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IN THE COURT OF COMMON PLEAS
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OF CUMBERLAND COUNTY
STATE OF fl~~;~~ PENNA.
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MICHELE A. JONES
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4923
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BP)DLEY T. JONES
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DECREE IN
DIVORCE
.f'~Io\u~ l'Z.~..
MicheLe. A.J:.Jnes .
. . . . BrildleyT.,..b1es .
ANn NOW,
1995.
... ,
It Is orclRrerJ and
dac:raarl thot
and,
. . , . , , . , " plnlntlff,
, , , '. dafannrmt,
are cJivorrarl from thf! honns of motrimony.
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The court retoins iLJrisrliction of the followinf:j c10ims which hove
been raisRrl of rerorcl in this oction for which a finol order hilS not yet
bRen entered;
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AlilTWY, alilTPl1ypendente li.te.ilI1d l11ilintenilnceof life, lnsurarx;e p:llicles., , . ,
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. ~, 'I, '1'1.1 I (',(:".1 7i<" I
MICHELE A. JONES
plaintiff
BRADLEY T. JONES,
Defendant
IN DIVORCE
NOTICE TO DEFEND AND CLAIM RIGHTS
You have been sued in Court. If you wish to defend against
the claims set forth in the following pages, you must take prompt
action. You are warned that if you fail to do so, the case may
proceed against you and a Decree of Divorce or annulment may be
entared against you by the Court. A judgment may also be entered
against you for any other claim or relief requested in these papers
by the Plaintiff. You may lose money or property or other rights
important to you, including custody or visitation of your children.
When the ground for the divorce is indignities or
irretrievable breakdown of the marriage, you may request marriage
counseling. A list of marriage counselors is available in the
Office of the Prothonotary at the Cumberland County Courthouse,
One Courthouse Square, Carlisle, PA 17013.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPIRTY,
LAWYIR'S nls OR EXPINSES BIFORE A DIVORCE OR AHHULMIlNT IS GRANTED,
YOU MAY LOSI THE RIGHT TO CLAIM ANY OF THIM.
YOU SHOULD TAKI THIS PAPER TO YOUR LAWYER AT ONCI. IF YOU DO
HOT HAVE A LAWYIR OR CANNOT AFFORD ONI, GO TO OR TILEPHOHI 'IRE
OFFICI SET FORTH BILOW TO FIND OUT WHIRE YOU CAN GET LIGAL HILP.
Court Administrator
4th Floor, Cumberland County Courthouse
Carlisle, PA 17013
Telephone: (717) 240-6200
AVISO PARA DEFENDER Y RECLAMAR DERECHQ~
Usted ha sido demandado en la Corte. si desea defenderse de
las quejas expuestas en las p6ginas aiguientes, debe tomar acci6n
con prontitud. Se Ie avisa que si no se defiende, el caso puede
proceder sin usted y decreto de divorcioo anulamiento puede ser
emitido en su contra por la Corte. Una decisi6n puede tambi~n ser
emitida en su contra por cualquier otra queja 0 compensaci6n
.
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 1)'/- ./'i.)J ('(1.1"'( .0/......-
MICHELE A. JONES,
Plaintiff
BRADLEY T. JONES,
Defendant
IN DIVORCE
COMPLAINT UNDER SECTIONS 3301lcl AND ld)
OF THE DIYQRCE CODE
Count I
1. Plaintiff is Michele A. Jones, who currently resides at
316 Wister Circle, Mechanicsburg, Cumberland County, Pennsylvania.
2. Defendant is Bradley T. Jones, whose last-known address
was 4173 Grouse Court, Mechanicsburg, Cumberland County,
Pennsylvania.
3. Plaintiff and Defendant have been bona fide residents in
the Commonwealth for at least six months immediately previous to
the filing of this Complaint.
4. Plaintiff and Defendant were married on or about
August 27, 1977 in Williamsport, Lycoming County, pennsylvania.
5. There have been no prior actions of divorce or annulment
between the parties.
6. Plaintiff has been advised of the availability of
marriage counseling and that she may have the right to request that
the Court require the parties to participate in counseling.
7. Plaintiff avers as the grounds upon which this action is
based:
.
(a) That the marriage between the parties hereto is
irretrievably broken; or/ alternatively
(b) The Plaintiff and Defendant have lived separate and
apart since January 10/ 1994/ and, at the appropriate time,
Plaintiff will submit an Affidavit alleging that the parties
have lived separate and apart for at least two (2) years and
that the marriage is irretrievably broken.
WHEREFORE, Plaintiff requests your Honorable Court to enter
a Decree in Divorce divorcing Plaintiff and Defendant absolutely.
