Form 1040 Es Payment Voucher ≡ Fill Out Printable PDF Forms Online

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Form Name	Form 1040 Es Payment Voucher
Form Length	42 pages
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Avg. time to fill out	10 min 30 sec
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Form Preview Example

I Detach Here and Mail With Your PaymentI

Department of the Treasury

Calendar Year '

2012 Form 1040-ES Payment Voucher 1

Internal Revenue Service

Due 4/17/2012

File only if you are making a payment of estimated tax by check or money order. Mail this voucher with your check or money order payable to the 'United States Treasury.' Write your social security number and '2012 Form 1040-ES' on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher.

Amount of estimated tax you are paying by check or money order . . . . . . . . . G

REV 11/22/11 TTMAC

1555

3,697.

123-45-6789		123-12-3498
JOHN	POULOS	INTERNAL REVENUE SERVICE
MARY	POULOS	PO BOX 37007
9 ARCHANGELS HIGHWAY		HARTFORD CT 06176-0007

HEAVENS GATE PA 31240

123456789 JP POUL 30 0 201212 430

REV 11/22/11 TTMAC

I Detach Here and Mail With Your PaymentI

Department of the Treasury

Calendar Year'

2012 Form 1040-ES Payment Voucher 2

Internal Revenue Service

Due 6/15/2012

Amount of estimated tax you are paying by check or money order . . . . . . . . . G

1555

3,697.

123-45-6789		123-12-3498
JOHN	POULOS	INTERNAL REVENUE SERVICE
MARY	POULOS	PO BOX 37007
9 ARCHANGELS HIGHWAY		HARTFORD CT 06176-0007

HEAVENS GATE PA 31240

123456789 JP POUL 30 0 201212 430

I Detach Here and Mail With Your PaymentI

Department of the Treasury

Calendar Year'

2012 Form 1040-ES Payment Voucher 3

Internal Revenue Service

Due 9/17/2012

Amount of estimated tax you are paying by check or money order . . . . . . . . . G

REV 11/22/11 TTMAC

1555

3,697.

123-45-6789		123-12-3498
JOHN	POULOS	INTERNAL REVENUE SERVICE
MARY	POULOS	PO BOX 37007
9 ARCHANGELS HIGHWAY		HARTFORD CT 06176-0007

HEAVENS GATE PA 31240

123456789 JP POUL 30 0 201212 430

I Detach Here and Mail With Your PaymentI

Department of the Treasury

Calendar Year'

2012 Form 1040-ES Payment Voucher 4

Internal Revenue Service

Due 1/15/2013

Amount of estimated tax you are paying by check or money order . . . . . . . . . G

REV 11/22/11 TTMAC

1555

3,697.

123-45-6789		123-12-3498
JOHN	POULOS	INTERNAL REVENUE SERVICE
MARY	POULOS	PO BOX 37007
9 ARCHANGELS HIGHWAY		HARTFORD CT 06176-0007

HEAVENS GATE PA 31240

123456789 JP POUL 30 0 201212 430

Form 1040

Department of the Treasury—Internal Revenue Service

(99)

2011

U.S. INDIVIDUAL INCOME TAX RETURN

OMB No. 1545-0074

IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2011, or other tax year beginning

, 2011, ending

, 20

See separate instructions.

Your first name and initial

Last name

Your social security number

John

Poulos

123-45-6789

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

Mary

Poulos

123-12-3498

Home address (number and street). If you have a P.O. box, see instructions.

Apt. no.

Make sure the SSN(s) above

9 Archangels Highway

and on line 6c are correct.

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Presidential Election Campaign

Heavens Gate PA 31240

Check here if you, or your spouse if filing

jointly, want $3 to go to this fund. Checking

Foreign country name

Foreign province/county

Foreign postal code

a box below will not change your tax or

refund.

You

Spouse

Filing Status

Single

Head of household (with qualifying person). (See instructions.) If

Married filing jointly (even if only one had income)

the qualifying person is a child but not your dependent, enter this

Check only one

Married filing separately. Enter spouse’s SSN above

child’s name here.

box.

and full name here.

Qualifying widow(er) with dependent child

Exemptions

Yourself. If someone can claim you as a dependent, do not check box 6a . . . .

Boxes checked

Spouse

. . . . . . . . . .

. }

on 6a and 6b

No. of children

Dependents:

(2) Dependent’s

(3) Dependent’s

(4) if child under age 17

on 6c who:

social security number

relationship to you

qualifying for child tax credit

• lived with you

(1) First name

Last name

(see instructions)

• did not live with

you due to divorce

If more than four

or separation

(see instructions)

dependents, see

Dependents on 6c

instructions and

not entered above

check here

Add numbers on

Total number of exemptions claimed

. . . . . . . . . .

lines above

Income

Wages, salaries, tips, etc. Attach Form(s) W-2 . . .

EXCESS. . .

ALLOWANCE. . . .

4000. . .

63,540.

Taxable interest. Attach Schedule B if required . . .

. . . . . . . . .

500.

Tax-exempt interest. Do not include on line 8a . . .

Attach Form(s)

Ordinary dividends. Attach Schedule B if required . .

. . . . . . . . .

W-2 here. Also

Qualified dividends

attach Forms

Taxable refunds, credits, or offsets of state and local income taxes

W-2G and

1099-R if tax

Alimony received

. . . . . . . . .

was withheld.

Business income or (loss). Attach Schedule C or C-EZ .

. . . . . . . . .

Capital gain or (loss). Attach Schedule D if required. If not required, check here

If you did not

Other gains or (losses). Attach Form 4797

. . . . . . . . .

get a W-2,

15a

IRA distributions .

15a

b Taxable amount . . .

15b

see instructions.

16a

Pensions and annuities

16a

b Taxable amount . . .

16b

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

Enclose, but do

Farm income or (loss). Attach Schedule F

. . . . . . . . .

not attach, any

Unemployment compensation

. . . . . . . . .

payment. Also,

20a

Social security benefits

20a

b Taxable amount . . .

20b

please use

Form 1040-V.

Other income. List type and amount

Combine the amounts in the far right column for lines 7 through 21. This is your total income

64,040.

Adjusted

Educator expenses

. . . . . . . . . .

Certain business expenses of reservists, performing artists, and

Gross

fee-basis government officials. Attach Form 2106 or 2106-EZ

Income

Health savings account deduction. Attach Form 8889 .

Moving expenses. Attach Form 3903

Deductible part of self-employment tax. Attach Schedule SE .

6,678.

Self-employed SEP, SIMPLE, and qualified plans . .

Self-employed health insurance deduction . . . .

Penalty on early withdrawal of savings

31a

Alimony paid

b Recipient’s SSN

31a

IRA deduction

Student loan interest deduction

Tuition and fees. Attach Form 8917

Domestic production activities deduction. Attach Form 8903

Add lines 23 through 35

. . . . . . . . .

6,678.

Subtract line 36 from line 22. This is your adjusted gross income

57,362.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 12/01/11 TTMAC

Form 1040 (2011)

