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2 FORM 1040 UNITED STATES Page 1 Treasury Department Internal Revenue Servce (Audtor's Stamp) INDIVIDUAL INCOME TAX RETURN 1941 OPTIONAL FORM 1040A MAY BE FILED INSTEAD OF THIS FORM IF GROSS INCOME IS NOT MORE THAN 3,000 AND CONSISTS WHOLLY OF SALARIES, WAGES, OTHER COMPENSA TION FOR PERSONAL SERVICES, DIVIDENDS, INTEREST, RENT, ANNUITIES, OR ROYALTIES. For Calendar \ear Code Seral No. (Do not use these spaces) To bo fled wth the Collector of Internal Revenue for your dstrct not later than the lslh day of the thrd month followng the close of your taxable year PRINT NAME AND ADDRESS PLAINLY. (See Instructon C) Dstrct (Casher's Stamp) (Name) (Use gven names of both husband and wle, f ths s a jont return) Item and Instructon No. (Street and number, or rural route) (Post offce) (County) (State) INCOME 1. Salares and other compensaton for personal servces, 2. Dvdends 3. Interest on (a) bank deposts, notes, etc., ; (b) corporaton bonds, 4. Interest on Government oblgatons, etc.: (a) From lne (h), Schedule A, ; {b) from lne (), Schedule A,._ 5. Rents and royaltes. (From Schedule B) 6. Annutes , ITEMS 7, 8, AND 9, BELOW (AND PAGES 3 AND 4) NEED NOT BE CONSIDERED UNLESS YOU HAVE INCOME (OB LOSSES) IN ADDITION TO ITEMS ABOVE. (a) Net short-term gan from sale or exchange of captal assets. (From Schedule F) Deductble Expenses (Attgah temzed statement (J>) Net long-term gan (or loss) from sale or exchange of captal assets. (From Schedule F). (c) Net gan (or loss) from sale or exchange of property other than captal assets. (From Schedule G) Net proft (or loss) from busness or professon. (From Schedule H) (State total recepts, from lne 1, Schedule H, _ ) Income (or loss) from partnershps; fducary ncome; and other ncome. (From Schedule )_ Total ncome n tems 1 to 9 DEDUCTIONS Contrbutons pad. (Explan n Schedule C) Interest. (Explan n Schedule C) Taxes. (Explan n Schedule C) es from fre, storm, shpwreck, or other casualty, or theft. (Explan In Schedule C)._ Bad debts. (Explan n Schedule C) - Other deductons authorzed by law. (Explan n Schedule C) Total deductons n tems 11 to 16 Net ncome (tem 10 mnus tem 17) 19. Net ncome (tem 18 above ) 20. Less: Personal exempton. (From Schedule D-l) 21. Credt for dependents. (From Schedule D-2). 22. Balance (surtax net ncome ) 23. Less: Item 4 (a) above 24. Earned ncome credt. (From Schedule E-l or E-2). COMPUTATION OF TAX Normal tax (4% of tem 25) 28. Total (tem 26 plus tem 27) 29. Total tax ( tcm 28 or lne 16, Sc 30. Less: Income tax pad at source. o 1 Income tax pad to a foregn -^ ' country or U. S. possesson. (Attach Form 1116). Cash Check M, O. Frst Payment 25. Balance subject to normal tax 32. Balance of tax (tem 29 mnu tems 30 and 31). - ' I/we swear (or affrm) that ths return (ncludng any accompanyng schedules and statements) has been examned by me/us, and to the best of my/our knowledge and belef s a true, correct, and complete return, made n good fath, for the taxable year stated, pursuant to the Internal Revenue Code and the regulatons ssued under authorty thereof. Subscrbed and sworn to by before me ths day of 194. hedulef) 27). - I L. '... U (Sgnature) (Sec Instructon E) (Sgnature) (Sgnature and ttle of offcer admnsterng oath) S tbs s a jont rclurn (not made by agent), t must be sgned by both husband and Areturnmade by an agent nus be accompaned by power of attorney. (See Instructon.) wfe, t musl be sworn to before a proper offcer by the spouse preparng the return. (IF THIS RETURN WAS PREPARED FOR YOU BY SOME OTHER PERSON, THE AFFIDAVIT ON PAGE 4 MUST BE EXECUTED)

