The URL can be used to link to this page

Home My WebLink About05-27-14 J {�y 1505610105 REV-1500 Ex(e'-11)IN),j!j1 ��s111177 OFFICIAL USE ONLY Department of Revenue P?mm�sylvartia Bu County Code Year File Number Bureau of Individual Taxes PO BOX 28o6o1 INHERITANCE TAX RETURN I�II LE r,, 1 n, �-•� Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of_Birth MMDDYYYY __�� 02/25/2014 02/15/1915 Decedent's Last Name - Suffix Decedent's First Name MI LINE _T !HENRY �1 (If Applicable)Enter Surviving Spouse's Information Below; ' Spouse's Last Name (Suffix—� Spouse's First Name �—MII LINE I CONSTANCE � B ' Spouse's Social Security Number u THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) OD 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust B. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES LEWIS PROCTOR, JR. 11(717)559-012 }' —c s—aa m REGISTER OF'�WI� S USE Otit)' ri O 1J r-r1 'ro n -t n First Line of Address r-J r i r\3 111-1 b 35 EAST HIGH STREET > o Second Line of Address u CD O _� -Tr1 SUITE 202 'T� t� m w—.__-_ —..-.� pgTE FILED City or Post Office State ZIP Code -_ CJT CARLISLE 771 PA 17013 Correspondent's e-mail address:LEGAL @JAMESPROCTORLAW.COM Under penalties of perjury,I de that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complF;<e.Decl er other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSO E FOR (LING RETURN DATE 05/23/2013 ADDRESS 283 OLD STONE HOUSE ROAD SOUTH, MECHANICSBURG, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 7 L 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: HENRY LINE [ RECAPITULATION 1. Real Estate(Schedule A). ..... ......... ........ 1. OM 2. Stocks and Bonds(Schedule B) ... . . ... ...... ...... .. .... .. ... ... ... .. 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 10,943.82 4. Mortgages and Notes Receivable(Schedule 0) ... ... ...... ... ... ... ..... . 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)...... 5, 2,659.89 6. Jointly Owned Property(Schedule F) COD Separate Billing Requested ...... . 6, 16,684.10 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) Q1ID Separate Billing Requested........ 7. 86,724.66 8. Total Gross Assets(total Lines 1 through 7).. ... . .. .. . 117,012.47 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 10,945.01 10 Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)- 10. 1,138.42 It- Total Deductions(total Lines 9 and 10)..... .. ..... ......... ........ 11.. 12,083.43 12. Net Value of Estate(Line 8 minus Line 11) .... ..--.................... 12. 104,929.04 13. Charitable and Governmental Bequests/Sec:9113 Trusts for which an election to tax has not been made(Schedule J) . . .. ... . .. ... ...... .. . .4 13. 0.00 14. Not Value Subject to Tax(Line 12 minus Line 13) --- ...... ..... 14. 104,929.04 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE PATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec-9116 (a)(1.2)X.0000 18,204.38 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 86,724.66 16, 3,468.99 17, Amount of Una 14 taxable at sibling rate X.12 t 17. 18. Amount of Line 14 taxable at collateral rate X.15 19. TAX DUE ... ....... . ... ... . . . ... ... ... . ... .. ... .. . .. .. ... . 3,468.99 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C:) Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME HENRY LINE STREETADDRESS 283 OLD STONEHOUSE ROAD SOUTH CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 3,468.99 2. CrediWPayments A.Prior Payments 0.00 B.Discount 173.45 3. Interest Total Credits(A+B) (2) 173.45 4. ft Urre 2 is greater than line 1+Line 3,enter the difference. This is the OVERPAYMENT. (3) 0,00 Fitt In oval on Page 2,Line 20 to request a refund. (4) 5. If Une 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 3,295.54 Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN 'X' IN THE APPROPRIATE BLOCKS t. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.................................................................................__.... ❑ E b. retain the right to designate who shall use the property transferred or its income........___.....................___ ❑ ■ c. retain a reversionary interest .............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or pre?...................................................................... ❑ 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.................................................................__....................................... E ❑ 1 Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ N 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? .... ____....................................____..............................___............... ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE C AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)). • The tax rate imposed on the net value of transfers to or for the use of the deoedents lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV.%So4 EX+tq.n) �,r j pennsylvania 'SCHEDULE C y� DEPARTMEMOFnEVWUE CLOSELY-HELD CORPORATION, INHERITANCE TAX RETURN PARTNERSHIP OR RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER HENRY LINE 2014-00349 Schedule Cd or C-2(including all supporting Information)must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VAWE AT DATE NUMBER DESCRIPTION OF DEATH 1. i Line 8 Line Jewelers r 10,943.82 2 Multi-Nall Diamonds,Inc. 0.00 '-- 3 Henry Line Watch Repair 0 OQ -1 TOTAL (Also enter on line 3, Recapitulation) $ "„ 10,943.82 (If more space is needed,insert additional sheets of the same size) REV-1505 EX+(11-11) i]pennsylvania SCHEDULE C-1 ' DEPARTMENTOFREVENUE CLOSELY-HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY LINE 2014-00349 1, Name of Corporation MULTI-NATIONAL DIAMOND,INC. State of Incorporation PA Address 21 DICKINSON AVE Date of incorporation 05122t00 City CARLISLE State PA ZIP Cade 1 013 Total Number of Shareholders 1 2. Federal Employer ID Number 25-1888128 Business Reporting Year 2011 3. Type of Business RETAIL Product/Service JEWELRY SALES AND REPAIR 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK votinglNor vcung SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ 0 Preferred $ 0 Provide all rights and restrictions pretaining to each class of stock. S. Was the decedent employed by the corporation? .... ......... . .............. .. .... 0 Yes 0 No If yes, Position JEWELER Annual Salary $ 0 Time Devoted to Business 100 8. Was the corporation indebted to the decedent? .......... ....... .......... ... .. ... 0 Yes a No If yes,provide amount of indebtedness$ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . , .. 0 Yes CK No If yes,Cash Surrender Value$ Net proceeds payable$ Owner of the policy S. Did the decedent self or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? 0 Yes IM No If yes, 0 Transfer 0 Sale Number of Shares .Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....0 Yes 9 No If yes,provide a copy of the agreement. 10.Was the decedent's stock sold? ..................................................... 0 Yes ®No If yes,provide a copy of the agreement of sale,etc. 11. Was the corporation dissolved or liquidated after the decedews death? .................... 0 Yes N No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . ... . . . . . . 0 Yes ® No U yes,report the necessary information on a separate sheet,including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or federal corporate income tax returns(Form 1120)for the year of death and four preceding years. C, If the corporation owned real estate,submit a list showing the complete address/es and estimated fair market value/s.N real estate appraisals have ' been secured,attach copies. D. List of principal stockholders at the date of death,number of shares held and their relationships to the decedent. E. List of officers,their salaries,bonuses and any other benefits received from the corporation. F. Statement of d'mdends paid each year.List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (11 more space is needed,insert additional sheets of the same size.) REV-1506 EX+(12-11) �pennsylvania SCHEDULE C-2 DEPARTMENT OF REVENUE PARTNERSHIP INNERMOICE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY LINE 2014-00349 1. Name of Partnership LINE 8 LINE JEWELERS Date Business Commenced 01/01108 Address 283 OLD STONE HOUSE ROAD SOUTH Business Reporting Year 2013 City CARLISLE State—RA_„_zip code 17055 2. Federal Employer ID Number 3. Type of Business RETAIL Product/Service JEWELRY 4. Decedent was a 0 General d Limited partner. If decedent was a limited partner,provide initial investment$ 5• PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT A. HENRY LINE 100 100 10,943.82 B. C. D. 6. Value of the decedent's interest$ 10 943.82 7. Was the partnership indebted to the decedent? . . . .. . . . . . .... . . . . . .. .. . . . . . .. . . . .. ❑ Yes la No If yes,provide amount of indebtedness$ 8. Was there life insurance payable to the partnership upon the death of the decedent? ...... ❑ Yes N No If yes,Cash Surrender Value$ Net proceeds payable$ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? 0 Yes III No If yes, ❑Transfer 0 Sale Percentage transferred/sotd Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 10.Was there a written partnership agreement in effect at the time of the decedent's death? ...... ❑Yes 9 No If yes,provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ......................................... O Yes ®No It yes,Provide a copy of the agreement of sale,etc. - 12.Was the partnership dissolved or liquidated after the decedent's death? .................... ❑Yes ® No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 13.Was the decedent related to any of the partners? ...................................... ❑Yes ®No If yes,explain 14.Did the partnership have an interest in other corporations or partnerships?............... ❑Yes ®No It yes,report the necessary information on a separate sheet,including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION r WITH THIS SCHEDULE A. Detailed catculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or federal partnership income tax returns(Form 1065)for the year of death and four preceding years. C. if the partnership owned real estate,submit a list stowing the complete addresses and estimated fair market values,if real estate appraisals have been secured,attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1506 EX+(12-11) [ipennsylvania SCHEDULE C-2 ' DEPARTMENT OF REVENUE PARTNERSHIP INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY LINE 2014-00349 1. Name of Partnership HENRY LINE WATCH REPAIR Date Business Commenced 01/01112 Address 263 OLD STONE HOUSE ROAD SOUTH Business Reporting Year 2012 City CARLISLE State_pg„_ZIP Code 17055 2. Federal Employer ID Number 3. Type of Business RETAIL ProducUService WATCH REPAIR 4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner,provide initial investment$ 5. PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT A. HENRY LINE 100 100 0.00 B. C. D. 6. Value of the decedent's interest$ 0.00 7. Was the partnership indebted to the decedent? . . . . . ... . . . . . . . . .. . . . . . .. . . . . . . . . . . 0 Yes N No If yes,provide amount of indebtedness S 8. Was there life insurance payable to the partnership upon the death of the decedent? ...... 0 Yes 0 No If yes,Cash Surrender Value$ Net proceeds payable$ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12.31-82? 0 Yes 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold Transferee or Purchaser Consideration$ Date Attach a separate shoat for additional transfers and/or sales. 10.Was there a written partnership agreement in effect at the time of the decedent's death? ...... 0 Yes 0 No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ......................................... 0 Yes 0 No If yes,provide a copy of the agreement of sale,etc. 12.Was the partnership dissolved or liquidated after the decedent's death? .................... 0 Yes 10 No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 13,Was the decedent related to any of the partners? ...................................... 0 Yes 0 No If yes, explain 14.Did the partnership have an interest in other corporations or partnerships?. ........ 0 Yes 0 No If yes,report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or federal partnership income tax returns(Form 1065)for the year of death and four preceding years. C. if the partnership owned real estate,submit a list showing the complete addresses and estimated fair market values.If real estate appraisals have been seared,attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-x508 EX+(o8-iz) rq]pennsylvania SCHEDULE E �a DEPARTMENT OF REVENUE CASH, SANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HENRY LINE 2014-00349 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. mm VALUE AT DATE NUMBER DESCRIPTION _- OF DEATH 1.i 'Savings account balance 2,659.89 _. 4 � 4 I + IF I Z . TOTAL(Also enter on Line 5, Recapitulation) $ (2,659.89 If more space is needed,use additional sheets of paper of the same size. REV-agog EX+(oT-io) _rry pennsylvania SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HENRY LINE 2014-00349 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING]DINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A ICONSTANCE B. LINE OLD STONE HOUSE ROAD SOUTH SPOUSE i MECHANICSBURG,PA 17055 C. r—^-- r JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTnUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DKEDENPS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FOR JOINTLY HUD REAL E STATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. f12/0� 7/93 Single-family house,191 Ridge Drive,Mechanicsburg,PA(foreclosed) 1 — — 00 501 0.00 ` �� ---1 1 2 1 A. 1 1 - Bank aDCOUnf,M&T Bank 31,39424 I 50 15,697.10 L_ s t�_J 3 A. 0 1101/00 1999 Mercury Sable 1,573.001 50 1 887.00 4' t A ! I04115185 Furniture 50 !f' 100.00 ❑ ❑ - �� ❑ ❑ ❑ �,� ❑ w o ❑ ❑� ❑ ❑ ❑ ❑ ❑ _ El Q ❑ � ❑ ❑ C ❑ El ❑ � - TOTAL(Also enter on Une 6, Recapitulation) 1$ 16,684.10 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) i pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND RESIDENT DE EDENTT1RN MISC. NON-PROBATE PROPERTY RESIDENT DKEDENT ESTATE OF FILE NUMBER HENRY LINE 2014-00349 This schedule must be completed and riled if the answer to any of questions I through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY INaw r NARE OF THE ruu,sFEAEE,TIEM A TIT PTo DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRAN4EA MACH A CORY OF THE DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST IF AFFUU VALUE 1. Cash,Peggy Sue SOUtner,Date of transfer 08/01/2013 86,724.66 0 3,500.00 86,724.66 TOTAL(Also enter on Line 7, Recapitulation) ; 86,724.66 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) -J-A%7.- SCHEDULE H Q DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDEW ' ESTATE OF FILE NUMBER HENRY LINE 2014-00349 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' 'Cmafion � y1,-850.00 L Dean:certificates 72.00 E3 C ro Doer s authorization 30.00 4 'Obituary Obituary-Carlisle Sentinel 536.00 Obituary-Patriot News 23.52 ' B. ADMINISTRATIVE COSTS: I. Personal Representative Commissions: 700 Name(s)of Personal Representative(s) PEGGY SUE SOUTNER Street address 283 OLD STONE: HOUSE ROAD SOUTH City MECHANICSBURG w state PA Zip 17055 Year(s)Commission Paid: N/A , 2. Attorney Fees: - - ' .2,264.99 3. Family Exemption:(if decedent's address is not the same as daimant's,attach explanation.)