Form 4562 (2009)
Page 2
Part V
Listed Property
(Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for
entertainment, recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete
only
24a, 24b,
columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section A
' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24 a
Do you have evidence to support the business/investment use claimed?
. . . . . . . . . .
Yes
No 24b
If 'Yes,' is the evidence written?
. . . . . .
Yes
No
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Type of property (list
vehicles first)
Date placed
in service
Business/
investment
use
percentage
Cost or
other basis
Basis for depreciation
(business/investment
use only)
Recovery
period
Method/
Convention
Depreciation
deduction
Elected
section 179
cost
25
Special depreciation allowance for qualified listed property placed in service during the tax year and
used more than 50% in a qualified business use (see instructions)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
26
Property used more than 50% in a qualified business use:
27 Property used 50% or less in a qualified business use:
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
. . . . . . . . . . . . . . . . . . .
28
29 Add amounts in column (i), line 26. Enter here and on line 7, page 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
Section B
' Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person. If you provided vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
(a)
(b)
(c)
(d)
(e)
(f)
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5
Vehicle 6
30
Total business/investment miles driven
during the year (do not include
commuting miles)
. . . . . . . . . . . . . . . . . . . . . . . . .
31
Total commuting miles driven during the year
. . . . . . . . .
32
Total other personal (noncommuting)
miles driven
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
Total miles driven during the year. Add
lines 30 through 32
. . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
34
Was the vehicle available for personal use
during off-duty hours?
. . . . . . . . . . . . . . . . . . . . . .
35
Was the vehicle used primarily by a more
than 5% owner or related person?
. . . . . . . . . .
36
Is another vehicle available for
personal use?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section C
' Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than
5% owners or related persons (see instructions).
Yes
No
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,
by your employees?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners
. . . . . . . . . . . . . . . . . .
39 Do you treat all use of vehicles by employees as personal use?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
vehicles, and retain the information received?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)
. . . . . . . . . . . . . . . . . . . . .
Note: If your answer to 37, 38, 39, 40, or 41 is 'Yes,' do not complete Section B for the covered vehicles.
Part VI
Amortization
(a)
(b)
(c)
(d)
(e)
(f)
Description of costs
Date amortization
begins
Amortizable
amount
Code
section
Amortization
period or
percentage
Amortization
for this year
42
Amortization of costs that begins during your 2009 tax year (see instructions):
43
Amortization of costs that began before your 2009 tax year
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
44
Total. Add amounts in column (f). See the instructions for where to report
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44
FDIZ0812 07/07/09
Form 4562 (2009)
MEDICAL TOURISM ASSOCIATION, INC
26-0753785
217.
217.