652
THE NEW ZEALAND GAZETTE.
[No. 39

Deductions.
Losses, outgoings, and expenses incurred in the
production of the gross income stated above .. £
(See Schedule F, page 3.)

Net income derived from business .. £

N.B.—Interest on mortgages cannot be deducted.
Land and income tax paid cannot be deducted.

Gross Income derived from Employment or Emolument.
(See Schedule E, page 3.)

1. From the profession, employment, or vocation
   of .. .. .. .. .. £
2. From salary, wages, allowances, bonus, pension,
   stipend, fees, charge, or annuity of any kind..
3. From commissions or share of profits by way
   of or in lieu of salary .. .. ..
4. From any other source not coming within any
   of the foregoing heads .. .. ..

Total .. .. .. .. £

Deductions.
Losses, outgoings, and expenses incurred in the
production of the gross income stated above .. £
(See Schedule F, page 3.)

Net income derived from employment
or emolument .. .. .. £

I claim deduction on account of amount actually
paid by me during the year as life insurance
premiums on my own life (not to include acci-
dent insurance) .. .. .. .. £

N.B.—This deduction is limited to £50, and if the
amount paid be less than that sum the exact figures
should be entered.

NOTE.—The exemption of £300 allowed by law will be
deducted in the office of the Commissioner of Taxes.

Income derived or received by the owner or occu-
pier of land in New Zealand from or out of land, or
from the use or produce of such land derived by such
owner or occupier, or from mortgages of land in New
Zealand, except where otherwise specially provided,
should not be included in the gross income; and losses,
outgoings, and expenses incurred in the production of
such income from land or mortgages cannot be de-
ducted.

I, the person making the foregoing return, do solemnly
and sincerely declare that the same, and the statements
therein referred to or accompanying such return, contain
true and accurate details of the several matters and things
set forth, and in particular contain a true and accurate ac-
count of all income derived by me during the year ending
31st March, 18 ; and the deductions claimed by me are
those which I am legally entitled to deduct. And I make
this declaration under the provisions of “The Land and In-
come Assessment Act, 1891,” and its amendments.

Dated this day of , 18 .
(Usual signature:)

Deduction claimed on account of Liability to pay Land-
tax in respect of Land occupied for Business or Em-
ployment, such Deduction being equal to 5 per Cent. on
the Amount upon which I am liable to pay Land-tax
on such Land.

N.B.—No deduction can be claimed by the owner in respect of
premises or portion of premises let to a tenant.

Names, Addresses, and Shares of Partners.
(To be filled up in the case of Returns made by or on account
of a Firm.)

Statement to be made by Persons acting as Attorneys or
Agents.

DESCRIPTION of every Person for whom I act as Attorney
or Agent where Principal is permanently or temporarily
absent from the Colony.

STATEMENT to be made by Government Departments, Local
Authorities, Persons, Firms, Companies, and Societies
employing Officers, Managers, Travellers, Clerks, Fore-
men, Workmen, Servants, and Others in New Zealand,
whether paid by Salary, Weekly Wage, or otherwise.

List of Persons in my Service or Employ.

NOTE.—In the case of any person the total payment to whom
does not exceed £160 a year, an entry need not be made.
If there should not be sufficient space in any of the above forms,
a sheet giving the required information may be attached.

SCHEDULE B.

“THE LAND AND INCOME ASSESSMENT ACT, 1891,” AND ITS
AMENDMENTS.

In pursuance of the above Act, and of the regulations made
thereunder, every company in receipt of income within the
meaning of the said Act is required to fill up the following
return as far as is applicable to its particular case, and deliver
the same at or forward it by post to the office of the Com-
missioner of Taxes, Wellington.

Commissioner of Taxes.

NOTE.—Any company failing or neglecting to furnish a return at
the prescribed time, or any company making a false return, is
liable to a penalty of not less than £5 nor more than £100, and to
pay treble extra duty.

RETURN OF THE INCOME OF

Name of company in full:
Postal address:

made in pursuance of “The Land and Income Assessment
Act, 1891,” and its amendments, and the regulations there-
under.

Income derived during the year ending 31st March, 18 :
£ , being gains and profits derived or received by the
said company during such year.

NOTE.—The income of a company shall include dividends earned,
sums carried to reserve fund, and any other profits made or income
derived during such year.

N.B.—Income derived or received by the owner or occupier of
land in New Zealand from or out of land, or from the use or produce
of such land derived by such owner or occupier, or from mortgages
of land in New Zealand, except where otherwise specially provided,
should not be included in the gross income; and losses, outgoings,
and expenses incurred in the production of such income from land
or mortgages cannot be deducted.

I, , being the duly appointed public officer of the
above-named company, and in that capacity duly authorised
to make the above return, do solemnly and sincerely declare
that I am well acquainted with the affairs of the said com-
pany, and that the said return contains a true and accurate
statement of the income of the company for the year ending
the 31st March, 18 , and that the copy of a balance-sheet
hereto attached is a true copy of the balance-sheet of the
said company issued to shareholders, or prepared for issue,
last prior to the date of this return.

Dated this day of , 18 .
(Usual signature:)

RETURN AS AGENT FOR HOLDERS OF DEBENTURES.

RETURN of the income received or receivable, for the year
ending the 31st March, 18 , by the holders of debentures