- ' 3,500.00 claimant PEGGY SUE SOUTNER Street Address 283 OLD STONE HOUSE ROAD SOUTH city MECHANICSBURG state PA Zip 17055 Relationship of Claimant to Decedent DAUGHTER C N .Probate Fees; 168.50 s. Accountant Fees: 1,500.00 6• Tax Return Preparer Fees: 7 TOTAL(Also enter on Line 9, Recapitulation) $ 10,945.01 If more space is needed,use additional sheets of paper of the same size. , REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HENRY LINE 2014-00349 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. Electric utility bill 684.70 2 Heating oil bill 453.72 i i { t I � r 1 TOTAL(Also enter on Line 10, Recapitulation) $ 1,138.42 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) zj pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HENRY LINE 2014-00349 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY DO Not List Trustee(sj OF ESTATE _ I TAXABLE DISTRIBUTIONS(Indade outright spousal distributions and transfers under Sec.9116(a)(1.2).) - 1- 'Constance Bentley Line 'Spouse � 100°!° gPeggy Sue Soutner-Inter vivos transfer within 1 year of death I�ughter 86i24161 . � j C] CQ Q Q ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH SB OF REV-1500 COVER SHEET,AS APPROPRIATE, 11 NON-TAXA6tE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: ` F1 J TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $1 If more space Is needed,use additional sheets of paper of the same size. '.. MEMORANDUM DATE: MAY 27, 2014 RE: HENRY LINE ESTATE— SOLE PROPRIETORSHIPS Henry Line maintained a sole proprietorship known as "Line&Line Jewelers" from its formation several decades ago until the date of his death. As of February 25, 2014, the value of Line & Line Jewelers is as follows: Jewelry and repair supplies (estimated value) $ 14,000.00 Less: Fuel oil $ 1,902.25 Watch supplies 338.97 Credit card payment system 814.96 3,056.18 Total $ 10,943.82 Mr. Line also operated a separate sole proprietorship known as "Henry Line Watch Repair". It began and ceased operations in calendar year 2012 and had no value as of 02/25/2014. The federal income tax returns for calendar years 2011 and 2012 for Mr. and Mrs. Line are enclosed, which include Schedule C reporting of these sole proprietorships. Peggy Sue Soutner, Executrix MEMORANDUM DATE: MAY 2712014 RE: HENRY LINE ESTATE—MULTI-NATIONAL DIAMOND, INC. Henry Line maintained a corporation known as "Multi-National Diamond, Inc." from its formation in June 2000 through the end of calendar year 2011. To the best of my knowledge, on or about December 31,2011, Mr.Line discontinued all operations of Multi-National Diamond, Inc. and subsumed its inventories into his sole proprietorship, Line&Line Jewelers.As of this date,however,Multi-National Diamond,Inc.remains an active Pennsylvania S-Corporation. The bookkeeper for Mr.Line's businesses,Rosemarie Redmond, died on February 16, 2014. The 2010 federal corporate tax return for Multi-National Diamond, Inc. has been included with the inheritance tax return for Mr. Line's estate. To date, no other corporate tax returns for Multi-National Diamond,Inc. have been found in any of Mr.Line's business records despite my best efforts to locate them. Peggy Sue Soutner,Executrix Fa,et U.S. Income Tax Retum for an S CorporAlon or�gsttwn�154sla 0 ►odr,dstL.ista.n�imSlQ�ecwr m6ot,erasfwo is �5VV.7 Osptwaoawf" IFcemLFi3toa4eettotwwScwz trsrmthessat Salto P.See sapartae babucamm Far cahvuft ym 2(009 or tax 2009 encMv 20 A SasCtxnstteeuvedxW fft m 0 eroloisrwwftl=�Mmrjbw 06t22t OOD t Mufti-ka0onal Diamonds,Ina 251966126 8 Oudnm Waft daft }p(, lexraa,CmClt awl m a a4o rc.as P.O.bO&too lenuc0OM 6 Odin knaporstod loft 0" d 09*9 21 Dickinson Ave 06r22lMO 453220 WAe Sap m town stmt.wid 2Rmdt FTaFrarehMatrt�iapt p"or CQ�R9sfaW VPa Carlilse,PA 17013.2903 13 74331 ti bL'*CMPM*w SW COV40bOMnSOMPMOOM116gr2ftWMV&UXVON? 13 Yea ONO if'Yec67aeachFwm2553*natskssdytied ti 1 8: (t)O Fttm mhmt M 0 Mama dwW a®Adtaass dtmtge 48 0 Amended mWm a O S e wOm tettdrtatbn or mvo m"m 1 Effw the number of a dwkfem who ware&mrehddas du"M any part of the tax year Ltit�dn#kA+>atoaMksdddrbu*mw3umleartJalperrasminec iRdao0y tr2t.5ee8+ei'aifr nt taraiaeiYboa�iora to f3OlrraD*borcft 54061 20 b tmnkmsw4 0 e4 c B/1 1c 54061 20 0 2 OKI A$O*ft9dd(6dreddaA.ke18) . . . . . . . . . . . . . . . . . . 2 30989 00 a Gm a VCM SWOad Sm 2 tam Sm lc . . . _ . . _ . . . 3 23072 22 4 "at gain#s}irom Fcrm4797,Part 8.9W 17AMWh FbrM 47" . _ . . . _ . . . _ 4 6 9tbdilvm.m on*(imkmo cfbm—mMwbsatemmq _ . . . _ . . . _ . . . S 6 TOW amww ftat,Add roes 3 Owagsh 5 . . ► Q 23072 22 7 CwV&mObnaIdfio7s . . . . . . . . . . . . . . . . . _ . . . 7 s s daAmardwlages f=arptopmrgczatfR',} . . . . . . . . . . . . . . . 8 18311 l5 9 Aepaks ands. . . . . . . . . . . . . . . . . . . . . . . 9 JE TO Bad ddrts TO TT Betts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 M TaxetandSceses . . . . . . . . . . . . . . . . . . . . . . . . . 12 1832 14 13 1 aaai . . . . . . . . . . . . . . . . . . . . . . . . . . . Ta 1431 05 14' Oep=Wdo notdakrted cn SdwdlisACremW%mean mtwn O wh Fwm 45564_ . . _ . 14 16 Da~009Mdeduct*I and gacdop$vGw4 . . . . _ . . . t5 18 AdwVs&pj . _ . . _ . . . . . . . . . . . . . . . . . . . . is 17 Pmsiet Poo-dmkt0,etc-.pims _ _ . . . . _ . . . . 17 in EnovMtommmixtow. - . - . . . . . • . u6 t9 OthedmdxGam e"ahs--Awtwt0 . . . . . . . . . . 19 17809 29 20 'rood Add km 7 ilsoirjt 19 . . . . . . . . . . . . . P. 20 37394 22 f1 21 Qrftmv ptlsftmixww & *ad Gm 20*=sma 21 .14312 00 220 £vommndonsirekcwmorifOtataphEe tsx0"kxsatxisons) - Ma b Taos trartl Srhed<de 0 Fb7m 11208. . . . . _ . . . . 2C Addtnm22a and 22b(m &sMxtbslarad&Swnaa. . . . 23a 2004esSnatedtaxpaptnakswd2006ovapsynwt Cred7tedto2009 Zia ..., .._., b Tax dr;tosiped stir Farsn 70D4 _ _ _ - _ c Ora&fat laft tax paid an tads(aM=h Form 413 _ _ . 23c d Add 4tcs 23A ftoj t23c . . . . . . . . . . . . . . . . . . _ 127 24 FSdmidadtm xpma8y�laekx&ucidr4ChKkNFann2220isadndred _ _ . _ . _ i 0 m Armutlow*& ffIM23dissmdli drtartthe'�ofbm22caW24.mrtwamatrtt vndf . .29 rttne23dishrWtatO letdtaldbms22cond24.esltganautRampaid . .27 Eiter ammwtfmmtite26QeSiadto20t0es"mat�edI=W Ratunded1• tidsOwAwuYpa. , ,1-, 0,a ad�alO�swlc x�blw Lq[dw,{tnr trmdt.MK tbtra 4 awl thdvmw cl m difs.ia7>✓ara}b, lmatft d I Pop"tas+elixnw�ka}p Sign l /J '" m .r. ; Here T ortsa omt TM Paid Cho*asedl- ptwwastsssNmpm Pmpfee f16Y°�xs Fltnb racm{a Usettnty xmsasrtt.smpblsd) sderoa,ad zlp FarP49m cyAMMd Papwwo*Bsdnc6wt Ad 00 6 sae, Carom Si5f0A now lima cam £arn 512x0 Qa00) P,rw 3 ' �rarRneidnt'l3aRyGl�ivatters immsnadl Totill2nwut 11 Section 179 deduction Wtach Fans 4564 . » . - _ . _ . . . . . - 11 129 Contributions _ . . . . . . . . _ . . . . . . . _ . . . 120 ig b lowntro"iOwed expense . . . . . . _ _ _ lab c` a s tion set�7R► � (1)TYPO 0 - - — __...__..-.- 0.1; d 01h rdeductions ¢p+einaYadYfmri . . Type► 12d 182 Lan-nnomehousingaertlR(9mviSon42@ft. . . . . . . . . . . . . . . 13a b Law-{noorne housing mdlt father) . . . . . . . . . . . . . 18b c QualFM reFra6lxatipn egnerwlMras kantd rest estaee){eeledr Fvm 3l16'6j . . . 18e d Olnare, ved credlsomirsBrrdiars) TYYPO►.................�-------------»_---.... lad V e Offw rental aedfa ism ir oro . . . TYPO►_....-.... ------------.------ 188 1 Alcohol and ceiltdosicb"malkids Oftich Fbrm 64M _ . . 9 . Type 10, 189 14n Name of country or U.S.pommlon M b Gross incomo 6om A sources . . . . . . . . . . . . » . _ _ 14b c Gnus boom sourced atshrdwiderWM . . . . . . . . . . . . . 14c FOMW O MM rrcarm amcedst corporaieieeet _ d passim calm wy . . . . . _ . . . . . » . . . . . . . . . 140 2 • GMrmd&#e9ory . . . . . . . . . . . ... . . . . . . . . . . life f Otlne{alladtsla�met� . . . . . . . . . . . . . . . . . . . . . i+N Deductions allocated andapporlianedat.dtae xMwk%W 9 tdanstaximme . . . . . . . . . . . . . . . . . . . . . 1- b Other. . . . . . . . . . . . . . . . . _ . . . . 141t i l 3eductiase/OCatedandappor0vneiat aeporale/arnitoAmafgr source i'ccorne i Passive category . . . . . . . . . . 141 j Generalvalegory . . . . . . . . . . . it OBrrr~stabnonfl . . . . . . . . . . . . . . . . . . . . i4t Odw inilcnnalion i ToGatfora" tmres(atnedtanal:► 0 (Paid ©Accrued . . _ . . . . . . 141 tan Poduclion in uses ovaitie lar credit daUsaA stateme4. . . . _ . . 140 n Olha foraWn tax in7umnallon{ettadi s1eEyner4 "^ ism A'aR-19V36 deirOdttior+aryusbnrert - - . . . . . . . . . . _ fSa •• b AdOstedgefnarloss. a Lk;iOsar,{otileraanaandgaay . . . . . . . . . . . . . . . . . tsc d Oi,w and 9mothemrd prapertirs-gross income . . . . . . . . . . . . 15d e Ot wm and geathermol Praporties-dedrro0arns . . _ . _ . . . _ . . 15e i COmAMTilan _ is 1 b 7aoc-e TAX -e heed income . . . . . . . . . . . . . . . . . . . 16a b Otlne4pttxerrlt inttorm 1Mlr c Ompers�s 16c e d PyopetydsirNtuius _ . - ,. _ . - _ - - - - . _ . 15d S n Agnaynrvtof lo2rta from stmeholdes 1Ee 17m irrtincar'rne . . . . . . . . . . . . . . . . . . . . . 172 b Maradrnsrd expenses_ . _ . » . . . . . . . . . - . _ t7b - c OhMetd distil abater Pad learn accara�d and pm is 170 d C"hertens and ar" rnts co 16 kwoerMws nxmw*s*mL Cxmbine the arno its an inns 1 Nnaogh 10 in iris far right . o ookowL Firer Me Rout,m*&aet the s rn of tine amounts an lines 11 livaugh 12d and 141 16 .14312 . 00 Fm 1120S VAM Fomti1206t2Dm) . Balance Sbeeta Per Sooka �r 4 8rdtaigdfaryer< FAddt�4s . A M I Caste . . . . . . . . . . CA" 2542 23 TradentR�and ama�s recdy061e - - — -- - -_ — — b Less abasfoetorbad . .. . . . . . . 4 U.S.gnyemvnat asgagor. . . . . . . 72181 71789 5 Tax-acemp somwfies(seektt&ucbmnj 0 OVW ones aestft tatzhgtjj%�_ 7 Laeslosh dwldes . . . . . . . . 8 Mbrapegeardreel bare 9 00faanesVnerets(a0apbsbdwmnQ _ - VM &Adhgs and 00w direr- --, assets. - b Le=am+nj*eddegecWon . . . . 11a Deplehdeassets .... -_ 12 Land(ne[ataryanorfimfimr). . . . . 13a kVAnUVftassetsWwr&ablcrM . . b Lass araafafaled arrwrfva6m - _ t — -- - - 44 Ober as9ds ,statornerro - - - - - . ._ . 15 Total aee . . . 78680 74331- LMAtles and Shareholders`Equb _- 16 ACCOUss payme . . . . . . . . . _—_ 18633 17 Mkstgspes,n*mbonds palmiek14=#wtyea 14!52 16 OB1v anent Oad (anadf siafamerlq 19 Leon lrorn Ow*wkk s • . . . . . - 146062 163590 20 Ik 1C n notes.bonds pryede H 7 yea or mote 23175 _ 228765 21 O0w rmbn&s tetbdfi stbmerlQ . . . . 22 Q�suxk - 23 AdiMorml peibin captA . . . . . . . 24 Po tailed ewrl* s . . . . • . . • . -317700 -332012 25 Ibfhadxil0eri'o[Milyb3�sfYeneq 26 Leas and of beaarry Told aM�lvetfolder 78680 74331 Reoatel4lion ct ktooaro(Lmo= per Books With lncorne&os#per sebum 1lefa SolmM8 Mf-3 regifired inatetl cr Sdwdrle M-1 7 bld aeaAS are 5101 rrion or nwre—see bskuelias 1 hktkwOfosopnrl -i m . . . . . . -14312 5 laveermsdmboeFsaf r:ylr+rtiadrdrd 2 tf00ft1a fldllded On Sdodls iC trees 1,2,3q 4, m5eediiKesle.�,sopr 5R 6.7,8a,9.a)d l%not raowded on buds 0is a Tax-Emrompt hottest$ y®Lek 3 Egmism raootded m boils Ora year not 8 Deducttnrrs fnAeded on Sdedrle !C 141 Owed on Sdfedlle K fifes 1 9rargil 12 aril ifes t SMO 12 and 14L nut dfapsl . 7111 k apairst book I miI fs yer(Ms++'bej a Dgpreolation S r Depredatbn E b Travel and mlertdrtnlent 7 Add fifes5 ard6 Affough 3 4. . fifes.! Antl -_..alt� yaa of AOa A*jMmdMs AccouM Ohher Adjuslalm A4xouM and Shareholders LAtdab�tuDad T1ltrab4e rlrotlne Are1f wyslil Taxed(se irldrticti0r15) FlrkaafMed ploesa g8lsra`sMatfodYklued a�ariceomrr4 murex evacr•:mrwpr�y>a.rd 1 Bdafceatbe�ainpolmryear . - 2 Or6nsytrworm kom page 1.fife 21 •14312 3 QM•addf3ors - i 4 1owtmrlp i,Fae21 . . . . 5 O0w"Kumorls_ . . . . . . . . - 6 Oo TMM Ones 1 9oorfgf 5. . . -14312 --- 7 Obbbfions COW 0mdWd--ddisbUgore 9 derd dtm 9baaut fne7 fife8 -14312 F® 1t2OS RM% 671109 Schedule K-1 �❑ FImMI K-1 ❑Amadod K-1 OMB No.1545-0130 (Form 11205) 009 Shareholder's Share of Current Year Income, Dop.'dtmart of the Tmanny 49 .7 Deductions,Credits,and Other Items Internal Revern Service For calendar year 2009.or tax 1 ordinsr)'bueklee9 Incorne ) 13 Credits year begionk,g /// .2009 endi^D /a/3/,20&.y_ 2 Net I prate ) Shareholder's Share of Income, Deductions, Credits, etc. ►see back of form and 3 Other rlet`a"n141OD11+o( ') separate lnatnrctions. IM Information About the Corporation 4 Interest Inca", A Corporation'awnpoyaiknVlicationnanber Sa Ordinary dividends a Corporation's norm,.addreta,dry,state.aM DP code 5b OuaGOar dMdords 14 Foreign trnnsagions / /.sl�i ( •/ �)0�3 7 Net short-tam capital gain(IdSS) C IRS Cents-hare corporation riled retum Be Net ion9-tam capkal gain(toss) Information About the Shareholder m c°r°'"bMa(28%)gain PoSS) 0 Shareholders klentiWV nurnper 8c Unr,cepturad section 1250 gain . E ShaNrokfers name.address.qfy,state.and DP code 9 Net section 1231 gain(loss) .de,i G�N re, 10 Darer krcorra(bss) 15 Aaarxtive ni;sr.,n tax(Ak(1) C4.r F Shaeh~s perca tege of stock /0 ownersNp for tax year 11 Section 179 deduction 16 Items affactiog y,orehober bass 12 Otherdeductk . m cc LL 77 Oillef kl}OrnnMl0r1 See attached statement for additional information. For Paperwork RWuetlon Act Notlee,na Instructions for Form 11205. Cal.Na 1152nD Schedule K-1 (Form 11205)2009 owrnarad a,w 7neuy°hnaeeW raneww seMce form 1 No U.S. individual income Tax Return 2009 Ift dn„w rbaaaa« In dAa For ft year Am 1•Dec 31, orr>Sf>w tax 2fterding ores ft.1s4S&mr4 LAW Yowbalfarw ale last ewmr Ymswoddse wityym dwr (anva 'di01 ) Henn Line aI iwragnwn,300056%AYtnwir•__. - _ - N - -Ursn a---- _ -_- -.-- -.__. _ t3satna _ s >mwvn,:+eRSrnm.+,ei wIsbaL Constance B Line Ou ermse, nom W&W OUTO6ar rant VA",a YOU nova a PA.t",saw aa4LCeps. Apwb"M You must enter your tdet�Pd nt social securdy or type. 191 Ride Drive A (s)above A •Yr+n Wpod afiW.ayou hwvaa IdIVNi, "wMw6w%. Slow Zip code Carliale PA 17015 + �� idinxi, tiection Cetnpstgrt flied here lt}aa,a i�vur spoux if hlirg Itdr�tly,aai+xd f3>fl alp to tlds fuid?(sm instiricfions) ................ ►[]You O spouse Filing Status 1 single 4 U dead of household(with qualifying person).(See 2 Matrw filing Jointly(erwh if mdy one had income} instructions)It the qualifying person is a chr Check only $ 'Mamod fling suaparatsy,Erdar spousa'x SSH abwA L fai ta na haryr'dependent,enter ttxs chifd's one box. rant trre..0, 5 I I OMiih'in0 aidoa(er}vdgs dtpndettt dill(see instnietiorxs} E1[an1oolls 6a YourselL It someone call claim you as a deperdont,do not check boss 6a .......,.... a„ `d. 2 b Espouse ..................................................................... a gs dfdaM C OaparidN4tS: sacha anti s Q1Oeoe is -{4)_p *SAW w: �tkty relationship •awa number to you a dds wMYOU - First name fast name tM* h •"14 "%a ti If more �tnatti6nsm . Ace ft"*" d Total number of ex tions ciaimed ...................................................... w oa:.... 2 Income Be Wages,salaries,tips,etc,AttachForm(s)W-2 ......................................... 7 Taxable interest.Attach Schaduie 8 if required ......................................... 8 a b Toxsxampt interest.oo not Include on line 8a..............I 8b! ^ Affich Forma) 9a Ordinary dividends.Attach Schedule 8 if required....................................... 9a W-2 let Abe lifi b0uacd dividends(wInstn) .................--............ 9b a 14.46 and 1099-it 10 Ttabbt (durwh6 otdds„w affseft of state and lad I'M trues(see iratru dk0l) ...................... 10 Iftni was wlttwlld. 11 Alimony received .................................................................... 11 12 Business income or(foss)-Attach Schedule C or C-E:Z .................................. 12 28 635, tgati di � 13 Daplhigainw(iossl.AltSdi0tirs4d.0hatmAdthrre.......................... Q 13 use lndru¢titxx 14 Other gains or(losses).Attach Form 4797 ............................................. 14 13a IRA distributions ............ t5a��bTaxa le amount(see instrs) ,, 15b dons ons and annuities,..... 163 b Taxable amount(see instrs) -. 16b 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc.Attach Schedule E .. 17 —34 312. ftS:kv bL4do 18 Farm tntoma or(toss)-Attach Schedule F...............--.......................... 18 StUgh SRI 19 � arar�)nsv d.%ZAdo 19 LA p� 200SWW28mitybaidtk.,..........120sE 20,453,lbTaxabkamourd(seeirabs) ., 29 0. MOM 21 09m income r ------"-------"'-----'------"--^^----"'fir. 22 Add the amounts in the far cobras far lures 7 21.Tn+s is our total Income. 