b) or 16(0), Part
18 . Net gain (or loss) from line 22, Part III
19 Total net (or loss) combine lines_JZ and_18Enter here and on line 36, Form 1040
0?0_16_ 370-046
NW 88326 Docld: 32245535 Page 141
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TAXABLE FORM
540
CALIFORNIA
1970
RESIDENT
INDIVIDUal INcOME Tax RETURN YEAR
For Calendar Year 1970 or Flscal Year Begun 1970 and Ended 1971
First NAME(S) AND INITIAL(S) LAST NAME Your social security number $
SAMUEL AND PHYLLIS RUBY 322 12: 7997
c Please
COUNTY Spouse $ social security number
Type; PRESENT HOME ADDRESS (Number and streot, or rural route)
or
162 50 Bircher [Los Ange les 349 18; 142 0 M
Prlnt City, TOWN OR PoST Office STATE Zip CODE Your occupation B
Granada Hill8 California 9134L Sel f-Employed
NAME AND ADDRESS Of EMPLOYER AT Time Of FIliNG Spouse $ occunation
Sel f-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 9
8,2.84..92
11346 Montgomery Avenue Grana da Hills, Calif IS differeniu Srowuelize 11, below, explaln
Filing Status Single 3_ Married, filing separate return-~spouse'$ name:
(check one) 2 Married, filing joint return Unmarried 'head of household"_Complete Part !, page 2
5. Hages, salaries, tlps, ete. (before payroll deductions) if more (han two employers, attach schedule
Income Employer' = mame Where employed (city and state)
'Ht Jolnt return;, 5
'Include all
Income of
{both husband
0. Qivldends. Enter total here (also Iist , in Schedule B (5401, Part |, if total is over $100) 20 6.0
and wlfe
1 1 Interest Enter total here (also Iist in Schedule B (540), Part Il, if total is over S1OO)
8. Other . income (from page 2, line 30) 8
8,284 /ez
1
9. Total (add lines 5, 6, 7 and 8) 9
8,305 52
10. Adjustments to Income (from page 2, line 35) 10 1
11. Adjusted gross Income (subtract Iine 10 {rom line 9) 8,305 /52
If you do not itemize deductions AND line 11 is under $10,000, find your tax in Tax Table in instructions Enter tax 0n line 12.
If; you itemize deductions OR Iine 11 is S10,000 or more, go to Part IV on page 2 to figure tax;
Your 12. Tax from (check one): Tax Table 0 Tax Computation (page 2, Part IV) @, or Schedule G.(540) 12
32
Tax,
and 13. Exemption credits (from page 2, line 43) 13
Credlts 14. Tax Ilability (subtract line 13 'from line 12) 14 None
15. Total other credlts (from page 2, line 49) 15
16. Net tax. Hlablllty (subtract line 15 from Iine 14-If $1.00 or less, enter zero") 16 Nonle
17: 1970 California estimated tax payment or credit ` from 1969 (if any) If none, enter "zero" 17
Balance 18 . Balance due_If any (subtract Ilne 17 from line 16) Pay in FULL With RETURN 18
Norle
Due or 10: ' Overpayment_~If any (subtract Ilne' 16 from line 17) OVERPAYMENT 19
Rotund 20. Portlon of Ilne 19 you wish to apply on 1971 estimated tex 20
21 . Retund _If any (subtract Iine 20 from line 19) REFUND 21
Do not write In these spaces Under penalties o perJury; declare that have examined thit Ineludlnp accompanying Ichedules and statements, and to the best of my knowledge and
belier it @s tue, correct and . complete: prepared by 0] person ather taxpayer , his declaration is based 0n all information ot which he has any knowledge:
Sign
You;`Signaturc ~i7 jointly;" Both "must"3ign Date Signature 0f"preparer other than taxpayer
here
Spouse' $ Tignatura Date
"AdareLAMBERT-MARKELLData
16633 VENTURA BLVD:
Mako Remittanee Payable to Franchise TAX BOARD_Mall to ENG;INO, CALIF: 91316
FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814.
NW 88326<Docld:32245535 Page 143
reluttna
aiing
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Form 540 1970 Page 2
PART 1Head ot Household _If claimed,answer the following questions (See Instructions)
Check Never married Final divorce/ dissolution Separate maintenance Widow(er)
one; Date Date Date
Individual; who qualified you as head of household:
Name_ Relationship Age_ Gross income
Is this person married? If yes, did he or she file a joint return with spouse? Did this person qualify as your dependent for
the calendar year 1970? Did this reside in your home for the entire taxable year?_ If not; circumstancos
Total amount necesary to maintain household How much did you contribute $_
Part; Ip Other Income
22. Business income (or Ioss) (attach Schedule € (540)) 22 8,2.8409?
23. Sale ~or exchange of property (attach Schedule D (540)) 23 Qo0 Q0 )
24. Pensions and annuities 24
25. Rents and royalties Attach 25
Schedule € 26. Partnerships Form 540) 26
27. .Estates or trusts 27
28. Farm income (or loss) (attach Schedule (540) ) 28
29. Miscellaneous income (state nature and source)
29
30. Total (add lines 22 through 291. Enter here and o page 1, Iine 8 30 7,284 97
PART III_Adjustments to Income
31 . "Sick pay" if included 0n page 1 line 5 (attach statement)_ 31
32. Movlng expenses (attach - statement) 32
33, Employee business expense (attach statement) 33
34. Military exclusion (maximum $1,000_S500 if separate return of husband or wife) 34
35. Total adjustments (add lines 31 through 34). Enter here and o page 1, line 10 35
PART IV__Tax Computation_If_'you do not use Tax Table or Income Averaging (Schedule G (540))
36. Adjusted gross. income (from.page 1, Iine 11) 36 2..3.05L.52
37. If you itemize deductions, enter total from Schedule A (5401, Iine 31
If you do not itemize deductions , and Iine 36 is S10,000 or more, enter 37
2,245] 44
(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 line 36) 38
4, 539| 33
39. Tax from Tax Rate Schedule in Instructions. Enter here and on page 1, line 12 39 51 00
PART V_'Exemption' Credits
40. Single =$25. Married couple or. head of household _350 40 5.0 00
41. Blind Yourself Your spouse $8 for each box checked 41
42. Dependents-__Do not list yourselt, your spouse, or person who qualifies you as head of household
NAmE (and addrets i diferent from yours)- RELATionshiP
Fred Brian, Eli8a
0
Thomas children
Number of dependents Ilsted . X 88 42
32 00
43, Totel exempllon crodlts (edd Ilnes 40, 41 and 42). Enter hore and on page 1 , Ilne 13 43 82 00
PART VI_Credit for Net Income Tax Pald to Another State Attach copy of "other state" returnand Retirement Income Credit
44. Income derived from sources within State of 'and also taxable by California 44
45. Callfornia adjusted gross ' income (from page 1, line 11) 45
46. California tax liability (from . page 1, line 14) 46
47. Credit limitation_-line 44 line 45 % (100%* maximum} X line 46 (cannot exceed tax other state) 47
48. Retirement income credit (attach Schedule R (540)) 48
49. Total (add lines 47 ad 48). Enter here and on page 1, line 15 49
PART_VII_Reconciliation_to_Federal Return 'If adjusted gross income_on_Federal_return is different_from line 1L, page 4, explain below
DTvidend Exc lusion
N788326 Docid:32245535 Fage
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explain person
from
paid
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TAXABLE SCHEDULE
CALIFORMIA
A
19 20
ITEMIZED DEDUCTIONS
YEAR FoRM 540 Attach to Form 540
Social Security Number Name as shown on Form 540
Samuel and_PhylLig_Ruby 322 12 7997
Itemized VS, Standard Deduction__You have a choice between two deduction if one spouse itemizes deductions, the other may nt use the Tax Table o claim
methods. You can either itemize your deductions or take a standard deduction as the standard deduction. If you choose to itemize your deductions, complete the
explained in the 540 Instructions On separate returns of a husband and wife, 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 2
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) 4
5 , Other medical and dental expenses. Include balance of insurance premiums for miedical care not
deducted on line 1 (attach schcdule) 5
6_ Total _(Add lines 4 and 5) 6
1 Enter 3% of adjusted gross income shown o Form 540 7
8. Subtract line. 7. from line 6 (if less than zero,' enter zero) 8
93 Total_ (Add lines 1 and 8) 9 150 00
Child Adoption Expense
10. Total expenses paid or incurred-__Attach itemized list 10
11, Enter 3% of adjusted gross income shown on Form 540 11
12. Subtract line 11 from line 10-See instructions for maximum limitations 12
Taxes;
13. Real estate 13
14, State and local gasoline 14
15. General salcs 15
16. Auto' Ilcense-Excess o registration ad weight lees (see ' instructions) 16
17, Personal property 17
18. State disability insurance (SDI)-Employer private disability plans do not qualify 18
19. Other (specify) 19
20 . Total taxes--(Add lines 13 through 19) 20 663 26
Contributions
21. Cash-, Including checks,, money orders, etc (itemize) 21
22. Total cash contributions 22
23. Other than cash (see instructions) Enter total here 23
24. Total-Add lines 22 and 23_Maximum deduction may not exceed 20%. of adjusted gross income 24 280 00
Interest Expense
25. Home mortgage 25
26, Installment purchases 26
21 . Other (itemize) 27
28. Total-_(Add lines 25, 26 and 27) 28 1552 18
Miscellaneous Deductions
29. For child care, alimony, union dues, casualty losses, etc -See instructions (itemizel 29
30. Total mlscellaneous deductions 30 100 00
31. Totel deductions_(Add lines 9, 12, 20, 24, 28 an 301. Enter total here and 0n1 540, page 2, in space provided S/ A 31 2,7451
Schedule 8 on reverse NPe38J23'Docld:32245535 Page 145
Form
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TAXABLE SCHEDULE
C
CALIFORMA
19_ 70
FORM 340
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
(Sole Proprietorships)
Amtach tals schedule to your Incomo tax return, Form 840 Or J4ONR Partnorships, ioint ventures, ete, must fle % Form 565
Social Security Number
Name as shown on Form 540 or 54ONR
Samuel and Phyllis Ruby 322 12 1992
A. Principal business activity- Food
wholosalo_tobacco; servicet-legal;
Ecodigct; manufacturing
-furniture; otc:) (For oxamplo: rotall-_hardwaro}
Snack Bar C_ Federal employer identification number;
B. Businese namo
0. Business location
5418 Van_Nuye Boulevard Van Nuys Cali fornia 91401
(Numbor and stroot or rural routo) (Clty-post offico) (State) (Zip codo)
E Indicate method ' of accounting: cash; accrual; other (describe)
6. Was there any substantial_ change in the manner of determining quantities, costs or valuations between the opening and closing
inventories? Yes 5 No. If "yes; attach explanation.
G. Were Forms 591, 592, 596 and 599, for the calendar filed (if required)? JYes No
1 Gross receipts or gross sales Less: Returns and allowances $
2.` Inventory af beginning of year (If different than last closing inventory attach
explanation)
3 Merchandise purchased less costof any items with-
drawn from business for personal use $
4 Cost of labor (do not include salary to yourself)
5. Material and supplies
6. Other costs (explain in Schedule C-I)
SCHEDUIE
7 . Total of lines 2 through 6
A TTAC HED
8 Inventory at end of this Year
9. Cost of goods sold and/or operatlons (subtract line 8 from line
10. Gross profit (subtract Iine 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-I)
13. Rent on business property
14. Repairs (explain in Schedule €-1)
15. Salaries and wages not included on line 4 (exclude any 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-1)
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 Il, Form 540 or 54ONR $ 9,284 /97
SChEDULE C-1 . EXPLANAtION Of LINES 6, 12, 10; AND 25
Llae No: Explanation Amount Lin Xo Explanation Amount
(Rev. 1970) Page T
NW 88326 Docld:32245535 Page 146
2551528
year
year's
paid
paid
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SCHEDULE TAXABLE
CALIFORNIA
0 1.970
FORM 540
SALES OR EXCHANGES OF PROPERTY
YEAR
Attach to Form 540 or 540NR
Name as shown on Form 540 or 54ONR Social Security Mumber_
Samuel and Phyllis Ruby 322 12 7997
Part I-CAPITAL ASSETS
SHORT-TERM_ASSETS HELD NOT MORE THAN 6 MONTHS
Cost or other basis,
Depreciation allowed cost of subsequent
8, Kind o property (I4 necessary , b . Date acquired c, Date cold (or allowable) improvements (if not 0 Gain or loss attach stalement ot descriptive (mo., day, Yr.) (Mo;, day, Yr. ) d_ Gross sales price since acquisition purchased, attach plus less' T) details not shown below) (attach schedule) explanation) and
expeise of sale
SCHEDUEE ATTACHBD 715,27EE00)
2. Enter 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 (if any) from line 16, Part Il
6. Enter.your share of net long-term (or loss) from partnerships and fiduciaries
7. Enter unused long:term capital loss carryover from preceding taxable (attach statement)
8. Net long-term gain (or loss) from lines 5, 6 and 7 (15,274 ,00)
9_ Combine the amounts shown" On lines 4 and 8 and enter" the net (or loss) here
J0. 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)
10_ Subtract line 10 from line 9, Enter here and on line 17, Part IlI
12. If line 9 shows a LOSS, enter here and on line 17 , Part Ill the. smallest of the following:
(a) the amount on 9; (b) the amount of taxable income o Form 540 or 54ONR, computed without capital
gains and; losses; or (c) $1,000 Carryover Loss (14.274 = 00 ) 1,000. 00)
Part_II_SALE OR EXCHANGE Of Property Under SsectionS 18181-82
13. Enter (if any) from 22 , Part IV
14. Enter (if any) from line. 25, Part IV
15. Enter share of (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 (or loss) from line 10 % 11, Part
18. Net gain (or loss) from line 31, Part IV
19. Total net (or loss)-_Combine lines 17 and 18. Enter here and on Form 540 or 54ONR, page 2 , Part
Il, line 23
(Rev. 1970) (Schedule continued on reverse)
NW 88326 Docld: 32245535 Page 147
Your
gain
gain
years
gain
line
line_ gain
gain
gain Your
gain
gain Form
Page
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4101 Sepulved& 989-2100-
'1 &i -
0221/ 45
Combined Departrnent of the Treasury Internal Revenue Service 1040
iotoform
US
Individual Income Tax Return
1969
For thelyear January !-December 34 1969, or_other_taxable_year beginning 4969, ending 19_
First namo and initiol (If joint retum, Uso firat ndmes and middla initials o both) Last name Your tclel scurity numbar
8
8
1
Homo gddress (Numberand streat' % rural moute) Your occupetion
1
town Or post oftice, Stato and ZIP codo Spouv'8 eoelal securlty numbet
Enter below name and address used on your return Tor 1968 (f same a5 above write "Same") |f none filea, Give Spousa 3 occupation reason__if changing from separate to joint %r joint to separate returns, enter 1968 names and addresses:
Your present employer and address
Your Single Unmarried Head of Household
Filing 2 Married filing joint return (even if only one had income) 5 Surviving widow(er) with dependent child
Status 3 Married filing separate return,and spouse is also a return: 6 Married filing separate return and spouse
(Check If this item checked give spouse's social security number in space provided is not required to file
Only: one) above and enter first name here
Check boxes for exemptions which apply Rutzneut 65 Or over Blind
7a Yourselt Enter
number
7b. Spouse (only It her (his) incoma Is included in this raturn or,sho (ho) hed no Incomo) Of boxes
checked
]
8 First names of your dependent children who lived with you
Enter number
"'(0) NAME Enter figure 1 in tho last (D) Rolation Mo Months 'liVed (d)5600 (0) Support you (0) Support furnished
I
9 OTHER column to right for each name listed ship? inoui_homo? Soo Or More furnished; If i00% by dependent and DEPENDENTS (if more spaca is' needed, use other side) page '3 of instr - income? write ALL. Others
$ I
10_Total exemptions_from lines Z, 8 and Jabove
0
11' Wages, salaries, tips, etc; Attith Forms W-2. If unavailable, explain on back 11
12a Dividends (Totel betore 8 (if ovor S100_ Less 126 Exclusion $
2.0O_Balancek
12c
H
exclusion) iist in Sch, B)
0
13 Interest (lf over $1OO, list in Schedule B, Part Il) 13 LL3
2
14 Other income from Schedule € 0, Schedule D 0, Schedule E O; Schedule F 16
(Add linos1] thru 14) (s00 back)
15a Total $ LL357 Less_1Sb_Adjustments 3
130,
Adjusted Gross Income 15c]
A If line KSc is $5,000 or more, g0 to Schedule T, to figure tax and surcharge: (Omit lines 16a and 16b.)
B Also g0 to Schedule T, to figure tax and surcharge if you itemize deductions; or claim retirement income credit; foreign credit, Or 8
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 porB applies use Tax Tables instead of Schedule T_ Complete lines 16b, and 16c, See paragraph D on back for 4
J
rules under which the IRS will figure your tax and surcharge:
8 16a from Tax Table: A O, 8 0, or C Q' (check one) 16a !
16b Tax surcharge on amount on line 16a (See 'Page 10 of instr:) 16b
I
16c Total add lines 16a and: 16b OR enter amount trom Schedule T (Form 1040) line 11 16c
17 Total Federal income tax withheld (attach Forms W-2) 17
Make check Or 3
3
18 Excess F.I.C.A tax withheld (two or more employers _see page 5 of instr ) 18 money order pay-
J
19 C Nonhighway Federal gasoline tax-Form 4136, Reg: Inv:~Form 2439 19 Relente Sertecaal
20 1969 Estimated tax payments (include 1968 overpayment allowed as a credit) 20 UIIIMUIUUMIUUII !
21 Total (add lines 17, 18 19, &d 20) 21 Ve
22 If line 16c is larger than line 21, enter BALANCE DUE 22
23 If line 21 is larger than Iine 16c, enter OVERPAYMENT 23 3
24 Line 23 to be: (a) Credited on 1970 estimated tax S (b) Refunded $
'Under,panelties of perjury, dociare that have exomined thls return, including accompanying schedules and statemonts, ond to tho best of my knowedee and bollof It
IS true; , correct,' and complote_
Your signature Date STgnature 01" preparez other (han (expayer, based on Date 9 all information of which he has any Knowledge_
Spouse'$ signeture (If jointly, BOTH must sign-even If only one had Income) Addross 18
TeNW88326-Docld;42243131-Pagez148
IRf
I
city,
filing
0
8
tax
16a,
Tax
6
filing
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SCHEDULE D Gains and Losges Fror Sales or Exchanges
(Form 1040)
U.S. Treasury Department
0f Property 1968
Irctefnal Revenue Servicc Attach this schedule to your income tax return, Form 1040
Name as shown on page 1 0f Form 1040 Social Security Number
Part I~CAPITAL ASSETS-~Short-terr' capital Gains ard iosses-_assets held nct more than 6 months
C, Hcw
3 Kind of prop- 8c h Cost Dr other
orty. Indicate 6_ Description Quired _ basis, cost cf
security, real (Examples; 100 sh_ 0; Fiter aquifec Dat?
0. Date sold Gross gale: aBexa /tion subsequent imprave: 1.. Gain cr log5
cctate_ or other '2' Co,, 2 story brick,
symhbol (mo., day, yr.) ~Gay, yr.) price allallabe} {Tn= ments (il no: (f "plus % Iess h)
(Specity} atc.) since Purchased, attach (Seo acquisition explanation} and instt.) expense Qi sale
42
Azi
EC 354
2 Enter your share %f net short;term gain (or loss) frorj partnerships
and tduciarie;
3. Enter uused 'short-term capital lcss' carryover from precedirg taxable years (attach statement)
Net short-term gain_(cr loss) from (ines 1, 2,' and 3
Longtem capital_galns and losses-_assets leid moro than 6 month (1 months Or mare tor certaln Ilvestock)
7352
5 Enter gain from Part I, Iine 3
Total long-term gross Sales price
6a Enter your share of net long-term gain (or lass) from partnerships and flduciarics
6b Enter your share of' net long-term gain from small business corporations (Subchapter S)
7i Enter: unused long-term capital loss carryover irom preceding tazabie years (attach statement)
8 Capital dividends (see Form 1040 Instructions, page 5) ,
9 Net long:term Bain (or loss) from lines 5,' 68, 6b, 7, and 8
10 Combine 'the amounts shorn on lines 4 and 9 and eriter' the 7et gzin (gr loss) here
352
11 H Iine 10 ghotv8 a GAIN-Enter 50% of Iine 9 or 50% 0f Iine 10, whichever is smaller. (Enter zera if there Is loss or no
On line 9.) (See reverse slde for computation 0f alternatlve tax )
@2 Subtract. Ilne' 11 from line 10. Entor here and in Fart IV, line 1, on reverse side
15354;)
13 It line 10 show? a LOSS '-Enter here ad in Part iV, Iine 1, the smallest of the following; (a) the amount on lina 10; (b)
the amount On Form 1040,page 1, "igg! lb, computed without regard to capitai gains or Icsses; or (c) $1,000
Part II-JGAIN]FROM]DISPOSITION OE DEPRECIABLE PROPERTY UNDER SECTIONS 1245 RKJ I?50
aSsets held more than 6 montts (see instructions for definitions)
0 snere doubls heidtga @Paear, 4sg the flrgt #eading for section 1245 and the second hcadlng section 1250
0. Klnd du.sio387& Df endhow acquired (if necessary, attach statement Coat or other basis, cost of
0f doteils not shown below ~write Or 1250 b_ Date acquired c. Date sold Gross Stkes price subsequent improverients (f to Indicato typo of assot) (mo, day.yr) (mo-, day, yr ) nat purchased, attach expla-
Ration) end expense %1 g3ie
Depreciation alloived (or allowable) since acquisilion
+1. Prior t January } , 1962 +-2 Afier Decem ber 31, 1861 E Adjusicd basis Tota} Bain
(le-Sertioary %i3)
OR Or (q loss suri % anm+2) (d less 5) (R Other gain:
Prfor to January 1 , 1984 After Decem bar 31 , 1953 (see instrictions) (h less
2 Total ordinary gain: Enter here and In Part IV, lino 2, Or: reverse slde
3 Total other gein: Enter here &nd In Part !, lino 5; however, if the gairis do not uxceed the losses wher this amount is
combined wtth other gains and losges from section 1231 property erter the %tal cf colurnt; in Part III, linc 1
Tw 88326 DocldZ245j85 Puge 1ig
(mo:^
S2:
gain
entry
Lim -
tor
1245
Rain
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SCKEDULE T
{Formeat JOaopawry Tax Computation
11969
Intemnal Rovonue Sorvico Attach this schedule to your Income tax return, Form 1040
Name (as shown on Form 104O) Social Securtty Numbar
Tax Computation
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 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 line at the right the .amount of your deduction figured under one of the
methods:
~If you itemize deductions, enter the total from Schedule A (Form 104O), line 14
'OR
~Figure your standard deduction as follows:
(a) Enter" 10" percent of line 1 " 'but" L392_
not more than S1,0Q0 (3500 if 0
married and filing separately) 5
nter the larger Of (@) or (b) on the
(b) Enter the sum of: $200 (S100 if line at the right: If spouse files
married and filing separately)
a separate return, determine your
plus $100 `for each exemption deduction in the same manner that
claimed in line,10 of Form 1040, she (he) has:
but do not enter more than
S1,000' (S500 if married and
filing separately) p2
3 Subtract the amount on Iine 2 from the amount on line 1 and enter the balance here
Enter number of exemptions claimed on line 10, Form 1040, 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
6a 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 0, Schedule D Or Schedule
6b Tax surcharge. If Iine 6a is less than $730, find surcharge from tables on page 10 of instructions: It Iine 6a
is $730 gr more, multiply amount o 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
70 Retirement income credit
7b Investment credit
7c Foreign tax credit
7d Total (add lines 7a, 7b, and 7c)
8 Income tax (subtract Iine 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 PRINTNG OFFICE:1%9 0-337-031
~Ni883267Docld:32245535-Page,1807=
902
your
PRO0fonir
BLMIMAE your
==================================================
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05
SCHEDULE 8 Dividends and Interest
(Form 1040) Incone Schedule
1989
Department 64 the Treasury
Intomol Rovonuo Sorvle) Attach thls schedule to your Inccme tax return, Form 1040
Name (as shown on page 1 of Form 1040) Social Security Number
PART 13 Dividends Income
Gross dividends and other distributions on stock (list payers and amounts_~write (H), (W), (J) for stock
held by husband, wife, or jointly)
Total line 1
2 Capital gain distributions (see
page 5 of instructions)
3 Nontaxable distributions (See
page 5 of instructions)
Total (add Iines 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 II__Interest Income (list payers and amounts below)
Earnings from savings and loan associations and credit unions
czck)_
3
13
4
Other Interest (on bank deposits, bonds, tax refunds, etc )
LhtIe
513
Total interest income. Enter here and on line 13 Lb3ZI
N-88326 -Doeld 32245535-Rage-15
PRC
PRELMINAR Y
7
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SCKEDULE A
(Form 1040)
Itemized Deductions 1969
Departmtnt otthe Trentury
Intornal Reranuo Sorvict Attach this schedule to your income tax return, Form 1040
Name (es shown on Form 1040) Soclol Security Numbar
Itemied Beductions_You have a choice between two amount equal to 10 percent of the income you report %n Jine
deduction methods: You can either itemize your actual 15c of Form 1040_ but not less than $200 plus $100 for
deductions or take a standard deduction. Deductions may be each exemption claimed on line 10 of Form 1040 (subtract
itemized tor charitable and other contributions, interest ex- S100 if married and filing separately). The maximum
pense, medical expense, certain taxes, casualty losses, child standard deduction is $1,000 (8500 if married and filing
care, and other items described in the instructions on separately). If you choose to itemize your deductions, fill
back It YOU take the_standard deduction, you will get an in the appropriate spaces below:
Medical and dental expense (not compensated by Insurance Contrlbutions_ Cash ~including checks, money orders etc:
Or othenwlso) tor medicine and drugs, doctors, dentists, nurses, (Itemize)
Z
hospital care, medical insurance premiums, etc.
GNL SouEs
1 One hal? ct Insurerce premlums for medi:
cal cars (Dut rot_ Mord than 8150)
2ELA
2 Medicine and drugs
3 Enter 1 % ot line 15c, Form 1040
Subtract Iine 3 from Iine 2 (not less than
zere)
5 Itemize other medical, dental expenses
(Include balance of insurance premiums
not deducted on Iine 1)
Ila Total cash contributions
401
11b Other than cash (see instructions for
required statement). Enter total of
such items here
Ilc Carryover from prior years (see in:
HespZns
structions on back)
Ild Total contributions (add lines 1la, pz Rzzs
bl 11b, and 1C_see instructions for
limitation) DZSEras
72 42] =
Interest expense Home mortgage D@ut
ZOlz
Installment purchases
Other (Itemize) DzZbln3a 331
AuEoZban De_ ZALEl L2
751
0Eza
6 Total (add lines 4 and 5)
7 Enter of line 15c, Form 1040: 12 Total_interest expense L3E_
8 Subtract: Ilne 7 from line 6 Miscellaneous deductions for child care,
9 Total (line 1 plus Iine 8) 642 alimony, union dues, casualty losses, etc.
Taxes - T Real estate See instructions: Z
State and Iocal gasoline
Zcou Pepazatial
General sales (See page 15 of instructions)
7S
State and local income
Personal property
10Total taxes 30 13 Total miscellaneous
14 Total:deductions (add lines 9, 10, d, 12, and 13 ~enter on Schedule T (Form 1040) , line 2) M
16 _
ZNW: 83326 Dogiubz453357p
6;
2}
FAwAe
CL
PRo@r
RpRE WAMINAY
3%
==================================================
Page 153
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79
Samuzi 0& Fnyili $ rivy Ai Stocks
0.346 MoNTGom eey: Acturedv4|
Granada Nices CAsie
U.s Indiv diial
0i2 6e
attached +
mack
Part %
nceme Jax Fpen_o4e 61
STB5 Dsce Te~ 7BMREq Pezs < EZTTC 783
KPE 4Ei#AuITon ad_@2
@0
MeecAnTiLs TrbusTkes
1_-6s Lz62 3303-|*9944 327
5e3 Bemtx Eiauirees
IlE 2.61 4,918-43224 294
MiswesieeM KinAnaiae le-b& 2.61 seb- (36
2es Mnoiesteex-IELN9NG,aL le_es: 2.61_ 46 (d1)
22081 yie JNc 3-69 5:61 S,281 4 4S0 867
SDonNels Ca_
Ioe Wect Bvlx FastMs &-6i 22-61 943- 833- 9
1oe Tlgeeiec-Cre J Amee R-6& 663 1,672| 14743 CzZ
kexrGBax
JMc_Melchanqis € 8 J-61 2,56.3 3,64s 86
00
HeNnsYLYAwa EnG_Cokei Ia-lr_ 1-61 44644+*3.89 82
304 Barady Eibus E,ks U-e8 2-62 4, 0104-3,226 294
1 3300 Neeana ENc L-61 2:661 2,6272,.429 "187
Ee3 22 Nkxx Delve - 2.69 1e-65 3,4 s 828 635
B NiReNELicteends_@o. le-65 lo-et Zzs2 272
TeeYcteom4 Cokk 3-61 ke:l Is6z-| szoo3 3e3)
Nxzeetss Ivc;
Ees: 11-21 3,320 466o- 34o-
Bekc'~s- We-sy Leyi
Loo
PEENe GuRus_IXDusTRc [2_62 10-62. [.33-182152 81;
17
Lop
HEeL4B_Aefism Acts '3261 h-61 1,072 1,237 GzI2
1oo AIclaep Ei; 9-68. le-6; 671- 1,21.3- (5ve
2 TEeEilsion Amee Iez-68. 12-63_ 362 7374 (327)
AEebvics, 661 1647,224 28
YelseeLIns L.6z| k-ei 1723424214 (727
Bace
F' (e
13o
Reze
1
Dy Wis Seg 1672 31
2343 (7
M Jcs]
Vece
Y
Ceee
1Lz 2-67 66e7z S8& J
Sigckay U_e2 1-63 2-49 62z] bgp
1531 Miovksaex Emikeal 'E6d-2-61 -,921420
Yhao
Ceneral
X
1-6h 5.61 4623] QXy _ 37
Jod GSC-enteeRe ses
ICs::
2-64: S75 979t 732 220
ic
Fupeaz__@Cbee slAmce &b2 L-69 L,5181_ (i76
Sex [QaNceai [Patfe €y +
RAM 6-61 Jo-en 3.3144 4,823 _2t-1
Iqel ke SedeFx + EnG, 10-61 2,4644-2, 267 0
Eenugs 2-6% [2-65 27 3059 Li3-
Totel 92- 1s824 4397
326-Docld;32245535-Rage-153
al
1,8e3- 589
4832
Qoeet;
INc
Nvc
I1-l9
Q8
Bareey Kzeama
2L745
6-L5 Teot
==================================================
Page 154
==================================================
J0mve 6ay TW
11.346 MaNtopmeey
Ge ANADA
Hills, CALic
am ched_ am& v & de 0 p o
U. $. Individual Income:Toi fstm 104?
Q be: i919
JekKhutd e4genses_arc W Connectlon Wjh Schedile
EMsEest
Atd
Dn
Mnedim.Acoun
Zache_+ l 137
McDelneel @a 143
Beecha= Weise-Kevut 7*
GoePbby_ Qo. 16
EE IeV
To+4L Nrkeesz 383
Bccn] (ebrca It' Services
uzo dxeeNs= Miles
Zass eSovad Mes
[BvanHT< atbodn MES 96_
erk XPGNIeS "'Ze+
N 88326 "Docld:32745335 Page 154
KX
ne
Coyad |
==================================================
Page 155
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Comblned Department ot the Treasury Internal Revenue Service 21040
iotboForm
US
Inelividual Bncome Tax Returm
3 1969
'For the year January !-December 31, 1969, Or other taxable year beginning 1939, endirz 19
Q0 332 7/3-
7747 344-18.1470 bay Your social security number 8
SamvEL 7
PnyLis Ruey
& 013+6 Nuit Gom6ry Ave
34 27442
1
GRana D Hizis, cl-ie 4i344
Your Occupation
0 3LZufuYo
Spouse" $ sociai securlly number
Enter below; name and address used on your: return for 1968 (( game as above_write "ana"); 1f none filed, give Spouse
3yaLAl
roason: , If changing troin to jgint or 't0,separate returns enter 1963 names and addresses; $ occupation_
Samuel
7
#yLS
{RGy
43
JaEYZG
ChicASS_ 60 6
Hszic
Name and address 0f employer at time c; filing
Your Single
S6b6
0 Unmarried Head pf Household
Filing 2 Married filing joint return (even If only ona had income) 5 Surviving widow(er) with dependent child
{Check
3 Married separate return .and spouse is also 2 retura _ 6 Married filing separate return and spouse
If this item checked give spous:'$ social secirity number in space provided is not filing a return only one)l above &nd enter first Game here
Check boxes for exemptions which apply Regular 65 or over Blind
7a ` Yourselt Enter
number 7b Spouse (applies only ifline 2 or Iine 6 is checked) ot boxes
checked 1
1
8 First names %iyour dependent children Who (iveq With you
Feed- Be; A Li SA Zowas Enter_number 1
9 OTHER (e) MAME__Enter figure 1 in the last (c) Morths lived (C} 5g00 (0) Support You (0 Support furnished
DEPENDENTS column to right for oach name Visted Relatdenship in your nome_ See or iTJre furnishad: If [j0o% by dependent and (if more space is needed, .4Se othar Side)_ instructionj , R-Z income? write 'ALL: others 1
S $
1
0 10' Total exemptions from lines Z, 8,and 9 above
11 Wages, salaries, tips, etc: (Attach Form W-2 to back If unavailable, explain on back) 11
1
12a Dividends Totel before] See item 2 12b Less Exclusion $ Balance 12c
L
exclusion 0n 1040-1
1
13 Interest (Enter total here and if over $100, also list in Schedule B, Part II) 13
2
14 Other: income; Tctal from attached schedules (check schedules used-c 0, DA; EQ, FD 14
Adjusted .
AddIlnes %a]' See Gross
15a , Total 126..43 & 8 15b Less Adjustments 104-1] $ 730 = Income 0 15c]
Yina #6c is 55,000 %r mtyje, %
237
Scheaule_T, to figure tax and surcnarge: (Orfff Tnes 16 and
907L_
Go to Sch. T to figure tax and surcharge if you itemize deductions; or claim retirement income credit; toreign tex credit, or inveeta 3
ment credit; or if you owe self-employment tax O tax trom recomputing prior year investment credit" (Omit lines
If neither of above two items applies, go to Tax Tables instead of Sch: T_Coiplete lines 16,17, & 18.
izmnmun
A
J
16 Tax from Tax Table (see tables on T-2 and T-3) 16 Sniclonc {e '%ie figare
L
17 Tax surcharge on line 16 (see T-1 for tax surcharge tables) 17 Your tex and surcharze !
18 Enter total %f lines 16and 17 OR amount from Schedule T, Iine 18, if applicable (check
if_from Tax_Table A D BE c_Qi Tax Rate Sch, Sch: D QL SchG 18
19 Total Federal income tax withheld (attach Forms W-2 to back) 19
8
3
20 Excess. F.I.C.A. withheld (two or more employers ~see R-2) 20
Money Oraek payr
21 Nonhighway Federal gasoline Form 4136; [] Irv-, Form 2439 21 able to Internal 1
22 1969 Estimated tax payments (includc 1968 ovcrpayment allowed &s a credit) 22 Reveque Service
'23 Total (add lines 19, 20, 21, and 22)
#0
23 H
24 If Ilne' 18.is larger than Iine 23, enter BALANCE DUE; Pay in full wlth return 24 1
|
6 25 If Iine 23 is larger than line 18, enter OVERPAYMENT 25
26 Line 25to be: (a) Credited on 1970 estimated tax p $ (b) Refunded P $
Under penalties *of oiipiate declare That have examined his return , including aceompanying schedules and statements, and to (ha best of my knowledge /na aliar #
Is true; correct, and
Your signature Date Signature of preparer other than taxpayer, bascd on Vate 9
all information of which he has any knowledge.
Spouse'$ signature (I$ filing jointly: ROTH must sign cven if only one had Income) Adatess
Docid;32245535 Page 155
tiling filing
E
'17,)
[
tax
Reg: tax,,
1
5
==================================================
Page 156
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Scheduie: A
(Form: 1040) Itemized Deductions 1969
Department of the Treasury See instructions on A-] and 4-2
intoznal Revanue Serice 98 Yor WS8 #bls schedule; #t22C61 % to FcFmn 1040.
