3768
THE NEW ZEALAND GAZETTE.
[No. 128

RETURN OF AMOUNTS DERIVED OR RECEIVED AS RENT OF LAND OR OF PROFITS DERIVED OR RECEIVED FROM THE USE OR OCCUPATION OF LAND BY

Name in full :
Occupation :
Postal address :

(NOTE.—As all notices and demands will be sent to this address, please correct if necessary, otherwise the additional tax imposed for late payment of the tax may be incurred.)

made in pursuance of the Land and Income Assessment Act, 1908, and Amendment Acts, 1912 and 1913, and the regulations thereunder, and the Finance Act, 1915, so far as respects all income from land received by me for the year ended on the 31st day of March, 19 .

Net Amount of Income.
£

1. From farming, as per Statement “C” herein..
2. From rents of property, as per detailed Statement attached, marked “A,” showing properties let, names of tenants, amounts paid for repairs, rates, and insurance on properties let, the net amount after deduction of these charges from the gross rent being entered here ..

Total net income .. £

I claim deduction on account of insurance, as per particulars on page .. .. £
I claim deduction on account of children, as per particulars on page .. .. £

I, the person making the foregoing return, do solemnly and sincerely declare that it contains true and accurate details of the several matters and things set forth. And I make this declaration under the provisions of the Land and Income Assessment Act, 1908, and its amendments.

Dated this day of , 19 .
[Usual signature.]

—

NAMES, ADDRESSES, AND SHARES OF PARTNERS.
(To be filled up in the case of returns made by or on account of a firm.)

This total should agree with net income on page .

—

“A.”—STATEMENT OF RECEIPTS AND EXPENDITURE IN RESPECT OF PROPERTIES LET DURING THE YEAR ENDED ON 31ST MARCH, 19 .

Receipts.
£

Rental received from houses .. .. ..
” business premises ..
” other sources [Specify] ..

Total .. .. .. £

Expenditure.
£

Rates .. .. .. ..
Insurance .. .. .. ..
Repairs and maintenance .. .. .. ..
Expenses of collection .. .. .. ..

Total .. .. .. £

“B.”—STATEMENT OF LIVE-STOCK AND PRODUCE ON HAND AND NOT SOLD ON 1ST APRIL, 19 , AND ON 31ST MARCH, 19 .

Live-stock.

Produce.

The above totals to be entered in account under “C.”

—

“C.”—STATEMENT OF RECEIPTS AND EXPENDITURE IN RESPECT OF FARMING OPERATIONS DURING THE YEAR ENDED 31ST MARCH, 19 .

Receipts.
£

For live-stock sold during the year .. ..
For produce sold during the year :—
Wool, meat, hides, skins .. ..
Wine .. .. ..
Dairy-produce .. .. ..
Grain .. .. ..
Chaff, oat-hay, lucerne .. .. ..
Other produce [Specify] .. .. ..
For rent of any part of farm let for grazing, cultivation, or other purposes .. ..
For stock or implements hired out .. ..
From any other source in connection with farm [Specify] .. .. ..
Estimated value of meat and other produce of the farm used for private and domestic purposes ..
Value of live-stock on hand on 31st March, 19 , as per statement “B” .. ..
Value of produce on hand on 31st March, 19 , as per statement “B” .. ..

Total £

Loss on farming .. .. ..

Grand Total £

Expenses and Outgoings.
£

Live-stock bought during the year .. ..
Rent paid for farm to [Give name and address of person to whom rent paid] .. ..
Mortgage interest paid to .. ..
Other interest paid to [Give name and address of person to whom interest paid.] .. ..
Seed bought .. .. ..
Feeding-stuff bought for stock .. ..
Wages paid for labour, &c., on farm .. ..
Amount paid for rations bought for employees ..
(Value of produce of farm used for feeding employees NOT to be included.)