Form 1120 (1975)

4 Enter dividends-received deduction allowed for dividends reported on line 9, Sch. C. See section 1564(b) for computation

5 Dividends paid on certain preferred stock of public utilities (see instructions)

6 Western Hemisphere trade corporations (see instructions)

7 Total special deductions—Add lines 2 through 6. Enter here and on line 29(b), page 1

1 Taxable income (line 30, page 1) .

2 Enter line 1 or $25,000, whichever is lesser. (Members of a controlled group, see instructions)
3 Line 1 less line 2

4 Enter line 3 or $25,000, whichever is lesser. (Members of a controlled group, see instructions)
5 Line 3 less line 4

13 Personal holding company tax (attach Schedule PH (Form 1120))

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

15 Tax from recomputing a prior year WIN credit (see instructions-attach computation)
16 Minimum tax on tax preference items (see instructions-attach Form 4626)
17 Total tax-Add lines 12 through 16. Enter here and on line 31, page 1

Schedule K

rial number

Form 503

Record of Form 503 Federal Tax Deposits (List deposits in order of date made-See instruction G)

Yes No

Did you claim a deduction for expenses connected with:
(1) Entertainment facility (boat, resort, ranch, etc.)?
(2) Living accommodations (except for employees on business)?
(3) Employees' families at conventions or meetings?..
(4) Employee or family vacations not reported on Form W-2?

H (1) Did you at the end of the taxable year own, directly or indirectly,
-50% or more of the voting stock of a domestic corporation? (For
rules of attribution, see section 267 (c).).

If "Yes," attach a schedule showing:

(a) name, address, and identifying number; (b) percentage owned; and

(c) taxable income or (loss) (e.g., if a Form 1120: from line 30, page 1, Form 1120) of such corporation for the taxable year ending with or within your taxable year.

(2) Did any individual, partnership, corporation, estate or trust at the end of the taxable year own, directly or indirectly, 50% or more of your voting stock? (For rules of attribution, see section 267(c).)

LIABILITIES AND STOCKHOLDERS' EQUITY

15 Accounts payable . .

16 Mtges., notes, bonds payable in less than 1 yr.

17 Other current liabilities (attach schedule)

18 Loans from stockholders..

19 Mtges., notes, bonds payable in 1 yr. or more

Other liabilities (attach schedule)

Capital stock: (a) Preferred stock

(b) Common stock

22 Paid-in or capital surplus

23 Retained earnings-Appropriated (attach sch.)

24 Retained earnings-Unappropriated

25 Less cost of treasury stock

26 Total liabilities and stockholders' equity

Beginning of taxable year

End of taxable year

(A) Amount

(B) Total

(C) Amount

(D) Total

(

Schedule M-1 Reconciliation of Income Per Books With Income Per Return

Schedule M-2 Analysis of Unappropriated Retained Earnings Per Books (line 24 above)

GROSS INCOME

City or town, State, and ZIP code

E Enter total assets from line

$

14, column D, Schedule L

IMPORTANT-All applicable lines and schedules must be filled in. If the lines on the schedules are not sufficient, see instruction N. 1 Gross receipts or gross sales Less: Returns and allowances

2 Less: Cost of goods sold (Schedule A) and/or operations (attach schedule)

3 Gross profit. . .

4 (a) Domestic dividends

(b) Foreign dividends

5 Interest on obligations of the U.S. and U.S. instrumentalities

1

2

3

4(a)

4(b)

5

9

Gains and losses (attach separate Schedule D (Form 1120S) and/or Form 4797):
(a) Net short-term capital gain reduced by any net long-term capital loss
(b) Net long-term capital gain reduced by any net short-term capital loss (if more than
$25,000, see instructions).

9(a)

9(b)

33 TAX DUE (line 31 less line 32). See instruction G for depositary method of payment.

34 OVERPAYMENT (line 32 less line 31).

33
34

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is Je, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he has any knowledge.

Schedule G Depreciation (See instruction 21). Note: If depreciation is computed by using the Class Life (ADR) Syster or the Guideline Class Life System, you must file Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline Class Life Sys tem) with your return.

6 Less: Amount of depreciation claimed in Schedule A

7 Balance-Enter here and on line 21, page 1

Schedule J Tax Computation (See instructions)

1 Taxable income (line 28, page 1) . .

2 (a) Enter 48% of line 1 (members of controlled groups, see instructions)

(b) Subtract $6,500 and enter difference..

3 Net long-term capital gain reduced by net short-term capital loss (from line 9(b), page 1)

4 Subtract $25,000. (Statutory minimum.)

5 Balance (line 3 less line 4) (see instructions)

6 Enter 30% of line 5 (see instructions)

6,500.00

25,000.00

7 Income tax on capital gains (line 2 or line 6, whichever is lesser)--Enter here and on line 29, page 1

Printed on Green Paper

Farm 1120S (1974)

Schedule K Computation of Undistributed Taxable Income and Summary of Distributions and Other Items
Computation of Corporation's Undistributed Taxable Income

1 Taxable income (line 28, page 1) . .

2 Less: (a) Money distributed as dividends out of earnings and profits of the taxable year

(b) Tax imposed on certain capital gains (line 31, page 1)

3 Corporation's undistributed taxable income

Summary of Distributions and Other Items (attach additional sheets if necessary)

(157) Page 3

3. Stock ownership

15. Percentage of time devoted

To

to business

C

D

4 Actual dividend distributions taxable as ordinary income (Do not include amounts shown on line 6)

5 Actual dividend distributions taxable as long-term capital gains (after tax)*

6 Actual dividend distributions taxable as ordinary income and qualifying for dividend exclusion

7 Nondividend distributions

8 Undistributed taxable income-taxable as ordinary income or (loss).

9 Undistributed taxable income-taxable as long-term capital gain (after tax)*

•Each shoreholder must be notified of his pro rata share of long-term capital gains that may qualify as subsection (d) gain. See section 1201(d). 10 Interest on investment indebtedness:

Additional Information Required

Product or service

Yes

No

(3) Employees' families at conventions or meetings?
(4) Employee or family vacations not reported on Form
W-2?

M Did you file all required Forms 1087, 1096, and 1099?. Yes

N Did the corporation, 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?
Yes No

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

O Answer only if (1) this is the first 1120S return filed since your election
to be treated as a small business corporation and (2) the corporation was
in existence for the taxable year prior to the election and had investment
credit property: Was in agreement filed under section 1.47-4(b) of the
regulations? .
Yes No

Schedule K-1 Shareholder's Share of Undistributed Taxable Income, etc. (Complete a separate Schedule K-1 (Form 1120S) for each shareholder. Attach Copy A to Form 1120S. Give Copy B to the shareholder. Keep Copy C for your records.)