Nama &S shown on Form 1040 Soclal Securty Nulnbar sSanuel WLLS 4E 334 12 2232
Medical and dental expenses (not compensatad by (nsurnca Ccvirlbutiuns Cash-nciudirig checks, money orders, etc:
or otherwlse) for medicine and drugs, doctors; dentists, nurses, (Itemize)_
hospital care, insurance premiums for rnedical care, etc;
2 Ona hal} 0f Irsurance premlutts #cF Meck 'e C"ujs I HMe
cal care (but not more than 5150)
2' Medicine and drugs
'#d
612z
SuIS
Hek
3 Enter 1 % of line 15c, Form 1040
'4 Subtract line 3 from line 2. Enter differ:
ence: (If less than zero, enter zero)
31 QHDES TlE,7IES
6 Itemize' other medical and dlertal 8x:
penses (include balance of insurance
premjums for medical care not deducted
on line 1)
Is Ezam
0
Ies fais
6p
11 Total cash cortriblitions TESTEus: 42
12 Other than cash (s2e instructions on
A-1 for required statement)- Enter Te
L 426 total for such items here
13 Carryover trom years ` (see in: T2 o6usez 33
structions on A-2)
14 Total contributions (add lines 11, KEYE EXM 77 12, and 13-_~see instructions on A-2
BRA4 3Am ikO {or !imitation)
AHcmro Irterest' expense Homc mortgage Wn 9
Installinent purchases
344 CLEfIE< Other (Itemize)
HurgLenn
Lsjes
Eavx
736
02
S€47 LSEE
15 Total interest expelse 735
6 Total (add lines 4 awd S) Imiscellaneous `deducticn: fct child care,
7 Enter 3%' of Iine 15c, Form 1040 alimony, union dues, casualty losses, etc.
8 Subtract lirie 7 from line 6_ Enter tilffer-
777
(see instructious on A-2)_
ence (if less than zero, enter zero)
9 Total deductible medical and 'dental ex-
ZNi
0 Me 1aa REra7n5,01
penses (add lines 1 and 8)
Lseed
Real estate
State and local gasoline
27
General sales (see sales tax tables)
State and local income
Personal property _ 16 Tutel nlscellmneolis doductions 35
17 TOTAL iterized OFDUCTIONS (add
Xines '9, 10, 14, 15, and 16_enter
10 Total taxes 30 here and on Scieriule T,' Iine 2) p _
ANL 88326 Docld: 32245535_Page_156
Zaze
MenPs
prior
Deiee Fok
OEces
THLS
Tazes-
Tod
4i3|
==================================================
Page 157
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SCHEDULE B
Dividend and Iiterest Incoie
(Form 1040) See itstructions on B-l
1969
Depertment of the Treasury If you use this schedtile; attacitit to Formt JO4O
Iuternal Rovenue Serice
Llnel nelie ii Griciai Security Rumher Name as shown on Form 1o40
SaMueL Pilsss 24211217.191
PART |~Diwidend Iricomie PART Il--Interest Incoine
1 Gross dividends and other distributions On stock (list Dayers 1 Eargings _ from savings arid Ioan associations and 'redit
and amounts-~write (H), {W); (J) for stock held Ly tlis- uriors (list Dayers and amounts)
band, wife, or jointly)
~(WZieei EEERiSYI
Akeev 0s09_ $ 335
223
2 Other Interest on bark deposits,. bonds_
tax refunds; atc, (list payers and amourts)
W)Cnieat_TzL Ez} W
513
2 Total of line 1
3 Capital distri-
butions (see instruc-
tions on B-1)
Nontaxable 'distribu-
tions (see instruc"
tions ori B-1)
5 , Total (add lines 3 ancl 4)
6 Dividends before exclusityn (subtract
iine 5 from line 2)_ Enter here and 0li 3 Total interest inconic. Enter here and
Forn 1040, lite_12a Oil For 1(1O, line 13 Leaz:
hl 88326_Docld:32245535Eage +57
CHb
gain
==================================================
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SCHEDULE D Sales or Exchanges 0f Property
(Form 1040)
See instructions 0n D-l and D?
1969
Depertmant of the Treasury
Internal Revenue Service I; Ityou use this scherule, &ttach it to Formn 1{40.
Narne as shown on Form 1040 Social Security Numiber SA Muel
Ti ky 32 121 Z1IZ
Part I_CAPITAL ASSETS It Short-lerry capital and |csses__assets held not teore thai 6 months
C. Hcw
Jc: h. Cust or other
3, Kind ol Prop b_ Description quired _ basis, cost % erty .. Indicate (Examples: 100 sh, %f Inter d_ Cate Dale sold Grcss sales g. Depreciation subsequent impfova- security, real "2" Co., 2 story brick, Jetter acquired (mo., Jey; piice allowed (QI menis (if aut Goin or /oss
estate, or other 0%c.} symtol (re? , day,yr.) Y96.), allpivable) sinc? purchased attech Dlus g Iess h) (Specity) {Se: acyisiiion axpianation) and instr.) exense cl sale S4e ScHzhzct AJTAcz)
32472
2 Enter-your share of net short-term gain (cr Ioss) {rorn partnerships and fiducieries;
3 Enter unused short-termn capitul loss carryover fromn preceding taxabie years: (attach stetement)
4 Net shottterm gain (or loss) fror lines 1, 2, and 3
Long-term capital gains_and_ losses-~assets helel more thai} 6 mlorths 12 months C rote certain livestock)
5 Enter gain from Patt Il, line 3
Total long-term grcss sales price
6a Enter your share of net long-term gain (or loss) from partrerships and fiduciaries
6b Enter your Share of net cterm from smzll business corporatiors (Subchapter S)
7 Enter unused long-term capital loss cafryover from preceding taxable years (atiach 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 (cr Ioss) here 3372
11 IF LINE 10 SHOWIS A GAIN-~Enter S0% cf line 9 or 50c of line 10, whichever is Sinaller. (Enter zero if thera is a loss
or nQ entry o line 9.) (See reverse side for comiputation of,alternative tax )
i2 Subtract line 1l from line 10 Enter here ad in Part IV, line 1, on reverse side
J6332
13 IF LINE 10' SHOwS A LOSS_Enter here and in Part IV, line 1, the smallest Of: (&) line 10;((b)_line 3 Sch (tine 1c,
Forni I040, if tax table used) computed without capital gains or losses; or (c) $1,000
Part IIz-GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250
assets held more than 6 months (see instructions 0ri D-1 for definitions)
ihere double teadings appear, use the tirst heading Ior sectlon 1245 arid the second heidinz for section 1250.
Kind, %f property and how acquired `(if necessary attach statement Cost or othur basis, cost ol
of descriptive deiails Tiat showq balow write 1245 or 1250' b; Date acquired fJate sold d_ Gros: sales price suesequent improvamants (it to indicata type of assut) (mo ,, Y;.) (mo;, noi purchased; atiach 2ple-
nation) and exponige of s3le
Depreciation alloved (or allswable) since acquisition
f-1, Prior t0 January 1 , 1962 1-2. After December JI, 1361 &. Adjusted basis h Tole/ Qein
({esOedtii3s2%ik)
OR OR- (0 less Sumn of f-1 ard f-2) (d less &} OR - j" other gein
Priar to JJanuary !, 1964 After ber 31 , [963 (sce iStiuctions) (h less ;)
2 Total ordinary gain. Enter here and in Part IV, Iine 2, on reverse sitle
3 Totai other gain: Enter here and in Part I, fine 5; however, if the zains do not exceed the losses wher this amount is
combined' with other gains and losses from section 1231 property erter the tolzl of ccluinn j in Part I, line 1
N88326, Decid:J2245535 Page 158
PHvLs' $
gains
{0i
long:t gain
gain .
dey, day, 9)
Deceiti=
==================================================
Page 159
==================================================
ULE T
Tax Computatiom 1969
NS
1040) made on line 14, line 16, or Iine 17, keep thls for Your records 'ded by tho
of "tho Treasury If no entry Is td' form '1040 Jns This is
'enue Sorvice If entry is made on_line_14, line 16, or line_ 17, atlach Iule T. Also Social Security Number
shown on Form 1040 5 P4LLis
0
By 372} 2
Muel
adjusted gross income (from line 15c, Form 1040)
deduction income is less than $5,000 ad you chcose t? take the standaco
table Ifyour adjusted gross
omit lines 2, 3, 4, 5, Find your tax in the appropriate
'ad of itemizing your deductions,_ 1I 8 Or D!Jte A0n T-2 or C onT-3); Enter tax on line 6 below: Ithere isnotax amount of your deduction figured: under one of the following
~Mini- 'r;' on.the line. at the right 'the 10 mua
Jods:
you itemize deductions; enter the total from Schedule A, line 17
Or $ 8
gure standard deduction as follows:
(1) . Enter 10 percent of line n but donot
'enter: more
than $1,000 (3500 `if Enter the larger of b(1)
8 8
married and filing separately) or b(2) on the Iine at the ;
'(2) 'Enter . the sum of: $200 (S1OO if right if your spouse files
married and filing separately) plus mireayotf @eduictioeten 3 8 8
SiOo for each exemption claimed in your
that 0
line 10 of Form 1040, but do not the sane manner
enter more than $1,000 (S500 if she (he) has-
married and filing:separately)
3 8 !
stract 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 06
8 88
er the amount here 3 and enter the balance here. This is your
tract' the amount on 'line 4 from the amount on line
Schedule (V, Il, or Ili) oi
1 8!
able income Figure tax on this amount by using the appropriate Tex Rate
Enter tax on line 6 below
'ou: claim the retirement income credit; enter amount from Schedule R; !ine 12, here
1 8 8
tract line 7 from line 6
If line 8 is
8 8
If line 8 is less than $735, find surcharge fror tax surcharge tables on T-1.
surcharge. amount on iine 8 by .10 ad enter result here 35 or;more, multiply 8 8 8
tal (Add Iines 6 and 9)
credit from Schedule R, line 17 (attach Schedule R)
1
8 8
itirement income
vestment credit (attach;-Form 3468) = 8 8 8
reign tax credit (attach Form 1116)
tal ' credits lines 11, 12,and 13) 8 8 8
0
come tax (subtract line 14 from line 10) 9 8 !
elf-employment tax (attach Schedule SE)
recomputing prior-year:investment credit (attach Form 4255)
H
2
8 8
aX from Enter here and on line 18 Form 104O (make 5? entry Oroine 16
Atay teor(adco4gesAlachGcand 1O FoEnter04804vd Vou eadean entry On line 14,.16,cr 17above 8
4
88
017, Form 1040). Attach
return, or as a surviving hus: To claim tax-free covenant bonds credit; 5
ie 'Averaging ~If your -income has (b) a joint
with taxable - incore ex" enter the arount of credit above lirie
ised substantially this year; it may bard g' ssizeo0d;
or (c) as a head of 14, and write "covenant bonds" to left %a 8 8
advantage to figure your tax foedenold
with taxable incorne exceecling of the entry. g
e surcharge under the "averaging
od Obtain Schedule G from an $38,000: Line 16_~Self-Employment Tax _~Enter
Ial Revenue Service office for full Line 9_Tax Surcharge:-~The rate amount stiown on Iine 9, Part Ill, Schedule 387 88
Is:, the calendar year 1969 is 10 percent: SE_
hative' Tax_-It will "usually be to The tax surcharge is Seeaddeioraxo Sbe
Line 17__Tax From Recomputing Prior 26 39 39 advantage to use the alternative tax regular income tax. See the Tax
Year Investment Credit _~Enter the
Jr net long-term capital exceeds charge Tables on T_1
amourit by whichi' the credit taken in a T-3 net,Short-term capital Ioss,;or if you
Taxes and Tax-Free prior year or years exceeds tne credit as
a net long term capital only, and Creditafor BoocignYoa
miay claimi' these recoinprited due t0 early disposition of
are
filing (a) a separate return_with Covenant Bonds
itemize deductions. property. Attach Formn 4255.
Jle income exceeding "$26,000, or credits only if you
jW88326. Docld;32245535 Page 159
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U.S, Amdiviouaj
U.s:
FreazuR Depagment; Internal Revenye Service
Ia
"ju40
Incom e Tax Retu r m
for the year January 1-December 31, 1968,
1968
er Other taxable year beglnning i968,ending 19_
Fint ndmo and Inltio} (It jolnt retum, use tirst names end mlddle Initials ol both) Last name Your social gecurity number 8
6
Simue PLylis_
322 12[ZIF2
1
Homa oddrass.(Numbor ond street or rural routo) Your occupation
LL3 M. J2Eolyed
L
town Or post ohco, and State ZIp code Spouse'$ social securlty number
Chysse EHinsis bOle4} 3H4HZRo
Enter below nam6 and address used On your return for 1967 (if same a5 above, write "Same"). If none filed, give Spouse'$ occupation
reason. If changing irom separato to joint or joint to separate returns; enter 1967 names and addresses:
SXl
Hous
K
wf_
Your present employer and address SeZE70pkyE
Your Status--check only one: Your Exemptions Regular 65or over Blind
1a Single 2a Yourself Eureber
1b Married Joint return (even If only one had income) 2b Spouse Ehexked
Jc Married:filing separately: If spouse is also filing a return, 3a First names %f yoyr dependent children who lived with
enter her (hls) social security number in space provided above
you Ers
(hl
and give first name here Zk LlS Enter
1
numbor Jd D Unmarried Head of Household 3b Number of other dependents (from page 2, Part /, Iine 3)
1e Q Sunviving widow(er) with dependent child Total exemptions claimed
Income 5 Wagessalaries,tipsetc If not shown on attached Forms W-2 attach explanation 5 {ufoincfgde] 6 Other income (from page 2, Part IL, line 8) 6
254
all income Total (add lines 5 and 6) 7
1
9usoahd 8 Adjustments to income (from page 2, Part IIL, line 5) I8
and wife 9 Total income ("adjusted gross income") (subtract line 8 from Iine 7) 9 1
Find tax 10 If you do not itemize deductions and Iine 9 is under $5,000,find tax in tables on
Irom table pages 12-14 of instructions: Omit lines Ila, b, C, r d Enter: tax on line 12a. 10
{6 OR
0 Ila Ifyou itemize deductions, enter total from page 2, Part line 17
If youa do not itemize deductions_andine 9is $5,000 or more enter the larger %f: 74c (1) 10 percent of line 9; OR (2) $200 (S100 if married and separate returm) 1la
plus $100 for each exemption claimed on line 4, above:
Figure tax
Deduction under (1) or (2) limited to 51,000 (3500 If married and filing separately). 1
Taiag tay 4lb' Subtract line 1la from line 9. Enter balance on this line" 11b 1662/3L
echedules lc Multiply total number of exemptions On line 4_above;by $600_ Ilc 3L04/20 L
JId Subtract line 1lc from line 11b. Enter balance on this line. (Figure your tax on this 11d amount by using tax rate schedule on page 1l of instructions:= Enter tax on line 12a. 3dzl 34
12a_Tax (Check_If_from:_Tax_Table Tax Rate Schedule Sch. D Dor Sch: G 12a Hkzc15z
12b Tax surcharge: (f line T2a iS Tess than 5734, find surcharge Trom tables on page T0 of instruc
tions; Wf line 12a Is $734 or more: multiply amount on line 12a bv .075 and enter result; (If 12b
you_claim retirement _income credit_use Schedule B (Form 1040)_to_tigure Surcharge) Zl co
12c Total (add lines 12a and 12b) 12c HKk2 57
13-: Total credits (from page 2, Part V, line 4) 13
Your 142_Income tax (subtract Iine 13 from line 12c) 14a 7 7S
ETas; 14b_Tax from recomputing_prior year investment credit (attach statement) 14b
Credits, 15 Self-employment tax (Schedule C-3 or F-1) 15 8
and 16 Total tax (add lines 14a, 14b, and 15) 16 11Zi0
17 Total Federal income tax withheld (attach Forms W-2) 17 Lsk /ii/iiiiiiiiiiiiiiiiiiiiiiii [
ments 18 Excess FL.CA tax withheld (two or more employers- see page 5 of instr) 18
Mohey cheek or
pay-
19 Nonhighway Federal gasoline tax_Form 4136, Reg: Inv: ~Form 2439 19 able to Internal
6 20 1968 Estimated tax payments (include 1967 overpayment allowed as a credit) 20
Revenue Service:-
7iiiiiiiii/i/iiiiiiiiiiiiiiii 8
21 Total (add lines 17, 1819,and 20) 21 4
22 If payments_(line_21) are_less than tax (line 16) , enter Balance Due: Pay in full with this return 22 32 5 Balance
23 If payments_(line 22) are larger than tax (line 16),enter Overpayment 23
1
Due Or
24 Amount of Iine 23 you wish credited to 1969 Estimated Tax 24 Refund
25 Subtract line 24_from 23.Apply to: US Savings Bonds wilh exccss refunded or Retund only 25 L
Under ponollioe ot porjury, doclaro thot hove Oxamlned thlo return, Including accompanylng schadulos and statements_ and to tha best 0/ my knowledzo ond beliot truo, corroce,,nd complolo: It proparad by 0 poreon Olhor thon toxpoyor, doolaration ( baead on all Informatlon 0l which ho hot ony knowlodgo.
Sign
Yous , ulgnaturo Dato STgnoruro oi Droporot olhot tan taxpoyor DDow here
055.5J0 @ignoturo (fhiiing 1o1u7, Both TRud wigg ovon /f only ono had ncomo) "7Aduroao O8a-16"8Q1ba -)
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Page 163
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11 Exemptious Comulele &niy for dependents claimedon lige 31, page 1 Formi 1040--1968--72g0
(0) MAME (If more space Is needed attach schedule) (6) Relationship (c) Months lived in your' (d) Did depend- (e Amount YOU furnished Amount furnished
home. If born % died dur: ent have income for dependent' "Ruppoct; $ by OTHERS includ:
ing year Write "8" or "D" 0t {600 or More7 If1007 wiite Ing dependent
4 S S
2
3 Total number of dependents listed above: Enter here and on page 1, line 3b
Parowl Incomefrom sourcesother than wages,etc; [[Pa Itemized deductions_Use only if youdo notuse
tax table or standard deduction.
1a Gross dividends and other distrlbutions 0n stock (list payers Medical and dental expense (not compensated by Insurance Or
otherwise)__Attach itemized list. and amounts _write (H), (W), (0), for stock held by husband, wife, or
pgintly) 1 One-half of insurance premiums for medi:
QunZE R29. LK (144 cal care (but not more than $150)
Gebukn_ S2.32 7us3zy +LYA 2 Total cost of medicine and drugs
ZFlas 20 GSEZEluIZZZ 3 Enter 1% of line 9, page 1
DVerzHisIHelals QQ 4 Subtract line 3 from line 2 (not less than zero)
5 Other medical, dental expenses (include
balance of insurance premiums for medi: IIIZE
cal care not deductible on !ine 1)
Total .line Ja 6 Total (add lines 4 and 5)
1b Exclusion (see Instructlons).
loQ 7 Enter 3% of line 9, page 1
8 Subtract line" 7 from Iine 6 (not less than:zero)
Ic Capital gain distributions 9 Total (add lines 1 and 8)
(see page 5 of instructions).
Contributions:_ ~ Cash-~including checks, money orders, etc; Jd Nontaxable distributions
(see gage 5 0f instructions). (itemize)
10 Total (add lines Ib, Ic, and Id) CQ
1f Taxable dividends (line Ia less line 1e
not less thanzero)
62s
Interest (list payers and amounts below)
Earnings from savings and loan asSOC. and credit unions. 10 Total cash contributions
11 Other than cash (sea instructions for required
statement). Enter total of such items here
12 Carryover from prior years (s80 pago 7 ot Instr:)
13 Total contributions (add lines 10, 11,
Other interest (on bark deposits, bonds, refunds, etc;:- and 12--see instructions for Iimitation))
@vow #l_ Taxes:-_Real estate
State' and Iocal gasoline
General sales (see page 15 of instructions)
State and local income
2 Total Interest Income 1$ Personal property
3' Pensions and: annulties, rents and royalties,
nerships, estates or trusts, etc. (attach Sch: B)
14 Total taxes
4 Business Income or loss (attach Schedule C) Interest expense.-~Home Mortgage
5' Sale or exchange of property (attach Schedule D) Installment purchases
6 Farm income or loss (attach Schedule F Other (Itemize)
Miscellaneous income (state nature and source)
ALess .LY
Lles Sckl_ks
15 Total interest expense
7 Total miscellaneous Income 'ZS0 Miscellaneous deductions.-~(see page 8 of instructions)
8 TOTAL (add lines 1f, 2, 3, 4, 5, 6,and 7)
Enter here and on page 1, line 6 5KLi
PafE JL] Adjustments to income
16 ' Total miscellaneous
4 "Sick pay"' if included in line 5, page 1 (at:
tach Form 2440 or other requlred statement) 17 TOTAL DEDUCTIONS (add lines 9, 13, 14,
15,and 16) . Enter here and' on page 1, line Ila.
2 Mqving expenses (attach Form 3903)
3
Employee + 2 busfiesz 3 expenge U ((Gttach-Form @PartNVI Credits
2106"0r other statemient)
'ZL6o,82
1 Retirement income credit (Schedule B)
Payments by self-employed persons to_re: 2 Investment credit (Form 3468)
tlrement plans,etc: (attach Form 295OSE) 3 Foreign tax credit (Form 1116)
4 TOTAL CREDITS (for_ page 1, line 13) TOTAL ADJUSTMENTS (lines 1 through 4)'
Y3 EXPENSE AccouNTS _1 You had an expense alowanca or, charged Enter here and on page 1, Ilne 8 expenses t0 your employer' check here Dand se0 paBo 6 0{ Inetruotons
U.8. GOVERNMENT PRinting Cfic ieo0-200-Ooi 0-16-Hoiu|
Xn88326Docld;32245535-Pgge-163
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==================================================
Page 164
==================================================
PREPARED BY_
DATE_
CHECKED:
FOOTINGS BY_
Smue/ 1/;s
EXTENSIONS BY_
9*/ 9h42
seniOR_
{23 |,
Aal Ejbe a #ached vo lancl ma de ~ncli v dua /
ncne Ilak Foxl
locLo JSk}
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list Xpenjes ar= i0
connecton i+h
ny_Scheaz
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n margin Gccouh
J Ddnald
'13 i 071
EExltp
15.32
Poths bilcl
3884
Bache
2421
Tota/| Znterest
25458
JBaok_Reciadik_aud Szzuices
_13227
Auto
Mles ' Travelled
k6oo"
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Hs0a
Buslness
157o_Q
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9 6C0.
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PREPARED BY__
DATE
CHECKED:
FooTinGs BY
imue/ Hh;s
EXTENSIONS BY_
SENIOR_ 183.
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{Total {Intevet
35458
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Page 166
==================================================
SCHEDULE D Gains and Losses From Sales or Exchanges
(Form 1040)
U.S. Treasury Department
of Property 1968
Interna/ Revenue Servlce Attach this schedule to your:income tax return, Form' 1040
Name as shown On page 1 9f Form 1040 Social Security Number
SaueLE Phyllis_ 52 1LZZ92
Part I=CAPITAL ASSETS Short-term capital and losses-__ assets held not more than 6 months
c. How
ac - h Cost or other
0, Kind of prop: b_ Descriptlon quired. basis, cost of securitydicese (Examples; 100 sh. of Enter d_ Date Date sold Gross sales g. Depreciation subscquont improve- I Gain or losg
estate,
@; ther '2' Co., 2 story brick, letter acquired (mo., dey, yr ) prica allowed (or ments (if not plus loss' h) etc.) symbol (mo:, day, yr ) allowable) since purchased, attach 8 (Specify) (Seo acquisition explanation) and
instr.) expense of sale
p
ZHa] Lx_ 6 732.33
2 Enter your share of net short-term (or loss) from partnerships and fiduciaries
3 Enter unused short-term capital loss carryover from preceding taxable years (attach statement)
Net short-term (or loss) from lines 1, 2, and 3 6363
Long-term capital gains and losses assets held more than 6 months (12 months or more for certain livestock)
5 Enter galn trom Part Il, Iine 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 (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 tha net (or loss) here
30632
11 K line 10 shows a GAIN-_Enter 50% of Iine 9 or 50% of Iine 10, whichever is smaller. (Enter zero If there is & loss or no
on line 9.) (See reverse side tor computation ot alternative tax;)
12 Subtract line 11 from line 10. Enter here and in Part IV , Iine 1, on reverse side
563
13 It line 10 shows 8 LOSS~Enter here and in Part IV, line 1, the smallest of the following: (a) the amount on Iine 10; (b)
the amount on Form 1040, page 1, line 1lb, computed without regard to capital gains or 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 appeer, use the flrst heading for sectlon 1245 and the second heading for section 1250.
0. ' Kind ot property how acquired (Wt necessary_ attach statement 0. Cost or other basis, cost of
0f] descriptive . details not shown below -write i245 Or 12501 b Date acquired C Date sold d: Gross sales price subsequent improvements
to Indicate type of ass0t) (mo:, yr,) (mo., day, purchased, attach expla-
nation) and expense of sale
Deprecietion allowed (or allowablo) since acquisition Ordinary gain
1A1. Prior to January 1, 1962 +2. After Docem ber 31, 1961 g; Adjusted basis h; Total gain (desser 0f f*2 or h) L. Other galn OR OR (0 less sum of and (+2) (d less &) OR (h loss Prior to January 1, 1964 After Decem ber 31 , 1963 (see instructions)
2 Total ordinary galn. Enter here and In Part IV, Ilne 2, on reverse side
3 Total other gain: _ Enter here and In Part I, Ilne 5; however; if the gains do not exceed the losses when this amount Is
comblned with other galns and losses from section 1231 property enter the total of column in Part III, line 1
Nw88326. Dpc1A2246535 766
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gain
gain
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Page:
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Page 167
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U.S: Individua
U.S. Treasury Deg Rovanue Service
1961
1040_
Bmco m e Tax Retu g; I fo; the yotk January ~December 31, 1967,
1967, erding 19_
or other taxable year_beglnning 'nomo
Your goclal gecurity number
and Inltlal (It foint roturn, 4te fint nemes and middle Initials of both) Lost
Fint nario
8 Rb 322 zlzzzz
6
Samuel Phullis
Your
Homa addross (Numbor stroet Or rural toute) Engineer
6a3 N_Haynee
ZIp code Spoute' aociol securlty number
1 town or post offico, #ndState 34G 18Iy22_
Chica4o Minis
above, write_ 'Same ). If none filed, give reason. if changin? Spouse'$ occupation
Enter below nama /nd addres; used % your returs ter 1966 nimes mand addreyses_ Hous wwkz
Erote' separata M foini or joint {0 separate returns, enter 1966 names me
Youf present employer and address Stanley= WLev
ZhicyL Tinels
Spouse s prosent employer and address I Joint retbon
Your Exemptions Regular 65or Over Blind Enter
Your Filing Status-check only one: number 2a Yourselt of boxos
1a Single checked
return (even if only one had income) 2b Spouse
1b Married filing joint
filing Feturn, 3a First names %f dependent chlldren who Ilved with;
Ic L Married filing separately: If spouse is also a
youpde
enter her (his) social security numbar in provided atove you
Ess
P
L4
Enter ELis Zhames number
and give flrst name here 3b Number of other dependents (from paga 2, Part /, Ilne 3)
Id 0 Unmarried Head of Household
exemptions_clalmed
re
C Surviving widow(er) with dependent child 4 Total
explanation 5 72 6
salaries, tips, etc:
If not shown on attached Forms W-2 attach
36 Income 5 Wages, 6 3
0 Xf joint re: 6 Other income (from page 2,Part Il,_line 8) 4g % {uqinelude 1
all incoma Total (add lines 5 and 6) 8
of both 8
Adjustments to income (from page 2Part I Iine 5)
husband
9
Total income (subtract Jine 8 from line Z) 9
ard wife deductions and Iine 9 Is less than $5,000: tind your taxzfrom 10
Find tax 10 Ifyou do not itemize Do not use lines 1la, b,.C, or d. Enter tax on line 12.
3 from table tables in instructions:
0 OR- itemize deductions; enter total from page 2, FarbGolineoz
of: Ila If you dedecteonstaandiine g s 35,000 '%r more enter the targer
8 {iyoiodercent erize %e
OR
'52)3200 (Si00 if married and filing separate return) 1la
(1) DOupescodt 8f lfac/ exeoption ciaimed On jine Habovea
tion Lnde?raach @2)efmtted {a41,0o8 (6500 If married and filing separately) 0 Eiinge &x Deduction
11b 3, 2b
rata 11b Subtract line 1la from line 9
Ilc 3
Tak
schedules total number of exemptions on line 4,above_by 5600 1
Ilc Multiply
lic from line 1b_ Enter balance on this line: (Figure your tax on this
Ild Subtract line- tax rate schedule on page 11 of instructions ) Enter tax on Iine 12. Ild I4k
amount by using
Tax Table, see line 1O,_or Tax Rate Schedule_see lines lla-jid) 12
zzI
12 Tax (from either 13
13 Total credits (from page 2 Part V, line 4)
14a KK_ 63
14a Income tax (subtract line 13 from line 12)
Your
14b
Tax from recomputing prior year _investment credit (attach statement) 14b
15 Tax;
15
Self-employment tax (Schedule_C-3 or F_1) Rf8 16 Credits,
16 Total tax (add lines 1 42. 14b, and 15)
2 and
17
Total Federal income tax withheld (attach Forms W-2) 17 gHzlkq
Excess ELCA tax withheld (two or more employers_see page 5_of instr ) 18
18 8
ments
19
Nonhighway Federal gasoline tax_Form 4136,LReg Iv_Form 2439 19
1967 Estimated_tax_payments (include 1966 overpaymenf allowed 9s 9 credit_ 20
20 21 345 L6
21 Total (add lines 1Z,18 19,and 20)
ihis return 22 (line 21) are less_than _tax_(linc 16)._enter Balance_Due: in full with
22 If payments 23 : Balance
23
Wpayments (line 21)are larger than tax (line 16)enter Overpayment
8 Due or
24
Amount of line 23 You Wish credited to 1968 Estimated Tax 24
Refund line 24 from 23. Apply to: U.S, Savings Bondswith excess refunded or Refund only 25
25 Subtract schedules and ,tatemdntty Ind to tho best %/ my Anowledgo and bollet It b 1
Under penalties o porlury, 'declare thai heve exmlneganhL:,reyur; hlnclacdiratiocco@ Baseiran Echedudemaina,'Batements HRG 8n, 'Kovtodsa
truo, correce; and complote If prepared by person other than taxpayer, 2Etks
Itleli
Sign 6ui5 siznaturo &/ proparor olhucino5 taxpgvo;
72728
1
Your "Enoiure 24L
here jtgnatvrati iiinz jolnily, Bofh muof iionly 0n6 hoa "Tcomo)" Adareis 00-16"70896-}
Spouso
NVB8326 , Docld: 32245535 167
FfteptkInrgrnal
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1 and
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space
Pay-
Pay
24
TTen Oven
Page
==================================================
Page 168
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SCHEDULE: D Gains and Losses From Sales or Exchanges
(Form 1040) 0f Property
1967
0.S: Treasury Department
Internal Revenue Service Attach this schedule to your income tax return, Form 1040
Name and address 08 shown 1 of Form 1040
Sanyel
"Ei
61L23 KLL 418_Chic4gy_Tlline
3
Part IX CAPITAL ASSETS Short-term capital gains and losses_ assets held not more than 6 Months
C. Hom h_ Cost or other 0c - 0 Klnd 0f prop" b Descriptton quired. basis, cost of
orty_ Indicato (Examples:100 sh_ 0t Enter d. Date
0, Date sold Gross sales 8. Depreclation subsequent improve- Gain or loss security, real '3' Co., 2 story brlck, letter acquired (mo., day, yr ) price allowed (or ments (Il not plus g Iess h) Gtate or] otbcr symbol (mo-, allowable) sinco purchased_ attach
(Specify) Bt ) '(See acquisition 'explanation) and
Instr.) oxponse 0f salo
Atoc ZLS HC 2ZIEFZEkz13T5F2 442335 EKZ3U
etec EKe 1322-2 Z.1_62[z,_2eozs Z 2L 94_36
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)
Net short-term gain (or Icss) from lines 1, 2' and 3' 64L9
Long-term capital gains and losses_assets heid more than 6 months (12 months or more_for_certain livestock)
5 Enter gain from Part Jl, line 3
SSts_k HE#ESteeL | 4 261 fz6z [3344 '5s462 3ZZ7
Stesk S_6 IZS 8z3.47 37_ 4s"
Stak ~yitcs
Qaz
[-42 SXI.23 S 32.24 23%2
Total long-term gross sales price
6 Enter the full" amount of your share 0f 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 Capital gain dividends (see Form 1040 Instructions, page 6)
9 Net long-term- (or loss) from lines 5, 6, 7, and 8 4S3
10 Combine the amounts shown on lines 4 and 9, and enter the net gain (or: loss) here LES.4S2
11 It Iine,10 shows a CAIN__Enter 50% of Iine 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a loss Or no
on line' 9.) (See reverse, side tor computation of alternative tax:)
12 Subtract line 11 from line 10. Enter here and in Part IV; line ,1,' on reverse side
13 IK lina 10 shows a LOSS_Enter here ad in Part IV," Iine 1, the smallest' of the_ following: (a) the amount o Ilne 10; (b)
the amount on;page 1, line Ilb, Form 1040, computed without regard to capital gains and losses; or (c)-$l,O00 185.48
Part II-GAIN . FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250 _
assets held more than 6 months (see instructions tor definitions)
wnere double headings appear, use the first heading for section 1245 and the second heading for section 1250.
0. Kind of property and how acquired (if necessary_ attach statemont Cost or other basis, cost ot
of descriptive details not shown below write 1245
Or 1250 b; Date acquired. C. Date sold d. Gross gales price subsequent improvements (f
to Indicate type of asset) (ma;, day, yr ) (mo , day, yr ) purchased, attach expla- nation) and expense 0f sale
Depreciation allowed (or allowable) since acquisition
& Adjusted basis h_ Total
dlesgedinar2 &ik)
L. Other gain
1-1, Prior to January 1, 1962 +2. After December 31, 1961 (0 loss sum ol f-1 +-2) (d less g) OR (h less i)
OR OR - (see instructions)
Prior to January 1, 1964 After Decem ber 31, 1963
2 Total ordinary gain. Enter here and in Part IV, line 2, on reverse side
3 Total other Enter here and in Part |, line 5; however, if tho 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 in Part Ill, lina 1
16--79725-1
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Complote only for dopondonts clalmod on Ilno 3b, Page 1 Form 1040_1967-_Page 2
[Pazl Exemptions
Relationship (c) Months Ilvod in Your (d) Did depond- 78 Gogondanou Uppoched 81870138 {nciudav:
(0) MAME (moro JPuce,/s naeded altach Ichedule) (D)
home: born or died dur- ont kave income dependent s #Atprori 6Ocpenaelic'
Inz yoar write "D" or 0" 0i SSco or Morel If 10% wrlta Inz
S_-
1
2 listed above. Enter here and on page 1, line 3b
3 Total number of dependents
than
etc.[LEEZ }temized deductions_Use only If you do not uso
@azzbl Incomefrom sourcesother wages, tax tablo or Standard deduction:
dividends gnd other distributions o stock (list paycrs Mcdical and dcntal exponse (not compensated by Insuranco or
1a Gross (W) , (), for stock held by husband, wife, 'or otherwiso) Attach itemized list: and amounts ~write (H),
1
One-half (but not more than $150) of In:
jointly) SL (R surance premiums for medical care EZzEz
44_ Exzhz 2 Total cost of medicine and drugs
me 0 3 Enter 1% of Iine 9, page 1
4 Subtract line 3 from Iine 2 (not less than zero)
5 Other medical, dental expenses (include
balance of insurance premiums for medi:
cal care not deductible on line 1)
6 Total (add lines 4 and 5)
Total line 1a
[e od Enter 3% of line 9, page 1b Exclusion (see instructions).
8 Subtract Iine 7 from Iine 6 (not less than zero)
Jc Capital distributions 9 Total (add lines 1 and 8) 03
(see page 6 %f instructions).
Contributions: Cash ~including checks, money orders, etc_
1d Nontaxable distributions (itomize) ,
(sce page 6 of instructions) . 00 H
Je Total lines 1b, 1c, and 1d)
Zk 1f Taxable dividcnds (line la less Iine 1e - 136 2] 20_4Q
not less than zero)
Interest (list payers and amounts below)
Earnings from savings and Ioan assoc. and credit unions.