Form 1040 (2011)																Page 2
Tax and	38	Amount from line 37 (adjusted gross income)									. . . . . . . . .				38	57,362.
Tax and	39a			You were born before January 2, 1947,							Blind.
Credits	39a	Check		You were born before January 2, 1947,							Blind.	Total boxes
Credits		if:	{	Spouse was born before January 2, 1947,							Blind. }checked			39a
		if:	{	Spouse was born before January 2, 1947,							Blind. }checked			39a
Standard	b	If your spouse itemizes on a separate return or you were a dual-status alien, check here												39b
Deduction	40	Itemized deductions (from Schedule A) or your standard deduction (see left margin) . .													40	23,151.
for—	40														40	23,151.
for—
• People who	41	Subtract line 40 from line 38									. . . . . . . . .				41	34,211.
check any	42	Exemptions. Multiply $3,700 by the number on line 6d . . .									. . . . . . . . .				42	7,400.
box on line	42	Exemptions. Multiply $3,700 by the number on line 6d . . .									. . . . . . . . .				42	7,400.
box on line
39a or 39b or	43	Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . .													43	26,811.
who can be		Tax (see instructions). Check if any from: a						Form(s) 8814 b			Form 4972 c		962 election			3,174.
claimed as a	44	Tax (see instructions). Check if any from: a						Form(s) 8814 b			Form 4972 c		962 election		44	3,174.
dependent,	45	Alternative minimum tax (see instructions). Attach Form 6251									. . . . . . . . .				45
see	45										. . . . . . . . .				45
instructions.	46	Add lines 44 and 45									. . . . . . . .				46	3,174.
• All others:	47	Foreign tax credit. Attach Form 1116 if required . . . .									47
Single or	47	Foreign tax credit. Attach Form 1116 if required . . . .									47
Single or
Married filing	48	Credit for child and dependent care expenses. Attach Form 2441									48
separately,	49	Education credits from Form 8863, line 23									49
$5,800	49	Education credits from Form 8863, line 23									49
Married filing	50	Retirement savings contributions credit. Attach Form 8880									50
jointly or	51	Child tax credit (see instructions)									51
Qualifying	51	Child tax credit (see instructions)									51
widow(er),	52	Residential energy credits. Attach Form 5695 . . . .									52
$11,600	52	Residential energy credits. Attach Form 5695 . . . .									52
$11,600
Head of	53	Other credits from Form: a				3800	b	8801	c		53
household,	54	Add lines 47 through 53. These are your total credits . . .									. . . . . . . . .				54
$8,500	54	Add lines 47 through 53. These are your total credits . . .									. . . . . . . . .				54
$8,500		Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-										. . . . . .				3,174.
	55											. . . . . .			55	3,174.
Other	56	Self-employment tax. Attach Schedule SE									. . . . . . . . .				56	11,612.
Other	57	Unreported social security and Medicare tax from Form:								a	4137	b	8919 . .		57
Taxes	57	Unreported social security and Medicare tax from Form:								a	4137	b	8919 . .		57
Taxes	58	Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . .													58
	58														58
	59a	Household employment taxes from Schedule H									. . . . . . . . .				59a
	b	First-time homebuyer credit repayment. Attach Form 5405 if required													59b
	60	Other taxes. Enter code(s) from instructions													60
	61	Add lines 55 through 60. This is your total tax									. . . . . . . .				61	14,786.
Payments	62	Federal income tax withheld from Forms W-2 and 1099 . .									62
	63	2011 estimated tax payments and amount applied from 2010 return									63		16,000.
If you have a	64a	Earned income credit (EIC)									64a
qualifying	64a	Earned income credit (EIC)									64a
qualifying	b	Nontaxable combat pay election					64b
child, attach	b	Nontaxable combat pay election					64b
child, attach
Schedule EIC.	65	Additional child tax credit. Attach Form 8812									65
	66	American opportunity credit from Form 8863, line 14 . . .									66
	67	First-time homebuyer credit from Form 5405, line 10 . . .									67
	68	Amount paid with request for extension to file									68
	69	Excess social security and tier 1 RRTA tax withheld . . . .									69
	70	Credit for federal tax on fuels. Attach Form 4136 . . . .									70
	71	Credits from Form: a			2439	b	8839	c	8801 d	8885	71

Add lines 62, 63, 64a, and 65 through 71. These are your total payments

16,000.

Refund

If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid

1,214.

74a

Amount of line 73 you want refunded to you. If Form 8888 is attached, check here .

74a

1,214.

Direct deposit?

Routing number

c Type:

Checking

Savings

See

Account number

X X

instructions.

Amount of line 73 you want applied to your 2012 estimated tax

Amount

Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions

You Owe

Estimated tax penalty (see instructions)

Third Party

Do you want to allow another person to discuss this return with the IRS (see instructions)?

Yes. Complete below.

Designee

Designee’s

Phone

Personal identification

name

no.

number (PIN)

Sign Here

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Joint return? See

Your signature

Date

Your occupation

Daytime phone number

Priest

instructions.

Keep a copy for

Spouse’s signature. If a joint return, both must sign.

Date

Spouse’s occupation

If the IRS sent you an Identity Protection

your records.

Teacher

PIN, enter it

here (see inst.)

Paid

Print/Type preparer’s name

Preparer’s signature

Date

Check

PTIN

Preparer

self-employed

Firm’s name

SELF PREPARED

Firm's EIN

Use Only

Firm’s address

Phone no.

REV 12/01/11 TTMAC

Form 1040 (2011)

SCHEDULE A					ITEMIZED DEDUCTIONS							OMB No. 1545-0074
(Form 1040)												2011
												2011
Department of the Treasury			Attach to Form 1040.				See Instructions for Schedule A (Form 1040).					Attachment
Internal Revenue Service (99)												Sequence No. 07
Name(s) shown on Form 1040											Your social security number
John & Mary Poulos											123-45-6789
Medical		Caution. Do not include expenses reimbursed or paid by others.
Medical	1	Medical and dental expenses (see instructions)							1	4,600.
and	1	Medical and dental expenses (see instructions)							1	4,600.
and	2	Enter amount from Form 1040, line 38				2		57,362.
Dental	2	Enter amount from Form 1040, line 38				2		57,362.
Dental	3	Multiply line 2 by 7.5% (.075)							3	4,302.
Expenses	3	Multiply line 2 by 7.5% (.075)							3	4,302.
Expenses	4	Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- .							. .	. . . . .	4	298.
	4								. .	. . . . .	4	298.
Taxes You	5	State and local (check only one box):
Paid		a	Income taxes, or	}	. . . . . . . . . . .				5
		b	General sales taxes	}
	6	Real estate taxes (see instructions)							6	1,500.
	7	Personal property taxes							7
	8	Other taxes. List type and amount
									8
	9	Add lines 5 through 8							. .	. . . . .	9	1,500.
Interest	10	Home mortgage interest and points reported to you on Form 1098							10	15,000.
You Paid	11	Home mortgage interest not reported to you on Form 1098. If paid
Note.		to the person from whom you bought the home, see instructions
Note.		and show that person’s name, identifying no., and address
Your mortgage		and show that person’s name, identifying no., and address
Your mortgage
interest
interest									11
deduction may									11
be limited (see	12	Points not reported to you on Form 1098. See instructions for
instructions).		special rules							12
		special rules							12
	13	Mortgage insurance premiums (see instructions)							13
	14	Investment interest. Attach Form 4952 if required. (See instructions.)							14
	15	Add lines 10 through 14							. .	. . . . .	15	15,000.
Gifts to	16	Gifts by cash or check. If you made any gift of $250 or more,
Charity		see instructions							16	3,500.
If you made a	17	Other than by cash or check. If any gift of $250 or more, see
gift and got a		instructions. You must attach Form 8283 if over $500 . . .							17
benefit for it,	18	Carryover from prior year							18
see instructions.	19	Add lines 16 through 18							. .	. . . . .	19	3,500.
Casualty and
Theft Losses	20	Casualty or theft loss(es). Attach Form 4684. (See instructions.) .							. .	. . . . .	20
Job Expenses	21	Unreimbursed employee expenses—job travel, union dues,
and Certain		job education, etc. Attach Form 2106 or 2106-EZ if required.
Miscellaneous		(See instructions.) Deductible expenses from Form 2106							21	4,000.
Deductions	22	Tax preparation fees							22
	23	Other expenses—investment, safe deposit box, etc. List type
		and amount
									23
	24	Add lines 21 through 23							24	4,000.
	25	Enter amount from Form 1040, line 38				25		57,362.
	26	Multiply line 25 by 2% (.02)							26	1,147.
	27	Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- .								. . . . .	27	2,853.
Other	28	Other—from list in instructions. List type and amount
Miscellaneous
Deductions											28
Total	29	Add the amounts in the far right column for lines 4 through 28. Also, enter this amount
Itemized		on Form 1040, line 40							. .	. . . . .	29	23,151.
Deductions	30	If you elect to itemize deductions even though they are less than your standard
		deduction, check here

For Paperwork Reduction Act Notice, see Form 1040 instructions. BAA

REV 12/06/11 TTMAC

Schedule A (Form 1040) 2011

SCHEDULE SE	Self-Employment Tax				OMB No. 1545-0074
(Form 1040)	Self-Employment Tax				2011
(Form 1040)

Department of the Treasury	Attach to Form 1040 or Form 1040NR.	See separate instructions.			Attachment
Internal Revenue Service (99)					Sequence No. 17
Name of person with self-employment income (as shown on Form 1040)			Social security number of person
John Poulos			with self-employment income	123-45-6789

Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Note. Use this flowchart only if you must file Schedule SE. If unsure, see WHO MUST FILE SCHEDULE SE in the instructions.

Did you receive wages or tips in 2011?

Yes

Are you a minister, member of a religious order, or Christian
Science practitioner who received IRS approval not to be taxed		Yes
on earnings from these sources, but you owe self-employment
on earnings from these sources, but you owe self-employment
tax on other earnings?

	No

Are you using one of the optional methods to figure your net		Yes
earnings (see instructions)?		Yes



	No

Did you receive church employee income (see instructions)		Yes
reported on Form W-2 of $108.28 or more?
reported on Form W-2 of $108.28 or more?

	No

Was the total of your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from self-employment more than $106,800?

Did you receive tips subject to social security or Medicare tax that you did not report to your employer?

Did you report any wages on Form 8919, Uncollected Social Security and Medicare Tax on Wages?

Yes

You may use Short Schedule SE below

You must use Long Schedule SE on page 2

Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.

