Income Tax Return for individual taxpayers

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1 April 1998 to 31 March 1999                                                    Income Tax Act 1994
                                       Accident Rehabilitation and Compensation Insurance Act 1992

1. IRD Number :
2. Name :	MrMrsMsMissDrProf. First  Last
3. Address :
4. Date of Birth :	//19
5. Phone No :
6. Fax No :
7. Email :
8. Were you the principal child carer and      entitled to family support, IFTC and/or      GMFI?      (See page 11 in the guide - you may      now qualify for these payments.)	No  Go to question 9 Yes  You also need to complete an FS2 form.               Read the note on page 11 in the guide.
9. Are you a non-resident of NZ for tax       purposes? Read the note on page 13       in the guide.	No  Go to question 10 Yes  You may need to complete an IR 3NR return.

10. Did you receive NZ Superannuation and/or Veteran's Pension? Do not include       income-tested NZ Super here; include it at Question 11.       No   Go to Question 11.       Yes  Copy the amounts from your yellow IR 12DN certificate to the boxes below.                          You may be liable for surcharge. To find out if you need to fill in an NS 60(3) form, read                          page 15 in the guide.                                                                                                                   Total tax deductions            Total gross NZ Super         NZ Superannuation only                               10A> $ 10B> $                                                                                  Total tax deductions  Total gross NZ Veteran's Pension         Veteran's Pension                                         10C> $ 10D> $

11. Did you receive income with tax deducted, shown on your IR 12 or IR 13 certificates?        Include shareholder salaries which have had tax deducted and income-tested NZ Super here, not at        Questions 10 or 19.       No   Go to Question 12.       Yes  Copy the amounts from your yellow IR 12 and IR 13 certificates to the panels below.                          Include family support paid by Income Support (not Inland Revenue). If you need more                          information about which income to include here, read pages 16  to 18 in the guide.                     Name of employer or payer                                                Tax deductions                         Gross earnings                 $           $                 $           $                 $           $                                     Total family support from Income Support               Total tax deductions               Total gross earnings                                            11> $  11A> $ 11B> $

 or