Count I";
CLAIM FOR EOUITABLE DISTRIBUTION OF MARITAL PROPERTY
8. Plaintiff and Defendant are the owners of various items
of real and personal property/accounts / vehic les / furniture,
household furnishings and other assets acquired during their
marriage which are subject to equitable distribution by this Court.
WHEREFORE, Plaintiff requests that this Honorable Court enter
an Order equitably distri.buting the marital property of the
parties.
Count I II
CLAIM FOR ALIMONY PENDENTE LITE AND Al,IMONY PENDETE LITl!:
9. Plaintiff is unable to sustain herself during the course
of this litigation.
10. Plaintiff lacks sufficient property to provide for her
reasonable needs and is unable to sustain herself through
appropriate employment.
.
,
11. Plaintiff requests the Court to enter an award of spousal
support and/or alimony pendente lite until final hearing and
thereupon to enter an award of alimony in her favor pursuant to
sections 3701(a) and 3702 of the Divorce Code.
WHEREFORE, Plaintiff respectfully requests your Honorable
Court to enter an award of spousal support and/or alimony pendente
lite until final hearing and thereupon to enter. an award of alimony
in her favor pursuant to Sections 3701(a) and 3702 of the Divorce
Code.
Count IV
CLAIM FOR COUNSEL FEES, COSTS AND EXPENSES
12. Plaintiff has employed Bruce F. Bratton, Esquire, to
represant her in this matrimonial cause.
13. Plaintiff is unable to pay her counsel fees, costs and
expenses and Defendant is more than able to pay them.
14. Defendant is employed and has the ability to pay
Plaintiff's counsel fees, costs and expenses.
15. Reserving the right to apply to the Court for temporary
counsel fees, costs and expenses prior to the final hearing,
Plaintiff respectfully requests that, after final hearing, this
Honorable Court order Defendant to pay Plaintiff's reasonable
counsel fees, costs and expenses.
WHEREFORE, Plaintiff respectfully requests that, pursuant to
Sections 3704(a)(1), 3323(b) and 3702 of the Divorce Code, this
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counsel as alleged. Plaintiff's counsel is without sufficient
information, however, to confirm Defendant's counsel's
representations that the enclosed pay records constituted a full
and complete disclosure of all earnings or earnings capacity of the
Defendant particularly since, as admitted in Paragraph 7 of
Defendant's Answer to the instant Motion, Defendant determined his
own hours of work.
17. Admitted in part and denied in part. It is admitted
that on or about August 31, 1994, Defendant's counsel forwarded
additional "financial information" to Plaintiff's counBel. It iB
denied, however, that Plaintiff or Plaintiff'B counsel haB had any
opportunity to verify or confirm the completeneBB of Buch
information or any other information provided by Defendant or to
confirm Defendants full earningB capacity, hours worked, etc.
18. The allegationB of Paragraph 18 of Defendant' B New Matter
conBtitute conclusionB of law to which no responBive pleading iB
required. To the extent a reBponBe iB required, Plaintiff
respectfully submitB that the Plaintiff iB entitled to seek
confirmation not only of Defendant'B income or "pay records" but
also aB to Defendant's diligence in performing his job which,
during 1993, generated income of approximately $100,000.00 per
year. Such need for confirmation iB only further highlighted by
the fact that Defendant who admittedly determined his own work
schedule has been terminated from his employment but Defendant has,
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MICBILI A. JOII.I, I III TBI COURT or COMMOII PLIAS
PlaintUf I CUMIIRLAlfD COUIITY, PI..IYLVAHIA
I
v. I CIVIL ACT:tOIl - LAW
I 110. 94-U:U
IRADLIY T. JOIIIS, I
Defendant I III DIVORCE
ORDIR or BIrURCATION
AND NOW, this ~ day of ~ ' 1995, upon
consideration of the within joint Motion for Bifurcation of Bruce
F. Bratton, Esquire, and Keith O. Brenneman, Esquire, it is hereby
ORDERED AND DECREED that the issue of Divorce and of equitable
distribution of marital property are hereby bifurcated from all
other economic claims heretofore raised by the parties to this
divorce action. Upon presentation of Affidavits of Consent, this
Court shall enter a Decree in Divorce incorporating the terms of
a Stipulation of the parties attached to the Motion for Bifurcation
as Exhibit "A" and retaining jurisdiction over all other unresolved
economic claims heretofore raised by the parties.