1a	Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form
	1065), box 14, code A	1a
b	If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
	Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Y	1b	(	)
2	Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
	box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
	Ministers and members of religious orders, see instructions for types of income to report on
	this line. See instructions for other income to report	2		94,540.
3	Combine lines 1a, 1b, and 2	3		94,540.
4	Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
	not file this schedule unless you have an amount on line 1b	4		87,308.
	Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
	see instructions.
5	Self-employment tax. If the amount on line 4 is:
	• $106,800 or less, multiply line 4 by 13.3% (.133). Enter the result here and on Form 1040, line 56,
	or Form 1040NR, line 54
	• More than $106,800, multiply line 4 by 2.9% (.029). Then, add $11,107.20 to the result.
	Enter the total here and on Form 1040, line 56, or Form 1040NR, line 54	5		11,612.

6Deduction for employer-equivalent portion of self-employment tax. If the amount on line 5 is:

•$14,204.40 or less, multiply line 5 by 57.51% (.5751)

•More than $14,204.40, multiply line 5 by 50% (.50) and add

$1,067 to the result.
Enter the result here and on Form 1040, line 27, or Form
1040NR, line 27	6	6,678.

For Paperwork Reduction Act Notice, see your tax return instructions. BAA

REV 12/01/11 TTMAC

Schedule SE (Form 1040) 2011

Form 2106-EZ				OMB No. 1545-0074
				OMB No. 1545-0074
	Unreimbursed Employee Business Expenses
	Unreimbursed Employee Business Expenses			2011
				2011
Department of the Treasury				Attachment
Internal Revenue Service (99)	Attach to Form 1040 or Form 1040NR.			Sequence No. 129A
Your name		Occupation in which you incurred expenses	Social security number
John Poulos		Priest	123-45-6789

You Can Use This Form Only if All of the Following Apply.

•You are an employee deducting ordinary and necessary expenses attributable to your job. An ordinary expense is one that is common and accepted in your field of trade, business, or profession. A necessary expense is one that is helpful and appropriate for your business. An expense does not have to be required to be considered necessary.

•You do not get reimbursed by your employer for any expenses (amounts your employer included in box 1 of your Form W-2 are not considered reimbursements for this purpose).

•If you are claiming vehicle expense, you are using the standard mileage rate for 2011.

Caution: You can use the standard mileage rate for 2011 only if: (a) you owned the vehicle and used the standard mileage rate for the first year you placed the vehicle in service, or (b) you leased the vehicle and used the standard mileage rate for the portion of the lease period after 1997.

Part I Figure Your Expenses

1Complete Part II. Multiply line 8a by 51¢ (.51) for miles driven before July 1, 2011, and by 55.5¢ (.555) for miles driven after June 30, 2011. Add the amounts , then enter the result here . . .

2Parking fees, tolls, and transportation, including train, bus, etc., that did not involve overnight

travel or commuting to and from work . . . . . . . . . . . . . . . . . . .

3Travel expense while away from home overnight, including lodging, airplane, car rental, etc. Do

not include meals and entertainment . . . . . . . . . . . . . . . . . . . .

4Business expenses not included on lines 1 through 3. Do not include meals and

entertainment . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Meals and entertainment expenses: $× 50% (.50). (Employees subject to

Department of Transportation (DOT) hours of service limits: Multiply meal expenses incurred while away from home on business by 80% (.80) instead of 50%. For details, see instructions.)

6Total expenses. Add lines 1 through 5. Enter here and on Schedule A (Form 1040), line 21 (or on Schedule A (Form 1040NR), line 7). (Armed Forces reservists, fee-basis state or local government officials, qualified performing artists, and individuals with disabilities: See the instructions for special rules on where to enter this amount.) . . . . . . . . . . . .

4,000.

Part II Information on Your Vehicle. Complete this part only if you are claiming vehicle expense on line 1.

7 When did you place your vehicle in service for business use? (month, day, year)

8Of the total number of miles you drove your vehicle during 2011, enter the number of miles you used your vehicle for:

a	Business	b Commuting (see instructions)	c	Other
9	Was your vehicle available for personal use during off-duty hours?		. .	. . . .	Yes
10	Do you (or your spouse) have another vehicle available for personal use?		. .	. . . .	Yes
11a	Do you have evidence to support your deduction?		. .	. . . .	Yes
b	If “Yes,” is the evidence written?		. .	. . . .	Yes

For Paperwork Reduction Act Notice, see your tax return instructions. BAA

REV 11/22/11 TTMAC	Form 2106-EZ (2011)

Charitable Organization Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Charity Name

Holy Trinity Greek Orthodox Church

Address

City

Heavens Gate

State

ZIP code

Combined Amounts Worksheet

Note: Amounts entered in worksheets below will be summarized in this worksheet.

Ref. No.

Date

Donation Description

Donation Type

Donation Amount

Various

Money

3,500.00

Total:

3,500.00

Prior Year Total:

3,500.00

ItsDeductible Item Donations Worksheet

Note: Amounts in this worksheet can only be entered using the interview process.

Ref. No. Donat. Date VM* Item Description High Value Qty. Med. Value Qty. Total Value

*VM, Valuation Method. 1 indicates it has been valued by ItsDeductible, 0 indicates you have created a custom valuation item.


Charitable Organization Worksheet page 2		2011
John & Mary Poulos		123-45-6789

	Other Item Donations Worksheet
	Note: Double-click to enter additional information if needed.

Ref. No. Donated Date Acquired Date

Donation Description

Donation Type

How Acquired

Donation Cost How Valued

Donation Value

Donation Allowed

Detail of Money Donations Worksheet

Don.
Ref. No. Donat. Date Each Don. Amt Per Yr	Once or Recurring	2011 Amount

1	Various	3,500.00	1	Once	X	Recur	3,500.00
				Once		Recur
				Once		Recur
				Once		Recur
				Once		Recur

Detail of Mileage and Transportation Costs Worksheet

Ref. No.	Donation Date			Description of Trip

Miles Per Trip		Trips Per Yr		Once or Recurring	Miles Driven

Other Costs			Description of Other Costs		Value of Miles	Total Donation Value

Once

Recur

Once

Recur

Once

Recur

Charitable Organization Worksheet page 3		2011
John & Mary Poulos		123-45-6789

Detail of Stock Donations Worksheet

Ref. No.

Date of Donation

Stock	Value on
Symbol	Donation Date

Date

Acquired

Stock

Original Cost

Donation Value

Charitable Organization Questions
1	Was the entire interest given for all property donated to this charity?	X Yes

2Were restrictions attached to the charity’s right

to use or dispose of any property donated to this charity?

Yes

3Did you give to anyone other than this charity the right to income from any

of the donated property or to possession of any of the donated property?

Yes

4What Type of charitable organization was it? Check one:

(a) 50% charity

(b) Other than 50% charity

Federal Information Worksheet

2011

G Keep for your records

Part I ' Personal Information

Information in Part I is completely calculated from entries on Personal Information Worksheets.

Taxpayer:

First name

John

Middle initial

Suffix

Last name

Poulos

Social security no.

123-45-6789

Occupation

Priest

Date of birth

01/01/1950 (mm/dd/yyyy)

or age as of 1-1-2012

Daytime phone

(123)456-7890 Ext

Legally blind

Date of death

Dependent of Someone Else:

Can taxpayer be claimed as dependent of another

person (such as parent)?

Yes

If yes, was taxpayer claimed as dependent on that

person’s return?

Yes

Credit for the Elderly or Disabled (Schedule R):

Is the taxpayer retired on total

and permanent disabilitY?

Yes

Presidential Election Campaign Fund:

Does the taxpayer want $3 to go to the Presidential

Election Campaign Fund?

Yes

Spouse:

First name

Mary

Middle initial

Suffix

Last name

Poulos

Social security no.

123-12-3498

Occupation

Teacher

Date of birth

02/01/1950 (mm/dd/yyyy)

or age as of 1-1-2012

Daytime phone

(123)456-7890 Ext

Legally blind

Date of death

Dependent of Someone Else:

Can spouse be claimed as dependent of another

person (such as parent)?

Yes

If yes, was spouse claimed as dependent on that

person’s return?

Yes

Credit for the Elderly or Disabled (Schedule R):

Is the spouse retired on total

and permanent disabilitY?

Yes

Presidential Election Campaign Fund:

Does the spouse want $3 to go to the Presidential

Election Campaign Fund?

Yes

Part II ' Address and Federal Filing Status (enter information in this section)

Address

9 Archangels Highway

Apt no.

City

Heavens Gate

State

ZIP code

31240

Foreign province/county

Foreign

postal

code

Foreign code

Foreign country

APO/FPO/DPO address, check if appropriate

Home phone

Check to print phone number on Form 1040 Home Check if you were affected by a natural disaster in 2011

APO

FPO

Taxpayer daytime

DPO

Spouse daytime

Federal filing status:

1Single

X2 Married filing jointly

3 Married filing separately

Check this box if you did not live with your spouse at any time during the year Check this box if you are eligible to claim your spouse’s exemption (see Help)

4	Head of household
	If the ’qualifying person’ is your child but not your dependent:
	Child’s name	Child’s social security number
5	Qualifying widow(er)
	Check the appropriate box for the year your spouse died		2009
			2010

Part III ' Dependent/Earned Income Credit/Child and Dependent Care Credit Information

Information in Part III is completely calculated from entries on Dependent/Nondependent Info Worksheets.

