Form 4684 - Casualties And Thefts - 1992
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1
24684
OMB No. 1545-0177
Casualties and Thefts
Form
See separate instructions.
Attach to your tax return.
Attachment
Department of the Treasury
26
Use a separate Form 4684 for each different casualty or theft.
Sequence No.
Internal Revenue Service
Name(s) shown on tax return
Identifying number
SECTION A.—Personal Use Property (Use this section to report casualties and thefts of property not used in a trade
or business or for income-producing purposes.)
1
Description of properties (show kind, location, and date acquired for each):
Property A
Property B
Property C
Property D
Properties (Use a separate column for each property lost or
damaged from one casualty or theft.)
A
B
C
D
2
Cost or other basis of each property
2
3
Insurance or other reimbursement (whether or not
3
you submitted a claim). See instructions
Note: If line 2 is more than line 3, skip line 4.
4
Gain from casualty or theft. If line 3 is more than
line 2, enter the difference here and skip lines 5
through 9 for that column. If line 3 includes an
4
amount that you did not receive, see instructions
5
5
Fair market value before casualty or theft
6
6
Fair market value after casualty or theft
7
7
Subtract line 6 from line 5
8
8
Enter the smaller of line 2 or line 7
9
Subtract line 3 from line 8. If zero or less,
9
enter -0-
10
10
Casualty or theft loss. Add the amounts on line 9. Enter the total
11
11
Enter the amount from line 10 or $100, whichever is smaller
12
12
Subtract line 11 from line 10
Caution: Use only one Form 4684 for lines 13 through 18.
13
13
Add the amounts on line 12 of all Forms 4684
14
14
Combine the amounts from line 4 of all Forms 4684
15
If line 14 is more than line 13, enter the difference here and on Schedule D. Do not
complete the rest of this section (see instructions).
15
If line 14 is less than line 13, enter -0- here and continue with the form.
If line 14 is equal to line 13, enter -0- here. Do not complete the rest of this section.
16
16
If line 14 is less than line 13, enter the difference
17
17
Enter 10% of your adjusted gross income (Form 1040, line 32). Estates and trusts, see instructions
18
Subtract line 17 from line 16. If zero or less, enter -0-. Also enter result on Schedule A (Form 1040), line 17.
Estates and trusts, enter on the “Other deductions” line of your tax return
18
4684
For Paperwork Reduction Act Notice, see page 1 of separate instructions.
Form
(1992)
Cat. No. 12997O
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