APRIL 17.] THE NEW ZEALAND GAZETTE. 1421

PART E.

Income from Sales of Land or any Interest therein (including Houses and other Buildings erected on the Land) during the Year ended, 19.

Sales of land during the year: [Area], sold for
Land unsold at end of year at cost price, plus
improvements: [Area], valued at

Less land held at beginning of year at cost
price, plus improvements: [Area], valued at
Purchases of land during the year: [Area],
bought for
Expenditure during the year on im-
provements: [Specify nature of im-
provements]

Gross income .. ..
Less other expenses incurred during the year,
namely:—

Net income .. .. £

PART F.

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 and houses.

NOTE.—Where taxpayer owns property from which income is derived or has an assessed interest therein Part G (4) of the form should be filled in.

PART G.

Claims for Special Exemptions.

NOTE.—In the case of partnerships, the particulars in respect of each partner should be separately shown. These exemptions should not be entered in any other part of this form.

1. Amount actually paid by me during the year—
   (a) As life-insurance premiums on my own life, for my own benefit or for the benefit of my wife and children .. .. .. £
   (b) To Superannuation Fund .. .. .. £
   (c) To National Provident Fund or insurance fund of friendly society .. .. .. £
   [Specify name of fund here.]

B

2. Amount claimed in respect of my own children under the age of eighteen years dependent on me, or in respect of my own children over the age of eighteen years incapacitated from earning own living by permanent mental or physical infirmity, particulars of whom are given hereunder.. .. .. .. £

(£50 for each child or proportionate part of £50 in cases where child is born, dies, or attains the age of eighteen years during the income year.)

• “Children” includes stepchildren, adopted children, and grandchildren.

NOTE.—If the space above is insufficient a separate sheet may be used.

3. Amount contributed during the income year towards the support of my widowed mother (not to include payments in respect of board and lodging of the contributor) .. .. £
   Full name and address of widowed mother:

4. Five per cent. on the capital value of my interest, as shown on District Valuation Roll, in the land used in the production of the income shown in this return, namely:—

(Only improvements shown on roll will be allowed for.)

STATEMENT No. 1.—NAMES, ADDRESSES, AND SHARES OF PARTNERS.

[To be filled up in the case of returns made by or on account of a firm or partnership.]

• The amounts to which each partner is entitled should be shown in these columns, whether actually drawn or not.

This total should agree with total of C, D, E, F in Summary .. .. £

STATEMENT No. 2.—TRUSTEES’ STATEMENT.

[To be filled up in case of a deceased person’s estate or other trust.]

• Please indicate in this column by “Yes” or “No” whether or not the beneficiary is entitled to receive or be credited with his or her share of the income during the income year. In case of new estates please forward extract from will showing distribution of income.

This total should agree with total of C, D, E, F in Summary .. .. £