10 Total cash contributions
14 Other than (see instructions for required
statoment) . Enter total of such items here
12 Carryover from prior years (eo pago 8 & Inttz:)
(banks, bonds, tax refunds, etc ) 13 Total contributions (add lines 10, 11_
Other interest 48 ard 12_~see instructions for limitation) 00
AsKliat BanLe LincelnsieerL
Taxcs - Real estate
State and Iocal gasoline
Generalt tsaleg ?sea page 15 of Instructions) 42
income State and Iocal income
2 Total Interest
3 Pensions and annuitics, rents ad royaltics; part: Personal property 2510 nerships, estatos or trusts, etc (attach Sch; B) 14 Total taxes
Income or loss (attach Schedule C) Intcrcst oxponse:-~Home Mortgage
Business
5 Sale or exchange of property (attach Schodule D) LSE lOther (itemize)
6 Farm income or loss_(attach_Schedule_2 10 0 Id
Miscellaneous Income (state nature and source) Cs Ehling
37,0 Mss
15 Total Intercst oxpense_
ZIEE
miscellaneous Income Miscellaneous deductions - ~(see page 9 of Instructions) _
7 Total S 2.4 lq.s Ia9
8 TOTAL (add lines 1f, 2, 3,,4, 5, 6, and 7) 313
Enter here and on page 1, line 6
FPaIC' Adjustments to income 16 Total_ misccllaneous_ SZos
1 "Sick pay if includcd in line 5, page 1 (at 17 TOTAL DEDUCTIONS (add lines 9, 13, 14,
tech Form 2440 or othor roquired stotement) 15,and 16) . Enter hore and 0n page 1, Ilne Ila. Lbbs
2 Moving expenses (attach Form 3903)
3 Employee business expense (attach Form
1
Zretremercrecotre credit (Schedule 8)
2106 Or othor statement) 2 Investment credit (Form 3468)
Payments by self-employed persons to re:
3 Foreign tax credit (Form 1116)
tirement plans, etc (attach Form 2950SE)
TOTAL CREDITS_(for page 1, Ilne 13)
5 TOTAL ADJUSTMENTS (lines 1 through 4); EXPENSE" ACCOUNTS _If you hed an Oxponde allowanco or charged
Enter here and on page 1, Ilne 8 oxpensos to your employor' Check herg O nd 8oe Pege 7 0r Instructlong
#us.,GOVERNMENT PRINTING OFFICE : 167-0-290-0Q1 08-1o-70D1-1
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Reference copy , JFK Collection: BSCA (RG 233 )
JFE ASSASSINETION COLLECZZON
IDENTI?]CETION FOPM
EEnET: ISCA 73100
Iecord Number:
Record Series: NUNEERDD FILES
lgency File Nunber:
00
4976
jriEinator: eitizev
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To:
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Title:
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~eEes: |69
Subjects:
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Clagcizicotion: D C 3 ` T
Kestrictions: Upen Jy 1B 1C 3 4 5 D
Cuzrent Status- 0 P X
Date oi Lest Reviewz r93
(teniuE Criterie:
Coments:
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Box #: Folder Title:
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NW 88326 Docld:32245535 171
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Reference copY , JFK Collection: BSCA 233 )
INDIVIDUAL TAXABLE YEAR
REOIDENT
540
CALIFORNIA 1976
Wo
INCOME TAX
Lace PREADDRESSED LABEL HERE If avallable: (Correct name and address, if necessary) Check Calendar Year
nter social security_numberls) only if incorrect or not shown o label One: Fiscal Year Ending 1977
FoR PRIVAC Y NotifiCA TiON
NAME (If folnt return; givo frst name: and initials of both) LAST NAME SEE PAGE 2 OF |NStRuctions
You Social Security SpmueLsP#yUls Ruh
2
PRESENT HOME ADDRESS (Numbor and street, including cportment number, or route) Spuity
1L2S BuaHe ST
Yours City, TOWN Or Post Office, STATE AND Zip CODE Occu- HLLLS PaTiom Spouse' $ Gnanpp
Singd (Check Only One ) 6 Personal If line 1 or 3 checked, enter 525 00
2 Married joint return (even if oly one had income) If line 2, 4 or 5 checked, enter $50
Separate return of married person__Enter spouse'$
5
Bonodenf; the person who qualifies you as head of household
social security number ad full name here LLSA
]
Head of Household -Enter name of qualifying
[ THama
Total Number @ 2X $8 0 00
individual_ 8 Blind (see instructions) Number of blind exemptions X $8 8 00
5 Widowler) with dependent child (Year spouse died 197_) 9 Total exemption credits (add Iines 6, 7 ad 8) Enter here ad on line 20 9 00
Attach copy 2 of Form(s) w-2 to face of this 10
10 Wages, salaries, tips and other employee compensation
return If unavailable, see instructions, Page 10
11 Dividends_before federal exclusion. Enter total (if over S400, complete and attach Schedule B(540) ) 11
12 Interest: Enter total (if over S400, complete and attach Schedule B(540) ) 12 5
13 S
13 Income other than wages, dividends and interest (from line 48) 0
14 Total (add lines 10, 11, 12 and 13) 14 27Ls
15 { 15 Adjustments to income (from line 55)
16 Adjusted gross income (subtract line 15 from line 14) 16 22YLL
!
If
do NOT itemize deductions AND line 16 is under $15,000, find tax in Tax Table ad enter '0n line 19.
5 You
4
If you itemize deductions OR line 16 is 515,000 or more, complete Iines 17 and 18.
17 Deductions: Itemized (from line 63 ) OR STANDARD ($1,000 if Iine 1 or 3 checked_$2,000 if line 2, 4 or 5 checked) 17
Sbxl
3
18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule_Enter_tax on line 19 18 2SS
1
19 Tax from (check one) Tax Table Tax Rate Schedule Income Averaging Schedule (G o G-l 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 Iine 68-Including Specia/ Low Income Tax Credit) 22
23
Net tax liability (subtract Iine 22 from line 21-if line '22 is greater than line 21, enter zero) 23
24 Olher taxes (from line 71 ) 24
25 Total tax liability (add lines 23 and 24) 25
26 Total California income withheld (attach W-2 or WZP to face of this return) 26
0
27 Renter' $ credit_if you lived in rented property o March 1,1976, complete Part 1 on page 2 27
28 1976 California estimated tax payments 28 1
29 Excess California SDI tax withhold (see instructions) 29
30 Total Credits _ 30
1
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 PAY In FULL ~ > 031
1
SACRAMENTO, CA 95867 Do not write in these spaces
32 If line 25 is smaller than line 30, enter amount OVERPAID 32 P
6
33 Amount of line 32 to be REFUNDED TO YQU: Allow at least six weeks
1 Mail return to: FRANCHISE TAX BOARD 33
P.O_ BOX 13-540
8 SACRAMENTO, CA 95813
1
34 Amount of line '32 to be credited o your 1977 ESTIMATED TAX 34
you do NOT want State income tax forms and instructions mailed to You next year, check here See Instructions, Pa ge 9 L
Under penalties of perjury, declare that have examined this return, including accompanying schedules and statements_ and to the best of my knowledge
and belief it is true, correct, and complete_ Declaration of preparer (other than taxpayer) is based o a/l information of which preparer has any knowledge
{
9
SIGN
Your sionature Date Preparer'$signaturt Lather_athan Date
NTv 88326 Docld:32245535 Page 172
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Fenzf} ipr
Reference copY , JFK Collection: BSCA 233 )
2-Form 540.41.976)
PART | G Renter's Credit AIl questions must be answered
35 Did you, on March 1 , 1976, live in rented property which was your principa residence? Yes {4o If no, you may not claim this credit
36 Was the property you rented exempt from property tax? Yes No If yes, you may not claim this credit
37 Did you live with ay other person who claimed you 85 a dependent for income purposes? Yes 0 No If yes, you may not claim this credit
38 Did or your spouse claim the homeowners property tax exemption 0 receive public assistance? Yes 0 No If yes , see page 3 of instructions
PART |i Olher Income
39 Business income (or loss) (atach Schedule Cq5401) 39 36
40 Net gain (or loss) from sale cr exchange of capital assets (attach Schedule D{540)) 40 k_Looe
41 Net gain (or Ioss) supplemental schedule of gains and losses (attach Schedule D-1(540)) 41
42 Pensions and annuities 42'
43 Rents and royalties ATTACH 43
SCHEDULE E 44 44 Partnerships Form (540)
45 Estates and trusts 45
46 Farm income (or loss) (attach Schedule F(540)) 46
47 Miscellaneous income
(a) Fully taxable pensions and annuities (not reported o Schedule E(540)) 47a
(b) Alimony 47b
(c) Other (state nature and source) Alc
Enter total of lines 47(a), 47(b), and 47(c) 47
48 Tota/ (add lines 39 thru 47). Enter here and on Iine 13. 48
246
PART IlI 5 Adjustments to Income
49 "Sick pay, if included in line 10 (see instructions attach Form FTB 3805T) 49
50 Mving expenses (see instructions attach Form FTB 3805U) 50
51 Employee business expenses (See instructions attach Form FTB 3805N) 51
52 Milf exclusion (see instructions 52
53(a) Payments to an individua retirement arrangement (attach FTB 3805P) 53a
(b) Payments to a Keogh (H.R. 10} retirement plan 53b
(c) Payments to a self-employed Defined Benefit Plan" 53c
Enter total of ines 53(a) , 53(b), and 53(c) 53
54 Forfeited interest penalty (see instructions} 54
55 Total adjustments (add lines 49 thru 54). Enter here and 0n Iine 15 55
PART IV Itemized Deductions
Attach Schedule A(540) and enter sub-totals on lines 56 thru 62, below
56 Tota| deductible medical and denta| expenses (from Schedule A(540), line 10) 56
4.4
57 Tota/ taxes (from Schedule A(540), line 17) 57 L2X
58 Total interest expense (from Schedule A(540), line 20) 58
59 Total contributions (from Schedule A(540), line 24) 59
60 Total casualty loss (from Schedule A(540) , line 29) 60
61 Tota/ miscellaneous deductions (from Schedule A(540), line 33) 61
62 Tota| child care and adoption expenses (from Schedule A(540) , line 37) 62
63 Total itemized deductions (add lines 56 thru 62). Enter here and on line 17 63 Ss6
PART V 4 Other Credits SEE INSTRUCTIONS FOR EACH CREDiT CLAIMEO BELOW
64 Other State" net income tax credit (attach copy of other state return and Schedule S(540)) _ 64
65 Retirement income credit (attach Schedule R(540)) 65
66 Special low income tax credit (see special instructions) 66
67 Solar energy tax credit (see specia/ instructions) 67
68 TOTAL (add lines 64 thru 67). Enter here and o line 22 68
PART VI Other Taxes
69 Tax 0n preference income (see instructions attach Schedule P(540) 69
70 Tax on premature distributions from attached Form FTB 3805P 70
71 Total (add lines 69 and 70) enter here and on line 24 71
PART Vii Reconciliation to Federa Return If adjusted gross income o Federal Return is different from line 16, page 1, explain below.
NW 88326 Docld:32245535 Page 173
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Reference copY , JFK Collection: BSCA (RG 233 )
sChedujE TAXABLE CALIFORMIA
1976
ITEMIZED DEDUCTIONS
Form 540 YEAR
Attach to Form 540
Name @} shown on Form 540 Soclal Socurlty Numbor
S+l Ryb 2/016 &1
USE Only If You 0o Not 'Use The TaX TaBLe Or Take The STANDARD deduction
Madlcel and dental expanses (not compensated by Insurance or otherwise) tor Contributions
mediclne and doctors, dentists, nurses, 21(a). Cash contributions for which you have receipts,
hospital care; Insurance premiums for medical
canceled checks, etc_
care, etc.
(b): Other cash contributions_ List donees and
amounts 1_ One half (but not More than S150) of Insurance
premiums tor 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 22. Other than cash See instructions for required state:
than zero, enter zero) ment
5. Enter balance of insurance premiums for medical care 23. Carryover from 1974 & subsequent years See
not entered on line 1 instructions
6. Other medical and dental expenses: 24, Total _ (Add lines Zla thru 23_ Maximum de:
(a) Doctors, dentists, nurses, etc duction may not exceed 20% of adjusted gross
(b) Hospitals income_ Enter here ad 0n Form 540, line 59)
Iou
(c) Other (itemize)
Casualty or Theft Loss(es)
NOTE: If you had more than oe loss, Omit lines 25
through 28-See instructions for guidance
25 . Loss before insurance reimbursement
26 . Insurance reimbursement
7 Total_ {Add lines 4, 5, 6a, b, and c)
27 . Subtract line 26 from line 25, Enter difference
8. Enter 3% of line 16, Form 540
(If less than zero, enter zero)
9. Subtract line 8 from line 7_ Enter difference (if less 28. Enter SIO0 or amount on line 27, whichever is
than zero, enter zero)
smaller
10. Total_(Add lines 1 and 9 Enter here and on Form 1q
29_ Casualty or theft loss (subtract line 28 from
540, line 56) _
line 27._ Enter here and on Form 540, line 60)
Taxes
Miscellaneous Deductions
1I. Auto license_Excess of registration &d weight fees
(see instructions)_ 30 , Alimony paid to:
12. Real estate _ 31 _ Employment Education Expense:
13. State ad local gasoline _ 32 . Union dues
14. General Sales Other (itemize)
15. Personal property (Boat and Aircraft_
16. Other (itemize) .
33 . Total (Add lines 30 through 32_ Enter here and
on Form 540, Iine 61 )
17. Total tares Add lines 1l thru 16. Enter here and
on Form 540, line 57) Child Care and Adoption Expense
34 . Child care expenses Attach Form 3805X
Interest Expense
35 . Tota | adoption expense 18. Home mortgage
19. Less 3% of line 16, Form 540 _ Other (itemize)
36 , Net adoption expenses _ See instructions
for maximum limitations
37 . Total child care and adoption expenses
(add lines 34 and 36. Enter here and 0n
20. Total_(Add lines 18 and 19. Enter here and on
Form 540, line 62). Form 540, line 58)
NW 88326 Docld:32245535 Page 174
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Reference copY , JFK Collection: ASCA 233 )
SCHEDLLE TAXABLE CALIFORMIA
197.6
DiVIdend AND INTEREST INCOME
Form 340 YEAR
Attach to Form 540
lame as shown on Form 540 Soclel Securlty_Number
SeLP_ Rubs
PART I~~Dividend INCOME 3
elne 1_Gross Divldonds and Other Distributions on tions) , less nontaxable portion, if on Form 540, page 1 _
Jock If gross dividends and other distributions (including capital Do NOT deduct the $100 federal exclusion.
"Capital dividends" are treated as ordinary dividends for
ain dividends) on stock were SBoo or]10ss, do not complete State income tax purposes and not as capital gains as permitted
is part; but enter gross dividends (including capital distribu- under the federal law.
Gross dividends ad other distributions o stock_-List payers ad amounts__Write (H), (W}, (J), for stock held by husband, wife, jointly:
Total dividends
Nontaxable distributions
Taxable dividends _ Subtract line 3 from line 2 Enter here and on line 11, form 540
PART 8I-JINTEREST INCOME
Interest on bonds, debentures, loans, notes, tax refunds and all (b) Bonds (but not other obligations) of California and its
'pes of savings accounts including banks credit unions and postal ical subdivisions issued after November 4, 1902.
is taxable: (c) Interest on bonds of Alaska and Hawaii issued 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 Note: If total taxable interest income was S400 or loss, do
the United States. (Interest on Philippine Islands obligations not complete this part; but enter the total amount of interest
issued on or after March 24, 1934 is not exempt ) received on Form 540, page 1
Interest income List payers and amounts_
NoZa_ON Weenk&y RLIED 4
IIEC
IRINS _u
WOZI
Totel Interest Income. Enter here and on Ilne 12, Form 540 5135
NW 88326 Docld: 32245535 Page 175
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gain
Polit-
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24 Reference copY , JFK Collection: BSCA 233 )
TAXABLE
SCHEDULE
CALIFORMIA
1922
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
FoRM 540 (Solo Propriotorshlps)
Partnershlps, vonturod, Ote, mubt alo 0n Form 563
tach Iats schedulo to Incomo tax rotorn; Form 940 or S4ONR
Soclal Securlty Numbe
me &s shown 0n Form 540 or 5ll "EQXyby
B Federal Employer I.0. No.
Name and Address of Business
JobLty
'BsIEo_CAFzz_ShbE lssUullznBnd Znandp 9SZers
retail-hardware; wholesale-tobacco; services-legal; etc)_Sz @LLEE S1es_h Kets
Principal business activity (i.e,
Indicate method of accounting: D cash; ~ccnual; other_
Were Forms 591, 592, 596 ad 599, fr the_calendar year filed (f required)? YES No
Method of inventory valuation CAst
valuations between the opening a closing inventories? Was there any substantial change in the manner of determining quantities, costs, or
YES NO If , "Yes;" attach explanation.
Balance
1 Gross receipts, sales, or fees $_ Less returns and allowances
2 Inventory at beginning of year (if different from last closing inventory, attach explanation) _
3 Purchases $_ Less cost of items withdrawn for personal use
4
Cost of labor (do not include salary to yourself) .
5 Materials and supplles .
6 Other costs (explain in Schedule C-2 or attach Schedule)_
7 Total of lines 2 *ru 6
8 Inventory at end of this year
9 Cost of goods sold (subtract line 8 from line 7)_
0 Gross profit (subtract Iine 9 from line 1).
Other income (attach schedule) _
2 Total Income (add lines 10 ad 11).
OTHER BUSINESS DEDUCTIONS
3 Depreciation (explain in Schedule €-1 or attach Schedule) _
4
Taxes on business and business property (explain in Schedule €-2 or attach Schedule)
15 Rent on business property _
'6 Repairs (explain in Schedule C-2 or attach Schedule)_
17 Salaries &nd wages not included on line 4 (exclude any to yoursein _
18 Insurance
19 Legal &d prolessional fees.
70 Commissions
21 Amortization (attach statement _
22 Retirement plans, etc. (other than your share, see instructions) _
33 Interest on business indebtedness .
24 Bad debts arising from sales or services (Not applicable if reporting 0 casi, batis) .
25 Depletion (attach schedule)_
26 Other business expenses (explain in Schedule C-2 or attach Schedule)
27 Total of Iines 13 thn 26
28 Net profit (or loss) (subtract line 27 from line 12), Enter here and o Page 2, Form 540 or 540NR
Depreciation Method of Life or Depreciation
Group and guideline class Date Cost or allowed (or allowable) computing Rate for this year
5 or description of property Acquired other basis in prior years depreciation
3 1 U
8
]
LINE AMOUNt LInE] EXPLANATION Amount
EXPLANATION NO: @ No:
83
1
l
1
6
NW-88326Boeld-245535-Page-176
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Reference copY , JFK Collection: BSCA (RG 233 )
SCHEDILE
CALIFORMIA
TAXABLE
0
1976
FoRm 540
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 jewolry.
Nome as shown on Form 540 or 54ONR STStunlty Fumky
Rub Si ZRL
Part I-Assofe Kold Ona Year Or Less
Cost ouor Beb V Ujusted, Cott]0i(ublr Kind of property and descriptlon 6 Date acquired Dete sald 4 Grots sles qujnt imarorbmu (m Galn & lots
(Exmple, 1CO thare o 'Z" Co. (mo., Yr.) (mo., dby, Yr. ) prict not durtrie] mteh (0, Iem 4 aplenatIon) ud 0' Dtntt at 4lo
23 Enter (or loss), if applicoble, 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 IL_Assots Held More Than One Yoar But Not Moro Than Fivo Years
5_
tnabaum
3
6_ Enter (or loss), if applicable, from line 19, Schedule D-1 (540) (attach copy)
7 . Enter share of net' gain or loss from partnerships and fiduciaries
8. Net gain or loss, combine linos 5, 6 and 7 (If gain, see 540 instructions, Iine 2 4a (Preference Income)) 53S$
Qart Wii~A88ots Keld Moro Than Flve Yoars
10. Enter gain (or loss), if applicable, from line 21, Schedule D-1 (540) (atach copy)
11. Enter your share of net or loss from partnerships and fiduciaries
12. Net Or loss, combine lines 9, 10 and 11 (If ga in, see 540 instructios, line 24a (Preference Income))
PARL_IV_Summary %f Capltal Gains ond Losses
13. Enter amountfrom line 4
14. Enter 65% of the amount on line 8
15. Entor 50% of the amount on line 12
16. Enter unused capital loss carryover from preceding taxable
,loZ Giach computation)
17. Combine the amounts shown on lines 13, 14, 15 and 16
[lszL)
18. If line 17 shows & galn, enter here and On Page 2, Part Il of Form 540 or 54ONR
19. If line. 17 shows a loss, enter here and on page 2, Part Il of Form 540
Or 54ONR the smallast of:
(a) amount on lines 17;
(6) the taxable income.for the taxable year (computed without regard to gains or logses from sale or exchange
of capital assets; or
(c) S1,000 (S500 in Ihe case of a husband or wife a separate return) Lopo
NW 88326 Docld:32245535 Page T77
duy .
gain
gain
Your
gain
gain
filing
==================================================
Page 178
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Reference copY , JFK Collection: BSCA (R 233 )
RESIDENT INDIVIDUAL'
TAXABLE YEAR 540 CALIFORNIA
1915
InCOME TAX
PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) Check {Calendar Year Enter social security number(s) only i incorrect 0r not shown un label One: [7 Fiscal Year Ending 1976
NAME (lf joint return, give first nd initiols o/ both) LAST NAME FOR FEDERAL PRIVACY Act NOtifi- '2o
CATion SEE PAGE 2 0F inStRUCtionS A NAEL Ruey
Ygur_Socjal Security.Nunt
PRESENT HOME ADDRESS (Number ond including oporimenf numbor 3Tural routo) 451
Spoust Social Securily Number
City, TOWN OR
L62$o
PoST OfFIcE, STATE AND Zip Cop
R 3 Ra_
Yours Occu- ERANA L KLLS (y
PATion Spouse $
9
FILING STATUS Check One: EXEMPTION CREDITS
If line 1 or 3 checked, enter $25 Single
6 Personal If line 2, 0r 5 checked, entcr 550 sol 00
2 Married filing joint return (even i only one had income) Dependents Do not Iist yourself, yqui spousc 0i Ihe person who qualifies You
3 0 Separate return of martied person- Enter spouse'$ a5 head of household. Enter name ad relationship
social security nmher an {ull name here
THQ
SAJ
Head 0/ Household Enter imc !i qualifying Iolal Numhier 00 X S8 individual.
8 Blind (refer to instructions) Number 0f blind exemplions X 58 8 00
5 Widowler) with dependent child (Year spouse died 197_ 9 Total exemption credits (add lines 6 1 and 8) Enter here and on line 20 9
10 Wages, salaries, tips and other employee compensation Attach copy 2 of Formis) W-? to lace 0f this return_ 1/ unavailable , see mnstructions, Page 10
11 Dividends_before federal exclusion. Enter total (if over $400, complete and altach Schedule B(540) ) Ml
12 Interest: Enler total (if over $400, complete and attach Schedule B(540) 12
13 Income other than wages, dividends ad interest (from line 48) @
14 Total (add lines 10, 11, 12 ad 13)
13
574
14 8
~ 15 Adjustments to income (from line 55)
15
16 Adjusted gross income (subtract line 15 from line 14) 2
If line Or 3 is checked and line 16 is $4,000 or less, enter zcro tax on line 23. Do not complete
6 If linc 2, 1 , 0i 5 is checked Jlic linc 16 is $8,000 or less, entcr xeto tax on lina 23. lines 11 thru 22
&akY
16
you do NOT itemize deductions AND Iine 16 is under 515,000, find tar in Tax Table and enter on line 19. 3
you itemize deductions OR line 16 is $15,000 or more, complete lines 17 and 18.
17 Deductions: Itemized (Otum 62} OR STANDARD ($1,000 if line 1 or 3 checked _$2,000 illine 2 , 4 0/ 5 checked) 17
523
1
18 Taxable income (subtract line 17 from line 16) Compute tax Ixm Tax Rate Schedule_Enter 0n line 19 18 32471
19 Tax from (check one) Tax Table 0 Tax Rate Scheddte Income Averaging Schedule (G or G-1) 19
20 Total exemption credits (from line 9, above) 20 21 Tar liability (subtract line 20 line 19_if line 20 is greater than line 19, enter zero) 21
22 Other credits (from line 65)
22
23 Net tax liability (subtract line 22 {rom line 21-_if line 22 is greater than 'ine 21,
enter zero) 23 24 Tax 0n preference income (see instructions
S= attach Schedule P(540) ) 1
25 Total tax liability (add lines 23 ad 24) 24
25
26 Total California income tax withheld (attach W-2 or W-ZP to face of this return) 26
1
27 Renter's credit_if you lived in rented property on March 1, 1975, complete Part 1 on page 2 27
28 1975 California estimated tar payments 28 3
29 Excess California SDI tax withheld (altach Form DE 1964 to face of this return) 29
30 Total prepayment credits (add lines 26 Ihtu 29) W
31 If line 25 is {arger Ihan line 30, enter BALANCE DUE: If it is equal to line 30, enter
30
Zero_ 2 3 in full a mail with return to: FRANCHISE TAX BOARD
SACRAMENTO, CA 95867 PAY in FULL 31
5
1
32 If line 25 is smaller than line 30, enter amount OVERPAiD Do not write in (hese Spaces
5 33 Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks_ 32
P 2
Mail return to: FRANCHISE TaX BOARD E 1
P.O. BOX 13-540 33
1 SACRAMENTO, CA 95813 M
A 0 34 Amount o/_line 32 ( be credited un your 1976 ESTIMATLD TAX 34 ESTIMATED TaX R
Under penalties of perjury , declare thot hove exomined this return, including
belief i is true, correct ond complete. If prepored by other
occomponying schedules and statements, and to Ihe best of my knowledge ond { person than ayer, his declaration is based on oll information of which he hos any knowledje
j SIGN
You signature Date Preparer" sipnature (other than taxpayer ) Date
NW 88826
KERE a:s2zasjsg"PagemTo6="
rclurn Date A[
"YrYLLs
72ikc+E
Only
Imn
tax
from
Pay
taxp
==================================================
Page 179
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Reference copy , JFK Collection: BSCA (RG 233 )
SCHEDULE TAXABLE
A
CALIFORNHA
1975
ITEMIZED DEDUCTIONS
YEAR FoRM 540 Attach to Form 540
Soclal Security Number Name as on Form 540 LYLLLS
Ruey
If your adjusted gross Income is $8,000 or less and your status Is Mar ried , Flling Jointly,' 'Head o Household," or "Widowler) With Dependent Chlld;
or]$4,000 or) less and Your status Is)"Single,' O[ "Married, Flling Separately,' do not Itemize, enter zero 0n Form 540, line 23, and check te 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 Interest Expense
medicine and drugs, doctors, dentists, nurses, 21. Homne mortgage hospital care insurance premiums for medical
care, etc_ 22. Other (itemize) _
1_ One half (but not more than 5150) of insurance
Sct
premiums for medical care
2 Medicine and drugs
3. Enter 1 % 0 Iine 16, Form 540 23 . Total-(Add lmes '1 and 22. Enter here and On
4 Subtract line 3 from line 2_ Enter difference (if less Form 540, line 59) 280
than zero, enter zero)
5, Enter balancc 0( insurance pIcmiums (or medical care
not entered on line 1 Contributions
6. Other medical ad dental expenses: 24, Cash contributions tor which YOU have receipts,
(a) Doctors, dentists, nurses, etc canceled checks, etc.
(b) Hospitals 25. Other cash contributions. List donees and amounts
(c) Other (itemize}.
LX
26 . Other than cash -~See instructions for required state:
7_ Total- (Add lines 4 5 6a, b, and c) mcnt
8. Enter 3% of line 16, Form 540 27. Carryover from 1974_See instructions
9. Subtract line 8 from line 7 Enter difference (if less 28 . Total__(Add lines 24, 25, 26, and 27. Maximum de:
than zero, enter zero) duction may not exceed 20% 0f adjusted gross
L0
10. Total_ (Add lines 1 and 9. Enter here and, on Form income_ Enter here and 0 Form 540, line 60)
540, line 56)_
Miscellaneous Deductions
Casualty or Thelt Lossles)_ See Instruclions Child Adoption Expense
11. Total expenses paid or incurred_Attach itemized list NOTE: If You had More than one loss, omit lines 29
12. Enter 3% of line 16, Form 540
through 33 ad follow instructions for guidance:
13. Subtract line 12 from line 11-See instructions for 29. Loss before insurance reimbursement
maximum limitations. (Enter here and on Form 540, 30 . Insurance reimbursement
line 57) . 31. Subttact line 30 line 29. Enter difterence (if line
30 is greater than line 29, cnler zeto)
Taxes 32. Enter $100 or amount on Iine 31, whichever is smaller
14. Real estate 33. Casualty or theft loss (line 31 less Iine 32)_
15. State ad Iocal gasoline . 34. Alimony paid _
16. 'General Sales 35. Child care_See instructions
17. Auto license_Excess of registration and weight fees 36 , Uaion dues
(see instructions)_ 37 . Employment educatlon expense _See instructions _
18, Personal property (Boat and Aircraft _ 38 . Other__(itemize)
19. Other (itemize}.
39. Total_Add lines 33, 34, 35, 36, 37, and 38. (Enter
20. Total taxes_(Add lines 14 thru 19. Enter here and 122
here and on Form 540, line 61) _
NW
8832forp328ali32785535' Page 179
shw3?AsEL
fillnz
fllng
Irom
==================================================
Page 180
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Reference copY , JFK Collection: ESCA (RG 233 )
SCHEDULE TAXABLE
6
CALIFORNIA
19
form 540
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
(Solo Proprlotorshlps)
Attach tat echodulo to your Iacomo tar roty@, Rerm 80 Or MAONR Pertorealest bolet voatures, 0t2, must @lo 00 form 8Ns
Name &5 shown on Form 540 or 540NR Soclal Security Number
SMELY
A_ Name and Address of Business B: Federal Employer I,D. No.
C. Principal
W2ZEZZUZAA
business activity (i.e;, retail-hardware; wholesale-tobacco;
@EEee
services_legal; etc)
ZERVICE
~irz42
D. Indicate method of accounting: cash; Kaccrual; Q other.
E Were Forms 591, 592, 596 ad 599, for the calendar_yeer: filed (if required)? YES NO C
Fa Method of Inventory valuation LS
Was there ay substantial change in the manner of determining quantities, costs, or valuations between the opening and closing Inventories?
YES NO If "Yes_ attach explanation.
Gross recelpts, sales, or fees Less returns and allowances Balance
2 Inventory at beginning of year (if dilerent from last year's closing inventory, attach explanation) _
3 Purchases $ Less cost 0f items withdrawn Ior personal use 9
Cost of labor (do not include salary paid to yoursell)
5 Materials and supplies
6 Other costs (explain in Schedule C2 or attach Schedule).
Total ot Ilnes 2 t 6
8 Inventory at end of this year
9 Cost of goods sold (subtract Iine 8 from line 7) .
10 Gross prolit (subtract Iine 9 from line 1)
11 Other income (attach schedule)_
12 Total Income (add lines 10 and 11)
OThER BUSiness DeoUcTIons
13 Depreciation (explain in Schedule C-1 or attach Schedule)
14 Taxes o business and business property (explain in Schedule C.2 or attach Schedule)_
15 Rent on business property
16 Repairs (explain in Schedule € ? o attach Schedule)
17 Salaries ad wages not included o 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 o cash basis) .
25 Depletion (attach schedule)
26 Other business expenses (explain in Schedule C-2 or attach Schedule)
27 Total of Ilnes 13 thru 26_
28 Net profit (or loss} (subtract Iine 27 from line 121, Enter here and on Page 2, Form 540 or 540NR
Sck
252
Group and guideline class Date Cost or Depreciation Method of life or Depreciation
2 or description of property Acquired other basis allowed (or allowable) computing Rate for this year in prior years depreciatlon
3 4 U
5
]
LInE EXPLANATiON AmouNt LINE EXPLANATION Amount 1 NO. No_
3
1
y
:
6
NVT 88326 745535 Page 780
YhyLkls Ruey
Stec
==================================================
Page 181
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Reference copY , JFK Collection: BSCA 233 )
SCHEDULE
CALIFORMIA
TAXABLE
0 1915
FoRM 540
CAPITAL GAINS AND LOSSES
YEAR
Attach to Form 540 r S40hr
Use this schedule to report gains and losses on stocks, bonds and similar investmonts,
and gains (but not losses) on personal assets such Os a home or lewelcy:
Name as shown on Form 540 or 54ONR shai Scurlyy NumBt
EMMEL HYLLL
Tuy
PART 1-_Assots Held Ono Year Or Loss
Cott Or other bah
edlusted_ com 0f subit_
Kind 0/ property and descriplion Dale acquired Dale tld d. Grous sales quent impronemants (It Galn o 1osg
(Examplt, 100 shaes 0( 2' Co. Mo. day, Yr.) (mo., day, Yr.) price Not Durchased , atlech (d. Ieus &.)
eplgna( lon) and
penge 0i elo
1924_Loss
We0 /92Y 10r1
2 Entor (or loss), i applicable , Itom line 18 , Schedule D-1 (540) (attach copy)
3. Enter Your share of net gain or loss from partnerships and fiduciaries
4 or loss, combine lines 1, 2 and 3
ParT II_Assets Hold More Than One Year But Not More Than Flve_Years
53
6 Enfer (or loss), if applicable, from line 20 , Schedule D-1 (540) (attach copy)
Kiot
7 . Enter your share of nel gain or loss from partnerships and fiduciaries
8, Net gain or loss, combine lines 5, 6 and 7 T7
PART III_Assets Hold More Than Flive Years
10. Enter (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)
M1_ Enter share of net or loss from partnerships and fiduciaries
12. Net gain or loss, combine lines 9, 10 and 11
PART IV__Summary ef Capital Gains and Losses
13. Enter amount from line 4
14. Enter 65% of the amount on line 8
3372
15. Enter 50% of the amount on line 12
16. Enter unused capital loss carryover Irom preceding taxable Years (attach compuiation)
6136e
17 . Combine the amounts shown on lines 13, 14, 15 and 16
lL2xx^
18. If line 17 shows 0 gain, enter here and on page 2, Part |l of Form 540 or 54ONR
19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or S4ONR the smallest of:
(a) amount on lines 17;
(b) the taxable income for the taxoble year (computed without regard to gains or losses from sale or exchange
of capital assets; or
K(1ovp
NW 88326 Dbena.32205533hPage' 1817 hushand nr wife filino sanarote ramn)
(RG
&o,3 Gasyer
gain
Net gain
gain
gain
gain Your
==================================================
Page 182
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Reference copY , JFK Collection: BSCA (RG 233 )
SCHEDULE TAXABLE
D-1
CALIFORMA
1925
SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
YEAR Form 540 (Sales o Exchanges Including Involuntary Conversions)
(Attach to Form 540, 540NR, 541 or 5651
Identifying number 4 thown On relurn Name as shown on Tax Return
SAMue!
[eylLuS
0
PART M Gain From Disposition of Property Under Soctlons 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 Ihis form is filed_by a partnership:
Date acquired Date sold Description of Sections 18211, 18212-1 8, 18219, and 18220 property (Mo., Yt. ) (Mo., day, Yt_ CFEEET7EO 4173.Y 977
'B)
{9
Correlate lines I(A) through 1(D} with Ihese columns Property Property Property Propetty
(A) (B) (C) (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 goin, subtroct_line 5 from line 2
7_ If Section 182 11 property:
(a) Depreciation allowed (or allowable) ofter applicable date
(See Instruction D-3)
(b) line 6 or line 7(a), whichever is smaller
8 If Section 18212-18 property:
(a) Enter additional eciation 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 B(c) times applicable percentage (Instruction D-4)
(e) Enter cxcess, if any, of line 6 over line 8(6)
(f) Enter line 8(a) or line 8(e), whichever is smaller
(g) Line 8(f) times applicoble percentage (Instruction D-4)
(h) Add line 8(d) and line: 8(@)
9 If Section 18220 property:
(a) If farm land, enlei soil and walcr conservation expenses
for current Year and (our preceding years
(b) If farm property, other than land, subtract line 7(b) from
line 6; OR, if farm land, enter line 6 or Iine %a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see Instruction D-5)
(d) Enter line %(b) or line %(c) whichever is smaller
10. If Section 18219 property:
(0) 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 of line IO(a) over 10(b)
(d) Line IO(c) times applicable percentage (Instruclion 0-5)
(e) Line 6 less line 10(b)
(F) Enter smaller of line IOd) Or line 1O(e)
SUMMARY OF PART (Complete Property Column_(A)through (D) UP te Line_TO(H) before_going fo LIno
11. Enter omounts from line 6
12. Enter amounts from lines 7(6), 8(h), %(d) and 10(f)
3
13. Subtract line 12 from line 11, enter here and in appropriate
Section in Part II (see Instruction D-2)
LS1s
14 Total of Preperty Columns (A) through (D), 12. Enter here and on line 24, Par III 2313.
NW-88326-Docld:32245535-Page 182
Ruey
~day,
"IThe;
SALA
depi
any,
line
==================================================
Page 183
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Reference copY , JFK Collection: ESCA (RG 233 )
NAME
SAMuel LltyLLI_AKe
CALENDAA YEAR 19
2J
JADDRESS SOC. SEC NO
DEDUCTIoN SCHEDULE
STATE FEOERAL CONTRIBUTIONS STATE FEDERAL ME OicAL
2MEDIciNEidaugs 21a CASH CONTRIBUTIONS
3LESS % A.G.l. (Line 18 10401 21b PARTNERSHIP SHARE
4NET MEDidrugs GIRLIBOY SCOUTS
SH & A INS ( EXCESS)
62 MEAR FUNUICANCER FUND
6a DR RED CROSS/UNITED FUND
To
DR. XMAS & EASTER SEALS
misc OFR(;ANIZEO) ChiAAiTIE
0a.
DR_
377 CHURCHES
DR_
da.
0a.
Dr.
