The Form 1040 Es Payment Voucher is a voucher that taxpayers can use to make estimated tax payments. This form helps to ensure that you are making payments towards your taxes throughout the year, so you don't have to worry about paying a large sum all at once come tax time. You can use this form to make either one payment or several payments throughout the year. Keep in mind, however, that there are limits as to how much you can pay using this form. Make sure to check the IRS website for more information.
Below is the data in regards to the PDF you were seeking to fill out. It can tell you the time it will take to complete form 1040 es payment voucher, exactly what fields you will need to fill in, etc.
Question | Answer |
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Form Name | Form 1040 Es Payment Voucher |
Form Length | 42 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 10 min 30 sec |
Other names | form 1040es fillable, irs form 1040 es 2019 fillable, 1040 es payment voucher 2019, printable 2019 form 1040 es |
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I Detach Here and Mail With Your PaymentI |
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Department of the Treasury |
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Calendar Year ' |
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2012 Form |
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Internal Revenue Service |
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Due 4/17/2012 |
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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
Amount of estimated tax you are paying by check or money order . . . . . . . . . G
REV 11/22/11 TTMAC |
1555 |
3,697.
JOHN |
POULOS |
INTERNAL REVENUE SERVICE |
MARY |
POULOS |
PO BOX 37007 |
9 ARCHANGELS HIGHWAY |
HARTFORD CT |
HEAVENS GATE PA 31240
123456789 JP POUL 30 0 201212 430
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I Detach Here and Mail With Your PaymentI |
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Department of the Treasury |
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Calendar Year' |
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2012 Form |
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Internal Revenue Service |
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Due 6/15/2012 |
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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
Amount of estimated tax you are paying by check or money order . . . . . . . . . G
1555
3,697.
JOHN |
POULOS |
INTERNAL REVENUE SERVICE |
MARY |
POULOS |
PO BOX 37007 |
9 ARCHANGELS HIGHWAY |
HARTFORD CT |
HEAVENS GATE PA 31240
123456789 JP POUL 30 0 201212 430
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I Detach Here and Mail With Your PaymentI |
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Department of the Treasury |
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Calendar Year' |
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2012 Form |
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Internal Revenue Service |
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Due 9/17/2012 |
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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
Amount of estimated tax you are paying by check or money order . . . . . . . . . G
REV 11/22/11 TTMAC |
1555 |
3,697.
JOHN |
POULOS |
INTERNAL REVENUE SERVICE |
MARY |
POULOS |
PO BOX 37007 |
9 ARCHANGELS HIGHWAY |
HARTFORD CT |
HEAVENS GATE PA 31240
123456789 JP POUL 30 0 201212 430
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I Detach Here and Mail With Your PaymentI |
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Department of the Treasury |
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Calendar Year' |
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2012 Form |
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Internal Revenue Service |
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Due 1/15/2013 |
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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
Amount of estimated tax you are paying by check or money order . . . . . . . . . G
REV 11/22/11 TTMAC |
1555 |
3,697.
JOHN |
POULOS |
INTERNAL REVENUE SERVICE |
MARY |
POULOS |
PO BOX 37007 |
9 ARCHANGELS HIGHWAY |
HARTFORD CT |
HEAVENS GATE PA 31240
123456789 JP POUL 30 0 201212 430
Form 1040 |
Department of the |
(99) |
2011 |
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||||||||||||
U.S. INDIVIDUAL INCOME TAX RETURN |
OMB No. |
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IRS Use |
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For the year Jan. |
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, 2011, ending |
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, 20 |
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See separate instructions. |
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Your first name and initial |
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Last name |
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Your social security number |
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John |
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Poulos |
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If a joint return, spouse’s first name and initial |
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Last name |
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Spouse’s social security number |
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Mary |
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Poulos |
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Home address (number and street). If you have a P.O. box, see instructions. |
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Apt. no. |
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Make sure the SSN(s) above |
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9 Archangels Highway |
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and on line 6c are correct. |
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City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). |
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Presidential Election Campaign |
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Heavens Gate PA 31240 |
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Check here if you, or your spouse if filing |
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jointly, want $3 to go to this fund. Checking |
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Foreign country name |
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Foreign province/county |
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Foreign postal code |
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a box below will not change your tax or |
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refund. |
You |
Spouse |
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Filing Status |
1 |
Single |
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4 |
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Head of household (with qualifying person). (See instructions.) If |
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2 |
Married filing jointly (even if only one had income) |
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the qualifying person is a child but not your dependent, enter this |
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Check only one |
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Married filing separately. Enter spouse’s SSN above |
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child’s name here. |
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box. |
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and full name here. |
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5 |
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Qualifying widow(er) with dependent child |
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Exemptions |
6a |
Yourself. If someone can claim you as a dependent, do not check box 6a . . . . |
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Boxes checked |
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b |
Spouse |
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on 6a and 6b |
2 |
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No. of children |
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c |
Dependents: |
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(2) Dependent’s |
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(3) Dependent’s |
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(4) if child under age 17 |
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on 6c who: |
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social security number |
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relationship to you |
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qualifying for child tax credit |
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• lived with you |
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(1) First name |
Last name |
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(see instructions) |
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• did not live with |
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you due to divorce |
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If more than four |
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or separation |
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(see instructions) |
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dependents, see |
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Dependents on 6c |
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instructions and |
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not entered above |
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check here |
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Add numbers on |
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2 |
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d |
Total number of exemptions claimed |
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lines above |
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Income |
7 |
Wages, salaries, tips, etc. Attach Form(s) |
EXCESS. . . |
ALLOWANCE. . . . |
4000. . . |
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7 |
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63,540. |
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8a |
Taxable interest. Attach Schedule B if required . . . |
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8a |
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500. |
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b |
8b |
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Attach Form(s) |
9a |
Ordinary dividends. Attach Schedule B if required . . |
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9a |
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b |
Qualified dividends |
9b |
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attach Forms |
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10 |
Taxable refunds, credits, or offsets of state and local income taxes |
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10 |
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11 |