3 Schedule A. INTEREST ON GOVERNMENT OBLIGATIONS, ETC. (See Instructon G) Page 2 I. Oblgatons or securtes 2. Amount owned at end ncludng your proportonate share of such oblgatons held by estates, trusts, partnershps, or common trust funds 3. Interest receved or accrued durng the year (a) Oblgatons of a State, Terrtory, or poltcal subdvson thereof, or the Dstrct of Columba, or Unted States possessons.. (4) Oblgatons ssued pror to March 1, 1941, under Federal Farm Loan Act, or under such Act as amended (c) Oblgatons of Unted States ssued on or before September 1, 1917_ (J) Treasury Notes, Treasury Blls, and Treasury Certfcates of Indebtedness ssued pror to March 1, 1941 (e) Unted States Savngs Bonds and Treasury Bonds ssued pror to March 1, 1941 (/) Oblgatons of nstrumentaltes of the Unted States (other than oblgatons to be reported n (b) above) ssued pror to March 1, _ (f) Dvdends on share accounts n Federal savngs and loan I assocatons I xxxxxxxx x n n x x x xx 4. Amount of prncpal, nterest on whch s exempt from taxaton AH 00 K Interest on amount n excess of exempton, and dvdends subject to surtax only (A) Total (enter as tem 4 (a), page 1)_ (/) Oblgatons ssued on or after March 1, 1941, by the Unted States or any agency or nstrumentalty thereof (enter amount of nterest as tem 4(b), page 1) Amount owned at end Schedule B- INCOME FROM RENTS AND ^YALTIES. (See Instructon 5) 1. K- ;c' o f ^.-operty 2. Amount 3. Deprecaton or depleton (attach schedule) 4. Repars xexplan below) 5. Other expenses (temze below) Interest reeer - or accrued durng the; -.r (subject to normal tax and surtax).. 6. Net proft (column 2 mnus sum of columns 3, 4, and 5) (enter as tem 5. page 1) Explanaton of deductons clamed n columns 4 and 5- Schedule C EXPLANATION OF DEDUCTIONS CLAIMED IN ITEMS 11, 12, 13, 14, 15, AND Item No. 2. Explanaton 3. Amount 1. Item No. (Contnued) 2. Explanaton (Contnued) 3. Amount (Contnued)... Schedule P. EXPLANATION OF CREDITS CLAIMED IN ITEMS 20 AND 21. (See Instructons 20 and 21) Status (1) Personal Exempton Sngle, or marred and not lvng wth husband Number of months durng the year n each status Credt clamed Name of dependent and relatonshp (2) Credt for Dependents Number of months durng the year Under 18 years old 18 years or over... Credt clamed Reason for support f 18 years Schedule E. COMPUTATION OF EARNED INCOME CREDIT. (See Instructon 24) (1) If your net ncome s 3,000 or less, use only ths part of schedule Net ncome (tem 18, page 1) Earned ncome credt (10% of net ncome, above). 1. State your prncpal occupaton or professon _ 2. Name and address of employer Dd you fle a return for any pror year? If so, what was the latest year? To whch Collector's offce was t sent? If separate return was made for the current year, state: (a) Name of husband or wfe (A) Personal exempton, f any, clamed thereon.. (c) Collector's offce to whch t was sent Check whether ths return was prepared on the cash L~] or accrual bass. If return on cash bass, do you elect, under secton 42, to nclude as ncome (2) If your net ncome s more than 3,600, use only ths part of schedule Earned net ncome (not more than 14,000) Net ncome (tem 18, page I) _ Earned ncome credt (10 % of earned net ncome or 10 % of net ncome, above, whcheve 1 amount v naler, but do not enter less than 300) QUESTIONS receved n the current year the n ease for current and pror years n the redempton prce of nonmercst-bearng oblgatons ssued at a dscount? If so, attach statement lstng oblgatons owned and computaton of the accrued ncome. Report such ncome as nterest n tem 3 or 4, page I, whchever applcable. 