TAX

DEDUCTIONS

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

1

2

3

4(a)

4(b)

5

6

7

8

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.

9(a)

(b) Net long-term capital gain reduced by any net short-term capital loss (if more than
$25,000, see instructions).

9(b)

19 Contributions (not over 5% of line 28 adjusted per instructions-attach schedule). 20 Amortization (attach schedule)

19

20

21

21 Depreciation (Schedule G)

22 Depletion (attach schedule).

22

33 TAX DUE (line 31 less line 32). See instruction G for depositary method of payment 34 OVERPAYMENT (line 32 less line 31)..

Schedule G Depreciation (See instruction 21). 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.

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

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

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

12 Balance (line 10 less line 11). (See instructions)

13 Enter 30% of line 12. (See instructions)

14 Income tax on capital gains (line 9 or line 13, whichever is lesser). Enter here and on line 29, page 1

77-169 O - 76 - 20

25,000.00

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

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),

6 Actual dividend distributions taxable as ordinary income and qualifying for dividend exclusion 7 Nondividend distributions

11 Interest on investment indebtedness: (a) Investment interest expense

(b) Net investment income or (loss) . .

(c) Excess expenses over rental income attributable to net lease property

(d) Excess of net long-term capital gains over net short-term capital losses attributable to investment property

12 Items of tax preference: (a) Accelerated depreciation on: (1) Low-income rental housing.

Form 1120S (1975)

Page 4

Schedule K-1 Shareholder's Share of Undistributed Taxable Income, etc. (Complete a separate Schedule K-1 (Form 1120S) for each shareholder. See page 5 of instructions, and also back of Copy C, Schedule K-1 (Form 1120S) Schedule Balance Sheets

4 Gov't obligations: (a) U.S. and instrumentalities

(b) State, subdivisions thereof, etc.

5 Other current assets (attach schedule)

6 Loans to shareholders

7 Mortgage and real estate loans

8 Other investments (attach schedule)

9 Buildings and other fixed depreciable assets

(a) Less accumulated depreciation

10 Depletable assets.

(a) Less accumulated depletion

11 Land (net of any amortization)

12 Intangible assets (amortizable only)

(a) Less accumulated amortization

13 Other assets (attach schedule)

О

Complete this form showing your relationship during the taxable year to one or more bank,
securities or other financial accounts in foreign countries. Use additional sheets if necessary.
Tax identifying number (Social security
number or employer identification
number if other than individual)

Name(s) as shown on return

NOTE: Ownership of 50% or less of the stock of any corporation which owns one or more foreign accounts is not a "financial interest" in these accounts and need not be reported by the shareholder. Accounts in a U.S. military banking facility operated by a U.S. financial institution are not foreign accounts and need not be reported.

Part I

1.

If you wish, you may also submit any other information or explanation not required by this form
concerning your interest in or authority over an account.

Check all appropriate boxes. See instruction F for definition of "financial interest."
Use additional sheets if necessary.

19.....

I had signature authority or other authority over one or more foreign accounts, but I had no "financial interest" in such accounts (see instruction I). Indicate for these accounts:

Name and tax identifying number (if any) of each owner ►

Address of each owner ►

(Do not complete Part II for these accounts.)

2. I had a "financial interest" in one or more foreign accounts, but the total maximum value of these accounts (see instruction H) did not exceed $10,000 at any time during the taxable year. (If you checked this box, do not complete Part II.) I had a "financial interest" in 25 or more foreign accounts. (If you checked this box, do not complete Part II.)

3.

I had a "financial interest" in one or more but fewer than 25 foreign accounts, and the total maximum value of these accounts (see instruction H) exceeded $10,000 during the taxable year. (If you checked this box, complete Part II.) Part II

Complete this part ONLY if you checked item 4, and provide information in items 5 through 10 for each account. Please use a separate Form 4683 for each account or use your own schedule to provide this information.

To avoid duplicate reporting on accounts owned by a corporation, partnership, or trust required to file this form, you may follow the procedure in instruction J by checking this box and completing the statement on the back of this form.

5. Name in which account is maintained

6. Name of bank or other person with whom account is maintained

7. Number and other account designation, if any

8. Address of office or branch where account is maintained

9. Type of account. (If not certain of English name for the type of account, give the foreign language name and describe the nature of the account. Attach additional sheets if necessary.)

Savings, demand, or checking

Securities

Other (specify) ►

10. Maximum value of account (see instruction H) Under $50,000

Instructions

$50,000 to $100,000

A. Who Must File a Return.-Each United States person who has a finan cial interest in or signature authority or other authority over a bank, securi. ties, or other financial account in a for. eign country at any time during a taxable year must report that relation. ship for each taxable year. Do this by filing an information return on Form

93 with the return you file for the

ble year.

B. United States Person.-The term "United States person" means (1) a citizen or resident of the United States,

Over $100,000

(2) a domestic partnership, (3) a do-
mestic corporation, and (4) a domestic
estate or trust.

C. Account in a Foreign Country.--
A "foreign country includes all geo.
graphical areas located outside the
United States, its possessions, and
Puerto Rico.

Report any account maintained with
a branch, agency, or other office of a
bank (except a military banking facility
as defined in instruction D) or broker
or dealer in securities that is located in
a foreign country, even if it is a part of
a United States bank or other institu.
tion. Do not report any account main.

Unable to determine (attach explanation)

tained with a branch, agency, or other office of a foreign bank or other insti tution that is located in the United States, its possessions, or Puerto Rico.

D. Military Banking Facility.-Do not consider as an account in a foreign country an account in an institution known as a "United States military banking facility" (or "United States military finance facility") operated by a United States financial institution un⚫ der designation by the United States Treasury to serve U.S. Government installations abroad, even if the United

(Continued on back)