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. <br />Scleec�ules E&R—Su;:�lernental 6�zeome SchedulE AF�� I�n�� <br />(Form ioao� Ii@ttI'���1ellt IItCO0Z1C CI'@(Ift CORI{]Utc7flOfl NJ <br />peC���menl ol the Tr.uury (Fiam pensions and annuitics, �enls anA �wallics, Dartncnhips, esfales and imsts, cle.) <br />imnnd B..m�e s<rv�« � Al�aeh to tann lU4U. ► �ee LrUuctions lai Schedules E ard R(Foim 1040). I <br />Your aocial seeunty immbcr <br />Na• � c(s) as shown on Form IQ40 ' S� c�, ' ? <br />o �EP. — �icKY � os7�c {� S�—:7Gz� <br />Sehedule E—Supplemental �I1COI11C SC�I^�U�C (Campleie SrheAule R un b�ck if eL4;ible fer relire�nent mcame crediq _ <br />�"� Pension and Annuity Income. u �ui�y t,:,bte, do not complete Ihis part CNer ainourl on fonn 10A0. 6ne 31:�. <br />For onc pensmn or annudv not fully taxablc, cnmplctr this pai1. II you havc morc th fn onr. pcnsum or anowty U�at i; <br />„�e twlv ta.a6le. atWch a schedule and enter combined total o11az%:61c port�ons on hne �. <br />1 Namcotpaycr........._. . . ....................._.._..._.. ......___..... .. . . o.. <br />2 Did Your employer contribulr, part o1 Ihe cosP .. ...... . . . . . . . . . . . . . L. ] Yes �__j N <br />_ l No <br />11 "Yes," is yoUr conlribution recoverable within 3 years of the annuity s��«�ng dal^? . ��] Yes _. <br />Ii "Yes,' show: Your contribution 3 ..................... Conlribution recovered in pror years .. I ...._................ <br />. $ <br />3 Amount received this year . . . . . . . . . . . . . . . . . �. . . . .—.............._. <br />4 Amou:it eccludable ll�is year . . . . . . . . . . . . . . . . . . . . <br />5 Tazablc portion (subtract linc 4 Irom linc 3) . <br />�Rent and Royalty Intontc. II you need more space, you may use Porm 4831. <br />Note: It you am repodmC la�m rental inmme hcre, sce Schcdule E Inslruchuns lo determine il you should also ide Porm <br />4835. I( at 'east two�thvds ol your �ross mcome �s from farmmg or hshing, check this box � <br />(d) �qrtciat�an (e.p4in (0 Ot�er uomm <br />p) 4inE �nd loutlon al Dme<ety Ib) Tobl �mount ld tald �muunf p.la.l u Geo�e!�on INoom:. �V.— <br />11 res�dmliJ. dso �u;e ••R•• ol �mts ol �aplhn (�Ibc� :ampu4tmnl e.Dbin belo..) _ <br />.R.����.rt(c,.r�..._ ............... ........ <br />J.4�'.�.__ _ _� .-.-....._ -_..._.�o.(�...._....4.�.`�". <br />1 Totals . . . . . . . . . . . I— ------- . <br />2 Net income or (loss) trom rents and royaities (column (�) plus column (c1 Iess colurnns (dl and (e)) . . <br />��"'y„�'� Income or Losses irom Partnerships, Estates or Trosts, Small Business Corporations. <br />Nole: If any o� �he parinership, eslale or trust mcome ieponed helow is iwm Ia�mmE ot lishmp. sr? Sche2ul? E �nslmc�ions to deteimine <br />if you shculd also lile form 4835. I! at Ieast Iwo�durds of yow C�oss income rs Irnm farmmg or Gshing, che[k this <br />box (�. <br />Enlrr i aolumn InP. i' br Pu�nnsnin C Im Cs i (el �".Citron�l Is: )c+ <br />LIe or�imtt. a� 5 loe Sm�ll Bmmeu ComonLm. 1 (q CmDIOYa I��� ����Te or (Io�U �•rv���+���n aeoi���+�i <br />��� :Jmdliupon numLer rnlY lo D��inu#�ipn <br />bI N�me l�l <br />....""" _. ....... . <br />_ .._ .. .. ......... . <br />._... . _ .__...... <br />... _" <br />... . . .. .._.. . <br />1 Totals . . . . . . . . . . . . . . . . . . . . . .. - <br />2 Income or (loss). To!al ol column (d) Icss total of column (c) . _ <br />T07AL OF PARTS I, II, AND II! (Enter here and on Form 1040, line 31a) . •• P � <br />❑em Fmcunt • I• • • • Ikm <br />Explanation oi Column (e), Part II 7� —,�a � � <br />Ilem Rmount I � fCYC.9./ .............._ ._... _ ..7. .... ....... _ . .. . ._... <br />. . .y.%i.�.. <br />`.3.C�.�=.-r:..✓..,..........._.....__ .�S ._ ...................._.............. ._.....- ...... <br />-_ ....._ ..... .... ...... <br />Gs,�b.��j.e....... _ ._...._.._5`/ .. ... _ _ _... _._ <br />?yl <br />Rmounl <br />.....bU7ae.,�...._......._ _. __ __.i. _ _ _ � <br />0.r� 5 y0 <br />Sehedule for Depreciation Claimed in Part II AboVe. If you need more space or you compuled depreciation under tne Class Lifz (nDe) <br />Syslem or Guidelinc Class Lilc Syslem, usc Poim 45G2. I — <br />I IE1 DeCrtai�tian pl Me1naE a� (q lde er I 1¢) ��oreol�Lon � <br />bl �uviDtion ol pmM�IY Ib1 U�b I (q Coil o� I�IloweJ or ailew�ple I aomDULnp 1j1e Im tnn �ne " <br />¢auiud olhtt buis m c��o� ror[ aeD�rptl�on <br />—'__'— _—"— _ _— <br />1 Tolal additional lirshyear deprecialion (do no� include in items balow7 _ _ _.__---- -�� <br />— ------ <br />--- 'Jo0 c�.aTj SL l�. ....... ?. • <br />...3.7.'l-......_ ..._5 ............................ . <br />..AP.r�✓IIG . .............................. <br />'�. ...... ..L�1' ` ._.... ''' <br />........ ......................................... .......... <br />. .I —�. . �,p o <br />2 Tolels . . • _ _. ' <br />