Form 1040a - Individual Income Tax Return - 1918

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Fill worksheet first
Page 1 of Return
Do not write in this space
FIRST PAYMENT
Form 1040A.—UNITED STATES INTERNAL REVENUE SERVICE
DELIVER OR SEND
THIS RETURN
INDIVIDUAL INCOME TAX RETURN
$
WITH PAYMENT
(Cashier’s Stamp.)
FOR NET INCOMES OF NOT MORE THAN $5,000
TO COLLECTOR OF
INTERNAL
For Calendar Year 1918
REVENUE ON OR
PRINT NAME AND ADDRESS PLAINLY BELOW
BEFORE
MARCH 15, 1919
DETACH AND KEEP
CASH
CHECK
M.O.
WORK SHEET
Examined by
AND INSTRUCTION
SHEET
1. Did you
2. If so, what address
make a re-
did you give on
turn for 1917?
that return?
3. To what col-
4. Give number, if any, assigned to
lector’s office
you for 1917 if it does not appear
was it sent?
in address at head of return
(Give district or city and State.)
5. Were you in 1918
6. If not, were you the head of a
7. How many dependent persons under 18 (or
married and living
family as defined in instructions
mentally or physically defective) received
with wife (or husband)?
under “Personal Exemption?”
their chief support from you during 1918?
8. If you claim any additional exemption on ac-
9. Write “R” if this return shows
count of dependent persons other than your
income received, or “A” if it
children, what was their relationship to you?
shows income accrued
10. Did your wife (or husband) or minor
child make a separate return?
(If so, give name and address thereon.)
11. Did you or your wife (or husband) or
dependent minor children receive any
interest on U.S. Liberty Bonds, or any
salary not reported elsewhere in this
return or in a separate return?
(If so, give sources and amounts.)
12. Enter name and address of each
organization to which you made
contributions claimed as deductions,
and amount paid to each.
13. Enter in this table details concerning repairs, wear and tear, and property losses claimed as deductions in Schedules A, E, and I on page
2 of return (see instructions):
Wear and tear (depreciation) and depletion
Losses not compensated for by
1. Refer
4. Cost of
5. Repairs not
2. Kind of property. (If
3. Year
charged off—
insurance
to “A,”
property (or
offset by claims
buildings, state also material of
ac-
“E,” or
market value
for wear and tear
6.
7. Amount
8. Amount this
10. Amount of
which constructed.)
quired.
9. Cause of loss.
“I.”
March 1, 1913).
or losses.
Rate
previous years.
year.
loss.
$
$
$
$
$
CALCULATION OF TAX
Do not write here.
Do not write here.
M. Net Income shown on page 2, Item J
$
P. Tax due (6% on amount of Item O)
$
N. Less personal exemption (see Instruction VI)
Q. Less normal tax of 2% on Item F
O. Balance (Income taxable at 6%)
$
R. Balance of tax due
$
NOTE.—If the amount on line O exceeds $4,000, the excess is taxable at 12%,
S. Amount of tax paid on submission of return
$
and your return should be made on Form 1040.
AFFIDAVIT
I swear (or affirm) that this return, to the best of my knowledge and belief, is a true and complete statement of all taxable gains, profits, and
income received by or accrued to me (or the person for whom this return is made) during the year 1918, and that all deductions entered or
claimed herein are allowable under the law.
(If return is made by agent, the reason therefor must be stated on this line.)
Sworn to and subscribed before me this
day of
, 19
(Signature of individual or agent.)
(Signature of officer administering oath.)
(Title.)
(Address of individual or agent.)

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