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10 FRANKLIN STREET MI qP NO. LOT NO. PROPERTY RECORD - CITY OF SALEM (WARD &PRECINCT) CARD NO. MEMORANDA /lc�rt;y15 /2/4/2$e eevirIA) RECORD OF OWNERSHIr NUB PHOTO DATE BOOK PAGE d to bot rc-/,irk 026 0405 00010FRANKLIN STREET BLS �a, . 1h KOZLOWSKI FPE!D T 04022 �`1cor,a f F �se Sfafrr.,e,�.,t 11 1WINTER ISLAND RD 0275 SALEM MASS 63 AC. S.F. 8775 VALUE 800 BLDG 2500 J/ VERIFICATION OF INSPECTION C I./ ASSESSMENT RECORD ' 1975 19 19 19 19 19 19 19 19 19 APPEAL DATA DWELLING Granted GARAGE Appeal Denied SWIM POOL Value Land APARTMENTS Change Building CONDO COMM OR IND TOTAL VALUE BUILDINGS TOTAL VALUE LAND TOTAL VALUE LAND & BUILDINGS _ Cond. Phys. Func. CONSTRUCTION Size Area Class Age Remod. Repl. Value Dep. Phys. Value Dep. Sound Value i*iv 4 16 18 19 22 23 25 26 29 30 31 32 37 38 39 40 45 46 47 48 53 _r'i to, PHOTOGRAPH 6-Le ,A./dr _3K'4.1/4-,0,2,6p f._a 3a £/ e soo z , o s 0 , o PERMIT COMP. DATE Total e 4, J LAND VALUE COMPUTATIONS Square Unit Unit Square Ft. Corner Depr.% I nfl Total Value 3 Footage 6 7 10 11 Price 14 15 % 17 18 Price 23 24 25 26 32 33 34 35 41 o 77 S- dii 2 -0- / 76S0 RENTAL EXPENSE ITEMS 1 PROPERTY INFORMATION VACANCY LAND COST HEATING BLDG.COST WATER SALE PRICE - ELECTRICITY GROSS ANNUAL INCOME , JANITOR LESS EXPENSES r - -. MANAGEMENT NET INCOME LAND @ %= 42-52 LAND RECORD Total Value Land BLDG. @ %= Sewer fh No Street E High I a Water B Dirt Street F Low j Total Value Buildings Gas -. Paved `,E" Level "K LTOTAL FLAT EXPENSES TOTAL Elec. D No Sidewalk H Total Value Land and Buildings ' BUILDING RECORD WHIPPLE,MAGANE AND DARCY CONTROL No. 7.---MEASURED BY I_S I"II DATE���/�3 LISTED BY I G I ci I DATE'S r 75 80 SEMI MOD KIT ,4. I_R, , Is" BLOCK LOT MOD BATH i'� 16 EXEMPT BLOCK LOT CLASS SEMI MOD BATH ,2i COMPUTATIONS 1 LJ I I I 12- 161 I I 1 4I01 5I I `^ I e • 4'fI i4-1I T STORE FRONT 6 7 11 12 16 17 20 FIRE PROOF CONST �NT 7 y, �" vQ �y NO. AREAOR UNIT TOTAL SERIAL NUMBER DATE BUILT SHEET/ OF MILLCONST GG I I ITEM OTC COST II I I I , I. _1 I i ' Is ICI'= ( ! I REINF CONC BEAMS&COLS S' y0 '), w, 21 26 27 32 34 STEEL FRAME 9 t STEEL BEAMS&C6�ts �_S^G — �� � EXTERIOR WALL VARIATIONS RAIAkt;.e fe �C�rrf/�� fODESIGN STEEL TRUSSES 3/RANCH 1. Common Brick V/F 5. Face Brick V/M STEEL OR BAR JOIST �A�/ �j1 �O c 2. Face Brick V/F 6. Cut Stone VIM TIMBER BEAMS&COLS /SIT • SPLIT LEVEL or BY LEVEL 3. Cut Stone V/F 7. Perna Stone ' WOOD TRUSSES d ADDITIONS OR DEDUCTIONS COLONIAL 4. Common Brick V/M SPRINKLER SYSig* III CAPE COD TYPE STORIES LINEAL FEET PASS ELEV ^ CONDO L ' _ ' ' t FREIGHT ELEV AI. Ned --_-_ CONVENTIONAL 35 36 37 38 40 MODERN FINISHED ATTIC OR SECOND FLOOR FLOORS 5 I;, RAISED RANCH B 1 _2 3 /f g�5/C,a' SINGLE FAMILY Cement V FAM. FLAT Fin.Area 43 1 I I 146 Hardwood -2/ Pine FAM. DUPLEX Fin.Attic% 47 I I I 1 50 Single Fl. FAM. CONV. /GfAvCir✓Q. �.2 `�fr`/ooit 8 -'7—') Unfinished%Story% 51 I I I 153 Asph.Tile G, COMM. ..-.:7„,-.,' _ / DORMERS /t/ r+aG e /Ld `N 6 APARTMENTS Wood Joist TOTAL No.of Fern. (50) NUMBER SIRE ' NUMBER 1 SIZE I Reinf.Conc. i/O A,007j,rlt INDUSTRIAL III I I I �J I I I FOUNDATION 54 55 56 57 58 59 60 61 CONCRETE S frQ , .//r BASEMENT AREA CEMENT BLOCK Rec.Room%I • I ILL_Liwl I I SALE 27$ I I I I I I I I33 OVERALL DIMENSIONS BASEMENT BRICK 62 63 64 65 66 67 68 STORIES WIDTH LENGTH AREA FULL- DATE 361 11 I I39 I • I I I I L I I I I I I I 1 ■ I I STONE No Concrete Floor CI 69 CAP IMPROV S I I I I I I I I59 II40 _ 41 42I42 43 44'44 45 46 49 50 52 TOTAL So / Dry Wall 0 2 Plaster 0 L� W LJJ I I I I I 1 • I I COST CONVE�iSiN ROOFING ��fi, / I I I I FACTOR ( /.1v fo 2 3 4 5 6 7 8 11 12 14 ASPHALT,ASBESTOS Air Cond. ❑ 4 Percent I ■ I I 1 DATE 62 65 REPLACEMENT WOOD SHINGLES 5 6 7 I. • I. ___1 W I I I I I 1 • I I VALUE 9 33 G SlO 27 28 29 30 31 32 33 36 37 39BATH ROOMSSLATE PHYSICAL DER 2 ' FIXTURES NO. FLOOR WAINS BOTH I • I W `____ _ I I I 1I 1 • I .2s-' TAR &GRAVEL / I I LJ 1 2 3 40 41 42 43 44 45 46 49 50 52 FUNCTIONALOR Y9 79 COMPOSITION 8 9 (10) BUILT IN PORCH PATIOS SHED DORMER LF U u 1 2 3 TYPE STORIES WIDTH LENGTH AREA Type WidthLength. '� Area - ECON. OBS, _ J Li DORMER LF 11 12 (13) E O G (53) L I I I I I I I I I I yp W IL2 CARPORT 2 3 4 5 6 I 1 1 19 I EXTERIOR WALL TYPE I 1 2 3 54 55 56 57 58 59 60 61 62 7 8 A. FRAME WITH WOOD, 14 15 (16) 30THER U �J I I I I I ASBESTOS,STUCCO, r FIREPLACES WIDTH LENGTH AREA _ 10 11 12 13 14 15 16 17 SUMMARY OF APPRAISED VALUE ALUM,SIDING (19) 1 1 ON 1 J 2ON 1 I I BUILT IN GARAGE I I I I I I I I I ] BAY WINDOWS NO.I I I STORIES L_LJ 18 19 20 21 22 24 25-26 27-28— PRINCIPAL BLDG. B. CONCRETE BLOCK BSMT (No.of Cars) 1 CI PORCHES 2 0 3 0 25 MISCELLANEOUS ADDS OR DEDUCTS APPRAISAL $ �f 7U ON TILCCTUCCO ON CODE DOLLAR AMOUNT OTHER PRINCIPAL HEATING 26 ROOMS B 1 2 3 TYPE STORIES WIDTH LENGTH AREA BLDGS.APPRAISAL $ DLOCK Oil TILE (19) 0 J�NONE Living E O G (33) I I I I I I I I I I I I I 43 I I I 145 4611 I 1149 ACCESSORY BLDGS. 