AFFIDAVIT No. 1. Where no return is made on page 2 of this blank, or where the return shows a net income of only $4,000 or less, the following statement must be sworn to and subscribed: State of County of SS.: 9 , being sworn according to law deposes and says that in the year 189, from January 1 to December 31, was not possessed of an income liable to be assessed according to the provisions of the act of August 28, 1894, and that during said year entire net income from every source, without any deduction or diminution whatever, did not exceed four thousand dollars. (FORM NO. 365, PAGE 4.) UNITED STATES INTERNAL REVENUE. Sworn to and subscribed this [Signature] I certify that I am satisfied the above declaration [Signature] Collector, TAXPAYER'S RETURN FOR ASSESSMENT .District, .Division,. In the. To Of. State of. day of Collector, NOTICE. Pursuant to an act of Congress in force August 28, 1894, tax. [Signature] , A. D. 189, before me. District, State of is true. District, State of 189. The gross income from any particular source should be The exemption and the deductions should be given next, in In case the income about to be assessed for said year did Dated this. AFFIDAVIT No. 2. already made Where the person about to be assessed has and rendered a return of his entire income for said year in some other district, the following declaration is required to be made by the taxpayer, under oath or by affirmation: State of District, State of Collector of said District. Subscribed and sworn to before me this [Signature] Collector, County of , 88.: being duly sworn, upon his oath or by affirmation declares that all the gains, profits, and income accruing to were duly returned on the day of 189, to Collector, and that the tax has been paid thereon to [Signature] " 9 I certify that I am satisfied the above declaration is true. [Signature] Collector, Office at. deposes, says, and in the year 189, day of District, State of (FORM 130, REVISED.) COLLECTOR'S SUMMONS TO TESTIFY AND TO PRODUCE BOOKS, ETC. To By virtue of the authority vested in me by Section 3173 of the Revised Statutes of the United States, and also by Section 3163 of the same, as amended by Section 1 of an act entitled "An act making appropriations for the legislative, executive, and judicial expenses of the government for the year ending June 30, 1877," etc., approved August 15, 1876, you are hereby summoned and required to appear before me, Collector of the United States Internal Revenue, duly appointed, commissioned, and qualified as such, for the District of on the day of 189 at o'clock of that day, then and there to testify before me in a certain arising under the internal revenue laws, depending before me, wherein And for the purposes aforesaid, you are further summoned and required to produce, and have before me, as such collector, at the time and place aforesaid, certain books, papers, and documents which you may have in your possession, custody, or care, to wit: 9 at my office, No. Street, " M. " UNITED STATES OF AMERICA, OFFICE OF COLLECTOR OF INTERNAL REVENUE, DISTRICT OF 189. Failure to comply with this summons will render you liable to attachment as for contempt, and punishment by the court, as provided by Section 3175, Revised Statutes of the United States. Given under my hand and seal, at my office aforesaid, on this day of 189. [Signature] Collector of Internal Revenue, District of (FORM 366, PAGE 2.†) RETURN BY BANKS, BANKING INSTITUTIONS, TRUST COMPANIES, SAVINGS RAILROAD, CANal, Turnpike, Canal Navigation, Slack-Water, TeleRAILWAY COMPANIES, AND ALL OTHER CORPORATIONS, COMPANIES, OR SECTIONS 32, 34, AND 35, ACT OF AUGUST 28, 1894. Return to be made to the collector of the district where the principal office or place be paid to the collector on or before The... of......, in the County of......, and......District of the State of......, makes and renders the following return of all gains, profits, or income received by or accrued to said ......, from the first day of January, 1894, to the thirty-first day of December, 1894, both days inclusive, pu nt to the provisions of the internal revenue laws: — 1. Gross receipts, credits, earnings, and gains from any business, or any interest therein, wherever carried on.. 2. From interest or coupons, due or paid on any bonds, or other evidences of in debtedness of any corporation, company, or association. 3. From dividends or interest on the stock, capital, or deposits of any corporation, company, or association.. 4. From undivided profits of any corporation, company, or association 5. From premium on bonds, stocks, notes, or coupons 6. From commissions or percentage.... 7. From interest on notes, bonds, or other securities of the United States, except such bonds of the United States the principal and interest of which are exempt from Federal taxation. 8. From interest received or accrued on all notes, bonds, mortgages, or other forms of indebtedness not included the foregoin tems. 9. From profits realized within the year from sales of real estate purchased since December 31, 1892... 10. From rents received or accrued.. 11. From all sources not above enumerated (specifying same), viz. : TOTAL RECEIPTS, GAINS, AND INCOME.. 12. OPERATING AND BUSINESS EXPENSES: 1. Interest paid or accrued within the year on bonded or other indebtedness... 2. Losses actually sustained during the year 3. State, county, municipal, or town taxes accrued during the year 1894 and actually paid... 4. Salaries, compensation, or pay of officers or other 5. Rents or necessary repairs, but not including amount 7. Cost price of material purchased for manufacture or resale, not increasing stock on hand Dec. 31, 1893. 8. Other expenses not above enumerated, viz. : DOLLARS CTS. TOTAL OPERATING AND BUSINESS EXPENSES... 13. Net profits or income over operating and business expenses... 