Alimony received |
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11 |
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was withheld. |
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12 |
Business income or (loss). Attach Schedule C or |
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12 |
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13 |
Capital gain or (loss). Attach Schedule D if required. If not required, check here |
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13 |
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If you did not |
14 |
Other gains or (losses). Attach Form 4797 |
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14 |
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get a |
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15a |
IRA distributions . |
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15a |
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b Taxable amount . . . |
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15b |
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see instructions. |
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16a |
Pensions and annuities |
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16a |
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b Taxable amount . . . |
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17 |
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E |
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17 |
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Enclose, but do |
18 |
Farm income or (loss). Attach Schedule F |
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18 |
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not attach, any |
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19 |
Unemployment compensation |
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19 |
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payment. Also, |
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20a |
Social security benefits |
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20a |
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b Taxable amount . . . |
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20b |
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please use |
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Form |
21 |
Other income. List type and amount |
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21 |
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22 |
Combine the amounts in the far right column for lines 7 through 21. This is your total income |
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22 |
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64,040. |
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Adjusted |
23 |
Educator expenses |
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23 |
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24 |
Certain business expenses of reservists, performing artists, and |
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Gross |
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24 |
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Income |
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25 |
Health savings account deduction. Attach Form 8889 . |
25 |
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26 |
Moving expenses. Attach Form 3903 |
26 |
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27 |
Deductible part of |
27 |
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6,678. |
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28 |
28 |
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29 |
29 |
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30 |
Penalty on early withdrawal of savings |
30 |
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31a |
Alimony paid |
b Recipient’s SSN |
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31a |
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32 |
IRA deduction |
32 |
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33 |
Student loan interest deduction |
33 |
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34 |
Tuition and fees. Attach Form 8917 |
34 |
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35 |
Domestic production activities deduction. Attach Form 8903 |
35 |
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36 |
Add lines 23 through 35 |
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36 |
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6,678. |
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37 |
Subtract line 36 from line 22. This is your adjusted gross income |
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37 |
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57,362. |
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For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 12/01/11 TTMAC |
Form 1040 (2011) |
Form 1040 (2011) |
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Page 2 |
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Tax and |
38 |
Amount from line 37 (adjusted gross income) |
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38 |
57,362. |
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39a |
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You were born before January 2, 1947, |
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Blind. |
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Credits |
Check |
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Total boxes |
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if: |
{ |
Spouse was born before January 2, 1947, |
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Blind. }checked |
39a |
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Standard |
b |
If your spouse itemizes on a separate return or you were a |
39b |
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Deduction |
40 |
Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . |
40 |
23,151. |
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for— |
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• People who |
41 |
Subtract line 40 from line 38 |
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41 |
34,211. |
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check any |
42 |
Exemptions. Multiply $3,700 by the number on line 6d . . . |
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42 |
7,400. |
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box on line |
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39a or 39b or |
43 |
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter |
43 |
26,811. |
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who can be |
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Tax (see instructions). Check if any from: a |
Form(s) 8814 b |
Form 4972 c |
962 election |
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3,174. |
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claimed as a |
44 |
44 |
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dependent, |
45 |
Alternative minimum tax (see instructions). Attach Form 6251 |
. . . . . . . . . |
45 |
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see |
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instructions. |
46 |
Add lines 44 and 45 |
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46 |
3,174. |
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• All others: |
47 |
Foreign tax credit. Attach Form 1116 if required . . . . |
47 |
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Single or |
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Married filing |
48 |
Credit for child and dependent care expenses. Attach Form 2441 |
48 |
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separately, |
49 |
Education credits from Form 8863, line 23 |
49 |
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$5,800 |
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Married filing |
50 |
Retirement savings contributions credit. Attach Form 8880 |
50 |
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jointly or |
51 |
Child tax credit (see instructions) |
51 |
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Qualifying |
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widow(er), |
52 |
Residential energy credits. Attach Form 5695 . . . . |
52 |
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$11,600 |
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Head of |
53 |
Other credits from Form: a |
3800 |
b |
8801 |
c |
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53 |
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household, |
54 |
Add lines 47 through 53. These are your total credits . . . |
. . . . . . . . . |
54 |
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$8,500 |
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Subtract line 54 from line 46. If line 54 is more than line 46, enter |
. . . . . . |
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3,174. |
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55 |
55 |
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Other |
56 |
. . . . . . . . . |
56 |
11,612. |
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57 |
Unreported social security and Medicare tax from Form: |
a |
4137 |
b |
8919 . . |
57 |
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Taxes |
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58 |
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . |
58 |
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59a |
Household employment taxes from Schedule H |
. . . . . . . . . |
59a |
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b |
59b |
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60 |
Other taxes. Enter code(s) from instructions |
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60 |
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61 |
Add lines 55 through 60. This is your total tax |
. . . . . . . . |
61 |
14,786. |
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Payments |
62 |
Federal income tax withheld from Forms |
62 |
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63 |
2011 estimated tax payments and amount applied from 2010 return |
63 |
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16,000. |
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If you have a |
64a |
Earned income credit (EIC) |
64a |
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qualifying |
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b |
Nontaxable combat pay election |
64b |
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child, attach |
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Schedule EIC. |
65 |
Additional child tax credit. Attach Form 8812 |
65 |
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66 |
American opportunity credit from Form 8863, line 14 . . . |
66 |
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67 |
67 |
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68 |
Amount paid with request for extension to file |
68 |
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69 |
Excess social security and tier 1 RRTA tax withheld . . . . |
69 |
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70 |
Credit for federal tax on fuels. Attach Form 4136 . . . . |
70 |
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71 |
Credits from Form: a |
2439 |
b |
8839 |
c |
8801 d |