First name Last name

Suff

Social security

number Relationship

Date of birth
(mm/dd/yyyy)
				Qualified
				Qualified
			Not	child/dep		Lived
	C		qual	care exps		with	Educ	*
	o		for	incurred	E	taxpyr	Tuitn	D
	d		child	and paid	I	in	and	e
Age	e	tax cr		2011	C	U.S.	Fees	p

* "Yes" - qualifies as dependent, "No" - does not qualify as dependent

John & Mary Poulos		123-45-6789 Page 2

Part IV ' Earned Income Credit Information (you must answer these questions to calculate EIC)

Is the taxpayer or spouse a qualifying child for EIC for another person? Was the taxpayer’s (and spouse’s if married filing jointly) home in the United States

for more than half of 2011? If the SSN of the taxpayer, or spouse if married filing jointly, was obtained to

get a federally funded benefit, such as Medicaid, and the Social Security card

contains the legend Not Valid for Employment, check this box (see Help) Check if you are filing head of household and your spouse is a nonresident alien

and you lived with your spouse during the last six months of 2011 Was EIC disallowed or reduced in a previous year and are you required to file

Form 8862 this year?

Check if you were notified by the IRS that EIC cannot be claimed in 2011

Yes

Part V ' Direct Deposit or Direct Debit Information (not applicable for Form 9465)

Do you want to elect direct deposit of any federal tax refund?

Yes

Do you want to elect direct debit of federal balance due (Electronic filing only)?

Yes

If you selected either of the options above, fill out the information below:

Name of Financial Institution (optional)

Check the appropriate box

Checking

Savings

Routing number

Account number

Enter the following information only if you are requesting direct debit of balance due: Enter the payment date to withdraw from the account above Balance-due amount from this return

Part VI ' Additional Information for Your Federal Return

Standard Deduction/Itemized Deductions:

Check this box if you are itemizing for state tax or other purposes even though your itemized

deductions are less than your standard deduction Check this box if you are married filing separately and your spouse itemized deductions Check this box to take the standard deduction even if less than itemized deductions

Main Form Selection:

Check this box to calculate Form 1040 even if you qualify to use Form 1040A or 1040EZ

Real Estate Professionals:

Do you or your spouse qualify for the special passive activity rules for taxpayers in real property business? (see Help)

Credit for Qualified Retirement Savings Contributions (Form 8880):

Is the taxpayer a full-time student? Is the spouse a full-time student?

Foreign Tax Credit (Form 1116):

Check this box to file Form 1116 even if you’re not required to file Form 1116 Resident country

Yes

USA

No No

Excludable Income from Am. Samoa, Guam, Commonwealth of the N. Mariana Islands, or Puerto Rico: Excludable income of bona fide residents of American Samoa, Guam, or the

Commonwealth of the Northern Mariana Islands

Excludable income from Puerto Rico

Dual Status Alien Return:

Check this box if you are a dual-status alien

Third Party Designee:
Caution: Review transferred information for accuracy.
Do you want to allow another person to discuss this return with the IRS?		Yes
If Yes, complete the following:
Third party designee name
Third party designee phone number
Personal Identification number (enter any 5	numbers)
If you are entitled to a filing extension or other disaster relief provision as declared by the IRS,
enter the appropriate information (see Help)

John & Mary Poulos		123-45-6789 Page 3

Part VII ' State Filing Information

Taxpayer:

Enter the taxpayer’s state of residence as of December 31, 2011 PA Check the appropriate box:

Taxpayer is a resident of the state above for the entire year X Taxpayer is a resident of the state above for only part of year

Date the taxpayer established residence in state above

In which state (or foreign country) did the taxpayer reside before this change?

Spouse:

Enter the spouse’s state of residence as of December 31, 2011 PA Check the appropriate box:

Spouse is a resident of the state above for the entire year X Spouse is a resident of the state above for only part of year

Date the spouse established residence in state above

In which state (or foreign country) did the spouse reside before this change?

Nonresident states:

Nonresident State(s)

Taxpayer/Spouse/Joint

Check this box if you are in a Registered Domestic Partnership, a civil union, or same-sex marriage If you checked the box on the line above, also check the appropriate box below:

Check if this is your individual federal return you are filing with the IRS Check if this is the joint return created to file joint state tax return (see Help)

Personal Information Worksheet

2011

For the Taxpayer

G Keep for your records

QuickZoom to another copy of Personal Information Worksheet

QuickZoom to Federal Information Worksheet

Part I ' Taxpayer's Personal Information

First name

John

Middle initial

Last name

Poulos

Suffix

Social security no.

123-45-6789

Member of U.S. Armed Forces in 2011?

Yes

Date of birth

01/01/1950

(mm/dd/yyyy)

age as of 1-1-2012

Occupation

Priest

Daytime phone

(123)456-7890

Ext

Marital status	Married
If widowed, check the appropriate box for the year your spouse died:
After 2011	2011	2010	2009

Are you retired on total and permanent disability? (for Schedule R, see Help). Check if this person is legally blind

If deceased, enter the date of death

Were you under the age of 16 as of 1-1-2012 and this is the first year you are filing a tax return?

Before 2009

Yes

(mm/dd/yyyy)

Yes

Do you want $3 to go to Presidential Election Campaign Fund?

Yes

Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer

1Can someone (such as your parent) claim you as a dependent?

2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent

on that person’s tax return?

Questions 3 through 5 are only required for individuals who claim the American Opportunity Credit.

3 Were you a full-time student during any part of five months during 2011?

4Did your earned income exceed one-half of your support? 5 Was at least one of your parents alive on December 31, 2011?

Yes

Part III ' Taxpayer's State Residency Information

Enter this person’s state of residence as of December 31, 2011		PA
Check the appropriate box:
This person is a resident of the state above for the entire year		X
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?

Part IV ' Dependent Care Expenses

Qualified dependent care expenses incurred and paid for this person in 2011

Personal Information Worksheet

2011

For the Spouse

G Keep for your records

QuickZoom to another copy of Personal Information Worksheet

QuickZoom to Federal Information Worksheet

Part I ' Spouse's Personal Information

First name

Mary

Middle initial

Last name

Poulos

Suffix

Social security no.

123-12-3498

Member of U.S. Armed Forces in 2011?

Yes

Date of birth

02/01/1950

(mm/dd/yyyy)

age as of 1-1-2012

Occupation

Teacher

Daytime phone

(123)456-7890

Ext

Marital status	Married
If widowed, check the appropriate box for the year your spouse died:
After 2011	2011	2010	2009

Are you retired on total and permanent disability? (for Schedule R, see Help). Check if this person is legally blind

If deceased, enter the date of death

Were you under the age of 16 as of 1-1-2012 and this is the first year you are filing a tax return?

Before 2009

Yes

(mm/dd/yyyy)

Yes

Do you want $3 to go to Presidential Election Campaign Fund?

Yes

Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer

1Can someone (such as your parent) claim you as a dependent?

2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent

on that person’s tax return?

Questions 3 through 5 are only required for individuals who claim the American Opportunity Credit.

3 Were you a full-time student during any part of five months during 2011?

4Did your earned income exceed one-half of your support? 5 Was at least one of your parents alive on December 31, 2011?

Yes

Part III ' Spouse's State Residency Information

Enter this person’s state of residence as of December 31, 2011		PA
Check the appropriate box:
This person is a resident of the state above for the entire year		X
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?

Part IV ' Dependent Care Expenses

Qualified dependent care expenses incurred and paid for this person in 2011

Form 1040

Forms W-2 & W-2G Summary

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Form W-2 Summary

Box No.		Description	Taxpayer	Spouse		Total

1	Total wages, tips and compensation:
	Non-statutory & statutory wages not on Sch C		59,540.		59,540.
	Statutory wages reported on Schedule C
	Foreign wages included in total wages
	Unreported tips
2	Total federal tax withheld		0.		0.
3	& 7 Total social security wages/tips

4Total social security tax withheld

5 Total Medicare wages and tips

6 Total Medicare tax withheld

8 Total allocated tips

9 Not used

10Total dependent care benefits

11Total distributions from nonqualified plans

12a Total from Box 12

b Elective deferrals to qualified plans

c Roth contributions to 401(k) & 403(b) plans d Deferrals to government 457 plans

e Deferrals to non-government 457 plans

f Deferrals 409A nonqual deferred comp plan g Income 409A nonqual deferred comp plan h Uncollected Medicare tax

i Uncollected social security and RRTA tier 1 j Uncollected RRTA tier 2

k Income from nonstatutory stock options l Non-taxable combat pay

m Total other items from box 12

14 a Total deductible mandatory state tax

bTotal deductible charitable contributions

cThis line does not apply to TurboTax d Total RR Tier 1 wages

e Total RR Tier 1 tax f Total RR Tier 2 tax g Total RRTA tips

h Total other items from box 14

35,000.

