Вы находитесь на странице: 1из 7

E ~ O~o Department of the Treasury—Internal Revenue Service (99) ~0

u~
. V.r7. ir~d~vidual Income ~'ax Return O OMB N0. 1545-0074 SRS Use Only—po not vmte or staple in this spaca,
Forthe yearJan. 1-Dec. 31,2014, or oiher tqx year beginning , 2074, ending ,20 See separate instructions.
Your first name and initial Last name r
Bernard Sanders
If a joint return, spouse's first name and initial Last name ~ Ouse's soc~a~ sacurit nu ber
Jane O Sanders
P.O. box, see instructions. Apt. no. Make sure the SSN(s)above
and on line 6c are correct.
airy, Town or post office, state, antl GIP code. If you have a foreign address, also complete spaces below (see instructions).
Presidential Election Campaign
Check here if you, or your spouse if filing
Foreign country name Foreign province/state county Foreign postal code ~01ntly, want $3 to go to this fund. Checking
a box befoul will not eha~ge your tax or
refuntl. ~ You ~ 5pousa
filing Status 1 ❑Single 4 ❑Head of household (with qualifying parson).(See Instructions.) If
2 ~ Married filing jointly (even it only one had income) the qualifying person is a chid but not your dependent, enter this
Check only one 3 (Q Married filing separately. Enter spouse's SSN above child~s name here. 1►
box. and full name here. ► 5 (~ Qualifying widower) with dependent child
Exemptions sa ~ Yourself. If someone can claim you as a dependent, do not check box 6a .
~ ~
b ~] Spouse ona$adBse~d
No of children 2
c Dependents: (2) DopendenYs (3) Dependent's (4) ✓ ii child under age 17 an 6c who:
(t) First name Last name social security number relationship to you q s)credit • dived with you
ualifii~ne InsirulcUo • did not live with
you dua to divorce
If more than four or separation
{see Instructions)
dependents, see
instructions and Dependents on 6e
not entered above
check here ► ❑
d Total number of exemptions claimed Add Warnbers on Ir.:~
. . . . . . . . . . . . . . . . lines above ►
~ t3G01'i'1~ 7 Wages, salaries, tips, etc. Attach Forms) W-2 7 156, 9 41.
8a Taxable interest. Attach Schedule B if required 8a 11.
b Tax-exempt interest. po not include on line 8a 8h
Attach Forms)
9a Ordinary dividends. Attach Schedule B if required 9a
W-2 here. Also 2.
attach Forms b Qualified dividends 9b
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes 10
f099-R if tax 11 Alimony received
was withheld. 11
12 Business income or (loss). Attach Schedule C or GEZ 12 4 , 9 00 .
13 Capital gain ar (loss). Attach Schedule D if required, if not required, check here ~ ❑ 13
If you did not
14 Other gains or(losses). Attach Form 4797. 14
get a W-2,
see Instructions. 75a IRA distributions 15a b Taxable amount 15b
16a Pensions and annuities 18a~ ~ b Taxable amounk 16b 9 982.
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
18 Farrn income or (loss}. Attach Schedule f" . 18
19 Unemployment compensation 19
20a Social security benefits ~ 20a ~ 46,213. ~ b Taxable amount 20b 3 9 , 2 8 7. .
21 Other income. List type and amount 21
22 Combinethe amounts in the fer right column for lines 7 through 21. This is your total income ►
22 2 05 , 617 .
23 Educator expenses 2S
14C~)US~@t~ 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 21D6-EZ 24
~t3C01'il$ pg Meaith savings account deduction. Attach Form 8889 25
26 Moving expenses. Attach Form 3903 26
27 Deductible part of self-employment tax. Attach Schedule SE 27 3 4 6.
28 Self-employed SEP, SIMPLE, and qualified plans 28
29 Self-employed health insurahce deduction 29
30 Penalty on early withdrawal of savings . 30
31a Alimony paid b Recipients SSN f► 3ia
32 IRA deduction 32
33 Student loan interest deduction . 33
34 Tuition and fees. Attach Form 8917. 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 35 36 3 4 6.
37 Subtract line 36 from line 22. This is your adjusted gross income ! 37 ?. 0 5 . 7 7 7 _
Far Disclosure, Privacy Act, and Papereaork Reduction Act Notice, sse separate instructiohs. gqp
REV 05/19/15 TTO Form 1040 (2014)
Fr::~r~ iG~4s1€~~if} t~~;
;a 2
~~ (ffQtll ~3i1~ a7 {~CIJIiSi:~ Csrc1~:5 I3't~ UrYF£1
HfT10'Jt'4f ~, ...-...........-. ~E~ Z ~ ~ ~_"..__.,._~..._
_.~..~,.,-i.__..______~_..__._.~ ~ %-

i:~~f~r~ J~~ai~aiy ~, 7 ~;~p, ~ Hlit~t€. ~ ~`of~! boxes


~C~~{ ~CtC3 '~~ ~~~~~'1< {. ~ You ur~r~ ~aor~~
:€: ~ ~j ~~ota~~ teas hc~r•3ti b~for~ xl~;tuur y 1, 1 s.~~t), ~ E,~i~1c1. cit~oketf A 3~a
~Y~~~~
b If yourspotrs~ ~#en,iaes arr a se~a~at~ fe9urr~ or yogi ~;~srs a du~~~siafu~ align, cl~~.ck heraP ~Sb[~
AO
m5tae~darc3 Y_M..~..._ d4emizoct daductlot~s {from Schedule A} oY yc~~.~r sYartttard ri~du~#ibn (s~~ left rnargin~ 0 `~ ,~ r 7.
tleductic~~~ q1 Sutatraat d ns Ai? #ran, line ab ~ Al ~ _t ~ 8, ~3 9~.
for—
• €~ean!„~ ~~.~i~a ~i2 Exemptt~ons, f` =s~_ v~ s v~a~,52a c~t`!n>s, a G>.t~~:!f ~3.~5~ e~, ,nv nt.:n~~r ~~ ;:off ud. 0ih.::°isa, ase ~?ss?tt3cf~~rrs ~ ~2 ?,90 CJ.
~~12C4 aE1~J ,~'~
~JQX OYi ~6(t$ '('~X~klfB IC1COt13~. .~'rlt~}ffc~C~
' ~f ~.' ~~2 f(4i1~ (Illy <> s. I'f ;(!"9r 4~ I~ tTtQt'F: ffi~ti ~3t18 ~#1, ?i1$BY ~~" ~~ ~ ~. ~ ~ j ~1 ~~f.
.-.~
3u~1 tSY 39h DY ,~A Tex (s~~ 1~7StrtdC$t`t7t15}. ~'Y?BCit It 2t1Y #~f}!1?: ~ ~ ~Llt`tl1(S~ 8~'~ ~ ~J k~ FOfitl ~~72 C ~ ~ ~ i. ~ ~i t ~______._._
~i ~..
~l0 ¢c~~? k8
4{~i~^1tt~ ~S ~ 4~ A~CBYii~3tV~ 11'i1P1sitlUYrt t~X (SQL it~SfCUG i4r75). AftBGl1 ~Off?t n25? e .Y 45
ae~htra~r'~f,
,,,~~ 4~ ~xC2SS ~tlV~r^,C~ pP~?~1iClr;i tc7~{ C~BC~it Y~~?c3y!YSBni. A,tfetC,h Form ~?Jii2 4i3
~~ts~rti.>tians. 47 ACici 1'+,tl~s ~A, k5, ~ittti 4~i ~ ~ Y► 47 ~'. 2 u ~ ~J ~_!. r
~ "~ _' --- - ._...—__._~_._.r._._.._...._..__
b t1Ei Q~i'e~EA.
48 t ar~ir~r~ tax crecli#. ,AttFcl~ Form 7'I 9f if r~~uii'~~ . ( 48
Srrgle ~r
titan~d t~Ei~,c~ ~~ Cred'st fior ci,(irl and d~~~~~~d=:~# care ~x#ae:,ses. k~fach Er~rn~ 2 ta7 —49 -~~. '~
~~garat~(y, -~--~.~
~u;2oc7 ~~ ~t~uc~#!on cr~di#s #ream Fc~r•in 8863. iii~e 19 150 ~
~,3~rr ~~i fi;in~ a1 Retirement savinc~}s cpntrfl;~ticns cr~ctit. At#ach F~arni 888(1 i ~2~"~'."-._._._.
5~ ,._._._____...
ja~nfly or [ ~~
C7u~E,[y;r~ ~hilr.} tax credit. A±tach Sc#~e~u!e £~81~, if rer~ii?rFci , ~~ ,~,,,~,,~„~
wicto.•.{~+}, p ~,3 F~~sidentiMi e~~~ryy credits. Httach Norm 5 95 ~ ~ ~3 .~~_____._~~.~....__.............1
~~2,a~r~
He~c# of ~4 t~~cter c=~u'~ts #rt~;tt ~orr~a: a %._I 3801 b i ) 8809 c ~ __.._~~._ 59, 5~
I~D~t:;etoid, ~,a 1~ud 6t~4~ nf3 thr~unh ~4, '1-~~sy ~r~ Your ~cstat croclifs
r~3.1{?0 ..._.. _.. ----- __ -- -~--
,~'j$ .
r'st1'C}ff7?GY ~Ii"ik3 ~3ri ~fOlil fttl~ -'~~. ~fi tiCl~v' J,~i IS i2lt)YF: ~~1~1t1 ~i71~' ~7, P,1?~.E!' -{)- ~' [ 1Q ~ ~ fJ .~. .

