166
THE NEW ZEALAND GAZETTE.
[No. 3

I claim to deduct, from the net income shown on page 1, 5 per cent. of the capital value of interest in business premises as follows:—

PORTION (if any) of the above Premises let or sublet, or otherwise not actually and exclusively occupied for Business Purposes by the Taxpayer.

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

Return of Persons in Service or Employ during Year ending 31st March, 19 .

(Return to be made by Government Departments, local authorities, persons, firms, companies, banks, and societies employing officers, managers, travellers, clerks, foremen, workmen, servants, and others in New Zealand, whether paid by salary, weekly wage, or otherwise.)

Amount actually paid by me during the year as life-insurance premiums on my own life, for my own benefit or for the benefit of my wife and children ..£
Amount claimed in respect of each of my children under the age of sixteen years dependent on me ..£

NOTE.—This deduction is limited to £125—that is, £25 for each child to the number of five, being under the age of sixteen years and dependent on the taxpayer; but must not be claimed in any case where the combined income of the father and mother exceeds four hundred and twenty-five pounds, whether such income or any part thereof is liable to income-tax or not.

Statement of Gross Income, and Deductions therefrom, for the Year ending , 19 .

Sales both for cash and on credit for twelve months ending at date of stocktaking (include goods supplied for taxpayer’s own use, and goods used in the business, or upon buildings, plant, fixtures, &c.) ..
Stock in hand at date of stocktaking on expiry of the twelve months ..
Less stock in hand at the commencement of the twelve months ..

Purchases of stock for twelve months ending at date of stocktaking (at cost laid down on the premises) ..
Labour and materials used in manufactures ..

Other income—viz., commissions, &c., as follows:—

Gross income ..

Deductions from Gross Income.

Salaries and wages (not to include any sums drawn by proprietors, or any sums deducted above under heading “Labour and Materials”) ..
Rent (include only rent of premises or portion of premises used exclusively for the purpose of the business; not to include rental value of premises owned by taxpayer) ..
Rates on business premises or portion of premises used exclusively for the purposes of the business (not to include payments for land-tax or income-tax) ..
Fire insurance (on business premises and stock only) ..
Accident insurance (for employees only) ..
Interest, exchange, and discounts allowed, less amounts received (not to include interest on capital or on mortgages) ..
Travelling-expenses, incurred in the business only ..
Printing, stationery, advertising, stamps, and telegrams ..
Repairs or maintenance of machinery, plant, or business premises (not to include additions or improvements to property or plant, nor any depreciation) ..
Petty expenses, incurred in the business only (not to include donations, gratuities, nor subscriptions) ..
Bad debts (to include those proved to be bad during the year and actually written off the books as bad and irrecoverable, and no others) ..
Other items (to be specified)—

Total deductions ..

Net income ..
£

7. SPECIAL DETAILS WITH REGARD TO INCOME FROM LANDS OCCUPIED FOR PASTORAL PURPOSES.

Proceeds of account sales—Wool, skins, hides, &c. ..
Sales (if any) of live-stock and meat during the year ..
Stock in hand—
Wool, skins, hides, &c., unsold at the end of the year, or the proceeds of sales not actually received ..
Sheep, cattle, and other live-stock unsold at the end of the year, or the proceeds of sales not actually received ..