22 14,123. 23 Educator expenses(see Instructions) ....................... 23 Adjusted 24 trxiain b sirisss expaaea of remvisb,pwfwming artists,amt fe"aus Gross IiNwwat of els.Attach Form 2106 or 2106-EZ .................... 24 Income 25 Reaith savings account deduction.Attach Form 8889 .,,,,,., 25 26 Moving expenses.Attach Form 3903 ....................... 26 27 One-half of setf-employment tax-Attach Schedule SE........ 27 2,023. 28 Self-employed SEP,SIMPLE,and qualified plans............ 28 29 Self-engtoped tieatih innea n daductim(sae instrudIv s) ............. 29 30 Penalty on early vAthdrawal of savings ..................... 30 31 a AUmory paid b PadpieM's 01....• .. 31a 312 IRA deduction(see instructions) ........................... 32 33 Student loan Interest deduction(see Instructions). 33 34 Tuition and fees deduction.Attach form 8917 ............... 34 35 Donestic pradmdion acti as deduction.Attach Form 890#..............135 36 Add Was 23-316 SW 32-36.............................................................. 36 2,023. 37 Subtract line 36 from tine 22.This 1s usted Toss Income ..................... 37 12,300. SAA For otactmi%Privacy Act,and lk"arwcrk Reduction Act Notice,sea Iastrudlons. FlxA0112 SOMAS, Form 1040(2009) Form 1090 Henry 6 Constance B Line P 2 -Tax and 33 Amourt from line 37(adjusted gross income) .......................................... 38 1 12,300. Credits 398 Ctieck You were born before January 2, 1945, Blind. Total boxes If: StandardSpouse was born before January 2, 1945. Blind. Metloed ► 39s 2 Deduction b M you apousa itwim m a stiparale mhxq a you were i dual-staha Mia4 sea rostra and eA here ► 39b for– 40•Itemized deductions(iron WOMB A)of your de ndad dedudlon sea left ( merygn)..................... 40a 27,220. •'Peofde wtn0 b if are throning tyaaax ft*, I I P'an M cerUM red estate tams,rew meta"We tares,or etteck any box a nst dhwsta loss,attach Schedule l ant check hem(sae in:Wdiom)..................... ► 40b 11 on line 34a.39E. 41 Subtract tine 40a from fine 38 .............. ................................ 41 –14,920. can be clakned 42 Exealptlan If line 38 is 2124160 or I=and you did not p vi*houshV tc a Midwestam displeced -– as a - In pH+3J by Ore manta an tiro 64 otherwise,see katrudlaa ...... .... 42 7.300. see�orn 43 Tax ale hhcvrlle.Subtract line 42 from lime 41. If line 42 Is more that line 41,enter-& ....................................................... 43 0. + All others: 44 Tax(see instrs).Check if any n tax is from: a Form(s)8814 U Single or Married b Form 4972 ........................... 44 0. fittrtp sallwatrJJt, 45 A1lemativa mtnbnum tax(see instructions).Attach Form 6251 ........................... 45 $5.7110 46 Add lines 44 and 45................................................................ M 0. 47 Foreign tax credit.Attach form 1116 if required ............. 47 �arrrt8y b7ag 48 Credit for chid wed depadud cue expenses.Attach Form 2441 .......... 48 widow(lying 49 Education credits from Forth 8863,line 29 .................. 49 $11,400 SO Retirement S"tW contributions credit.Attach Form 8880 ... 50 51 Cldtd tax credit(see Instructions) .........:................ 51 - ! Head of S2 Oedt from Fome a 1096 Is Q 8839 e Q X95....... 52 $8350 53 other as ban Farm a ❑30 b Q 8801 c [] 53 S4 Add fines 47(trough 53.Thm are yow total audits .................................... 54 55 Subtract line 54 from line 46. If tine 54 is more it=line 46.ender.0. ...............— ► SS 0. 56 Self-e plgmud tax Attach Sdadule SE ...................................................... 66 4,046. Othe, 57 UTMuted solid warily ad lledicam tax from tam a [:]4137 b Q 8.419....................... S7 Taxes S8 Additional in an 1 of er qualified MU'w4M etc.AtteM Form 5319 t required ................... 58 59 AddfialM tans: aU AM paymen6 b �afMusebo erhpbyh– taxes.Atiedh Schedule tl........... 59 60 Add linesSf59.Thsis your totalhx ...................... ................................ 60 4 D46. Payments 61 Federal income tax vdthhetd from Forms W-2 and 1099 ...... 61 62 2009 estimated in papim is and amoed applied from 2008 rehem ........ 62 if you have 8 63 Maidrq wok pay and goruanent retiree credit Af ech Sd*dhde M ........ 63 300. quabfymg 64aEamedirKOmeaedit(EK).............................N,o 64a d b,attach b hbldamhte cmmbat pay dectah..... ► 64b Sdnedtde EIC. 65 Additional child tax credit Attach Form 8812 ................ 65 66 Refundable education credit from Form 8863, line 16 ........ 66 67 First-time homebuyer credit.Attach Form 5405 .............. 67 68 Annum paid with request for aAer sk to file(see imttlhxions) .......... 68 . 69 Mess social waxily and tier 1 RRTA tax wfdnhdd(see Ins r'; ....... 69 70 ihMds from Form a Q 2439 b Q 4136 c Q 8801 d b M .1 70 1 _ 71 Add ba 6l' i6S70.These are par tab f .........................................e, 71 300. Refund 72 11 line 71 is more tart tiro%ufted lino 60 from lino 71.This is the amatM you averW................ 72 Dlreet depasit7 73a Amount of tine 72 you want refunded to vm if Fonn 8888 is attached,creek here ..► 73a See inSirtlttians w b Routing number........ XXXXXXXXX • e T Checking Savings and fill in 73b, . d Account number ....... XXXXXXXXXXXXXXXXX 73c,and 73d or Form 8888. 74 Annad of tine 72 wad led f9 2010 estimlat¢d in I....... ► 74 Amount 75 Amount you are.ShNhwd line 71 from lire 61 For details an low tc pay,see iratructim ............... ► 75 3,765. You Owe - 76 Estimated tax t see instructions .................... 76 19. Wpaw 00 you mart 10 allow amihar pnxmn to dam this rablm with to 8t8(sum imUuciam)l .......... _ Yes Co*ete the following. No '3ianee r y . v�tahr y ' reoar . Sign swhdn d OslihsY.t e.mra art 1 Mrs aramkrd eta rsban and aoearipdhyhhhp ryas sna dMnrnb,and b Vw b W d try labor 1,,I, rd '1an BRIM. era tier,oarxi ant oanakb.OexYratim d Praorer(o hen asae"h booed en an InMIAM Wn d stack Kt7B prapara Ira any biowMdps. Joint reirsn7 You Oahe You oaapmion 010)"M Ph"nurOer SaoInstruetions• Jeweler /gatchmaker Me1(�paoopy , �s .na mUn,both mutt sign. am Spamf oavpatah --- 1 row rewords. Greeter Oo>e Rowers SSd a Vied Paid � ones t sBw are ern. Self-Prepared Use n y Fl>t0fit. p i I VN .aa m a d -- 2nP_ade-.. - - ——- vtwne no. -- - Form 1040(2009) eDA012 tAn7M SCHWULEA itemized Deductions 115003719 .0ro"11110" 2009 (99) • Attach to POM 100. -SeeftlittICUIM ftrSdt0"A(F*tmlOWJ6 Adva"KA s�m. 07 ftw4o)zl . mFomIDOO Yow*WWOMOky Henry & Constance B Line 1174- Redlad Caution,Do not include expenses rehTftwsed or paid by Dental 1-1-1 and I Wfulkalviddentalew (mimnetiom) ., 2.429. Expenses 2 Ed*womt hm form 1040,fire 38 .....t ij–.......*ii"*i'00 3 "Iply Ime 2 by 7.5%(475) .— —.; ...................._.. 3] 923. 4 Subtract line 3 from line 1.It fine 3 Is more than line 1,enter-0- ...................... 4 1,506. Taxes You 6 State and local(check on!y one bo*. Paid Income taxes,or :H General sates Wes ..................... S 6 Real estate taxes(see instructions)............................ 6 2.856. 7 New motor vehicle taxes from line 11 of the worksheet on page Poe 2.Skip this line if you checked box 5b ......................... 7 8 Other taxes.Ust We and amount 9 �k@—ji——�'&Rjj�-87--———— Imes ........ ............ .................. ........ ........... 9 2,856. 11111161100 10 Harr fft Interest am p*ft reported to you on farm 1098 10 22,858. You Paid 11 Met roxigage kfttd ft reported?b you an Form 109&If 'a ft Oman fm whim M bought ft twm w hebudion&M show f4ripersorfs rwM wwaling Mat r.arx!am ------------------------------- ------------------------------- --------------------------------- 0–7v;– –––––– 11 Note, 12 n 12 PePersonal 13 Oualified mortgage insurance premium(see instructions)....... 13 es not 14 Investment interest Attach Form 4952 It required. deductible. (S"hft&) 14 15 AM lines 10 though 14 ......................... ...... ...... ...... IIS 22,858. Culls to 16 Gifts by cash or check.If you made any gift of$250 or charity more,see Insins ......... .......... ............... 16 you me* 17 Other than by cash or check.If any gift of$250 or irand banclit awe,see instructions.You must attach Form 8283 if iat see over$500 ................................................... 17 Instructions. 18 Carryover from prior year ................................. ... IS 19 Add Ines 16 through 18 ..............--............ ........... T9 1 ,C,NS%Ift 2" Theft Losses 20 Casualty or MR lass(es).Attach Form 4684. CSee instructions)......... ....... .......... 20 .1101)Expenses 21 timmimthned er eg� -job travel,union dues, a 'V and Certain job education, Attach 21�6 or 21 -E2 if 011scellarteaus required.(See instructions.) m- Deductlons ------------------ W - ------------ -- 21 22 T;x;; aalWie;s.......................................... 22 fSee 23 Other expenses-investment.see deposit box,etc.List fttructions-) b"and amount • -------------------- .... 23 24 Add tines 27-Or-o-ug-h-23- 24 25 Eft NVA IMM form 1041 Jim 38 . ...1 25 1 1— -1 26 Multiply line 25 by 2%(.02) ........... iii 27 S—dArad line 26frm line 24,If line 26 ��ejliI�iinaX enter -Q- ........... 27 Other 28 Other-from list In the Instructions,List b"and amount- -------------y_ - Deductio1111sceflanews n --------------------------------------------- 28 TOW 29 Is Form 1040i line 38,over$166,800 Over$83A00 if fterntred married filing"Pars")? Oaductions &o. Your deduction is nottimilod.Add the amounts in the WWrcofumn for lines 4 through 28.Also,enter this annoiant on Form I line 40a. 29 27,220, C]Yes. Your deduction may be limited.See instructions for the amount to enter. 30 H shed bstamixe demuctiora oven are lass than smndard dad crack tore► 1 - OAA For Papenvm*Reduction Act Notice,sea form 1 00 instructions. FIXAMI 11AM Schedule A(Form 104M 2009 SCHEDULE C Profit or Loss From Business CM No.1501 r4 00"n"M Mw Prop"01,61110) 2009 a T� == 09" �)a€nf verrtams etc gemrally mast file form 1065 or1d65 8. more Of vrop6ow Henry, Line A *mPii1btwN &"rCw&t"" Watchmaker ►448310 C Line & Line R ao*m&wfts(w44ft raft a rwm no4w 21-Dickinson Avenue---------------------------------- Cazlilse��PUA 10 at 101bothar CWecily) F Accounting method: 0) tK I Cash (2) U ............ 0 Did you'matanally participate'in the operation of this business;during 2009?if ft, sob inshictions for Omit an 14 stal f started or acquired this business during 2OD9,check here arts income I Gross ireft"or Miles,Qw0w Sea the instructions OW of tM box JP 0 This Income was reported to you on Form W-2 and ft Stftltvy ornployW box on Vial form was wIted,or 0 0 You ore a member of a qualifted joint venture reporting a*rental real estate income rot subject to seff-employment tax-Also we instructions for fimff on losses ..................... 1 45,879. 2 Returns and allwances ..... ....... ...... 2 3 Subtract line 2 from fine I ."._-..-.-1.- ....._...... 3 45,879. 4 Cast of goods sold(from line 42 on page 2) ....... ...... ................ ....... ............ 4 14,432. SOms pnift Suilitract fine 4 from line 3 ........ ........................ ......... ........ .... 5 31,447. 6 Other income,including federal and state gasoline or fuel tax credit or refund (we instructions).......__...__...... .....I....I'.......____...__1_1__'__._...—— 6 7 Oross incom Add lines 5 and 6.............. ......._..........__........I.,..... ... 1- 7 31,447. Part If I Exoeuses.Enter for business ts"e of home only on line 30. 6 Advertising. ...... 8 1,200. 18 Office expense .... ...... 9 Car and truck expenses 19 Pension and profit-sharing plans. 19 (see instructions)..........._ 9 20 Rent or lease(see instructions): 10 Commissions and fees.. 10 a Vehicles,machinery,and equipment .....J2DA 11 coeweet labor b Other business property.... .............. 20b (we instructions) I...... 11 21 Repairs and maintenance .......... 21 12 Depletion ..... ...... 12 22 Supplies(not included in Part HD ........ 22 Is tion and section 23 Taxes and fice ....—.......... 23 1 =deduction 24 Travel,mats,and entertainment: (not in Pan 10) — ("6 butfuctiofts) sTravat ......___ 24; 14 b OeducMe meats ard ertertainrrmm =101%Von linepro9farris..... 14 (see instructions) ....... ......__.... 24b IS Insurance(other than health) ... 15 1,172. 25 Utilities .......................... ..... 25 240. 16 Interest: 26 Wages am employment credits) ........ 26 a Mw"(oil In b0s, IG& — Z? Other expenses(from fine 48 on b Olher... .... Ifib page 2)... ....... ....... 27 17 Legal&professional services.—,17 200., 28 Total expenses before expenses for business use of home.Add lines 8 through 27 .......► 28 2,812. 99 Tereotive proM or(tm).Subtract One 28 from fine 7........ 29 28,635. SO Expenses for business use of your home.Attach Forth SM ...... ............... .................. 30 31 ft profit or(loss}.Subtract line 30 from line 29. *#a enter on both Form 104D,fine 12,and Schedule SE,lift 2 of on Form 104CM Mina 13(it you checked the tK*on line 1,toe Estates and trusts,ante on form 1041,Brie 1 131 28,635. * ff a loss,you must go to fine 32. 11 32 ff you have a toss,check the box that describes your investment in this activity(see instructions). • if you checked 32a,enter the loss on both Form 1040,line 14 and Schedule SE.fine 2,or on Form 1040MR,fte 13(if YU ctx-cw the Wx on fine 1,see the line 31 Instructions).Estates and trusts,enter All investment is an form 1041,Kne 32S at risk I Some investment • if you chocked 32b,you must attach form 6198.Your loss may be limited. 32b F1 is not at MA GAA for PV*,wmk Roduction Act Notim,am Form 1040 instrucHons. Schedule C(Form 1040)2009 fO20112 06118M Schedule 0 OFbnm 100 20M HenrX Line Paget Iftim LLI Cost of Goods Sold(see insttruc!onus) __ 33 Method(s)used to value closing invantory; * UCost bU Lawny Qf cost ormarket cLj other(attach explanation) 34 Was Owe any dwW in determining quantifies,costs.or valuations between opening am dosing inventory? If Yes,'$Uach explanation .............. C]Yes (]No as Inveft"at beginning of year.If different from last years closing kwerdory� ~explanation...... ...... ............. 35 I 36 PwdwAs IM cost Of items Withdraw for personal use ............... ....... 36 9.872. 37 400M of tabor.Do not iinckda any amounts paid to yourself. ............. ............. ... 37 38 Matenats am supplies........ .....I.........I......... .........."....... .................... so 4,560. 39 Other costs .. ––�... ......... ...... ................ ...--......... ........... 39 40 Add lines 35 through 39............ ............... ...................... ...... 40 14,432. 41 twerdory at end of year -------—..............---- ......... 41 42 Costa!gMft sold.Subbed fire 41 from line 40.Enter the result hem and on page 1,line 4 42 14,432. Part IV Information on Your Vehide.Complete this part only if you are claiming r or truck expenses online 9 and are not required to Worm 4562 W this business.See the instruclionsfor line 11 to find out it you must file Form 4162* 43 When did you view your vehicle in service for business purpows?{month,day,year) ........... 44 Of the total number of miles you drove your vehicle during 2009,enter the number of miles you used your vehicle for: 0 aushess ––––––––––– to Commuting(see instructions) cotter 45 Was your vehicle av*HW*for personal use during off-duty horns? .................................................... C]Yes Q ft 46 Do you(Or your spouse)have another vehicle available for personal use? ......... ....................... ...... []Yes No 47s 00 you have evklence to supW your deduction? .......—........ oyes ofto b If*Yes,'Is the evidence written? ... oft rOtt OUM EXMsei6 List below business expenses not included on lines 8-26 or line 30. --------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------------- --------------------------------------------------------- ---------------------------------------------------- 48 Total other 6*"s*&Enter here and on page 1,fine 27 48 Schedule C O:orm 1040)2009 MaD112 ONIM Schbdufe E(Form 1 20D9 Attadrmrd ftguence No.13 Page 2 tanrrfo as a an naxn.Oo nil mhr moan and wrltl auR;pi nueber a�qMn m?7aar�. Vo odd"awfe,n.abw Henry 4 Constance $ Line t all"M The RS CWMWft am Uft reported On Your tax return with arnoums ShOWM am S&*duta s K•1. art II I income or Loss From Partnerships and S Corporations if attactr FerTrrrenart see s -risk activity for which any amamt is eat at risk,you must che&pr One ybox r in eo3tam(e)on lure 28 acrd 27 Are Ion from reporting any toss a ive aactivity{A that lossm�rep rted on Foorrm at-risk 8`�82,or wrefr riburs partnersmp experts"?..... Q Yes E]No If you answered'Yes'see irvstrucGrnrss before completing this section. (b)frier P (c)Cneck it td)Plnptoyar (a)C"a&it 28 (a)Nam parbronship' foreign NicatIon arty amount S fa ti parbwwp number is not at risk A Nuiti-Natinal Diamonds Inc. S 25-1866126 1 f3 C 0 Passive facoree and Loss krcam and LOSS (f)Passive loss allowed (a)Passive income Or) �t (4 Mien 179 @ Nonpassive (attach forth 85a2 if required) from Scitedofe K i from ergs ucGar �rrrj 14,312. 456Y f3 C Q 29aT4Wts ............... b Totals ............... 14,312.1 30 Add CAM=(g)and(p of fine 24a ..........................__.............................,......... 30 31 Add coasters(f),(v),and n of line 29b .................................................................. 31 -14 312. 32 Total partrrarstrtp and S conwrafion intern or(loss?.Combine tines 30 and 31.F.mer the resrM frets and imi de In the t0otinal om line 4 below...................................................................... 32 -34,312. art 10 I Income or Loss From Estates and Trusts 33 Notre ID no. B Passive income amt Loss trrconor and Loss (q Passive deduction or toss allowed (dy Passive atcorne (a)Deduction or loss (0 otner income (a8ach Form 8582 if required) from Schedule K-1 from Schedule K-1 from Schedule K-1 B 34a Totals ............. ....................... ItTataiS..................................... 35 Add cakrons(d)and V)of line 342 ................ 35 .................................... 36 Add col nms(c)and(e)of tore 34b...................................................................... 36 37 Total estabi mad trust fncoms a tfassl Comb nil lines 35 and 36.Enter the result here and fricfude in the total on tine 41 below ........................................:............... 37 _ Fart IV I Income or Loss From Real Estate Mortgage Investment Conduits EM1CS —Residual Holder (b)Err�foyar (c Excess induskn (d)Taxable trxwnre (e)Income from 38 (a)Name kientification Wylber lr Sdr emirs Q. (net foss)from �edsdes Q,line 3b ffnelk srstnstrr+ctnm Sdradafesti fine lb 39 Carr4rirre cdvrrevs and e .Enter the result here and include in the total m fine 41 below............. 39 aft V sJDlnina 40 Net farm rental incorne or Voss)from Form 4835.Also,canplete fine 42 below ............................. 40 41 Toud income or ttasA Combine lines 26,32.37.39.and 40.En*ft result here and on Form 1040.line 17,or Form 104",fine 18 ......................................................... • 41 -14E,3 2- 42 Reconciliation of Band fishing income.Evrter�ss f(aFmmng ) �144,,�r B Schreedule K (Farm 11�}box'17,Code U and scheldi K-1 ------ -- (Form 1041),line 14,code F(see instructions) ................................ 42 43 Reconciliation for real estate professionals.If you were a real estate .-- professional(sae instructions).enter the net income or Voss you reported anywhere on orrnr 1040 or Forrrr 1040NR from all rental tea estate activities — — —in witich you rnaterially participated under the passive activity loss rates......... 43 OAA roam Wall 9 Schedule E(Form 1040)2004 I SCHEDULE SE 011481 no.isrsoors ¢arm lw� Self-Employment Tax 2009 w`s:wc.""' .Atd�di to FOrm t8a0.+See tasvuetfons for StheduM SE(imm t4+14}. . 17 tome d rr/rm,M dRam�yneet acme td Qeen m fmv talOr qr number Hens Line wNth satterr4itoyrnni iroicarne� Who Must file Schedule SE You must file Schedule SE tf: • You fled net earnings Ir m self-employment from other @hem death employee income(tine 4 of Shoo}Schedule SE or line 4c of Long Schedule$E)of$400 or more.or • You had church emrpfwlea income of$10828 or more.Income from services you performed as a minister Ora member of a religious order Is riot church employee Income(see tnsWttiohs), NoW either vin if y u had a floss or II o small amoral of irlc ome from self-employment,it may be to your benefit to file Schedule SE and use Long Schedule SE(see instnrctiors). Emeplaft ft YoUr only seN np rxxxrte was from earnings as a minister,member of a religious order,o Christian Science prachfioner arrf you Sled Form 64 nI%xJ received tRS approval root to be taxed on Raw earnings,do not file Schedule SE.Instead, write t:acerttpt-Ferro 43611'of Fom HMO,Ilne 36. May��Short dy yS�Me S �E. uf N @"s rt w If o, t f Schedule .It ua�a Who k'Rik Sdhedarfe SE above. Did you receive wages or tips in 20047 no ]yes Areyou a minister,member of a religious order,or Yes Yes Christian Sefanoe prawooner who received IRS approval Was Nee total of your wages and tips subject to social not to be tarred on earrings from these sources,but you 5earily or railroad retirement(tier 1)tax phug your net owe sail tax an other earnings? earrings trom sett-employment more than SItMAW. - No 111 NO Are you t>sing am of the optional methods to f due your Yes Old Ya receive tips subject to social sedum or Medicare Yes net eamtlgs(sae insmiefions)7 tax hai you and not report to your employer. Ito tt0 Form WU7eo Std moo income reported on Yes No Social Security Se acrd wages on Medicare Form x on Wages? i yes 111110 , You may use Short Sduedhde SE below �iYou must use Long Schedule SE on page 2� Section A-Shod Schedule SE.Cauftm Read above to see if you can use shot schedule SE. 1 a clot farm profit o QoW from Sdvx hie F,line 36,and term partnerships,Schedule K•1 (Fart 1066). box14,ootlaA-................................................ -...................................., Is b It you received social security retirement or disability bent"its,enter the amount of Conservation Reserve Program payments included on Schedule F,fin 6b.or fisted an Schedule K-1 (Form 1065),box 20, . codoY ...........................................................................I.................... ib 2 NM or{loss)from Schedule C,line 31,Schedule C-E7,tine 3:Schedule K-1{Form 1065),box 14,code A(r>�than farming);and Schedule K-1 (fhorm IO65�,box 9,.ade A.Ministers and members of religious orders.echo mstrs for types of imeorne to report on this line.See rostra for other income to report.............. 2 28,635. 4 Combine Ins le, lb&2................... 3 28,635. 4 that eamihgs from cattemptoymeaL Multiply line 3 by 92.35%(.423.5).if less than$400,do hot fife this sdrodtie:you do not owe self-employment in .....................................................* 4 26i444. S Self employment tar.If the amount on line 4 is; •$105,800 or bas,multiply line 4 by 15.3%(.153).Enter the result here and on form 1040,the 56 •Mora man$106,800,rrtlf�ply line 4 by 2.9%(.029).1htKh,a�$13,24320 t0 pte relit.F-mer the 5 4,046. total here and on Form 1040,one 56. S Deduction for one-half of self-employment tax,Multiply line 5 by 50% Fail ire result here and on Form 1004400 5 2 023.fine 27 ......................... W for Paperwork fieductton Act Modoe,see form 1040InsWCtiam Feu ruor 10/210 Schedule SE Term 1040)2004 it SCHMULE Making Work Pay and Government °i'a"°''�` " (Form 1�pAOr 104>n Retiree Credits 2;:� tro°e°w nia..«.a°srmw"�0 '{99) •Ainfi to remn 154K 1010.or 10tOW •See ^ " saparahtinstrucOons. w. 166 Henn b constanee B Line 1 s tm See the instructions if you can be claimed as someone else's dependent or are filing Farm i ('Mack the 1W box below and sea the instructions t (a)you have a net less from a business,(A)You received a taxable Sdolarship or fellowship grant trot report a Form W-2,(c)yes wages Include pay for work while an irvrtate m a penal insfiitlon,(d) received a pension or=ty,from a compensation plan or a nongovamnrerrtat section 457 plan,or(e)you are filing Form 2555-EZ. filing!yyou'�(and your sparse tf filing jointly)have 2004 wages of mare than$6,451 ($12.903 if married Q Yes.SNP limes to tivo gh 3.Enter$400($800 ff married riling jointly)on line,4 atW go to ling 5. ®No.Enter Your earned income(see instructions) ........................... 1 a 26 612. b Nontaxable combat pay included on tine to (see Instructions) ................................1 11161 _ 2 Murtipy line to by 6.2%(.062) ........................................•...... 2 1, 650. 3 Err*$400 OW if married filing jointly) ..................................... 3 800. 4 F.rkr Uta smaikr of lino 2 or tine 3(u im you dt wiled Yes'on rime f a)................................... 4 goo. 5 Fatter the amount from Form 1040,line 380,or Form 1040A,line 22............. 5 12,300. 6 Enter$75.000($150,=if marrW fling WrAW............................... 6 150,000. 7 Is the amourl an line 5 more Ow the amount on late 6? No.Skip line 8.Ender ft amount from line 4 on line 9 below. Yes Subtract lino 6 from tine 5........................................... 7 8 'Muf6ply Him 7by2%(.02) ................ ...................•................................ ...... 8 0 Subtract fine 8 from fine 4.ff zero or less,enter-0• ................................I...................... 9 800. 10 Did you(or yarn spouse.O filing jointly)reoeive an economic recovery m 2009?You may have re ieived i�if you veterans e ed social security�fns,supplemte�souaity income.railroad disability compe pension benefits(see irtsfruclions). No.Enter-0-on line 10 and go to fine 11. Yes.Enter the total of ft payments received by you((and,your spouse,O filing jointly). ,.......... 10 500. Do not enter more Oran 1250($500 O rsarmed frfrrgl jointly) 11 Did you(or d filing iatndy)receive a pension orgaavmeruniy in 2009 for services performed as an ftLS s�0o not includes Government or annuity state mported on Form W-2. ward not covered by social No.Ender 4 on line 11 and go to line 12. Yes. +If you docked'No'on line 10,enter$254($500 if married filing jointly and the answer an fine 11 is'Yee for both spouses ........... tt 0. •if you dudced'Yes'on line 10 enter-0•(exception:enter$250 O filing jointly ' and the apace who received tjne pension or annuity did not receive an economic.recovery payment described on line 10) _ 12 Add lines 10 W d f l .............................................. ..................................... 12 500. 13 Subtract tine 12 from line 9.ff zero or Less,enter-0. ....................................................— 13 300. 14 f tdng wig pay will go0ra�ftrH retiree credits.Add Ones 11 and 13.Enter the result here and on Fame 1040.fine 63.Form 1 A,MV 40:or Form 1040NR,One 60 .............................................. 14 300. nf you are filing Form 2555,25%-EZ,or 4553 or you are excluding income from Puerto Rico see instructions. _ SAA Fair POC"M k ReducOon Act Notice,see Form 1040A,1040,or 1040HR InOructions. .. Schedule M(Font+1040A or 1040)2009 FtxhaSpt tp+pRg a 1040 Uepamw*offf.TmaawY—kdanaf Revenue Savke (99) LS OO U.S. Individual Income Tax Return OMB No.1545-00741 1r+sUse om a y-Do a aaawena:aaPaa. For Uhe year Jan.1-0ec.31,2011,a oNer lax year beginning ,2011,endue ,20 See separate instructions. Your first name and Wial Last name Your social security number Henry Line It a iofm return,spouse's first name and initial Last name Spouse's social security number Constance B Line Home address(number and street).If you have a P.O.box,see instructions. Apt.no. . Make sure the SSN(s)above 191 Ridge Drive and on line 6c are coned. aty,tovm or post office,state,and ZIP code.H you have a tadgn address,also complete spaces below(see inshuctions). Presidential Oe llon Campaign Carlisle PA 17015 tlndci,aeiya,ayarspaueg Rng Foreign country name Foreign provincelcoumy, Foreign postal rnde Jointly,ward S3 to go to the. 1".Ofecift a box below will not doge yaw tax a refum. ❑You ❑Spouse Filing Status 1 ❑ Single 4 ❑ Head of household(with qualifying person).(See mstrudlons)H 2 ® Marred filing jointly(even if only one had income) the qualifying person is a child but not your depended,enter this Check only one 3 ❑ Married filing separately.Enter spouse's SSN above child's name here. ► box. and full name here.► 5 ❑ Qualifying wido w(er)with dependent child Exemptions 6a ® Yourself.If someone can claim you as a dependent,do not check box 6a . . . . . Bo e a d chocked 2 as b El Spouse No.of children e Dependents: (2)Depended's (a)Depended's (4) .1 if child under age 17 on 6c vfio: (1) first name Last name social seadty RuMbef relationship to you qualifying for chlid tax wo •lived with you (see Instructions) •did not We with ❑ you due to divorce if more than four er separation dependents,see ❑ (see instructions) — Dependents on 6c instructions and El Dependents entered above _ check here ►❑ ❑ Add numbers on d Total number of exemptions claimed lines above ► 2 Income 7 Wages,salaries,tips,etc.Attach Form(s)W-2 . . . . . . . . . . . . 7 Be Taxable interest.Attach Schedule B if required . . . . . Be b Tax-exempt interest.Do not include on line Be . . 8b Attach Form(s) 9a Ordinary dividends.Attach Schedule B if required . . . . 9a W-2 here.Also - attach Forms b Qualified dividends . . . . . . . . . . 9b W2G and 10 Taxable refunds,credits,or offsets of state and local income taxes . . . 10 1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11 was withheld. 12 Business income or poss).Attach Schedule C or C-EZ . . . . . . . . . . 12 16, 927 . 13 Capital gain or Poss).Attach Schedule D H required.If not required,check here ► ❑ 13 g you did not 14 Other gains or(losses).Attach Form 4797. . . . . 14 get i stru 15a IRA distributions 153 b Taxable amount . . . 15b see instructions. 16a Pensions and annuities 16a b Taxable amount . . . 16b 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc.Attach Schedule E 17 -38,449. Enclose,but do 18 Farm income or poss).Attach Schedule F . 18 not attach,any payment Also 19 Unemployment compensation 19 please use 20a Social security benefits I20a 21, 88.7 la, Ta'xable amount 20b 0. Form 1040-V. 21 other income.List type and amount 21 22 Combine the amounts in the far right column for lines 7 through 21.This is your total income ► 22 -21,522. 23 Educator expenses . . . . . . . . . . 23 Adjusted 24 Certain business expenses of reservists,performing artists,and Gross fee-basis government officials.Attach Form 2106 or 2106 EZ 24 Income 25 Health savings account deduction.Attach Form 8889 25 26 Moving expenses.Attach Form 3903 26 27 Deductible part of sett-employment tax.Attach Schedule SE 27 1 196. 28 Self-employed SEP,SIMPLE,and qualified plans 28 29 Set-employed health insurance deduction . . . . 29 30 Penalty on early withdrawal of savings. . . . . . 30 31a Alimony paid b Recipient's SSN ► 31a 32 IRA deduction . . . . . . . . . . . 32 33 Student loan interest deduction . . . . . . . . 33 34 Tuition and fees.Attach Form 8917. . . . . 34 35 Domestic production activities deduction.Attach Form 8903 35 _ 36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . 36 1, 196. 37 Subtract line 36 from line 22.This is your adjusted gross income ► 37 -22,718. For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate instructions. SAA REV 02122A2TTw Form 1040 (2011) Form 1040(2011) Page 2 Tax and 38 mount from line 37(adjusted gross income) , . . . . . 38 1 -22,718. Credits 39a Check ® You were bom before January 2,1947, ❑Blind. Total boxes IV Spouse was born before January 2,1947, Q Blind. I checked► 39a 2 Standard b If your spouse itemizes on a separate return or you were a dual-status alien, check here► 39bo Deduction on 40 Itemized deductions(from Schedule A)or your standard deduction(see left margin) 40 14,401, +People who 41 Subtract line 40 from tine 38 41 —37,119. check any 4Y Exemptions.Multi $3,700 the number on line 6d. box check line Pt PN by 42 7,400. 