5T Saff-~mnlayt~i~tzt s~;<. AtY~~I~ Sct~wdu~~ SC 57 ~ ~'~ .


~~~~~ 5$ U~1r'e~ao~t~c3 voc`ti s~~tfrity ttt~~! Nl~dic~~°e ia?t frDm (~c~rm: ~a ~ 4137 b ~ 89#J 58 ~ _ ~q____ _m_______~-
s~ Ac:cilfi4na~ Yax c~t~ iHr~s, c~ii~ear t{ua4ifite~ retir~rnen# psa;~s~ r~?c. F~fCach Fprm a32~ if reef€~~r~r.~ 5~ ------- _. _._..__.,..~_
~r~3C~~a
6Da hlGus~tiCaici errSployrrter~t ta~css ~rc~~~s ~ci~~~t~(a is i Sba _...._ ._...~__
f1 (=iYst-tiirtt~ its€nebi yei Cr~G#i~t reCr~y~rle zt Ati cif #"~Y,~Yr ;s`~~El;i if ~t~~tx~si~A 6fSb _._,.d
f~i k-lealth e~rP: irlazv€cittat r~s~~zn~ihi9f[y (.~;~, ~.1.~c~~f~~i~~~) I=uH-Ye~~r c~verac~e IX~ ~1 .._......~~.._._~ ____~.,_,.
6~ 7ax~s fro~~c a ~ Farm 8~?5S h t;~;; xcsrn~ ~~?oi3 c j(r}struuiions; ~~tfer code~sj _________ g~ ._ ___...
F~ ACld 1't~~s ~~+ tittoU it 62. `I"ttlS iS Diir #t7f~t[ i1X I►°
.~-.d~,.,-~--..~.~._...-...._-.-....~._....~..,...,~....__ 6~ ~Ir vv ~ ~ ,
F~~'~it1~Y1'~S 6~ F~cieFal ii~com~ tax a~:~thl~etd frai{~ Fatn~s i~:-2 and t o99 8~ ( ~ 31, £3 L'~ .
_~__W.._._.,.t 9Qi4 e~~~eEiat~;a eax #~~)~m~`~Y~ ~t;ci ~rntsa;~t agAiE~ from 2U1`,>, ~~~iirvi
~a 65
~ ~ )+iJ11 ~r la+~3 it
~`CqH ~c'lCi18C~ Itl~£`C73Tt8 CP~'C~~~ ~~~~.`~

uF,;4c1, "Ytt~:C~i ~ i''~6%tcY.~~~g C~t?t~IB~ (.~}° n'::;;~i0t1 #?


Sc€~e~~.~lc~ EiC.~ f7 i~csd~iional child +~x ~re<irt, AttaG~s Sch~~u!~ 8II1~ 6?
.. t~ Ar~r~eri~r~n s~ppai~fui~Ity c~~r~it irarn ~urciz £3£363, ling f3 6~ ~._......._,..._._.~._.~~
69 Nit ~reariit~r~~ tax creai#. lattat#~ ~=orrn H9~2 ~ 69
7~ /dI"ITt7UJ1C Ck~C1 441t1't F~L~jEl~SY ~Ot' 8'X{~'-~t_?iLttl ICJ 3i1~ 7{7 ,.....A, j
.~..,~,_`..._..~......___..._.~....,
.
y~ f~xc~ss soci~el ~s~wurii~~ a~ici tier i ~;3Trh tax =.:ithst~zl,i 7i
72 Crecz~t for #~~erul tam an fuels Atfac'~ f`~r~i ~`E93G 7~ ~
~._....___._..........................
73 C~. .ssrc:n€~otm: a i~ 2r~v'~ b ~_ ~ _ .:; c ~' f?_ .,`• ci C.( ~ 73 -
7~ ;~cia iiY~cs 6<f, 6'i, E~f~a, a[td 67 fi rrc~sac~E~ 73. Tf~~se ~~rc; yvur toE~t payments ~► 74 .3 ~, , $ ~ J .--.
.
'"~ ,~ , i2
~$~~~dt1f~ ?5 }# ti~~e 7~ is rr~ore ~hat7 Eine 6~, s~h~r~e~ Cir~E 63 ;R4~~i ling 7~. 'i#~~ ;~ fEte an~Qurt ~~o~a over~,aCet ~ ~~
76£~ /a.lTT9Uni O# 111~P ~5 }~ - ~" ~ iS ii~~.iG~IE'.d, C41~C~:i~r~ ~ ~l►' !J ~ 'y~j7 ~§ f I~ .
~~....,~..._____.e.~_..._~
t'a~~~ct ~~pasit? ~' ~ F~autir~g rsurt;ber ► c ~'y~;a: ~ ChR~it~ng ~j Savint}s ~
~~
~.:W ~ d .~~.cou~~~ nu~~7~aer [ ! ~ w ~
i~.,~.~
~ 015 as#if~i~#ed_tax
~ Vi?~_._. y .~...._.__..._. ._~ #r 77 __.~..,...., ~.._..~._........~...]71(p
A#t'tUut~tt 7i3 Amount 'yt au vv~~.~ui 2 ~~. ~'Qf C#&ta3~l5 CSY! hiQt~l $(J ~3°'~~f e SSE? IfiSftt7G`Y[bY1$ ~' j ~78
f'" Ytract line ~~# from f111
_.<,».....,..._.~...... ____.~.,,_.__....
Yt~U ~'t~+~ ~J Estir4T~ted tax Eserc~fiy (~~~ ir..s~r~tciio3^s) ,~ ~ 7~ i ---~----- _-- ---- -------
~~31'~ ~"s~~i'~I ~C5 }~C~Li i~i~.tT~ `LO Si.- t~Ot': c1Ci0'~'i1BF }74'!'St~YI ~L> t'~d.:~S.`f1SS ~Y:}5 f &':kiiY'1 ('Vtx(1 ti14 ~F~.~' (54.8` til:s~f'1.1C~l6YiS}`l ~~~ ~QVf. ~,f,~iT1}',7~~f3~Cf ~.10~~:'.~. !X~ ~({Y
Q~CL~Ei~3rS - '~'iiGitS~ fT@f6L)n f IJ`33'ynrat;~'~?f)Tt i_._.~_.... . . _ _ _. _. . .
3.+~~''5~~~}~i~.
__a.,....._.~..~_~.~~
~ ~. ~►
t7<^xRtc~S ._ — _' ttC}. ~ ~~ .e_.._~.__ Il.i.fTEt16Y
._. (FSI#~) ~` £ .. _.. .~.._.._..._..._.__.,.,,,,
.. ~~