22 OTHER THAN CASH
23CAARY OVER FFROM Pnior YRS
6b KOSPITAL ZATOTAL CON kibuTiONS
156
prosthetic APPLIANCES
CASUALTY OR THEFT (L OSS(ES)
HEARING AId 25 Loss BEFORE ADJUSTMENT
26 INSURANCE REIMBURSEMENT
6c AMBULANCE 27
LABORATORIES 26 (S100 LimitaTion PEA,CAS )
TRAVEL FoA MED_ QOA 2Q 29 tor CAS OR ThefT Loss
MSCELLANE OUS DEDUCTIONS
MEDicARE INS 30 ALIM()NY
GLASSES 31(NiON/PRUFESSIONAL UUEs
MEDICAL EXPENSES
T674 762Z 32 CHILD & DEP CARE (Form 2441)
LESS REIMBURSED BY INS 33INCOME TAX PREPARATION
8 LESS 3% AOJ GROSS INC 220 5Z/ UNIFORMSIPROTEC. ClOThING
9 132L SMALL TOOLS AND SUPPLIES
+Y To S150) OF H & A INS
BS
LAUNDRY AND CLEANING
10TOIAL MEDICAL DFo
8 3
AUTO USE /UAMAGE
TAXES INVEST CUUJNSEL & PUBS (Sched
ISIAIE & LOCAL INCUME EMPLUYMENT AGENCY FEES
12 REAL ESTA TE
32
SAFE DEPOSIT BOX
13 STATE & LOCAI GASOLINE
YS TEL REQ. IN BUSINESS
14GENERAL SALES TAX POLITICAL CONTiributions
151 PERSONAL PROPEATY
156 PERSONAL PROPERTY AUTO 22
16 SALES TAX AUTQ 50
34 Io!AL Mise _ UEO
SUMMARY OF WTEMZED DED STATE FEDEAAL
DTOZ 35 Tut D:DU:7A: L KDlcAL DENTAL 17 TOTAL TAXES T63
PLNSLi POx 101
WTE REST (TO WHOM PAID) 36 TOTAL TAXES Ftom LINE 171
18 MOR TGAGE
2Z7Y 37 TOTAL INTEREST (Line ?0)
38 TOTAL CONTR_ (Line 24)
39CAS. & THEFT LOSSIES) (Line29)
40 520u2 MISCELLANEOUS 19INSTALLMENTLOANS M OEDUC Tions (FROM LinE 34
N MEEZZ)
Tx2
3#
183 71 BTEE 8TE EOrER
1040
DEUTe 5 3
REMARKS
20 TOTAL iNTEREST 555
Prolcssirn}l ' talicxwes,Itua PSI
10 Fem 1!1 SCHEDULE
NW 88326 Docld:32245535 183
1a,
1257
Page
==================================================
Page 184
==================================================
Reference copY , JFR Collection: ESCA 233 )
StMuELb [xyLLIs kaey
NO _ CALENDAR YeaR 19_
NAME 0r
SOC _ SEC . NO _
F |SCAL YE AR EndinG
ADORE S 5
SCHEDULE 0f PROF | T OR LosS FROM BUS INE SS OR PROFESSTON
PRi~CIPAL BU$ inES$ Activity
[Mfi)yERS No
BUS inESs Name
AUs iXESs ADDRE S $
ToTAL Rece |PTs
73924
inventory 4T BE Ginging 0F YEAR
ZO
MeRchAnd | SE Purchased
TYi.)
TOTAL
2M
L: 5 & inVENTORY AT End OF YtAR
b
GRoss Prof |T
ZYR
Jo:; ncomi
0) IMER Husin#ss Dcouc 7 UN;
A0f RTising
49
4*( tRucr {XpiNSi
Tgoo
84" 12' 8 ) $
comm sS OnS
Ot iivE#'
PPLCiA1 |Om Sef DUE ULLV
324
ouf 5 ANd Suascp P1 |u)Ns
EnTER inment ANC PR omot i ONA [
NsurANCE
7H
imT "t 5 !
AN O8 ANU MauA IR
Li GAI. ANV Accuun IN"
TO
Ni | 'cE suniu; AnY VSi
Afn!
HS]
Rf PA | RS Ard MAinTcmaRci
61S
SAL ARiES And #aGES
7s34
SuP PLTES
{AXES AND LicENSES
TAYES PAYROLL
39
FELE PhONE AND UTil'TES
ENRACICAEo R
#4
NE 1 PRof | T 07 iLoS> Ff DE RA { R E TUfN
1x
NE ! P R 0f | ] Of (205 5 9 St^ Te KTuRN #r DEPREC SCHEDULE FOk'
DFETHEETW)IYE
SCHEDULG_OF_DEPRECIATION
Prio UEPRECTATTON
DATE YEARS COsT OR
METH_ OR % OTMER BASIS DEPREC: This YEAR
No_ KiND AND LocaTion OF Property ACQUIRED
EQUIPMEMT ephxtsksyeioz241 L3391 "GZY
65_6 OWIEL LZiZYL 3563D L0
PrufeSs O#AL STaT |ONE# $ inC Forv 1044 SCHEDULE
Los AnGELES CAL ! f
NW 88326 Docld:32245535 184
(RG
DF
T^
1#|
Page
==================================================
Page 185
==================================================
7,iie *tt34
Reference copY , JFK Collection: BSCA (RG 2 33 ) 6iswen
REBIDENT
INDIVIDUAL
TAXABLE YeAR
540
CALIFORNIA
1914
INCOME TAX
PLACE PREADDRESSED LABEL HERE, it available. (Correct name and address, if necessary) For calendar year 0r
Enter social security number(s) only i incorrect or not shown 0n label_ Taxable year ending 197_
NAME (Ulpint roturn, givo frst initiolt of both) LAST #ME Your Soclal Securlly Number
KAMUEL
"EEEX-:
LBY
PRESENT Home ADDRESS (Numbor and including oporimoni numbor, ortural routo) Spouse Sociai Srcurity Number
Lby{Q
273E
R_ S7 Wxeei
city, IOWN OR POST OFFICE, STATE Zip Code OccU: Yours E
0 N 0 D A
^9
1L CA PATion Spouse
FILING STATUS Check One: EXEMPTION CREDITS If line 1 or 3 checked, enter $25
Single 6 Peronal If line 2, or 5 checked, enter $50
2 Married filing joint return (even if only one had income) Depeadeats Do not Iist yoursell; Youi spouse or the person whu qualifies you
0s
head 0f household. Enter name &nd relationship
O Separate return of married person -Enter spouse'$
social security number ad full name here
3ams
5
Head of Household__Enter name 0f qualitying Total Number X $8 7
individual_ Blind (refer to instructions) Number of blind exemptions X $8 8
5 Widowler) with dependent child (Year spouse died 197_) Total exempton credlb (add lines 6, 7 and 8) Enter here and 0n line 20 9
Atijch cody 2 & Fom(1) M-2 t0 futt 0t tals 10 10 Wages, salarles, tips and other employee compengstlon
return. m uaan Ileble, Itsch explanation_
11 Divldends before federal exclusion_ Enter total (if over M400, complete and attach Schedule B(540) 11
12 Intorest: Enter total (if over S400, complete and attach Schedule B(540) ) 12
13 Income other tan wages, dlvidends and Interest (from Iine 48) 13
RQEY
0
14 Total (add lines 10, 11, 12 and 13) 14 0.70_
8 15 Adjus tments to income (from Iine 54) 15
16 Adjusted gross income (subtract line 15 from line 14) %eza
2
I you do NOT itemize deductions AND Iine 16 is under $10,000, find tax In Tar Table and enter 00 Iine 19.
6
N Il you itemize deductions OR Iine 16 is $10,000 or more, com plete lines 17 &d 18.
3 17 Deductions: Itemized (from line 61) OR Standard (51,000 if line 1 Or 3 checked 52,000 if line 2, 4 or 5 checked) 17
SYR
18 Taxable income (subtract line 17 (rom line 16) Compute tar Irom Tar Rate Schedule_Enter tax on line 19 18
1
19 Tar (rom (check one) Tax Table Tax Rate Schedule Income Averaging Schedule (G 01 6--) 0 19
20 Total exempUon credits (ftom line 9, above) 20
35
21 Tar Ilablllty (subtract line 20 from line 19__if Iine 20 is greater than line 19, enter zero) 21
22 Other credits (from Iine 65_Includes special low income tax credit) 22
23 Net tax liability (subtract Iine 22 from line 21-_if line 22 is greater than line 21, enter zero) 23
24 Tar 0n preference income (see instructions-_attach Schedule P(54O} ) 24
25 Total tar liability (add lines 23 &d 24) 25
0
26 Total California income tax withheld (attach . Form(s) W.2 or W-ZP to Iace of this return) 26
27 Renter's credit_if you lived in rented property 0 March 1, 1974, complete Part 1 on page 2 27 1
28 1974 Callfornia estimated tax paymenty
29 Excess Calitornia SDI tax witheld (attach Form DE 1964 to face o this return) 1
30 Total prepayment credlts (add lines 26 thru 29) 30
W
31 If Iine 25 is larger than line 30, enter BALANCE DUE If it is equal to Iine 30, enter zero
Pay in full and mail with retura to; FRANCHISE TAXBOARd PAY In FULL 31 8 5 SACRAMENTO, cA 95867 Do not write in these sptcts
3
1
32 If Iine 25. is smaller than Iine 30, enter amount OVERPAID P
Mail return to: FRANCHISE TN Bonrd 32 7t +
E ! 8 P.o: BoX 13-540
SACRAMENTO, Ca 95813 M 1
33 Amount of line 32 to be REFUNDED. (Allow at least six weeks) REFURO TO YOU 33 1
34 Amount of line 32 t0 be credited 0 your 1975 ESTIMATEO TAX 34 Sniiu48 0
Undor penoltios of poriury, doclaro that havo oxominod this roturn; including occompanying schedulot and stotement, and to Ihe bost of my knowlodgo and
boliof i is Irue, corroct ond complete. 1tpreparod by ponon othor than taxpovor, his doclaralion i based on all information of which ha hat any knowlodge.
1
SIGN
Your signature Data Preparer'$Ilpnttuft (other than texpeyer ) Deto 1
88717 VANOWEN StrE?;
NW
aa8JREStdr322465B5-Page7785
return Deb Address (and Zip c0o IN Wurs; CA , TEiN (Or SSA) No:
367.948770
6 p LS
Only
3,g3t
91T7prrparer' $
==================================================
Page 186
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Reference copy , JFK Collection: BSCA 233 ) #iow $`
SCHEDULE
CALIFORNIA
TAXABLE
a
1974
ITeMIZed DEDUCTIONS
YEAR FORM 540 Attach to For 540
Soclal Scurlty Hurbcr Name Os shown on Form 540
SamuzL
Ku e_
Use only it you do not use the Tax Table or take the stendard 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
1S One half (but not more than 8150) of insurance 24. Other (itemize)
premiums for medical care
23 Medicine and drugs
3. Enter 1 % o adjusted gross income shown o Form
540.
Subtract Iine 3 from Iine 2_ Enter difference (if line
3 is greater than Iine 2, enter zero)
Tc#
5. Enter. balance of insurance premiums for medical
care not entered on line 1
25. Total {Add lines 22, 23 and 24. Enter here and
on Form 540, page 2 line 58) 2292
6. Other medical and dental cxpenses:
(a) Doctors, dentists, nurses, etc_ Contribuuon:
(b) Hospitals 26. Cash contributions for which you have receipts, can:
(c) Other (itemize) celed checks, etc.
27 . Other cash contributions. List donees and amounts
Sch
7 Total- (Add lines 4, 5, 6a, b, and c)
8 Enter 3% of adjusted gross income shown on
Form 540 28. Other than cash: See instructions for required
9. Subtract Iine 8 from line 1 Enter difference (if statement
line 8 is greater than line 7, enter zero) 29. Total_(Add lines 26, 27 and 28. Maximum deduction
10. Total-_ (Add lines 1 and 9. Enter here and on may not exceed 20% of adjusted gross income
Isa
Form 540, page 2, line 55)
i38l Enter here and on Form 540, page 2, line 59)
Miscellaneous Deductions Chlld Adoption Expense
Casu?lty or Thett Loss(es} See Instructions
11. Total expenses paid Or incurred_Attach itemized NOTE: If You had more than one loss, omit lines 30
list through 34 and follow instructions for guidance.
12. Enter 3% of adjusted gross income shown on Form 30. Loss before insurance reimbursement
540 31 . Insurance reimbursement
13. Subtract line 12 from line 11 = See instructions 32. Subtract line 31 Irom Iine 30. Enter diflerence
for maximum limitations. (Enter here and on Form line 31 is greater than line 30, enter zero)
540, page 2, Iine 56) 33. Enter 5100 or amount on line 32, whichever is
smaller
Taxes 34. Casualty or thelt loss (line 32 less line 331
14. Real estate 35. Alimony pald
15. State and local gasoline 36. child caro_ See instructions
31. Unlon duos 16. General sales
38. Employment educatlon expense_See instructions
17. Auto license__Excess of registration and weight fees
(see instructions) 39. Other_See instructions (itemize)
10. Personal property
19. State _ disability insurance (SDI)-_Employer private
disability plans do not qualify
20. Other ZCH
21, Total taxet_ {Add lines 14 through 20. Enter here 40. Tobl_Add lines 34, 35, 36, 37, 38 a 39. (Enter
and on Form 540, page 2, line 57)
QY 01
here ad o Form 540, page 2, line 60)
Nu88326 Docid:32245535 Page 186
(RG
PLYLLL
Sctt
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Page 187
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Reference copY , JFK Collection: BSCA (RG 233 ) 01
SCHEDULE TAXABLE
6
CALIFORMIA
1928
ForM 540
PROFIt (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
(sole Proprleforshlps)
Amtach thls schedule to your Intomo tax rotutn, Form 560 or S4OMR Pertnorcalpt lolnt vonturas, ote, muet Alo on Form 385
Name as shown on Form 540or Sociji Securily Number
Cac
"EizLZLS
A. Principal businesg_activity
SERvic e
1
product.
(nackear
(Soo Instructiont for Item 4 (For exomplo rolail-hardworo stobacco; servlcos-looal; manufocturing-furniture; atc.)
B. Busine; aadee:;
Wa8e;S2
1L 0f_
B4wa
RA
9E55534
N
Pplev;r;' Identification
9
43365324
E Indicate method of accounting: L cash; M accrual; other (Zip codo)
;.. Were Forms 591, 592, 596 and 599, for calendar filed (if required)? Yes No
G. Method of inventory valualion
Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
YES NO. If attach explanation:
IMPORTANT_All applicablo lines and Ichodulos mus Bo alled In.
U Gross receipts or sales $ less refurns allowances Balance
2 Less: Cost of goods sold (Schedule C-I, line 29) ond/or operations (attach schedule) 1
J Gross
Other income (attach schedule)
5 TOTAL income (add 3 and
6 Depreciation (exploin 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 woges not included on line 24, Schedule C-1 (exclude any
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 IS(a))
(6) Employee benefit programs (see Instructions for line 15(6))
7
16 Interest on business indebtedness
17 Bad debts arling from sale: or sOrvices
18 Depletion
19 Other business expenses (specify):
(a)_
(6)_
(c)
(d)
(e)
(g)
(h) Total other business expenses (add lines I9(a) through I9g))
20 Total deductions (add lines 6 through 19)
Si_
21 Net profit (or loss) (subtract line 20 from line 5). Enter here and o page 2, Form 540 or Form 54ONR
993Y
SchEdule c-I. Cost Of GOODS SOLD (See Schedulo C Insfructlons for)Ilno 2)
22 Inventory at beginning of year (f different from lost years closing inventory, attach explanation)
23 Purchases $ Less cost of items withdrawn for personal use Balance
24 Cost of labor (do not include salary to yourself)
25 Materials and supplies
26 Other costs (attoch 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.88326 Docld:32245535 Page 187
RuBY
2ymbeg
Etlezeq Year
"Yes,
and
Profit
lines
Paid
paid
==================================================
Page 188
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04 Reference copy , JFK Collection: BSCA (RG 233 ) Vir
SCHEDULE
CALIFORNIA
TAXABLE
0
1974
CAPITAL GAINS AND LOSSES
YEAR Form 540
Attach to Form 540 or 54ONR
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.
soqia Sacurlty Numt Name shown on Form 540)r
SauEL
Pix_4 =
PART I-_Asseto Held One Year Or Less
Cost 0r other bas s djurted, cost 07 subse -
Kind of property and description 0 Dtle acquired Dale wld Gross sales quent imarovements (it Gain Or lost
(Example, 1CO shae 0 *Z" Co.) (mo. Yr.) (mo., duy, Yr,) price not purchased _ attech (d. less &.)
mxplanation) and I:
Dense of sle
LDANTaSummitEACLE Cokhoe#tien
3 81 88}e274 oke
07. CMIEETA
"hz 81,95 652
I3.8
2 Enter (or loss), il applicoblc; from line 18, Schodulo D1 (540) (altach copy)
3_ Enter your share of net or loss from partnerships and fiduciaries
4 Net or loss, combine lines 1 2 and 3
233)
PART II_~Assets Held More Than One Year But Not More _Than Flve_Years
5
6BTEfOR 0 6, i6rl 287.2 22
02
NiIron 91
Y
R L3 L
7i3v
32 1.
6_ Enter (or loss), if applicable, from line 20, Schedule D-I (540) (attach copy)
7 . Enter Your share of net or loss from partnerships and fiduciaries
8. Net gain or loss, combine lines 5, 6 and 7
YY0 6
PART III_Assets Held Moro Than Flve Years
AZLS CArrYQver
Jb0.63
LEs /0)n
10. Enter (or loss), if applicable, from line 22, Schedule D-I (540) (attach copy)
M1. Enter your share of net or loss from partnerships and fiduciaries
12. Net Or loss, combine lines 9, 10 and 11
PART IV_Summary %t_Capital Gains Losses
13. Enter amount from line 4
3
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)
(1z063 20260 2_
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 54ONR
19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 54ONR the smallest of:
(a) amount on lines 17;
(b) the taxable income for Ihe taxable year (computed without regard t or losses from sale or exchange
of capital assets; or
L0)
(c)S1,000 (S500 in the case of & husband orwife filing a separate return)
NW-88326-Daeld*32245535-Page-188
Ruey
day.
gain
gain
gain
PET
5
gain
gain
gain
gain
gain
and
gains
==================================================
Page 189
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Reference copy , JFK Collection: BSCA (RG 233 )
MAME
JAm4:L
LlyLLy
CAAEDAR YEAR 19
7
ADDRESS SOC. SEC. NO_
DEDUCTION SCHEDULE
ME DICAL STATE FEDERAL CONTRIBUTIONS STATE FEDERAL
2MEdiciNEIDRUGS 21PARTNERSHIP SHARE
3LESS % A.G.l. (Linc 18 10401 GIRLIBOY SCOUTS
4NET MEDIDRUGS HEART FUNDICANCER FUN
5h & A INS: (Y EXCESS)
30Y
RED CROSSIUNITED FUND
fa 0R_ XMAS & EASTER SEALS
T37
DR_ MISC. ORGANIZED CHARITIES
DR. POLITICAL contributions
DR.
731
CHURCHES
DR
DR
DR_
0R.
22 OTHER THAN CASH
23 CARRY OVEIX FROM r'mioR YRS
6b HOSPITAL 24 TOTAL CONTRIBUTIONS LQ
PROSTHETIC APPLIANCES CASUALTY @R THEFT L OSSIES)
HEARING AID 25 Loss BEFQRE ADJUSTMENT
26 INSURANCE REIMBUIRSE MEN /
6c AMBULANCE 27 Difference (not less thun zero)
LABORATORIES 28 (S100 LimiTATION PER CAS )
TRAVEL FOR MED TOD 20 29 Tor CAS. OR THEFT LoSs
MSCELLANEOUS DEDUCTIONS
MEDICARE iNS. 30 ALimONY
GLASSES 31UNION/PROFESSIONAL DUES
7MEDICAL EXPENSES
1ZY 32 CHILD & DEP. CARE (Furm 2441)
LESS REIMBURSED BY INS 33 INCOME TAX PREPARATION
8LESS 3% ADJ_GROSS INC 278 UNIFORMSIPROTEC. CLOTHING
9 SMALL TOOLS AND SUPPLIES
Y (TO S150) OF H & A iNS
3z
LAUNDRY AND CLEANING
IOTOTAL MEDICAL DED
TZ EEb Auto Use Mi
TAXES INVESLCOUNSEL & PUBS (Schea
11STATE & LOCAL INCOME EMPLOYMENT AGENCY FLES
12 REAL ESTATE
3n
SAFE DEPOSIT BOX
13STATE & LOCAL GASOLINE TEL REQ_ IN BUSINESS
14 GENERAL SALES TAX
ISa PERSONAL PROPERTY
15b PERSONAL PROPERTY AUTO 2
16 STATE DIS. INS. H W
SALES TAX AUTO 3 TOTAL MiSc DED_
SUMMARY OF TTEMZED DED . STATE FEDERAL
17 TOTAL TAXES
7PI 1q5 35 FE858S FROH; MeZ 885 8 DENTAL
NTEREST TO WHOM PAD) 36 TOTAL TAXES (From LINE 17)
18 MORTGAGE 243 37 TOTAL INTEREST (Line 20)
38 TOTAL CONTR (Line 24)
39CAS. & THEFT LOSS(ES) (Line2g)
19 INSTALLMENT LOANS 40 BgBuE#8dEtONOHSE 34
7ex5"4
263
SkA
78
AET} ONTO? 388488N55 Zh32 LE2
REMARKS
NGia 6VtiEEIE652245535_Page 247
Kuey
==================================================
Page 190
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{6b: Reference copy , JFK Collection: BSCA 233 ) WtA800*
NQ_ CALENDA R YEAR 19
2Y _
NAME 0R
SOC _ SEC . NO _
F |SCAL YE AR END inG
ADDRESS
19
SCHEDULE OF PROF | T (Ok Loss FROM BUS INESS OF PROFESS ON
PrincipAL Bus INESS AcTiv iTy
BUS iNESS NaME EMPLoyERs No
BUs NESS AddrE Ss
ToTAL Rece iPts
TZH
INVENToRY AT BEGinNiNG 0f YEAR
MERCHAND iSE PURCHASED
387
LABoR
TotAl
E3zz
3012
invENTory AT END OF YE AR
Gross PRuf |1
31E04
GRuss incomE
350
oThER BUS INESS DEdUcT ons
ADVERTisinG
23
Auto AND TRuck EXPENSE
14452HL
ArTY
BAD DE BTS
CASH Short
Comm i SS /OnS
DEL /VERY
DE PREC AT | ON SCKEDULE ATTACHED
TEZ
ouE S AND SubscR | PT | ONS LL
[NTERTA inmfnT ANd PRomoti ONAL
inSURANCF
NTEREST
BH
JANiToR SERv |CE
LAUNDRY
24Z
LEGAL AND ACCOUNTinG
170
MA iNTENANCE
Jff icE SUpPL |ES AND EXPENSE
REnt
RE PA |RS
3
SALAR|E$ And WAGES
SALAR |ES Of F ICERS
SUPPLTES
TAXES AND LICENSES
TAXES PAYROLL
34
TELEPHONE
TRAVEL
UTIliTiES
TARKTNG
NF T PRof | T 0 R L O5$ F fDERAL R[TMKN
2#
Z3Y
NE T PRof | T 0R Loss STA TE RE TURN SEE DEPREC_ SCHEDULE FoR DIfF_ Ddr
NW 88326s Daclu: 32245335s Page 190m 10 4 SCHEDUL E
(RG
Ruey_ Sam2
RayLey
==================================================
Page 191
==================================================
Reference JFK Collection: ESCA (RG 233 ) 84:
1 1
0
2
1
1 '1
o m
17
3 1
8
1 N
3
2
4
4
1
W 8
2
1
1
8
g % 82
8
1
1
2 8
3
8
L
5
8
77
19
8
3 1
4
8 1
3
8
:
1
2
3
8
1
1
8
4
5
1
1
1
1 H
NW 88326 Docld: 32245535 Page 191
copy =
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Page 192
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Reference copY , JFK Collection: BSCA (RG 233 )
(NZJViDUAL TAXABLE Ydaa
EDEmT
j'
MALIFORNIA 11972
L:9a; tax
S 1072,C7 Olhar (axcbl yecr b-i 1972, crding 1973
LAsT NAHP Your tlahaFm
fx 7+,(5)
Ii3i_ RubY
36 090_JC,3m5); QU_L3 , Cr (etz} rcyi)) Ni;rsEGL: TSC
0*8811
Zip CODE Occi. Ycurs 3q2T EE
14ll0 Galleornta Patim 11f2'> Houneni-+
Mai_L RArt5 6 1eaj" {- 9. @-perdon?sDo nor (lst ycureell, ycur spouss Or pcrson who qualllles you as hced o/ houcenold
wAme (Inciucb I::t CJE) Anf/67 eddrcs; Il dlfercnl (rom Youra) nELATiOMSMi?
'Silin Kst;i retur Ered ,_ Jrlcn,Elloa
D -
Thoman
fii; } E3#cl reluri)-_Entcr epcus?' $ soclal
Enter Mzju i6 6r9? rema hcru Numbar D 5
0. Ellzd (refcr to Instructlons) Number of blind excmptions claimed 6
Pcrt 1, 2 7_ Ict-I dcpondont :J bilnd oxompdons (add lines 5 ad 6)
Ks"-3-Conzlt: Po?
020 C:.1 2 cl Ecmnua) :12 0 rheic" 22 #
1Gc &Mw. b-marWul L.9 9
iji:] (i 6731 85C), conii. } E#] atizch Eeiczul} (0(-G) ) 10
Eucm) F3.) 2, Iln: #}} 13
'2 .Jz] i4) 12
7; ) 2, Iin; G2) 13
J
hUtzct Ilno 1J fx") E3 [2) 1 03
Jim6e:Wi]on:ltael €it3i C) {lj P9
CJTs%bVEJ 0 Gan Cz b [-@ : 16. CCO
C Hsta(om paga 2, lins 56) 15
83 {sutiu; {in} 15 itejz 14,3 10 Figuro yCr tz O {hls czcnt by using th) oppropriata Tox Rato
Hn. afI 0_J 7 16 6,,051
0 1is Tuj, D Tox @-:) Ecnccule ( C Sch:Julo 'G/5RO) 17
2 &-325, { aric] czuple 0r herd cf Rzuschuld_ i) 15 50 D0
~~Totl 0n It 7 abov:, X 88 19 j200
20 W.Je_ ; (edd Ilzzs [8 2d ] 9) 20
Jf: 2Unct Ip '20 from lina 17} 21
% 65.1 6_.7; (rom paze 2, |ine %) 22
23. Mi % E24 (subtrect iing 22 from ling 21) 23
24, Tex 0"1 pieference incgra (see instructions-attach Schedule P(540) 24 1
25, Tckl 15 liiiity (add iines 23 ad 24) 25
26. Tcic} EzEizmi] InccC? %x Wlnn-ld (attzch Form(s) W!? Of DEZP to frorit) 26
27. {872 Eeillbinla estleetsd J2x peymcrt; 27
23 [:23; Gallafole SD1 &x clthheld (zItech Fcrf) DE 1964 9 fece of roturn) 28
21. Tolei caymoats' (add Ilnog .26, 27 ond 28) 29
In full. Meil mlth return to 30 20 If Ilsv 25 Is Iarger thgn_line 29 , entor CALANCE DUE: Franchlse Tax
Maa d"yaceamenkoh,
CA 95867 .
L 3 31. I Iino 29 ig lerger than Ilne 25, cntcr OVZOPAYMEHT. Moll rcfutn to P.O. Box 13.540, 31
Sact amento, CA 95913.
24, Line 31 io t? (a} @EUN@SD. (Allov at Icast cix wecks for your rcfund)
(b) Crediled on 1973 estimatcd tax
Do raf wchf? 'n (Ac;?
Uaz= GEk;} 0/ prf dctlcza that hzyo cxomaIn:d Ihis rutezn, Inetudlnp ectocranying #theduies end etetemcnts, end to (t? best 0 GY 577zRE Crj
0377 02 @ {uc, ccItt:? anJ cczfite Repzred by 8 pertutl Othar (ian taxpayer , his @cciaralion Is besed 0n 2ll Inlrmatlon ot wnlch he hEJ ory
P 1 EDWARD L LAMBERT
2
8j
Yes; Sionikire ~; "AiinD " joiniiy, Boti =E:? ziyn Deta
"gy39c v JATUFS {fokky:! Imu" #5
NW 88326 Docld:32245535 192
Pay
Page
==================================================
Page 193
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Reference copY , JFK Collection: BSCA (RG 233 )
OCHUVULE
CHEIFFORMIA ~apLci
19 72
MZCXzZ@ [SZbUcti@JS
YEASZ
FC 00 C:) t Fcto %.)
ATICT 8-3 17
.2l "vltj Rroy
i or} szjue2 itcmiz:; # Luctors, th? Olk%r mgy OJt us? the Tox T2'Mi2 Cr cle: #3
8 G; €3.i3d d_llciiun If }cd coos? fo Itemiz your d:ductiom3, com ci) f:
cf Ag] aproprioto items bziow
GCJ- c_) Cc_tituizz:
7%
{f-c, 22 Coct_Including checks, money orders, etc.
(itorizo) 22
90] 2
2464 [Jje:-d CpjiIJ 2
07 %0 3
S2: ;. In: 3 @c:) ik 2_ Eni &3cJ
713, 23 Tot} cech cortricutic;; 23
31 O3% #Jn caci) (cc? if3tructione) Ent-t rotal
6erj 241
31. Tot-!_Wdd lines 23 2d 24 , #lxximum Gzcuction
GT t excecd %09 ch ; WSIL;j #"59 icrcina 3J,}
1019) dufuia5 21 25
Bl
LmEe
"ms;n) 23
2 Ic_puich-33 27
2} Qinj (tznize} 23
{5.}G% .i L {6E7"
2 aw EuKJ ] Cm 150.00
6488 **"1
19
2 Ict: JAcd Iinge 26 , 27 end 28. Enter here &d 3 232.Cn
on Form 540, 0e;e 2) 29
E30823
Cz__ig Gr Zheft Lcsslcsl Cv) Instruczona
11
NOTE: ii VoU hzj Moic lmizn Or? cacualiy or (t;oft
kc ; oc-Tcncs, orit {ines Z0 (Arouin 33 ewd follu;/
{0 12 icwacilcn} for 'euidelico,
2. Los} bjtoro adlu: Imcntj 30
34. Inzutazco rolmburecmsnt 31
Rus [ixknz Inlijid. (En,{ Ii0 Liji4timm 32 SCu.tHD
590-Pzze 2)= 13 32. 8109 Ilmltation
23. Add Ilnes 31 end 32 33
34,0 Casualty or thsft Ioss. (Llna 30 Ies9 Ilna 33) 34
[ed eztte 10
35 Cle: CTa_See instructicns 35
Ctw w Ipc:) €;= 15
Czejnl azlz3 " 16 31. ou:r__For education, &limony, unlon ducs, etc,
Instructions 36
#uto: liccis Erc:ss 0f Fogi:_aiion G7d Kiel;n _
Ices Iga [nsaruxtinne) 17
Fezonal prop:ty J0
etc dbel@t GC} Ftiwatn
dsz_ Le M020 19
0 0ar 20
1. Tofzi tcs_{Acw Iln3? ` 14 {hrouzh 20, Entcr 37. Totel mlscollangous deductlons_-Add Ilnca 34,35
hero eiid cn Fcru ESU, pEZJ 21 21 841 . 00 nnd 36, (Entor haro ond on Form 540, pago 2)1 37
434+l
NW 88326 Docld:32245535 193
&
L 3
~Seo
#c:
%
Page
==================================================
Page 194
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Reference copY , JFK Collection: BSCA (RG 233 )
EAQADEe
{CHEDULE CALIFORNIA
19 72
"o.ndd
Profit (07 LosS) FQJC] CWSIESS @R PROFESSHON
YEA?
(Solb Pzczrt-orahipj)
GJ0-10Jc? @FIRJ Pontz37-~7h |o8-) Wzijzzzo CiG, Eo)C)odz3c
DnAID "Fcii Seceinci
$
Gervlcq prorluct
e (Tar cioml !aull-hurd:alo: vahclatala-Iobaccoj 'nrvlcos -Iogjul, muulcs}urin)--furnllutj; 61.)
Leiin {7ib
Snaek_Wez
0L
G. Fedoral omployor idoniiflcation numbor_
Lacnxdess 5410.Ven_Nuyg Blvd. Vqa Nuy8a Californkn
(ZV7 cc*o)
Iee; R3hod cf aSc ~unting: cGah; D'cccrual; Orhcr.
Kc:: "c3 591/592,0&. ond 5_ Ior: fhe calat _ flcd {if required)? Yes No
ig % ximcn lccried iNo @+suldaries of tie city, toin Blc. indicated? Vcs
Dici !% ~wii fhis tujine ; / #crd cf #he taxcbl ear? Yes
Xow {onth; of #h:: #ctls Yedr did You cin ihis businoag? 12
owe2X]8u: LcE: m
t73BC`;c Elc"2ma: Irn: Gexzovi;
:loC-J, lin) C) EJtt -Fz2u4; (ciicch ochcdulo)
-7or
003
inclce-jjcn lina 3, Skul {cx_,cny Fed fo yourself)
Y3ej
nion (3 ceR::
rajivii Giiu plcii-jidffWu piulla (seu iiruciions for iinid i3(a))
#yc_ f-47Lfn-jti fccj I_truciicnj for linj I5C))
n w# 1S "EW
4ui,3*s3aauserviccs
Rs-'cion
B#G.
(d)
(o)
(m)
(r)
(0}
(p) Total oiher business expenses (add lines I%0) through Iglo))
20 Totai deductions (add lines 6 through 19)
21 Net (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 54ONR 60 969 40
NW 88326 Docld:32245535 Page 194
Tuby
Yeat
Profit
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Page 195
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TAXABLE
Sc Hzbuls
CALIFORMHA
1971
CAPITAL GAINS AND LOSSES
YEAR
foRm s40
Attach to Form 540 0r 540MR
and losses on stocks, bords and similar investments,
Use this ,-=edule to report
assets such as 0 hore or jewelry.
C2 (buf not lo:ses) on personal
Scciai See::ty Mumje:
Narne as shown on Form 540 or 5--
Samuel and Phvlliz Puby
ShORT-TERM__ASSETS_HELD NOT MORE THAN 6 MONTHS
Cost Or other :: :is. as
UJjuste:_ cast 31
subie vent 17 3Jeats Gin & loss
anj t07tm 6 Dale a Zuired Dal sold G: Ks sales price (if njt pltzhaled 0) Kird %1 2rnder [y
"1" { (mo. djy, X.) (Mo, dmy. Yt.) ailin eapfjnalis) iumal, ICd Inares ol anj ex pe nse 0/sa
248.(0)
SCHTMIIIE AFtAC:
share of nef sho:-trm
(or loss) from parterships and fiduciaries
2. Enter
3. Enter net (or loss), corbis- lines 4 and 2
unused short-term
loss carryover from preceding taxable (attoch statement)
4. Enter
5. Nef short-term (or loss), cambine lines 3 and 4
LONG-TERM_ASSETS_HELD MCR: THAN 6 MONTHS
6
7 . Enter if from lae 4 , Schedule D-I (Form 540) (attach copy)
8 Enter your share of net long-term (or loss) from partnerships and fiduciaries
9. Ner gain (or loss) combine lines 6.through 8
(14 2Z4.Q)
10. Enter unused long-term
ioss carryover from preceding taxable years (otlach slatement)
11.
Net long-term gain (or loss} combine lines 9 and 10
shown lines 5 11, and enter Ihe net (or loss) here
(15,522..00)_
12. Combine the amounts
13, If line 12 shows a
of line 12, whichever is smaller. Enter zero if there is a loss or no entry on line 11
(0) Enter 50% of line 11 0r 5035
(b) Subtract line 13(a) from line 12. Enter herc and on line 32, Form 540 (line 33, Form S4ONR)
14. If line 12 shows 0 loss
and 10 (if lines 4 and 10 aro blank, enter 0 zero here and on lines 14(b) and IA(c) ond go to
(a} Add lines 4
line I4(d) )
(b) Combine lines 3 and 9- enter gain; if loss, enter Icro
(c) Enter smallest of () lime 14a) lcss line 14(b); (ii) Ihe amouni of taxoble income on Form 540 or S4ONR,
and or
losses _ determine this figure via a
side computation; or (iii) $1,000
computed wilhout
9-:
enter loss; if gain, enler zero here ad on line I4e) and go to line }4/f)
(d) Combine 3 and loss,
(e) Enter smallest of () tke crount of taxable income on Form 540 or 54ONR, computed without capital 'jains
and or losses, Iess line 14c} delermine this figure via 0
side computation; (ii) $1,000 (S500 if married and
# lize 3 is zero or shows a
gain, 50% of line I4(d); (iv) if 9 is zero or shows 0
separately); (iii)
if lines 3 and 9 show losses, line 3 odded to 50% of line ?
goin, amount on line 148,; or (v)
(6) Enter and on lina 32. Form 540 (line 33, Form S4ONR) the sum of lines I4(c) ond I4(e) ~(Do nof
enter an amount grecter than $1,000)
1,000,00)
Carrvover (1-;) (S14,5: 2.60)
Soo Inmruttions on Back
NW 88326 Docld:32245535 Page 195
guins
goins
Iess
gain Your
gain
years copite;
gain
applicable goin
gain
capitc:
gain and 86
gain
gain,
capitol gpins
lines
line
filing
here,
==================================================
Page 196
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TAXAZLE
SCHEDULE
CALIFORNIA
19 _1
itemIzeD DEDUCTIONS
YEA?
Form 540 Attach t Form 540
Socixl Securily Nvaot
Nama as shown on Form 540
7t"
Saquel andWhulLis Rubv
ccduclions. the olhcr may not use Ihe Tax Table Cr : }
Standurd Deduction_You have 3 choice bel een (o deduction i} onc spse ilemires
chnnsc Io itemize your deduclions, complel? itezi:ed W itemize ycur deductions or (2ke a standard deduction a5 'hc standurd Geduction ii You
meirccs Yc' Fa" 5ei8ensteciiony"
On separate returc:s cl 3 husband and wile, appropriate ilems belom.
ezcljs-d in the 540 Ins
(cot compensated by insurance
or otherrise} fur medicine &d drugs, doctors, dentists, nurses, hospital cre, insurance
Kedial 31: deabl_expenses
premiums for medical cate, etc_
1. Ona haif (but not more than $150) of insurance premiums for medical care
2 2. Hedicina &d druzs
3
3 Enter 1% of adjusted gross incoma shown 0n Foim 540
4 Subtrac: lice 3 (rom line 2. Enter dimerence (if less than zero, enter zero) 4
5. Enter Ealance o/ insurance premiums for medical care not entered on line 5
6 6. Other redical and dental expenses (attach ilemized list)
1
1 Total_IAdd lines 4 5 ad 6)
x
8. Enter J% 0l ndjusted income shorn 0n form 540
9
9_ Sub}rac/ line 8 Irom line 1. Enler dilfcrence (il Ics; Ihan /0r0, culer zctn)
150) 10
10. Tolal-_{Add lines 1 and 9)
Child Adoplijn Expense
11
11_ Total expenses paid or incurred_Attach itemized list
12
12, Enler 3% of adjusted gross income shown 0 Form 540
13 13. Sublract line 12 from line Il-See instructions tor raximum limitations
Taxee
14
14. Real estate 15
15. Stale and local gasolino
I6
16. General sales 17 17. Aulo license-Excess o tegislration &d weight fees (see inslructions)
18
18. Personal prcperty 19 19. State disability insurance (SDI)_Employer privale disability plans d not qualily
20
20. Other (specify) 21 143
21, Total taxes-(Add lines 14 through 20)
Contributions
22
22. Cash_Including checks, money orders etc (itemize)
23
23. Total cash contributions
24
24. Other Ihan cash (see instructions). Enter total here
25. Tobal_Add lines 23 and 24_Maximum deduclion May nof exceed 20% oi adjustcd Pjoss incame 25
Iaterest EIeequ!