39a or 39b or 43 Taxable income. Subtract line 42 from line 41.If line 42 is more than line 41,enter-0- 43 0. who can be daimad as a 44 Tax (see instructions).Check if any horn: a 0 Fonn(s)8814 b ❑ Form 4972 c ❑ 962 election 44 0. w�°dent' e 45 Attemadve minimum tax (see instructions).Attach Form 6251 . . . . . . . . . 45 instructions. 46 Add lines 44 and AS - . 1110- 46 0 Single or•All others: 47 Foreign tax credit,Attach Fort 1116 if required . . . . 47 Married filing 48 Credit for child and dependent care expenses.Attach Form 2441 48 separately, $5,600 49 Education credits from Form 8863,line 23 49 iMoaarrr{iied filing 50 Retirement savings contributions credit.Attach Form 8880 50 quaPdyt"r�ng 51 Child tax credit(see instructions) . . . . . . 51 _ $11,600 , 52 Residential energy credits.Attach Form 5695 . . . . 52 Head of 53 Other cracks from Form: a ❑3800 b ❑ 8801 c ❑ 53 hold. 54 Add lines 47 through 533.These are yourtotai credits '54 65 Subtract line 54 from line 46.H tine 54 is more than line 46,enter-0- ► 55 0. Other 56 Self-employment tax.Attach Schedule BE . . . . . . . . . . . . 56 2, 07 9. Taxes 57 Unreported social security and Medicare tax from Form: a Q 4137 b []8919 57 58 Additional tax on IRAs,other qualified retirement plans,etc.Attach Form 5329 if required 58 59a Household employment taxes from Schedule H . . . . . . . 59a b First-time homebuyer credit repayment.Attach Form 5405 if required . . . . , . . 59b 60 Other taxes.Enter codets)from instructions 60 61 Add lines 55 through 60.This Is our total tax _ ► 61 2,07 9. Payments 62 Federal income tax withheld from Forms W-2 and 1099 62 63 2011 estimated tax payments and amount applied from 2010 return 63 If you have a 64a Earned income credit(EIC) . . . . 64a qualifying child,attach b Nontaxable combat pay election 1.64bl Schedule EIC, 65 Additional child tax credit Attach Form 8812 65 66 American opportunity credit from Form 8863,fine 14 66 67 First-time homebuyer credit from Form 5405,line 10. . , 67 68 Amount paid with request for extension to file . . . . 68 69 Excess social security and tier 1 RRTA tax withheld 69 70 Credit for federal tax on fuels.Attach Form,4136 . . . , 70 71 Credits from Farm: a E)2439 b ❑8839 c E]8601 d ❑ 6665 71 72 Add lines 62,63,64a, and 65 through 71.These are your total payments . . ► 72 Refund 73 If line 72 is more than line 61,subtract line 61 from line 72.This is the amount you overpaid 73 74a Amount of line 73 you want refunded to you.If Form 8888 is attached,check here . ►❑ 74a Direct deposit?00 b Routing number �X ((� X I X I-c Type: E]Checking []Savings see ► d Account number �x} x x l X X X.1 x l x I x I X I X I X I x l x i x l x I X I mstrtwakons. 76 Amount at tine 73 ou want applied to your 2012 estimated tax► 1 75 Amount 76 Amount you owe.Subtract line 72 from line 61.For details on how to pay,see instructions ► 76 2,120. YOU OWe 77 Estimated tax penalty(am instructions 77 1 41. Third Party Do you want to allow another person to discuss this return with the IRS(see instructions)? []Yes.Complete below. ® No Designee Designee's Phone Personal identification name ► no. ► number(PIN) ► Sign Under panatties of pop",I dedare that I have examined this rehxn and accompanying edt an and statements,and to are hat of my knowledge. mx4 beget, Flare ihe5'aratrue,correct.and Comdata,t)edaration of prepmar(other than taxpayer)is based on aq iMannetron of which pmparar has any knnwfadge. uoka roRxn? Sex Your signature Date Your occupation Daytime phone number instructions. 14141IJ Jewelry/Watchmaker "j Keep a copy for te*s ' nature.7ta;int term,both must sign. Date Spwse's occupation If the IRS sent you an Identiy Protection Y n!CW'ds. flN,War it 6 housewife Pere Pis Paid Print/type preps ers name Preparers s gnatu a Date Check ❑If PTIN Preparer sett-empkyad Use Only Finn's name SELF PREPARED F nn s EIN ► Firm's address► Phone no. REVC 12mv Form 1040poti) SCHEDULE Itemized Deductions OMB No.1646-0074 (Form 1040) ©1 '! Depertmens of treTmasuy ►Attach to Form 1840. ►see instructions for Schedule A(Form 1040). Attachment kaema4 Revenue Sovkc M uence No.07 Namo(s)shimn on Farts 1040 Your social security oumber Henry 6 Constance 8 Line Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses(see instructions) . . . . 1 3, 106. Dental 2 Enter amount from Form 1040,line 38 2 -22, 718. Expenses 3 Multipty fine 2 by 7,54'0(.075) 3 0. 4 Subtract fine 3 from line 1,If line 3 is more than tine 1,enter-0- . 4 3, 106. Taxes You b State and local (check only one box): Paid a O income taxes,or ( 5 b ❑General sates taxes J 6 Real estate taxes(see instructions) . . . . . . . . . 6 3, 403. 7 Personal property taxes . . . . . . . . 7 8 Other taxes,List type and amount IN- 9 Add lines 5 through 8 . 91 3, 403. Interest 10 Home mortgage interest and points reposed to you on Form 1648 10 7,892. You Paid 11 Home mortgage interest not reported to you on Form 1098.If paid to the person from whom you bought the home, see instructions Note, and show that Your mortgage Your Warne,identifying no.,and address 0, interest deduction may 11 be limited(see 12 Points not reported to you on Form 1098. See instructions for instructions). special rules. . . . . . . . . . . . . . . . . 12 13 Mortgage insurance premiums(see instructions) . . . . . 13 14 Investment interest.Attach Form 4952 if required.(See instructions.) 1141 15 Add lines 10 through 14 . 15 7,892. . . . . . . . . . . . . . . . . . . . Gifts to 16 Gifts by cash or check. If you made any gift of$250 or more, Charity see instructions. . . . . . . . . . . . . . . . 16 If you made a 17 Other than by cash or check. If any gift of $250 or mare,see gift and got a instructions.You must attach Form 8283 if over$500 . . . 17 benefit for it, 18 Carryover from prior year . . . . . . . . . . . . 18 see instructions. 19 Add lines 16 through 18 . 19 . . . . . . . . . . . . . . . . . . . . Casualty and Theft tosses 20 Casualty or theft loss(es).Attach Form 4684.(See instructions.) . 20 Job Expenses 21 Unreimbursed employee expenses—job travel, union dues, and Certain Job education, etc. Attach Form 2106 or 2106-EZ if required. Miscellaneous (See instructions.) ► 21 Deductions 22 Tax preparation fees . . . . . . . . . . . . . 22 23 Other expenses—investment, safe deposit box, etc. list type and amount ► 23 24 Add lines 21 through 23 . . . . . . . . 24 25 Enter amount from Form 1040,line 38 25 26 Multiply tine 25 by 2%(.02) . . . . . . . 26 27 Subtract line 26 from line 24, If line 26 is more than line 24,enter-0- 27 Other 28 Other—from list in instructions.List type and amount ► Miscellaneous Deductions 28 Total 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount Itemized on Form 1040,tine 40 29 14190i_ 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 Forth 1040 instructions. 8AA REV rmrsnr TTw Schedule A(Form 104012011 SCHEDULE C-EZ Net Profit From Business OMB No.1545-0074 (Form 1040) (Sole Proprietorship) �O i 1 Department of ft Tmawry b-Partnerships,joint ventures,etc.,generally must file Form 1065 or 1065-6. Attachmem Internal Revenue SwAoe(99) ►Attach to Form 1040,1040NR,or 1041. ►See instructions on page 2 Sequence No.09A Name of proprietor social security number ISSN) Henry Line General Information • Had business expenses of$5,000 or •Had no employees during the year. YOU May Use •Use the cash method of accounting. •Are not required to file Form 4562,. Schedule GEZ •Did not have an inventory at any time Depreciation and Amortization,for during the year. this business.See the instructions for Instead of •Did not have a net loss from your Schedule C business. Schedule C,line 13,to find out if you Only If You: •Had only one business as either a sole And You: must file. proprietor,qualified joint venture,or •Do not deduct expenses for business statutory employee. use of your home. •Did not receive any credit card or • nor y Do not have year unallowed similar payments that included p amounts that are not Includible in your passive activity losses from this income(see instructions for line 1a). buslness. A Principal business or profession,including product or service B Enter business code(see page 2) Watchmaker 10.14 9 18 13 11 10 C Business name.If no separate business name,leave blank D Enter your£IN(see page 2) Line 6 Line E Business address(including suite or room no.).Address not required if same as on page 1 of your tax return. 21 Dickinson Avenue City,town or post office,state,and ZIP code Carlilse, PA 17013 F Did you make any payments in 2011 that would require you to file Form(s)1099?(see the Schedule C instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ONO G If"Yes,"did you or will you file all required Forms 1099? ❑Yes ❑No Figure Your Net Profit to Merchant card and third party payments.For 2011,enter-0- . . . . . 1 a 0- b Gross receipts or sales not entered on line 1 a(see instructions) . . I 21, 562. c Income reported to you on Form W-2 if the "Statutory Employee" box on that form was checked. Caution. See Schedule C instructions before completing this line 1c d Total of lines 1a, 1b,and 1c.If any adjustments to line 1a,you must use Schedule C(see instructions) td 21,562. 2 Total expenses(see page 2).If more than$5,000,you must use Schedule C . . . . . . . 2 4, 635. 3 Net profit Subtract fine 2 from line 1 d. If less than zero,you must use Schedule C. Enter on both Form 1040,line 12,and Schedule SE,line 2,or on Form 1040NR,line 13 and Schedule SE, line 2(see instructions).(If you entered an amount on line 1 c, do not report the amount from line 1c on Schedule SE,line 2.)Estates and trusts,enter on Form 1041,fine 3 . . . . . . 3 1 16, 927. Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2. 4 When did you place your vehicle in service for business purposes?(month,day,year) ► 5 Of 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 page 2) c Other 6 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . ❑Yes []No 7 Do you(or your spouse)have another vehicle available for personal use? . . . . . . . . . . . ❑Yes; []No Ba Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . ❑Yes ❑No b If"Yes,"is the evidence written? ❑Yes ❑No For Paperwork Reduction Act Notice,see your tax return instructions. SAA REV 1f=11 Ttw Schedule C-Q(Form 1040)2011 Schedule E(Farm 1040)2011 Attachment Sequence No.13 Page 2 Names)shown on return.Do not enter name and social security number 0 shown on other side. Your social security number Henry 5 Constance B Line 1 Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s)K-1. Income or Loss From Partnerships and S Corporations Note. if you report a loss from an at-risk activity for which any amount is not at risk,you must check the box in column(e)on line 28 and attach Form 6198. See instructions. 27 Are you reporting any toss not allowed in a prior year due to the at-risk or basis limitations,a prior year unallowed loss from a passive activity (f that loss was not reported on Form 8582), or unreimbursed ❑ Yes ❑x No partnership expenses?If you answered"Yes,"see instructions before completing this section. 23 {a) Name (b) Enter P far (c) Check if (d) Employer (a) Check if Partnership;S foreign identification airy amount I. for S corporation partnership number not at risk A Multi-Natinal Diamonds, Inc. S ❑ 25-1866126 ❑ B ❑ ❑ C ❑ ❑ D ❑ ❑ Passive Income and Loss Nonpassive Income and Loss M Passive loss allowed (9) Passive income (h) Nonpassive loss lik section 179 expense 0) Nonpassive income (attach Form a5821f required) from Schedule Kt from Schedule K-1 deduction from Form 4562 from Schedule K-1 A 38, 449. B C D 29a Totals b Totals 38,449. 30 Add columns(g)and 6)of line 29a. . . . . . . . . . . . . . . . . . . . . 30 31 Add columns(f),(h),and n of line 29b . . . . . . . . . . . . 31 ( 38,449. ) 32 Total partnership and S corporation income or{loss). Combine lines 30 and 31. Enter the result here and include in the total on line 41 below . 32 -38,449. LEOWL . . . . . . . . . . . . . . Income or Loss From Estates and Trusts 33 (a) Name (b) Employer identification number A B Passive Income and Loss Nonpassive Income and Loss (c)Passive deduction or loss allowed (d)Passive income (e)Deduction or loss (f)other income from (attach Form 5592 it required) from Schedule K-1 from Schedule K-1 Schedule K-1 A 13 34a Totals b Totals 35 Add columns(d)and(1)of line 34a. . . . . . . . . . . . . . _ . . . . 35 36 Add columns(c)and(e)of line 34b . . . . . . . . . . . . . . . . . . . 36 37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . 37 Income or Loss From Rea( Estate Mortgage Investment Conduits(REMICs)—Residual Holder 36 (a)Mane (b)Employer identification (c)Excess inclusion from (d)Taxable income(net loss) (e)Income from number Schedules 0,line 2c from Schedules 4,line to Schedules Q,line 3b (see instructions 39 Combine columns and o only. Enter the result here and Include in the total on tine 41 below 39 Summary 40 Net farm rental income or(loss)from Form 4835.Also,complete line 42 below . . . . . . 40 41 Totaifncomeor(foss).Combinefines28,32,37,39,anif 40.Fntertheresdt here and wFam1040,We17,or Fam1040NR,line 18► 41 -38, 449. 42 Reconciliation of farming and fishing income. Enter your gross farming and Fishing Income reported on Form 4835,line 7;Schedule K-1 (Form 1065),box 14,code B;Schedule K-1 (Form 1120S),box 17,code U;and Schedule K-1 (Form 1041),line 14,code F(see instructions) 42 43 Reconciliation for real estate professionals. If you were a real estate professional (see Instructions), enter the net income or{lass)you reported anywhere on Form 1040 or Form 1040NR from all rental real estate activities in which you materially participated under the passive activity loss rules . . 43 REV W24112 Tnv Schedule E(Form 1040)2011 SCHEDULESE (Form 1040) Self-Employment Tax OMB No.15450074 X011 Department of the Treasury ►Attach to Form 1040 or Form 1040NR. ►See separate instructions. Attachment Imemai Revenue Service Name of person with self-employment Sequence No.17 crop oymem income(as shown on Form 1040) Social security number of person Henry Line with self-employment income► 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. Oid you receive wages or tips in 2oti7 No yes Are you a m{nistor, member of a religious order, or chnstian Was the total of ur wa es and ti sub ed to nodal seta' Science practitioner who received IRS approval not to be taxed Yes 1'O 9 ) my Yes on comings from these sowces,but you owe sett-employment or railroad retirement (tier 1)tax plus your net earnings from tax an other eamkgs? sex-employment more than$106,8007 No No Am you using are of the optional methods to figure your net Yes Did you receive tips subject to social security or Medicare tax Yes earnings(see Instructions)? that you did not report to your employer? No No Did you reoefve church employee income (see instructions) Yes No Did you report any wages on Form 8919, Uncollected Social Yes reported on Form W-2 of$108.28 a morel Security and Medicare Tax on Wages? No You may use Short Schedule SE below You must use Long Schedule SE on page 2 Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. t 1a Net farm profit or Qoss)from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065),box 14,code A. . . . . . . . . . . . . . . . . . . . . to b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F,line 4b,or listed on Schedule K-1 (Form 1065),box 20,code Y 1b ( ) 2 Net profit or Qoss)from Schedule C, line 31;Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than fanning); and Schedule K-1 (Form 1065-B), box 9, code J1. Ministers and members of religious orders, see instructions for types of income to report on this line.See instructions for other income to report . . . . . . . . . . . . . . 