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SECTION B: Name and Address or Other Establishments Operated By or Affiliated With Business or Nonprofit Organization (if None, type "None") <br />Name: <br />None Address: Type of Business or Activity: <br />SECTION C: Gross Receipts Determination for Business or Farm Operations <br />ITEM BASE PERIOD <br />Gross Receipts or Gross Sales <br />Less Returns and Allowances Year:2009 Year:2010 Average: <br />, $23,100.00 $149,604.00 $86,352.00 <br />SECTION D: General Tax Information (NOT to be completed by Nonprofit Organizations) <br />Name(s) Used on Income Tax Return(s) Tax Returns Filed with Director of Internal Revenue In: <br />Michelle Smith YEAR CITY STATE <br />Employer Identification Number(s) Shown on Tax Return(s) <br /> <br />570-08-9010 <br />2009 <br />Santa Ana <br />CA <br />Principal Business Activity Type Reported on Tax Retum(s) <br /> <br />Livescan/Notary/Office services <br />2010 <br />Santa Ana <br />CA <br />SECTION E: Computation of Average Net Earnings or Net Revenues for Base Period <br />ITEM (complete appropriate table) BASE PERIOD <br /> I Year: 2009 Year. 2010 Average: <br />TABLE l: INDIVIDUAL OR SOLE PROPRIETOR (Relates to IRS Form 1040) <br />(1) Net Profit (or Loss) Before Taxes from IRS Form 1040 ($3,252.00) $48,142.00 <br />(2) Compensation Paid to Owner, Owner's Spouse and Dependents <br />(List names and amounts in Remarks) <br />(3) Net Earnings (Add lines (1) and (2) ($3,252.00) $48,142.00 $24,071.00 <br />TABLE II: CORPORATION (Relates to IRS Form 1120 or 1120-S) <br />(4) Taxable Income (form 1120) or Ordinary Income (form 1120-S) <br />(5) Compensation Paid to Principal Stockholders, Their Spouses and Dependents <br />(List names and amounts In Remarks) <br />(6) Net Earnings (Add lines (4) and (5)) $0.00 $0.00 <br />$0.00 <br />TABLE III: PARTNERSHIP (Relates to IRS Form (1065) <br />(7) Ordinary Income (or Loss) Before Taxes from IRS Forth 1065 <br />(8) Compensation Paid to Principal Partners, Their Spouses and Dependents <br />(List names and amounts in Remarks) <br />(9) Net Earnings (Add lines (7) and (8)) $0,00 <br />$0.00 <br />$0.00 <br />TABLE IV: NONPROFIT ORGANIZATION <br />(10) Annual Gross Revenues: <br />(11) Administrative Expenses: <br />(12) Net Revenues (Subtract fine (11) from line (10) $0.00 $0.00 $0.00 <br />REMARKS: <br />Based on Livescan N More's annual net earnings they are eligible for the maximum $20,000 fixed payment in lieu of a payment for actual reasonable moving <br />and related expenses. <br />Overland, Pacific & Custer, Inc. <br />Page 2 or2 <br />25B-37 =BC-05 (4/04)