16Total state wages and tips

17Total state tax withheld

19Total local tax withheld

Form W-2

Wage and Tax Statement

G Keep for your records

2011

Name

John Poulos

Social Security Number

123-45-6789

Spouse’s W-2	Military: Complete Part VI on Page 2 below
Do not transfer this W-2 to next year

a Employee’s social security No	123-45-6789
b Employer’s ID number	09-3124556

cEmployer’s name, address, and ZIP code

Holy Trinity Greek Orthodox Church

Street	12	Apostles Circle
City	Heavens Gate
State	PA	ZIP Code 31240

Foreign Country

dControl number

XTransfer employee information from the Federal Information Worksheet

eEmployee’s name

1Wages, tips, other compensation

59,540.00

3Social security wages

5Medicare wages and tips

7Social security tips

11Nonqualified plans

12Enter box 12 below

2Federal income tax withheld

0.00

4Social security tax withheld

6Medicare tax withheld

8Allocated tips

10Dependent care benefits

Distributions from sect. 457 and nonqualified plans (Important, see Help)

First	John	M.I.
Last	Poulos	Suff.

fEmployee’s address and ZIP code Street9 Archangels Highway City Heavens Gate

State PA ZIP Code 31240 Foreign Country

13Statutory employee Retirement plan Third-party sick pay

14Enter box 14 below after entering boxes 18, 19, and 20. NOTE: Enter box 15 before entering box 14.

Box 12	Box 12	If Box 12 code is:
Code	Amount	A:	Enter amount attributable to RRTA Tier 2 tax
		M:	Enter amount attributable to RRTA Tier 2 tax
		P:	Double click to link to Form 3903, line 4
		R:	Enter MSA contribution for		Taxpayer
					Spouse
		W: Enter HSA contribution for			Taxpayer
					Spouse
		G:		Employer is not a state or local government

Box 15

Box 16

Box 17

State

Employer’s state I.D. no.

State wages, tips, etc.

State income tax

89088902841

Box 20

Box 18

Box 19

Associated

Locality name

Local wages, tips, etc.

Local income tax

State

Box 14

TurboTax Identification of Description or Code

Description or Code

(Identify this item by selecting the identification from

on Actual Form W-2

Amount

the drop down list. If not on the list, select Other).

HOUSING ALLOWANCE

35,000.00

Other (not classified)

Form W-2

Additional Wage and Tax Information

G Keep for your records

2011

Name

John Poulos

Employer’s Name

Holy Trinity Greek Orthodox Church

123-45-6789 Page 2

ADDITIONAL INFORMATION

Part I Foreign Income

The income reported on this W-2 is from a foreign source and is eligible to be excluded on Form 2555

Part II Electronic Filing

Complete if you are filing this return electronically.

2 a This W-2 is ’non-standard’ (handwritten, typewritten, or altered in any way)

bThis W-2 is a corrected W-2

Part III Statutory Employees

	Complete if box 13 Statutory employee box is checked.
3	Will you be deducting any expenses in connection with this income?	Yes	No

4If so, select the copy of Schedule C you want to report this income on (double-click)

Part IV Dependent Care Benefits

Complete if box 10 of this W-2 has an entry.

5Did this employer hire an on-staff care provider or furnish dependent care at

your workplace?

Yes

6Enter any amounts forfeited from a flexible spending account

Part V Clergy, Church Employees, Members of Recognized Religious Sects

Complete if this W-2 is for clergy, church employment, or for a member of a recognized religious sect.

Clergy only:

7 a Enter your designated housing or parsonage allowance

35,000.00

bEnter the smallest of (a) your designated housing or parsonage allowance,

(b) amount spent on qualifying housing expenses, or (c) fair rental value

31,000.00

If no FICA was withheld, check box c, d, e, or f below as appropriate

cPay self-employment tax on housing or parsonage allowance only

d Pay self-employment tax on W-2 income only

eX Pay self-employment tax on both W-2 income and housing allowance

f Exempt from SE tax and have an approved exemption Form 4361

Non-clergy:

If no FICA was withheld, check box a or b below as appropriate

8 a Pay self-employment tax on this W-2 income

bExempt from SE tax and have an approved exemption Form 4029

Part VI

Military

9 a Active duty military pay

bNon-taxable combat pay (From box 12, Code Q)

Part VII Unreported Tip Income

10 a Tips $20 or more in a month which were not reported to employer

bTips less than $20 in a month which were not required to be reported

cValue of non-cash tips, such as tickets or passes, not reported to employer d Actual amount of allocated tips if different than the amount in box 8

e Tips paid out by you through a tip-sharing arrangement

f Employer is a federal, state, or local government and tips only subject to Medicare tax

Part VIII Inmate In a Penal Institution

11 a Pay from work performed while an inmate in a penal institution

Part IX Paid Family Leave

12 a Income from Paid Family Leave

Form 1099-INT Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Ownership:	Check if Spouse
(defaults to taxpayer)	Check if Joint

Payer’s name

Saintly Bank and Trust

Box 1

Interest income for 2011 (not included in box 3)

500.00

Choose type if special state handling (State Use Only ' see Help).

Box 2

Early withdrawal penalty

Box 3

Interest on U.S. Savings Bonds and Treasury obligations

Box 4

Federal income tax withheld

State income tax withheld

State ID

Box 5

Investment expenses

Box 6

Foreign tax paid (All interest is considered passive. See Help)

a Check to deduct foreign taxes on Schedule A

b DoubleClick to link to a copy of Form 1116

c For Form 1116, select which column

dForeign source amount included in interest

Box 7	Foreign country or U.S. possession
	Check this box if foreign tax is from a mutual fund or a registered
	investment company. See Tax Help for additional information.

Box 8	Tax-exempt interest-Total

Tax-exempt Interest State Allocation

For each row, enter state ID in column (a) and enter percent in column (b) or amount in column (c).

	(a)	(b)	(c)
	State	Percent of	Amount of
	or	total	interest
	Territory	interest	for
	ID	for state	state
Enter resident state ID
Enter XX for all nonresident states (recommended)
	or
Enter each nonresident state on separate row
Total
State ID	where exempt interest was earned. If more than 1 state, see Help

Box 9	Specified private activity bond included in Box 8 subject to AMT, if any	OR
	Private activity bond interest percentage of Box 8, if any			%

Box 10

Tax-exempt bond CUSIP number

Adjustments to Interest

Check the box that identifies the type of adjustment being made:

N O B

Nominee distribution	A
Original issue discount (OID)	H
Amortizable bond premium (ABP)	U

Accrued interest Other

U.S. savings bond interest previously reported

Enter adjustment amount (enter as positive if subtracting/negative if adding)

Wages, Salaries, & Tips Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

The following amounts are included in the total entered on line 7 of Form 1040 (or Form 1040A), on line 1 of Form 1040EZ, on line 8 of Form 1040NR:

1Wages, from Form W-2

2Miscellaneous income, from Form 8919

3 Items from Form 1099-R:

a Disability before minimum retirement age b Return of contributions

4 Excess reimbursement, from Form 2106

5 a Taxable tips, from Form 4137 b Noncash tips

6 Excess moving expense reimbursement, from Form 3903

7 Wages earned as a household employee (if less than $1,700 and without a Form W-2)

8 Items not on Form W-2 or Form 1099-R: a Sick pay or disability payments

b Total foreign source income

c Check this box if the amount on line 8b is

eligible for the foreign exclusion/deduction

dOrdinary income from employer stock transactions not reported on Form W-2

9Other earned income

Form W-2 unused clergy housing

10Subtotal.

Add lines 1 through 9

11Taxable employer-provided dependent care benefits, from Form 2441

12Taxable employer-provided adoption benefits less any excluded benefits from Form 8839

13Scholarship/fellowship income not on Form W-2

14Other non-earned income

Taxpayer	Spouse	Total

59,540.		59,540.

4,000.		4,000.



63,540.	63,540.

15 Total of lines 10 through 14

63,540.