U^~'~ r ~ Es o t T' r~~. 14f-~. i~ k?t t i it z y e a i s air-'sty fl a ; i ~ o~,~r ~y r~ e,:arlu- s no sfzeera~~nts a tcl to tr a hes* of ~~ kr r~ ~cr _ <, xe€ ~_ :=
v~.~gIC~~$
~
to;, < ~ c;.,et~..,. ac,c3 con~f.:~.-... U~.,1~.. :utuo of c~re..u~er {shier •;~ t~x~,,_ye-} ~s ~ .,.,.,c# on ~til : fctn~,_t:en o€ Zola c§~ pse~.~~~r F 3s a ,icr ~ H ;.,.
S~l~~~ fC~_!7 L;e:c1~liPP ~ ~~C7ttt 4f 6UC7".t$IC~~I ~ ~ xsit't4 S>~Bi]f;~ ilCiil ltJcf'

,.irvy.4.3. ~:) 7~'~'Y~T[1E:Ili iJf''«~.7•i:C£''


~~a~~~'s sianat~ise. if a yoii~i ~•et~.rn, both m~rsi si~~~. date t ~ ~ ,t, ..,~;.
: ~tµ~n{ y I'c~ ~~ .~
fc ~a -~ c ~Fs ~.,t v~sa~xs~
. s occu~~at3U~ iSt
SE~1~—tau .LtS ~~~t t~.... <._r,.s~,t~ ,..~,.,,, .. #
______.w..~..~._..
'c~n;lF'ype };cenarei "s ~~a<r.~ ~*r~cares s s~ru~tur-~ j Ua°r ~~'T"iN
~°c"~IC71 ~ Crrc
~ f f
---_________,_w,.A~_ _.., ~ ..~__. .__._._--__._.___ ~. .._.._..,__ ~ s~ff ~3p!v}eo ----_—._
~'Y~`~3c"33't?t'
_'s;rr~t'sna~nr~ Ir ........ Sc.1?`-t°~Y~Y~~L'~C~ ,.....,v,.,~.......................~..,...M.,e,....., ~-~nt5rlkliw,.____T__,............. ...~..
~!~'~ti~~f
3-itt'it~5 P.Cidfs'z~S ~ ~~~96{in3 t16,
..a•;;>e,irs.{~~viYc~rm1~}-rte ttd~~0~1~Jt;37T0 ~p~rr1 ~~~~ ('y(;14)
(~~rrr~ 9~4fl) ~ .~_;
1 ~ ~rrfor~~~#fare ~►yc~u# Schedulo A anci its se~atate instructions i~ at wwt~,frs,gr~visahedutea. ~~~ t~l
f ~ . t of p r4a~~art
Ea~~^ ,
Atr ~ i~ze~.~
trio ~ t-~ :~.,:. C ~'e {J~} ~)aL2~C}~ #Q ~OYfT1 f040. fi~t~ue:ice No. ~~
t~a~r,a{s) s~jov.,n ors Form 7b»Q Your s~~ial sect~rify t~t~mber
~3~~Tir`2, Y'C~ ~+", cl u'z ?'?G.' ~ ~ii:~c1E:5:';~ ~ ~~_.......Y.
. . _. _ _.
~~Ufiot7. ~9 11Ea~ 1rlCltlde ~Xp~1~S~S t"~iYC6bUrs~d br' ~~iC( ~~y Oit1~Cs.
{~lt~clie~l ~( Me~+icul ~nr~ ci~nta! ex~~ns~s {s~~ ir~;s~ructiar~~) ~1 "`~'"'.~-.._.
~ttt~ 2 ~n#er ainc,~,nt frc~dn Fc~r~rn 7 (~4~i, line 3~3 I._~.L._____ ~,____~ ~
CTet~ta( 3 ~~uiti~(y ling 2 by i0°l~ (.1QJ. But if either you oi' you~~ apaus~ :,'~s ~ ~ ~ §(
~}2~ns~s ~t~i'~~ b~#ire J~t~u2~~'y 2~ 1~~~3, ~'tu1t~~~y {ine 2 ~sy 7.51 ~.07a) h~steae{ ~ ~ ~ I
4 subtract (one 3 fr~~~ ling ~, i~ lire 3 is ~r~ar~ th~r~ 1Ene 1, ~n~~er ~0- . ,~} 4
~r`~3f~'S. ~t)U ~J ~'~atE c'~Y1d ~4C8~ t4`~TEC{C t?f1~jJ At]4 ~JCiX}:
~r~ICj c'~ ?X~ ItlCt7tTtf ~~X~S, QY ~ J { ~ y`OG~C} , v.,
~ C~ ~Qnarai sans taxes ~ ~`M(( ---~
~ r~~~1 Asia#e taxes ~sr-,c in~ts'c~c#ion,~ ~ 5 I _,.___.. 1. r , ~ 4 3 .
7 P~rson~l ~~•o~~rty tars
~ CSfiier #axea, L.isi type ~3nd an~~r~unt ►~ ~ I

~ f~t'~C~ ~I(1f';~ ~ tll€C.l~i ~'1 ~ $ ~ ~ ~s .' c~ ~ ~ f~ ~ .


i~1~~!`~~t '1t? Ho~nA ~r~ar#a~a~ inter~si end ~9irtfs r~e~arteci ire yon, ota ~rrn 103 '}Q ~_ 7 ~, 9 4 ~ .
~ptd ~~1G~ ~~ ~~C?RlG' (31:3i'fQ~~~ ItI~C'YL::~ 11G~ ~`C^j3QS~F,C~ t0 ~4U C3?1 ~C7YtT1 ~{Q~$. (f gciiC.~
a„
iv tl1B ~G-(SOti gCUtY! :'J~lt')IT: ~~C)L# ~]QU~~t# ~~'3~ ~1QtTiL', 5F°@ t~t5t!'t1C~ipCFS
t~o~e, a~ci s(~d~ r t} ~t person s n~n3e, idef~t ty~nq r~~ ,grid ~c~dress ~ ~
~(Gt~f tTiO;`iCfcC~G'

decu~ftoit rtlay -- ------- -___ ..._.___e______e_____._.._______________.._____e- ---- '~~~'~~.,_


~~
k~a lrrrnc~r~ (::~~ ~~ I'o~n#s teat re~orte~! 4c~ you on ~'ort~ 1CJ9t3. S~~ ir~struC;tangy #r~{
irtitr«ctcor!sj, Sr~~Ct~! rules . ~
'!fit "_`_~
i~ Mr~r~tgage ik~sur~znce ~re«-~i~zr~s {see insiructicrn~} . ~ 't3 ~~ .~. _u.......
1d invesfrn~r~t i~tt~re5t. Attach ~c~rm ~~35~ if r~quG~~d, (Sep instr~.ictions.} '#4 ~ ~ l