8885 |
71 |
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72 |
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Add lines 62, 63, 64a, and 65 through 71. These are your total payments |
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72 |
16,000. |
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Refund |
73 |
|
If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid |
73 |
1,214. |
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74a |
Amount of line 73 you want refunded to you. If Form 8888 is attached, check here . |
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74a |
1,214. |
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Direct deposit? |
b |
Routing number |
X |
X |
X |
X |
X |
X |
X |
X |
X |
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c Type: |
Checking |
Savings |
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See |
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d |
Account number |
X |
X |
X |
X |
X |
X |
X |
X |
X X |
X |
X X |
X X |
X X |
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instructions. |
75 |
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Amount of line 73 you want applied to your 2012 estimated tax |
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75 |
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Amount |
76 |
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Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions |
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76 |
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You Owe |
77 |
|
Estimated tax penalty (see instructions) |
. |
77 |
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Third Party |
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Do you want to allow another person to discuss this return with the IRS (see instructions)? |
Yes. Complete below. |
No |
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Designee |
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Designee’s |
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Phone |
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Personal identification |
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name |
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no. |
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number (PIN) |
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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 |
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Date |
Your occupation |
Daytime phone number |
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Priest |
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instructions. |
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Keep a copy for |
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Spouse’s signature. If a joint return, both must sign. |
Date |
Spouse’s occupation |
If the IRS sent you an Identity Protection |
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your records. |
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Teacher |
PIN, enter it |
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here (see inst.) |
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Paid |
Print/Type preparer’s name |
Preparer’s signature |
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Date |
Check |
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if |
PTIN |
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Preparer |
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Firm’s name |
SELF PREPARED |
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Firm's EIN |
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Use Only |
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Firm’s address |
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Phone no. |
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|
REV 12/01/11 TTMAC |
Form 1040 (2011) |
SCHEDULE A |
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ITEMIZED DEDUCTIONS |
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OMB No. |
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(Form 1040) |
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2011 |
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||
Department of the Treasury |
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|
Attach to Form 1040. |
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See Instructions for Schedule A (Form 1040). |
|
Attachment |
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Internal Revenue Service (99) |
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Sequence No. 07 |
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Name(s) shown on Form 1040 |
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Your social security number |
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John & Mary Poulos |
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Medical |
|
Caution. Do not include expenses reimbursed or paid by others. |
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1 |
Medical and dental expenses (see instructions) |
1 |
|
4,600. |
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and |
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2 |
Enter amount from Form 1040, line 38 |
2 |
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57,362. |
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Dental |
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3 |
Multiply line 2 by 7.5% (.075) |
3 |
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4,302. |
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Expenses |
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4 |
Subtract line 3 from line 1. If line 3 is more than line 1, enter |
. . |
. . . . . |
4 |
298. |
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Taxes You |
5 |
State and local (check only one box): |
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Paid |
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a |
Income taxes, or |
} |
. . . . . . . . . . . |
5 |
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b |
General sales taxes |
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6 |
Real estate taxes (see instructions) |
6 |
|
1,500. |
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7 |
Personal property taxes |
7 |
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8 |
Other taxes. List type and amount |
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8 |
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9 |
Add lines 5 through 8 |
. . |
. . . . . |
9 |
1,500. |
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Interest |
10 |
Home mortgage interest and points reported to you on Form 1098 |
10 |
|
15,000. |
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You Paid |
11 |
Home mortgage interest not reported to you on Form 1098. If paid |
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Note. |
|
to the person from whom you bought the home, see instructions |
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and show that person’s name, identifying no., and address |
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Your mortgage |
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interest |
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11 |
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deduction may |
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||
be limited (see |
12 |
Points not reported to you on Form 1098. See instructions for |
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instructions). |
|
special rules |
12 |
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|
13 |
Mortgage insurance premiums (see instructions) |
13 |
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|
14 |
Investment interest. Attach Form 4952 if required. (See instructions.) |
14 |
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||||||||
|
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, |
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||||||||
Charity |
|
see instructions |
16 |
|
3,500. |
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||||||||
If you made a |
17 |
Other than by cash or check. If any gift of $250 or more, see |
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|
||||||||
gift and got a |
|
instructions. You must attach Form 8283 if over $500 . . . |
17 |
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||||||||
benefit for it, |
18 |
Carryover from prior year |
18 |
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||||||||
see instructions. |
19 |
Add lines 16 through 18 |
. . |
. . . . . |
19 |
3,500. |
||||||||||
Casualty and |
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Theft Losses |
20 |
Casualty or theft loss(es). Attach Form 4684. (See instructions.) . |
. . |
. . . . . |
20 |
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Job Expenses |
21 |
Unreimbursed employee |
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|
||||||||
and Certain |
|
job education, etc. Attach Form 2106 or |
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|
|
||||||||
Miscellaneous |
|
(See instructions.) Deductible expenses from Form 2106 |
21 |
|
4,000. |
|
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|
||||||||
Deductions |
22 |
Tax preparation fees |
22 |
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||||||||
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23 |
Other |
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and amount |
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23 |
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24 |
Add lines 21 through 23 |
24 |
|
4,000. |
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||||||||
|
25 |
Enter amount from Form 1040, line 38 |
25 |
|
57,362. |
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|
|||||
|
26 |
Multiply line 25 by 2% (.02) |
26 |
|
1,147. |
|
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|
||||||||
|
27 |
Subtract line 26 from line 24. If line 26 is more than line 24, enter |
. . . . . |
27 |
2,853. |
|||||||||||
Other |
28 |
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|||||||||
Miscellaneous |
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Deductions |
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28 |
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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 |
|
OMB No. |
|||
(Form 1040) |
|
2011 |
|||
|
|
|
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||
|
|
|
|
|
|
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 |
|
Social security number of person |
|
|
|
John Poulos |
|
|
with |
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?
No
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 |
|
||
|
|||
tax on other earnings? |
|
||
|
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|
|
No |
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|
||
Are you using one of the optional methods to figure your net |
Yes |
||
earnings (see instructions)? |
|||
|
|||
|
|||
|
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|
|
No |
|
|
|
|
||
Did you receive church employee income (see instructions) |
Yes |
||
reported on Form |
|
||
|
|||
|
|
|
|
|
No |
|
|
|
|
|
No
Was the total of your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from
No
Did you receive tips subject to social security or Medicare tax that you did not report to your employer?
