Consolidated Professional
Services, Inc.

The first Income Tax Declaration (USA)

Year 1913

To be filed by collector Form 1040 To be filed by Internal Revenue Bureau

List No ………………….. INCOME TAX File No ……………………

………………………….. The Penalty

……. District of ………… For Failure to have this return Assessment List …………..

…………………………... in the hands of the collector

Date received …………… internal revenue on or Page ……… Line ……….

Before March 1 is $20 to $100

United States Internal Revenue

RETURN OF ANNUAL NET INCOME OF INDIVIDUALS.

(As provided by Act of Congress, approved October 3, 1913)

RETURN OF NET INCOME RECEIVED OR ACCRUED DURING THE YEAR ENDED DECEMBER 31, 191_

(For the year 1913, from March 1 to December 31)

Filed by (or for) ……………………………………. of …………………………………………

in the city, town, or Post Office of ………………………. State of ……………………………..

1. Gross Income (see page 2, line 12) ……………………………… $ ………………………….

2. General Deductions (see page 3, line 7) ……………………… $ ………………………….

3. Net Income ……………………………………………………… $ ………………………….

Deductions and exemptions allowed in computing Income subject to the normal tax of 1 percent

4. Dividends and net earnings received or accrued, of corporations,

etc., subject to like tax. (See page 2, line 11) …………………… $ …………………………

5. Amount of Income on which the normal tax has been deducted

withheld at source at the source. (See page 2, line 9, column A) …… $ …………………….

6. Specific exemption of $3,000 or $4,000, as the case may be.

(See instructions 3 and 19) ………………………………………… $ ………………………

Total deductions and exemptions. (Items 4, 5, and 6) ……… $ …………..

7. Taxable Income – on which the normal tax of 1 percent

is to be calculated …………………………………………………… $ …………………….

8. When the net Income shown above online, 3 exceeds $20,000, the additional tax thereon must be calculated as per schedule below

Income Tax

1 percent on amount over $20,000 and not exeeding $50,000 ……..$………. $ …………..

2 “ 50,000 “ 75,000

3 “ 75,000 “ 100,000 ………………………………

4 “ 100,000 “ 250,000 ……………………………….

5 “ 250,000 “ 600,000 ……………………………….

6 “ 500,000 …………………………………………………………..