~5 Add lirt~ qC1 #htra~.F F~ ~4~ , t~ 22, ~f~ ~.
+~ ~#~ ~~ ~~ ~i#t:~ by cash Qr check. If you rr~ad~ and+ gift or ~w~:>0 or more, 1 ( ~

I~yOU?1"iclGf~c1 ~~ ~
• .~{l~Y ff2c~i1 ~~ Cr~Sf3 C7Y L:~~'C~(. ~i ~$C!~ C~JIf~ Qf ~`~fl
J~ Q5I'11Qf8, S~& ~ .v .~ J f
t~iii c`~.{id t7D~ ~ Ii15~?'UC~(4115. YUU fTil.tS~ ~~~~C~l ~l~C[Tl ~~f}'J' I~ C~VBi` ~J~~ ~~ ~ j ~+~.
g _.._....~_______
bencf~t far rt; f 8 Garryav~r fi~arrT pr~ir~r ye~3r _
:
~C3 kftBIt'UE)2Sbi7a~ .~.~
f~t,~q ~tt1~S ~6 ~~"lt'6t,IC~~i ~{~i ,,... ~~ ~' ~;%~J
...w.._,.._..._.~_.__..~,..__._A..
C~SU~Ity ~tit3 ~
`l~e~t L(s~5~s ~0 Casi,~it nrr tE~eft lays{e~}. Attach ~c~rFr~ ~1v~~. (S~~ instr~ctfUn~.) , 20" ~---.--.._.._...__._._
Job ~xp~►~s~s ~1 llnt-~.irrbursed ert~rpl4yee exp~rtW~S—joie e 4r~v~1, tt?~~ic~n dues, ~
1t~d C~~~ilt jab education, e#c Af#acit ~orrt~ 2106 of 27{36 ~~ if r~quiret~.
~lii~C€i~3l~ftep~~S (S~~~nStru~tior~sj P ~vczu~~~~~~ ~fp~=s~, ~:r ~a~~ 2~0~ ~~ ~?,<~73a
~~C~UC.~ttJliS 22 1~x (»'Fj3~t"~tiOSl f~~;a ~ ~a 2 ~? 9 .
2~ Qfl~~r ex#~e~ses--inuVstr~~e~~~, safe ~e~4sit bc~x, ~tG, !_ist type ~
~~~cs amo~fnt
._ _ ,___',._ ____._ 23
_.__:..-' ----. ~~~
~~ F1c#d iin~s 21 ~tht'o~,c~t~ 23 -, 4, ~ 7 J,
~~}~, ~7~. -----~.-~ ___._.
~S Crtt~r ernc>uni f{rim ~c~~'m 1G~~(3, iina ~€~ ~2~~ ..._....... . ._.~,. ~~
~£i t~/1UI$i~?ly ti#le 2J kJy ~°/b (.f32) . ~ 6, ~+, 1.C~ ~`~ . ~ i
~7 St~t~tr~act [ ~~e 25 franc l rs~ 2~+. If line ~6 is rnv~e tt~~,~ #ins 2~, ~r~ier -0- ~~~7; 7? ? .
€ _.._..,....,e_..._...,...m
C}tht3~ ~8 Qtiier--frotrr list in r7structic~a~s. List type anti ~mour~t fA
~1i~c~Et~neat~s
[3~'dtEG~~~t~S ?~
~ ~-~---~..-~--_..,.._.~.
'f"~~~3 2~ Es I=orm 'f Q~€t?; iit~e :38, ~av~r ~ fi Z2,52.'.i?
It~rrtii:~~t~ !~,1 Ncs. Your deduciion fs not !irn`st~cl. Add the ~mou~~ts itt tn~ far right ~nluenn ,
E)~£~klCtiflriS Per lines ~ ttTrc~4,~(~ 2$ F~Iso. eater this atYi~ur~t an ~'r~rrr3 ~ 040, (ir e ~#Q. 29_, " tii, ,~.~„_.,.
I7 .
iXl Yes. Yotty' ~eduCtian rr~ay E~~ timifed. S~~ ti18 tt~trtixed [?c~iuctic~rrs ~
tinlorl<sf~~at in the in~tr~~cis`c~E,s try fi u~'~ e~~~ ~mottnt to ~nt€;e. ~~.„T .~~
~~3 ff ~~au c1~c# to item~z~ d~d~sctian~ ~v~n tP~pugt~ they ~r~ less th~r~ your stanti~rd t
cl~dG~etior~, ch~~k il~art~ . ~ (~ C
~nr Pa~ertv~r~k Fieduckiari fact Not3ae, see Form 104(1 instrua#ions. BAS r~fiv ~zr:~oi~a ~ ~r; scl~edutc A norm 1p4~) 2b1n
C~i'.'it~~~, 1:J+J-Q014
a~
7~.+i"'ii::~4J k. 4i gaF~2~ 4iR ~4T~w~h 1 ArtA9ER @G7ba~9996i.~~J .._. .....a... ,A..,.—..w__ __.
~ ~V391 ~~I#{~}~ {$712 ~Y47~}S`lE#OYShtp) i~~ ~ `~
` , u1
f. r
~ fnforr~atian af~out Schedut~ G and its s~parai,~ instructions is sit www.irs.gov/schadulec. /1,l a.,t}i} .il
_ Y - '- 1Y Of 1~
. i
:~,Gf ~_=,e, ., ~~r.:,.E ,2v} .Attach tU far€r~ 9(744, ~04U~l3~, ar 1U41; ~»rtrtersh ~s gener~rlly must file Forn190~5. ~e~u~nce Na.~3
hdame;of ~3rapr t~trr .Y {$SN)
_. ~
vct"tc~ C~ Sc~l1C~'~is _._. ...,..,,_._..,m~. ~ ~ .^ ~
/~1. ~fiCiC(5~E K?tbu'tG1~9S OY ~.7C(7f~'S~iC111s tf?G~t1GIf7F,~,1 }~IOUt1~~ Of S9i'ViCB ~~~~ ~I1S'f!'U~tlOti~j ._...^ ~ ~tT~~Y COdfs fY6tY! ltt5#fUBIIA[76
. ~ ~ O d U ~ C~ tJ ~ O
~
ri''~Lt'~.'s':~ ~`U?IU7l.`">.".iSiOS1E?' .-"'.__.~....._.._.._T._..____..._..
a
'~ ~4(S)IT£38 t ~§Tl&. ~~ t3~~SPZ7i5Cr~~E f3UyIFlE3S,~ YEe~fYtFS, ~FrAV@ {9~£iY1k, L7 ~C~1~SiQyCY IC) t7U1tt1l~I ('SIN} (SG'-i1S''•~
# p 1 I }'

