April 3.] THE NEW ZEALAND GAZETTE. 533

Statement of Gross Income derived from Business, and Deductions therefrom.

[NOTE.—This may be taken for twelve months ending at date of stock-taking or annual balance nearest to 31st March.]

For the Year ending , 189 .

Sales for twelve months ending at date of stock-taking (Include goods supplied for
proprietor's own use, and goods used in the business, or upon buildings, plant,
fixtures, &c.) .. .. .. .. .. .. .. : :
Stock in hand at date of stock-taking on expiry of the twelve months.. .. ..

Less: Stock in hand at the commencement of the twelve months .. .. ..
Purchases, &c., for twelve months ending at date of stock-taking (at cost laid
down on the premises) .. .. .. .. ..
Labour and materials used in manufactures .. .. .. .. ..
[This should only appear in case of a manufacturing business.]

Other income from business—viz., commissions, &c.—

                    Gross income .. £

[Gross income should correspond with amount shown on page 1, heading 4.]

    *Deductions from Gross Income.*

Salaries and wages (not to include any sums drawn by proprietors, or any sums claimed
under above heading "Labour and Materials") .. .. .. ..
Rent (Include only rent of premises or portion of premises used exclusively for the
purpose of the business) .. .. .. .. ..
Rates on business premises (not to include payments for land- or income-tax) .. ..
Fire insurance (on business premises and stock only) .. .. .. ..
Interest, exchange, and discounts allowed, less amounts received .. .. ..
Printing, stationery, advertising, stamps, and telegrams .. .. .. ..
Travelling-expenses, incurred in the business only .. .. .. ..
Repairs or maintenance (not to include additions or improvements to property or plant)
Sundry petty expenses, incurred in the business only .. .. .. ..
Bad debts (to include those proved to be bad during the year and actually written off,
and no others) .. .. .. .. .. ..
Other items—

                    Total deductions .. £

[N.B.—Total deductions should correspond with amount shown on page 1.]

                    Net income .. £

SCHEDULE D.

"THE LAND AND INCOME ASSESSMENT ACT, 1891."

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 Commissioner of Taxes, Wellington, on or before the day of
, 189 . , 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
the regulations thereunder.

Income derived during the year ending 31st March, 189 : £ , being gains and profits derived or received by the
said company during such year, as per details shown within.

[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 company,
and that the said return contains a true and accurate statement of the income of the company for the year ending the 31st
March, 189 ; 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 , 189 . Usual signature :

    *Return as Agent for Holders of Debentures.*

Return of the income received or receivable, for the year ending the 31st March, 189 , by the holders of debentures
issued by the company, in respect of money borrowed on debentures by the company: £ .

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 company,
and that the said return contains a true and accurate statement of the income for the year ending the 31st March, 189 , of
the debenture holders in respect of money lent to the said company on debentures.
Dated this day of , 189 . Usual signature :