No
Did you report any wages on Form 8919, Uncollected Social Security and Medicare Tax on Wages?
Yes
Yes
Yes
You may use Short Schedule SE below
You must use Long Schedule SE on page 2
Section
1a |
Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule |
|
|
|
|
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 |
1b |
( |
) |
2 |
Net profit or (loss) from Schedule C, line 31; Schedule |
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|
box 14, code A (other than farming); and Schedule |
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|
Ministers and members of religious orders, see instructions for types of income to report on |
|
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|
|
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 |
|
|
|
|
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, |
|
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|
|
see instructions. |
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|
|
5 |
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|
• $106,800 or less, multiply line 4 by 13.3% (.133). Enter the result here and on Form 1040, line 56, |
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|
or Form 1040NR, line 54 |
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|
|
|
• 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
•$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 |
|
|
|
OMB No. |
|
|
|
|
|
|
Unreimbursed Employee Business Expenses |
|
|
|
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|
2011 |
||
|
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|
|
|
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 |
||
|
|
|
|
|
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
•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,
1
2
3
4
5
6
4,000.
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 |
. . |
. . . . |
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 |
No
No
No
No
For Paperwork Reduction Act Notice, see your tax return instructions. BAA
REV 11/22/11 TTMAC |
Form |
|
Charitable Organization Worksheet |
2011 |
G Keep for your records
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
Charity Name |
|
Holy Trinity Greek Orthodox Church |
|
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|
|||||||
Address |
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|
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|
||
City |
|
Heavens Gate |
|
State |
|
PA |
ZIP code |
|
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|
|||
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|
|
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|
||||
|
|
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|
|
Combined Amounts Worksheet |
|
|
|
|
||||
|
|
Note: Amounts entered in worksheets below will be summarized in this worksheet. |
|
|
|
||||||||
|
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|
|||||
|
|
Ref. No. |
Date |
Donation Description |
|
Donation Type |
Donation Amount |
|
1
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 |
|
|
||
|
|
|
|
|
|
Other Item Donations Worksheet |
|
|
|
|
Note: |
|
|
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 |
|
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|
|
|
Once |
|
Recur |
|
|
|
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|
|
Once |
|
Recur |
|
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|
|
Once |
|
Recur |
|
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|
|
|
|
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 |
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|||
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|
|
Other Costs |
|
|
Description of Other Costs |
|
Value of Miles |
Total Donation Value |
||
|
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|
|
|
|
|
|
Once
Recur
Once
Recur
Once
Recur
Charitable Organization Worksheet page 3 |
2011 |
||
John & Mary Poulos |
|
|
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:
X |
(a) 50% charity |
|
(b) Other than 50% charity |
No
No
No
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 |
|
|
|
|
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|
||
Last name |
Poulos |
|
|
|
|
|
|
|
|
|
|||
Social security no. |
|
|
|
|
|
|
|
||||||
Occupation |
Priest |
|
|
|
|
|
|
|
|
|
|||
Date of birth |
01/01/1950 (mm/dd/yyyy) |
||||||||||||
or age as of |
62 |
|
|
|
|
|
|
|
|
|
|
|
|
Daytime phone |
|
|
|||||||||||
Legally blind |
|
|
|
|
|
|
|
|
|
|
|
|
|
Date of death |
|
|
|
|
|
|
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|
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|
|
|
|
Dependent of Someone Else: |
|
|
|
|
|
|
|
|
|
||||
Can taxpayer be claimed as dependent of another |
|
|
|||||||||||
person (such as parent)? |
|
|
Yes |
|
X |
|
No |
||||||
If yes, was taxpayer claimed as dependent on that |
|
|
|||||||||||
person’s return? |
|
|
|
|
|
Yes |
|
|
|
|
No |
||
Credit for the Elderly or Disabled (Schedule R): |
|
|
|||||||||||
Is the taxpayer retired on total |
|
|
|
|
|
|
|
|
|
||||
and permanent disabilitY? |
|
|
Yes |
|
|
|
|
No |
Presidential Election Campaign Fund:
Does the taxpayer want $3 to go to the Presidential
Election Campaign Fund? |
|
Yes |
|
No |
Spouse:
First name |
Mary |
|
|
|
|
|
|
|
|
|
|||
Middle initial |
|
|
|
|
Suffix |
|
|
|
|
|
|
||
Last name |
Poulos |
|
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|
|
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|
|||
Social security no. |
|
|
|
|
|
|
|
||||||
Occupation |
Teacher |
|
|
|
|
|
|
||||||
Date of birth |
02/01/1950 (mm/dd/yyyy) |
||||||||||||
or age as of |
61 |
|
|
|
|
|
|
|
|
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|
|
Daytime phone |
|
|
|||||||||||
Legally blind |
|
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|
|
|
|
|
Date of death |
|
|
|
|
|
|
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|
|
Dependent of Someone Else: |
|
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|
|
|
|
|
|
|
||||
Can spouse be claimed as dependent of another |
|
|
|||||||||||
person (such as parent)? |
|
|
Yes |
|
X |
|
No |
||||||
If yes, was spouse claimed as dependent on that |
|
|
|||||||||||
person’s return? |
|
|
|
|
|
Yes |
|
|
|
|
No |
||
Credit for the Elderly or Disabled (Schedule R): |
|
|
|||||||||||
Is the spouse retired on total |
|
|
|
|
|
|
|
|
|
||||
and permanent disabilitY? |
|
|
Yes |
|
|
|
|
No |
|||||
Presidential Election Campaign Fund: |
|
|
|
|
|
|
|||||||
Does the spouse want $3 to go to the Presidential |
|
|
|||||||||||
Election Campaign Fund? |
|
|
Yes |
|
|
|
|
No |
Part II ' Address and Federal Filing Status (enter information in this section)
Address |
9 Archangels Highway |
|
|
|
|
|
|
Apt no. |
|
|
|||||
City |
Heavens Gate |
State |
PA |
ZIP code |
|
|
|
31240 |
|
||||||
Foreign province/county |
|
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|
|
Foreign |
postal |
code |
|
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||
Foreign code |
|
|
Foreign country |
|
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|
|
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 |
|
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|
|
If the ’qualifying person’ is your child but not your dependent: |
|
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||
|
|
|
Child’s name |
|
Child’s social security number |
|
|
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|
|
5 |
Qualifying widow(er) |
|
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|
|
|
|
|
|
Check the appropriate box for the year your spouse died |
2009 |
|
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||
|
|
|
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|
|
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
MI
Suff
Social security
number Relationship
Date of birth |
|
|
|
|
|
|
|||
(mm/dd/yyyy) |
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|||
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Qualified |
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Not |
|
child/dep |
|
Lived |
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C |
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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 |
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* "Yes" - qualifies as dependent, "No" - does not qualify as dependent
John & Mary Poulos |
|||
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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
Yes
Yes
No
No
No
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? |
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Yes |
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No |
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Do you want to elect direct debit of federal balance due (Electronic filing only)? |
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Yes |
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No |
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If you selected either of the options above, fill out the information below: |
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Name of Financial Institution (optional) |
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Check the appropriate box |
Checking |
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Savings |
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Routing number |
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Account number |
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Enter the following information only if you are requesting direct debit of balance due: Enter the payment date to withdraw from the account above
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
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
Yes
Yes
USA
No
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
Third Party Designee: |
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Caution: Review transferred information for accuracy. |
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Do you want to allow another person to discuss this return with the IRS? |
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Yes |
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If Yes, complete the following: |
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Third party designee name |
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Third party designee phone number |
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Personal Identification number (enter any 5 |
numbers) |
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If you are entitled to a filing extension or other disaster relief provision as declared by the IRS, |