~LI~?FIBS $C~C3!'~'$5 ~1t1C~UG~tI'?Cj S€iitC~ Of YOt3i?i ~i~.} ~'


r ty, tot.=~~ or east office, ~t~t~, ar~ci X14' cc~~ie __._._._..___.......__.____.____.~,._
~ ~rcaun#=r,~n~atilod: (9} (X.3~~5h (2) ~Acxru~l (gyp ~Otl~~r(s~e~i#y}to
C Bicf yntt '°fn~t~r;aliy n~rt~c~ipatm" in ~~}~ c~~~iat's~r~ ~,i t~~s ausiness ~ur~ny 2t?i~i?' #f "N~.'~uE i~T:~~rilc#~otts for 1it~~it on losses ,c~ Yes ~ Ne
~)
(~ ~~ ~~OLI ST?.P'~@i~ faY e'~. Ct~li3T~'C~ t~'S35 ~EI$.€I;~$~ C~#3f1i5~~d7~#. C~~L'C~C. 37EYC9 ~ ~ ~' L...~
E pid you tt~ak~ ~r~y ~Aym~r,~~ i~t ~0~4 in~t ~.°douid r~t~uh e you t4 file ~br3~c{s} ~{~3~? {see ti rst~u~fionsj ~ Yes ~'~ Nv
J (f 'Ycs clict data ar rs ii yaps file r~gciir~;~i Forans 1(3 #9? ~ ~ Yes i~ Nv
dneorrt~ - ~ .
or~~__._._..____ .~._._..._______
7t Cress reCei~t~ QR saes. See ins#~•Uctiarts bar fire 1 ~trzc~ ct3eo3t ~i~2 I~ox if #E7is ~ ~c,on e 1 tis rz~grt~d 4~ you
f~:~rrr~ NJ-2 ~nci Ella .̀St~fut4ry ~mpipyee"" bax CR I#tai f9r3n3 seas CheG;c~u , Y [„~ 1 `,c~0.
_..._..____..~...W,...~..
~
1 E?eturns ~nci aila~~:anc~s
~ ~~.Ji~tract ~i~:; 2 firol~i ii}~~ fi 3 j G, a~~.
—.....____.,...______
~4 ~;~4t afi pucciy S~Ed {fiYorn line ~2) 4 s̀
~irc>~s ~aPafit. ~tihir~c;# Iin~ d; frc~rrz irt~ ~ 5 ~
_____.~___~_............._._-,_.. `- , ~~Q
._..._. , _.
_._._...
$s C7LIi~3" iRCC7tilt'~, tl'iC~UC3't(3~7 ~~;:Efa~ iTC4C~ 5~r`.$4' Cj~SC)~tC;~ t7i' #ti~~(.~ ~rZX Ci'~'dit flP !"P.ft<t1Ci(S~t IiYS?sUCltlf)f".S)
7 t"xros5 inGQ~l38~Add lit?~S 5 and 6 _ ~__ Dr T ~__~~_~ ~,9C1Q.
• ~t'1'~&Y PX. ~i~~a~5 ~pY ~SUSIt~~~3 USA C~~OUF'~Qlll~
._wX~~t~~E.'S, (' O[11~1 Clot~it'1P 30. _ _ __.~ ,,,,.__ ..a.___aT....__..~_..
~8 ~;c{v~r~~s~r~y . _______~~
M ~ 98 C)ff"ce ~xpe>~se (~n~~ i:tstrtrr,Y;r~r~s} ~ ~ #8 ~ __.._ ._._....~...__,.._.._.___
'
~ {.ic3' i±~C7 ~,''Ut.t< 4'X~~f1S~S ~SL'~ E i ' ~~ ~~f'1S36V1 ili~C1 (7S"0~!~-S'tl& t~C~. ~SiF1t3S ~'~ j ___„_,._...____..v...__
i t75~'C4,C€ItZiiS}. ~ ~ 3 ~~„~,~,~ 2~ ~sttip GfE~s~~c {4~8 ti?SffUGtit)!3S};
2
1a Ct~r~t~r~Gs~ic~ns tartd #$2s 'f0 ! ~ c~ Veii~cles, !,~.~rdi r~ry, ~~id ea;ai~~zr~nt 2Ua
1'~ C'rJs'.`.~'aS.+ I..'~I}LF (g?~L 'tR31~'Es~;dic~r`.'S)
~~~'"'''''"~._.._.!_,,...~....__ b C~'~~if'f btt5it» 'i ~tA[J8~'~~ ~ 2{1tT~ .w...,~..~
.~,,,,_.,. ..,..~
'~'a~.E ~i~37~v'~(0!7 z
f '~~ ~~~.~•~.~.._.,r...__~ ~ '.,~'~
~ 2~ . (#sxtJc'?.t:~ c1tT.Cf !Y's'3t/iZnf?^f1G'e? ~ [ ~'~ ~.~.~..~.~.~~..~.._..~..........__
'
~~- 1)~:7YG~L~{"xflt7 c.~ C~ ~~C$fG11 '~~~J ~ ~t1~3D~i~S (t1t'3t if~CltltYud ;`t F~YE 1I1~ ~ ~ ~ .,_._.~.._.—_..,~
C.tit7e: S4' ~~'4~tiC~lCStl ~llf7~
~ 23 ~~x~~ r~EacJ Clcc~n~s€,s , ~23 {~ ` _.______._.._..~.
ir~~l~ac}~~s in Part f!I} (~
~~~
i~7Str~t~t(orts). ~ '~~ ~._~ 24 Tfa~~r rt~Gz~ls> arc9 c.~ie~~tir7rna%~t:
1~Q ~s11(~itJ~Et3 "t?SR~c'flf pYCL,Jdc'.4Yt"tai e`! '~Y~SVc.i . ~ ;~Qr`i.
{at!?er titan an i'sne 9~3}. ~Q __..~_~_._..__._._ _~ ~~ [`~~~tuvti~4~ rste is a,~d ~ ~
#5 i~SCrr ~n0~ (o€I~~' #Itan t"t?alYFtj ~9~ .~......,~.~.._...._...~__ _.f ~tat~tfa~nn`tcnt {SE:e instr~~G~iot~~~ ~2~~€~
~ ~# ,,__._~ ______.
~ ~! ~~ g
96 ftt:eYc~st: ~ 2~ 41tF(3tt~S ~
a ivtcrinac~a jpu~tl to bztr cs, ~tG.) = 96~ j v _ _..,~m_:~ ',L~ Wags (1;55 ~:ttt~ioyn~~~~i t>r~c~t#5j , ~2~i~~-mTT--~~-~.
►~ C~ti~er ~ 1~ib 27a
GY7tnr CxpC:rs s (tralrt time 4£~) ~ 27~ ~.__
1I ~~t_~ arci pra~~~~~~~tat sus ~?s -t 7' Rc~~r~rvecl ~~r futc,rb t~r~ . --------=~27#~ ~
i ~S
28 Trrt~l expenses f~eforq ~xs~F3r~ses #oi tarasa~zess k~~:a c+f (~~«~e. Ac~ci lii~~5 8 #I~~u~zr~h 27a .~~ ~ ~~ ~~~ry
~~~;ti~afiv~ r.~rci~~ or (loss}. SitF~frdct li~'rP ~£3 frcrr~ fine '~ . _ ~9 ~~_.~~_~~~~ ~ ~ n__
(~ ~~
30 ~x~c~nsQ~ ferr bifsiness t~s~; of yd;ar haa~~~. (~a rapt ra~arf fh~~~ sxperYs~s els~'~.~hest~~. t\tEa~h f=a~r77 fig??~ E
ual~~s ttsit~g Fi~a sirn~l;f~~d rr~ethoei (~ad'sa~struCsic,i .~;.