26
28 . Home mortzage 27
21. Installment purchases
28
28. Other (itemize)
29 2,617 k8
79. Total- {Add , lines 26, 27 &d 28)
Yiseallareous Deductions
JJ. For child care, alimony, union dues, casualty losses, etc -See instructions (itemize) 30
31 500 br
JTctal miscellaneous deductions
92. Totsl deductions_ (Add Ilnes 10, 13, 21, 25, 29 ard 3I). {nter total here and on farm $40, pavc 2 in space previded S/: 32 I) !0
NW 88326~Docld: 32245535 Page 196 Schadulc a 0 5 [Ovorb0
Rios;
==================================================
Page 197
==================================================
TAXA3LE
sChEDiE
CALIFORRIA
19_
71
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
FORM,540 (Sole Proprietorships)
Portnerthips, jolnt ventures, etc , must fla on Form 56 : Amtach {hi, ,chedulo lo your Income tox return, Yerm 340 or s4OnR
Sch Se:ity Munjc
Name as shon on Form 540 or 54ONR
Sarnel rhl{a Ruhv
Fondl Service product
A. Principal business activity
~hordworo; wholosola-toborzo; service: -legol; munulocturing-furnilure; ot.=
'for uampl
Snack Rar C Federal empl;y8identification number
B. Business name
Nuvs Tlvi "an "S (ah ornia
D. Bus;ness location
5418 Van
(City ofco} {State {Zi? ccc
'Numbor and trool or rurol route) ~Post
E Indicate method of accounting: cash; accrual; other (describe)
substantial change in the manner of determining quantitics, costs or voluations between Ithe openirg and closic:
FS Was there
inventories? Yes 3 No. If Yes, attach explanotion.
6_ Were Forms 591, 592, 596 and 599, for the calendar filed (if required)? CYes No
1 Gross receipts or gross sales $ Less: Returns and allowances $
2. Inven:ory &} beginning of ycar (If different than lost ycars closing inventory G'tach
SCHEDi L.E
explanation)
$ Wess cosi of ony Mems ATTACIIED 3. Merchandise purchased
drawn from business for personal use $
4 Cosf o} labor (do nof include solary Io 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
9. Cost of sold and/or operations (Jubtracl line 8 from line 7
10. Gross (subtrac/ 9 from linc 1)
OTHER BUSINESS DEDUCTIONS
11. Deprecialion (explain in Schedule C2)
12. Taxes on business and business property (explain in Schedule C
13. Rent on business property
14. Repairs (explain in Schedulc C-1)
15. Salaries and wages not included o line 4 (exclude any_ Io yoursclf)
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 of mines, oil and gas wells, timber, ctc_ (allach schedule)
24. Othcr business expenscs (explain in Schedule CI)
25. Tolal of lines 11 Ihrough 24
26. Net profit (or loss) (sublract line 25 from line 10). Enter und on pag" 2 , Form 540 or 54ONR 7 33
SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24
Llm Ns. Ernlan(lon Amount Lint No. nclanalion Amounl
Ww 88328 1 'bocld:32245535 197 Page
and
rtail-
any
year
with-
paid
year
goods
linc profif
paid
350
herc
Page
==================================================
Page 198
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TAXABLE
S( HEDuLe
CALIFORMA
1971
CAPITAL GAINS AND LOSSES
YEAR
Form 540
Altach to Form 540 or 540HR
Use this schedule to report and losses on stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as 0 home or jewel:y.
Scial Stc-:ity Mumbr:
Name as shown on Form 540 or S4CNR
Sawuel and Phyllis Pubw
SHORT-TERM_ASSETS HELD NOT MORE THAN 6 MONTHS
Cas/ Or otter : :i,. 3} adjusted_ cast 3
Kind 01 Jroderty description 6 Dale aquired bal: sold 6*s sales ~price subseautnt i:3 teats Gain G7 Ioss
(ii njt alrthued (4 {ess &) Exmpl, IC #are of "" Ca.) (mo._ djy. Jr.) (mo. day. yr. ) attxh exgiznatian)
ard exDense 0/ sale
SCHEMIITF ATTACHED 218" ()o)
2. Enter share of nel short-term (or loss) from partnerships and fiduciaries
3, Enter net (or loss), combine lines 1 and 2
4
Enter unused short-term capital loss carryover from preceding toxable (attach statement)
5. Net short-term gain (or loss) combine lines 3 and 4
LONG-TERM ASSETS HELD MORE THAN 6 MONTHS
6_
7 Enter if applicoble from line 4, Schedule D-1 (Form 540) (altach copy)
8 . Enter your share of net long-term (or loss) from partnerships and fiduciories
9 Net (or loss), combine lines 6 through 8
10. Enter unused long-term capital loss carryover from preceding taxable years (otlach statement) (14 2Z4.QQ)
11. Net long-term (or loss), combine lines 9 and 10
12. Combine the amounts shown on lines 5 and 11, and enter the net (or loss) here: (15,522..02)
13. If line 12 shows 0
(0) Enter 50% of line 11 or 50% of 12, whichever is smaller. Enter zero if Ihere is & loss or no entry on line 11
(6) Subtract line 13(a) from line 12. Enter herc and on line 32, Form 540 (line 33, Form 54ONR)
14. If line 12 shows a loss =
(a} Add lines 4 ond 10 (if lines 4 and 10 are blank, enter 0 zero here and on lines 14(b) and I4(c) and go to
line I4(d) )
(6) Combine lines 3 9_if enter gain; if loss, enter Icro
(c) Enter smallest of () line I4(a) less line 14(b); (ii) the omount of taxoble income on Form 540 or 54 NR,
computed wilhout gains and or losses _determine Ihis figure via 0 side computation; or (iii) $},000
(d) Combine lines 3 and 9-_if loss, enter loss; if gain, enter zero here and on line I4(e) and go to line 14/f)
(e) Enter smallest of (i) the amount of taxable income on Form 540 or 54ONR, computed without capital 'jains
and or losses, Iess line 14(c) __determine this figure via 0 side computation; (ii) $1,000 (S500 if married and
separately); (iii) if line 3 is zero or shows 0 goin, 50% of line I4(d); (iv) if line 9 is zero or shows 0
gain, amount on line I4(d); or (v) if lines 3 and 9 show losses, line 3 odded to 50% of line 9
(6) Enter here, and on line 32, Form 540 (line 33, Form 54ONR), the sum of lines I4(c) and 14(e) -(Do nof
enter an amount greater than $1,000) 1,0,0Q)
Carrvover (1- ;) (S14,5 2.60)
Soo Inmruations on Buck
NW 88326 Docld:32245535 198
goins
and
gain Your
gain
Ycors
gain
gain
gain
gain
gain
gain _
line
and gain,
capital
filing
Page
==================================================
Page 199
==================================================
nei erence copy , Jr K Co[fecrion: D>LA (Ko 2J0 )
INDIVIDUAL TAXABLE YEAR
REBIDENT
540
CALIFORNIA 1,9073
INCOME TAX
1 The year January / December 31,1973,_or Other taxable_year beginning 1973, ending 19
Your Social Security Mumber
FIRST NAME(S) AND INITIAL(S) LAST NAME
ea50
SAMLEL
'yLyJS
LAy
Spouse Social sccuuriky_WUnber
PRESENT HOME ADDRESS (Number street, including aportment number or rural route) Fo
1ZfQ ER
Int ciTY, TOWN OR POST OFFICE, STATE Zip CODE OccU- Yours
6ANADA
Hi<
L LALJE PaTion Spouse
Status Check Only One Exemption Credits If line 1 or 3 checked, enter $25
Single 6. Personal Exemption: If line 2, 4 Or 5 checked. enter S50
Married filing joint return 1 Dependents _ Do not list person who qualifies you &s head of household
0 Married separate return__Enter spouse's full Name (include last name and/or address It diferent {rom Eatiptio
name
TmomAA
0 Head of Household-_Enter name of qualifying
Elija
individual Total Number X $8 7 Ixx
52 Widowler) with dependent child: Enter year spouse 8. Blind (refer to instructions) Number of blind exemptions X $8 8
died 19. 9_ Total exemption_credits (add Iines 6 7 and 8) Enter here a on line 20` below 9
ZYL
Attach copy 2 of Formls) W2 to front;
Income` 10. Wages, salaries, tips and other employee compensation if unavailable, attach explanation 10
11. Dlvidends_before federal exclusion. Capital gain dividends must be included at 100 % 11
0 12. Interest (See instructions for taxability of {ederal, state and municipal bonds) 12
3y1
13. Income other than wages, dividends and interest (from line 50) 13
JLab
"
14. Total (add lines 10,' 11, 12 and 13)
14[72..33
2
15. Adjustments to income (Krom line 56) 15
5 16. Adjusted gross Income (subtract line 15 from Iine 14) 16 1L:
N' If you d NOT itemize deductions" AND Iine.16: is under 10,000,; find tax in Tax Table and enter,on. line 19.
3
If you itemize deductions OR line 16 is 510,000 or more, complete lines 17 and 18.
17. Deductions: Itemized (from line 63) OR Standard ($1,000 if Iine 1 or 3 checked_52,00O if line 2, 4 Or 5 checked) 17
Siel
1
18. Taxable income (subtract line 17 line 16) Compute tax from Tax Rate Schedule_Enter tax o line 19 18
19. Tax_If an averaging method is used, check appropriate box Schedule G, or Schedule G-1 19
20. Total exemption credits (from "Iine 9, above) 20
21. Tax llability (subtract Iine 20 from line 19_if line 20 iJ greater than line 19, enter zerdj 21
Your 22. 0ther credits (from line 66) 22
Tax 23, Net tax (subtract line 22 from line 21-if line 22 is greater than line 24 enter zero) 23
and
24. Special tax credit_from tine 75 (see Instructions, page 2, for allowable crddit) 24
0 Credits
25. Net Tax liability (subtract line 24 from Iine 29_if line 24 is greater than llev 23, enter zero) 25
26. Tax 0n preference income (see instructions__attach Schedule P(54O)) 26 1
27. Total tar liability (add lines 25 a 26) 27 122
1
28. Renter'$ credit_if you' lived in rented property on March 1, 1973, complete Part ` on page 2 78 1
Your 29. Total California income tax withheld (attach Form(s) W-2 or W-ZP to face of return). 29
1
Pre: 30. 1973 California estimated tax payments (include amount allowable as a credit from 1972 return) 30
Payment
31, Excess California SDI tax withheld (attach Form' DE 1964 to face of return) 31
3 Credits
32. Total prepayment credits (add lines 28 through 31) 32 h
33. If line 27 is equal to or larger than line 32, enter-amount of BALANCE DUE 33 12z
5 in full and mail with return to: Franchise Tax Board, Sacramento, CA 95867 Do not write in (hese spages
Balance 34 P 1
Due 34. If line 32 is larger than line 27, enter amount OVERPAID
Or Mail return to: Franchise Tax Board, P.O. Box 13-540, Sacramento, CA 95813
Refund 35. Amount of line 34 t be REFUNDED. (allow at least ` Alx weeks for your refund) 35 1
36. Amount of line 34 to be credited o your 1974 estimated tax 36 M
'Under penalties o perJury, declare that have examined this including accompanying schedules &nd statements, and to the best & my knowledae and 1
beliet it is true correct and complete: prepared by person other Tampayer, his declaration 7 Based on all information of which he has any knowledpe
1 SIGN
Your" signatura Date Priepa;e; signaiur; (other iaxpaye;)
Yel3ST
88HERE
Date Aidress (and 'Zip code)" Preparer Empioye; 4 aentincation (0r SSA) Mumbe
NW ocldi7745i55 Tggreturn"
771 7 N "TRr'
BIRCcot
ling
filing
12At
from
Pay
retuntiha "
than
ipilge
==================================================
Page 200
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Reference copY , JFK Collection: ESCA (RG 233 )
6
TAXABLE SCHEDULE
0-1
CALIFORMIA
1927
SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES
YEAR FORM 540 (Sales or Exchanges Including Involuntary Conversions)
(Attach to Form 540, 54ONR, 541 or 565)
Identifying number as shown 0n relurn Name as shown on Tax Return
SAmLEL
ZLyLI_Kuey
PART 1 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 Preperty _ or farm land; or, if this form is filed by 0 partnership
Date acquired Dale sold
1 Description of Sections 18211, 18212-18, 18219, and 18220 property. (mo.. day, (mo., day, S.)
(A) SMACK Eaz Y 70_ 27.31.33
(
38
Correlate lines I(A) through I(D) with these columns Property Property Procerty Proderty
(A) (B)
2. sales 28027
3. Cost Or other basis and expense of sale 28138=
4 Depreciation allowed (or allowable) L23.26
5 Adjusted basis, line 3 less line 4
1iZ
6 Total_gain,_subtract_Iine 5 from_line 2 12X?
7 If Section 182 1 1 property:
(a) Depreciation allowed (or allowable) after applicable date:
(See- Instruction D-3)
12366
(6) Line 6 or line 7(a), whichever is smaller [23Y2
8 Tf Section 18212-18 property:
() Enter additional depreciation after 12-31-63 and before
1-1-71
(6) Enter addilional 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
(9) Line 8(f) times applicable percentage (Instruction D-4)
(h) Add line &d) and line 8(@)
If Section 18220 property:
(a) If farm land, enter soil and water conservation expenses
for current year and four preceding
(6) If farm property, other than land, subtract line 7(b) from
line 6; OR, if farm land, enter line 6 or line %a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see Instruction D-5)
(d) Enter line 9(b) or line %(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 %d), if any; otherwise, enter a zero
(c) Enter excess, if any, of line IO(a) over 10(b)
(d) Line IO(c) times applicable percentage (Instruction D-5)
(e) Line 6 less line IO(b)
(F) Enter_smaller_of line IOd) or_line_lOle)
SUMMARY OF PART TComplete_Preperty Columns (A)threugh (D) @P to Line 1OH berore_going to Line 11)
11_ Enter amounts from line 6 122.%8
12. Enter amounts from lines 7(b), 8(h), %d) and 10(f) LLE
13. Subtract line 12 from line 11, enter here and in appropriate
0
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 IlI TLR
NW-88326-Docld-32245535Page 200
Yr.)
Gross price
years
==================================================
Page 201
==================================================
Reference copy , JFK Collection: ESCA (RG 233 )
FORM TAXABLE
540
CALIFORNIA
1970
RESIDENT
INdividual INcOME taX RETURN YEAR
For Calendar Year 1970 or Fiscal Year Begun 1970 and Ended 1971
first NAME(S) AND INITIAL(S) LAST NAME Your sociai security aumder
SAMUEL AND PHYLLIS RUBY c Please
PRESENT HOme ADDResS (Number and stroot, or rural route) COUNTY Spoust_ social security numbe Orpe
16250 Bircher ILos Ange les 844 47 Jxhu #$ M
Prlnt city, TOWN OR Post Office STATE Zip CODE Your occupation B
Grana da Kille California 91344 Se l f - Employed
P
NAME AND ADDRess Of EMPIOYER AT Time Of FIlING Spouse $ occupation
Sel f-Employed Housewife
NAME AND ADDRESS ON 1969 CALIFORNIA RETURN_ IP SAME As ABOvE_ Write "SAME' IF NONE FIlEd, Adjusted pross income 0n 1970 Federal
GIVE REASON_ Retur n S ._
8,284-..97
11346 Montgomery Avenue Grana da Hills, Calif { datere 'r93geize 11, below, explaia
Filing Status Single Marrled, filing separate return_spouse'$ name:
(check one) 2 Married, filing joint return Unmarried "head of household" Complete Part V, page 2
5. Hages, salerles tlps, etc. (before payroll deductions) if more than two employers, attach schedule
Income Employe '$ name Whert emnloyed (city and state)
It Jolnt return, 5
Include all
Incomo of
both husband
0. Divldends. Enter 'total here (also Iist in Schedule 8 (5401, Part 1 if total ` is over S100) 20 60
and wlfo
1 13 Interest Enter total here (also Iist in Schedule B (540), Part Il, if total is over S100)
8. Other Income (from page 2, line 30) 8
8,284 07 1
9_ Total (add lines 5, 6, 7 and 8) 9
8,305. 72
10. Adjustments to Income (from page 2, line 35) 10 1
11. Adjusted grost Income (subtrect Ilne 10 from line 9) 8,305 52
you do nt itemize deductions AND line 1l 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 o more, go to Part IV on page 2 to {igure tax
Your 12. Tax from (check onel: Tax Table O, Tax Computation (page 2, Part IV) @, or Schedule G (540) 12 32
Tax
13. Exemptlon credlts (from page 2, line 43) 13
Credlb 14. Tax liability (subtract Iine 13 '{rom Ilne 12) 14
Norl
15. Total other credlts (from page 2, line 49) 15
16. Net tax Ilablllty (subtract line 15 line 14-If $1.00 or less, enter 'zero") 16 Norle
17. 1970 California estimated payment or credit from 1969 (if any). Il none, enter "zero" 17
Belance 18 , Balance due ~It any (subtract Ilne 17 from Iine 16) Pay In FUlL With RETURN 18
Nore
Due or 10. Overpayment _If eny (subtract Ilne 16 from line 17) OVERPAYMENT 19
Rofund 20, Portlon of Ilno 19 you wish to epply o 1971 estlmated tax 20
21. Relund_If any (subtract Iine 20 Irom line 19) REFUND 21
Do not write In (hese spac es Under penallies %r perJury, declare that havo examined thlt Includlnp accompanyinp uchedules and statements. and to Uhe best of my knowledge and
bellet it @ true, cortect and complete. prepared by Rertonouher taxpayer , is dcclaration (s based 6 all infor mation of which he has ary Knowledge_
Sign
Yov;' "zipnatui"4f"diin;" Joinily;" Boti ausi slon Data Signaturi 0f preporer biner tha taxpayer
here
Spoust ;lanatur; 0
"Addret AMBERT-MARKELLDa:
16633 VENTURA BLVD
Mako Romittance Payabl to FRANCHISE TAX BOARD_Mail to EN(;INO, CALIF. 91316
FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814.
NW 88326 Docld: 32245535 Page 201
and
from
tax
Tellttnt
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Page 202
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Reference copy JFK Collection: BSCA (RG 233 )
TAXABLE SCHEDULE
UHALIFurNH
4
19 70_
Itemized DEducthons
FORM 540 YEAR
Attach to Form 540
Social Security Fumber Name as shown on Form 540
Samuel and Phyllis_Ruby
Itemized VS. Standard Deduction-_You have 3 choice between two deduction i( one spouse itemnzes deductions, (he other may nt use Ihe Tax Table or claim
methods. You can either itemize your deductions 0 take a standard deduction a5 the standard deduction. II you choose to itemize your deductions c" mplete the
explained in the 540 Instructions On separate returns of 8 husband and appropriale items below_
Medlcal and dental expenses (not compensated by insurance or otherwise} for medicine ad drugs, doctrs, dentists, nurses, hospilal care, insurance
premiums for medical care, etc.
15 One half (but not more than S15O} of insurance premiums for medical care
2_ Medicine and drugs 2
33 Enter 1 % of adjusted gross income shown on Form 540 3
4. Subtract line 3 from line 2 (if less than zero, enter zero) 4
5, Other medical and dental expenses. Include balance of insurance premiums for n ,dical care not
deducted on line 1 (attach schcdule) 5
6 Total_(Add lines 4and 5) 6
7 Enter 3% of adjusted income shown on Form 540
8 , Subtract line 7 from line 6 (if less than zero, enter zero) 8
9. Total-(Add lines 1 and 8) 9 150 00
Child Adoption Expense
10. Total expenses paid or incurred-_Attach itemized list 10
11. Enter 3% of adjusted gross income shown on Form 540 11
12. Subtract line 11 Irom line 10-~See instructions for maximum limitations 12
Taxes
13. Real estate 13
14. State and local gasoline 15
15. General sales
16. Auto Ilcense_Excess of registration and weight Ices (see instructions) 16
17. Personal property 17
18. State disability insurance (SDI)_Employer private disability plans do not qualify 18
19. Olher (specify) 19
20. Total taxes-_(Add lines 13 (hrough 19) 20 663 26
Contributions
21. Cash-_Including checks, money orders, etc, (itemize) 21
22. Total cash contributions 22
23. Other than cash (see instructions) Enter total here 23
24. Total-Add lines 22 and 23_Maximum deduction may not exceed 20% of adjusted gross income 24 280 0Q
Interest Expense
25. Home mortgage 25
26. Instellment purchases 26
27 . Other (itemize) 27
28 . Total __(Add lines 25, 26 and 27) 28 1,552 18
Hiscellaneous Deductions
29. For child care, alimony, union dues, casualty losses, etc -See instructions (itemize}. 29
30 . Totel_miscellaneous deductions 30 1 00 QQ
31 . Total deductions _ (Add lines 9, 12 , 20, 24, 28 and 301. Enter Iotal here and 0n Formi 540. page 2 _ I} spare prc vided S/ A 31 ,7/ 5
NV 88326, Docld:32245535 Page 202 0A"
wife,
gross
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Page 203
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Reference copY , JFK Collection: ESCA (RG 233)
AXABLE SCHEDULE @CHLHFONA
19_ 70
6
FORM 540
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION
YEAR
(Sole Proprietorships)
Antach thle schedulo to your Income tax return, Form 500 or S4ONR Partnershlps, ioinf vonturos etc, must fle on Form 565
Social Security Number
Name as shown on Form 540 or 54ONR
Samuel and Phylli8 Ruby
A. Principal business activity _ Food Product; monvfoctoring
furnituro; elc ) (For oxomplo; rotoil-hardwaro} wholotal-tobacco; 'ervicos
B. Businoss namo
Snack Bar C_ Federal employer identification number_
2551578
D. Business location
5418 Van_Nuyg Boulevar Van Nuys_ California 91401
(Numbor and stroot Or rural routo) (Clty-Post offico) (Stato) (Zip codo)
6. Indicate mothod of accounting: K7 cash; accrual; other (describe)
F Was there substantial change in the manner of determining quantities, costs or valuations between the opening and closing
inventories? 0 Yes No. If "yes;' attach explanation.
G. Were Forms 591, 592, 596 and 599, for the calendar filed (if required)? QYes No
1 Gross receipts or gross sales Less: Returns and allowances $
2. Inventory af 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 Io yourself)
5. Material and
6. Other costs (explain in Schedule C-1)
SCHEDUIE
7 . Total of lines 2 through 6
A TTAC HED
8. Inventory at end of this Year
9. Cost 0f goods sold and /or operatlons (subfract line 8 from line
10_ Gross profit (subtract line 9 from line 1)
OTHER BUSINESS
DEDUCTIONS
M1. Depreciation (explain in Schedule C-2)
12. Taxes on business and business property (explain in Schedule C-I)
13. Rent on business property
14.
Repairs (explain in Schedule €:1)
15. Salaries and wages not included on line 4 (exclude any to yourseif)
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-1)
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 Il, Form 540 or S4ONR $ 9,284
SCHEDULE C-. EXPLANATION OF LINES 6, 12, 14, AND 25
Linz Fo Explanation Amount Lim No Explanation Amount
NW 88326 Docld:32245535 Page 203 DAn^
any
Year
paid
supplies
paid
==================================================
Page 204
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Reference JFK Collection: BSCA 233 )
SCHEDULE
CALIFORMHA
TAXABLE
0
1970
Form 540
SALES OR EXCHANGES OF PROPERTY
YEAR
Attach to Form 540 or 54ONR
Name a8 shown on Form 540 or 54ONR Social Security Number,
Samue 1 and Phyllig Ruby
Part |-CAPITAL ASSETS
SHORT-TERM_ASSETS HELD NOT MORE THAN 6 MONTKS
Cost or other basis_
Kind o property (It necessary, Depreciation allowed cost of subsequent
attach statement ot descr iptive b. Date ecquired Date told 4_ Gross sales ptice (orallowable) improvements (if not Gain or loss
details not shown belom) (mo-, Yt,) (mo., day, Y.) sinct acquisition purchased, attach plus less
(attach schedule) explanation) ard
expense of sale
SCHEQULE ATTACHBD 715,2.74 ,00 )
2. Enter your share of net short-term (or lose) from parinershipt and fiduciaries
3. Enter unused short-term capital loss carryover from preceding taxable Years (attach statement)
4. Net short-term (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 II
6. Enter share of net long-term (or loss) from partnerships and fiduciaries
7. Enter unuted long-term capital loss carryover from preceding taxable years (attach statement)
8 . Net long-term (or loss) from lines 5, 6 and 7 (15,274 . 00)
9 Combine the amounts bhown on lines 4 and 8 and enter the nef (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
loss or no entry on line 8)
11. Subtract line 10 from line 9, Enter here and on line 17, Part IlI
12. If line 9 shows a [OSS, 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 S4ONR, computed without capital
and losses; Or (c) $1,000 Carryover Loss (144274.00} 1000.00)
Part II_SALE Or EXCKANGE 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. Enter your share of gain (or loss) of Section 18181-82 items from partnerships and fiduciaries
16. Net (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 (or loss) from line 10 or 11, Part
18. Net (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 54ONR, page 2 , Parf
Il, line 23
NI 880261 Docld:32245535 Page 204 'Srhedolo 70mtina 0" rovP' {01
(RG copy ,
day,
gain
gain
gain Your
gain
gain
gains
gain
gain
gain
Pag"
==================================================
Page 205
==================================================
PAGE
SCHEDULE € SHAREHOLDERS SHARE OF INCOME AND CREDITS
(It additional space is needed, attach schedule)
3
2
(21} .(31
(1)
Sociol Secufity Number-01 Namo and Addreso 0/ Each Shareholdor Sher08
8
Numbor
(a) Geaes; mecvs;
1302 @am GAAleNs pe:
NZISZEwy| ZC82
(b)
EEE31ney
EiDe Biarizlinghuliibiel 2ree
7
(c)
(d);
6
(e)? 8
(T):
(a)
7
():
(
{0
AAmCEJt JEOEtoiaon
Anotnttrrbi tordin Umiburivo(ineom trmioooo
Ln0 0 [ouch ote-o 23bote44
imcticereddp
D Wn PU: 2 A7ei Gotadilo Oino Ch CeO 33do7rdbi0 2
Ua 41z081 Dins 07) amxno Dot Iicolymn
colin 6iZZo lnotrdon
La) 35 03689
3380.38
{bu; 32 "06 B? S%z? 31886328
(c)
(a)
Lg)
8h)
(i)
Nee2,62a0r25g
Pag
==================================================
Page 206
==================================================
PAGE 4
SCHEDULE E - SHAREHOLDERS SHARE OF INCOME AND CREDITS
(If additional space is needed, attach schedule) 3
8
(21 (31 (1) Social Security Numbar 0t Namo nd Addreso 01 Each Shareholder
Number Shar 08
89
(a) Geakse
7733E5
5& NZIEZEBLY 8 7f 08
130 Msawl
(b)
RRL Koer.
4370 SToNEZEiEZEE "EEEEHZlibrel 7 f6o
7
(c)
(d) 6
(e)
f):
8
(g)
(h):
1
Ti):
(i)
(0}
LLpung a naroholdo
Amouni,texcbio Diat-lburiv Inoomo Impzpo Mlonizhon 5e2 2032
Incona "(gchedtta Wo cotoediia Wns 29 *n Paoo 2 Ratadeie
u.8: 1120-61 0on7adliitnd B3155 Golunt
Ondtoolvmi Ge( hotrtoiton )
(a): $ 3 03629 E80338
3y380.38
{b)
32.03438 Z8ozb2 3128 28
(c)
(d)
Ue
(fl
lg
(b)
(i)
Ne3e3326 12TTF2567 18892C4
J8t2ine0
==================================================
Page 207
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Sixzdile ? ~ SciARricdzrs SHARE C; icoivz Ao Cazdiis
(if additional space is reeded, atzach schedule)
(1) (2) (3) (4)
3
Name and Address of Each Shareholder Social Security Number of Amount taxable as ordinary
Number Shares income (schedule K total of
lines 4 and 8 , US. 1120 S)
8
(a) EmRL 6,0R
3
3o ST24Z QWE
32' %i6n 4; 2409
40.240,04
6
(b) 88n][ o7.G6322 MAc4S
NGz?) #//50 GhiCA6o Ik.ko.a
46.2+0.S
(c)
7
(d)
(e)
6
(f) 5
(g)
(h)
7
(i)
(5) (6) (7) (8)
Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
pago 1 line 5, or page 2, holder on MI-1040 (enter on Ml.104O, page 1, Iine 22 MI-1040 each shareholder's
schedule B, Iine 6 page 2, schedule 1, line 34 or each shareholder'$ pro- proportionate share of Single
on page 2, schedule 2, line 43) portionate share of per- business tax paid_
difference between column sonal property taxes (See instructions)
and column 5 on inventories Or
(See instructions) the credit for franchise
fees paid.
(See instructions)
(a) #ayo-oy
(b) Y6, &Yu.05
(c)
(d)
(e)
(f)
(g)
(h)
(j)
NW 88326 Docld:32245535 Page 207
PAZE 2 C=_
2680
paid
==================================================
Page 208
==================================================
SCi-eduiz F 3
SHARZHOLDZRS SFiARE 07 iNCOmz And LRcuiis
(If additional space is needed, attach schedule)
(2) (3) (4)
3
(1) Social Security Number of Amount taxable as ordinary
Name and Address of Each Shareholder Shares income (schedule K_ total of 8
Number
lines 4 and 8 , U:. 1120S)
8
(a) 6305 Ryz
@5,912 Sod 19,720./6
4682_STeNeY
Rivef Girm M1
(b) AXA75 4F RG € MARcps 30 , /j
Ui
W. WACMINGTDNEIE? ZHcAseEELy_Gol 9x So) 152
(c)
7
(d)
6
(e)
(f)
8
(g)
(h)
7
(i)
(j)
(6) (7) (8).
(5)
Amount to be used by share- Enter here and on form Enter here and on form
Distributive Income from
holder on MI-1040(enter on Mi-1040, Page 1_ line 22 Mi-1040_ each shareholder's
page 1_ line 5, or page 2,
schedule line 34 or each shareholder's Pro- proportionate share of Single
schedule B, line 6 page 2, 1,
portionate share of per- business tax paid_ on page 2, schedule 2, Iine 43)
difference between column sonal property taxes (See instructions)
and column 5 paid on inventories Or
(Sea instructions) the credit for franchise
fees paid_
(See-instructions)
(a) 19,730.6 Y6.GL
(b) 16 7e9,0 Y6.L4
(c)
(d)
(e)
(f)
(g)
(h)
NW 88326 Docld:32245535 Page 208 Dc0-
63:
==================================================
Page 209
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D-1040 (NR) City 0f DetROIT InCOME TAX
City OF
INDIVIDUAL RETURN _NONRESDENT
1976
3
DETROIT
or other Iaxable Year beginning 976, ending 19
First Nome and Initial Last Name Social Security Number EXTENSION NUMBEI
Earl Ra and Marge Ruby
2
Your Occupation If You are an EMPIC; PLEA SE (If joint return of husband and wife, use First names and middle initials of both) enter Federal EA;Plc)
Print Home Address (Number and Street or Rural Route)
Sales
Identi
Kcuriofedeca her;:
8
OR Spouse'$ Social Security Number
TYPE 18135 Livernois
Town or Post Ofice State Postal Code APP_ Spouse'$ Occupation IP FP
Detroit, Michigan 48221 Housewi fe OA.
A_ If married, is spouse 0 separate return? YES No. #f Yes, enter spouse'$ first nome_
7
B_ Enter the name and oddress used on Your return for 1975 (If the same as above write "Same" If different, indicate date
moved,) If none filed, give reason. Same Auditor
5
Regular 65 or over Blind Entef
SCHEDULE A _ L EXEMPTIONS 1 YOURSELF number 0f
exererkion:
{
spouSE
2 Enter first names of each of your DEPENDENT CHILDREN who lived with You: Enter Ro_ 1
Enter figure
NAME last column to
Relationship
yotontomivad adring
7
3 right for each name listed 1976
OTHER
6 DEPENDENTS
3
Total exemptions 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
Totol wages reported Detroit Income Tax WAGES, ETC_ EARNED 6 Employer' $ Name Where employed (City and State) on Dw-2 or W-2 Withheld IN DETROiT
CoBo CLEANERS TNc Dzjee Zi Micd, $,
16s.29e O0 13e.k2 <3.9l2
Ce0 Rumn
sZies,
TNc Dzzroit; nictl_ i6 5osi05 LLe_ 00 8252'82
6. TOTALS 80 700 0o
402o
L00 Je 3So1od
1.
1
7. Rentol income (or loss) tangible property in the of Detroit from page 2, Schedule B, line (3(
8 , Other income (or loss) partnerships, etc: L from page 2, Schedule ;, 4 +80..409
9 Gain (or loss) from sale or exchange of tangible property in the of Detroit ~ from poge 3, Schedule E, Jine 10 _
10. Net profit (or loss) from business T from page 3, Schedule C, line 8
11. Income (or loss) T TRUSTS AND ESTATES ONLY _ page 4,. Schedule G, line 7 (see instructions for: exemption to enter on line 15)
12_ Total (add lines 6 Ihrough 11 of last column) 4e2nz
9
13_ Less: Deductions page 2, Schedule M, line 5 (if none, enter zero)
14. Total (line 12 less line 13) 95 463'71
8
15. Less Amount for Exemptions: Enter number of exemptions from line above and multiply " by 5600.: (1a2 2 00
16. TOTAL INCOME SUBJECT To TAX 94 263172
17 . city Of DETROiT TAX: Multiply Iine 16 by 005 (V%)
4713 / 6
PAYMENTS AND CREDITS
18. a_ Tax withheld by employer ~from line 6 above ATTACH Forms Dw.2 or w.2 0 So '40
6
b_ Payments and credits on 1976 Declaration of Estimated Detroit Income Tax
1
c Other Credits W explain in attached stalement (See Instructions)
19_ TOTAL ~ Add Lines 1 8a, 6, and 080 /9 0
TAX DUE OR REFUND 1
20. If your payments (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT
Go8 '69
21 . Check box if wish overpayment on line 20 t be: (A) Credited on 1977 Eslimated Tox @ (B) 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 peyable to: "TREASURER CITY Of DETROIT ' A balance due of less than one dollar (S1.00) nded not be
declare that have examined this return (including accompanying schedules and statements) .and Io Ihe best of my knowledge and belief i1 i Irue, correct and
complete. If prepared person other. than taxpoyer, his declaration i, based on all information of which he has any knowledge. SIGN
SIGN HeRE
HERE (Taxpayer signalure and date) (Signalure of preparer other than taxpayer) (Dato)
SIGN HERE
GORDOn L_HOLLANDER;_PC:_
(Spouse'$ signature and date) (If joini return, BOTH HUSBAND AND Wife Must SIgN) CERTIFIED PUBLIC ACCOUNTANT
NW 88326 Docld: 52245-3s Fjggce gpartment, Treasury Division, 104 City-County IGd DIBSTGEMMlEAR0AR26
ocTuoitc WcT D € r"rn nv nnn 0AX 7eee 4 -
Your
City, Zip
filing
from
8
123 from City
from line
City
from
from
You
Paid:
bY
==================================================
Page 210
==================================================
iico_ of Treasury Mne JojLY 196
:ZJAOX Sckedule 0f Partners or Shareholders _
1976 3
Partzership, Subchanter $ Professional Corp:
See instructions on reverse side
8
1 Name: 2 Account Number:
Cobo-Rumar Sales , Inc. 38-1812707
9
!h;h SU;MARY
6
3 Total Number of Partners or Shareholders _
4 Total Number of Qualified Partners or Shareholders from Part IL_enter here and on C-8000, line 60a _
iNai;h QUALiFizD PARTNERS o3 SHAREKOLDERS
7
6 NAME AND ADDRESS B SOCIAL C % D SHAREHOLDER'S E* % PARTNER'S or SHAREHOLDER'S
SECURITY No. Time SALARY Own; F Share of Bus. Inc, G Share of SBT Paid 6
Earl Ruby
4380 Stoney_ River Birm. 1002 18,000 00 1007 00 00 8
% 00 % 00 00
% 00 % 00 00
7
% 00 % 00
% 00 % 00 . Oq"
% O0 % 00 00
% 00 % 00 00
7 00 % 00 00
% 00 % 00 00
% 00 % 00 00
MaV;h; Mtl Non-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is needed submit separate schedule and enter totals on lino 7_
00 % 00 00
00 % 00 00
00 7 00 00
00 % 00 00
O0 % 00 00
00 % 00 O0
00 % 00 00
00 % 00 00
00 % 00 00
00 % O0 00
00 % Q0 00
NV7B33267 Wopkde32z1471x Pagez7n41)
O0 0 Oo
Dapt:;
Corp-
==================================================
Page 211
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Muillo jiE' U'
Calendar Year 19_ ThiS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONI
Or FiSCAL YEAR 3
Beginning 19_
Ending 19_ FOR OFFICE USE ONLY 8
INDIVIDUAL (Check
FIDUCIARY One) RUBY EARL & MARGIE 6 9 8 8 5',5 8
181 35 LIVERNOIS AvE
DETROIT MI 48221
Husband' $ Social Security No.
