RECEIVED ON U. S. LIBERTY BONDS, VICTORY NOTES AND CERTIFICATES.
TAXPAYER

ADDRESS
(Name of Individual, Partnership, Association or Corporation)

TEMPTIONS APPLICABLE
Redemption
Interest Principal

100.000 Met
Maturity
Nov 15, 1917

1932-1947 1st 4's June 15 Nov. 15, 1917

1927-1942 and 4's May 15 May 9, 1918

1932-1947 Ist 4%'s June 15

Totals for Tax Retum (interest received should agree with Item (h) Summary, Table )........ a) This amount is not necessarily taxable, but when combined with other items of taxable income, less allowable deductions, it may be subject to star od creme

and war profits taxes.

RECEIVED ON U. S. LIBERTY BONDS, VICTORY NOTES AND CERTIFICATES.
TAXPAYER

ADDRESS
(Name of Individual, Partnership, Association or Corporation)

BXEMPTIONS APPLICABLE

Totals for Tax Return (interest received should agree with Item (h) Summary, Table m ...... (x) This amount is not necessarily tatable, but when combined with other items of taxable income, less allowable deductions, it may be subject to surtax and excess process

and war profits taxes.

(Page 8)

Allowed by Law to Individuals, Partnerships,

Associations and Corporations

4% First Liberty Bonds, converted into)

Second Loan 4X% First Liberty Bonds, converted

into Third Loan Second Liberty Bonds, original

issue, unconverted 44% Second Liberty Bonds, converted

into Third Loan 4%% Third Liberty Bonds, original

issue

(2) No limitation.
(b) Until the expiration of two years

after the date of the termination
of the war between the United
States and Germany as fixed by
proclamation of the President

4%

IV
(a) Form normal income taxes.
(b) From surtaxes and excess profits and

war profits taxes only to the ex-
tent of interest received after
Jan. 1, 1918, on an aggregate prin-
cipal amount of $45,000 of these
bonds, provided that the exemp-
tion shall be limited in all cases to
interest on an amount of bonds
one and one-half times the prin-
cipal amount of the Fourth Lib-
erty Loan originally subscribed
for and still held by the tax
payer at date of return. (1)

No limitation

No bimitation

(a) No limitation.
(b) No limitation.

Obligations of Possessions of the United From all income and excess profits and
States.

war profits taxes. (S)
Securities Issued under Federal Farm Prom all income and excess profits and
Loan Act of July 17, 1916.

war profits taxes. (5) Bonds Issued by War Finance Corpora

(al From normal income taxes. tion.

(b) From surtaxes and excess profits

and war profits taxes only to the
extent of interest on an aggregate
amount of principal not exceed.

ing $5,000. (6)
(1) Under Act of Sept. 24, 1918.
(2) Under the "Victory Liberty Loan Act" approved Mar. 3, 1919.
(3) Under the Second Liberty Bond Act," approved Sept. 24, 1917
(4) Under the "First Liberty Bond Act," approved April 24, 1917
(5) Under the "Revenue Act of 1918" Sec. 213 (4), approved Feb. 24, 1919.
(6) Under the "War Finance Corporation Act," approved April 5, 1918

(Page 6)