~im~ltfl~ti rr~etltpc# liiea's t~nJy, e~tfe~' :tie tr.,tal Squzr~ €~~ta~e crft (~) yc~t~t nr~rr,~: ._ ._ ..,.___.__._..._... _.____----
~e;ci (i~) t~,~ p,~ri crf yatrr ho~n~ ~+scat far' P~t~~ti sees. . l,~e ti~~ b~n~r~P `led ~
f~~3~fhgcl WoritSi~Fat Fn Fne insir~rctic~ns kz~ f~c~ur~ tiros u«iat~~~~ t~ ~:nt~r on tr9t~ 3p .V_. . ~ 30 ~ ......._.__
."31 IV~i (Jt tS'~€f OP ~IO~€S~. .7U~7Qt r`lCt ~%3t ~~ ~t (JFT7 CtRE' ~~
tf ~ prafiaf ~nt~,t t~~t 11Gth Fdvt~ 1t1Q0 t~t~~ `I~ (p~ ~orni t4~4£}t~1R iifi~e 13) ~=id c~~t u~ci~~r~t~tt? SE, lit~4 2,
(ii ye~~t c~te~v,t~d fits box ear (~~~e i~ w~~ tr?~2r~tt.txc,r,~~. E ~ t~.s~;~ ~,rtt~ ta,f~ts, ~- +.~• C~~ Fot't~ 'i~4'[, liC~e ~. ~9 --__..,....a._.r`i~ °p E? .
~,....,,__~,
if ~ E~as~. yon must can is Eh~e ;i2,
32 If ;~c~L+ taave ~ ions, cnc~ck lire t~ox tnaz descr~beS yovi ir~u~stra~~t~t in ti~is ~~ti~r~ty (see it?structic~ns}.
d !t you ci3ecked 32u, e~tc~~ tine l~sa ntt bath Farm i17d0, ilne 12, (ar ~ot^m it1~40NR, line± 13) a~~~f
on ~chezltrl~ S~, ling 2. (If your Ct~~Ck,~d Elr~ fax ~n fine 't, See the Iltt~ ~i ir~s9r~~ctiv~5s). ~sts~tr3 ~n~t s2a !?5~ X31 ~~~vest~7~r of Is ~t elsk.
$2!) ~, „~ •~i01TtE ;Ilv~S1~71t?t1i 1~ t~Ot
#tE1StS, GtStE?P Qtt ~*AfifTI '~~~~ r ~iYt4; 3.
4'ib ~tril~~
$ ~f )ICU Gil^;.C~<Uii £`+.'~t3r X471.1 135Uruf ci~teiG~l ~ClYI't1 ~'t~~. ~~OCk!' X965 t[tiSf ~TL' ~Ifilkl~~~
~c~P` P~pBrwal'k R4d~lGifiatl f-!Ct ~lOtice, ~e~ ttte 5eparat+~ instYucfions. BAA etcVo;i~~l1~ rt'o Sci~ed~tis C (~ons~ 9GA0) 2t)td
Sct-_:ii.;'~: O (`rO~r7^ 1~J4t1) ~Jir} 2

:
#3 N'eYho~(s) Used fo
v<-~iue cloying in+y~ntnry: ~ ~j Cosf b ~j L.a:ver of cast: trot' rr~~ket c ~J Otit~t {~ifkch expl~rsttti~n)
34 1~1asth~r~ pry chanraa its d~te~anina~g c~i~ar~iitias, c~sis, ~e v~(is~tir~ns brytteeen op~,~iin~ ana closing inv~ntbr~7
li `'Y:~;~,~" ~4t~:c}~ t>pi~n~ilon i~ Yes (`~, i~1v

3~ I3~v~.=rtory at begPaiiit~c~ cif y~~c Ifi diff~:~nt frc~tn I~sf Z+ear`s c~losina i~r~e?2tory, ~~t~ch ~xpi~n~~io~~ 3v ~~..~.

36 I'~~~~riZ~sys less Iasi ~f ~izn~s ~~,ianc~~~.•n fior j~erso~tal Gsp 36 _._.........___m.r

3~' C,ost cst Ia~rar. €~o t~o~ incliad~ <~c5y ~not~f~t~;~~aic? try yaur~~if . 37 f _______

.'$C'f ~c1~63"St'l~5 €tI1C~ SIlY)j~~3t`:y

AO Add liras 3a throtty+~ 3~' QD ~ .,..^._._..___.___,...

~#1 tr~r~n#ory ai ~t~d of y~~r ~ 41 ~ __~______

~,`~ (;+t)u~ C7~( ~t7f1i~"~" i:Qlt~. dU~tf£3C~ ~i(1~ ~~ ~I'OPii ~t!'14: 4{}. E(7't~( ~~lp t'n.~tl~i f1~fE,' s^.Pl(~ Otl ~Ii1P ~ I k~+t

.~ lnforrr~~~iora on Your 1/ehictev C~rnplet~ this r~art only if you ire ~I~imii~g car or truck expenses ors ling 3
ar~~ are not r~r~uired to file F'ort~'t ~&,"~G2 for this b~~sir7ess. Sep ti~~ irtstruction5 for lire ~ 3 tc~ fit~~i out if you must
file Fr~rrn ~t562.

4~ ~+lh~~ raid yr~e~ ~3l~c~ yae~a~ u~htale in set~~iafe for h~~si~~tss }~Lrr~ose~? (i~s;c~i7tn, efa~+. ~,~~ar) ~

qA. Cif the #nt~! number car` rnlles you drove y~uf• ve4~ic~~ ciuri~~~ 20i4, ~nt~r [tie ns~mi~~~ of rni~e~ yeti used yr~Efr vehlcl~ for;

~ ~~~sxne~~~? E~ ~a~n#t`~u~~~~9 (:`~c ir;s@rucEion~j c Utrs~r

95 b"J~~ }jour vei~ccle avaii~ka{e fqr pc;r~so~al t~se dtjring of§-duty hours? ~ Y~~ ~ i~a

~#f~ G?p ypu (Ur your s~c~usej gave ax~ot#~~r s~hicl~ ~v~ilaM[e fni p~r~gn~! use?. [~ YeS (~i No

&7~ C1cs j+ou have z~vid~t~~e to suupori yaur c~ec4uc;ica~~`t {.~ Yes ~~ ~lcr

rev ~~,~~,~:~ <:c, scs,a~~,te c Er-~:~m ~aaa~ aa~q~


~.
Ots~ iVq. 1~,a-U(~~~
~~~rr~~ 1 t?~~}
~ Inforr~~atias~ about Scllertuie S~ and i#s separat~z instructions is at cvcvvvs.lr~.c~ovlsottedutes~. ~~~~~
. Htt;~~r?:rE~i ,g
t o~ ~ I r~~ ~?1f ~ s~;~~ ~^ ~#each ~tb Fo~•~rt it~~#U oY FOrrn 1040~i1i, ___. r's~.'s.~JB;~t:2 f4U. i
.
tJ~r;,~= c~# ~;rs;pn c~.i~ self-er in on;s(as s~~o:r~ un f=cr,~~ 4t~w0 tar F'o=rn 1{~4~~^:~?)
~s ~gCi,~l S~CUriiy nutnia~t' of ~ersoi~
~T~nr.. `~ ;-:c3t1C7.~YS :~.ith s~4f-employment ircor?~€~9~

