2852
THE NEW ZEALAND GAZETTE.
[No. 82

PART B.

Statement of Receipts and Expenditure in respect of properties let or Royalties derived from Land during the Year ended on 31st March, 19 .

• Including rental from subletting rooms or houses.

PART C.

Income derived from Salary, Wages, Interest, &c., or from a Profession, or a Trading or Manufacturing Undertaking.

During the year ended , 19 .

(Note.—This may be taken for TWELVE MONTHS ending at date of stocktaking or annual balance nearest to 31st March.)

1. From salary, wages, allowances, or bonus, as employee of . . . . . .
2. From commissions, &c., received from or credited to me by . . . . . .
3. From pension, annuity, superannuation, or retiring-allowance, or other annual payments
4. From interest—
   (a.) On registered mortgages of land and unpaid purchase-money for land sold
   (b.) From Government loans (not including war loans at 4½ per cent.)
   (c.) From debenture interest, issued by local and public authorities
   (d.) From any other source (state source) . .
5. From mining (not to include dividends on shares in registered mining companies)
6. From dividends paid or profits credited by any building society
7. From royalties (state nature of royalties) . .
8. From goodwill derived from any lease, license, or easement affecting land
9. From the profession of . . . . . .
10. From any other source (state source) . . . . . .
11. From the trade, business, manufacture, or concern of . . . . . . as follows :—

DEDUCTIONS.

(Expenses incurred in the Production of the above 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 purposes of the business), not to include rental value of premises owned by taxpayer [Give name and address of owner of land]
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 (premiums on business premises and stock only)
Marine insurance [State to whom payable] ..
Accident insurance (for employees only) ..
Exchange and discounts allowed, less amounts received
Interest on registered mortgage [State names and addresses of mortgagees and amounts paid to each]
Other interest (not to include interest on capital nor on money borrowed to invest in war loans other than Post Office Inscribed Stock) [State name and address of, and amount paid to, each person]
Repairs or maintenance of machinery, plant, or business premises (not to include additions or improvements to property or plant, or any depreciation)
Travelling-expenses incurred in the business only
Printing, stationery, advertising, stamps, and telegrams
Petty expenses, incurred in the business only (not to include donations, gratuities, or subscriptions)
Bad debts (to include those proved to be bad during the year and actually written off the books, and no others)
Other items (to be specified) :—

Total deductions .. .. £

Net income .. .. .. £

Care should be taken to fill up the above items as correctly as possible
No averages or estimates will be accepted.

PART D.

Income derived from the Business of dealing in Live-stock, Meat, Butter, Cheese, Grain, Fruit, or other Crops (Section 79 (e) ).

During the Year ended , 19 .

(Note.—This may be taken for TWELVE MONTHS ending at date of stocktaking or mustering nearest to 31st March.)