THE NEW ZEALAND GAZETTE.
[No. 24

Statement of Gross Income and Deductions.

[NOTE.—This may be taken for twelve months ending at annual balance nearest to 31st March.]
For the Year ending , 189 .

Gross income—

                Total gross income  .. £

Deductions from Gross Income.

Salaries and wages .. ..
Rent (Include only rent of premises or portion of premises used exclusively for the
purposes of the business) ..
Rates on business premises (not to include payments for land- or income-tax) ..
Fire insurance (on business premises 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    .. £

                Net income  .. £

SCHEDULE F.

"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 , from investments of any kind other than investments in land or upon mortgages of land: £ , as per details shown within.

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 , from investments of any kind other than investments in land or upon mortgages of land; 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:

*I claim to have deduction made from net income shown on page 1 on account of liability to pay land-tax in respect of land occupied for business or employment, such deduction being equal to 5 per cent. on the amount upon which the company is liable to pay land-tax on such land under Schedule A, "Land and Income Assessment Act, 1891."

Assess-
ment
No. Description of Land used as Place of Business or Employment. Actual
Value. Value of
Improvements. Amount of
Mortgage. Amount on
which Land-tax
payable.

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

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

List of Persons in the Service or Employ of the Company.

Name in Full. In what Capacity employed. Place of Residence. Amount of Pay received, including Salary, Wages, Bonus, Commissions, and Allowances.

[In the case of any person the total payment to whom does not exceed £160 a year an entry need not be made.]