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Form Node INCOME TAX. HAYA SARAL PROFESSION OP CAPITA Gi ncaa [iii EE ORECEANOL CECA 2 ADDRESS meena Choge) (BRR MOM ISAS SIUC BAe 9 Penmiaenk Accourt Humbor (AN BI 34 PITIS Holl lo ba} 4 DaloofBith RISHTSLEIe) 1, SEX “Hl FORM FOR RESIDENT INDIVIDUALEINDU ULORIDED FAMILY HOT AGRICULUTURA Buk CRIOASA IOI on Bese) tee at 08 MING ECOME FRO ARTA MF 8, Acsosemont Yor Qev5~O 6 5: Stout Indi Hea undies amy Porividteng® 9. Retan : Onna or Reiaad — OA p val i 6, WordOrclelSpecid ranga Sonabhlpbur 10. Pastcars of Bank Accnurt (for peyant of round) \ Name of tho Book MICR Coca! Aeros of Beak Beach Tpecttecont —— pocaurt Murat | [ BE CFP4S | (MeL Gn Bex Buria.—] (Scam; (Oieoosa ee] ‘CORPUTATION OF INCORE AROUNT 4. Income chargeabie under the head * Salaries * fAllach Fo 16] Rs. 3, 0,252 + Rs. Slea(L7C-aeog) (BT, 416 +f 2. Annus Value 1 Higher or Annwal rent receie of receivable / Reduced annul end receled or receivable because of vacancy 3. Taxes acluty pai te local athorty [ore 4. Annual value of property (23) é ay 5. Less : Deductions claimed ws 24 (3) Tit percent of ru vaio (0) eres payable on borrowed capt) © C227) 6, Total of above 7. Income chargeatte under the head * Income ftom House Property (4-6 ) TO} 8. Gross income from other sources Gross Amount ‘Amount Exempted (2). Dividends from companies Ooo O-7d, ' (0) Disdonds from units oe | (c). Interest D246 REM4 (8) Reval inceme fn machinery, plats, ee Cae Ceo (6) others ate] cas Total (RRR ] 8, Total of 8 above ( Gross amount minus Amount exempted ) (BFaa eo] 40, Dodson we 67 {a} Depreciation LT ® Cem ® Cea 11, Total of 10 above Cea : 12. Income chargeable undor the hoad * Income from Othor Sources * [9-14] Bead t 43, Gross Total Income (1474412) Ty 245-55 14 Doductions u/s on VIA AMOUNT AMOUNT ( wooo (Toe) (ec CSTR ETT] Gy oonnel owe) (®) 800 oo {}00 [RBRG-ST] (Soo ("SV } (©) 89 Fo (coon Ser} 15 Total of $4 above (SABER) 15 Total seme (13-15) (ay wo Fr 4.7 Taxon tl Income 4B. Less Retole AMOUNT AMOUNT (a) Sec. 88 (9) Soc. vec OF Ge) (&) Sec, sea [0+ oo 19. Total of 18 above F s 20. Baloece tax payable (17-19) 21 Aid Surcharge 22. Tax payable [20+24] 23. Rebel uls 89 24. Batanee tax payable (22-23) 25.. Tax Deducled al Source (a) Salaies [EIS (0) Otrers[ 86S] 26. Total of 28 above 21._hdvance Tax paid (Alach copy of chafan) Dale | Amoat (@) Upto 1505 (© 10 HI () 0S to W912 : (0) 1605 to 3103 8. Total oD above 78, Tx pad ing tne proious yoor [26+20] 30, Inlorocl Payable Aumont | (a) Section 2344 ail (€) Section 2346 (0) Section 2348 Talal loreal [avd] 34, Less : Self essessmord tax pad (Allach copy of challan ) 2. Tax payable / Reltndable (24-79430-24 ive Verification 1_SHAMBHU THA (name in fall and in block letter), son/daughter © TE 4, ARAYAN THA colemnly decase that to the best of Imowledge and belief, © > Hes and statements accompanying it axe coucet, complete an¢ stated and in accordance with the provisions of the Income Tax Act, 1961 ia sespect of Inceme changeable 10 Incon: Tax for the previous year relevant to the assessment year Qa FOG INCOM Wax Shobha Tha E Signature of the Asscssee Date _ 25 /F/ 2005 co: MCL, Tago Vihoy lah Receipt No, 22.9 S Signature of th Wd) care the Incana-tu: undar tha hes: narg=3u 1984 for tae lsries iNane end Addr. of the Employer] Name and Designation of the Emplayee [Mahanadi Coalfiakds Led | SHAMBH JHA, cosy CaQDBRIRe» Lisgeuti Vihacs BURLA £ SMe iSambalpur, aRrssa t [TDS Circle where snnual Return{ Pariod Assesamant [/Statenant under s2c.206 ix tof Fran f To Year fhe filled. SAMBALeUR "2005 ‘2005. DETAILS OF SALARY PAID AND ANY OTHER INCOME AND Tax DEDUCTED Gross salary t C£8S 7 ALIuw. axenptad = { andar section 19 t + BALANCE 1-24 t + BEBUCT IONS + f arid ded. Rs 30000, 1 operat, Tax Rs 2400.00 | epleas on As 33SAB.00 0 | i t ! t t t z @ Hous Prop. 3. Aggragate or 4 (a to

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