34 35 36 37 38 39 40 42 C. BRICK OR STONE 60 APPRAISAL $ r 1 DFORCEDHOTAIR Dining E O G (50) 1 I I I 1 ( I I I I I I I I I I 162 631 I I I 166 ;:� :a VENEER (19) 1 2 OSTEAM 1 PIPE Bed 5I 1 5L3i j 5�>j 57I (5 i TOTAL BLDG. ���� D.SOLID BRICK OR Kitchen E O G (2) 121 I I 114 151 I I I J 18 APPRAISAL $ 1 STONE (19) 3 OFLOOR OR WALL - 3 4 5 6 7 8 9 11 TOTAL LAND Rec. Rm. Finish--— — 4 ❑CeilingRadiantElec., ATTACHED GARAGE Over Physical Depr. 19I I 120 APPRAISAL Width $ ' 7 r DC OTHER - 5 0 Baseboard Electric Apts. 231 1 124 251 I 126 271 I I 129 IJ30 Economic Obs. 21I I 122 C� Office TOTAL APPRAISED 6 ❑FloorRadiantElec. . I I I I I I I VALUE $ L._ 7 Floor Radiant Hot _ Stores Other Accessory Bldgs 3 Water 8 ('Gravity-Pipeless 9 0 Steam 2 Pipe Total Land Value 42 I I I I I I 48 CLIENT COPY OF • INCOME TAX RETURN [yElli 13LOCIC Take advantage of our FOR YEAR ROUND SERVICE year'round service OR ASSISTANCE. PLEASE CONTACT MAIN OFFICE AT: Our "one-time" fee entitles you to assistance with estimates, audits, 323 B_(0ADWAY and tax questions. Each year the LYf N, MASS. 01904 Internal Revenue Service selects a Tel. 598-6810 number of returns for audit. If you receive notice that your return has been selected, you should call H&R Block immediately. -- i [ &LK3BLOCK THE H & R BLOCK GUARANTEE If we make any error in the preparation of your tax return that costs you any EXECUTIVE OFFICES 4410 MAIN STREET KANSAS CITY, MISSOURI 64111 816--753-6900 interest or penalty on additional taxes due, while we do not assume the lia- bility for the additional taxes, wewill pay that interest and penalty. Furt eer- more,if your return is audited,we will accompany you at no extra cost to the Internal Revenue Service an explain how your return was prepared, even though we will not act as your legal representative. Dear CI i ent: Thank you for letting H & R Block prepare your income tax return. We are pleased that you trusted us with this important task. You may rest assured that all information on your return will remain strictly confidential. Your return was carefully prepared by competent tax people who have double—checked the accuracy of each figure. Our famous guarantee above is honored at more than 6,000 H & R Block offices world—wide. We have worked hard over the years to merit your trust and confidence. Therefore, we have become the world's largest and finest tax service. If you are satisfied with our service, please recommend us to a friend. You have every right to expect all of us at H & R Block to do our best to satisfy you with our service and with the manner in which you were served. Therefore, if any of us should fall short of your expectations, we would consider it a favor if you would let us know. We value your comments because they will help us improve. We look forward to serving you again next year. In the meantime, if you have any questions regarding your income tax return, please call or come to the H & R Block office nearest you. 1 Very truly yours, H & R BLOCK, INC. Henry W. Block President PRINTED IN U.S.A. 1, ., Confidential Service . . . i WHEREVER YOU ARE, WHEREVER YOU GO „ iii -4,f 1 . Otiiiiiii -I Ilit MINVISE. 1,,,,,-:41:' . 1- ''5.2 4 ::: -.-: 7 I 1 'o t 'k; f_ 't.* *Zit .iliplit _ ..- . �. ZEN ,,. Wirrir; Arillitifiri. . ...tz ."/ , - T E ;Cti TAX IP % 0 - L I 1 ©H & R BLOCK 1973 --- 1 Department of the Treasury—Internal Revenue Service t���� 1 040 �J,.,!. Individual Income Tax Return 19 For the year January 1—December 31, 1973, or other taxable year beginning 1973, ending COUNTY OF Your social security number a x Name(If joint return,give first names'and initials of both) Y,C' . L Q Last name c N:. RESIDENCE O? LC. '� "C Spouse's social security no. Present home address(Number and street,including apartment number,or rural route) `<...,c t N1 tr.. °CCU. I Yours ► �''C k:. 1 Y+P.6 City,town or post office,State annd2. /�ZIP code , 2 Cj pation Spouse's ► o. �r,�1 � G \Y; ., A-` �-lti�-J�� • Enter Exemptions Regular/ 65 or over I Bli❑nd Filing Status—check only one: 6a Yourself . . • ©../� ❑ number / ❑ of boxes 1 ❑ Single • b Spouse . • . ❑ ❑ checked ► 2 ❑ Married filing joint return (even if only one had income) 3 ❑ Married filing separately. If spouseg is also filing give c First/ na •f your dependent children who liked with / „ . Enter spouse's social security number in designated space above number ► and enter full name here ► • ► 4 �nmarried Head of Household d Number of other dependents (from line 27) ► 5 ❑ Widow(er)with dependent child (Year spouse died► 19 ) 7 Total exemptions claimed 8 Presidential Election Campaign Fund.--Check 1Note❑•. ifT you will not to design to $taxooryour taxes yourfor refund.rat this fund. IfInote joint return, check ❑ if spouse wishes to designate $ (Attach Forms W-2. If g ,r `/ 9 Wages, salaries,tips, and other employee compensation. unavailable, attach explanation) I w , Balance ► lOc (See inst actions lOb Less exclusion $ °' 10a Dividends\ on page a. )$ $ ) t 1 E 10d (Gross amount received, if different from line 10a . 