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enter the appropriate information (see Help) |
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No
John & Mary Poulos |
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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
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 |
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Middle initial |
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Last name |
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Poulos |
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Social security no. |
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Member of U.S. Armed Forces in 2011? |
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Yes |
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X |
No |
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Date of birth |
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01/01/1950 |
(mm/dd/yyyy) |
age as of |
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62 |
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Occupation |
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Priest |
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Daytime phone |
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Ext |
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Marital status |
Married |
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If widowed, check the appropriate box for the year your spouse died: |
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After 2011 |
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2011 |
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2010 |
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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
Before 2009
Yes
(mm/dd/yyyy)
Yes
No
No
Do you want $3 to go to Presidential Election Campaign Fund?
Yes
No
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
4Did your earned income exceed
Yes
Yes
Yes
Yes
Yes
X
No
No
No
No
No
Part III ' Taxpayer's State Residency Information
Enter this person’s state of residence as of December 31, 2011 |
PA |
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Check the appropriate box: |
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This person is a resident of the state above for the entire year |
X |
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This person is a resident of the state above for only part of year |
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Date this person established residence in state above |
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In which state (or foreign country) did this person reside before this change? |
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Part IV ' Dependent Care Expenses |
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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 |
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Middle initial |
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Last name |
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Poulos |
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Social security no. |
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Member of U.S. Armed Forces in 2011? |
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Yes |
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X |
No |
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Date of birth |
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02/01/1950 |
(mm/dd/yyyy) |
age as of |
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61 |
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Occupation |
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Teacher |
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Daytime phone |
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Ext |
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Marital status |
Married |
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If widowed, check the appropriate box for the year your spouse died: |
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After 2011 |
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2011 |
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2010 |
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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
Before 2009
Yes
(mm/dd/yyyy)
Yes
No
No
Do you want $3 to go to Presidential Election Campaign Fund?
Yes
No
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
4Did your earned income exceed
Yes
Yes
Yes
Yes
Yes
X
No
No
No
No
No
Part III ' Spouse's State Residency Information
Enter this person’s state of residence as of December 31, 2011 |
PA |
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Check the appropriate box: |
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This person is a resident of the state above for the entire year |
X |
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This person is a resident of the state above for only part of year |
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Date this person established residence in state above |
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In which state (or foreign country) did this person reside before this change? |
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Part IV ' Dependent Care Expenses |
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Qualified dependent care expenses incurred and paid for this person in 2011
Form 1040 |
Forms |
2011 |
G Keep for your records
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
Form
Box No. |
Description |
Taxpayer |
Spouse |
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Total |
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1 |
Total wages, tips and compensation: |
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59,540. |
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59,540. |
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Statutory wages reported on Schedule C |
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Foreign wages included in total wages |
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Unreported tips |
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2 |
Total federal tax withheld |
0. |
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0. |
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3 |
& 7 Total social security wages/tips |
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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
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
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. |
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35,000. |
16Total state wages and tips
17Total state tax withheld
19Total local tax withheld
Form
Wage and Tax Statement
G Keep for your records
2011
Name
John Poulos
Social Security Number
Spouse’s |
Military: Complete Part VI on Page 2 below |
Do not transfer this |
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a Employee’s social security No |
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b Employer’s ID number |
cEmployer’s name, address, and ZIP code
Holy Trinity Greek Orthodox Church
Street |
12 |
Apostles Circle |
City |
Heavens Gate |
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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
9
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
14Enter box 14 below after entering boxes 18, 19, and 20. NOTE: Enter box 15 before entering box 14.
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Box 12 |
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Box 12 |
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If Box 12 code is: |
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Code |
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Amount |
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A: |
Enter amount attributable to RRTA Tier 2 tax |
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M: |
Enter amount attributable to RRTA Tier 2 tax |
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P: |
Double click to link to Form 3903, line 4 |
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R: |
Enter MSA contribution for |
Taxpayer |
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Spouse |
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W: Enter HSA contribution for |
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Spouse |
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G: |
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Employer is not a state or local government |
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Box 15 |
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Box 16 |
Box 17 |
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Employer’s state I.D. no. |
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State wages, tips, etc. |
State income tax |
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PA |
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89088902841 |
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Box 20 |
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Box 18 |
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Box 19 |
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Associated |
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Locality name |
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Local wages, tips, etc. |
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Local income tax |
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Box 14 |
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TurboTax Identification of Description or Code |
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Description or Code |
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(Identify this item by selecting the identification from |
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on Actual Form |
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Amount |
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the drop down list. If not on the list, select Other). |
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HOUSING ALLOWANCE |
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35,000.00 |
Other (not classified) |
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Form
Additional Wage and Tax Information
G Keep for your records
2011
Name
John Poulos
Employer’s Name |
Holy Trinity Greek Orthodox Church |
ADDITIONAL INFORMATION
Part I Foreign Income
1
The income reported on this
Part II Electronic Filing
Complete if you are filing this return electronically.