E~~f+are you ~r~r~in: Tt~ cief~rmir~c; it ~Ot.7 nt~st fi(c~ SUhe~uia ~~`, s~~ the instr'uC~ions.

~y t ~~e aha~~fi ~~~c~~.Bi~ ~~ ear ~tst!11s~ ~.cara~ h~du1~ ~~`?

i~t~4~, Ua~ tnis tiny.chart anly if yon n~~.ist file Schedui~ ~E. if u~7s~.~rer see ~rha ;t~it~sf ~11~ ~c~edtite SE in tn~ n~truc#ians.
t3it[ ycru YeG~ive gages ttr ts~s in 3b#4~ ~
~_~..,...~,.~.M..~.__ e.,_._.
t~to YES
--_____.— _._.._ --7
t
~r~ y~;u ~ r:~ nister fn 7 t r of rr 3 ous c r ':~ c ~ Cf~~.s <` as tixr~ fc~i~ti ~r 3uzr e., x, ad i[~5 str'a~s:4 to sac ~
; ~,a~Fy "des
,~ 3 ~racvttot v ~o rv; eta E~., ~ <{.~s,~var not
~ t~ f~~ t x~a Yes t ~ ~,
car f ca t3 ssr r~~r e~i (tca~ `[~ ~x phis your ri ~Y e~~rr~ n~_, fr<a;tr
r~3 r~Kr~.i~ ~ros1 fr, ye ~o~re.._. bu# re n:=te se,~ ~~,:; nt~<~; ~~ ~` .,:r?~tayfn;:n? ;t7ora ;~w~n S~'!f,t%Df}?
!max cm c:tk , ~r.-r~~;+ ,s`i 1 Y~ ~ y 4 ~

tVo

'ti /~~i vs- o ~e 9f tf~a oGt~os~a3 tr~ti~o~.~ 4c~ i;~~ire y~.s= a~~# ~Y~~ J;d y;~ rEceive tip> ,Eat ,`:~ ip tai +~~ ~ ~~.,c:r~ig~ or €.'c~ C9re rra Yes
thaf yc~ dici rzoE re~ori io ya:€r e+np~ioy~~-'t ~

E~tO
Rto ~ ~~d you rer7ort any tr~~~s pn ~a~n~ 8;~t9, Urico;Pec=~cl Sc~w.~J ~Yc~~
.r'i!C-~ VG`U iE. i~.'£t Gf:t}fi,3 E~;Yii}i0}'f~ (S1G4ti1~ {~~ it'StitlCtiOiSS~ """"'~ S v.?,
:ty in~l F'Rtiicaza'Y~x an 1'ta~~s? j
r~var~e<3 or ~"c;rn >"r a of aiG~.2P ~a° n^aye%
....:.._~..,..,......_,._. - - - -_a___.~.ril~__._.... ._...~__.____..~.._.

~ Yost r»~y c~s€~ 517art ~c}ietfute S[ helaw ~ You must use ~.srng Schac~uia SE on pogo ~ ~

.s'@C~(R11 ~-~"~Sl'ii~l'~~v' CF184~lf~B .,9~.


r ~rt"ttltlCllt. ~1~~({ ~~7C54rG fp 5f't? if }rOdi Cc1Cl US(9 ~~1L~Y~ .5,'. ~f'1G'C~UIG-~ ~.
--~----_.w.,..._...
~}~, i~~t fart~~ profit ar Gass} from 4,checlu3c~ F, 1is~~ 34. ~,nd f~rr~l p~r#n~rsilips, S~YZ~dule K~'i (~orn~t~(

b ifi ydu reu~iaretl social s~~~rrity retirc~rv~~f nr t~[sa~iEit;i benefits, ~rrf~ ~i~~ arnaGin~ rs~ G€~n~ervatlfln Fi~ser~~~ ~~ Ef
Prti~rarr~ ~ayrrea~ts ir~clud=e# can Sch~J~z;c~ F, €!n~ 4t,, ~r• iisfet3 4n Sc~3~~u1~ !<a1 {Form 106~~, bc~x 20, c~~r~e 7 ~ '9~{ _..ew.3
2 (t:Fi j~P~Jff~t t?((1055 ~fQf11~C~`iG'C~U~€' ~i, it[lt3 v`~~, ~~~`f1L~C1l~~E: ~i-~~~ li€~f:'3 e`'~'lCPt~~Ei~~. ~~~ ~~OYC(1 ~~ ~1~`5~i}, j~
v~ ~ --._ _ ~•
~7~X i~$, CC3C~G' ~ {C7~I1~'!' ~~1c'.~l ~u#'31t1i"i~~; ~C1C~ a~.C~lv~~t1{£' ~-~ ~~QYC4l '~~J~7~-~~~ ~"3QX .~a, COC`~4' a~`~. ~
1Usir~ist~rs ~i~c3 r~~vrt7bet~s of r~lic~ia~{s oi~ci~~s, ~~a i~~structipns fioi~ ty~~s of incor~~~ to re~r~rY on ~
this lire. 5~,~ i~~strG~cEicrr~ts irr other incanrt~ fa r~pc+~~ 2 ~ <, 90~.
'
•J i.t~~~~~~{7C'. i~~~.~.~~ 14~s I ~~. [~~~)~ /. r . J ~ I :fV \1
~..~,,..__ ...._..~..m,..,.v.,~~...................~..........4..,.......

4 Nt~+lt{F~ly' I3n~ 3 try 92.:35% (.923~J. If less that, ~~ado, yo~4 da nit o~~re se~f-emp{o~~r3cnx taX; c10 ~ _~~
nb~ tdc; this ~cr~aci~tfr~ u~1less yoar i~au~— an ~rncau»t t~;~ li~~~ 11~ ~ E
____-' 4 ~ ~''~.
q s._._.____.._.__........_._______..__._._.
t
grate. i~ ling G~ i~ i~ss tl~wn ~4c70 el«~ ro Car;verv~tior~ Res~rv~ Prs~c~~~a+i~ ~~yrrreryts at~~ line t~~,
~~e instructarts. •'.
5 SSE#-errtpfoymsnf tax: If il~e ~mo~ant ors iin~ 4 is: E
i
t rt 7,~{i0 0~~ I~ss, a~~ulticiy li~~~ ~ #~y ~~,3% (.~5,i}. ~r~ter 4kre i•e~u(# h~~•~ ancE on ~+arr~ 1C~AQ, line 5~',
c}r ~urtn 9(1~9~C~~t, tine ~~v ?
tvtcsra th<ia~ ~1 17.t3ClC), ~~~ulti~Sy ling ~ by ~.3°io l.(~~9}. Th~t~, ~dci ~;4,503 is #E~e rH*suit.
~~t~~~ ti;~ tots1 her~a zrid an ~crrrn 'ft14C2, iir~e 57, ~4~ rt~rr~ 'ti34CJN~, I[rte ~~. ! ~ ~ .,~,.._.._._..___~__~.~'G.~_
5 C9sc3~ac4ian for oa~e-Waif flf self-ecnploytt~ent tax.
Mt~ltix~ly lint; 7 by ~C3°/Q (.54}, E'~~tcr the result fire ar~t~ on dorm
'iQ~~,1i~e 27, car ~s~rtn 1[3~~~x lute ~7 . ~ ~, ~ .~ r~ ~ .
~QY f~i~~?@YFVOY~t ~6I~LIC41S?t't ~SC~ ~UkIGt,', 58F? j~UL1Y t~X YH~1lPt'1 1t18~YttCftUt3S. AAA ~yr~,t t~,.,~~s9A ~O SCh~Lftit~ SE i~Qfi171 ~~4Q} ~Q14
~' ~
"i ~ ~'
' ~' : t A