14. Dividends and gains, heretofore included in the statement of profits under para- AMOUNT OF NET PROFITS OR INCOME LIABLE TO TAX.. 15. Amount paid in salaries, or other compensation, or pay of officers or other per- sons employed, including only salaries of more than four thousand dollars.... TOTAL SALARIES, ETC., PAID..... NOTE. The interest on all bonds of the United States should be returned as income by the person, corporation, company, or association owning or holding such bonds, except the interest on bonds of the funded loan of 1891 continued at two per cent, and the four per cent funded loan of 1907, and the five per cent loans of 1904, which is exempt. [ Pages 1 and 4 contain only extracts from the income laws which are elsewhere printed in full in this volume. ED.] (FORM No. 366, Page 3.) COMPANIES, INSTITUTIONS, FIRE, MARINE, LIFE, OR OTHER INSURANCE of business is located, on or before the first Monday of March, 1895, and the tax to the first day of July, 1895. 17. Name and address of each person to whom a salary of more than four thousand dollars was paid, and the amount paid to such person: NAME OF PERSON. POST-OFFICE Address. TOTAL.. 1. Dividends declared or paid on stock, capital, or deposits, etc... 2. Annuities declared or paid on bonds, stock, capital, or policies. 3. Interest paid on shares, stocks, capital, or deposits.. TOTAL INTEREST, ANNUITIES, AND DIVIDENDS. 4. Undivided profits, over dividends declared or paid, on hand or carried to the account of surplus or other fund..... Statement of all interest, annuities, and dividends declared due or paid to shareholders, stockholders, policy holders, or depositors by the from the first day of January, 1894, to the thirty-first day of December, 1894, both days inclusive, and of all undivided pronts of said on hand or added to any fund, and amount of net annual profits, or income, of said used for construction, enlargement of plant, or any other expenditure or investment, paid from the net annual profits of said for said year, pursuant to the provisions of the internal revenue laws: 5. Amount of net profits or income used for construction... 6. Amount of net profits or income used for enlargement, betterment, or permanent improvement of plant.. 7. Amount of net profits or income used for other expenditures, or investment.... TOTAL NET PROFITS.... DOLLARS. DOLLARS. CTS. CTS. QUESTION 1. Has the corporation, company, or association, for which this return is made, kept full, regular, and accurate books of account, upon which all its transactions were entered from day to day for the full period covered by this return? ANSWER..... QUESTION 2. Is this return made exclusively from said books? ANSWER.... QUESTION 3. Have the full amounts set forth in this return as salaries of officers and pay to employees been actually paid within the year covered by this return to bona fide officers and employees of this corporation, company, or association for services actually rendered? ANSWER....... " QUESTION 4. What are the particular items of losses included in the amount set opposite paragraph 2, under Operating and Business Expenses on page 2 of this return, and when did each occur? ANSWER.. COUNTY OF..... STATE OF..... of the.. do swear (or affirm) that the foregoing return contains a true, full, regular, and accurate account of all the gains, profits, and income received by or accrued to said... ... from the first day of January, 1891, to the thirty-first day of December, 1894, both days inclusive, and a true and complete statement of the net profits or income of said... for said year, and the true amount and kind of operating and business expenses thereof; and of all dividends, interest, or annuities declared due or paid by said... ....; and of all undivided profits thereof; and the amount of net profits or income used for construction, enlargement of plant, or investment, as therein specified; and that the above questions have been fully and truthfully answered. Sworn to and subscribed before me this. day of.... 1895. In case there is not sufficient space to contain the names of persons under paragraph 17, a supplementary list should be made and securely attached to the return and made a part thereof, under said paragraph, and marked "Exhibit A to para. graph 17." President," "Cashier," "Secretary," as the case may be, of resident corporations, etc. Resident Manager," or Resident Agent," as the case may be, of foreign corporations, etc. In computing income for taxation non-resident corporations shall include in their annual returns the entire profits or income of such corporations derived from all business conducted in the United States, deducting the operating and business expenses incurred in conducting such business. CIRCULAR PROMULGATING CIVIL SERVICE INCLUSION AND CLASSIFICATION OF THE INTERNAL REVENUE SERVICE. TREASURY Department, OFFICE OF THE SECRETARY. WASHINGTON, D. C., December 12, 1894. By direction of the President of the United States, and in accordance with the third clause of section 6 of an act entitled “An act to regulate and improve the civil service of the United States," approved January 16, 1883: It is ordered, That all clerks, storekeepers, storekeepers and gaugers, and gaugers, be and they are hereby arranged in the following classes, without regard to salary or compensation: Class one, clerks; class two, storekeepers; class three, storekeepers and gaugers; class four, gaugers: Provided, That no person who may be required by law to be appointed to an office by and with the advice and consent of the Senate, and that no person who may be employed merely as a laborer or workman, shall be considered as within this classification; and no person so employed shall be assigned to the duties of a classified place. It is further ordered, That no person shall be admitted to any place not excepted from examination by the civil service rules in any of the classes above designated until he or she shall have passed an appropriate examination under the United States Civil Service Commission, and his or her eligibility has been certified to by said Commission or the appropriate board of examiners. J. G. CARLISLE, Secretary of the Treasury. |
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