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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 <br />Address: <br />Type of Business or Activity: <br />SECTION C: Gross Receipts Determination for Business or Farm Operations <br />ITEM <br />BASE PERIOD <br />Gross Receipts or Gross Sales, Less Returns and Allowances <br />Year:2008 <br />Year:2009 <br />Average: <br />$225,784.00 <br />1 $169,767.00 <br />$197,775.50 <br />SECTION D: General Tax Information (NOT to be completed by Nonprofit Organizations) <br />Name(s) Used on Income Tax Return(s) <br />Raymond G. Mori <br />Tax Returns Filed with Director of Internal Revenue In: <br />YEAR <br />CITY <br />STATE <br />Employer Identification Number(s) Shown on Tax Return(s) <br />68-0078287 <br />2008 <br />Santa Ana <br />CA <br />Principal Business Activity Type Reported on Tax Return(s) <br />Law Office <br />2009 <br />Santa Ana <br />CA <br />SECTION E: Computation of Average Net Earnings or Net Revenues for Base Period <br />ITEM (complete appropriate table) <br />BASE PERIOD <br />Year: 2008 Year: 2009 Average: <br />TABLE I: INDIVIDUAL OR SOLE PROPRIETOR (Relates to IRS Form 1040) <br />(1) Net Profit (or Loss) Before Taxes from IRS Form 1040 <br />$194,079.00 <br />$139,867.00 <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) <br />$194,079.00 <br />$139,867.00 <br />$166,973.00 <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)) <br />$0.00 <br />$0.00 <br />$0.00 <br />TABLE III: PARTNERSHIP (Relates to IRS Form (1065) <br />(7) Ordinary Income (or Loss) Before Taxes from IRS Form 1065 <br />(8) Compensation Paid to Principal Partners, Their Sopuses and Dependents <br />(List names and amounts in Remarks) <br />(9) Net Earnings (Add lines (7) and (8)) <br />$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 line (11) from line (10) <br />$0.00 <br />$0.00 50.00 <br />REMARKS: <br />Based on Mr. Mori's average annual net earnings, he is eligible for the maximum $20,000 fixed payment in lieu of a payment for <br />actual reasonable moving and related expenses. Per tenant request, OPC staff reviewed and returned copies of his 2008 & 2009 tax <br />returns, verifying their contents for this claim on March 30th. <br />Overland, Pacific & Cutler, Inc. <br />Page 2 of 2 <br />=BC -05 (4/04) <br />