Mo_ Yr Wife' $ Social Security No
7
09 30 76 698855 007 82 LL: 76 | 12
Retroactive Date Intangible Account Number Type County File Date
Ifthis return is tor an Estate, give Probate. POSTED: AUDiTed: Employer Identification No_ 6
File No County Date of Death
LINe LINE
8
No. Computation of Tax Due AMOUNT
NO. TAX
1 _ Accounts and Notes Receivable (non-income producing only) 1
2 Less Accounts and Notes Payable 2
7
3_ Balance Taxable @ 1/1Oth of 1%
4. Accounts ad Notes Receivable (income producing only)
;
5. Less Accounts and Notes Payable (use ontv that portion, if any, not used in Line 2)
6. Balance Taxable 6_
7 Income applicable to balance 7 .
8. Tax @ 3 Vz% of Income (Line 7) or 1/1Oth of 1% of Balance (Line 61, whichever is greater: 8
9. Stocks ad Bonds Schedule A, Column 9 9
23722
10_ Mortgages ad Land Contrects Schedule B, Column 8
11 _ Annuitias Schedule C, Column 9
"8.
12_ Beneticiary Return (attach copy hereto) 12_
13 TOTAL 1 3.
3226.2
14, Less Statutory deduction (S175.00 or S350.00 by husbands and wives joint return) 14.
30 0o
15 BALANCE DUE 5_
3,016.73
16. Cash on Hand or in Transit 9s of retroactive date (include cash in safety deposit boxes) 6
17 Bank Deposits in Banks Located Outside of Michigan or Withdrawn trom Mich: 17.
Banks or A8s'n8. atter 18. Savings in Building ad Loan Ass'ns. Located Outside of Michigan retroACTiVE DATE, 18
19. TOTAL 19
20. TAX @ ZO per S1OOO.00 of Line 19 20
21 _ TOTAL TAX DUE (Line 15 plus Line 21
322433
22. Less Advance Payment of Tax 22
23_ TOTAL TAX OUE 23_
3.626,6 3
24 Penalties & Interest; Penaltv %, S_ Interest % Months, S 24
25. TOTAL AMOUNT DUE With This RETURN (Due on or before April 30) 25_ 2, 034a3
Or Four Months after End of Authorized Fiscal Year
Make Remittance Payable To: "STATE OFMICHIGAN Wite your Intangible Account No: on your check
Mail_ MICHIGAN DEPARTMENT OF TREASURY, TREASURY BUILDING, LANSING, MICHIGAN 48922
Business or Profession of Taxpayer: Amount Single Bueinese Tax Paid: Single Business Tex Account No.= Telephone Numbor:
SALES 863 _ 0400
Year Of Last Return Filed: Address of Last Raturn:
93 SAmE
Check which Method your return is Computed by. NOTE: #this return is from 8 Trustee attach 8 list 07 Names &nd
AETROACTIVE DATE MONTHLY AVERAGE Addresses of Beneficiaries and Date of Creation ot
declare under the nannlting imnngedby Act No_ 301 PA_ of 1930, 08 Amenclad_
Iin) Ilia toiimm, Imxhullnu miy atinomviniviniu a"hoillaa 0mti #iaiainamia mar 1vddii
o*biiimini| Ivy InO mnd Io Ilie Ivout of imv hnwlailum bii( huliot ia trua, oocroot
0n1d complate raturn: Signaltuo
Fropared By:
GORDON-LHOLLANDERPe
Signature CERTIFIED Public AccOUNTANT
NV.883264 Dnc 33633-NFSgeFEn-M#LE ROAD
Title: (State whethor Indlvlduul; Ornof, Exocutor, Administratot _ Trujtoe, Otc.)
76
Day
City
tiling
201
To:
Trust
==================================================
Page 212
==================================================
J1ytiuyu
MCHIGAN UNCIVIduAL INCOMe TaX RETURN 3
for 1975, or taxable year beginning 1975, ending 19
8
Your social secuty numbel Firsi name ad initial ( joint relurn, use lirst names and inilials 0t both) Lasi name
Earl R. and Marge Ruby
9
Your occupalion
Home address (number and streel or rural route)
Sales
18135 Livernois
ZIP code Spouse's social security 0o 2
City, lown or post olfice and State
6 Detroit, Michigan_ 48221
1 Residency Slalus during tax
Spouse'$ occupation
7
X Resident Non-resident Part-year resident, from to
1
Filing Status: {eEneonere the number of exemptons claimed o your
A Single
federal income tax return
%
B Married , filing jointly See
c Married, filing,separately (see instructions, page 2) (b) Special exemption for paraplegics & quadriplegics Unstructions
Name of Spouse
(c) TOTAL EXEMPTIONS, add lines I(a) and 1(b) 8
(Give spouse s SocSec No in the space provided)
the 'YES boxes NQIE; Il you check
2_ STATE Do you wish to designate $2.00 of your taxes for this fund? YES no
it will not increase your tax Or
CAMPAIGN FUND joint return, does your spouse wish to designate $2.00? YES NO reduce your retund_
3. Adjusted gross income as defined in the InterpaeRevenue Cede zndwhicb should bereported on Federal Form 1040,
128,23l12
7
Attach copies o any Federal schedules (hat loss or line 15, or 1040 A, line 12 from gross incoma. (Sec page 5 of ihe instructions)
9 4. Additions to adjusted gross income, (from page 2, line 35)
5 8 5. Total, add lines 3 and 4
6. Subtractions from adjusted gross income, (from 'page 2, line 44). L75 0 36 1& !
7. Subtract line 6 from line 5
3
8. Residents multiply exemptions claimed on line 1 by 51,500.00 (part-year and nonresident allowance from line 48)
0347/3
9_ 472
9. Income subject to tax (subtract line & from line 7) _ Z3/A8
10. Tax: multiply line 9 by 4.37% (.0437) 10.
8
CREDITS (See instructions pageb 7-10) AMOUNt Paid CREDIT
ool& Ila;
3d09
11. Income tax paid to Michigan cities _ 1
12. Contributions to Michigan colleges & universities (attach receipts) _ 12a.
13. Income tax to another state (attach copy of return)_ 13. 2ol2&
14, Total credits (add lines Ila, 12a, and 13a) , enter total here 34IZ9
15, Income tax, subtract line 14 from iine 10 (if line 14 is greater than line 10, enter 'NONE)
16. Credits from any Ml-1040 CR form. (see page 9 of instructions).
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 18
19. Tax not eligible for credit; enter 3.5% (.035) of line 17 _ 19.
20. Subtract line 19 from line 18, if line 19 is greater, enter 'NONE' 20 .
4 21. Property tax credit, 60% (.60) of line 20, (S500.00 maximum) 21.
22. Personal property tax on inventory: 22) 39% (.39) 22. 3
PAYMENTS 152I5Q
23. Michigan tax withheld (attach State copy of W-2)
Oo 00
24. Michigan estimated tax payments
3 25. 1974 overpayment credited to 1975 _ 6 /Szs8
3 26, Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25
PaY
26 .
1YoBL
27 . If line 26 is less than line 15, enter BALANCE OF TAX DUE HERE.
1 28. If line 26 is than line 15, enter AMOUNT OVERPAID REFUNO
28_
29 29. Amount of line 28 to be REFUNDED TO YOU:
NOTE: all 0/ overpayment (line 28) i5 to be
30. Amount of line 28 to be credited to 1976 estimated tax _ 30 refunded (line 29), make no entry on Iine 30
OFFICE USE
This return is due April 15, 1976 or on the I5th of the fourth month after the close of your tax year.
Under penalties ol perjury, deciare that have examined Ihis return. including accompanying schadules and
atatementa, and to the bes; of my knowledge and beliel i ia true correct and complete: I preoared by perjon
Other Inan ',ne faxpayer; his declaratlon I baded on al inlormation ol which he has any knowledge.
Dale
Sign Your signature Date IGoRDUNe e' "HTOLEANbER Fc;
NW 88326 pecld;32245535
'2
Page_31? Both' must sign even if only one had income)
1Ac72
CERTIFIED PuBLic , ACCQHNTANT:
DA^r
year:
92q[81 L28,
0 0
3
paid
paid
I
greater
day
==================================================
Page 213
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'im1 4! 1yi8
2 . Exemptions (number of allowable exemptions times S1.500.00)
3. Subtract line 2 line 1 (This is your estimated laxable income)
3
4 _ Estimated tax (line 3 times .046 or 4.6%)
5 LESS: Total estimaled tax credit for Michigan City income taxes personal property tax on inventories 8
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
8
MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS_ 1976
FORM MICATGAN: Mi-1040-ES
For calendar year 1976 or fiscal year ending 19_ STATE OF MiCHiAN
Iut Department of Treasury
5
7
First name and inilial (if joint declaralion, USt names and initials of both) Last njme Your social security numbet
Spouse' $ social security number
Please Address (number and streel)
5
Or 'Ype
Cily, State, and ZIP code 8
[ 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 S100, no declaration is required) .
1
4_ computATion OF INSTALLMENT. Check proper box below ad enter amount indicated.
If this declaration is April 15, 1976, enter 1/4 0l 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 lax 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 less line 6)
8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credil) with this return eliminates the of
quarterly estimates.Enter lump sum payment _here_
have examined this declaration and to the best of my knowledge it is correct_
Signaturets)_ Date. 19
joini esiimate , both"husband and" Wife must Sign
MicHiGAN DECLARATION OF ESTIMATED income TAX For InDividuALS_
1976
FoRM MichTGAn
Mi-1040-ES
Tul
For calendar year 1976 or Iiscal year ending 19 STATE Of MichigAN
Department of Treasury
I
First name and initial (if joini declaralion, Use names and initials of both) Last njme Your social securily number
Earl R: and Marge Ruby
Please Address (number and streel) Spouse'$ social secufily number
or IYpe 18135 Livernois
City, Stale, Zip code
Detroit, Michigan 48221
1 Your estimate of 1976 income tax SLee:e4
2 Estimated income tax withheld and to be withheld during entire year of 1976
3 ESTIMATED TAX (line ! less line 2). (If less than sj0o, no declaration is required) _ 00 0 5
computation Of installmenT, Check proper box below and enter amount indicated.
If this declaration is April 15, 1976, enter 1/4 of line 3; September 15, 1976, enter 1/2 of line 3 J
400.02
due lo be liled on: JJune 15, 1976, enter 1/3 0l line 3; Jan. 15, 1977, enter amount on line 3
5. If you had a overpayment 0 your 1975 income tax return which you elected to have applied as a
credit against your 1976 eslimated tax, enter the amount here
6_ To apply entire overpayment credit to this installment and any excess to (he next, enter here (he amount on line 5. To
spread credit evenly lo each installment, divide it by number 0 installmenls and enter results here
7 . Amount to be with this declaration at lime of (line less Iine 6)
8_ Note: The payment o (he estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the
of quarterly estimates. Enter lump sum payment here
NW 88328e 932i8282/4.983l3rapdyc2 3he best of my knowledge it is correct:
nate 19
from
print
liling
print
and
liling paid
filing
==================================================
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D-1040 (NR) City OF DETROIT INCOME IAX 3
CITY OF INDIVIDUAL: RETURN_NONRESIDEN]
1975
DETROIT
or other taxable Year beginning 1975, ending 19 8
First Name and Initial Last Name Your Social Security Number EXTENSION Numbei
Earl Rs and Marge Ruby
Your Occupation If Emioi
8
You are an PLEA SE (If joint return of husband and wifez_Use first_names ond 'middle initials of both) Sales enter your Federal EMPLO
PRINt Home Address (Number and Street OI Rural Route) Identification No. here:
OR Spouse'$ Social Security Number
TYPE 18135_Livernois_
Town or Post Office State Postal Zip Code Spouse'$ Occupation IP FP App
OA- Detroit, Michigan 48221
1
A. If married, is spouse filing separate return? YES NO. If yes, enter spouse'$ first name
B. Enter the name and address used on Your return for 1974 (If the same Os above write "Same" If diferent, indicate date
6
moved ) If none' filed, give reoson: Same Auditor
Regular 65 Or Over Blind Enter
8
number 0f SCHEDULE A W EXEMPTIONS 1. YOURSELF exemptions
checkod SPOUSE
2 Enter first names of each of your DEPENDENT CHILDREN who lived with You: Enter
I
Denise Joyce
NAME Months lived in
7
Enter figure in the last column to Relationship your home during
right for each name listed 1975
OTHER
6 DEPENDENTS
3
Totol exemptions 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
Jotal wages reportod Detroit Income Tax WAGES, ETC_ EARNED
" Employer' $ Name Where employed (City and State) on DW-2 or W-2 Withheld IN DETROIT
02.9 CceANees Tc 23 Mieri 83 70 0 00 0 3 23122 35, 0 60
{ Ikse 11 8 25632'
33 0' 0 0 43 293100
6. TOTALS 1:
1
7 Rental income (or loss) from tangible property in the City of Detroit from page 2, Schedule B, line
13
3 fogiso
8. Other income (or loss) from partnerships, etc I page 2, Schedule F, line
9. Goin (or loss) from sale or exchange of tangible property in the City of Detroit page 3, Schedule E, Iine 10_
10_ Net profit (or loss) business L page 3, Schedule C, line 8
11. Income (or loss) TRuSTS AND ESTATES ONLY _ from page 4, Schedule G, T (see instructions for exemption to enter o Iine 15)
46 154 13
12_ Total (add lines 6 through 11 of last column)
9
13. Less: Deductions from page 2, Schedule M, line 5 (if none, enter zero)
14. Total (line 12 less line 13)
4K,3443
1 3400 00 8
15. Less Amount for Exemptions: Enter number of exemptions from line above and multiply; by $600-
43,75443
16 TOTAL INCOME SUBJECT To TAX
2/8 '72
17 . City OF DETROiT TAX: Multiply line 16_by 005 (Vz%) 6
PAYMENTS AND CREDITS 3 39,64
18. a. Tax withheld by employer 5 from line 6 above _ ATTACH Forms DW-2 Or W.2
6
b. Payments and credits on 1975 Declaration of Estimated Detroit Income Tax
1
c. Other Credits explain in attached statement (See Instructions)
3390
19_ TOTAL 7 Add Lines . 1Ja, 6, and
TAX DUE OR REFUND 20 23 1
20. If your paymenfs (line 19) are than Your tax (line 17), enter amount of OVERPAYMENT
21. Check box if you wish overpayment on line 20 to be: (A) 0 Credited on 1976 Estimated Tax gr (8) K Refunded.
22_ If your tax (line 17) is than your payments (line 19) eter amount of BALANCE DUE Poy in full with this return
Make_check Peyoble te: 'TREASURER_CITY_QF_DETRQIL " A_balonce due e less than one dollar (S1.00) need not be
declare that have examined this return (including accompanying schedules and statements) and to Ihe bestof my knowladge and: belief it i true, correct and
complete. If prepared by a person other than taxpayer, his declaration is basod on information of which he has any knowledge. SIGN
SIGN HERE
(Taxpoyer" signature and date) "(Signature of preparer other than toxpayer) (Dato) HERE GORdON LHOLLANDER Pc_
NW 883261
BGcdE8iza5535iRag6z186)
(If return, BOTH HUSBAND AND Wife Must SiGN) CERTIFIED PUbLIC ACCQUKFANT)
City,
from
8
3941_
from
from
from from
Iine
larger
larger
Paid.
all
joint
==================================================
Page 215
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"Lii Ui 7 njiju /
Revenue Division ThIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONi El
INTANGIBLES TAX RETURN
3
Calendar Year 19
OR FISCAL YEAR
2
Beginning 19 do NOt Write Above This Line
Ending_ 19 RUAY EARL R MaRGJE 6 9 9 9 5; 5
8
Individual_ 18135 LIVERNQIS A VE
Partnership
Check DETROit MI 48221 68 Michigan Corporation One
Foreign Corporation POSTED Filed
Fiduciary IF ESRTREGURN MRoc
7
Momth DAY YEAR County
11 30 75 698855 0 0 7 82 75 12
File No
RetROAcTivE DATE AccOUNT No_ Type CounTY city K C File DATE Date of Death_ 6
=
Line Computation of Tax Due AMOUNT Kae] TA'
No.
Accounts and Notes Receivable (non-income producing only)
8
2. Accounts &nd Notes Payable_ 2
3. Balance Taxable M/1Oth of 1%_
4 . Accounts and Notes Receivable (income producing only)
1
5. Less Accounts and Notes Payable (Use only that portion, any, not Used in Line 2) 5.
7
6. Balance Taxable
6
7 Income applicable to balance_ 7 .
8. Tax @ 3Va% of Income (Line 7) or 1/10 of 1% of Balance (Line 6), whichover is greater 8 ,
9. Stocks and Bonds Schedule A, Column 9_ 9
Saje
10. Mortgages and Land Contracts Schedule B, Column 8
1. Annuities Schedule C, Column 9
12. Beneficiary Return (attach copy hereto)
13_ TOTAL 553
14_ Less Statutory deduction ($175.00 or 5350.00 by hutbands and wives filing ioint roturn) 380 O(
15. BALANCE DUE
16. Cash on Hand o in Transit &9 of retroactive dulo (include cosh in safoty doposit boxes) _
17. Bank Deposits in Banks Located Outside of Michigan_ or0Withdrawn from Mich.
Banks Or As'nt.aftor 18. Savings in Building &d Loan Ass'ns. Located Outsido of Michigan_ RETROACTiVE DATE.
19. TOTAL 19.
20 TAX @ 404 Por]s1oo0.00 of Line 19_ 20
21 _ TOTAL TAX DUE (Line 15 plus Lino 20) 21
(oala
22_ Less Advance Payment of Tax 22
23 TOTAL TAX DUE 23 H€a/8"
24_ Penalties & Interest; Penalty %, Interest_ Months, 24
25, TOTAL AMOUNT Due 25. ~6 6
MAKE REMTTANCE PAYABLE TO STATE OF MCHGAN
Please forward Remittance tor Amount Shown Here % or betore_Aerl 30.
To: MCHGAN DEPARTMENT OF TREASURY, LANSWG, MCH 48922 (or Dontbs attorond 0t oubborbsed dscal reot)
IMPORTANT;_Be Sure to Answer the following Question When Applicable:
1 Business or Profession of Taxpayer
SALES
Phono No__
SL3 0403
2 Give year of last return filed.
1934
Address of Last Return
SAME
3. Check here if return is computed on Retroactive Date Method or Monthly Averoge Method
A_ If taxpayer i corporation give Stale &nd Date of Incorporation_ Federal Employars Identification Numbor
5_ If this is the return of Trustee attach list of ndmos &nd addressos of baneficiarios &nd dato of creation of Irust.
6. If this i Business Return 0 copy of the Balance Shedt &9 of tho closa of Iho Tox Year mutt bo attached
tleclare unaler Il nanalltog hniiaed hv Art Nn_ 701 P, ^ 0f 1979, 40 Amentleal, Ilit Ihl rohmn, Includlno anv arcomhanyinu chealuilee and batcnieu Uhsr Iuon_oramlned by
anel 10 Ilo hott o( my knowlurlua Ail Imliol h iiue , (Mi0u $ 0imt1 comnlalo faiutn. Sma Iol Jocurlly Numbor
GORDON L HOLLANDER_Rc Signed
Return Propared by_ TERTTTTEV PUBLIC ACCOUNTANT Signed
NW 88326, Docld:32245535 poj852185ST TEN MILE ROAD
Less
tow
==================================================
Page 216
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Je,tEuuci / ~
SriA.EnciORS SHASZ€; iVcOiz ~li ~ozuiiy
(if aciditiona' space is rieeced, atrzch schedule)
(1) (21 (3) (4)
3
Name and Address of Each Shareholder Social Security Number of Amount taxable 35 ordinary
Number Shares income (schedule K total 0f
lines 4 and 8 , U.. 1;20S) 2
(a) Emk U 15./
8
039 SToi; 21'8 52.`{3;n m' 2259
40240,04
(b) 0F Ga3k4 MAcyS
NGty) +VEO C+ICA6o Tk. Gala
46 340.85
(c)
7
(d)
(e)
%
(f) 8
(g)
(h)
7
(i)
(j)
(5) (6) (7) (8)
Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
pago 1_ line 5, or page 2 , holder on Mi-1040 (enter on MI.1040, page 1, line 22 Mi-1040_ each shareholder's
schedule B, line 6 page 2, schedule 1, Iine 34 or each shareholder'$ pro- proportionate share of Single
on page 2, schedule 2, Iine 43) portionate share of per- business tax paid_
difference between column sonal property taxes (See instructions)
and column 5 on inventories Or
(See instructions) the credit for franchise
fees
(See instructions)
(a) #LSYo-y
(b) Y6, &yu.05
(c)
(d)
(e)
(f)
(g)
(h)
NW 88326 Docld:32245535 Page 216
PAeE 2 Cs_
Xt
2630
paid
paid
==================================================
Page 217
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jiu Z-iY7U
MichIGAN INcIVIduaL INcOME TAX RETURN
3
for 1975, or taxable year beginning 1975, ending 19 8
Your social security aumber First name and inifial (l joinf relurn, use lrst names and inilials 0f both) Last name
Earl Ra and Marge Ruby
Your occupalion
9
Home address (number and slreet or rural route)
Sales
18135 Livernois
ZIP code Spouse $ social security no_ 2
town 0r post olfice and State
6 Detroit, Michigan 48221
Spouse's occupation
Residency Slalus during tax year: 2
Resident Non-resident Part-year resident, from to
7
1
Filing Status:
1 EeEnegmere the number of exemptons claimed on your
A Single
B Married , jointly federal income tax return see 5
C Married, filing separately (see instructions, page 2) (b) Special exemption for paraplegics & quadriplegics Unstructions
(c) TOTAL EXEMPTIONS, add lines I(a) and 1(b)
Name of Spouse
provided) (Give spouse's Soc Sec No. in the space NQIE; If you check the YES boxes
8
2 STATE Do you wish i0 designate $2.00 of your taxes for this fund? YES NO
will not increase tax or
CAMPAIGN FUND It
joint return, does your spouse wish to designate $2.00? YES No reduce your relund_
3. Adjusted gross income as defined in the Internal Revenue Cede endwhicbshould_beceported on Federal Form 1040,
178 63clug
Attach copies 0 any Federal schedules (hat indicate Ioss or deduction
7
line 15, or 1040 4, line 12 from gross incoma. (Sec page 5 of rhe instructions)
4 4. Additions to adjusted gross income, (from page 2, line 35)
036u 5_
{ 5. Total, add lines 3 and 4
6. Subtractions from adjusted gross income, (from page 2, line 44) 05 0 36 1 !
7 , Subtract line 6 from line 5 0 0
7
8. Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48) 8
034
9_ 173
9. Income subject to tax (subtract line 8 from line 7) _ Z3/798
10
10. Tax; multiply line 9 by 4.37% (.0437)
8
CREDITS (See instructions pages 7-10) Amount Paid CREDIT
Dolg Ila.
Ad04
11. Income tax paid to Michigan cities _ 1
12. Contributions to Michigan colleges & universities (attach receipts) 1Za.
13, Income tax paid to another state (attach copy of return) . 13. 2998
14 14. Total credits (add lines 1la, 12a, and 13a) , enter total here 3+T7164
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)
Do not complele 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 18
19. Tax not eligible for credit; enter 3.5% (.035) of line 17 _ 19.
20. Subtract line 19 from line 18, if line 19 is greater, enter 'NONE' 20.
4 21. Property tax credit; 60% (.60) 0f line 20, (ss00.00 maximum) 21.
22. Personal property tax 0n inventory: 62 39% (.39). 22. 3
PAYMENTS 1S So
23. Michigan tax withheld (attach State copy of W-2)
Oo0 00
[
24. Michigan estimated tax payments
6 25. 1974 overpayment credited to 1975 61Szl58
3 26. Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25
PAY
26.
14o]
27. If line 26 is less than line 15, enter BALANCE OF TAX DUE HERE_
28. If line 26 is than line 15, enter AMOUNT OVERPAID 28. 1
29. Amount of line 28 to be REFUNDED TO YOU:
REDiEDa all 0( overpaymeni (line 20)45 10 be
30. Amount of Iine 28 to be credited to 1976 estimated tax _ refunded (line 29) make no entry on Iine 30_
Tffice USE
This return is due April 15, 1976 or on the I5th day %f the fourth month after the close 0f youd&ae Yea;
Under penalties o/ perjury; declare that have examined Inis return. including accompanying schedules and
and lo Ihe best 0t knowledge and belief It is true. correct end complete: If predared by a person
otht8rnean: ,nadac8y9r. his declaration Is Dased on all information ol which he ha: any knowledge
Kpa te
Sign Your signature Date EoRDUNrez2' "HRO_E ANbER; Fc
Here
BoTH musi Jign even i only one had income)
CERTIFIED: PUbLIC: ACCQIHNJANT:
NW 88326 Docld 32245933repuaila i2a7:
uail ranun
4196275n,WESTirTEM MMhhe IRPA8 Drane H Lmting 43904
City.
filing
your
L28_
3
paid
greater
my
0^
==================================================
Page 218
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D-1040 (NR) City OF DETROIT INCOME TAX
CITY OF INDIVIDUAL RETURN_NONRESIDENT
1975
3
DETROIT
or other taxable year beginning 1975, ending 19
First Name ond Initial Last Name Your SocialSecurity Number EXTENSION NUAABE 8
Earl Ra and Marge Ruby
Your Occupation If You are an ENPIO'
PLEASE (If joint return of husband end_ wife Use first names and middle initials of both) Sales enter Your Federal Eki?1o}
8
Identification No. here; Print Home Address (Number and Street or Rural Route) Social Security Number Or Spouse' $
TyPE 18135 Livernois_
Town or Post Office State Postal Code Spouse'$ Occupation IP FP 'APP.
OA. Detroit, Michigan 48221
As If married, is spouse filing separate return? YES NO. If yes, enter spouse'$ first nome.
7
B. Enter the name and address used on Your return for 1974 (If the same as above write "Same If diferent, indicate date
moved ) If none filed, give reason. Same Auditor
6
Regular 65 or Over Blind Enter
number of SCHEDULE A = EXEMPTIONS 1 YOURSELF exemption:
{
checkod SPOUSE
2 Enter first names of each of your DEPENDENT CHILDREN who lived with You: Enter 1
Denise Joyce
Enter figure
NAME last column Io
Relationship
yoonlomixadring
7
Tighi for each nome listed 1975
OTHER
6 DEPENDENTS
3
Total exemptions 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; Sa indicate (W) for wife
Total woges reportod Detroit Income Tax WAGES, ETC." EARNED
5 Employer' $ Name Where employed (City and State) on Dw-2 or W.2 Withheld IN DETROIT
22.9 CSeaNees TNC Za ^iari 0 0 00 0 3 22722 35, 06 0 20
: kSeo 11 J 8 25802
6. TOTALS
33 '0 0 43 280i00 1
7. Rental income (or loss) from tangible property in the of Detroit S page 2, Schedule B, line
39413
8. Other income (or loss) from partnerships, etc: S page 2, Schedule F, line
3 Sogijo
9. Gain . (or loss) sale Or exchange of tangible property in the City of Detroit L from Page 3, Schedule E, line 10
10. Net profit (or loss) from business S from page 3, Schedule C, line 8
M1= Income (or loss) _ TRUSTS AND ESTATES ONLY _ from page 4, Schedule G, line 7 (see instructions for exemption to enter on line 15)
5y4
12_ Total (add lines 6 through 11 of last column)
9
13. Less: Deductions page 2, Schedule M, line 5 (if none, enter zero)
14_ Total (line 12 less line 13)
44.54.43
3 460 00 8
15. Less Amount for Exemptions: Enter number of exemptions from line above and multiply: by $600
16. TOTAL INCOME SUBJECT TO TAX
43,75443
17_ CITY Of DEtROit TAX: Multiply_line 16 by 0o5 (Va%)
2/8 '77 6
PAYMENTS AND CREDITS
3 39,08
18. a. Tax withheld by employer 5 line 6 above C ATTACH Forms DW-2 Or w.2 6
b. Payments and credits on 1975 Declaration of Estimated Detroit Income Tax
J
Other Credits S explain in attached statement (See Instructions)
19 TOTAL L= Add Lines 1Ja, 6, and
3392
TAX DUE OR REFUND 20 33 1
20. If your payments (line 19) are larger than your tax (line 17), enter amount of OVERPA YMENT
21 . Check box if You wish overpayment on line 20 to be: (A) 0 Credited On 1976 Estimated Tax gr (B) K Refunded:
22. If your tax (line 17) is than Your payments (line 19) enter amount of BALANCE DUE in full with this return
Make check Peyeble_to: 'TREASURER_CIY_QF_QETRQWL _ A belance due %f less than one_dollor_(SL OO) need net_be_Poid;
declare that have examined this return (including occompanying schedulos and statements) and to the best; of my knowledge and belief it is truo, correct and
complete. If prepared by person other than taxpayer, his declaration i bajed on all information of which he has any knowledge. SIGN
SIGN HERE
(Taxpayar' signature and date) '(Signaturo of preparer other Ihan Iaxpayor) (Dato) HERE
SIGN HERE
GORdON LHOLLANDER; PC
(Spouso signaturo and dato) (lf joint raturn, BOTH HUSBAND AND Wife Must SigN) CERTIFIED Pubiic ACCOUMTANt)
NW 88326 Docld: 32245525: PaaRclfepartment, Treasury Division, 104 City-Ca98781Wq8e,TeN}rMILEiRaen 482261r
Zip City,
from
8
0
City from
from
from
from
from
larger Pay
==================================================
Page 219
==================================================
{:i"1o I 9i6
2 . Exemptions (number of allowable exemptions times 51,500.00)
3. Subtract line 2 from line 1 This is your estimated laxable income) 3
4 Estimated tax (line 3 times .046 or 4.6%)
5_ LESS: Total estimated tax credit for Michigan City income taxes. personal property tax 0n inventories,
Michigan homestead property taxes ad contributions t0 Michigan colleges and universities
8
6. Subtract line 5 from line 4_ Enter here and on line below 8
MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS_
1976
FoRM MichIGANN Mi-1040-ES
For calendar year 1976 or fiscal year ending 19_ STATE 0F MichiGAN
Iu( Department of Treasury
First name and initial (if joint declaration, use names inifials of both) Last name Your social security number
7
Please Address (number and street) Spouse'$ social securily number
prinf
6
or fype
City, State, and ZIP code
1 Your estimate of 1976 income tax
8
2. Estimated income tax withheld and to be withheld during entire year of 1976
3.. ESTIMATED TAX (line less line 2). (If less than $100 , no declaration is required)
4 Computation OF INSTALLMENT. Check proper box below and enter amount indicated.
7
If this declaration is April 15, 1976, enter 1/4 of line 3; September 15, 1976, enter 1/2 of line 3
due to be fiied on: June 15, 1976, enter 1/3 of line 3; Jan_ 15, 1977 , enter amount on line 3
5. If you had a overpayment 0 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 ay excess to the next, enter here the amount on line 5. To spread
credit evenly to each installment, divide it by number of inslallments 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 of
quarterly estimates_Enter lump sum payment here
have examined .this declaration and to the best of my knowledge it is correct.
Signaturels) Date. 19
joint estimate both husband and wife must sien
MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS_ 1976
FORM MichGAN;
Mi-1040-ES
For calendar year 1976 or fiscal year ending _ 19 STATE Of MichiGAN
Department of Treasury
{(
First name and initial (if joint declaration, use names &nd initials of both) Last name Your social securily number
Earl R. and Marge Ruby
Please Address (number and streeh) Spouse $ social security number
or fype 18135 Livernois
City, State, and ZIP code
Detroit, Michigan 48221
1 Your estimate of 1976 income tax 5lee.ex
2 Estimated income tax withheld and to be withheld during entire year of 1976
3 ESTIMATED TaX (line less line 2). (If less than $1OO , no declaration is required) _ 00 05
computation 0f iNSTAlLMENT. Check proper box below and enter amount indicated.
If this declaration is April 15, 1976, enter 1/4 of line 3; September '15, 1976, enter 1/2 of line 3 Lntee:ee
due to be filed on: June 15, 1976, enter 1/3 0( line 3; Jan, 15, 1977, enter amount o line 3
5. If you had a overpaymenl 0 your 1975 income tax return which You elected to have applied a5 a
credit your 1976 estimated tax, enter Ihe amount here
6. To apply entire overpayment credit to this installment and any excess to (he next, enter here the amount 0 line 5 To
spread credit evenly to each installment, divide it by number 0/ installments and enter results here
+00-60
1_ Amount to be paid with (his declaration at time of filing (line less Iine 6) _
8_ Note: _ The payment of the estimated tax (line 3 less ay 1975 overpayment credit) with this return eliminates the filing
of quarterly estimates. Enter lump sum payment here
have examined this declaration and to the best of my knowledge it is correct_
NW 88326tDlocld: 32245535_Page 219 Date. 19_
and
filing
pfint
against
==================================================
Page 220
==================================================
~J6 'J5
#Liii Ui 'ilnaiii
ThiS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONC El
Revenue Division
INTANGIBLES: TAX RETURN
Calendar Year 19_
3
OR FISCAL YEAR
Beginning_ 19_ Do Not Write Above This Line
2
Ending_ 19 EARL & MaRGJE 6 9 8 9 5 5
Individual 18135 LIVERNOIS AvE
8
Partnership_
Check DETROit MI 48221
Michigan Corporation One
Foreign Corporation POSTED FILEd
Fiduciary if This RETURN Is Foi
Month DAY YEAR
ESTATE GIVE Proba
7
County_
1 1 30 75 698855 0 0 7 R? 75 12
File No_
Retroactive DATE AccOuNT No. Type county city K| C FiLe DATE Date of Death_
Line Computation of Tax Due AMOUNT [Kioe/ TA'
6
No.
Accounts and Notes Receivable (non-income producing onlv)
2. Less Accounts and Notes Payable_ 2.
8
3. Balance Taxable M/10th of %
4 Accounts and Notes Receivable (incomo producing only)
5. less Accounts &nd Notes Payable (use only that portion, ay, not Used in Line 2)
; 7
6. Balance Taxable
7 Income applicable to balance
7 .
8. Tax @ JV% of Income (Line 7) or 1/10 of 1% of Balance (Line 6), whichever is greater_ 8_
9. Stocks and Bonds Schedule A, Column 9_ 5
10. Mortgages and land Contracts Schedulo B, Column 8 10.
M1_ Annuities Schedule C, Column 9_
12. Beneficiary Return (attach copy hereto)
"
8a 8
13. TOTAL
380 Ot
14. Less Stalutory deduction ($175.00 or s350.00 by husbands and wivos joint return)
G
15. BALANCE DUE
16. Cash on Hand o in Transit & of retroactivo dato (include cosh in safety deposit boxes)
17 , Bank Depotits in Banks Located Outside of Michigen_ or Withdrawn from Mich.
"
Banks O1 Ats' nt. aftor
18. Savings in Building and Loan Ass'ns. Located Outsido of Michigan_ RETROACTiVe DATE.
19_ TOTAL 19.
20_ TAX 404 Por]S1000.00 of Line 19_ 20.
21 _ TOTAL TAX DUE (Line 15 plus Lino 20) 21
(oxp7
22 . Less Advance Payment of Tax 22
23 . TOTAL TAX Due 23
21221Z
24_ Penalties & Interest; Penalty %, Interest_ % Months, 24_
25_ TOTAL AMOUNT DUE 25
2/4.22/8
MAKE REMITTANCE PAYABLE TO STATE OF MCHGAN
Please torward Remittance tor Amount Shown Here
O2 er_betore_Aprll 30.