2 16,927. 3 Combine lines 1a,1b,and 2 . . . . . . . . . . . . . . . . . . . . . 3 16, 927. 4 Multiply,line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do not file this schedule unless you have an amount on line 1 b . . . . . . . . . . . ► 4 15, 632. Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions. 5 Self-employment tax.If the amount on line 4 is: •$106,800 or less,multiply line 4 by 13.3%(.133).Enter the result here and on Form 1040,line 56, or form 1040NR,line 54 •More than$106,800,multiply line 4 by 2.9%(.029).Then,add$11,107.20 to the result. Enter the total here and on Form 1040,line 56,or Form 104014R,line 54. . . . . . . 5 1 2,079. 6 Deduction for employer-equivatent portion of self-employment tax. If the amount on line 5 is: •$14,204.40 or less,multiply tine 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 1, 1960 For Paperwork Reduction Act Notice,see your tax return instructions. BAA REV 1001111 Trw Schedule SE(Form 1040)2011 Form 1040 Social Security Benefits Worksheet 2011 Line 20 ► Keep for your records Name(s)Shown on Return Social Security/Railroad Retirement benefits received in 2010 . . . . . . . . Taxpayer Spouse A Total net benefits from Box 5 of all SSA-1099 forms . . . . . . . . . . 14, 572. 7,315. B Total federal tax withheld from box 6 of all SSA-1099 forms C Total Medicare B premiums withheld from all SSA-1099 forms. . . . . 1, 158. 1,291. D Total Medicare C premiums withheld from all SSA-1099 forms. . . . . 221. E Total Medicare D premiums withheld from all SSA-1099 forms. . . . . 436.-3 6. Note:If self-employed,Medicare premiums are deductible as Self-Employed Health Insurance. If self-employed,enter premiums on the business activity form (Schedule C, F,etc), not on Lines C, D and E above. F Total net benefits from Box 5 of all RRB-1099 forms . . . . . . . . . . G Total federal tax withheld from box 10 of all RRB-1099 forms H .Total Medicare premiums from Box 11 of all RRB-1099 forms . . . . . 1 Add amounts from line A and line F above.Also enter this amount on Form 1040, line 20a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 21, 887. 2 Enter one-half of line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 10, 944. 3 Add the amounts on Form 1040,lines 7(before adoption benefits exclusion), 8a(before U.S.savings bond interest exclusion),8b,9a, 10 through 14, 15b, 16b, 17 through 19,and line 21.Also include certain income of bona fide residents of American Samoa or Puerto Rico. . . . . . . . . . . . . . . . . . . . . . . 3 -21,522. 4 Enter the total of any exclusions/adjustments for: • Foreign earned income or housing exclusion . . . . . . . . . . . . . . . . . . . . . 4 5 Add lines 2,3,and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 -10,578. 6 Amount from Form 1040,lines 23 through 32,plus any write-in amounts on line 36 (other than foreign housing deduction). . . . . . . . . . . . . . . . . . . . . 6 1, 196. 7 Subtract line 6 from line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 -11,774 . 8 Enter$25,000($32,000 if married filing jointly;$0 if married filing separately and you lived with your spouse at any time in 2011) . . . . . . . . . . . . . . . . . . . 8 32,000. 9 Subtract line 8 from line 7. If zero or less,enter-0. . . . . . . . . . . . . . . . . . . . 9 0. If line 9 is zero or less,stop here;none of your social security benefits are taxable. Enter-0-on Form 1040,line 20b. If you are married filing separately and you lived apart from your spouse for all of 2011,enter'D'to the right of the word'benefits'on line 20a. If line 9 is more than zero,go to line 10. 10 Enter$9,000 ($12,000 if married filing jointly;$0 if married filing separately and you lived with your spouse at any time in 2011) . . . . . . . . . . . . . . . . . . . 10 11 Subtract line 10 from line 9. If zero or less, enter-0. . . . . . . . . . . . . . . . . . . . 11 12 Enter the smaller of line 9 or line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Enter one-half of line 12. . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Enter the smaller of line 2 or line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 15 Multiply line 11 by 85%(.85). If line 11 is zero, enter-0. . . . . . . . . . . . . . . . . 15 16 Add lines 14 and 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Multiply line 1 by 85%(.85). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Taxable social security benefits. Enter the smaller of line 16 or line 17 . . . . . . . . 18 If prior year lump-sum benefits were received,go to line 19,otherwise, skip line 19 and enter the amount from line 18 on line 20. 19 Taxable benefits with lump sum election. Enter the amount from line 20 of the Lump-Sum Social Security Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . 19 20 Taxable Social Security benefits. Enter the smaller of line 18 or line 19 Also enter this amount on Form 1040, line 20b. . . . . . . . . . . . . . . . . . . . . 20 Schedule K-1 Shareholder's Share of Income, Credits, 2011 (Form 1120S) Deductions, etc. Keep for your records Shareholder's Name Social Security Number Henry Line Information About the Corporation A Corporation's Employer Identification Number . . . . . . . . . . . . . . .25-1866126 8 Corporation's Name . . . . . . . . . . . . _ _ - Multi-Natinal Diamonds, Inc. Address. . . . _ . . . . . . . . . . . . 191 Ridge Drive City . . . . . . . . . . . . . . . . . . . . Earlilse State . . . . . . . . . . . . . . . PA ZIP Code. . . . . . . . . . . . . . . . . 17o15 C IRS Center where corporation filed return . . . . . . . . . . . . . . . . . . .Harrisburg, PA Ki-WIF-1 Information About the Shareholder Shareholder is Taxpayer . . -Ex Spouse. . . . Joint . . . D Shareholder's Identifying Number . . . . . . . . . . . . . . . . . . . . . . E Shareholder's Name . . . . . . . . . . . . . . . . . . Henry Line Address. . . . . . . . . . . . . . . . . . 191 Ridge Drive City . . . . . . . . . . _ . . . . . . . . Carlisle State . . . . . . . . . . . . . . . . . . . PA ZIP Code . . . . . . . . . . . . . . . . . . 17015 F Shareholder's percentage of stock ownership for tax year. . . % At-Risk Status(check one): All investment in corporation is at-risk . . . . . . . . . . . . . . . . . . Some investment in corporation not at-risk . . . . . _ . . . . . . . ►[� f__j Rnal K-1 0 Amended K-1 Part Ili Shareholder's Share of Current Year Income,Deductions,Credits,Other Items Check Type of Activity Reported on this Schedule K-1: Business . . . . . . . . Rental Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Rental Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other(investment dub,etc.) . . . . . . 1 Ordinary business income(loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . -38,449. Check it"materially"participated in the business activities . . . . . . . . . . . ►EO 2 Net rental real estate income(loss) . . . . . . . . . . . . . . . . Check if"materially"participated in rental real estate activities. . . . . Check it"actively*participated in rental real estate activities. . . . . . . . . . Check if rental of property to a nonpassive activity . . . . . . . . . ► 3 Other net rental income{loss} . . . . . Check if rental of property to a nonpassive activity . . . . . . . . . . . . . . . -M 4 Interest income. . . . . . . . . . . . . . . . . . . . . . . . . Interest income from U.S.obligations included in box 4. 5 a Ordinary dividends. . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . 5 b Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . Interest income from U.S.obligations included in box 5. . . . . . . 6 Royalties . . . . . . . . . . . . . . . . . . . Double-click to link royalties to Schedule E Worksheet . . . . . . ► Henry Line Page 5 Corporation Name Multi-Natinal Diamonds, Inc. Sectian Income and Loss Reported on Schedule E, Supplemental Income or Loss Passive income and Loss Nonpassive Income and Loss # Description (t) (g) (h) (1) 0) Loss K-1 Income K-1 Loss K-1 Section 179 Income K-1 1 A Multi-Natinal Diamonds, Inc. 38, 449. Federal Carryover Worksheet 2011 Keep for your records Name(s)Shown on Return 60cial Security Number Henry & Constance B Line 2010 State and Local Income Tax Information(See Tax Help) (a) (b) (c) (d) (e) M (g) State or Paid With Estimates Pd Total With- Paid With Total Over- Applied Local ID Extension After 12/31 held/Pmts Return payment Amount PA Totals - - Other Tax and Income Information 2010 2011 1 Filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 MFJ 2 Ml:"J 2 Number of exemptions for blind or over 65(0-4). . . . . . . . . 2 2 2 3 Itemized deductions . . . . . . . . . . . . . . . . . . . . . . . . . 3 27, 916, 14,401 4 Check box if required to itemize deductions. . . . . - . . . . . , 4 .._O._ Li 5 Adjusted gross income 5 -1,240. -22,718. 6 Tax liability for Form 2210 or Form 2210•F . . . . . . . . . . . . 6 2, 935. 2,079. 7 Altemative.minimum tax. . . . . . . . . . . . . . . . . . . . . . . 7 8 Federal overpayment applied to next year estimated tax. . . . . 8 OuickZoorn to the IRA Information Worksheet for IRA Information . . . . . . . . . . . . . . Excess Contributions 2010 2011 So Taxpayer's excess Archer MSA contributions as of 12131 . . . . So to Spouse's excess Archer MSA contributions as of 12131 . . . . b file Taxpayer's excess Coverdell ESA contributions as of 12/31. . . 10a b Spouse's excess Coverdell ESA contributions as of 12131, . . . b 11 a Taxpayer's excess HSA contributions as of 12/31 . . . . . . , - 11 a b Spouse's excess HSA contributions as of 12131 . . . . . . . . . b Loss and Expense Carryovers 2010 2011 Note:Enter all entries as a positive amount 12a Short-term capital loss. . . . . . . . . . . . . . . . . . . . . . . . 12a b AMT Short-term capital loss . . . . . . . . . . . . . . . . . • . • b 13a Long-term capital loss. . . . . . . . . . . . . . . . . . . . . . . . 13a b AMT Long-term capital loss. . . . . . . . . . . . . . . . . . . . . b 14a Net operating loss available to carry forward . . . . . . . . . . . 14a b AMT Net operating loss available to carry forward . . . . . . . . b 15a Investment interest expense disallowed . . . . . . . . . . . . . . 15a b AMT Investment interest expense disallowed. . . . . . . . . . . b 16 Nonrecaptured net Section 1231 losses from: a 2011. . . 16a b 2010. . . b c 2009. - . c d 2008. . . d e 2007. . . e f 2006. . . f Federal Carryover Worksheet page 2 2011 Henry a Constance B Line Loss and Expense Carryovers(cont'd) 2010 2011 17 AMT Nonrecap'd net Sec 1231 losses from: _ a 2011. . . 17a b 2010. . . b c 2009. . . c d 2008. . . d e 2007. . . e f 2006. . . f Credit Carryovers 2010 2011 18 General business credit. . . . . . . . . . . . . . . . . . . . . . . 18 19 Mortgage interest credit from: I a 12011 . . . . , , . . . . . . 19a b 2010 . . . . . . . . . . . . b c 2009 - . , . . . . . . . . . c d 2008 ... . . . . . . . . . . d 20 Credit for prior year minimum tax. . . . . . . . . . . . . . . . . . 20 21 District of Columbia first-time homebuyer credit. . . . . . . . . , 21 22 Residential energy efficient property credit . . . . . . . . . . . . 22 Other Carryovers 2010 2011 23 Section 179 eTd rise deduction disallowed . . . . . . . . . . . . 23 24 Excess a Taxpayer(Form 2555,line 46) . . . . . . . 24a foreign b Taxpayer(Form 2555,line 48) . . . . . . . b housing c Spouse(Farm 2555,line 46) . . . . . . . c deduction: Spouse(Form 2555,line 48) . . . . . . . d Charitable Contribution Carryovers 25 2010 Carryover of Other property Capital Gain charitable contributions from. (a)50% (b)30% (c)30% (d)20% a 2010 . . . . . . . . . . . . . . b 2009 . . . . . . . . . . . . . c 2008 . . . . . . . . . . . . . . d 2007 . . . . . . . . . . . . . . e 2006 . . . . . . . . . . . . . 26 2011 Carryover of Other Property Capital Gain charitable contributions from: (0)50% (b)30% (c)30% (d)20% a 2011 . . . . . . . . . . . . . b 2010 . . . . . . . . . . . . . c 2009 . . . . . . . . . . . . . . d 2008 . . . . . . . . . . . . . e 2007 . . . . . . . . . . . . . . 27 Amount overpaid less earned income credit. . . . . . . . . . . . . . . . 0. 2010 Slate Capital Loss Carryovers(For users not transferring from the prior year) State Short-term AMT Short-term Long-term AMT Long-term Capital Loss AMT Capital Loss ID Capital Loss Capital Loss Capital Lass Capital Loss (combined) (combined) for State for State for State for State for State for State t° ■ 040 Dcpamnax of me Tm*wy-1ntmW Reverure Seroce �) LSO1 U.S. Individual Income Tax Return OMB No.1545-0074 IRS USe 0nk/–Do no wMea staple MINS Sp$ce For the year Jan,1-Dec.31,2012,a other tax year begixiiq ,2012,ericring .20 See separate instructions. Your first name and Initial Last name Your$octal security number Henry Line If a joint return,spouse's first name and Initial Last name Spouses social security number Constance B Line Home address(number and street).If you have a P.O.box.see instructions. Apt.w. . Make sure the SSN(s)above 191 Ridge Drive and on line 6c am correct. Ciry,tam a Post office,state,and 73P code.x you have a foreign ackl ss,aim complete spaces below(see Instnlctiuns)• Presidential Election campaign Carlisle PA 17015 oeckhasa you,a Your spolaeattng ForelliRcountryname Foreign Province/statelcaunry Foreign postal wee '1e"'$3 b got io fhb herd'Chddtg o box, wi rot Jorge you tax a ld• ❑You ❑spouse Filing Status 1 ❑ Single 4 ❑ Head of Household(with qualifying person).(see inst actions.)It 2 ( Married filing jointly(even if only one had income) the qualifying person is a child but not your dependent,onter this Check only one 3 ❑ Married filing separately.Enter spouse's SSN above child's name here.► box. and full name here.► 5 ❑ Qualifying wldow(er)with dependent child Exemptions 6a ® Yourself.II someone can claim you as a dependent,do not check box 6a . . . . . Box as checked 2 b El Spouse — No.of children e Dependents: Ch Depewerd's (3)Dependent's (4) V If child comer ape 17 on 6c who: (1) Find name Ust name aadot seamry umber a atiduh p to you dab tac�Waetll you sm n �) .did not We with ❑ punt ar to divorce If more than tour ❑ lee,Insbuctlom) dependents,see — instructions and ❑ not &bbe" check here ►❑ ❑ Add numbers on d Total number of exemptions claimed linos above ► 2❑ Income 7 Wages,salaries,tips,etc.Attach Form(s)W-2 . . . . . . . . . . . . 7 8a Taxable Interest.Attach Schedule 6 if required . . . . . 82 b Tax-exempt Interest.Do not include on tine 8a . . 8b ___ Attach Form(s) W-2 here.Also .ga Ordinary dividends.Attach Schedule B if required . 9a attach Forms b Oualified dividends . . . . . . . . . . 9b I _- W-2G and 10 Taxable refunds,credits.or offsets of state and local Income taxes . . . . . . 10 1099-R If tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11 was withheld. 12 Business income or(loss).Attach Schedule C or C-F2 . . . . . . . . 12 10, 496. 13 Capital gain or(loss).Attach Schedule D if required.If not required,check here► ❑ 13 If you did not 14 Other gains or(losses).Attach Form 4797 . . . . . . . . . . 14 get a W-2, see instructions. 15a IRA distributions 153 b Taxable amount . . . 15b 16a Pensions and annuities 16a to Taxable amount . . . 16b 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc.Attach Schedule E 17 0. Enclose,but do 18 Farm income or(loss).Attach Schedule F . . . . . . . . . . . . . 18 not attach,any payment.Also, 19 Unemployment compensation . . . . . . . . . . . . . 19 please use 20a Social security benefits 120a I 21, 639. b Taxable amount . . 20b 0. Form 10404. 21 Other Income.List type and amount 21 22 Combine the amounts in the far tight column for lines 7 through 21.This is your total income ► 22 10, 496. 23 Educator expenses . . . . . . . . . . 23 Adjusted 24 Certain business expenses of reservists,performing artists,and Gross fee-basis government officials.Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction.Attach Form 8889 25 28 Moving expenses.Attach Form 3903 . . . . 26 27 Deductible part of self-employment tax.Attach Schedule SE 27 741. 28 Self-employed SEP,SIMPLE,and qualified plans 28 29 Self-employed health insurance deduction . . 29 1 1, 934 . 30 Penalty on early withdrawal of savings. . . . 30 31a Alimony paid b Recipient's SSN ► 312 32 IRA deduction . . . . . . . . . . . . . 32 33 Student loan interest deduction. . . . . . . . 33 34 Tuition and fees.Attach Form 8917. . . . . . . 34 35 Domestic production activities deduction.Attach Form 8903 35 36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 2 675. 37 Subtract line 36 from line 22.This is your adjusted gross Income . ► 37 7 821 . For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate instructions. SAA REV o2A7n3 T1w Form 10Q (2012) Form 1040(2012) Page 2 Tax and 38 Amount from line 37(adjusted gross income) . . . . . . . . . 38 7,821. Credits 39a Check ! ® You were born before January 2,1948, ❑ Blind. Total boxes If: l ® Spouse was bom before January 2,1948, ❑ Blind. checked ► 39a E2 Deduction io b If your spouse itemizes on a separate return or you were a dual-status alien, check here► 39b❑ for- on 40 Itemized deductions(from Schedule A)or your standard deduction(see left margin) 40 15, 609. for- , -heck cy who 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . 41 -7,788. box on line 42 Exemptions.Multiply$3,600 by the number on line 6d. . . . . . . . . . . . 42 7, 600. 39a or 39b or 43 Taxable Income. Subtract line 42 from line 41.If line 42 is more than line 41,enter-0- 43 0. who can be claimed as a 44 Tax (see instructions).Check if arry from: a ❑ Form(s)8814 to ❑ Form 4972 e ❑ 962 election 44 0. Se�ent. 45 Alternative minimum tax (see instructions).Attach Form 6251 . . . . . . . . . 45 Instructions. 46 Add lines 44 arid 45 . . . . . . . . . . . . . . . ► 46 0. •An others: 47 Foreign tax credit.Attach Form 1116 if required . . 47 Single or Married filing 48 Credit for clsld and dependent care expenses.Attach Form 2441 48 separately' $ separately. 49 Education credits from Form 8863,line 19 . . . 49 Married filing 50 Retirement savings contributions credit.Attach Form 8880 50 jointly orgg urn alZfyi rl, 51 Child tax credit.Attach Schedule 8812,if required. . . 51 $11,900 52 Residential energy credits.Attach Form 5695 . . . . 52 Head of 53 Other credits from Form: a ❑3800 b ❑ 8601 c ❑ 53 58.700 household. 54 Add lines 47 through 53.These are 68.700 u9 your total credits 54 65 Subtract line 54 from line 46.If line 54 is more than line 46,enter-0- ► 55 0. Other 56 Self-employment tax.Attach Schedule SE . . . . . . . . . . . . . . . 56 1,289. Taxes 57 Unreported social security and Medicare tax from Form: a []4137 b ❑ 8919 57 58 Additional tax on IRAs,other qualified retirement plans,etc.Attach Form 5329 if required 58 59a Household employment taxes from Schedule H . . . . . . . . . . . . . . 59a b First-time homebuyer credit repayment.Attach Form 5405 0 required . . . . . . . . 59b 60 Other taxes.Biter code(s)from instructions 60 61 Add lines 55 through 60.This is your total tax ► 61 1,289. Payments 62 Federal income tax withheld from Forms W-2 and 1099 . . 62 63 2012 estimated tax payments and amount applied from 2011 return 63 If you have a 64a Earned Income credit(EIC) . . . . . . . 64a qualifying child,attach b Nontaxable combat pay election 644 _ Schedule EIC. 65 Additional child tax credit Attach Schedule 8812 . . . . . 65 fib American opportunity credit from Forth 8863,line 6. . . . 66 67 Reserved . . . . . . . . . . . . . . . 67 68 Amount paid with request for extension to file . . 68 69 Excess social security and tier 1 RRTA tax withheld . 69 70 Credit for federal tax on fuels.Attach Form 4136 . . . . 70 71 Credits from Form: a ❑2439 b ❑Reeval c ❑8601 d ❑ 8885 7i _ 72 Add lines 62,63,64a, and 65 through 71.These; your total payments . . ► 72 ' Refund 73 If line 72 is more than line 61,subtract line 61 from line 72.This is the amount you overpaid 73 74a Amount of line 73 you want refunded to you.If Form 8888 is attached,check here . ►❑ 74a Direct deposit? ► b Routing number _ ►c Type: ❑ Checking ❑ Savings see ► d Account number x x x x x X, x x x x l x ( x i x l x l x l x l x l Instructions. 75 Amount of One 73 you want applied to your 2013 estimated tax► 1 75 Amount 76 Amount you owe.Subtract line 72 from line 61.For detals on how to pay,see Instructions ► 76 1,312. You Owe 71 Estimated tax penalty(see instructions 77 1 23. Third Party Do you want to allow another person to discuss this return with the IRS(see Instructions)? ❑ Yes.Complete below. ® No Designee Designse's Phone Personal identification 1 1 name 11- no. ► number(PIN) ► Sign Under penalites of Perjury,l dedate that I have exarrhad this return and accompanying schedules and statements.and to ua best of my knowledge and belief, Here irm afe trim•oowect,and complete.Doclsralion of proparw(other than taxpayer)is based on 0Information of which pmparor has any knowiadge. Jost return? see Your signature Date Yotaoccupatron Daytime phone number kcr1nX1iom. k I Self employed (717) 249-3931 Keep a copy (or Spouse's signature.If a joint return,both must sign. Date Spouse's occupation a the M seal you an ldaxrly Protection 1�records. PM,eAef it Homemaker time tint. Paid PdntfType preparar's name P epa efs s gnature Date Check ❑if PTIN Prepared sea-employed Use OnIy Firm's mine ► SELF PREPARED Firm'sEIN ► Firm's address► Phone ra. REV 0=7113TTW Form 1040(2012) SCHEDULER Itemized Deductions OMB No.1545-0074 (Form 1040) �0 A Departmem of the Trans ► ww Information about Schedule A end its separate instructions is at Jrs.gov/formi0W0. Int"Rewanue Service(991 ►Attach to Form 1040. Attachment ScQuence No. Name(s)shown on Form 1040 Vour social security number Henry & Constance B Line Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses(see instructions) . . . . . 1 1,296. Dental 2 Enter amount from Form 1040,line 38 2 1 7, 821. Expenses 3 Multiply line 2 by 7.5%(.075) . . . . . . . . . . . 3 587. 4 Subtract line 3 from line 1. If line 3 is more than line 1,enter-0- . 4 709. Taxes You 5 State and local(check only one box): Paid a ❑Income taxes,or l 5 b C]General sales taxes J 6 Real estate taxes(see instructions) . . . . . . . . . 6 3, 513. 7 Personal property taxes . . . . . . . . . . . . . 7 8 Other taxes:List type and amount ► L . 8 _ 9 Add lines 5 through 8 . 9 3,513. . . . . . . . . . . . . . . . . . . . . Interest 10 Home mortgage interest and points reported to you on Form 1098 10 11,387. You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions Note. and show that person's name,identifying no.,and address► Your mortgage interest ---------------------------------------------------------------------------------- deductionmay ----------------------------------------------------------------------------------- 11 be limfted(see 12 Points not reported to you on Form 1098. See instructions for instructions). special rules . . . . . . . . . . . . . . . . . 12 13 Mortgage insurance premiums(see instructions) . . . . . 13 14 Investment interest.Attach Form 4952 if required.(See instructions.) 14 15 Add lines 10 through 14 . 15 11,387. . . . . . . . . . . . . . . . . . . . Gifts to 16 Gifts by cash or check. If you made any gift of$250 or more, Charity see instructions. . . . . . . . . . . . . . . . 16 If you made a 17 Other than by cash or check. If any gift of$250 or more, see gift and got a instructions.You must attach Form 8283 if over$500 . . . 17 benefit for it, 18 Carryover from prior year . . . . . . . . . . . . 18 see Instructions. 19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . 19 Casualty and Theft Losses 20 Casualty or theft loss es.Attach Form 4684. See instructions. 20 Job Expenses 21 Unreimbursed employee expenses—job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-EZ if required. Miscellaneous (See instructions.) ► 21 Deductions 22 Tax preparation fees . . . . . . . . . . . . . 22 23 Other expenses—investment, safe deposit box, etc. List type and amount ► _ ---------------------------------------------------------- - ----------- - --------------------------------------°°-------------- 23 24 Add lines 21 through 23 . 24 25 Enter amount from Form 1040,line 38 1251 26 Multiply line 25 by 2% (.02) . . . . . . . . . . 26 27 Subtract line 26 from line 24. If line 26 is more than line 24,enter-0- 27 Other 28 Other—from list in instructions. List type and amount ► Miscellaneous Deductions 28 Total 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount Itemized on Form 1040,line 40 . . . . . . . . . . . . . . . . . . . . . 29 15, 609. 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 Farm 1040 instructions. SAA REV 01/10113 my schedule A(Form 1040)2012 SCHEDULE C Profit or Loss From Business OMB No.1545-0074 (Form 1040) (Sole Proprietorship) 2012 Department of the Treasury ►For information on Schedule C and its instructions,go to www.irs.govlschedulec. Attachment Internal Revenue Service(99) ►Attach to Form 1040,1040NR,or 1041;partnerships generally must file Form 1065. - Sequence t No.Og Name of proprietor A Principal business or profession,including product or service(see instructions) B Enter code from instructions watch re air ► 14 12 13 19 14 10 C Business name.If no separate business name,leave blank. D Employer ID number(EIN),(see imlr.) Henry Line Watch Repair E Business address(including suite or room no.) ► 191 Ridge Dr. City,town or post office,state and 71P code Carl i 1 se, PA 17015 F Accounting method: (1) x❑Cash (2) ❑Accrual (3) ❑Other(specify) ► G Did you"materially participate"in the operation of this business during 2012?If"No,"see instructions for limit on losses ®Yes ❑No H If you started or acquired this business during 2012,check here . . . . . . . . . . . . . . . . . ► ❑ 1 Did you make any payments in 2012 that would require you to file Form(s)10997(see instructions) . . . . . . . . ❑Yes ®No i If"Yes,"did you or will you file required Forms 1099? ❑Yes ❑No . . . . . . . . . . . . . . . . . . . . Income 1 Gross receipts or sales.See instructions for fine 1 and check the box if this income was reported to you on Form W-2 and the"Statutory employee"box on that form was checked . . . . . . . . .► ❑ 1 3, 600. 2 Returns and allowances(see instructions). . . . . . . . . . . . . . . . . . . 2 0. 3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . 3 3,600. 4 Cost of goods sold(from line 42) . . . . . . . . . . . . . . . . . . . . . . 4 5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . 5 3, 600. 6 Other income,including federal and state gasoline or fuel tax credit or refund(see instructions) . . 6 0. 7 Gross income. Add fines 5 and 6 . . ► 7 - 3, 600. . . . . . . . . . . . . . . . . . . . ExDenses Enter expenses for business use of your home only on line 30. 8 Advertising . . . . . 8 18 Office expense(see instructions) 18 9 Car and truck expenses(see 19 Pension and profit-sharing plans 19 instructions). . . . 9 20 Rent or lease(see instructions): 10 Commissions and fees . 10 a Vehicles,machinery,and equipment 20a 11 Contract labor(see instructions) it b Other business property . 20b 12 Depletion . . . 12 - 21 Repairs and maintenance . . . 21 13 Depreciation and section 179 22 Supplies(not included in Part III) . 22 150. expense deduction (not included in Part III) (see 23 Taxes and licenses . 23 instructions). . . . . 13 1 24 Travel,meals,and entertainment: 14 Employee benefit programs a Travel. . . . . . . 24a (other than on line 19). . 14 b Deductible meals and 15 Insurance(other than health) 15 320. entertainment(see instructions) . 24b 16 Interest: 25 Utilities . . . . . . . . 25 55. a Mortgage(paid to banks,etc.) 16a 625. 26 Wages(less employment credits). 26 b Other . . . . . . 16b 27a Other expenses(from line 48) . . 272 17 Legal and professional services 17 5, 000. b Reserved for future use . . 27b 28 Total expenses before expenses for business use of home.Add lines 8 through 27a . . . . . . ► 28 6, 150. 29 Tentative profit or(loss).Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29 —2,550. 30 Expenses for business use of your home.Attach Form 8829.Do not report such expenses elsewhere 30 0. 31 Net profit or(loss). Subtract line 30 from line 29. • If a profit,enter on both Form 1040,line 12(or Form 1040NR,line 13)and on Schedule SE,line 2. Of you checked the box on line 1,see instructions).Estates and trusts,enter on Form 1041,line 3. 31 1 —2,550. • If a loss,you must go to line 32. 32 it you have a loss,check the box that describes your investment in this activity(see instructions). • If you checked 32a,enter the loss on both Form 1040,line 12,(or Form 1040NR,line 13)and on Schedule SE,line 2.(If you checked the box on line 1,see the line 31 instructions).Estates and 32a El All investment is at risk. trusts,enter on Form 1041,line 3. 32b❑ Some investment is not • If you checked 32b,you must attach Form 6198.Your loss may be limited. at risk. For Paperwork Reduction Act Notice,see your tax return instructions. SAA REV O1roa13 TTw Schedule C(Form 1040)2012 Schedule C(Form 1040)2012 Page 2 Cost of Goods Sold (see instructions) 33 Method(s)used to value closing inventory: a ❑ Cost b ❑ Lower of cost or market c ❑ Other(attach explanation) 34 Was there any change in determining quantities,costs,or valuations between opening and closing inventory? If"Yes,"attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes [] No 35 Inventory at beginning of year.If different from last year's closing inventory,attach explanation . . . 35 36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36 37 Cost of labor,Do not include any amounts paid to yourself. . . . . . . . . . . . . . 37 38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38 39 Other costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40 41 Inventory at end of year . . . . . . . . . . . .. . . . . . . . . . . . . 41 42 Cost of goods sold. Subtract line 41 from line 40.Enter the result here and on line 4 . 42 Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes?(month,day,year) ► 44 Of the total number of miles you drove your vehicle during 2012,enter the number of miles you used your vehicle for: a Business b Commuting(see instructions) c Other 45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . ❑Yes ❑ No 46 Do you(or your spouse)have another vehicle available for personal use?. . . . . . . . . . . . . . ❑ Yes ❑ No 47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No b If"Yes,"Is the evidence written? . ❑ Yes ❑ No . . . . . . . . . . . . . . . . . . . . . . . . Other Expenses. List below business expenses not included on lines 8-26 or line 30. 48 Total other expenses. Enter here and on line 27a 46 REV 01104113 Tf W Schedule C(Farm 1040)2012 SCHEDULE Profit or LOSS From Business OMB No.1545-0074 (Form 1040) (Sole Proprietorship) 2012 Department of the Treasury ►For information on Schedule C and its instructions,go to www.irs.gov1SChedu/ec. Attachment Intemal Revenue service(99) ►Attach to Form 1040,1040NR,or 1041;partnerships generally must file Form 1065. Sequence t No.09 Name of proprietor Social security number(SSN) Henry Line A Principal business or profession,Including product or service(see instructions) B Enter code frmn Instructions Wath repair 0- 14 2 13 19 14 10 C Business name.If no separate business name,leave blank. D Employer to number(EINI,(see insh.) Line and Line Jewlers E Business address(including suite or room no.) ► 21 Dickinson Avenue City,town or post office,state,and ZIP code Carlisle, PA 17013 F Accounting method: (1) x❑Cash (2) ❑Accrual (3) ❑Other(specify) ► G Did you"materially participate"in the operation of this business during 2012?If"No,"see instructions for limit on losses ®Yes ❑No H If you started or acquired this business during 2012,check here . . . . . . . . . . . . . . . . . ► ❑ 1 Did you make any payments in 2012 that would require you to file Form(s)1099?