7. Dd you receve durng the taxable year any nontaxable ncome other than nterest reported n Schedule A (see Instructon G)? If so, attach schedule showng source, ruture, and amount of such ncome. 8. Dd you at any tme durng your ta e year own drectly or ndrectly any stock of a foregn corporato a personal holdng company as defned by secton 1 of the Interna, evenue Code? If 80, attach statement requred by Instructon J. lf a42ar,

4 DETACH PAGES 3 AND 4 IF NOT USED Page 3 Schedule F. GAINS AND LOSSES FROM SALES OR EXCHANGES OF CAPITAL ASSETS. (See Instructon 7) 1. Knd of property (f necessary, attach statement of descrptve. detals not shown below) 2. Date acqured Mo. Day Year 3. Date sold Mo. Day Year 4. Grose sates pnce (contract prce) 5. Cost or other basn 6. Expense of sale and cost of mprovements subsequent to acquston or March I Deprecaton allowed (or allowable) snce acquston or March I, 1913 (explan n Schedule J) 8. Gan or loss (column 4 plus column 7 mnus the sum of columns 5 and 6) SHORT-TERM CAPITAL GAINS AND LOSSES ASSETS HELD NOT MORE THAN 18 MONTHS Gan or loss to be taken nto account 9. Percentage _ on LONG-TERM CAPITAL GAINS AND LOSSES ASSETS HELD FOR MORE THAN 18 MONTHS BUT NOT FOR MORE THAN 24 MONTHS 1. Classfcaton 1. Total net short-term captal gan or loss (enter as tem 7 (a), page 1, amount of gan shown n column 5) LONG-TERM CAPITAL GAINS AND LOSSES ASSETS HELD FOR MORE THAN 24 MONTHS 2. Total net long-term captal gan or loss enter as tem 7 V), page 1, amount of gan or loss shown SUMMARY OF NET CAPITAL GAINS OR LOSSES 2. Net short-term captal loss of precedng taxable of net ncome for such year) Net gan or loss to be taken nto account from column 10, above Gan 4. Net gan or loss to be taken nto account from partnershps and common trust funds Gan -. 66V 3 66% 66V, 'Total net gan or loss to be taken nto account n columns 2, 3, and 4 of ths summary Gan. - LJ COMPUTATION OF ALTERNATIVE TAX Use only: If you had a net long-term captal gan, and tem 22, page 1, exceeds 12,000, or If you had a net long-term captal loss, and such loss plus tem 22, page 1, exceeds 12, Net ncome (tem 18, page 1). (See Instructon 7) 2. (a) Net long-term captal gan (tem 7 (4), page 1) (b) Net long-term captal loss (tem 7 (b), page 1) 3. Ordnary net ncome (lne 1 mnus lne 2 (a) or lne 1 plus lne 2 (&)). (See Instructon 7) 4. Less: Personal exempton. (From Schedule EM) 5. Credt for dependents. (From Schedule D-2) 6. Balance (surtax net ncome) 7. Less: Item 4 (a), page 1 8. Earned ncome credt. (From Schedule E-l or E-2). (See Inst. 7)._ 9. Balance subject to normal tax. Schedule G. GAINS AND LOSSES FROM SALES OR (See 1. Knd of property 2. Date acqured. 10. Normal tax (4% of lne 9) 3. Gross sales prce (contract prce) _ 11. Surtax on lne 6. (See Instructon 27),. 