To: MCHIGAN DEPARTMENT OF TREASURY, LANSNG, MCH 48922 (or Donik aftor ond et authorkrod Becal yoas)
IMPORTANT;_Be Sure to Answer the following Question When Applicable:
1. Business orProfession of Taxpayer
SALES
Phono No__
SL3 0402
2. Give Year 0f Iast return filed:
1954
Address of Last Return
Same
3. Check here if return is computed on Retroactive Date Method or Monthly Average Mathod
4 If taxpayer is corporation give Stale '&nd Data of Incorporation_ Federal Employers Idenlification Numbor
5. If this is the return of Trustee aftach list of ndmes &nd addresses of boneficiarlos &d data ofcreation Of trust.
6. If this i Business Return 8 copy of the Balance Sheot 08 0f Ihe closo 0f Iho Tox Yoar muit b0 attached,
dleclare Umtler Ihin nanaltleg Inpmid hy Act No, 301 P ^_ of 1070, Amenelerl, Ihat Inlo rohin, Includlna any accoiijanyinu achedlules_ Jbeen oamlned b=
Atk| Iq Ili hnott o( my knowluilua Al| Imliu/ h Iiilo , Mfidi at| roimnlala (oiurn, SaaIal Jocurily Mumber
GORDON LHOLLANDER_Rc Signed
Raturn Prepored by TERTITTEV PUBLIC ACCOUNTANT Signed
NW
88326rBocld: 322455155/9675YEST
TEN MILE RQAD
Mlto ELT: MITTITTM aOnif Cr Z
RUAY
filing
tow
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Page 221
==================================================
Sitedule ? ~
SXASEACLOERS StARZc iCoiz A,c cazum
(if acditional space is reeded, atrach schedule)
(1) (2) (31 (4)
3
Nare and Address of Each Shareholder Social Security Number of Amount taxable as ordinary
Number Shares income (schedule K total of
lines 4 and 8 , US. 1720S) 8
(a) E_ 6,, i3 >_
8
3o 13
R1v2 32' B66n.3; 2582 4 2 840,04
(b) 0F G#3k4: MA?c4S
NGtYL #uSO CtICA6s 12_ Lo8ox
46.840.05
(c)
1
(d)
(e)
6
(f) 8
(g)
(h)
(i)
7
(5) (6) (7) (8)
Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
Pzgo 1, line 5, or page 2, holder on Mi-1040 (enter on Mi-1040, page 1 line 22 Mi-1040 , each shareholder's
schedule B, lino 6 page 2_ schedulo 1, line 34 or each shareholder's pro- proportionate share of Single
on page 2, schedule 2, Iine 43) portionate share of per- business tax paid_
difference between column 4 sonal property taxes (See instructions)
and column 5 paid on inventories Or
(See instructions) the credit for franchise
fees paid_
(See instructions)
(a) #LSJe-et
(b) Y6, &Yu.85
(c)
(d)
(e)
(f)
(g)
(h]
(j)
NW 88326 Docld: 32245535 Page 221
PKEE 2 C=_
77f
2430
==================================================
Page 222
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SCR+EDULz f V=
StARsHOiDZRS StAREU7 iNcomz AD crEuij
(If additional space is needed, attach schedule)
(1) (2) (3) (4)
3
Social Security Number of Amount taxable as ordinary Name and Address of Each Shareholder
Shares income (schedule K, total of Number
lines 4 and 8 , US. 1120 S) 8
(a) 828 Rxit Sbo 19.732.16
89
46k2STONEY
Rivef 6lemL1L
00
(b) 97A7 8F CEjRC, { MARcps
So3 19, 2 30'/1
Uw: WASHINGTDN (E3 CHUSAse-ELy Gol &l
(c)
7
(d)
(e)
5
(f) 8
(g)
(h)
7
(i)
(j)
(6) (7) (8).
(5)
Amount to b0 used by share- Enter here and on form Enter here and on form
Distributive Income from
holder on Mi-1040 (enter on Ml-1040, page 1 , line 22 Mi.1040 , each shareholder's
page 1, line 5, or page 2, each shareholder's proa proportionate share of Single
schedule B, line 6 page 2, schedule 1, line 34 or paid. on page 2, schedule 2, Iine 431 portionate share Of business tax
difference between column sonal property taxes (See instructions)
and column 5 on inventories Or
(Sea instructions) the credit for franchisa
feos paid_
(See instructions)
(a) 19,72246 46.6/
(b) 16 Jeeuf Y6.6 (
(c)
(d)
(e)
(f)
(g)
(h)
(j)
NW 88326 Docld:32245535 Page 222 PLAF C
per-
paid
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Page 223
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sico. of Treasury DMASZ Ju6_yY
€-88*33 Sckecule 0f Partwers or Sharekolders _
1976
Parizership, Subchawter $ Professional Corp: 3
See instructions on reverse side 8
Name; 2 Account Number:
Cobo-Rumar Sales Inc. 38-1812707 8
i:;h: SU;RAARY
3 Total Number of Partners or Shareholders .
0 Total Number of Qualified Partners r Shareholders from Part II_enter here andon C-8000,line 60a
i:V4;h} QUALIFIED PARTNERS Or SHAREHOLDERS
7
A NAME AND ADDRESS B SOCIAL C % D SHAREHOLDER'S E % PARTNER'S or SHAREHOLDER'S
SECURITY NO. Time SALARY Own; F Share of Bus, Inc: G Share of SBT Paid
Earl Ruby_
5
4380 Stoney River Birm. 1007 18,000 00 1007 00 00
% 00 % 00 00
8
% 00 % 00
2 00 % 00 00
L
2 00 % 00
% 00 % 00 00
% 00 % 06 00
% 00 % 00 O0'
% 00 % 00 00:
2 00 % 00 00
IPAihn ! NON-QUALIFIED PARTNERS OR SHAREHOLDERS: If more space is neoded submit separate schedule and enter totals on Iine 7.
00 9 00 00
00 % 00 00
O0 % 00 00
00 % 00 00
00 % 00 00
O0 % 00 00
00 % 00 00
00 % O0 00
00 % 00 00
00 % 00 00
00 % 00 00
Totals (Ratt Iand Part II)) 00 % O0 00
NW-88326-Docid: 37245535 Page 223"
Dapt.
Corp-,
==================================================
Page 224
==================================================
"c Jepi. 0 {reasur
68-312 Seedluz 0f ?zrzers o S_zreto lers_ 1976
Parirership, Suichamier $ Professiomal Corp ;
See instructions on reverse side
2 Account Number:
8
Name:
Cobo Cleaners Inc 38-1.806433 8
SU;IRRARY
08 3 Tota| Number of Partners or Shareholders_
4 Total Number of Qualified Partners or Shareholders from Part enter here and on C 8000,line 60a
;:I;hi QUALifiED PARTNERS or SHAREHOLDERS
1
A NAME AND ADDRESS B SOCIAL C D SHAREHOLDER'S E % PARTNER'S or SHAREHOLDER'S
SECURITY NO_ Time SALARY Own: F Share of Bus. Inc. G Share of SBT Paid
Earl
00 00 00
%
4380_Stoney_River;_ Bir, 100 144,600 100
% 00 % 00 00
8
% 00 % 00 00
7 00 % 00 00
1
% 00 % 00 00
% 00 % 00 00'
% 00 % 00 00
% 00 % | 00 00
% 00 % 00 00
% 00 % 00 00
'A4V;hi Mec
NoN-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is needed submit separate schedule and enter totals on line 7 _
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 2 00 00
00 % 00 00
[ 6 TOTALS (Part Il and Part III) 00 % 00 00
NW-88326-Docld: 32245535 Page 224 Onac Q ac/
Corp
Ruby
==================================================
Page 225
==================================================
Mvtcf. Jept 0 ireasur
c-~JJZD Se_adulz 0 Parirers or Sharetoldlers _ 1976
Parirers_zp, Sulchapter $ Protfessional Corp 3
See instructions 0n reverse side
Name: 2 Account Number:
8
Cobo Cleaners Inc 38-1.806433 8
"Ah! SU;;ARY
3 Tota Number of Partners or Shareholders
0
Total Number of Qualitied Partners or Shareholders from Part II_enter here and on C-8000, line 60a
AAlh? QUALIFIED PARTNERS Or SHAREHOLDERS
1
NAME AND ADDRESS B SOCIAL C % D SHAREHOLDER'S E % PARTNER'S or SHAREHOLDER'S
SECURITY NO. Time SALARY Own: F Share of Bus. Inc G Share of SBT Paid
Earl_ Ruby
00 00
6
#+380Stoney_ River Birm. 108 144,600 00 106
% 00 % 00 00
8
% 00 % 00 00
% 00 % 00 00
L
% 00 % 00 00
% 00 7 00 00'
% 00 % 00 00
% 00 % 00 00
% 00 % 00 00
% 00 % 00 00
AA;h; Ml
Non-QUALIFIED PARTNERS OR SHAREKOLDERS: I( more space is needed submit separate schedule and enter totals on line 7_
00 9 00 00
00 % 00 00
00 2 00 00
00 7 00 00
00 2 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 2 00 00
00 % 00 00
00 2 00 00
1h TOTALS (Part I and Part III) O0 % 00 00
NW-88326-Bocid. 32745335" 225 Mnac 4 n/
Corp;,
Page
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Page 226
==================================================
"cn_ Jept 0; {reasury
C-8333
Seeduz 0f ?ariters or Shzrekolders _ 1976
?arirersmip, Suichapter $ Professional Corp:
3
See instructions on reverse side 2
Name: 2 Account Number:
Cobo Cleaners Inc, 38-1806433
9
JV;m! SU;?RZARY
3 Tota= Number of Partners or Shareholders
4
Tota/ Number of Qualified Partners or Shareholders from Part W_enter here and o C-8000,Line 6Oa
A:(;h: Qualified PARTNERS Or SHAREKOLDERS
7
A NAME AND ADDRESS B SOCIAL C % D SHAREHOLDER'S E % PARTNER'S or SHAREHOLDER'S
SECURITY NO. Time SALARY Own; F Share of Bus. Inc: G Share of SBT Paid
Earl Ruby
5
380_Stoney River Birm. 100 144,600_ 00 108 00 00
% 00 % 00 00
&
% 00 9 00 00
% 00 % 00 00
1
% 00 % 00 00
% 00 9 00 004
% 00 % 00 00
% 00 % 00 00
% 00 % 00 00
% 00 % 00 00
PAL;hi Non-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is needed submit separate schedule and enter totals on line 7
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % Q0 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % 00 00
00 % Q0 00
NWi 88326 4 poela 924S333 Ipyge 328u) 00 % 00 00
Corp;,
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Page 227
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M
Separiner;; 0i Treasury
{o;_!973. 0r taxable year beginning 1973, 19
Tis; Manlie Miri 'Mim; joini 70;arn_ USe irs; ilmes Jiia Imtials 0i boih) Lasi nanie Your social security (lmne; 2 84 A- ToAs= RsBY
Hotile adafess {a4mner and Sifee: 0r fural ;ouic) Your occlpaiion 6
3 9 1 ! #8wo!S <4245
:mri ur 3os; Oflae, and; S;aie ZIP code Spouse $ sociai security no_ 2 1 (ChIs A ^ 837
Exemptions-Enter Rere total number of exemptions claimed on your
Were YOU & Mchigan resicent prior to July 1, 19722 WYes No 1973 Federal income tax return
2 Siaius creck ore. Married Joinily Single GlResident (full year)
Ma;ried Filing Separately Name of Spouse Peri-year irom :0
Give spouSe'$ social security n6. in space provided Nonresicent
3. Adjusied gross income as deiined in the Intergal Revenue Code and which should be reported on Federal Form 1040,
4 Aftach copies 0f any Federal schedules that inidicaie a loss or deduction Lii Lire 15 or 1040A, Line 12 frodc 3ross encome: (See pages ed une insarucdose
4. Additions {irom page 2, line 36) 2
5. Add iines 3 and 4 5 122
!
6 . Subtraciions (irom page 2, line 44)_
7 7_ 3alance line(5 less 'ine 6) _ 7 L3e2c2l3
8. Residerts multiply exempiiors claimed on line 1 by S1200.00
Part-year and nonresident allowance irom line 48 3,64oe
0 9. Income subject to tax (line 7 less line 8) 9. 127 7-21
16. Tax: multiply line 9 by .039 (3.9%) 10. C_ 1
CREDITS AmoUnt PAid CREDIT
(See pages 8, 9, and 10 of the instructions)
li. {ncome tax paid i0 Michigan cities 92 Zlla.
12. Coziribulions ic Michigan collezes and universities (attach receipis) _ 12a.
13. Income tax paid' to anoiter staie (attach copy of return) 13. 3
i4. ;otal credits (add lines ]la, 12a, and 13a,) enter total here 14.
15. Subt;act line 14 from lire 10 (If 14 is greater than line 10, enter NONE) 15.
332977
Komes:ead properiy t3x reliel lincs 16 Ihru 20 senior citizens, veterans and blind persons see form MI-]OAOCR
16. Eniter 1973 homes:ead property tax or line 51
17. Household Income from line 58 2
18. Enter 3.5% (.035) ci Household Ircome shown 0n line 17 18.
3 19. Difference betveen line 16 ad line 18 (If Iine 18 is greater
than line 16, erter NONE) _ 19. 1
20. Ente; 60% of line 19 (Maximum S5O0.00) 20
21. Credi: irom MI-104OCR (attach form M-1O4OCR)_
6 22. Persanal property tax paid on inventory"_
2
23. Inventory iax credit 25% of line 22 23.
PAYMENTS 1
24. Michigan tax wihheld (attach .State copy of W-2) _ 224i 0
25. iiichiga; estimated tax payments Laso?
26. 1972 overpayment credited to 1973_
27 . Add line 20 or 21 to lines 23, 24, 25, and 26 27
2,76i |<8
28. If line 27 is less than line 15, enter BALANCE OF TAX DUE HERE PAY IN FULL WITH RETURN FZE7
29. Ii line 27 is greater than line 15, enter OVERPAYMENT HERE 29,
30. Amount of line 29 you wish to apply to your estimated tax payments_
31. Anount to be REFUNDED (subtract line 30 from line 29)
This return is due April 15, 1974 or on the ISth day of the fourth month after the close of your tax
Under penallies 0f eompiete declare that have examined this return, including 'deccoraRonyig & schedules and slatements, and I0 the best of my knowledge and belel It is irue, correct and If prepared by a person other Ihan laxpayer his IS based on all" information of which he has any knowledge.
Your signalure Daie" Signature of preparer other than Iaxpayer Date
Here
Spouse'$ signature (if jointly. BoTH must sigr even if only one had income) GORDON L; HOLLANDER; P.C;
Make checks payable to "State of Michigan: Mail return and payment to Mich Gir765Izo: Pa901 €) : ACozrUNT Awrsing, Michigan 489C4
17350 TEN MILE ROAD
NW 88326 Docld:32245535 227 SOUTHFIELD, MICHIGAN 42073,
FEE_C
endirg
Cct;.
Flz Filing
3
line
year.
Sign
filing
Page
==================================================
Page 228
==================================================
4 0 49'
3853ms (606J%; 0; diuwabie eerijtiois %ires Si,580.00}
3_ Sujiac; iivie 2 ;JGice {Tn;s iS yoi; estimaied :axable icome)
4 Estimatad iax {ire 3 :imes .039 Jr 3.9%}
5. LESS: Toial estimaied ix credit for #icnigan income taxes, persona' property iax 03 inventories
#ctigan homesiezd propery iaxes and contributions io Michizai; colleges ad universities
6. Sur;iac: {ifie 5 line 4. Eriter here and 0 line i below
MYCXIGAN DECLARATION Of ESTIMATED incomz TAX FoR INDiVIDUALS_ 972
FORM
For calendar year i974 0r fiscal year 19 STATE OF MICHIGAN Mi-logj-ES
Min Department of Treasury
:{
{j{
First name and initial (if joint declarafion, use names and inifials 0f both) Las; name Your social security number
Piease Adaress (number and sireet) Spouse'$ social securify numoer
prin;
or Type
Cify, Sfafe, ara ZIP code
Your estimaie 0f 1974 ircome tax
2 Estimated income tax withneld and to be withfeld during entire year 0f 1974
3. ESTIMATED TAX (line ] lessiine 2). (If Yess than Si00, no Geclaration is required) _
4. COMPUTAThON OF INSTALLMENT. Check proper box below and enter amount indicated.
Ii this declaration is April 15, 1974, enter 1/4 of line 3; September 16, 1974, enter 1/2 of line 3
due to be filed 0;: June 17, 1974, enter 1/3 of line 3; Jan _ 15, 1975, enter amount on line 3
5. !f you had a overpayment 0n your 1973 income tax return which you elected to have applied .as a
credit against your 1974 estimated iax, erter 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 everly to each installment, divide it by rumber of installnents &nd enter results here
7 Amoun: io be pzid with this declaration at time of filing (line 4 less line 6) _
3 Note: The paymen: of :he estimated tax (line 3 less any. 1973 overpaynent credit) with this return eliminates the illing of
quarierly esiimates Enter lump sum payment here
have examined this declaratior ana to the best of my krowledge it is correct;
Signaturefs) Date_ 19
joint estimate_ both husband and wife must sign
MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS_ 2 974
Mic FOR;
For calendar year 1974 or iiscal year 19_ STATE OF MiCHIGAN Mi-; 040-ES
8in Department of Treasury
J
firsf name and initial (if joint declaration, use names and initials of both) Last name Your social security number
E44 AND NARGE
Riey
Piease Address (number and street) Spouse'5 social security number
or type
/8131 Livernmis
City, State, and ZIP code:
StaJi Mc1 16AN 4232)
1_ Your estimate of 1974 income tax C2.40
2. Estimated income tax withheld and to be withheld entire year of 1974
5_ ESTIMATED TAX (lina 1 less line 2). (If less than S1OO, no declaration is required)_ 020 ce
4_ Compufation 0F ISTALLMENT. Check proper box below and enter amount indicated.
If this declaration is Qapril 15, 1974, enter 1/4 of line 3; September 16, 1974, enter 1/2 of line 3 Sos.60
due to be filed on: Oiune 17, 1974, enter 1/3 of line 3; Jan_ 15, 1975, enter amount 0 line 3
5. If you had:an overpaymeat 0 your 1973 income tax return which you elected to have applied as a
~edit against your 1974 estimated enter tne amount here
6. To apply ertire overpayment credit to this installment and any excess to the next; enter here the amount 0n 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 Iine 6) _
8_ Noie: The payment of the estimated tax (line 3 less any 1973 overpayment credit) with this return eliminates the
of quarterly estimates._Enter lump sum payment here
have examined this declaration and to the best of my knowledge it is correct:
Signature(s) Date: 19
NW 88326 Docid.327455j55pag6 228 husband Jnd wife Must Sign
Gity
iom
ending
ending
print
during
tax,
filing
==================================================
Page 229
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oincr ":@4ycg_beginning 973, ercins_
~ovu {{ Ifiui las None You; Sozic: Sccufiy Nunbe; 2733} {R
4 7 704293 Your Occupction
iom rfur YOU cr:: (1n1 I9ic; Yo1s wona.C
Aaaire's9 (N; ideniificc;cn 70, #ers: RUzy EARL { MARGE Szouse'$ Sccial Secur ; Nugber
{ow; 0i ?35;
15135 LTVEFNOIS
4P?
CE TRot , X[ 4322 1 Spouse'$ Occupa;ion
OA-
ff ,narried_ {5 jcuse sepcrate refurn? Yzs 2 NO_ If yes, enter spouse'$ first name
:.0 ;he Gcmc cri Gddress used on Your rcfurn for 1972 (I; the same as cbove write "Scme" If diferent, indicate date
Gcved.) If none filed, give racson
Auziic;
rit Regular 65 or cycr Biind Ecw SCxilie X L EXEM?TCNS 1 YOURSELF nuncr cf
exempfion;
SPOUSE cRckvd
Enter first #CTes of ezch of your DZPZNDENT CHiLDREN who lived with You: Enfe;
NAME Monihs ivee in Enfer figure in tne {ast columr to Reiationship Your home curi;g 3_ righf for each name lisied 973 OxeR
DE?ENDENTS
Tofcl cxemptions 1, 2 and 3; erter here ond on lire 15 below_
IlLiZ= AFOA DDIAZ INCOME (If joic: return, include all incorie of both husband and wife)
5, In;er GROSS income from employers for wages, salaries, commissions, tips, etc ~ indicare (W) for wife
Total wages reported Detroit Inccmc Tax WAGES ETC_ EAP:ED
Hoyer' ; Name Where empleyed (City and State) on DW.2 or W-2 Withheld IN De7roif 913X3 ZN S_ S_
"f 2 s/ 8} JNG p2 (40
6 TOTALS
7 . Renfal ircome (or loss) tangible property in the City of Detroit ~n from page 2, Schedule B, line
3, Cther incore (or {oss) partnerships, etc. from page 2, Schedule ;, line 4
9 . Gain ior loss) sale or exchange of tangible property in the City of Detroit L from page 3, Schedule E, line 10
{0_ Net profi; (or ioss) from business S page 3, Schedule C, line 8
T! _ Income (or ioss) TRUsts AND ESTATES ONLY L from page 4, Schedule 6, line 7 (see instructions for exemption to enter on line 154
12_ Total (add iines 6 throush 11 of last column) _
{3_ iess: Deductions 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 line above ond multiply by 5600
16_ TOTAL INCOME SUBJECT T0 TAX
17 City OF DETROiT TAX: Multiply line 16 by .005 (V%)
?AYMENTS AND Credits
6 13. a. Tax withheld .by employer ~a from line 6 above S ATTACH forms DW-2 or w-2
3r 1_
5, Paymests crd credits on 1973 Declaration of Estimated Detroit Income Tax
8 Orher Credifs explain in attached statement (See Instructions)
19 TOTAL 1 Add Lines i8a, 6, and
TAX DUE OR REFUND
20_ Your payrents (linc {9) are than Your tax (line 17), enter amount of OVER?AYMENT
2; _ Check box if you wish overpayment on line 20 to be: (A) C Credited on ']974 Estimated Tax o(8} {Z Refunded_
22_ If Your tax (line 17) is than your payments (line 19) enter amount of BALANCE DUE in full with this return
Mcike_check payable to: "TREASURER, CITY OF DETRQiT " A balance due of less than one dollar (S1.00) need nof be
ceckaire thaf have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belief ; ;5 ;rue, correct and complete. If prepared by person other than taxpayer, his declaration is based on all information of which he has any knowledge. SCN
SIGN HERE_
Taxpayer' $ signature and date) (Signalure of preparer ofker than taxpayer) (Date)
SiGN KERE
Gordow L_KOLLANDER,&C,
(Spouse" signaturc and datc) (If joint rclurn, DOTH HUSBAND AND WIfE Must SIGN) Cer78Fizd PUEL:C Atcc: TAR;
MAIL To: Trcasurer, 104 City-County Building, Dctroinzab8icEN423Zz RChE
RETURNS Must BE Filed EY APRIL 3OSOUTAFIELD, MICtICkN'
~307;
NW 88326 Docld:32245535 229
"r
fling
No_
from lines
:npl
from
irom
from
from
{rom
from
larger
larger Pay
Paid.
City
Page
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684e Divisic z TX Nu,3e? WXZV SUEN TTIG ?AYMZ , 8? : CorZo
IIZZ TiI 3.73)
C_uczr %ezz 1373
07 ~CA; Yzfiz
sic_ i9_ 00 Not Write Aeove This Line'
Zdig iS
{rdividuai
R UB % EARL 8 MARG IE 6 9 3 3 5 5
181 35 LIVERNOIS AVE
?ari;ership_
Check DETROit MI 48221
Nchigin Corporation One
Foreign Corporation
POSTED 7iLED
Fiduciary
IF Txis fe7nN iS For AN
Z54T2 Giv: ?R034T2
mnti D4Y YEAR County
1 : 30 73 898 8 55 C07 82 7 3 12 File No
ZETR0AcTive DaTz Account No. TyPE county city K | C File DATE Date of Deaih_
Lioe Corputeior oi Tax Due AMOUNT i6ie ~AI N
1 Accour;;s and Nofes Receivable (non-income producing only)
2 Less Accounts and Notes ?ayable
Zalance' Taxable i/iin of % 2
Accourts and Notes Receivable (income producing only) 4
5, less Accounfs and Notes ?ayab'e {use only that portion, 1 any, not used in .Line 2) 5
6. Salance Taxable 6
7 _ income appiicable fo balance
6 _ Tax 3Va% of Income (Line 7) or 1/10 of 1%' of Balance (Line 6}, whichever is greater_ 8
9_ Stocks ana Bonds Schedule A, Column 9 9
10. Mor:gases ana Land Contracts Schedule 8, Column 8 10
M. Annuities Schedule C; Column 9_
13_ Feimy 7ct {#ach copy hereto)
i IAL
Lun Statulory duductiun (175.00 or 5J50.00 by hucband: arid wivut joinl rulurn}
15. EALANCE DUE
16. Cash on ind or in Transit a5 of retroactive date {include cash in safery deposir boxes) 16_
17. Bank Depos;rs in Binks Located Outside of Michigan_ or Wiuhdrawn from Mich. 17
Banks or Ass'ns. after
18. Savings in Building and Loan Ass'ns. Located Outside of Michigan RETROACTiVE DATZ_ 8
19_ TOTAL 9
20_ TAX 4of SiOCO.OO of Line 19_ 20
21 TOTAL TAX DUE (Line 15 plus Line 20) 21
22_ Less Advance Payment of Tax 22
23 TOTAL TAX DUE 23_
24_ Penalties & Interest; Penalty %, S_ Interest % Months, 24_
25 TOTAL AMOUNT DUE 25.
JVMKE REMIITTANCE PAYABLE TO STATE OF MICHIGAN
Plecea %orwarzd Remittance tor Amount Shown Here
92 or betore April 30.
To: VICHCAV DEPARTMENT OF TREASURY, LENSING, MICH 42922 (or fow monthg aiter end o: cuthorizca "scal yea;)
IMPORTANT__Be Sure to Answer the following Question When Applicable
Busiress or Proiession 0f Taxpayer
SALES
Phone No_
819- J
2. Give Year of last return filed_
91 73
Address of [ast Return_ SAME
3, Check here` if refurn is computed on Retroactive Dafe Method Or Monthly Average Method
4. {f taxpayer is corporation give State and Date of Incorporation_ Federal Employers Identification 'umber_
5. If this is the return of Trustee artach list of names ad addresses of beneficiaries a date of creation of trust.
6, If ;his is Business Return copy of the Balance Sheet as Of the close of the Tax Year must be attached_
declare undcr Ihe penalties imposed by Act No. 301 P A of 1939 , as Amcnded, that thit return, including any accompanyino_{ahgde Ia statectnat_nd8 Bcen examined by
and to the besf of my knowledge ad belief is true, correct ad complete return. Sociol Security Number
GrbCw L KOLLANDER, P.C.
Signed
Refurn Prepared by ~eANED publie AeeaunttAN
Signed 37350 TEN MILE ROAD
Acdress_ SOUTHEIELD MIGHHIGAN 48075 Titlo
Stat? whether Individual Ovine: Mc,ie: NW 88326 Docld:32245535e Page 230N REVERSe SIDE Adminis Jtor _ {Ui ??, 03. ct 80
fior
per
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L
;EA Zcr
6; #-is-31R-J Rav_ 3.73;
;CTA SetRoi; NcCM: EX?ECTE) iN 1974
3 Zempt;ons (S*cj,Co FoR EACX ExeMPTION)
85wAtZD 3E.RJ;7 JAXABLZ Incom: (Lin: A Less L!NE 8)
ZSTimATE) Draoit INCOME TAX-NCNRESIDZNT INDIVIcUALS ENTER Va OF i% OF LINE C All Othe? TAXPAYERS ENTZR 2% Of [iNZ C, ExTer TAX HZRE AND ON LINE 1b Of DECLARATICN BEow
3-Coko-ES City Of DeTRCiT DECLARATICN Of ESTIMATED incom: TAX
Eei Calenclar Year _1974 or Fiscc} Yedr Ending
19
4975
'4 ~AES) {PRINT OR TY?E) YCU? SOCIAi security NUMEER CXECX Ty?: Of DECLARaTION
ADjRESS INDiV:SUAL
SPOUSE' s SCCIAL SECURiTY NUMSER CORPORATION
C,ty STATE POSTAL ZIp CODE PARTNERSH'?
OfheR
332 Ia. Your 1973 Detroit Incore Tcx S Ib. Your Estimate of |974 Detroif Ircome Tax
2 Anount of Detroit Income Tax {0 be withheld or other credi: expected in i974
TX15 3 . ESFImATED' TAX (line Ib less line 2)
4. Compufction of Installmant: Check Date of declarafion below and enter portion of line 3 as indicaied:
co?y Apr. 30, 1974_1/4; [J June 30, 1974_1/3; 30, 1974_1 /2; Jan. 31, 1975-100%
5. Amount of overpayment on 1973 return which You elecied to claim as credit
6 AMOUNT T0 5E PAID WITH ThIS DECLARATION (line 4 less line 5) {on
Yol?
RECORds '6 YoU ARE AN EMPLOYER, ENTER EM?LOYER iDENTIFICATION NUMBER
M4E ZTACE ?AYAEZ {0 "TREASURZR, City Of Dziroit" This declaration of esrima:ed tax is not Tcx Refufn AND MAiL With DECLARATON To:
CIC: Of T;E City TRZASURER T INCOME TAX DIVISION DATZ
104 City-COUNTy BUILDiNG
DetRoit, MichigAN 48226
DETACH ON PERFORATION AND SEND FORM BELOW With YouR REMITTAN'CE
0-1320-E5 City OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
Fer Calenclar Year 1974 Or Fiscal Year Ending: 19.
327c,
NAMES) (PRINT OR TYPE) YOUR SOCIAZ SECURITY NUMBER en Check TYPz Of DZCiaZaTON
ADDRESS "NDiViDUAL
1SS LivENNA$
SPQUSE'S SOCIAL SECURITY NUMBERI CORPORATION
CiTY STATE POSTAL Zi? CODE PARTNERSKI?
M Icxi 6/41 OTHER
Ta. Your 1973 Detroit Income Tax $ 1520-3
1b. Your Estimate of 1974 Detroit Income Tax 5
68 <i:0 1
2. Amount of Defroit Income Tax to be withheld or ofher credit expecfed in 1974
3. ESTIMATED TAX (line 1b less line 2) 7/7
4 Computation of installment: Check Due Date of declaration below and enter portion of Iine 3 as indicated:
30, 1974_1/4; [J June 30, 1974_1/3; 30, 1974_1 /2; Jan. 31, 1975-100% S
40913 0
1
5. Less: Amount of overpaymenf on 1973 return which You elected f0 claim as credit S
6 AMOUNT To BE PAID With This DECLARATION (line 4 less line 5) Ycoia
1
IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
Czrtify TXAT This IS A CORRECT DECLARATION_ This declaration of estimcted tax is no; Tcx Re:u;a,
5unuilru 0f Tux?oyer. Spojwo Jibo if ivitt declarotion:
Dati
NW 88326 Docld:32245535 Page 231
Due
Sept.
Less:
6,0
Apr. Sept.
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72
{3js { LoeRy
7 6.31103,G
xiie
Zcon
Cj
~ J; Wf;] G 3 %
2p_
{2mcr 0.1 '. 72jc
{203323831-
24 ad0w. 7iEuic
27 300 8. Saic; 0; Zicce[: Cinint Yajr' : 6, 20
0 Lc: j mzic: 3 amo 3
0
:,~
c3toutn (Sce irsructic; 1} Xoitc: If deprectatisi: Is forspu:i:d by_tci;: t;o &u60 :0 kn !97c or ;re Gieziigj Cljss Lif Syseed #; RSce placed In ferce Senone !971, ycu {Gus: 2 07;
4183
2 ": iide CS_Sysen; #ianYoun [2a4mBcep.%6 Gaerwsn Xfresriy orcviced 'n rc;lticnrscc:ia;
cur Ecc.icn 1.167;0)-.2_ anc provisions 0f Revi:-e Pfoczcles 62-21 jJC 83-13 &73 GE: jfFiCsiic67323293;
-: 0G0&n &co2 this taxable yeer t !S} Cizzs Life (AD?) Sxsie:: : /o e*+. Scli %3&
GZ_adicmz C:o 3 Co:; 3;
Eefrecisiion} 5. 34 4 1 G; 7.3782 acqui;d ois;er Lasis -il: or cwa:h? cjg?eec srij; 7cars
:ctc:z diioi' f:s cezrciatior {dc nai incluze in er;s belcw)
c3,n80 # F37n <222 _
3-x831a21J6 tC Fcn:i 33og
:5riabJ6
6%
{; 261 iinc
~pricn &7gent
Je.:0
3_ (c)_
7xl3
Lcss ~mou;: oi depreciation Claimed in Schedule A
{CC_cme; Xere JGd on iirie 21, pzRe
SUXMA? 3; DEPEEHION (C20321284c42144242372627222225)
Set; 0; U.ic straiatt lizc Declinijg bi3c0 ezrs-:iz P; Cuctio; Ot (3im}
}fer. n iom: Foz;} 4332
lihm icj %c. n sujj
CDEUTTON (Sa8 ics:uzeors)
1 Taxsinconne {line 28, peze 1)
2 (0) Enc; L% 0f line 1 (members f controlled grou?s, sze Irstructions)
(6) Suseric: $5,500 3,d ente: difererce SCo-0o
Noe !oicn0t Chpika] Sain reduzud by Gct short-tc;t; czjital {OSs {#ror: line 9(0), page 1)
Suvrract.S2+,0C0. (Srarutory minirum:) 23.61
Sclz.ice (nx3 le3s linc 4) {sze iristructicns)
Znter so% o; line 5 {see instructions)
'1c312t (ine2 0; lice &,"kicheve; is lesser) Ente; tere Jnd on lne 29, Fage ]
NW 88326 Docld:32245535 Page 232
Cz?
Jez:
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13J 2; 2-1)
4 0Ew 38
0. cc: ~RGArV
RMZeenicn?
3RCCOZ
w 2. R R
Mir X 38222cmi : (Co _kcuCe ZGcUbalwGcc {0 &)
i?a #-43828.220%nzR3I:Ci7.3: g-ing {er0ntw2
'vc? ~ruo.c %able €3 Orinzry iniorje &nd Guclo;zt:didecd cclscn
:k. Gk
;id ~%2i: nome _taablc 45 crdizy i.orie c; (*35:;
78raw2k__b?20W3in zzora: Zamn :2. e
3211l/i5e V:co 400402 { #uWEne 01
5E333 (2} Rxinz;d foUtu Cc*
~aisis eXp8/30 {3} On-ths-job traiging f125
3mnc3 (oss} Gire CCi::
0; 6332.121 lcsscson bc deysc:
:238,nra: irco.te
330 3 J2: :3250 S7cty Grzrcic: ;n8r ic3;
cSS c.3 iG33c. cmc) zirz {6; 3ces; Psnce;tC? Ccplso
sho: ^0mm czzizzl icsscs
92tc Tv: Ten: property { #W%n cpilz] 3 Ant}
: 12EZ CED Xc
2,14 &recic7 Cf:
Lcv mcma.e32mOusing Zzei: & (c) 2 J Zobui%sgi
{e:
Ce r: 7rocety {32: 3) 8 c aCie cuizz %277733
{03) Zc.o2! ?ropariy Subject to 2 pno ei (:} 7cGye1
;cNazse 638 30 Rs; Jrws; #3#7
; GGcnzitof: O: inv; i0; 50 mjtu Ern
=u9 icilics _ EE:; m 7 : Gci%3
COX?LETE A SE?ARTE SCXEDULZ %-1 ?0? ENC %XW7EKOLDER_7il3 400?e
ZZ%2 cEcd%u 0j_
!eze you: Rcaber cf 2 CjGtlld %maj
313 Gnjuictc- 02 z viriozz 0; Scctic;; iSEl cr 17827
L DM;Ucuns 3 dccucian : 7 @X7228 cGcctC
Wgt;odin #: inc cid cf #hc txzbla year Jm, ciciy € b (1} Zuna nc%: acilty (036, ;3or , (ch ec,57 0% :3
Cecm -p Gr Mcre cftlc votinz Stack of 3 domestic ccom {2} Livi:s icccrmcdaliors '~X37n =jgpG
JX j# (Fo;' Tlles cf cttibution, S20 scctoa 237i0}.1 i)
0Gn "c3;" ciiach 3 szhecuic showing; (3) Ex;lyces' taniles 2t Corvemtic:: c; 3086
4Gnss, C.d emic;cr {ontii-otion %iabc;; &d Zzivc0 0; kniiy vzcztio;s G: ;7or*z: 0;
{; 7rrtnge Owicd Fo;iti !I-2? C%
2 : ~pjrc idm du;izg the tux-Sie %car #jva &,Y Cortacts &r cuj- #dc yr @e 2 r-ind forzs l1c?, lO~ Ji037 2
cjriizcic Slt;c: t the icregotation Act of 19512 Yes 4 N N' Dic fic corgoratiom, # & #.e #urig ine t141
{c 20y i:tercst :c Jr sinature J; &lrc; Ju 0;;
"es; 2iicf 3 JEprezaie soss Zollar gcunt billed durinz the
Cxef 8 2k, Securilies, or Otker {ira;cim) ZCCog:
7e:; 3 iGreign CJin?
if "c5 #cfua4G23 (or de@1on-, Icc 70601)
iEsm% icJm;c 0r (oss) f;: 1970 0 izrc cniy if (1) tiis t2 ; i1288 rtt; {4s;
{971 1972 tc : #ced 28 3 Smali tezircss co;eetaron 3 ()0
%2s in exiSt Ce {Cr thc taxztlc %czi gric? io itc Chcic:: 4 :cwnoloitucions 35d3* tpe prigcipa}; ;m: Cedh Frcccny:
Emis acticy "$ 2 Egeerienlt fiied urcer zection 1.47-() cf
Xxnct G; sce Zktens2
NW 88326 Docld:32245535 Page 233
8
C??;
43,
0
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1; LC
0 3-;3.i.;:;R: 3731
T37A; 3:7o : Cok: #Ec7Ed ; {97+
IZMPTONS {S3cC.Co FOR ZACH' EXEMPTION)
3Wnj3 Uet,oit TAXASL: INCOME (LINE A LESS i{NE 8}
5 ZmATZ0 DEOit incomE TAX-NONRESIDENT iNDividAlS ENTER Vz Of 1% 07 LINE C S ALL RZR TAXPAYERS ENTER 2S OF LiNE C. ENTER TAX HERz AND ON LINE :b O7 DECLARATION Glow
31306 Ciy 0f DetrO!t DECLARATION Of ESTIMATZD InCOm: TAX
Zx Extencar Yed 1274 @ Zui Yecr Exei-3 :9.
NA*E'S) {PR'NNT OR 7y?E; YouR SOCIAL SEcURHTY VCme:R ChZck TX?:of DECLARATON
A3cesS IoviduA
spouse'S SOCial S:curity Nlmer CC#ORATICN
City STATE ?OSTAi Zi? Cod PAEEAERSX?