2 a This
bThis
Part III Statutory Employees
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Complete if box 13 Statutory employee box is checked. |
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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
Part IV Dependent Care Benefits
Complete if box 10 of this
5Did this employer hire an
your workplace? |
Yes |
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No |
6Enter any amounts forfeited from a flexible spending account
Part V Clergy, Church Employees, Members of Recognized Religious Sects
Complete if this
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
d Pay
eX Pay
f Exempt from SE tax and have an approved exemption Form 4361
If no FICA was withheld, check box a or b below as appropriate
8 a Pay
bExempt from SE tax and have an approved exemption Form 4029
Part VI |
Military |
9 a Active duty military pay
b
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
e Tips paid out by you through a
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 |
2011 |
G Keep for your records
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
Ownership: |
Check if Spouse |
(defaults to taxpayer) |
Check if Joint |
X
Payer’s name |
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Saintly Bank and Trust |
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Box 1 |
Interest income for 2011 (not included in box 3) |
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500.00 |
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Choose type if special state handling (State Use Only ' see Help). |
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Box 2 |
Early withdrawal penalty |
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Box 3 |
Interest on U.S. Savings Bonds and Treasury obligations |
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Box 4 |
Federal income tax withheld |
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State income tax withheld |
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State ID |
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Box 5 |
Investment expenses |
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Box 6 |
Foreign tax paid (All interest is considered passive. See Help) |
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a Check to deduct foreign taxes on Schedule A |
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OR |
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b DoubleClick to link to a copy of Form 1116 |
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c For Form 1116, select which column |
A |
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dForeign source amount included in interest
Box 7 |
Foreign country or U.S. possession |
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Check this box if foreign tax is from a mutual fund or a registered |
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investment company. See Tax Help for additional information. |
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Box 8 |
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For each row, enter state ID in column (a) and enter percent in column (b) or amount in column (c).
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(a) |
(b) |
(c) |
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State |
Percent of |
Amount of |
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or |
total |
interest |
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Territory |
interest |
for |
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ID |
for state |
state |
Enter resident state ID |
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Enter XX for all nonresident states (recommended) |
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or |
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Enter each nonresident state on separate row |
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Total |
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State ID |
where exempt interest was earned. If more than 1 state, see Help |
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Box 9 |
Specified private activity bond included in Box 8 subject to AMT, if any |
OR |
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Private activity bond interest percentage of Box 8, if any |
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% |
Box 10
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
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
2Miscellaneous income, from Form 8919
3 Items from Form
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
8 Items not on Form
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
9Other earned income
Form
10Subtotal.
Add lines 1 through 9
11Taxable
12Taxable
13Scholarship/fellowship income not on Form
14Other
|
Taxpayer |
|
Spouse |
Total |
|||||
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|
59,540. |
|
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59,540. |
||
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4,000. |
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4,000. |
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63,540. |
|
63,540. |
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15 Total of lines 10 through 14
63,540.
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
1Prescription medications
2Health insurance premiums: a From Form(s)
b For medical care, other than
NOTE: If LTC premiums are associated with a specific business activity, enter them directly on the applicable
d |
Taxpayer’s gross |
2 d |
e |
Taxpayer’s allowable |
e |
f |
Spouse’s gross |
f |
g |
Spouse’s allowable |
g |
h |
Dep or child under 27 gross |
h |
i |
Dep or child under 27 allowable |
i |
jTotal allowable
kTaxpayer’s
n
3Fees for doctors, dentists, etc
4 Fees for hospitals, clinics, etc
5 Lab and
6 Expenses for qualified
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 |
d |
eOther medical transportation costs not included above
for example: ambulance fees |
e |
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)
1
2a b c
j k l m n 3 4 5 6 7 8
9f
10
11a b c d e f g h i j
12
13a
b
14
3,000.00
1,600.00
4,600.00
4,600.00
Tax Payments Worksheet |
2011 |
G Keep for your records
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
Estimated Tax Payments for 2011 (If more than 4 payments for any state or locality, see Tax Help)
|
Federal |
|
State |
|
|
Local |
|
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|
Date |
Amount |
Date |
Amount |
ID |
Date |
Amount |
ID |
1 |
04/18/11 |
|
4,000. |
04/18/11 |
|
|
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|
04/18/11 |
||
2 |
06/15/11 |
|
4,000. |
06/15/11 |
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06/15/11 |
||
3 |
09/15/11 |
|
4,000. |
09/15/11 |
|
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09/15/11 |
||
4 |
01/17/12 |
|
4,000. |
01/17/12 |
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01/17/12 |
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5 |
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Tot Estimated |
16,000. |
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Payments |
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Tax Payments Other Than Withholding |
Federal |
State |
ID |
Local |
ID |
||||
(If multiple states, see Tax Help) |
|
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|
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 |
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10 Forms |
|
0. |
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11Forms
12Forms
13Forms
14Schedules
15Forms
16 |
Social Security and Railroad Benefits |
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17 |
|
Form |
St |
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Loc |
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18 a |
Other withholding |
St |
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Loc |
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b |
Other withholding |
St |
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Loc |
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c |
Other withholding |
St |
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Loc |
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d |
Positive Adjustment |
St |
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Loc |
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e |
Negative Adjustment |
St |
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Loc |
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19 |
|
Total Withholding Lines 10 through 18e |
|||||||||
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0. |
||||
20 |
|
Total Tax Payments for 2011 |
|
16,000. |
Prior Year Taxes Paid In 2011 |
State |
ID |
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)
ID
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
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:
(1) S t a t e
(2)
Date
Lived in
State
From
(3)
Date
Lived in
State
To
(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)
ST
(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 |
X |
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: |
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b
d Add lines 3a through 3c (to Schedule A, line 7)
4Other taxes:
aOther taxes from Schedule(s)
bForeign taxes from interest and dividends c Foreign taxes from Schedule(s)
d Other foreign taxes (not used to claim a foreign tax credit) e Other taxes.