11 d 11 Interest income 12 m e 12 Income other than wages,dividends, and interest(from line 38) 12 E c 13 Total (add lines 9, 10c, 11, and 12) 14 u. moving expenses,etc. from line 43) . { r- 14 Adjustments to income {such as"sick pay,' 15 0 m 15 Subtract line 14 from line 13 (adjusted gross income) r r • If you do not itemize deductions and line 15 is under $10,000, find tax in Tables and enter on line 16. a ° • If you itemize deductions or line 15 is$10,000 or more, go to line 44 to figure tax. V . ,C • CAUTION. If you have unearned income and be claimed asa dependTatxoRate your ScheduletXn Yhor Zeck here► ❑and see instructions on page ` ax Tables 1 c_. /O I 16 Tax, check if from: Form 4972 16 Schedule G Form 4726 OR❑ 1r ❑ Scheme 17 • � li U :0 17 Total credits (from line 54) 18 o- U 18 Income tax (subtract line 17 from line 16) 19 __ 19 Other taxes (from line 61) 'G • j /j/ / 20 Total (add lines 18 and 19) N 21a Total Federal income tax withheld (attach Forms 21a I • ,rJ .®' c W-2 or W-2P to front) ant / /2/Eb 1973 estimated tax payments (include amo b ///, a r r m 1972 return) . • • • — ,/ ; �� „j/• ,% L to allowed as credit f o /p// O. Application for Automatic ��/ /// co c Amount paid with Form 4868,ApP c /�j// a Extension of Time to File U.S. Individual Income Tax Retum d d Other payments (from line 65) 22 ai and d) '0 22 Total (add lines 21a, b, c, . ' ' O T Pay in full with return. Make 23 -- check or money order payable ti) CD 23 If line 20 is larger than line 22, enter BALANCE DUE IRS to Internal Revenue Service rL (Check here ► ❑ , if Form 2210, Form 2210F, or statement is attached. See instructions on page 8.) I. 24 -- o 24 If line 22 is larger than line 20, enter amount OVERPAID 0. 25 25 Amount of line 24 to be REFUNDED TO YOU //i////////,;-; ;�% j v toy �i % //je// e pp ° 26 Amount of line 24 to be credited on 1974 es 26j �� ���,,,/;�%� . mated tax . ° Note: 1972 Presidential Election Campaign Fund Designation.—Check ❑ if you did not designate $1 of your taxes on you ° 1972 return, but now wish to do so. If joint return,check ii if spouse did not designate on 1972 return but now wishes to do so. f c Under pen [i s of perjury, I declare that I have examined this return, ncluding accompanying schedules and statements, and to the best of my knowledgand elio tbit is true,c act,and complete�)eetaration of preparer(other than taxpayer)is based on all information of which heknowledge. '� Sign ' repar�s —te " here Date Preparer ° (other than taxpayer) �, your Sig lure 5?�- t'3) 2 4 4 - 0 6 0 7 8 5 6 2 'Spouse's signature (if filing jointly, BOTH must sign even if only one had income) Address(and ZIP Code) Preparer's Emp. (dent.or Soc.Sec.No. F __HS FS-- .1 cc —_wa--C 71, S BLOCIK Page 2 Form 1040(19731 (a) NAME (b1 Relationship (c)Months lived in your home. (d) Did depen- (e)Amount YOU fur. (f) Amount furnished C If born or died during year, dent have in- nished for depen- by OTHERS including ..- ry write B or a come of$750 or dent's support. If dependent. = C more? 100%write ALL. -$ I O' d $ • G d C 27 Total number of dependents listed in column (a). Enter here and on line 6d �7 ,�,► " 28 Business income or(loss) (attach Schedule C) 28 / .::•.�^ 29 Net gain or(loss) from sale or exchange of capital assets (attach Schedule D) 29 - —�• 30 Net gain or (loss)from Supplemental Schedule of Gains and Losses(attach Form 4797) . . . . 30 31 Pensions,annuities,rents,royalties,partnerships,estates or trusts,etc.(attach schedule E) . . . 31 75/'`7 — 32 Farm income or (loss) (attach Schedule F) 32 cr 33 Fully taxable pensions and annuities(not reported on Schedule E—see instructions on page 8) . . 33 a 34 50%of capital gain distributions(not reported on Schedule D) 34 35 State income tax refunds 35 36 Alimony received 36 37 Other (state nature and source)► 37 38 Total(add lines 28,39,30,31,32,33,34,35,36,and 37).Enter here and on line 12 ► 38 , 39 "Sick pay."(From Forms W-2 and W-2P.If not shown on Forms W-2 or -2P,attach Form 2440 or statement.) . . . 39 2/ 7= 40 Moving expense (attach Form 3903) . . . . . .I''. '.w= . . ti`a+' p" `ii.::aft'40 41 Employee business expense (attach Form 2106 or statement) 41 a 42 Payments as a self-employed person to a retirement plan,etc.(see Form 4848) . . . . . . 42 -�? 43 Total adjustments(add lines 39,40,41,and 42). Enter here and on line 14 . . _43 , 2," / 44 Adjusted gross income(from line 15) 44 . 45 (a) If you itemize deductions,enter total from Schedule A, line 41 and attach Schedule A I 45 (b) If you do not itemize deductions, enter 15% of line 44, but do NOT enter more than 1. . . 1— $2,000. ($1,000 if line 3 checked) cc a 46 Subtract line 45 from line 44 46 47 Multiply total number of exemptions claimed on line 7,by$750 47 48 Taxable income. Subtract line 47 from line 46 48 _ (Finn.yen in n In rowel ee li..illy esiq In We Sclelelt A.Y.or 7.a,I wlbc*lt be ellemlne In Ire,.Sc►ble 0 leumt nerq,q in.Scle*le S.