ANY PANEL(S) OR SECTION(S) THAT DO NOT REQUIRE AN ENTRY SHOULD BE LEFT BLANK.
2015120
Spouse or
PPS Number
Self
Civil Partner
Health Expenses
[534 - 545] Health Expenses incurred by you (and your spouse or civil partner if you are taxed under Joint
Assessment). Complete and retain Form Med 1
Nursing Home expenses
[534 - 539] - Enter details in relation to maintenance/treatment in 2015
534. (a) Amount of expenses
.
00
,
(b) Name and address of Nursing Home,
include Eircode (if known)
Deductions
[535 - 538] (Sums received/receivable in respect of Nursing Home expenses)
.
00
535. From any public/local authority (e.g. Local Health Office)
,
.
00
536. Under any policy of medical insurance
,
.
537. Compensation claim, etc.
00
,
.
00
538. Total Deductions (Nursing Home expenses only)
,
539. Net amount of Nursing Home expenses on
.
00
,
which tax relief is claimed
‘Other’ Health Expenses incurred
[540 - 545]
.
540. Enter total of ‘Other’ Health Expenses incurred in 2015
00
,
Deductions
[541 - 544] (Sums received/receivable in respect of ‘Other’ Health Expenses only)
.
541. From any public/local authority (e.g. Local Health Office)
00
,
.
542. Under any policy of medical insurance
00
,
.
00
543. Compensation claim, etc.
,
.
00
544. Total Deductions ('Other' Health Expenses only)
,
545. Net amount of ‘Other’ Health Expenses
.
00
,
on which tax relief is claimed
J - HIGH-INCOME INDIVIDUALS: LIMITATION ON USE OF RELIEFS
[601 - 603]
.
.
00
00
601. Excess Relief forward to 2015 under S. 485F
,
,
,
,
Amounts at Lines 602/603 should be transferred from a completed 2015 High-Income Individuals Statement: Form RR1
602. Taxable Income calculated on the basis that
.
.
00
00
,
,
,
,
Limitation on the Use of Reliefs does not apply
.
.
00
00
603. Recalculated Taxable Income for 2015
,
,
,
,
K - CAPITAL ACQUISITIONS IN 2015
Spouse or
Self
Civil Partner
701. If you received a gift or an inheritance in 2015, insert T in the box
(Note: 1. Where the value of a gift or an inheritance, when added to the value of prior aggregable benefits (if any) received on or after
5 December 1991 within the same group, exceeds 80% of the relevant threshold, a Capital Acquisitions Tax return must be made.
2. A gift is treated as having been received on the date of the gift. An inheritance is treated as having been received on the date of death
of a person.)
PAGE 26
FOR OFFICE USE ONLY