CfxzR
Ia. Your 973 Detroi; Income Tax S 1b. Estinate of 197 4 Detroit Income Tax 5
2 . Amount of Detroit income Tax f0 be withheld or Other credit expected in 1974
75 3_ ESTIMATED TAX {ine 13 less Iine 2)
Compufafion of Installment: Check Due Date of decla;at;on below and enter portion of line 3 as indicated;
Co?x Apr. 1974_i/4; 3 June 30, 1974_1 /3; Sept, 30, 1974_1 /2; Jan. 31, 1975_iOCs
5. Lcss: Amoun; of overpayment on 1973 refurn which You elected to claim CS credit
6 . AMOUNT T0 52 ?AID With This DECLARATION (line 4 less Jine 5) 7CR
{oi?
If You ARE AN EMPLCYER, ENTER EMPLOYER IDENTIFICATION NUMBER RCCRSS
#Axz RZMFTTANCE ?AYABLZ To "TREASURER, City Of DeTRCiT" This declaratior of esticated tax is aot Tcx Za;ufo A1D Mai WntX DECLARATICN TO:
0FFC5 Of THE City {REASURER INCOME TAX Division DAT:
{04 city-CouNty Building
cetroit, mickigaN 4E225
DETAcX ON PEFORATION AND SENS FORM BeloWi With YOUR REMTTA vcE
3-1040-25 City Of DETROIT DECLARATION CF ESTIVATED {VCO,: JAX
F2r Caiendar Yedr 1974 or Fiscal Yedr Ending; 19.
316
NAMES) (?RINT OR TYPE) YCUR SOCIAL SeCLRiTY NUNEER
J SALSS Iwc_ CCk TY?e O; DECiAMATON
ADDRESS INDIVIDUAL
3198 L'verNais
SPQUSE'S SOCIAL Ecurity NUMbZ CORPORATion
City STATE POSTAL ZIP_CODE PARTNERSHI? hihSAN
Other
la. Your 1973 Detroit Income Tax $_ 249.4 Ib. Your Estimate of 1974 Detroit Income Tax $ 3 3{ 1
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1974
3_ SjiMATED TAX (line 1b less line 2)
4. Computation of Installment: Check Due Date of declarction below and enter portion of line 3 as indicated:
Apr. 30, 1974_1/4; [J June 30, 1974_1 /3; 30, 1974_1 / 2; Jan. 31, 1975_10o%
1
5. Less: Amount of overpayment on 1973 return which You elected to claim as cred;x
6, AMOUNT TO BE PAID With This DECLARATION (line 4 less line 5)
1
If YOU ARE AN EMPLOYER, ENTZR EMPLOYER IDENTIFICATION NUMBER
Czrtify THAT This IS A CORRECT DECLARATION_ This doclaration of estimated tGx is Go; Tcx Relurs
Signature of Taxpayor: Spouse also if joint declarotion. DATZ
NW 88326 Docld:32245535 Page 234
Your
30,
Sept.
==================================================
Page 235
==================================================
ZC
2 seie {i,cazcz_ 3..d
{2; i*i Sccizi Zcc_;v NLci N:me ad Addfasz of Zacn Snarakoner
Num;ber 3nc8
(b;
{w}
(&}
(e;
(t)
(s)
(h)
(5)
Amount fo bu Igea %v #nrcnokof cf;
incor1e (schedule K, toral iine 5 or page 2 , sctedul8 3, 'Vic; 3 0; Oi' 0c70ii
0f Iines 4 and 8 _ U.S. Iine & Iine 431 diffurence Setwean colurn
1{20-S) 4Jrd coltmn 5 (saa {nstructicns;
(a) $ 3X 707- 33 33,707.87
{0) 7. 33 2
{c}
(:)
{2)
(g)
ih)
(i)
NW 88326 Docld:32245535 Page 235
38 707
==================================================
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L ~ .
# : _
J; 3-i5-S;i-j Arv. 6-73,
7CJ4 SeTRO:; {cCm: EX?ECTED iN 974
2 #pWONS i~eCo.Co FoR EACH EXEMPTIoN)
C. SWAATZD OeRJ;T {AXASLZ INCON: (LN: AS Less !INE 8)
0_ Zs71ATE) DztRoit WCOmE TAX-NONRESIDENT INDIVIcUALS ENTER Vz OF i% OF LINE C Ali OTXER TAXPAYERS ENTER 2% Of LNz C_ ENTER TAX HErRE AND ON LINE !b Of DECLARATiCN BElOw
0-334O-ES City Of DztRCiT DECLARATICN Of ESTIMATED 'Nconi: FAX
Fg: Calenda: Year_1974 or Fiscc] Yecr Ending
19.
{973
~Aas) {PRNT OR Ty?z; YCUR SSCIAi SEcURity NUMEER CHECX TyPz Of DZCLARATICN
AujREsS 0 'NDiV'SUAL
SPQuse"'5 SCC AL SECURiTY NUMBER COR?ORATION
City STATE POSTAL Z!p CODE PARTNERSH:?
OThER
ic.Your 1973 Detroit Incore Tcx $ 1b. Your Estimate of 197 4 Detroit Income Tax
2 Anount 0f Detroit Income Tax to be withheld or other credit expected in i974 _
TS 3. ESFImATED TAX (line 1b less line 2)
4. Conpufaticn oi Installment: Check Due Dafe of declaration below and enfer portion of line 3 as indicafed:
Co?x Apr. 30, 1974_1/4; 0 June 30, 1974_1/3; 30, 1974_1/2; Jen. 31, 1975-i00%
5. Less: Amoint 0f overzayment on 1973 return which elected to claim as crecif
5. AMOUNT i0 62 PAID With This DECLARATION (line 4 less line 5) 8?
YOU?
RECoRds Xf You ARE AN EMPLOYER_ ENTER EM?LOYZR iDENTIFICATION NUMBER
# ZMiZTANCZ ?AYAELE {o "TREASURER, Cijy Of DztrCIT" 79is declaration of AN) ,AiL Witx DECLARATHOV To: estimaed tax is not Tcx Rafufn
OFC: Of TxE City TRZASURER INCOME TAX DIVisIoN DATE 104 CtY-COUNTY BuildinNg
DETRO}T, MICHiGAN 48226
DETACX ON PERFORATION AND SEND FCRM 3ELOW WItH YOuR REMITtANCE
9-1320-E5 City Of DeTROIT DECLARATION OF ESTIMATED INCOME TAX
Fer Calendar Year 1974 Or Fiscal Year Ending:
19.
3876,
NAMES) (PRint OR TYPE) YQUR SOZiA SEcurITY NUMEER 3K,9 CCen FNc CHECK TyPe Of DECLARATiON
ADDRESS {NDiVidUA!
1:-14 LiVEe: $
SPOUSE'S SCCIAL SECURITY NUMBERI CORPORATION
City STATE POSTAL Zi? CODE PARTNERSKI?
MICXIAA4U OTHER
ia. Your 1973 Detroit Income Tax $_ 1.580_3
Ib. Your Estimate of 1974 Detroif Income Tax Gi <c< L
2 Amounf of Detroit Income Tax to be withheld or ofher credit expected in 1974
3 ESTIMATED TAX (line 1b less line 2) Laoa
4. Computation of installment: Check Due Date of declaration below and enter portion of line
3 as indicated:
Apr. 30, 1974_1 /4; 07 June 30, 1974-1/3; Sept. 30, 1974_} /2; Jan. 31, 1975-100% $
489130
1
5. Less: Amount of overpayment on 1973 return which You elecied to claim
as credit
6. AMOUNT To BE PAID With This DECLARATION (line 4 less line 5)
1
IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
Czrtify TRAT Tkis IS A CORRECT DECLARATION; This declaration of estimcted tax is not Tcx Re:u;a.
jiuuluru 0f :0x?U/. Spoujo 010 ioiut declarotion. CATE
NW 88326 Docld: 32245535 Page 236
Sept,
You
==================================================
Page 237
==================================================
Iy
Cl:
77h1 SfRO : :om: EPEC7Ed i 1974
1jCN5 {~gic.co FOR ZACH EKEMPTION)
#5#us,om TAXASLZ INCOME (LINE A LEss iN: 3)
0 287mjj DEROi; incomz TAX_NONRESiDENT INDivic ALS ENTER Vz Of % 07 LINE C A!l C7 zR {AXRA"ERS ENTER 29 Of LINE (. ENTER TAX HErz ANJ ON LINE :b Of CECLARATICN 32lOw
3.103 Cxty Of DEtro!t DECLARATICN O5 ESTIATED INCO:: 7A8
Ze1 Exenc r Yedr 1274 o #ici YearEnding
NAS) ;Prinnt 0R {YPE) Yoi? SOCIAL Security Nume:r CnZet?:o7 jeClsZARON
A3cResS NoiviDua:
S?oUsE'$ SOCiA: SECURTY NlxZER CC#ORATCN
City STATE POSFAi Zi? CoDZ PAFTNE?SK?
Cfke?
{a. Your 1973 Detroi; Income Tox $_ ib. Your Estimate of 97 4 Detroif Ircome Tax
2_ Amouni 0; Detroif 'ncome Tax t0 Se withheld or other credit expecied in 1974
3 EStimA zD TAX {ine 13 less {ine 2)
Compu:a;icn of Instcllment: Check Due Date of declaration below and erter portion of 3 as indicated:
CC?y Ap:. 30, 1974_i/4; {J June 30, 1972_i/3; 30, 1974_; /2; Jan. 31, 1975_iOc%
5_ Less: Amoun; of overpayment on 1973 return which You elected fo claim os cfedif
6. AMOUNT T0 B: ?AID With ThIS DECLARATION (line 4 less line 5) 7c2
8o
1; YOU ARE AN EMPLCYER, ENTER EMPLOYER IDZNTIFICATION NUMBER R3Cc?3S
MRK %ZTTANCE ?AYABLZ To "TREASURER, City Of DZTRCIT" This declaration of esigcied tax i act Tcx {J;Uf; An0 MAi Wintx DECLARATICN TO;
OffIce Of THE City FREASURER L JNCOME TAX Div:SION DATZ
{J4 city-county Building
cet.oit, MICgAN 4e228
CETATA ON PERRFORATION AND SENS FORM BeloW Witx YOUR :EMTTANCE
3-10-0-3 City Of DETROIT DECLA RATiON OF ESTIVATED NCO:: JAX
E2 Czendar_ Yedr 1974 %r Fiscal Year Ending: 19.
MAMS) (RinT OR TypE) YCUR SOCIAL Seclrity MXZE SALES Zwc. CXickTpeo; DECLAMton
AcSRES: C IND;VIDUAL
6:S OverNas
SPQUs'S SOCIALEZCURITY NU.AEd CORPORATICN
Cif STATE POSTAL ZI?_COCE PARTNZ,SXi?
riah!GAN Oter
3 Ta. Your 1973 Detroit Income Tax $ 241224
Ib. Your Estimate of 974 Detroit Income Tax S 41 3 2 Amount of Detroit Income Tax to be withheld or other credit expected in 1974 1
3 ESTiMATED TAX (line 1b less line 2)
4_ Computation of Installment: Check Due Date of declarotion below cnd enter ?ortion of line 3 as indicated:
A21. 30, 1974_1/4; [3 June 30, 1974_1 /3; 4 30, 1974_1 /2; Jan. 31, 1975-i0C %
1
5_ Less: Amourf of overpayment on 1973 return which you elected to claim as cred: 5
6 AMOUNT To BE ?AiD With ThIS DECLARATION (line less I;ne 5)
1
IF YOU ARE AN EMPLOYER ENTER EMPLOYER IDENTIFICATION NUMBER
CzRTify THAT This is A_ CORRECT DECLARATION_ This doclaration of estimated taX is Go; Tax Scfuri
Signaturo of Taxpayor. Spouse also if joint declaration. DATE
NWV 88326 Docld:32245535 Page 237
iine
Sept.
Sept.
==================================================
Page 238
==================================================
Sciadjijiz
5 34,Zx_czRS SfiA;Z 0? {CC_Am c,izc:;s
(If acditional spacc is neeced, afiac; sciecu;a)
(1) {21 (3)
Namo and Address of Each Shareholder Sociai Security Vunkoi 07
Numbur Snare;
(a)
4929 RivE} Ei+. LCHL
(b) Ot 6ER02. T27 Cus
65 W" WAnGtjijfIso Ctiizhil =ili
(c)
(d)
(e)
(g)
(h)
(4) (5) (6) (7)
Amount taxable as ordinary Distributive Income from Amount to b0 used by share- Entcr here and on form
income (schedule K total page 1, line 5, Or page 2, holder on Ml-1040 (enter on MI-1040, pace 1 , line 25
of lines 4 and 8 US: schedule 3, line 6 page 2, schedule 1, line 37 or cach sharehoicers pro-
1120S) on page 2, schedule 2, line 46} portionate share O; Fer-
difference between column 4_ sonal Property {axes
and column 5 (see instructions) d 077 inventorics or
the crecit for franchise
fees paid.
(see instructions)
(a) $ L16z 61 i LL9-C9
(b) 9iLS 9,169.69
(c)
(d)
(e)
(f)
(g)
(h)
i)
(j)
NWV 88326 Docld: 32245535 Page 238
5 nar 7 ?
Z500
paie
==================================================
Page 239
==================================================
J-1 Jo-is ctx 0f Jchui LECLA_A OA&} 3iiiniz mLOWa #
TAX COMPUTATiON SCREDiiz
"Jj
C of D-iS-DIT-J (Rev. 8.74}
A TOTAL DETROiT INCOME EXPECTED IN 1975
B: EXEMPTIONS (3600.00 FOR EACH EXEMPTION)
ESTIMATED DETRoit TAXABLE INCOME (LINE A LESS LINE 3) $
D ESTIMATED DETROiT INCOME TAX-NONRESIDENT INDIVIDUALS ENTER Va OF 1 % OF LINE C 5
Ali 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 4
For Calendar Year 1975 or Fiscal_Year Ending 19.
NAME(S) (PRInT OR TYPE) YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION
ADDRESS INDIVIDUAL
SPoUse's SOCIAl SECURITY NUMBER CORPORATION
City STATE POSTAL Zip CODE PARTNERSHIP
OTHER
KEE? Ja. Your 1974 Detroit Income Tax S Ib. Your Estimate of 1975 Derroit Income Tax
2. Amounf of Detroit Income Tax to be withheld or other credit expected in 1975
This 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 indicafed:
CoPY Apr. 30, 1975-1 /4; LJ 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 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" This declaration of estimated tax is not Tax Roturn.
AND MAIL With DECLARATION To:
FINANCE DEPARTMENT I inCOME TAX Division DATE
104 city-COUNTY BUiLdiNG
DETROIT, MichiGAN 48226
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 . 19_
1975
NAME(S) (PRINT OR TYPE) YOUR SOCIAL SECURITY NUMBER CKECK TYPE Of DECLARATION 039 Romae SAS TNs
INDIVIDUAL
ADDRESS 1813< LLVERNUlS
SPOUSE' $ SOCIAL SECURITY NUMBER CORPORATION
city STATE POSTAL Zip CODE PARTNERSHIP
Dzteo ST MeNIGAN 22 OTHER
la. Your 1974 Detroit Income Tax $.
347.39
b. Your Estimate of 975 Detroit Income Tax 4o0i 0
1
2 Amount of Detroit Income Tox to be withheld or other credit expected in 1975
3 ESTIMATED TAX (line 1b less line 2) 486185
4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated: Loo{01
Apr. 30, 1975_1 /4; 0J June 30, 1975_1 /3; Sept. 30, 1975 _ 1 /2; Jan. 31, 1976-100%
0
5. Less: Amount of overpayment on 1974 return which you elected to claim as credit
6. AMOUNT To BE PAID with This DECLARATION (line less line 5)' 03l30
1
IF You ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
CERTifY THAT This is A CORRECT DECLARATION_ This doclaration of estimated tax is o1 Tax Return;
'imlro of uxpuve. Spuyr ult joint doc letetiou. daiE
NW 88326 Docld:32245535 239 Page
==================================================
Page 240
==================================================
schzoUiz 7 Le
SHAREXOLDERS SNAhE 07 iNCC Z And Cned;tz
(If additional space is needed, attaci: sciecule)
(Z) {3)
(1) Sociol Socurity Nuinbar of
Name and Address of Each Shareholder Number Shares
Ku8y (a4322
Tone
"Eiez '5r '8iR"1EII42vi 7,162
(b)
ERTAIE QE. 4EPRsE IRRCg:
69 Wfe+WGTon #I1S0
EHisAGZEioek 7402
(c)
(d)
(e)
(g)
(h)
(i)
(j)
(41 (5) (6) (7)
Amount taxable as ordinary Distributive Income from Amount to be used by share- Enter here and on forrn
income (schedule K total page 1, line 5, or page 2, holder on Mi-1040 (enter on Ml-1040, page 1 , line 25
of lines 4 and 8, U.S: schedule B, Iine 6 page 2, schedule 1_ Iine 37 or each shareholccr'$ pro-
on page 2, schedule 2, line 46) portionate share 0f 1120S)
difference between column sonal property taxes
and column 5 (see instructions) paid on inventories or
the credit for franchise
fecs paid:
(see instructions)
(a) $ 34.33/.38 26 23/.38 9L9y
(b) 36 331.37 34 33/.37
91.94
(c)
(d)
(e)
f)
(g)
(h)
(i) .
(j)
NW 88326 Docld:32245535 Page 240 Dfs7 2 ` 4
por-
==================================================
Page 241
==================================================
L~ij-c Cmy Us Ulrn V' JLL-Xo Vi Oic Mly 0n
TAX COMPU;ATiON SCtzdiia
1Z3
ot 0-15-d/.) 8.74;
TOTAi DETRoit iNCOmE EXPECTED IN 975
p EXEM?TIONS (S600.00 For EACH EXEMPTION)
ESTiMATED Detroit TAXASLE INCOME (LINE A_ LESS LINE 8)
D ESTImATED DETROiT INCOME TAX_NONRESIDENT INDIVIDUALS ENTER V OF % OF LINE C
AlL OTHER TAXPAYERS ENTER 2 % OF LINE C- ENTER TAX KERE AND ON LINE 1b OF DECLARATION BELOw
D-1040-ES City OF DETROIT DECLARATION OF ESTIMATED INCOME TAX '75
For Calendar Year.1975 or Fiscal Year Ending 19
NAME(S) (PRINT Or TyPE) Your SOCIAL SECURitY NumbER CHECK TYPE Of DECLARATION
INDIVIDUAi ADDRESS
SPOUSE'S SOCiAL SECURiTY NUMbER CORPORATION
PARTNERSHIP City STATE POSTAL Zip CODE
OTHER
KEEP la. Your 1974 Detroit Income Tax $ Ib. Your Estimate of 1975 Detroit Income Tax
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
This 3 ESTIMATED TAX (line 1b less line 2)
Computation of Installment: Check Due Date of declar ation below and enter portion of line 3 as indicated:
CoPy Apr. 30, 1975_1 /4; { June 30, 1975_1 /3; 30, 1975_1 /2; Jan. 31, 1 976-100%
5. iess: Amount of overpayment on 1974 return which you elected to claim 0s credit
6 AMOUNT To BE PAID With This DECLARATION (line less line 5) For
YOUR
If You ARE AN EMPLOYER, ENTER EmplOYER IDENTIFICATION NUMBER RECORDS_
MAKE REMITTANCE PAYABLE To "'TREASuRER City Of Detroit" This declaration of estimated tax is not Tax Retura:
AND MAIL With DECLARATION To:
FINANCE DEPARTMENT INCOME TAX DIVISION DATE
104 City-CouNTY BUildiNG
DETROit, MICHiGAN 48226
DETACH ON PERFORATION AND SEND FORM BELOW With YOUR REMiTTANCE
D-,0Go-ES City OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
For Calendar Year 1975 or Fiscal Year Ending 19.
1973
NAMc(S) iPRiNT OR TYPE) YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION SLEAVZE T~<
INDIVIDUAL
ADDRESS 613 < Liver Nois
SPOUSE'S SOCIAL SECURiTY NUMBER CORPORATION
PARTNERSHiP City STATE POSTAL Zip CODE
ItRo , 7 mietlgAN OTHER
02 a. Your 1974 Detroit Income Tax $.
1.42129
Ib. Your Estimate of 1975 Detroit Income Tax
2 . Amount of Detroit Income Tax t0 be withheld or other credif expected in 1975 1
3 ESTIMATED TAX (line 1b less line 2)
Computation of Instailment: Check Due Date of declaration below and enter portion of line 3 as indicated:
Apr. 30, 1975_1/4; C June 30, 1975 _1 / 3; Sept, 30, 1975_1 /2; Jan. 31, 1976_100%
1
5, Less: Amount of overpayment on 1974 return which You elected to claim as credit
6. AMOUNT To BE PAID With ThiS DECLARATION . (line less line 5)- 26
1
IF You Are AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
CeRTify THAT This IS A CORrECT DECLARATION Thit declaration 0f estimated Iax is noi Tar Return.
Jivnuiyra of Tompove. Spouto ols i6 ioint doctaroron_ DA;E
NW 88326 Docld:32245535 Page 241
Rev.
Sept.
==================================================
Page 242
==================================================
Sc o~iuiz iAnexolceRS 3AnZ 0? {CCm#AnnC,ic,.s .
iIf acditional space is neeced, aitac:? scecu;a)
(1) {21 (3)
Name and Address of Each Shareholder Social Security Murkor 0f
Numbar Snares
(a) 0;
2780
RIEI BR7 M /C+l. ~E
(b) Zie Ot Gaxs., Cus
69 W_ WAS+WNSTou #FIe S1zzab Siilii 2529
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(41 (5) (6) (7)
Amount taxable as ordinary Distributive Income from Amount to be used by share- Enter here anc "n form
income (schedule K, total page 1, Iine 5, or page 2, holder on MI-:040 (enter on Mi-1040, pace 1_ line 25
of lines 4 and 8, U.S: schedule 8, line 6 page 2, schedule 1 line 37 or cach sharehoicer' $ pro-
1120-S) on page 2, schcdule 2, line 46} porzionate share 0; pet-
difference between column 4 sonai property faxes
and column 5 (see instructions) d 07 inventorics or
the credit for franchise
fees paid:
(see instructions)
(a) $ LenL1 LLLA L9
(b) 9h1 UeSC9
(c)
(d)
(e)
(g)
(h)
(i)
(j)
NW 88326 Docld:32245535 242
7 07 4
72-
Pais
65
Page
==================================================
Page 243
==================================================
J-10L0-35 cix 6; U-Rui ViCLAAAo oc 27343 ZOi T3
TAX CO,PUTATiON SCHEDUle
~is
of D-15-din-J (Rev. 8.74)
A TOTAL detRoit INCOME EXPECTED IN 975
8 EXEMPTIONS (3600.00 FOR EACH EXEMPTION)
C ESTIMATED DETROit TAXABLE INCOME (LINE A LESS LINZ 3)
D ESTIMATED DETROiT INCOME TAX_NONRESIDENT INDIVIDUALS ENTER Vi OF 1% OF LINE C_
ALL OTHER TAXPAYERS ENTER 2% OF LINE C_ ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW
D-T040-ES City OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 1973
For Calendar Year 1975 or Fiscal Year Ending 19_
NAME(S) (PRINT OR TYPE) YouR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION
INDIVIDUAL ADDRESS
spouse's SOCIAL SECURitY NUMBER CORPORATION
PARTNERSHIP City STATE POSTAL ZIP CODE
OTHER
KEE? Io; Your 1974 Detroit Income Tax S Ib. Your Estimate of 1975 Detroit Income Tax 5
2. Amount of Detroit Income Tox t0 be withheld orother credit expected in 1975
this 3 ESTIMATED TAX (line 1b less line 2)
4 Computation of Instollment; Check Due Date of declaration below and enter portion of line 3 as indicated:
COPy Apr. 30, 1975_1 /4; 07 June 30, 1975_1/3; 30, 1975_1 /2; Jan. 31, 1976-100%
5_ Less: Amount of overpayment on 1974 return which You elected to claim 0s credif
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" This declaration of estimated tax is not Tax Return:
AND MAIL With DECLARATION TO:
FINANCE DEPARTMENT S INCOME TAX DIVISION DATE
104 City-COUNTY BUilding
DETROIT, MICHIGAN 48226
DETACH ON PERFORATION AND SEND FORM BELOW With YOUR REMITTANCE
D-040-ES City OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
For Calendar 1975 or Fiscal Year Ending 19
1975
NAME(S) (PRINT OR TYPE) YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION Co3 0 Rumae SALES IN
INDIVIDUAL
ADDRESS 18123 LLVERNWS
SPOUSE'$ SOCIAL SECURIY NUMBER
ZcORPORATION
city STATE POSTAL Zip CODE PARTNERSHIP
Dezeo McrllGAN 623 OTHER
Jo, Your 1974 Detroit Income Tax $_
3672.39.;
Ib. Your Estimate of 1975 Detroit Income Tax
4ooi36
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
1
3 , ESTIMATED TAX (line 1b less line 2)
480/80
4_ Computation of Installment: Check Due Dote of declar ation below and enter portion of line 3 0s indicated: 1oe !86
Apr. 30, 1975_1 /4; Cj June 30, 1975_1/3; Sept. 30, 1975_1 /2; Jan, 31, 1976_100%
0
5. Less: Amount of overpoyment on 1974 return which You elected to claim as credit
6. AMOUNT To BE PAID With This DECLARATION (line less line 5) 03l0 0
1
IF YOU ARE AN EMPLOYER ENTER EMPLOYER IDENTIFICATION NUMBER
CERTify THAT This is A CORRECT DECLARATION_ This declaration of estimaled Iax is not Tax Return.
'sititsllts of Tunpu/o, Spuuw ulw i6 ioini docluration_ OA:
NW 88326 Docld:32245535 243
Sept.
Year
Page
==================================================
Page 244
==================================================
scxzouie 7 SXAZEXOLDEAS SXATE Uf iNCCK,z Ai C,izi;ts
(If additionai space is needed, #ttach scriedule)
(z) {3)
(1) Sociol Socurity Numniar of
Name ind Address of Each ' Shareholder Numbor Sharus
Ku8Y
(a) 4322 Toe:
"EiEz' '521 37R73 7562
(b)
EKTAIE QE. G39R.9 IRRCS:
69 W WFEAWGToN 4I1So CtilAC2 'iEZioi3h 7302
(c)
(d)
(e)
(g)
(h)
(4) (5) (61 (7)
ordinary Distributive Income from Amount to be used by share- Enter here and on {orr
Amount taxable as holder on Mi-1040 (enter on Mi-1040, page 1, line 25
income (schedule K total page 1, line 5, or page 2, shareiolccr'$ pro-
of lines 4 and 8, U,S: schedule B, Iine 6 page 2, schedule 1, line 37 or each
on page 2, schedule 2, line 46) portionate share 0f pur- 1120S)
difference between column somal property taxes
and column 5 (see instructions) paid on inventories or
the credit for franchise
fecs paid:
(see instructions)
(a) $ 34.334.38 26,.23/38 9i.94
(b) 36 331.37 36 33/.37 91.94
(c)
(d)
(e)
(g)
(h)
NW 88326 Docld:32245535 244 D;S? 2
Zijizoi:
Page
==================================================
Page 245
==================================================
~ku-) CI;" Ur L-tc" UtLkical U; 4.G Al' ~
TAX COMPU;ATiON SCtikdiiz
or 0_15.dit.) Rev. 8.74,
TOTAi DETROit iNcOME EXPECTED iN 1975
Exzm?tions (S600.00 FOr EACH EXEMPTION)
ESTimATED DETRoit TAXABLE INCOME (LINE A LESS LINE 8) $
D_ ESTIMATED DETRoit INCOME TAX_NONRESIDENT INDIVIDUALS ENTER Va OF 1% OF LINE C
Ali OiHER 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 975
For Calendar Year 1975 or Fiscal Year Ending 19
NAME(S) (PRINT OR TYPE) YoUR SOCIAL SECURity NUMBER ChECK TYPE OF DECLARATION
INDIVIDUAi ADDRESS
spouse'$ SOCiAl SecuRity NuMBER CORPORATION
PARTNERSHIP Cify STATE POSTAL Zip CODE
OTHER
KZeP Ja. Your 1974 Detroit Income Tax S Ib. Your Estimate of 1975 Detroit Income Tax
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
Txis 3_ ESTimATED TAX (line 1b less line 2)
4. Computation of Installment: Check Due Date of declar ation below and enter portion of line 3 as indicated:
CoPy 30, 1975_1 /4; 0J June 30, 1975-1/3; 30, 1975_1 /2; Jan. 31, 1976_100%
5_ Less: Amount of overpayment on 1974 return which You elected to claim as 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 "'TREASURERCity_ Of Detroit" This declaration of estimated tax is not Tax Return:
AND MAIL With DECLARATION To:
FINANCE DEPARTMENT income TAX Division DATE
104 city-COUNTY Building
DetRoit, MichigAN 48226
DETACH ON PERFORATION AND SEND FORM BELOW WiTH YOUR REMITTANCE
C-;o4o-ES CItY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
For Calendar Year 1975 or Fiscal Year Ending 89
1973
NAMc(S) iPrint OR TYPE) YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION
CCe Nia Tn<-
INDIVIDUAL
ADORess 435 LiVer No iS
SPOUSE' $ SOCIAL SECURIY NUMBER CORPORATION
City STATE POSTAL COde PARTNERSHiP
IRo ,7 m)ztlgAN 321 OTHER
Ta. 1974 Detroit Income Tax $_
14272
Ib. Your Estimate of 1975 Detroit Income Tax 20
2_ Amoun} of Detroit Income Tax to be withheld or other credif expected in 1975
1
3_ ESTIMATED TAX (line 1b Iess line 2)
4 Computation of Instailment: Check Due Date of declaration below and enter portion of line 3 0} indicated; 48
Apr. 30, 1975_1 /4; C June 30, '1975_1/3; 30, 1975_1 /2; Jan. 31, 1976_100%
1
5 . Less: Amounf of overpayment on 1974 return which You elected to claim as credit 150
6. AMOUNT To BE PAiD With This DECLARATION (line less line 5) 269
1
IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
CERTify THAT This is A CORRECT DECLARATION_ Thit doclaration of estimaled tax is not Tax Roturn.
Siynuluo 0f Toxpovet. Spouno ols if joini declararon: DATE
NW 88326 Docld:32245535 Page 245
Sept. Apr _
Zip
Your
Sept.
==================================================
Page 246
==================================================
3-'UtO-is CiTy Gi ~iii U_iiAAcv Or 6572 "WUm ; "J5
TAX COM?UTATION SCHEDULE
of D_15-DIT.J (Rev 8.74)
A TOTAL DETRoIT INCOME EXPECTED IN 1975
6 EXEMPTIONS (S600.00 FOR EACH EXEMPTION)
ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B) 5
D ESTIMATED DETROiT iNCOME TAX_NONRESIDENT INDIVIDUALS ENTER Vz OF 1 % OF LINE C
ALL OTHER TAXPAYERS ENTER 2% OF LINE C ENTER TAX HERE AND ON LINE 15 OF DECLARATION BELOw
D-I040-ES City OF DETROIT DECLARATION Of ESTIMATED INCOME TAX 1975
For Calendar Year 1975 or Fiscal_Year _Ending 19
NAME(S) (PRINT OR TYPE) YOUR SOCIAL SECURiTY NUMBER CHECK TYPE OF DECLARATION
INDIVIDUAL Address
SPOUSE'S SOCIAL SECURiTy NUMBER CORPORATION
city STATE POSTAL Zip CODE PARTNERSHIP
OTHER
KEEP Ia. Your 1974 Detroit Income Tax 5 Ib. Your Estimate of 1975 Detroit Income Tax
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
This 3 ESTIMATED TAX (line 1b less line 2)
4_ Computation f Installment: Check Due Date of declar ation below and enter portion of 3 as indicated:
Copy 30, 1975-1/ 4; 0 June 30, 1975-1/3; 30, 1975-1/2; Jan. 31_ 1976-10o%
5_ Less: Amount of overpayment on 1974 return which You elected to claim as 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 "TREA SURER,City Of Detroit" This declaration of estimated tax is not Tax Roturn;
AND MAIL With DECLARATiON To:
FINANCE DEPARTMENT income TAX Division DATE
104 city-COUNTY Building
DETROiT, MichigAN 48226
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.
1975
NAME(S) (PRINT Or TYPE) YOUR SOCIAL SECURUTY NUMBER CHECK TyPE Of DECLARATiON
n ( 45: TNa
INDIVIDUAL
ADDRESS 813s _ivernoiS
SPOUSE'S SOCIAL SECURITY NUMBER CORPORATION
PARTNERSHIP City STATE POSTAL Zip CODE ZTQNT micni64" 42221 OTHER
Ia. Your 1974 Detroit Income Tax $.
58.22
Ib. Your Estimate of 1975 Detroit Income Tax 0 0 0o
2. Amount of Detroit Income Tox to be withheld or other credit expected in 1975
L
3 ESTIMATED TAX (line 1b less line 2)
7c0 0J
4_ Computation of Installment: Check Due Date of decloration below and enter portion of line 3 as indicated: 10 0 0
Apr. 30, 1975_1 /4; 0J June 30, 1975_1 /3; 30, 1975_1 / 2; D Jan. 31, 1976_100%
0
5_ Less: Amount of overpayment on 1974 return which You elected to claim as credit
6 AMOUNT To BE PAID With This DECLARATION (line less line 5) 7
1
IF You ARE AN EMPLOYER ENTER EMPLOYER IDENTIFICATION NUMBER
ceRTiFy THAT This is A CORRECT DECLARATION_ This declaration of ettimated tax is not Tax Return:
Siunulur of Taspoyer. Spouso ols il ioinl duclaration. DAIE
NW 88326 Docld:32245535 'Page 246
line
Sept. Apr.
Sept.
==================================================
Page 247
==================================================
J- U+u-z9 C;jy Gj; Jioi UeCLAXAMv 8; 373 "#yta ;cX 3975
TAX COMPUTATION ScHzDUl:
of D-15-DIT-J (Rev. 8.74}
TOTAL DETROit INCOME EXPECTED IN 1975
8 EXEMPTIONS (S600.00 FOR EACH EXEMPTION)
C ESTIMATED Detroit TAXABLE INCOME (LINE A LESS LINE B)
D ESTIMATED DetRoit iNCOME TAX_NONRESIDENT INDIVIDUALS ENTER Va OF 1 % OF LINE C
ALL OTHER TAXPAYERS ENTER 2% Of LINE C 'ENTER TAX HERE AND ON LINE Ib OF DECLARATION BElOW
D-I040-ES CItY OF DETROIT DECLARATION Of ESTIMATED INCOME TAX 75
For_Calendar Year 1975_or_ Fiscal_Year Ending 19
NAME(S) (PRINT OR TYPE) Your SOCIAL SECURity NUMBER CHECK TYPE OF DECLARATION
INDIVIDUAL ADDRESS
SPOUSE'S SOCIAL securiTY NUMBER CORPORATION
PARTNERSHiP
City 'STATE POSTAL Zip CODE
OTHER
KEEP Ia. Your 1974 Detroit Income Tax $ Ib. Your Estimate of 1975 Detroit Income Tax
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
TKIS 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:
CO?Y Apr. 30, 1975_1/4; 0 June 30, 1975_1/3; 30, 1975_1/2; Jan. 31, 1976-100%
5. Less; Amount of overpayment on 1974 return which You elected to claim as credit
6. AMOUNT To BE PAID With This DECLARATION (line less line 5) FOR
YOUR
If You ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUmbeR RECORDS_
MAKE REMITTANCE PAYABLE To "TREASURER City Of DETROIT" This declaration of estimated tax is not Tax Return;
AND MAIL With DECLARATiON To:
FINANCE DEPARTMENT income TAX Division DATE
104 city-COUNTY Building
DEtROIT, MIChiGAN 48226
DETACH ON PERFORATION AND SEND FORM BELOW With YOUR REMITTANCE
0-1040.ES City OF DETROIT DECLARATION Of ESTIMATED INCOME TAX
For Calendar Year 1975 or Fiscal Year Ending 19.
1975
VAME(S) (PRINT OR TYPE) YOUR SOCIAL SECURiTY NUMBER CHECK TYPE Of DECLARATION
n A ' UE TNc.
INDIVIDUAL
ADDRESS 8130 CiVERnoiS
SPOUSE'S SOCIAL SECURITY NUMBERF CORPORATION
PARTNERSKIP city STATE POSTAL Zip CODE ZTrT mctIGA" 48231 OTHER
Ia. Your 1974 Detroit Income Tox $ _
4&.22
Ib. Your Estimate of 1975 Detroit Income Tax 0 00
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
0
3, ESTIMATED TAX (line 1b less line 2)
4_ Computation of Installment: Check Due Date of declar ation below and enter portion of line 3 as indicated: 1 0 0 |0 0
0j Apr. 30, 1975_1/4; 0J June 30, 1975_1/3; 30, 1975_1/2; Jan. 31, 1976-100%
1
5 . Less: Amount of overpayment on 1974 return which You elected to claim as credit
6. AMOUNT To BE PAiD With This DECLARATION (line less line 5). 3217
1
IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
CERTifY THAT This is A CORRECT DECLARATION; This declaration of estimated tax is not Tax Return:
Siunulure of Taspoyer. Spouto ols if ioinl duclaration. DAIt
NW 88326 Docld:32245535 247
Sept.
Sept.
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