(see instructions) . . . . . . . . ❑Yes ®No J If"Yes,"did you or will you filerequired Forms 1099? . ❑Yes ❑No . . . . . . . . . . . . . . . . . . . . income 1 Gross receipts or sales.See instructions for line 1 and check the box if this income was reported to you on Forth W-2 and the"Statutory employee"box on that form was checked . . . . . . . . .► ❑ 1 31,750. 2 Returns and allowances(see instructions) . . . . . . . . . . . . . . . . . . . . 2 3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 31,750. 4 Cost of goods sold(from line 42) . . . . . . . . . . . . . . . . . . . . . . 4 5 Gross profit Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5 31,750. 6 Other income,including federal and state gasoline or fuel tax credit or refund(see instructions) . . . . 6 7,849. 7 Gross income. Add lines 5 and 6 . . ► 7 39,599. . . . . . . . . . . . . . . . . . . Ex enses Enter expenses for business use of your home only on line 30. 8 Advertising . . . . . 8 300. 19 Office expense(see instructions) 18 1, 665. 9 Car and truck expenses(see 19 Pension and profit-sharing plans 19 instructions). . . . . 9 20 Rent or lease(see instructions): 10 Commissions and fees . 10 a Vehicles,machinery,and equipment 20a 3,245. 11 Contract labor(see instructions) 11 b Other business property . . . 20b 0. 12 Depletion . . . . . 12 21 Repairs and maintenance . . . 21 4,533. 13 Depreciation and section 179 22 Supplies(not included in Part III) . 22 expense deduction (not 23 Taxes and licenses . . . 23 2,456. included in Part III) (see instructions). . . . . 13 24 Travel,meals,and entertainment: 14 Employee benefit programs a Travel. . . . . . . 24a (other than on line 19). . 14 b Deductible meals and 15 Insurance(other than health) 15 2, 195. entertainment(see instructions) . 24b 16 Interest: "�� 25 Utilities . . . . . . 25 8,555. 9404 a Mortgage(paid to banks,etc.) 16a 0. 26 Wages Pass employment credits). 26 b Other . . . . . . 16b 1, 104 . 27a Other expenses(from line 48) . . 27a 17 Legal and professional services 1 17 1 2,500. b Reserved for future use 27b 28 Total expenses before expenses for business use of home.Add lines 8 through 27a . . . . . . ► 28 26,553. 29 Tentative profit or Poss).Subtract line 28 from line 7. . . . . . . . . . . . . . . 29 13,046. 30 Expenses for business use of your home.Attach Form 8829.Do not report such expenses elsewhere 30 31 Net profit or Poss). Subtract line 30 from line 29. • If a profit,enter on both Form 1040,line 12(or Form 1040NR,line 13)and on Schedule SE,line 2. (If you checked the box on line 1,see instructions).Estates and trusts,enter on Form 1041,line 3. 31 1 13,046. • If a loss,you must go to line 32. 32 If you have a loss,check the box that describes your investment in this activity(see instructions). • if you checked 32a,enter the loss on both Form 1040,line 12,(or Form 1040NR,line 13)and on Schedule SE,line 2.Of you checked the box on line 1,see the line 31 instructions). Estates and 32a ❑ All investment is at risk. trusts,enter on Form 1041,line 3. 32b❑ Some investment is not • If you checked 32b,you must attach Form 6198.Your loss may be limited. at risk. For Paperwork Reduction Act Notice,see your tax return instructions. BAA REV 01/04/13 TTW schedule C(Form 1040)2012 Schedule C(Form 1040)2012 Page 2 Cost of Goods Sold (see instructions) 33 Method(s)used to value closing inventory: a ❑ Cost b ❑ Lower of cost or market c ❑ Other(attach explanation) 34 Was there any change in determining quantities,costs,or valuations between opening and closing inventory? If"Yes,"attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No 35 Inventory at beginning of year.If different from last years closing inventory,attach explanation . . . 35 36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36 37 Cost of labor.Do not include any amounts paid to yourself. . . . . . . . . . . . . . 37 38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . 36 39 Other costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . 40 41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41 42 Cost of goods sold. Subtract line 41 from line 40.Enter the result here and on line 4 . 42 LEM Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes?(month,day,year) ► 44 Of the total number of miles you drove your vehicle during 2012,enter the number of miles you used your vehicle for. a Business b Commuting(see instructions) c Other 45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . ❑Yes ❑ No 46 Do you(or your spouse)have another vehicle available for personal use?. . . . . . . . . . . . . . ❑ Yes ❑ No 47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No b If"Yes,"Is the evidence written? ❑ Yes ❑ No . . . . . . . . . . . . . . . . . . . . . . . . Other Expenses. List below business expenses not included on lines 8-26 or line 30. 48 Total other expenses. Enter here and on line 27a 48 REV 01N4113 TTW Schedule C(Form 1040)2012 Schedule E(Form 1040)2012 Attachment Sequence No.13 Page 2 Namo(s)shaven an return.Do not enter name and social security number it shown on other side. Your social socuriy number Henry 6 Constance B Line 1 Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s)K-1. Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which any amount is not at risk,you must check the box in column(e)on line 28 and attach Form 6198. See instructions. 27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? If you answered"Yes,"see instructions before completinq this section. ❑ Yes ® No 28 (a) Name Enter P for (c) n (d) Employer e) ipa rtners identification amount s fors tion hip number not at risk A Multi-National Diamonds Inc S ❑ 25-1866126 ❑ B ❑ Cl C ❑ ❑ D ❑ ❑ Passive Income and Loss Nonpassive Income and Loss (f) Passive loss allowed (9) Passive income (h) Nonpassive loss @ Section 179 expense 01 Nonpassive Income (attach Fortin 6592 if required) from Schedulo K-1 from Schedule K-1 deduction from Form 4562 from Schedule K-1 A 0. B C D 29a Totals _ 0. b Totals ] 30 Add columns(g)and @ of line 29a . . . . . . . . . . . . . . . . 30 0. 31 Add columns(f),(h),and n of line 29b . . . . . . . . . . . . . . . . 31 ( ) 32 Total partnership and S corporation income or Voss). Combine lines 30 and 31. Enter the result here and include in the total on line 41 below . 32 0. . . . . . . . . . . . . . . Income or Loss From Estates and Trusts 33 (a) Name (b) Employer identification number A 6 Passive Income and Loss Nonpassive Income and Loss (c)Pmhre deduction or loss allowed (d)Passive income (e)Deduction or loss (i)Other income from (moo Form 9592 If required) from Schedule K-1 from Schedule;K-1 Schedule K-1 A B 34a Totals b Totals 35 Add columns(d)and(f)of line 34a. . . . . . . . . . . . . . . . . . . . . 35 36 Add columns(c)and(e)of line 34b . . . . . . . . . . . . . . . . . . . r37 37 Total estate and trust income or Voss). Combine lines 35 and 36. Enter the result here and include in the total on line 41 below . . . . . . . . . . . . . . . . . . . Income or Loss From Real Estate Mortgage Investment Conduits REMICs —Residual Molder (c)Excess inclusion from 38 (a)Name (b)Employer Identification Schedules O,line 2c (from Taxable(ncomo(rot loss) (o)Incase iron camber see instructions from Schedules O,line 1 b Sehodulea O,line 3b 39 Combine columns and a only. Enter the result here and include in the total on line 41 below 39 � Summary 40 Net farm rental income or Voss)from Form 4835.Also,complete line 42 below . . . . . 40 41 Total income or Voss). Combine fins 26,32,37,39,and 40.Enter the result here and on Forth 1040 fine 17 or Form 104ONK fine 18► 41 _ _ 0. 42 Reconciliation of farming and fishing income. Enter your gross fanning and fishing income reported on Form 4835,line 7;Schedule K-1 (Form 1065), box 14,code B;Schedule K-1 (Forth 1120S),box 17,code U;and Schedule K-1 (Form 1041),box 14,code F(see instructions) . . 42 43 Reconciliation for real estate professionals. If you were a real estate professional(see instructions), enter the net income or Voss) you reported anywhere on Form 1040 or Form 1040NR from all rental real estate activities in which you materially participated under the passive activity loss rules . 43 REV 01/301137TW Schedule E(Form 104M 20,112 SCHEDULE SE (Form 1040) Self-Employment Tax rtm °"'a"° ' Department of the Trette ry 11-Information about Schedule SE and its separate instructions is at www.bs.gov//ormfo40. 2012 2 WWW Revenue Savlee N9 b-Attach to Form 1040 or Form 1040NR. AttecFrnent sequence No.1 T Name of person with sea�mployment Income(as shown on Form 1040) Sociel security number of person Henry Line withseH-employment income► 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 2012) No Yes Am you a minister, member of a religious order, or Ctvistim Silence practitioner who received IRS approval not to Do taxad Yes was the teal of your wages and tips subject to soda)security Yes on earMrgs from these sources,but you owe Self-employment P or railroad retirement(tier 1)tax plus your not earnings from tax on other awnings? sellcmployrnem more than 5110,100? No No Are you using ono Of the optional methods to figure your not Yes Did you receive tips subject to social security or Medicare tax Yes earnings(too Instructions)? that you did not report to your employer? No No Did you receive church employee income (sea Instructions) Vet No Did you report any wages on Form 8919, Uncollected Social Yes reported on Form W-2 of$108.28 or morel security and Medicare Tax on wages? No You may ufe Short Schedule SE below You mutt use Long Schedule SE on page 2 Section A—Short Schedule SE. caution. Read above to see if you can use Short Schedule SE. 1a Net farm profit or(loss) from Schedule F. line 34, and farm partnerships, Schedule K-1 (Form 1065),box 14,code A. . . . . . . . . . . . . . . . . . . . . . . . 1 a b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F,line 4b,or listed on Schedule K-1 (Form 1065),box 20,code Y 11D ( ) 2 Net profit or(loss)from Schedule C, line 31;Schedule C-EZ, line 3;Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-8), box 9, code J1. Ministers and members of religious orders, see instructions for types of income to report on this line.See instructions for other income to report . . . . . . . . . . . . . . 2 10,496. 3 Combine lines 1a, 1b,and 2 . . . . . . . . . . . . . . . . . . . . . 3 10,496. 4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do not file this schedule unless you have an amount on line 1b . . . . . . . . . . . ► 4 9, 693. Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions. 5 Self-employment tax.If the amount on line 4 is: •$110,100 or less,multiply line 4 by 13.3%(.133).Enter the result here and on Form 1040,line 56, or Form 1040NR,line 54 • More than$110,100,multiply line 4 by 2.9%(.029).Then,add$11,450.40 to the result. Enter the total here and on Form 1040,line 56,or Form 1040NR,line 64. . . . . . . 5 1 1,289. 6 Deduction for employer-equivalent portion of self-employment tax. If the amount on line 5 is: •$14,643.30 or less,multiply line 5 by 57.51% (.5751) • More than $14,643.30, multiply line 5 by 50% (.50) and add $1,100 to the result. I Enter the result here and on Form 1040, line 27, or Form 1040NR,line 27 6 741. For Paperwork Reduction Act Notice,see your tax return instructions. gAA f1EV 11n3n2TTw Schedule SE(Form 104M 2012 Form 8829 Expenses for Business Use of Your Home OM6 No.tsas0074 ►File only with Schedule C(Form 1040).Use a separate Form 8629 for eachr 12 Depa"W.at fheTM=NY home you used for business during the year. Attactxnent vnemai Revenue Sorvire(sYi ►Information about Form 5629 and its separate instructions is at www.7rs.govfiarm8629. Sequence No.176 Namo(s)of propnotor(s) your social security number Henry Line Part of Your Home Used for Business Watch re air 1 Area used regularly and exclusively for business, regularly for daycare, or for storage of inventory or product samples(see instructions) . . . . . . . . . . . . . . . 1 200 2 Total area of home . . . . . . . . . . . . 2 3,000 3 Divide line 1 by line 2.Enter the result as a percentage . . . . . . . . . . . . 3 6.67 eta For daycare facilities not used exclusively for business,go to line 4.All others go to fine 7. 4 Multiply days used for daycare during year by hours used par day 4 hr. 5 Total hours available for use during the year(366 days x 24 fours)(see instructions) 5 8,784 6 Divide line 4 byline 5.Enter the result as a decimal amount . . . 6 7 Business percentage. For daycare facilities not used exclusively for business, multiply line 6 by tine 3(enter the result as a percentage).All others,enter the amount from line 3 ► j 6.67 % Figure Your Allowable Deduction 8 Enter the amount from Schedule C. line 29, plus any gain derived from the business use of your home and shown on Schedule D or Form 4797,minus any loss from the trade or business not derived from the business use of your home and shown on Schedule D or Form 4797. See instructions 8 -2,550. See instructions for columns (a) and (b) before - completing lines 9-21. a Direct e s Indirect expenses 9 Casualty losses(see instructions). 9 10 Deductible mortgage interest(see instructions) 10 11 Real estate taxes(see instructions) . . . . 11 12 Add lines 9,10,and 11 . . . . . . . . 12 13 Multiply fine 12,column(b)by line 7. . . . 13 14 Add line 12,column(a)and line 13 . . . . 14 15 Subtract line 14 from line 8.If zero or less,enter-0- 15 0. 16 Excess mortgage interest(see instructions) . 16 17 Insurance . . . . . . . . . . . . 17 300. 11482. - 18 Rent . . . . . . . . . . . . . . 18 19 Repairs and maintenance 19 200. 2,400. 20 Utilities . . . . . . . . . . 20 500. 1 7,200. 21 Other expenses(see instructions). . . . . 21 1 22 Add lines 16 through 21 . . . . . . . 22 1 000. 11 082. 23 Multiply line 22,column(b)by line 7. . . . . . . . 23 739. 24 Carryover of operating expenses from 2011 Form 8829,line 42. 24 _ 25 Add line 22, column(a),line 23, and line 24 . . . . . . . . . . . . . . . . . 25 1,739. 26 Allowable operating expenses.Enter the smaller of line 15 or line 25 . . . . . . . . 26 01 27 limit on excess casualty tosses and depreciation.Subtract line 26 from line 15 27 0. 28 Excess casualty losses(see instructions) . . . . 28 29 Depreciation of your home from line 41 below 29 30 Carryover of excess casuatty losses and depredation from 2011 Form 8629,line 43 30 31 Add tines 28 through 30. . . . . . . . . . . . . . . . . . . . . . . . 31 32 Allowable excess casualty losses and depreciation.Enter the smaller of fine 27 or line 31 32 33 Add lines 14,26,and 32. . 33 0. 34 Casualty loss portion,if any,from tines 14 and 32.Carry amount to Form 4684(see instructions) 34 35 Allowable expenses for business use of your home. Subtract line 34 from line 33. Enter here and on Schedule C,line 30.If your home was used for more than one business,see instructions M 35 0 le reciation of Your Home 36 Enter the smaller of your home's adjusted basis or its fair market value(see instructions) 36 37 Value of land included on line 36 . . . . . . . . . . . . . . . . 37 38 Basis of building.Subtract line 37 from line 36 . . . . 38 39 Business basis of building.Multiply line 38 by tine 7. . . . . . . . . , 39 40 Depreciation percentage(see instructions). . . . . . . . . . . . 40 % 41 De reciation allowable see instructions).Multiply line 39 b line 40.Enter here and on line 29 above 41 Ca aver of Unat)owed Expenses to 2013 42 Operating expenses.Subtract line 26 from line 25.If less than zero,enter-0. . . . . . . 42 1,739. 43 Excess casually losses and depreciation.Subtract line 32 from line 31.If less than zero,enter-0- 43 For Paperwork Reduction Act Notice,see your tax return instructions. 6AA Rev ovtdna rsw Form 29{2012)