4 Enter dividends-received deduction allowed for dividends reported on line 9, Schedule 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 ines through 6. Enter here and on line 29(b), page 1

InSchedul Tax Computation (Fiscal year members of a controlled group electing section 1562, omit lines 1-4 and see Form 1120-FY.)

1 Taxable income (line 30, page 1).

2 Surtax exemption-Enter line 1 or $25,000, whichever is lesser. (Component members of a controlled

group see instructions and enter your surtax exemption or line 1, whichever is lesser.)

3 Line 1 less line 2

4 (a) 22% of line 1

(b) 26% of line 3

(c) If multiple surtax exemption is elected under section 1562, enter 6% of line 2.

5 Income tax (sum of line 4, or alternative tax from separate Schedule D, whichever is lesser)

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

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

11 Tax from recomputing a prior year WIN credit (see instructions-attach computation)

SCHEUS
Serial numer

of Form 503

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

6 Date incorporated D

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) 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).)

If "Yes:"

Yes No M Refer to page 7 of instructions and state the principal:
Business activity

Product or service..

N Were you a member of a controlled group subject to the provi-
sions of: (1) Section 1561?

(2) Section 1562? .

If answer to (1) or (2) is "Yes," check the type of relationship:
(a) parent-subsidiary (b) brother-sister

(c) combination of (a) and (b)(See section 1563.)

If answer to (2) is "Yes," are you excluded from paying the
66 additional tax because section 1562(b)(1)(A) applies?

0 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?

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

P Were you a U.S. shareholder of any controlled foreign corporation?
(See sections 951 and 957.)

If "Yes," attach Form 3646 for each such corporation.

Q During this taxable year, did you pay dividends (other than stock
dividends and distributions in exchange for stock) in excess of
your current and accumulated earnings and profits? (See sections
301 and 316.)

If "Yes," file Schedule A, Form 1096. If this a consolidated
return, answer here for parent corporation and on Form 851,
Affiliations Schedule, for each subsidiary.

R Taxable income or (loss) from line 30, page 1, Form 1120 for
your taxable year beginning in:

་་་་་་་་་་་་་་་་་་་་་་

IMPORTANT-Fill in all applicable lines and schedules. If the lines on the schedules are not sufficient, see instruction N. 1 Gross receipts or gross sales.

GROSS INCOME

Less: Returns and allowances...

$

1

2

3

4

5

6

7

8

9(a)

9(b)

10

11

12

13

14

15

16

17 Taxes (attach schedule)

17

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

35 Enter amount of line 34 you want: Credited to 1976 estimated tax ►

Refunded

34 OVERPAYMENT (line 32 less line 31)

30
31

33

34

35

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

4 Dividends from wholly-owned foreign subsidiaries
subject to 100% deduction (section 245(b))

5 Other dividends from foreign corporations

6 Includable income from controlled foreign corpora-
tions under subpart F (attach Forms 3646)

7 Foreign dividend gross-up (section 78)

8 Qualifying dividends received from affiliated groups
and subject to the 100% deduction (section 243
(a)(3)).

9 Qualifying dividends received from affiliated groups
and subject to the provisions of section 1564(b)

10 Taxable dividends from a DISC or former DISC not
Included in line 1 (section 246(d)).

11 Other dividends

12 Total-Enter here and on line 4, page 1.

Page 2

Schedule G Depreciation (See instructions for Schedule G) Note: If depreciation is computed by using the Class Life (ADR) System or the Guideline Class Life System, you must file Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline Class Life System) with your return. Check box(es) if you made an election this taxable year to use Class Life (ADR) System and/or Guideline Class Life System. See Publication 534.