•mlwrt In Ins Fen 4111,A*fehl forglq t,..Farm 4177.1 Env tea a Use If 49 Retirement income credit(attach Schedule R) 49 50 Investment credit(attach Form 3468) 50 F 51 Foreign tax credit(attach Form 1116) 51 a 52 Credit for contributions to candidates for public office—see instructions on page 9 52 a 53 Work Incentive(WIN)credit(attach Form 4874) 53 54 Total credits(add lines 49,50,51,52,and 53).Enter here and on line 17 ► , 54 - 55 Self-employment tax (attach Schedule SE) 55 56 Tax from recomputing prior-year investment credit (attach Form 4255) 56 • > 57 Tax from recomputing prior-year Work Incentive(WIN)credit(attach schedule) 57 ccc 58 Minimum tax. Check here► , if Form 4625 is attached 58 ' a 59 Social security tax on tip income not reported to employer(attach Form 4137) 59 60 Uncollected employee social security tax on tips(from Forms W-2) 60 , 61 Total(add lines 55,56,57,58,59,and 60).Enter here and on line 19 ► 61 62 Excess FICA tax withheld (two or more employers—see instructions on page 9) 62 , 63 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil(attach Form 4136) 63 a 64 Credit from a Regulated Investment Company(attach Form 2439) 64 , A. 65 Total(add lines 62,63,and 64).Enter here and on line 21d ► 65 in Did you,at any time during the taxable year, have any interest in or signature or other authority over a bank, •- c securities,or other financial account in a foreign country(except in a U.S.military banking facility operated `o o by a U.S. financial institution)'? ►❑ Yes + '�a If "Yes," attach Form 4683. (For definitions, see Form 4683.) Employer's Name (City&State) H!W Federal Wages,etc F I.C.A State State City Tax Tax Tax Tax r `c:,'ry4C `..itiO4a1 Sh,v.r.„E 'PA9:tor1 M0, 50C•,. )b 3°40'• 1',I4 0.2S•y5. . EXCESS F.I.C.A. TAX: (Enter here and on line 62, Form 1040) — TOTALS: (Enter here and on line 9 and 21A, Form 1040) _ 1 INCOME AVERAGING INFORMATION (TAXABLE INCOME) 1973 Line 48, 1972 Line 55, 1971 Line 50, 1970 Line 50, 1969 Line 5, 1968 Line lid, 1040 p.2 1040 p.2 1040 p.2 - 1040 p.2 — • Schedule T _ 1040 p.1 f e 2 1040-2 '.-:BLACK . DIVIDEND AND INTEREST WORKSHEET H5 FS CC WS T! NAME A B C D E F GROSS AMOUNT QUALIFYING NON-QUALIFYING CAPITAL GAIN NON-TAXABLE • H w-J PAYOR RECEIVED DIVIDEND DIVIDEND INTEREST DISTRIBUTION DISTRIBUTION L�4 u- r y ���,sir - Jfi • SUBTOTALS — --- — — _ Column B (H) — - — — ---- Column B (W) Column B (J) TOTALS 'Column A enter on Line 10d. 1040 p.1, •Column B plus C.enter on Line 10a. 1040 p 1. Column E enter 'Column D enter on Line 11, 1040 p.1 on Schedule D or Less Dividend Exclusion (Enter here and on Line 10b, 1040 p.1 . Less 50 Enter here and on Line 10c. 1040 p.1 To Line 34 1040112 ADDITIONAL WAGES AND WITHHOLDING INFORMATION FROM W-2 EMPLOYER ADDRESS. CITY & STATE Fed. Tax Wages F.I.C.A. State Tax State Tax - City Tax • • • — — — — TOTALS (Record Fed.Tax on Line 21a. Wages on Line 9, 1040i T RETIREMENT --_— -- `INCOME CREDIT AND SALES TAX INFORMATION Social Security Pension (H)$ (W)$ (J)$ Other Non-Taxable Pensions (H)$ (W)$ (J)$ Railroad Retirement 1040-4 4 S:; :BLOCK SCHEDULE CF HS `S (Form 1040) Profit or (Loss) From Business or Profession W5 Department of the Treasury (Sole Proprietorship) (M73 Internal Revenue Service ► Attach to Form 1040. ► L Partnerships, joint ventures, etc., mus fife-Form 1065. Name(s) shown on Form 1 0 r'`� .f . /7 >- ej ,� / Sociat security number A Principal business activi see Schedule C 1 J ' I �� J actions) ►- .d e ,.+ as • B Business name ►.........t-P. � /`s `!yam . ; wedged- ►_ -�' �?,f , a C Employ r identification number ► D Business address (number and street) ►"_-,d_ . �_� • �,,. ' City, State and ZIP code ► r< f' s�j:Dr }M E Indicate method of accounting: (1) t1.5. . MI (�, (2) Accrual (3) Other ► ''t"" _ F Were you required to file Form W-3 or Form 1096 for 1973? (See Schedule C Instructions.)- Yes No If "Yes," where filed ► 1_.�. G Was an Employer's Quarterly Federal Tax Return, Form 941, filed f r this business for any H Method of inventory valuation ►_ quarter in 1973? /� %// the manner determining t.. ;Y2 -�"' quantities, costs, or valuations between the opening and closing inventoried?(Ifas "Yes,"Yes,'attach ere any texplanation)antial e m I L. de'' 1 Gross receipts is or sales ' ar $ -CO ....., . Less: returns and allowances 2 Less: Cost of goods sold and/tar operations (Schedule C-1, line 8) Balance S. 3 Gross profit —I 4 Other income (attach schedule) . . • • ' ' ' • • • 5 Total income (aplain in Scheddd fines 3 and 4) 6 Depreciation (exule C- ~ _ 7 Taxes on business and business property (explain in Schedule C-2) 8 Rent on business property , • . . . 'J 9 Repairs (explain in Schedule C-2) . . • ' . . • • 10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself) . . 11 Insurance • 12 Legal and professional fees . Q . 13 Commissions / 14 Amortization (attach statement) . 