Schedule A	Medical Expenses Worksheet	2011
Line 1	G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

1Prescription medications

2Health insurance premiums: a From Form(s) 1099-R

b For medical care, other than self-employed health insurance c Medicare premiums

NOTE: If LTC premiums are associated with a specific business activity, enter them directly on the applicable Self-Employed Health and Long-Term Care Insurance Deduction Worksheet, not on lines 2d - 2i below.

d	Taxpayer’s gross long-term care premiums	2 d
e	Taxpayer’s allowable long-term care premiums	e
f	Spouse’s gross long-term care premiums	f
g	Spouse’s allowable long-term care premiums	g
h	Dep or child under 27 gross long-term care premiums	h
i	Dep or child under 27 allowable long-term care prem.	i

jTotal allowable long-term care premiums, sum of lines 2e, 2g, and 2i

kTaxpayer’s long-term care premiums not deducted as an adjustment to income l Spouse’s long-term care premiums not deducted as an adjustment to income m Dependent’s long-term care premiums not deducted as an adj to income

n Self-employed health insurance not deducted as an adjustment to income

3Fees for doctors, dentists, etc

4 Fees for hospitals, clinics, etc

5 Lab and x-ray fees

6 Expenses for qualified long-term care

7 Eyeglasses and contact lenses

8 Medical equipment and supplies

9 Medical transportation expenses:

a Medical miles driven 01/01/11 thru 06/30/11

9 a

bMultiply the number of miles on line 9a by 19 cents

per mile	b
c Medical miles driven 7/01/11 thru 12/31/11	c

dMultiply the number of miles on line 9c by 23.5 cents

per mile

eOther medical transportation costs not included above

for example: ambulance fees

fTotal medical transportation expenses (add lines 9b and 9d and 9e)

10 Lodging for medical purposes (up to $50 per night per person)

11 Other medical and dental expenses: a

b c d e

g h i j

12 Total of medical and dental expenses (add lines 1 through 11j)

13 a Less: insurance reimbursement for any expenses listed

b Less: medical savings account (MSA) or health savings account (HSA) distributions

14 Total deductible medical and dental expenses. Subtract lines 13a plus 13b from line 12 (to Schedule A, line 1)

2a b c

j k l m n 3 4 5 6 7 8

11a b c d e f g h i j

13a

3,000.00

1,600.00

4,600.00

Tax Payments Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Estimated Tax Payments for 2011 (If more than 4 payments for any state or locality, see Tax Help)

	Federal		State			Local

Date	Amount	Date	Amount	ID	Date	Amount	ID

1	04/18/11	4,000.	04/18/11		04/18/11
2	06/15/11	4,000.	06/15/11		06/15/11
3	09/15/11	4,000.	09/15/11		09/15/11
4	01/17/12	4,000.	01/17/12	01/17/12
5

Tot Estimated	16,000.
Tot Estimated
Payments

Tax Payments Other Than Withholding		Federal	State	ID	Local	ID
(If multiple states, see Tax Help)

6Overpayments applied to 2011

7 Credited by estates and trusts

8 Totals Lines 1 through 7

16,000.

92011 extensions

Taxes Withheld From:	Federal		State	Local

10 Forms W-2		0.

11Forms W-2G

12Forms 1099-R

13Forms 1099-MISC and 1099-G

14Schedules K-1

15Forms 1099-INT, DIV and OID

16	Social Security and Railroad Benefits
17		Form 1099-B	St	Loc
18 a		Other withholding	St	Loc
	b	Other withholding	St	Loc
	c	Other withholding	St	Loc
	d	Positive Adjustment	St	Loc
	e	Negative Adjustment	St	Loc
19		Total Withholding Lines 10 through 18e
					0.
20		Total Tax Payments for 2011			16,000.

Prior Year Taxes Paid In 2011

State

Local

(If multiple states or localities, see Tax Help)

21Tax paid with 2010 extensions

222010 estimated tax paid after 12/31/10

23Balance due paid with 2010 return

24Other (amended returns, installment payments, etc)

Schedule A	Tax and Interest Deduction Worksheet	2011
Lines 5 - 12	G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Tax Deductions

Social Security Number

123-45-6789

1State and local taxes:

	Optional Sales Tax Tables
a Available Income:
(1)	Income from Form 1040, line 38	57,362.00
(2)	Nontaxable income entered elsewhere on return	31,000.00
(3)	Available income: 2010 refundable credits in excess of tax	0.00

(4)Enter any additional nontaxable income

(5) Total available income

88,362.00

bSales Tax Per State of Residence:

Enter state in column (1), then enter total (combined) state and local sales tax rate in column (4).

Arizona, California, Colorado, New Jersey, New York or South Carolina only:

Double-click in column (4) to select your locality for each state entered.

(1) S t a t e

(2)

Date

Lived in

State

From

(3)

Date

Lived in

State

(4)

Enter

Total

State &

Local

Rate (%)

(5)

State

Sales

Tax

Rate

(%)

(6)

Local

Sales

Tax

Rate (%)

(4) - (5)

(7)

State

Sales

Tax

Table

Amount

(8)

Local

Sales

Tax

Amount

(9)

Prorated

or Total

Amount

cTotal general sales tax using tables

d Sales Tax Paid on Specific Items (see help):

(1)

(2)

Total

State &

Local

Rate

(3)

Description

(4)

Type

(5)

Cost

(6)

Rate if

Different

(7)

Actual

Sales Tax

Amount

Paid

(8)

Specific

Item

Deduction

eTotal sales tax deduction on specific items

fTotal general sales tax per tables plus sales tax on specific items g Actual State and Local General Sales Tax:

Actual sales taxes (enter the total sales taxes paid during the year on all items) h State and Local Income Taxes:

State and Local Income taxes

i State and Local Tax Deduction to Schedule A, line 5:

Greater of line 1f, line 1g, or line 1h (to Schedule A, line 5)

j Check a box to choose to use income taxes paid, sales taxes paid, or whichever provides the greater deduction:

Income Taxes

Sales Taxes

Greater amount

2Real estate taxes:

a Real estate taxes paid on principal residence not entered on Form 1098

1,500.00

bReal estate taxes paid on principal residence entered on Form 1098 c Real estate taxes paid on additional homes or land

Personal portion of real estate taxes from Schedule E Worksheet for: d Principal residence

e Vacation home

f Less real estate taxes deducted on Form 8829

g Add lines 2a through 2f (to Schedule A, line 6)

1,500.00

3Personal property taxes:

aAuto registration fees based on the value of the vehicle.

2010 Amount		Enter 2011 description:

bNon-business portion of personal property taxes from Car & Truck Exp Wks c Other personal property taxes

d Add lines 3a through 3c (to Schedule A, line 7)

4Other taxes:

aOther taxes from Schedule(s) K-1

bForeign taxes from interest and dividends c Foreign taxes from Schedule(s) K-1

d Other foreign taxes (not used to claim a foreign tax credit) e Other taxes.

2010 Amount		Enter 2011 description:

fAdd lines 4a through 4e (to Schedule A, line 8)

Interest Deductions

5Home mortgage interest and points reported on Form 1098:

a Mortgage interest and points from the Home Mortgage Interest Worksheet

15,000.00

bQualified mortgage interest from Schedule E Worksheet

cLess home mortgage interest/points deducted on Form 8829 d Less home mortgage interest from Form 8396, line 3

e Add lines 5a through 5d (to Sch A, line 10) or line A2 from above

15,000.00

6Home mortgage interest not reported on Form 1098:

aMortgage interest from the Home Mortgage Interest Worksheet b Less home mortgage interest deducted on Form 8829

c Add lines 6a and 6b (to Sch A, line 11) or line B2 from above

7Points not reported on Form 1098:

aAmortizable points from the Home Mortgage Interest Worksheet

bOther points not on Form 1098 from the Home Mortgage Interest Worksheet c Less points deducted on Form 8829

d Add lines 7a through 7c (to Schedule A, line 12) or line C2 from above

Schedule A	Home Mortgage Interest Worksheet	2011
Lines 10 - 12	G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Note: Use this worksheet to report home mortgage interest you paid on your main home or second home. Enter mortgage interest you paid for business property other than a home office on the appropriate schedule or form for the business activity (Schedule C, Schedule E, etc.).

1 Was the mortgage interest reported to you on Form 1098?

Yes

2	Recipient’s/lender’s name	Saintly Bank and Trust
3	Mortgage interest paid on your main home or second home in 2011		15,000.00

4Points paid in 2011 to buy your main home from Form 1098, box 2

QuickZoom if you paid more interest than is shown on Form 1098

5If you bought your home from the recipient and did NOT receive a Form 1098, enter the recipient’s identifying number and address:

Recipient’s SSN or ID number Recipient’s address

City

State

ZIP

6If you and someone else were liable for this mortgage and the other person received the Form 1098, enter the other person’s name and address:

Name Address

City

State

ZIP

Points NOT reported on Form 1098:

7Points not reported on Form 1098 that you paid in 2011 to purchase or improve your main home

8If you paid other points to this lender which must be spread over the life of the loan, for example points you paid on your second home, on a home equity loan, or when you refinanced, enter the following:

aTotal points originally paid on a loan for which the points must be amortized b Date loan was made or date of refinance

c Length of loan (years)

d Points deducted in prior years for this loan e Amortized points allowable this year

f Check this box if the points remaining for this loan are deductible in full in 2011

because you refinanced or paid off the loan

gAmortizable points deducted this year (to Tax and Interest Deduction Wkst., line 7a)

Schedule A	Cash Contributions Worksheet	2011
Line 16	G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Cash Contributions

Social Security Number

123-45-6789

	Name of Charitable Organization	Type		2011 Amount
	Note: Summarized from the Charitable Organization Worksheet.
	Enter amounts on the Charitable Organization Worksheet.