2010 Amount |
Enter 2011 description: |
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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
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 |
X
No
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
|
Name of Charitable Organization |
Type |
2011 Amount |
||
|
Note: Summarized from the Charitable Organization Worksheet. |
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|
Enter amounts on the Charitable Organization Worksheet. |
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||
1a Holy Trinity Greek Orthodox Church |
|
A |
3,500.00 |
||
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2 |
From Schedule |
2 |
3 |
From Form(s) |
3 |
4Miles driven:
a To perform charitable service |
4a |
bFrom Detail of Mileage and Transportation Costs Worksheet
|
above |
4b |
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|||
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c Add lines 4a and 4b |
4c |
|
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d Multiply line 4c by 14 cents per mile |
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4d |
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5 |
Parking fees, tolls, and local transportation |
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a To perform charitable service |
5a |
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b From Charitable Org. Wks |
5b |
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c Add lines 5a and 5b. |
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5c |
|
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6 |
Add lines 1 thru 5 and enter here (to Schedule A, line 16) |
6 |
|
3,500.00 |
||||
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Charitable Contributions Summary |
|
2011 |
|
|||||||||||||
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G Keep for your records |
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||||||
Name(s) Shown on Return |
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Social Security Number |
|||||||||
John & Mary Poulos |
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Cash Contributions Summary |
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||||
Part I |
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(a) |
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(b) |
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(c) |
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(d) |
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||
|
Name of Charitable Organization |
|
Total |
|
50% |
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30% |
|
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RESERVED |
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||||
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Limit |
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Limit |
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for future |
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use |
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Holy Trinity Greek Orthodox Church |
|
3,500. |
|
3,500. |
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Totals: |
|
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3,500. |
|
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3,500. |
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|||||
Part II |
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||||||
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|
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Total |
|
|
Other Property |
Capital Gain Property |
|||||||||
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|||
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(a) |
|
|
(b) |
(c) |
(d) |
|
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(e) |
|||||
|
Name of Charitable Organization |
Total |
50% |
|
|
30% |
|
|
30% |
20% |
|
||||||||
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Limit |
Limit |
Limit |
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Limit |
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Totals:
Part III Contribution Carryovers to 2012
|
|
|
Total |
|
Cash and Other |
|
|
Capital Gain |
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Property |
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|
(a) |
(b) |
|
(c) |
(d) |
|
(e) |
(f) |
|||||
|
|
|
Total |
RESERVED |
50% |
|
|
30% |
30% |
|
|
20% |
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|
Limit |
Limit |
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Limit |
Limit |
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|
1 |
2011 contributions |
3,500. |
|
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|
3,500. |
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2 |
2011 contributions |
3,500. |
|
|
3,500. |
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|
0. |
0. |
|
|
0. |
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allowed |
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3 |
Carryovers from: |
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a 2010 tax year |
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b 2008 tax year |
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c 2007 tax year |
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d 2006 tax year |
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e 2005 tax year |
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4 |
Carryovers |
0. |
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0. |
|
0. |
|
0. |
|
0. |
5 |
allowed in 2011 |
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|||||||
Carryovers |
0. |
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|
0. |
|
0. |
0. |
|
0. |
|||
|
disallowed in 2011 |
|
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|
|
6Carryovers to 2012:
a From 2011 |
0. |
|
0. |
0. |
|
0. |
0. |
||
b From 2010 |
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|
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|
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?
X
Yes
Yes
Yes Yes
No
XNo
XNo
XNo
Earned Income Worksheet |
2011 |
G Keep for your records
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
Part I ' Earned Income Credit Wks Computation |
Taxpayer |
Spouse |
Total |
1If filing Schedule SE:
a Net |
94,540. |
|
|
|
94,540. |
bOptional Method and Church Employee income
c |
Add lines 1a and 1b |
94,540. |
|
|
|
94,540. |
d |
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
of that Schedule C or
4 Add lines 1e, 2c and 3. To EIC Wks, line 5 |
87,862. |
|
|
|
87,862. |
Part II ' Form 2441 and Standard Deduction Worksheet Computations
5 Net |
87,862. |
6Wages, salaries, and tips less distributions
from nonqualified or section 457 plans, etc |
0. |
7Taxable
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
12 SE exempt earnings less nontaxable income |
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.
0.
87,862.
87,862.
56,862.
15Net
16Wages, salaries, tips, etc
17Net
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
23
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
(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
Part I |
Farm Profit or (Loss) Schedule SE, line 1 |
1Total Schedules F
2Farm partnerships, Schedules
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
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
3 Forms 6781
4 Other SE income reported as income on Form 1040, line 7
5 a |
Clergy Form |
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
4 Other gross farming or fishing
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
4 Other gross nonfarm
5 Total gross income for Nonfarm Optional Method
John & Mary Poulos |
Page 2 |
||
|
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|
Schedule SE Worksheet
?For purposes of calculating the
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
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
J
KDeduction for
LSubtract line K from line J for adjustment difference
Taxpayer |
Spouse |
87,308.
13,358.
6,679.
6,679.
6,678.
1.