12. Partal tax (lne 10 plus lne II) 13. (a) 30% of net long-term captal gan (30% of lne 2 (a)).. (b) 30 % of net long-term captal loss (30 % of lne 2 ({)) Alternatve tax (lne 12 plus lne 13 (a) or lne 12 mnus lne 13 <4» Total normal tax and surtax (tem 28, page 1) 16. Tax lablty (f a net long-term captal gan, on lne 2 (a), enter lne 14 or lne 15, whchever s the lesser; f a net long-term captal loss, on lne 2 (J), enter lne 14 or lne 15, whchever s the greater). (Enter as tem 29, page 1)_ _ EXCHANGES OF PROPERTY OTHER THAN CAPITAL Instructon 7) 4. Cost or other bass 5. Expense of sale and cost of mprovements subsequent to acquston or March 1, 1913._ Total net gan (or loss) (enter as tem 7 (c), page 1) Slate the famly, fducary, or busness relatonshp to you, f any, of purchaser of any of the tems on ths page: If any of such tems were acqured"by you other than by purchase, explan fully how acqured; L! 6, Deprecaton allowed (or allowable) snce acquston or March 1, 1913 (explan n Schedule J) No net lass allowable (see Instructon 7) ASSETS 7. Gan or loss (column 3 plus column 6 mnus the sum of columns 4 and 5) _

5 Schedule H. PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION. (See Instructon 8) Page 4 (State (1) nature of busness and address f dfferent from name and address on page 1. Total recepts. COST OF GOODS SOLD (To be used where nventores are an ncomedetermnng factor) 2. Inventory at begnnng 4. Labor 6. Other costs (temze below) 8. Less nventory at end 9. Net costof goods sold (lne 7mnus lne B). 10. Gross proft (lne 1 mnus lne 9) < :- If the producton, manufacture, purchase, or sale of merchand: 2 and 8 to ndcate whether nventores are valued at cost, or cost or Explanaton of deductons clamed n lnes 6, 14, and 17 OTHER BUSINESS 11. Salares and wages not ncluded pensaton for yourself) 12. Interest on busness ndebtedness 13. Taxes on busness and busness property 14. es (explan below) 15. Bad debts arsng from sales or servces.; (2) number of places of busness ; (3) busness name.. ) AUCTIONS -abor" (do not deduct com- 16. Deprecaton, obsolescence, and depleton (explan n Schedule J). 17. Rent, repars, and other expenses (temze below or on separate sheet) 'S. Tota. ' : neslltol7 Tota nes 9 and 18 _ Net proft (or (lne 1 mnus lne 19) (enter as tem 8, page 1). s an ncome-producng factor, nventores are requred. Enter "C," or "C or M," on lnes market, whchever s lower. Schedule I. INCOME FROM PARTNERSHIPS, FIDUCIARIES, AND OTHER SOURCES INCOME (OR LOSS) FROM PARTNERSHIPS, SYNDICATES. ETC. (SEE INSTRUCTION 9 (a)) (FDRNISH NAMES AND ADDRESSES) INCOME FROM FIDDCIARIES (FURNISH NAMES AND ADDR." ES) INCOME FROM OTHER SOURCES (STATE NATDRE) Total amounts n Schedule I. (Enter as tem 9. page 1). Schedule J. EXPLANATION OF DEDUCTION FOR DEPRECIATION CLAIMED 1. Knd of property (If buldngs, state matera] of whch constructed) 2. Date acqured 3. Cost or other bass (Do not nclude land or other nondeprecable property) 4. Assets fully deprecated n use at end 5. Deprecaton allowed (or allowable) n pror years 6. Remanng c r other bass t. rccoverea IN SCHEDULES F, G, 7. Estmated lfe used n accumulatng deprecaton 8. Estmated remanng lfe from begnnng AND H 9. Deprecaton allowable ths year '. AFFIDAVIT. (See Instructon E) (If ths return was prepared for you by some other person, the followng affdavt must be executed) I/we swear (or affrm) that I/we prepared ths return fc- the person or persons named heren and that the return (ncludng any accompanyng schedules and statements) s a true, correct and complete statement of all the nformaton respectng the tax lablty of the person or persons for whom ths return has been prepared of whch I/we have any knowledge. Subscrbed and sworn to before me ths of 194. day (Sgnature of person preparng the return) (Sgnature of person preparng the return) (Sgnature and ttle of offcer admnsterng oath) (Name of frm or employer, f any) GOVERNMENT PflNTINS OFFICE