portfolio part 2_1040 form(done).png - E'I 040 Department of meTreasuryInlamol Revenue Service(99 2 1 6.3 Individual Income Tax Return OMB No 1 545-0074

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Unformatted text preview: E 'I 040 Department of meTreasury—Inlamol Revenue Service (99} 2 © 1 6 ° ”.3. Individual Income Tax Return OMB No. 1 545-0074 Ins Useomy—Do not writearslaple in this space- For the year Jan. 1—Dec. 31 . 2016, or other tax year beginning . 2016, ending , 20 See separate instructions. Your first name and initial Last name Your social security number 5 7V ,1 i150!) 1}wa / If a joint return, spouse‘s first name and initial Last name Spouse’s social security number Home address (number and eat). It you have a PD. box, see instructions. Apt. no. A Make sure the SSN(s) above 3’ [5 $2! ' {C D( andonlineficarecorreot. I City, town or pos office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions) Presidential Election Campaign A! Mi 920W diagrams; Foreign country name Foreign provincelstatefcounty Foreign postal code lambda" will [:10 change your'tax or "9 refund. D You '3 Spouse Filing Status 1 i! ingle 4 Ci Head of household (with qualifying person). (See instructions.) if 2 [I Married filing jointly (even it only one had income) the qualifying person is a child but not your dependent, enter this Check OHIV one 3 Ci Married filing separately. Enter spouse’s SSN above Child’s name here. " hint. and full name here. D 5 El Qualifying widow(er) with dependent child - ' Boxes checked Exemptrons . 6a igfl'murself. if someone can claim you as a dependent. do not check box 6a . on Ga and at: L b El Spouse . . . . No.of children (4) I if child under age 17 , on So who: c Dependents: quarrying for childti-Jx credit . lived with you (1) First name Lastnamo {see instructions) . did not live with you due to divorce or separation If more than four (see harms-lions) dependents. see Dependents on Br: instructions and MI ememd above disc“ “9’9 ’ D Add numbers on d Total number of exemptions claimed . . . . . . . . . . . . . _ . lines above b I Income 7 Wages, salaries, tips, etc. Attach Fem-Ks) W—2 . . . . . . . . . . . . - 0, 0 0 0 8a Taxable interest. Attach Schedule B if required . . . . . . . m— !) Tax-exempt interest Do not include on line 83 . . . 8b 2J9 2CD H- Attach Form(s) . . . . . w_2 here. Also 9a Ordinary dIvrdends. Attach Schedule B it requrred . Q) attach Forms to Qualified dividends . . . . . . . 9b W-ZG and 10 Taxable refunds, credits, or offsets of state and local Income taxes . . . . ,‘ 5'70 "’99“ if tax 1 1 Alimony received . . . . . . . . . . . . . . . . was withheld. 12 Business' Income or floss). Attach Schedule C or (3— E2. . . . . _ 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here > If you and ”Gt 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . get a W—2, _ _ _ . . see instructions, 153 iRA drstnbutlons . 15:: a h Taxable amount 16a Pensions and annuities @“ b Taxable amount 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 1 18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . 19 Unemployment compensation . . . . . . . . . . . . . q . . IEEHHHHHI q BEEHE 20a Social security benefits I 20a I Q I I b Taxable amount . . 21 Other income. List type and amount _-_--__-_----_____-_____-_______._-._-___-_-_._--.__---._. 22 Combine the amounts in the far right column for tines 7 through 21. This is your total income P -m _ 23 Educator expenses . . . . . . . . . . . --- 7 AdJUSted 2.4 Certain business expenses of reservists, performing artists, and 5 Gross fee-basis government officials. Attach Form 2106 or 210642 kl I Income 25 Health savings account deduction. Attach Form 8889 . —— 26 Moving expenses. Attach Form 3903 . . . . 27 Deductible part of self-employment tax Attach Schedule SE. 28 Self-employed SEP, SIMPLE, and qualified plans . 29 Self—emptoyed health insurance deduction . 30 Penalty on early withdrawal of savings . . 31a Alimony paid I) Recipient‘s SSN r ’ lFtAdeduction . . . . . . . . . Student loan interest deduction. . . . Tuition and fees. Attach Form 8917. . Domestic production activities deduction. Attach Form 8903 Add lines 23 through 35 . . . . . . Subtract “no 36 from |me22 ThIs Is your adjusted gross income . . . . . #- E’ 32“ 5'40 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 113203 Form 1040 (2016) \ EEEHEEHEHH IIIIIIIIII flgtfifii‘ifi ...
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  • Spring '16
  • Revenue, Taxation in the United States, Attach Form, attach schedule

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