Form Ir-1 - City Income Tax Return For Individuals Page 3

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Name(s) as shown on Page 1

Primary Social Security

STOP:

If your only source of income is from wages, do not complete the remainder of this page. Return to Page 1. Copies of your Federal Schedule C, E and F may be

attached to your city return in lieu of completing the schedules below.

PART F

SCHEDULE C — INCOME (LOSS) FROM SELF-EMPLOYMENT

If you conducted business in more than one city, you must allocate income on Schedule Y (below)

Business Name:

Business Address:

Has City income tax been withheld from and remitted for all taxable employees dur-

Nature of Business:

ing the period covered by this return?

Federal ID (if any):

Yes

No (if NO, explain on an attached statement)

Date Business Began in Englewood:

Section 1

INCOME

Total Receipts Less Allowances, Rebates and Returns ………………………………………………………………………………………………….

Less Cost of Goods Sold or Cost of Operations …………………………………………………………………………………………………………..

Gross Profit (Subtract Line 2 from Line 1) ………………………………………………………………………………………………………………….

Dividends _____________________ + Interest _________________+ Royalties ___________________= ……………………………………..

Rents Received ………………………………………………………………………………………………………………………………………………..

Other Business Income (attach schedule) ………………………………………………………………………………………………………………….

Gross Income

……………………………………………………………………………………………………………….………...

(Add Lines 3 through 6)

Section 2

EXPENSES

Advertising and Promotion …………………………..

Repairs ……………………………………………….

Bad Debts ……………………………………………..

Salaries and Wages ………………………………...

Car & Truck Expenses ……………………………….

Compensation of Officers …………………………..

Depreciation/Amortization/Depletion ……………….

Commissions (attached 1099s) …………………….

Interest of Business Indebtedness ………………….

Taxes & Licenses ………………………………….

Rents …………………………………………………..

Other—attached schedule if over $5,000 ………..

Total Expenses

……………………………………………………………………………………………..……………………….

(Add Lines 8 through 19)

Net Profit (Loss) from Business or Professions

………………..……..

(Subtract Line 20 from Line 7) - Carry this figure to Page 1 in PART B in Column H

PART G

SCHEDULE E — RENTAL INCOME (LOSS)

Carry these figures to Page 1 in PART B in Column I

Property A

Property B

Property C

Property D

Address of Property

…………………………………….…..……..

(Street/City/State)

Rents Received ……………………………………………………………………….

Total Expenses ………………………………………………………………………..

Net Income (Loss) -

…………………………………..

Carry this figure to PART B on Page 1

Local Tax Paid

…..

(limited to 1.75% of Line 6)

Carry this figure on Page 1 in PART B on Line 11

Name of City that Taxes were paid to

……..

— ATTACH A COPY of the other city tax return

SCHEDULE Y

BUSINESS ALLOCATION FORMULA

Use this schedule if engaged in business in more than one city and you do not have books and records which will disclose with reasonable accuracy what portion of the net

profits is attributed to that part of the business done within the boundaries of the city or cities involved.

A. LOCATED

B. LOCATED IN

PERCENTAGE

EVERYWHERE

ENGLEWOOD

(B ÷ A)

STEP 1

Original Cost of Real & Tangible Personal Property ………………….

Gross Annual Rentals Paid Multiplied by 8 …………………………….

Total Step 1 ……………………………………………………………….

STEP 2