1a Holy Trinity Greek Orthodox Church			A	3,500.00

2	From Schedule K-1 ' Partnerships and S Corporations	2
3	From Form(s) W-2, Box 14	3

4Miles driven:

a To perform charitable service

bFrom Detail of Mileage and Transportation Costs Worksheet

	above	4b
	c Add lines 4a and 4b	4c
	d Multiply line 4c by 14 cents per mile		4d
5	Parking fees, tolls, and local transportation
	a To perform charitable service	5a
	b From Charitable Org. Wks	5b
	c Add lines 5a and 5b.		5c
6	Add lines 1 thru 5 and enter here (to Schedule A, line 16)	6		3,500.00

Charitable Contributions Summary

2011

G Keep for your records

Name(s) Shown on Return

Social Security Number

John & Mary Poulos

123-45-6789

Cash Contributions Summary

Part I

(a)

(b)

(c)

(d)

Name of Charitable Organization

Total

50%

30%

RESERVED

Limit

for future

use

Holy Trinity Greek Orthodox Church

3,500.

Totals:

3,500.

Non-Cash Contributions Summary

Part II

Total

Other Property

Capital Gain Property

(a)

(b)

(c)

(d)

(e)

Name of Charitable Organization

Total

50%

30%

20%

Limit

Totals:

Part III Contribution Carryovers to 2012

		Total		Cash and Other				Capital Gain
			Non-Capital Gain Property					Property

		(a)	(b)		(c)	(d)		(e)	(f)
		Total	RESERVED	50%		30%	30%		20%
					Limit	Limit		Limit	Limit

1	2011 contributions	3,500.			3,500.
1	2011 contributions	3,500.			3,500.
2	2011 contributions	3,500.		3,500.		0.	0.		0.
	allowed	3,500.		3,500.		0.	0.		0.
3	Carryovers from:
	a 2010 tax year
	b 2008 tax year
	c 2007 tax year
	d 2006 tax year
	e 2005 tax year

4	Carryovers	0.		0.	0.		0.	0.
5	allowed in 2011
	Carryovers	0.	0.		0.	0.		0.
	disallowed in 2011

6Carryovers to 2012:

a From 2011	0.		0.	0.			0.	0.
b From 2010

c From 2008

d From 2007

e From 2006

f From 2005 (expired)

Part IV Special Situations in Your Return for Current Year Donations

1Was the entire interest given for all property donated to all charities?

2 Were restrictions attached to any charities’s right

to use or dispose of any property donated to any charity? 3 Did you give to anyone other than the charity the right to income from any

of the donated property or to possession of any of the donated property? 4 Was any charity other than a 50% charity?

Yes

Yes Yes

XNo

Earned Income Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Part I ' Earned Income Credit Wks Computation

Taxpayer

Spouse

Total

1If filing Schedule SE:

a Net self-employment income

94,540.

bOptional Method and Church Employee income

c	Add lines 1a and 1b	94,540.	94,540.
d One-half of self-employment tax		6,678.	6,678.
e	Subtract line 1d from line 1c	87,862.	87,862.

2If not required to file Schedule SE: a Net farm profit or (loss)

b Net nonfarm profit or (loss) c Add lines 2a and 2b

3If filing Schedule C or C-EZ as a statutory employee, enter the amount from line 1

of that Schedule C or C-EZ

4 Add lines 1e, 2c and 3. To EIC Wks, line 5

87,862.

Part II ' Form 2441 and Standard Deduction Worksheet Computations

5 Net self-employment earnings (line 4 above)

87,862.

6Wages, salaries, and tips less distributions

from nonqualified or section 457 plans, etc

7Taxable employer-provided adoption benefits

8 Add lines 5 through 7. To Form 2441, lines 19

and 20

87,862.

9 a Taxable dependent care benefits

bNontaxable combat pay

10Add lines 8, 9a and 9b . To Form 2441, lines 4

and 5

87,862.

11Scholarship or fellowship income not on W-2

12 SE exempt earnings less nontaxable income

-31,000.

13Distributions from nonqualified/Sec. 457 plans

14Add lines 8, 9a and 11 through 13. To Standard

Deduction Worksheet

56,862.

Part III ' IRA Deduction Worksheet Computation

87,862.

-31,000.

56,862.

15Net self-employment income or (loss)

16Wages, salaries, tips, etc

17Net self-employment loss

18Alimony received

19Nontaxable combat pay

20Foreign earned income exclusion

21Keogh, SEP or SIMPLE deduction

22Combine lines 15 through 21. To IRA Wks, ln 2

52,862.

4,000.

56,862.

52,862.

4,000.

56,862.

Part IV ' Form 8812 and Child Tax Credit Line 11 Worksheet Computations

23Self-employed, church and statutory employees

24Wages, salaries, tips, etc

25Nontaxable combat pay

26Foreign earned income exclusion

27Combine lines 23 through 26. To Form 8812, line 4a & Line 11 Wks, line 2

52,862.

4,000.

56,862.

52,862.

4,000.

56,862.

Schedule SE Adjustments Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

(a) Taxpayer

(b) Spouse

QuickZoom to the Short Schedule SE (Schedule SE, page 1)	X
QuickZoom to the Long Schedule SE (Schedule SE, page 2)

AUse Long Schedule SE, even if qualified to use Short Schedule SE B Approved Form 4029. Exempt from SE tax on all income

C Chapter 11 bankruptcy net profit or loss for Schedule SE, line 3 D QuickZoom to the Explanation statement for any adjustment to SE income/loss shown on a partnership K-1. (See Help)

Part I

Farm Profit or (Loss) Schedule SE, line 1

1Total Schedules F

2Farm partnerships, Schedules K-1

3Other SE farm profit or (loss) (See Help)

4Less SE exempt farm profit or (loss) (See Help)

5 Total for Schedule SE, line 1

6 Conservation Reserve Program payments not subject to self- employment tax reported on:

a Schedule F, line 4b

b Schedule K-1 (Form 1065), box 20, code Y c Total CRP payments not subject to SE tax

Part II Nonfarm Profit or (Loss) Schedule SE, line 2 1 a Total Schedules C

bLess SE exempt Schedules C (approved Form 4361)

2 Nonfarm partnerships, Schedules K-1

3 Forms 6781

4 Other SE income reported as income on Form 1040, line 7

5 a	Clergy Form W-2 wages	59,540.
b	Clergy housing allowance	35,000.

cLess clergy business deductions

dQuickZoom to the Explanation statement for entry on line 5c

6 Other SE nonfarm profit or (loss) (See Help)

7 Less other SE exempt nonfarm profit or (loss) (See Help)

8 Total for Schedule SE, line 2

94,540.

9Exempt Notary Public income for Schedule SE, line 3 (See Help)

Part III Farm Optional Method Schedule SE, page 2, Part II 1 Use Farm Optional Method

2Gross farm income from Schedules F

3Gross farming or fishing income from partnership Schedules K-1

4 Other gross farming or fishing self-employment income 5 Total gross income for Farm Optional Method

Part IV Nonfarm Optional Method Schedule SE, page 2, Part II

1Use Nonfarm Optional Method (Must have had net SE earnings of $400 or more in 2 of prior 3 years and used the

Nonfarm Optional Method less than 5 times)

2Gross nonfarm income from Schedules C

3Gross nonfarm income from partnership Schedules K-1

4 Other gross nonfarm self-employment income

5 Total gross income for Nonfarm Optional Method

John & Mary Poulos		123-45-6789	Page 2

Schedule SE Worksheet -- Recalculation of One-Half SE Tax Deduction

?For purposes of calculating the one-half of self-employment

tax deduction, this worksheet recalculates Schedule SE using the full 15.3% rate of SE Tax. See Help.

Short Schedule SE:

ASchedule SE, line 4 B SE Tax:

1 If Line A is $106,800 or less, line A multiplied by 15.3% (.153)

2 If Line A is more than $106,800, line A multiplied by 2.9% (.029) plus $13,243.20

C One-half SE Tax: Line B multiplied by 50% (.50)

Long Schedule SE: D Schedule SE line 6 E Schedule SE line 9

F Multiply the smaller of line D or E by 12.4% (.124) G Multiply line D by 2.9% (.029)

H SE Tax: Add lines F and G

I One-half SE Tax: Line H multiplied by 50% (.50)

JOne-half SE Tax deduction as computed above

KDeduction for employer-equivalent portion of SE Tax on Schedule SE

LSubtract line K from line J for adjustment difference

Taxpayer

Spouse

87,308.