15 (a) Pension and profit-sharing plans (see Schedule C Instructions) . (b) Employee benefit programs (see Sche use C Intructions) 16 Interest on business Indebtedness sr- 17 Bad debts arising from sales or services I y:: 18 Depletion 17 19 Other bus"Hess expenses (specify) • (b)•.-•--•- e�- ".-.f : 1. e (c) ' (e) v (0 • (g) • (h) (i) • (►1) (k) Total other business expenses (add lines 19(a) through 19(j)) 20 Total deductions (add lines 6 through 19)loss { f _ 21 Net profit or "'r ' (loss) (subtract line 20 from line 5). Enter here and on Form enter on Schedule SE, line 5(a) 1040, line 28. ALSO I SCHEDULE C-1.--Cost of Goods Sold and/or Operations (See Schedule C Instructions for L � ' 1 Inventory at beginning of year (if different from last year's closing inventory, attach explanation) . ) 2 Purchases$ Less:cost of items w:"`,drawn for personal use$ 3 Cost of labor (do not include sale Balance ► 4 Materials and supplies , ry paid t. yourself) . , f�0 5 Other costs (attach schedule) . . . . . • ' ' ' ' • • • • 1 6 Total of lines 1 through 5 , 7 Less: Inventory at end of year 8 Cost of goods sold and/or operations. Enter here and on line 2 above . 1040:5 5 /9 7 '`:....,:- r972 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF CORPORATIONS AND TAXATION Form 1 RESIDENT INDIVIDUAL INCOME TAX RETURN For the year January 1 - December 31, 1972, or other taxable year beginning 1972, ending .. 19 1 °0 First na e and initial(I joint return, use first names and middle initials of both) LaAt name Your social security number w c ! Present home addres (Number and street, including apartment nu ber, or Ural route) Spouse's Isocial security rity number , City, town or post office- State and ZIP code �— Om- Youra {{ ° �da/ c' Y e' pation Spouse's ,3y ❑ CHECK BOX: (a) If narrfe or address are NOT THE SAME as used on your 1971 return;or (b) IF NO RETURN FILED LAST YEAR(also give reason);or to IF CHANGING from separate to joint or joint to separate returns. FILING STATUS. Check only one: ! DEPENDENTS AND 65 OR OVER EXEMPTIONS CLAIMED 1 Single* 4 Dependent children (enter number from U.S. tax return, Line 8) . / 2 Married filing joint return (even if only one had 5 Other dependents (enter number from U.S. tax return, Line 9) . income). Both must sign. 6 Total dependents claimed (add Items 4 and 5. Enter in Item 71) 6 3 n Married filing separate return. Enter first name 7 65 or over before 1973: •E You. Your spouse if filing jointly. •%f% of spouse even if she(he)is not filing a return. 8 Enter number of 65 or over boxes checked . 8 9 Total for $600 exemptions (add Items 6 and 8. Enter in Item 48) . i 10 Wages, salaries, tips, and other employee compensation* (from U.S. Form 1040 or 1040A, Line 11) . cm?4/V. 11 . 11 Pensions and annuities* (from U.S. Form 1040, Line 40 plus U.S. Schedule E, Part I, Line 5). ( .)?/7./ , = 12 Interest after exemption* from savings in Massachusetts banks (from Page 2, Item 56) . ��' 13 Net profit or (loss) from business or profession (from Schedule C, Item 21) . . . . . 7' ./" cc 14 Rent and royalty income (from Massachusetts Schedule E, Part II, Item 2) . L " u. 0 15 Income or (loss) from all partnerships and non•Mass. estates and trusts* (Massachusetts Schedule E, Part III, Item 2) 0 16 Other* 5% income (state sources and amounts) " 0_ °.) 17 Total 5% income subject to taxation (add Items 10 through 16) . . . . . 17 c • 18 Total deductions (from Page 2, Item 43) . . 18 vv)) 19 Total 5% income before exemptions (subtract Item 18 from Item 17. If Item 18 is larger, enter "0") . J a20 Total exemptions (from Page 2, Item 52) . . 4 *. 20 '. 21 Net taxable 5% income (subtract Item 20 from Item 19. If Item 20 is larger, enter "0") . If W 22 Tax on 5% income (multiply Item 21 by .05) • cn W a 23 Dividends and 9% interest* (from Massachusetts Schedule B, Part I, Item 14) . 23 24 Net capital gain (from Massachusetts Schedule D, Item 13, if loss, enter "0") . . . 24 25 Total 9% income before exemption (add Items 23 and 24) . . . 26 Exemption from 9% income, if any* (subtract Item 19 from Item 20. If married, file jointly) 27 Net taxable 9% income (subtract Item 26 from Item 25. If Item 26 is larger, enter "0") 28 Tax on 9% income (multiply Item 27 by .09) . • I �W Wcc• ,ox 29 Total tax before any credits (add Items 22 and 28) But if Item 40 No Tax Status applies, enter"0" > °0 30 Massachusetts income tax withheld. Attach Wage and Tax Statements to front* . 30 zo 31 1972 Massachusetts estimated tax payments (Acct. No. ) 31 o 2 W 32 Credit if total income subject to taxation is $5,000 or less* (from Page 2, Item 72) . . 32 f a.) oo 33 Other jurisdiction income tax and/or limited income credit* (from Schedules F and/or G) 33 !t22 oix 34 Total payments and credits (add Items 30 through 33) . . i,°� 35 If Item 29 is larger than Item 34, enter BALANCE DUE. Pay in full with this return . V 35 z W 36 If Item 34 is larger than Item 29, enter REFUND . 36 $ - /4 4, ox O V 37 Interest ; 38 Penalty 39 Total tax Zi 40 NO TAX STATUS.