Federal Carryover Worksheet |
2011 |
G Keep for your records
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
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 |
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Totals
(g)
Applied Amount
Other Tax and Income Information |
|
|
|
|
|
2010 |
|
|
2011 |
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1 |
Filing status |
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1 |
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2 MFJ |
|
2 MFJ |
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2 |
Number of exemptions for blind or over 65 (0 - 4) |
|
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2 |
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3 |
Itemized deductions |
|
|
|
3 |
|
23,124. |
|
|
23,151. |
|||||||||
4 |
Check box if required to itemize deductions |
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4 |
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5 |
Adjusted gross income |
|
|
|
5 |
|
57,643. |
|
|
57,362. |
|||||||||
6 |
Tax liability for Form 2210 or Form |
|
|
|
6 |
|
15,239. |
|
|
14,786. |
|||||||||
7 |
Alternative minimum tax |
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7 |
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8 |
Federal overpayment applied to next year estimated tax |
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8 |
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QuickZoom to the IRA Information Worksheet for IRA information |
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Excess Contributions |
|
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2010 |
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2011 |
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9 a |
Taxpayer’s excess Archer MSA contributions as of 12/31 |
|
9 a |
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b Spouse’s excess Archer MSA contributions as of 12/31 |
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b |
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10 a |
Taxpayer’s excess Coverdell ESA contributions as of 12/31 |
|
10 a |
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b Spouse’s excess Coverdell ESA contributions as of 12/31 |
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b |
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11 a |
Taxpayer’s excess HSA contributions as of 12/31 |
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11 a |
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b Spouse’s excess HSA contributions as of 12/31 |
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b |
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Loss and Expense Carryovers |
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2010 |
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2011 |
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Note: Enter all entries as a positive amount |
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12 a |
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12 a |
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b AMT |
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13 a |
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13 a |
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b AMT |
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14 a |
Net operating loss available to carry forward |
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14 a |
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b AMT Net operating loss available to carry forward |
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15 a |
Investment interest expense disallowed |
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15 a |
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b AMT Investment interest expense disallowed |
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b |
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16 |
Nonrecaptured net Section 1231 losses from: |
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a |
2011 |
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16 a |
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b |
2010 |
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b |
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c |
2009 |
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c |
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d |
2008 |
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d |
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e |
2007 |
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e |
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f |
2006 |
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f |
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Federal Carryover Worksheet page 2 |
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2011 |
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John & Mary Poulos |
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Loss and Expense Carryovers (cont’d) |
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17 |
AMT Nonrecap’d net Sec 1231 losses from: |
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a |
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2011 |
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17 a |
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Credit Carryovers |
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2011 |
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18 |
General business credit |
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18 |
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19 |
Mortgage interest credit from: |
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a |
2011 |
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19 a |
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b |
2010 |
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b |
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c |
2009 |
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c |
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d |
2008 |
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d |
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20 |
Credit for prior year minimum tax |
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20 |
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21 |
District of Columbia |
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21 |
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22 |
Residential energy efficient property credit |
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22 |
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Other Carryovers |
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2010 |
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2011 |
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23 |
Section 179 expense deduction disallowed |
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23 |
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24 |
Excess |
a |
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Taxpayer (Form 2555, line 46) |
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24 a |
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foreign |
b |
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Taxpayer (Form 2555, line 48) |
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b |
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housing |
c |
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Spouse (Form 2555, line 46) |
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c |
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deduction: |
d |
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Spouse (Form 2555, line 48) |
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d |
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Charitable Contribution Carryovers |
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25 |
2010 Carryover of |
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Other Property |
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|
Capital Gain |
||||||||||||||
|
charitable contributions |
|
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|
|
|
|
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|
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|
|
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|
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|
||||
|
|
|
(a) 50% |
|
|
|
|
|
(b) 30% |
|
|
|
(c) 30% |
|
|
(d) 20% |
||||||||||
|
from: |
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|
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|
|||||||||
a |
2010 |
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||
b |
2009 |
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|
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|
|
|
|
|
|
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c |
2008 |
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d |
2007 |
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e |
2006 |
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26 |
2011 Carryover of |
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|
Other Property |
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|
|
Capital Gain |
||||||||||||||
|
charitable contributions |
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||||
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|
(a) 50% |
|
|
|
|
|
(b) 30% |
|
|
|
(c) 30% |
|
|
(d) 20% |
||||||||||
|
from: |
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|
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
ID
AMT |
AMT |
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 |
|
|
|
|
|
|
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|
Form 2106 |
Form 2106 Adjustments Worksheet |
2011 |
Lines 4, 7, 10 |
G Keep for your records |
|
Your Name
John Poulos
Social Security Number
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
1
2
3
4
5
6
4,000.
7Total other business expenses. Add lines 1 through 6. Carries to Form 2106, line 4
7
4,000.
Line 7 ' Allocation of Employer Reimbursements
8Reimbursements that were not reported in box 1 of Form
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
8
9
10
11
12
13
14
15
16
17
18
19
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)
23
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)
20
21
22
23
24
4,000.
4,000.
2011 |
Name(s) Shown on Return
John & Mary Poulos
Social Security Number
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. |
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
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. |
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
Income tax |
|
3,246. |
|
3,174. |
|
|
|
|
|||
Additional income taxes |
|
|
|
|
|
|
|
|
|
|
|
Alternative minimum tax |
|
|
|
|
|
|
|
|
|
|
|
Total Income Taxes |
|
3,246. |
|
3,174. |
|
|
|
|
|||
Nonbusiness credits |
|
|
|
|
|
|
|
|
|
|
|
Business credits |
|
|
|
|
|
|
|
|
|
|
|
Total Credits |
|
|
|
|
|
|
|
|
|
|
|
|
12,793. |
|
11,612. |
|
|
|
|
||||
Other taxes |
|
|
|
|
|
|
|
|
|
|
|
Total Tax After Credits |
|
16,039. |
|
14,786. |
|
|
|
|
|||
Withholding |
|
|
|
|
|
|
|
|
|
|
|
Estimated and extension payments |
|
16,000. |
|
16,000. |
|
|
0. |
|
|
0.00 |
|
Earned income credit |
|
|
|
|
|
|
|
|
|
|
|
Additional child tax credit |
|
|
|
|
|
|
|
|
|
|
|
Other payments |
|
800. |
|
|
|
|
|
|
|||
Total Payments |
|
16,800. |
|
16,000. |
|
|
|
|
|||
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 |
|
|