13,358.

6,679.

6,678.

Federal Carryover Worksheet

2011

G Keep for your records

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

2010 State and Local Income Tax Information (See Tax Help)

(a)	(b)	(c)	(d)	(e)	(f)
State or	Paid With	Estimates Pd	Total With-	Paid With	Total Over-
Local ID	Extension	After 12/31	held/Pmts	Return	payment

Totals

(g)

Applied Amount

Other Tax and Income Information

2010

2011

Filing status

2 MFJ

Number of exemptions for blind or over 65 (0 - 4)

Itemized deductions

23,124.

23,151.

Check box if required to itemize deductions

Adjusted gross income

57,643.

57,362.

Tax liability for Form 2210 or Form 2210-F

15,239.

14,786.

Alternative minimum tax

Federal overpayment applied to next year estimated tax

QuickZoom to the IRA Information Worksheet for IRA information

Excess Contributions

2010

2011

9 a

Taxpayer’s excess Archer MSA contributions as of 12/31

9 a

b Spouse’s excess Archer MSA contributions as of 12/31

10 a

Taxpayer’s excess Coverdell ESA contributions as of 12/31

10 a

b Spouse’s excess Coverdell ESA contributions as of 12/31

11 a

Taxpayer’s excess HSA contributions as of 12/31

11 a

b Spouse’s excess HSA contributions as of 12/31

Loss and Expense Carryovers

2010

2011

Note: Enter all entries as a positive amount

12 a

Short-term capital loss

12 a

b AMT Short-term capital loss

13 a

Long-term capital loss

13 a

b AMT Long-term capital loss

14 a

Net operating loss available to carry forward

14 a

b AMT Net operating loss available to carry forward

15 a

Investment interest expense disallowed

15 a

b AMT Investment interest expense disallowed

Nonrecaptured net Section 1231 losses from:

2011

16 a

2010

2009

2008

2007

2006

Federal Carryover Worksheet page 2

2011

John & Mary Poulos

123-45-6789

Loss and Expense Carryovers (cont’d)

2010

2011

AMT Nonrecap’d net Sec 1231 losses from:

2011

17 a

2010

2009

2008

2007

2006

Credit Carryovers

2010

2011

General business credit

Mortgage interest credit from:

2011

19 a

2010

2009

2008

Credit for prior year minimum tax

District of Columbia first-time homebuyer credit

Residential energy efficient property credit

Other Carryovers

2010

2011

Section 179 expense deduction disallowed

Excess

Taxpayer (Form 2555, line 46)

24 a

foreign

Taxpayer (Form 2555, line 48)

housing

Spouse (Form 2555, line 46)

deduction:

Spouse (Form 2555, line 48)

Charitable Contribution Carryovers

2010 Carryover of

Other Property

Capital Gain

charitable contributions

(a) 50%

(b) 30%

(d) 20%

from:

2010

2009

2008

2007

2006

2011 Carryover of

Other Property

Capital Gain

charitable contributions

(a) 50%

(b) 30%

(d) 20%

from:

a2011 b 2010 c 2009 d 2008 e 2007

27 Amount overpaid less earned income credit	761.

2010 State Capital Loss Carryovers (For users not transferring from the prior year)

State

Short-term	AMT Short-term	Long-term	AMT Long-term	Capital Loss	AMT Capital Loss
Capital Loss	Capital Loss	Capital Loss	Capital Loss	(combined)	(combined)
for State	for State	for State	for State	for State	for State

Form 2106	Form 2106 Adjustments Worksheet	2011
Lines 4, 7, 10	G Keep for your records

Your Name

John Poulos

Social Security Number

123-45-6789

Occupation in Which You Incurred Expenses

Priest

Line 4 ' Other Business Expenses

1Business gifts

2Education

3Home office (QuickZoom to Employee Home Office Wks)

4 Trade publications

5 Depreciation and amortization

(for vehicles, use the Vehicle Expenses Worksheet)

6 Other:

Vestments and Books

4,000.

7Total other business expenses. Add lines 1 through 6. Carries to Form 2106, line 4

4,000.

Line 7 ' Allocation of Employer Reimbursements

8Reimbursements that were not reported in box 1 of Form W-2

9Total expenses for the period(s) covered by the reimbursements on line 8

10Meal and entertainment expenses included in line 9

11Divide line 10 by line 9

12Employer reimbursement for meals and entertainment. Multiply line 8 by line 11. Carries to Form 2106, line 7, column B

13Employer reimbursement for other than meals and entertainment. Subtract line 12 from line 8. Carries to Form 2106, line 7, column A

Department of Transportation (DOT) Employees - complete lines 14 - 19

14Employer reimbursement for meals and entertainment expenses

15Total meals and entertainment expenses for the period(s) covered by the reimbursements on line 14

16Meal expenses included in line 15 that are covered by DOT rules regarding hours of service limits

17Divide line 16 by line 15

18Employer reimbursement for DOT meals. Multiply line 14 by line 17

19Employer reimbursement for other meals and entertainment. Subtract line 18 from line 14

Line 10 ' Allocation of Business Expenses

(Qualified Performing Artists, Armed Forces Reservists, and Disabled Individuals)

20Total employee expenses from Form 2106, line 10

21Qualified performing artist expenses. Carries to Form 1040, line 24 (or to Form 1040NR, line 35)

22Armed Forces Reservists related travel more than 100 miles from home (up to the federal per diem rate). Carries to Form 1040, line 24

(not applicable to Form 1040NR)

23Impairment-related work expenses. Carries to Schedule A (Form 1040), line 28 (or to Schedule A (Form 1040NR), line 14)

24Net employee expenses. Subtract lines 21, 22, and 23 from line 20. Carries to Schedule A (Form 1040), line 21 (or to Schedule A (Form 1040NR), line 7)

4,000.

Two-Year Comparison

2011

Name(s) Shown on Return

John & Mary Poulos

Social Security Number

123-45-6789

Income	2010	2011		Difference		%

Wages, salaries, tips, etc	63,540.		63,540.	0.		0.00
Interest and dividend income	500.	500.		0.		0.00
State tax refund
Business income (loss)
Capital and other gains (losses)
IRA distributions
Pensions and annuities
Rents and royalties
Partnerships, S Corps, etc
Farm income (loss)
Social security benefits
Income other than the above
Total Income	64,040.		64,040.	0.		0.00
Adjustments to Income	6,397.		6,678.	281.		4.39
Adjusted Gross Income	57,643.	57,362.		-281.		-0.49

Itemized Deductions
Medical and dental	277.	298.		21.		7.58
Income or sales tax
Real estate taxes	1,500.	1,500.		0.		0.00
Personal property and other taxes
Interest paid	15,000.		15,000.	0.		0.00
Gifts to charity	3,500.	3,500.		0.		0.00
Casualty and theft losses
Miscellaneous	2,847.		2,853.	6.		0.21
Total Itemized Deductions	23,124.		23,151.	27.		0.12
Standard or Itemized Deduction	23,124.		23,151.	27.		0.12
Exemption Amount	7,300.		7,400.	100.		1.37

Taxable Income	27,219.		26,811.	-408.		-1.50

Income tax	3,246.	3,174.		-72.		-2.22
Additional income taxes
Alternative minimum tax
Total Income Taxes	3,246.	3,174.		-72.		-2.22
Nonbusiness credits
Business credits
Total Credits
Self-employment tax	12,793.	11,612.		-1,181.		-9.23
Other taxes
Total Tax After Credits	16,039.	14,786.		-1,253.		-7.81
Withholding
Estimated and extension payments	16,000.	16,000.		0.		0.00
Earned income credit
Additional child tax credit
Other payments	800.			-800.	-100.00
Total Payments	16,800.	16,000.		-800.		-4.76
Form 2210 penalty
Applied to next year’s estimated tax
Refund	761.	1,214.		453.		59.53
Balance Due

Current year effective tax rate	5.53 %

			Tax History Report					2011
			G Keep for your records

Name(s) Shown on Return
John & Mary Poulos

				Five Year Tax History:

	2007	2008			2009		2010	2011
Filing status						MFJ		MFJ

Total income							64,040.	64,040.
Adjustments to income							6,397.	6,678.
Adjusted gross income							57,643.	57,362.
Tax expense							1,500.	1,500.
Interest expense							15,000.	15,000.
Contributions							3,500.	3,500.
Miscellaneous
deductions							2,847.	2,853.
Other Itemized
Deductions							277.	298.
Total itemized/
standard deduction							23,124.	23,151.
Exemption amount							7,300.	7,400.
Taxable income							27,219.	26,811.
Tax							3,246.	3,174.
Alternative min tax
Total credits
Other taxes							12,793.	11,612.
Payments							16,800.	16,000.
Form 2210 penalty
Amount owed
Applied to next
year’s estimated tax
Refund

Form 1040 Es Payment Voucher – Fill Out and Use

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