* Use only if Total Income is $3,000 or less if sing'Q or $5 000 or less if married and filing jointly. Vry �s no C1 Total Income as reported on Page 2, Item 64 was $•(frj► ,? and therefore I have entered "0" in Item 29. 0 U J Under pV penaltie5 of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the b t of my 4 rn knowledge a belief it is true,correct and complete. W W Sign H�-R BLOCK „, x , r i '.1......4.:. 'a Date all information of which he has any knowledge. here 0 Spouse's signature(If filing jointly,BOTH must sign even if only one had income) Address—ZIP Code Emp. !dent. or Soc. Sec. No. 5,140M-10.72-070400 *See Instructions .� H IR BLOCK Form 1 (Massachusetts) 1972 *See Instructions. **See Instructions and Attach Schedule or Statement. Page 2 PART I. DEDUCTIONS FROM 5% INCOME PART ill. INTEREST INCOME FROM SAVINGS DEPOSITS IN MASSACHUSETTS BANKS* 41 Payments to Social Security, Railroad, U.S. Enter only interest credited on savings deposits, savings accounts, shares or and Massachusetts re ireent ssy�stems* . 41 share savings accounts in any savings, cooperative or national bank or trust ..e r° fr I Form 040, company, savings and loan association, credit union or similar organization 42 AdLine mentsje i com om located in Massachusetts. This interest is taxed at 5%. List payers and Line 16. See Instructions. Attach S edule. 42 — amounts. Report all other interest income and dividends in Schedule B. 43 Total deductions from 5% income (add Items ++�� 41 and 42. Enter on Page 1, Item 18) . _+'`"f 53 • ¢ is� M� ; sY ,:.'�r PART II. EXEMPTIONS 44 Personal exemption: If single, enter $2,000; co if married filing separately, enter $1,000; r` z or if married filing jointly, enter $2,600 , 44r` o Additional exemption for spouse with the a smaller wages, salaries or other compensa- 54 Total interest income listed above . 54 Lief 4/ } tion*. Complete Items 45, 46 and 47 ONLY if a married and filing a joint return AND if EACH 55 Exemption. If married and filing jointly,enter z• had income reported in Item 10 on Page 1: $200. If filing separately or if single, enter A rx 45 Husband's wages,etc.(in Item 10)451 $100 . . . . 55 f.0 0 _ W z 46 Wife's wages, etc. (in Item 10)461 __ 56 Interest after exemption from savings in W Massachusetts banks (subtract Item 55 from - 47 Enter the amount from Item 45, or from Item Item 54. Enter here and on Page 1, Item O O 46, or $2,000 — whichever is SMALLEST. If 12; but not less than "0") .'it m "0" is in Item 45 or Item 46, enter "0" here 47 48 Total number of dependents and 65 or over PART IV. INCOME SUBJECT TO TAXATION AND TOTAL INCOME* w exemptions (from,Page 1, Item 9) ENTER A LOSS FOR ANY ITEM AS"0". a / multiplied by $600 . 48� _ INCOME SUBJECT TO TAXATION FOR CREDIT PURP �� 57 Total 5% in a (from Pa e 1, Item 17).. 51 o ,(j, a Z 49 Medical and dental,expenses only if itemized �i' " 0 v; r *�a . • on your U.S. Form 1040. Enter amount from • I 58 Div. ° s suy ect to taxa-, 7 e 7 r • 1972 U.S. Form 1040, Schedule A, Line 10* 491 tion(from-Massartne11s Schedule B,Item 10) 58 _ / ;� rr 50 Blindness or adoption fee exemption(s) for 59 Total-•capita$' afns*-1/18§'achi' ti'Sched- r �* p , z you and"or your spouse if filing jointly* . 50 ule O,--Item•7)' . 59 1 ~' s` i51 Exemption for the net premium paid for corn- . 60 Income subject to taxation (add Items 5�7, ' /rri; , o pulsory, bodily injury insurance for one, pas- 58, and 59. If$5,000 or less,complete Items- aa senger motor vehicle only — owned by you I 65 through 72) . . . - • or your spouse and registered in Massachu- setts for your personal, non-business use.* TOTAL INCOME FOR NO TAX STATUS- ' Exclude any return of premium and rebate. a If married and filing separately, enter "0" . 51 61 Interest on U.S. obligations* . . . 61 ?;:). .. W a 52 Total exemptions (add Item 44 with Items 47 62 Interest from bonds, etc., of Massachusetts through 51. Enter total here. Also enter on or its political :.ubdivisions* . . 62 . . . aPage 1, Item 20 unless the following apply) . 63 Income taxed directly to trusts or estates* . 63 • w 64 Total Income (add Items 60 through 63. If a Exclude any part of total exemptions used on Forms 2 or 1-NR** $3,000 or less and if single or if $5,000 or less and if married filing jointly, enter on , s . If you were a legal resident for part of the year only, reduce total Page 1, Item 40 and check box) . ' ' exemptions to an amount based on the ratio of months*: Months as Item 52 a resident X $ — $ PART V. CREDIT INFORMATION. Answer only if claiming credit. 12 • See instructions and check each box if it applies. Enter the result on Page 1, Item 20. I 65 Total income subject to taxation in Item 60 above is$5,000 or less. 66 Lam'was a Massachusetts legal resident for at least six months This return, together with payment in full, is due on or before during 1972. g p y April 15, 1973. Make check or money order payable to the Commonwealth of Massachusetts. 