F A#Each to dorm 'i{~4{3 or ~artr~ 'l~~ON~3. A1te2t~3thtc:+;i


C3; r i Etc r.,fe C ~
.s.~ i rc. rig(i~z ~'lnform~fiQn about Form 294G ai d its separa#e insiructiatts is av~iiable at avt~rvr,irs.yav/fc
/ ~~ow;encot+:o. ~~~
YOi;r' natt;t QC:fiti ict bit fd't'4Yi`Wil fC7t3 1114;U(Yc~ 9kF32•
•i.+GAS

i?e~~Y2ct'Gi ~c's':C~c?~~ v0'tpG. Zilti~T1L ~a ~rV~.C~

~tou ~aa~ €use 'fii3i~ ~+arrr► ~Jnly if Ali ofi ~ o i=o)~awing A}~ply.
ffi Y~au ire ~n ~mp(oye€ deducting ordinary and necessary ex~et~se~ attrii~utab(e Yo yaur ~~b. An t~rdin~r~~ expense i~ one tfr~t is
common and ~cc~pt~d ~~~ your field of traci~, busiri~ss, ar pra#e~sic~n, A r~~cessary ~xpens~ is any ti-~at is he#~iu( and appropriate for
your k~usin~ss. An expense does nr~t have 4o b~ iequiret~ to be co~~$ide~~~ci nFcessafy.
Ypu coo rsQ~ get raimburs~d try your ern~loy~t~ for at~~+ ~xpen~~s {arnc~ui~#s your ~inployer iitcivaed in bc~x 1 afi your ~c~ri`~~ t~J-2 are nAt
consiu~eretl t`ei;nt~tarsemen4~ far #t~is ~urpo~~),
I~ yc~u a~-~ clai~nirl~ v~l3iclu ~:xperts~, ycau ~r~ ~.isinc~ tf3e Standard mifeage rate f~~~ X114.
~acat~on; Ycu r~~r, use t~~ stan~ar~a m,'ie~g~ r~~t~ for 2119~~ ar~~y r`f,• l~? You v~vi,~ri #rye v~hicte ar7[~ ussci trt~ ~tanrr'~rd trifeage rite fr~r fr`~e first year
~~of, f~t~ceci €h~ t~ef~feJa its service, nr (b) you leased tn~ v~iaicla ~r~d Ers~d the stano~~~d mr'fe~ge rite far fhe portion of ttt~ lease periad aft~r~ ?~37,
~s~u~e Your penses

7 Cotnpiet~ }~~rt Il. Multiply iine 8~ Ly 5~~ {.56j, Ent~~'tE1~ r~esttlt ttcr~ ~_._.~_____ _ .~~.__~.

2 F'a~{<ir~q f~~s, falls, ar~d tr~nsportati~tt~, inc(uciing tYait-~, ia~s, etc., that ctid not involve ov~r~lgt}t
rr~~v~! ear camtt~ruting tc~ end fir~:~ ~~ork _ ~ ~ ;

~ ~~Cea;~~r exp~ns~ while auvay ~r~rra h~rn~ averraight, i~~c~uding fodcrin~, ai~~Zlan~, car r~r~ta1, etc, t3e~
?Y~i~ alIGIUC~O t~"~~'~ES c~t1d SCi~~Y~~i(1CY1C~1fi . _ ~ _„_,__ _.~..,_,__..,.._._,....._

~ ~usin~s~ ex~er~ses nod ii-~ctue~~~' can lina5 'i tt~ratsoh 3, (3a nak include meals ancf

5 ~~~Is and ~nt~rt~rntr~et~t ~x~etts~s: S ~zs, 9~ ~~ x 5~°r (.:i0}. (Et~~}~lay~es ~ukaject to i


(~d~art~tt~nt of Tr~tispor-~afi~rt (DC7T} haur-s of service limits: Mu{tiply in~ai expenses inourr~d
.faY~ile a~~:~.y ~rcat-n han~e ~n b~~siness by #3~~1a (.8Qj inst~~d of 50~'f~. for details, set ir~structkon~.) ~ rx, ~: J ~ .

"I'ca~~l expenses. t~.dd Ii~~s 1 fit~rcaugi~ 5. ~i~t~r i~x~r~ ~ncl nn S~h~ciuie A (Fot~rtt ip4{}), litre ~1 (a~' t
c~r~ ~cE~~du{e R {~orr~~ i0~f}i~~)i line 7j, {,~rrri~c~ ("ns~c;es resArvists, fee-t;asis st~t~ c~a~ fc~c~i
c}c~vernr~rr~n~ o€iiciais> c~ualifiecl ~er€~rr~snc# artists, and irrdi~~ic#ci~ls s^dith dis~bilitics: Sep the
instr~.~eiions far special rules <>n where ~c~ ante~~ #iris an~aunt.j g ~, ~ "13 .
.~. Op-rfor atiQrn ot~ `dour 1fe~~ cle. Care}~let~ this ~a~~ Canty i~ yc~~ are claiming v~i~icl~ ex~~r~~e cafe line `t.

7 Wh~:r~ cil~# yot: place year v~i~ici~ 't r7 ~~rvlce Ycr business use'1 (r~7car~tii, clay, yeas'} 1>

8 Cif the tot~~l nG~n~ber of rniies ~~c~i.~ circ~vca your uel~ici~ cl~~ri~~g 201~d, ~nt~r the nt~~mr~er~ of mtCes yoti~ us~~ your v~hicie ~c~r;

~ ~~.~sireGs ~ Gc~r~~r~~iating (see instruetiar-~;~} c t~t~rc~r

9 Vtras yot~t` ve3~ic1~ avail~#~1e far per-sar~al use duriF~g o(f-cl~t~ ho~,rs? ~.1 Yep a,~ N~

~it7 E 10 yr~ii (ar your s~pus~) I~~zv~ ~nattier v~l~icl~ ~uaii~l~le far ~~~~~sn~~ul use,? . ~~„( Yes ~ (V~

19a €~o yo~~ hive evidence t~ sia~~Pori yc~r aec~uctiort~ ~1 Y~~ 1...7 !Vo

b I~ "Y4s," is fi~~ ~v~d~r~ca ~n~ritte3~? ~.~ Yes i~ tadts


i=or P~s~~~rtie~rk k~ecS~sctiot~ Ac#Notice, sea your fax r~turi~ insYr~ictivn~>. AAA ' ttwv cf~ear~=; rra ~ ~r7„ ~'106~~~ ;;rva=:)