Schedule N Individual Form - Rental Income - 2004

Schedule N Individual

Rev. 05.04

RENTAL INCOME

2004

Taxable year beginning on _________________, _____ and ending on ________________, _____

Taxpayer's name

Social Security Number

Part I

Questionnaire

68

Fill in here if this is your principal industry or business

Rental Income (fill in one):

Code

Taxpayer

Spouse

1

2

Location of rented property - Number, Street and City

Fully Taxable

(01)

Tax Incentives under:

Act No. 78 of 1993

(02)

Act No. 52 of 1983

(03)

Act No. 8 of 1987

(04)

Act No. 135 of 1997

(05)

Nature of rented property (i.e. residence, apartment, etc.)

Case or concession number

Number of employees

Part II

Determination of Gain or Loss

77

00

1.

Income ..............................................................................................................................................................................

(01)

00

2.

Less: Operating expenses and other costs (Detail in Part III) ....................................................................................................

(10)

00

3.

Net income ........................................................................................................................................................................

(11)

00

4.

Less: Net operating loss from previous years (Submit schedule, see instructions) .......................................................................

(12)

00

5.

Adjusted net income ............................................................................................................................................................

(13)

00

%

6.

Less: Exempt amount _______

of line 5 (See instructions) ................................................................................................

(14)

7.

Gain (or loss) (If it is a gain determined under provisions not considered under Act No.135 of 1997, transfer to page 1, Part 2, line 2P of

00

the return. If it is a loss, see instructions) ................................................................................................................................

(15)

8.

Tax on income derived from the operation of a business with exemption decree under Act 135 of 1997:

10%

7%

4%

2%

Other _____ %. (Multiply line 7 by the corresponding %.

00

Transfer to page 2, Part 4, line 24 of the return) (See instructions) .................................................................................................

(20)

Part III

Operating Expenses and Other Costs

87

1.

Salaries, commissions and allowances to employees ...............................................................................................................

00

(01)

2.

Payroll expenses ................................................................................................................................................................

00

(02)

3.

Contributions to pension plans ................................................................................................................................................

00

(03)

4.

Contributions to deferred income plans ....................................................................................................................................

00

(04)

5.

00

Medical or hospitalization insurance ........................................................................................................................................

(05)

6.

Interest on business debts .....................................................................................................................................................

00

(06)

7.

Property taxes ....................................................................................................................................................................

00

(07)

00

8.

Other taxes, patents and licenses ...........................................................................................................................................

(08)

00

9.

Repairs ...............................................................................................................................................................................

(09)

00

10.

Motor vehicles expenses ......................................................................................................................................................

(10)

00

11.

Utilities ...............................................................................................................................................................................

(11)

00

12.

Insurance ...........................................................................................................................................................................

(12)

00

13.

Advertising .........................................................................................................................................................................

(13)

00

14.

Travel expenses ..................................................................................................................................................................

(14)

00

15.

Professional services ...........................................................................................................................................................

(15)

00

16.

Maintenance .......................................................................................................................................................................

(16)

00

17.

Depreciation and amortization (Submit Schedule E) ...................................................................................................................

(17)

00

18.

Other expenses (Submit detailed schedule) .............................................................................................................................

(18)

19.

Total (Transfer to Part II, line 2 of this Schedule) .....................................................................................................................

(30)

00

Conservation Period: Ten (10) years