67 F.11 was not the dependent of another taxpayer. Write Social Security number on check or money order. 68 ri If married, I am filing a joint return.(both must sign). If making PAYMENT, mail to: P.O. Box 7003, Boston, Massachusetts 02204. 69 ❑ My spouse was not the dependent of another taxpayer. If claiming REFUND, mail to: P.O. Box 7000, Boston, Massachusetts 02204. If filing a DECLARATION OF ESTIMATED INCOME TAX and if claiming REFUND If boxes 65,66,67,and if married 68,are checked,claim a credit. . on this return, mail to P.O.Box 7007, Boston, Massachusetts 02204. If box 69 is not checked,do not claim$4 Mail other returns to: Massachusetts Income Tax Bureau, 100 Cambridge. for your spouse. Number Per Amount Street, Boston, Massachusetts 02204. ,® 70 For you_(and your spouse if qualified). N . THE CARD FORM IA AND THE $20,000 TAX TABLE MAY BE USED FOR 71 For each dependent(from page 1, Item 6) SALARIES OR WAGES, MASSACHUSETTS SAVINGS DEPOSIT INTEREST, PENSIONS AND ANNUITIES, 65 OR OVER, AND NO TAX STATUS. SEE 72 Add 70 and 71 amounts:If qualified to claim /02 INSTRUCTIONS. this credit,entej total amount on Page 1, Item 32, 242 a---sLOCK RETRN INCOME TAX THE COMMONWEALTH OF MASSACHUSETTS CHEC ORMPEFfUFORMFILED: SCHEDULE B DEPARTMENT OF CORPORATIONS AND TAXATION 1 I ,, I MR SCHEDULED DIVIDENDS AND 9% INTEREST CAPITAL GAINS AND LOSSES 1972 Name(§)ems showri,on Page return 4� { Social Security Ny'nbar. SCHEDULE B. PART I. DIVIDEND AND 9% INTEREST INCOME* 1. �' 1 Total gross dividends (from U.S. Form 1040, Schedule B, Line 2; or if not over $200 from U.S. tax return, Line 12a) 1 2 Total interest income (from U.S. tax return, Line 13) . 3 Other* dividends and interest not included above (state sources and amounts) 2 7 / 4 Total (add Items 1, 2 and 3) . . 3 5 Capital gain distributions* (from U.S. Form 1040, Schedule B, Line 3) See Schedule D, Item 2 below 6 Interest on U.S. obligations* included in Item 2 above . 7 Total interest on savings in Massachusetts banks (from Form 1, Page 2, Item 54) . O 8 Dividends and interest taxed directly to Massachusetts trusts and estates* � � 9 Add Items 5 through 8 . 8 10 Dividends and 9% interest subject to taxation (subtract Item 9 from Item 4) . 9 11 Interest deduction (from Massachusetts Schedule B, Part II, Item 12) 12 Subtract Item 11 from Item 10 . • 11 C.) 13 Capital loss reduction (if any), $1,000 maximum but not more than amount in Item 12 above: Use 1972 loss from Schedule D, Item 7 first (a) ; Use 1971 unused loss* next (b) •14 Dividends and 9% interest (subtract Item 13 from Item 12). Enter here and on Form 1, Page 1, Item 23. Not less thanI"0" 6 SCHEDULE B. PART II. INTEREST DEDUCTION* Enter interest paid on unsecured loans or on loans secured by intangible personal property. List names, addresses, and amounts to whom interest was paid. 1 2 Total interest payments . . 3 Dividends and 9% interest (from Part I, Item 10 above) . 2 4 Massachusetts capital gain (from Schedule D, Item 7. If loss, enter "0") , 5 Add Items 3 and 4 . • 6 Amount received from trusts and estates not subject to taxation in Massachusetts and from all partnerships and included in Item 5 above 7 Applicable 9% income (subtract Item 6 from Item 5) . 6 8 Non-taxable dividends, interest, and capital gains** . 9 Total income applicable to this deduction (add Items 7 and 8) 8 10 Item 2 $ X Item 7 $ Divide above result by Item 9 $ 11 Multiply Item 7 by 80% . . 12 Enter Item 10 or Item 11, whichever is smaller, here and in Part I, Item 11 above . SCHEDULE D. CAPITAL GAINS AND LOSSES* (Attach Copy of U.S. Schedule D) 1 Enter net gain or (loss) from U.S. Schedule D, Line 3 . 2 Enter net gain or (loss) from U.S. Schedule D, Line 11 (If not filing U.S. Schedule D, report 100% of capital gain distributions) 2 3 Add Items 1 and 2 . 4 Enter net gain or (loss) from Massachusetts fiduciaries inc'uded above 5 Exclude* Item 4 from Item 3 . . 4 6 Adjustment of gain or (loss) resulting from differences in Massachusetts basis of property**7 Massachusetts 1972 gain or (loss) (combine Item 5 with Item 6). If a loss, omit Items 8 — 13 and enter up to $1,000 of such loss in Schedule ,B; Part I, Item 13 (a). Also if a loss, enter "0" on Form 1, Page 1, Item 24 . 8 If Item 7 is a net gain, enter any net gains from intangibles included in Item 7* . 9 Unused intangible loss carryover from: 1969 1970 t 10 Intangible loss carryover used in 1972 (enter Item 8 or 9, whichever is smaller) Total 11 1972 capital gain after intangible loss carryover (subtract Item 10 from Item 7) , • 10 12 Enter 1971 unused loss, if any (from 1971 Massachusetts Schedule D, Item 12) but not more than Item 11 above 12 13 Net taxable 1972 capital gain (subtract Item 12 from Item 11). Enter gain here and on Form 1, Page 1 Item 14 1972 unused loss available for 1973-1977 (exclude Schedule B, Item 13(a) from Schedule D, Item 7 loss) 24 . 15 1971 unused loss available for 1973-1976* Report net ordinary gain or (loss) shown on U.S. Form 1040, Page 2, Line 37 only as Other 5% income or (loss) on Form 1, Page 1, Item 16. Losses claimed as itemized deductions on Schedule A of U.S. Form 1040 are not allowable. 1,050M.10-72•070400 *See Instructions. **See Instructions and Attach Schedule or Statement. 042104500 WAGE AND TAX STATEMENT q i 79 • COMPTROLLER (For use in States or Cities authorizing combined form) BOSTON NAVAL SHIPYARD Employer's State Identification Number BOSTON, MASS. 02129 Copy C • — Typeorprint EMPLOYER'S Federal Identification number,name,and address above. I I For employee's records FEDERAL INCOME TAX INFORMATION SOCIAL SECURITY INFORMATION STATUS ' Federal income tax Wages paid subject to Other compensation FICA employee Total FICA wages 1. Single 4111 1I �* withheld withholding in 1972' paid in 1972 x tax withheld s paid in 1972° 2. Married "" EMPLOYEE'S social security number Ile. of State State Form No. State income tax withheld • Name of City City Form No. City income tax withheld • li 'Excludable sick pay. "*Gross wages for State if different from Federal. ' Includes tips reported by employee. Amount is before payroll deductions or sick pay I exclusion. Add this item to wages in reporting wages and salaries on your income tax return. 1 The social security (FICA) rate of 5.2% includes .6% for Hospital Insurance Benefits • and 4.6%for old-age,survivors,and disability insurance. 4 Includes tips reported by employee. Type or print EMPLOYEE'S name and address (including ZIP code)above. Uncollected Employee Tax on Tips . . $ FORM W-2 Department of the Treasury, Internal Revenue Service V • NOTICE TO EMPLOYEE: 1. Income Tax Wages.—This statement is important. Copy B must be filed with your Federal • Income Tax Return for 1972 and Copy 2 must be filed with your State or City Income Tax Return for 1972. If your social security number, name, or address is stated incorrectly, correct the information on copies B and 2 and notify your • employer. 2. Social Security Wages.—If your wages were subject to social security taxes, but are not shown, your social security wages are the same as wages shown under "FED- I!" ERAL INCOME TAX INFORMATION," but not more than the maximum amount subject to FICA tax. 3. Credit For FICA Tax.—If more than the maximum of FICA (social security and hospital 111111-41: insurance) employee tax was withheld during 1972 because you received wages from more than one employer, the excess should be claimed as a credit against your Federal income tax. See instructions for your Federal income tax return. 4. A copy of this form has been sent to the Internal Revenue Service. ! U. S. GOVERNMENT PRINTING OFFICE: 1972-466-200 r_ COMPLIMENTS OF Ha Eg 11 .0 C , ' ' ' aI• H$R BLOCK,INC.1973 INCOME TAX SAVER FOR THE YEAR 197 ALL RIGHTS RESERVED UICOE ]L LIST TOTAL FOR EACH CATEGORY AND KEEP RECEIPTS OR CANCELLED CHECKS IN THIS TAXSAVER. RETAIN THESE RECORDS. DIVIDENDS INTEREST RENTAL CORP.NAME AMOUNT CORP.NAME AMOUNT REC'D FROM AMOUNT REC'D FROM AMOUNT GROSS INCOME AMOUNT AMOUNT EXPENSES Carpentry Decorating—Painting Electrical OTHER INCOME Plumbing—Furnace TYPE OF INCOME AMOUNT TYPE OF INCOME AMOUNT Roofing Alimony Tips Pensions&Annuities Prizes&Awards Royalties Hobby Water Estates&Trusts Commissions Heat Jury Duty State Refund Electricity Telephone GAINS & LOSSES FROM SALE OF PROPERTY Interest DESCRIPTION DATE BOUGHT DATE SOLD SALES PRICE COST GAIN OR LOSS Taxes Insurance FHA Insurance Supplies Pest Control Trash Hauling Janitor—Yard Work Advertising—Commissions Auto—Travel 1 DIDTICIrOVAZ LIST TOTAL FOR EACH CATEGORY AND KEEP RECEIPTS OR CANCELLED CHECKS IN THIS TAXSAVER. RETAIN THESE RECORDS. MEDICAL TAXES CONTRIBUTIONS OTHER DEDUCTIONS/ADJUSTMENTS Drugs&Medicines Federal Income Bat.Paid Church Sick Pay Refund Church Moving Expense Quarterly Estimate Church 1st I2nd 3rd 4th Boys Town EMPLOYEE BUSINESS EXPENSE State Income Bal.Paid Cancer Auto Hospital Insurance Refund Crippled Children Travel Quarterly Estimate Heart Sales Dr. 1st 2nd 3rd 4th Polio Supplies Dr. Auto Lic.—City/State Red Cross Office in Houle Dr. Pers.Prop.—State Salvation Army Self Employed Retirement Dr. Pers.Prop.—City Scouts Boy/Girl Dr. Real Estate State Tuberculosis MISC. DEDUCTIONS Dr. Real Estate—City United Campaign Alimony Dr. Sales-Auto/Boat Child Care Dr. City Earnings Education Dr. Intangibles Employment Agency Fee Dentist Gas Tax Safe Deposit Box Dentist Speedometer Reading Tax Return Fee Dentist 1/1 12/31 Tools/Equipment Hospital 1/1 12/31 Uniforms—Cost/Cleaning Hospital Union/Prof.Dues Lab Fees INTEREST Vocational Supplies Home Mortgage Required Telephone Hearing Aids&Batteries Safety Equipment Glasses&Contact Lenses CONTRIBUTIONS OTHER THAN CASH Eye Exams Clothing , OVER$100.00 FROM Medical Supplies Furniture LOSSES LIGHT LIGHTNING. WIND, WATER, CAR Transportation Transportation ACCIDENTS 8 THEN tNOT REIMBURSED BY INSURANCE) Reimbursement