BY THE COURT:
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MICBILI A. JOIIS, I II TBI COURT or COMMON PLIAS
Plaintiff I CUMBIRLAKD COUITY, PlnSYLVUIA
I
v. I CIVIL ACTION - LAW
I NO. 96-69:23
BRADLIY T. JONIS, I
Defendant I II DIVORCB
MOTIOI rOR BIrURCATION
Bruce F. Bratton, Esquire and Keith O. Brenneman, Esquire,
attorneys for Plaintiff and Defendant, respectively, in the above-
captioned divorce action, move this Honorable Court for an Order
of Bifurcation and, in support thereof, represent as follows:
1. The parties to thi13 divorce action have executed a
Stipulation, a true and correct copy of which i13 attached hereto
as Exhibit "A".
2 . The parties, although able to resolve some of the
economic issues raised by this divorce action, i.e. , as to
equitable distribution of property, have not yet resolved other
economic issues raised by the pleadings.
3. Defendant Bradley T. Jones is planning to relocate to the
State of Arizona.
4. The parties believe that their best interests, as well
as the best interests of the parties' minor children, will be
advanced by the bifurcation of the divorce and resolved economic
issues from the limited remaining unresolved economic disputes and
by permitting the parties to obtain a Decree in Divorce
incorporating the terms of the Stipulation attached hereto as
Exhibit "A" and retaining jurisdiction over unresolved economic
is SUBS ,
5. Each of the parties has executed an Affidavit of Consent
and have authorized their respective attorneys, upon the entry of
an order of bifurcation, to file such Consents and take such other
steps as may be reasonably required to obtain a Decree in Divorce
incorporating the terms of
Exhibit "AU and retaining
the Stipulation attached hereto as
jurisdiction in the Court as to
unresolved economic disputes or issues.
WHEREFORE, counsel for the parties respectfully request that
this Honorable Court enter an Order bifurcating the issues of
divorce and equitable distribution of marital property from all
other economic issues not yet resolved.
Respectfully submitted,
MARTS~/1;Li
By '(. >/(z.'/ L.__
Btuce F. Bratton, Esquire
Attorney I.D. No. 23949
2515 North Front Street
P. O. Box 12106
Harrisburg, PA 17100-2lu6
(717) 236-4241
Attorneys ~9r Plaintiff
SNELBAKER& BRiNEMAN
By } .tu'tfil/f/I/V!lI/7-/\
Keith O. Brenneman, Esquire
Attorney I.D. No. y/f) 11
44 West Main Street
P. O. Box 318
Mechanicsburg, PA 17055
(717) 697-8529
Attorneys for Defendant
Date J (;A-<I;\j 9)"
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"ICIILI A, 070111., I IN THI COURT or COMMON PLIAS
Plaintiff I CUMBIRLAND COUIITr, PIIIN.rLVANIA
I
v. I CIVIL ACTION - LAW
I NO. 91-6923
IIMDLII T. JONI8, r
Defendant I IN DIVORCI
STIPULATION
Bradley T. Jones, Defendant, and Michele A. Jones, Plaintiff,
parties to the above-captioned divorce action, and their respective
counsel, hereby stipulate as follows:
1. Both parties and their respective counsel hereby request
that the Court enter an Order of Bifurcation separating the issue
of divorce from economic issuos raised in this divorce action and,
upon the Court's entry of such an Order of Bifurcation, the parties
wil,l each file Affidavits of Consent to permit the ent,ry of a
decree in divorce.
2. The Court shall retain jurisdiction over economic issues
or claims heretofore raised by any party.
3. Notwithstanding the foregoing, the parties agree that all
equitable distribution issues are hereby finally resolved upon the
following terms:
a. The parties real property and marital home
located at 316 Wister Circle, Mechanicsburg, Cumberland
County, Pennsylvania shall hereafter be and become the
sole and separate property of Plaintiff Michele A. Jones,
EXHIBIT "A"
. ,
free and olear of any and all right, title, interest or
claim of Defendant, Bradley T. Jonesl Defendant Bradley
T. Jones, oontemporaneously with the execution of an
Affidavit of Consent in accordance with this Stipulation,
eha1l execute and deliver to Plaintiff, Michele A. Jones
or her attorney an appropr.iate deed to tranllfer his title
and interest in and to the said real property and
improvements to Michele A. Jonesl
b. Any prior agreement notwithstanding, Bradley
T. Jones hereby waives any and all right, title and
interest in and to a certain office Clesk and chair stored
in the basement of the marital home and such desk and
chair shall horeafter be end become the sole and separate
property of Michele A. Jones free of any right, title,
interest or ~laim of the said Bradley T. Jones.
c. All other items of personal property currently
in the posseBsion or control of either party shall
,
hereafter be and remain the sole and separate property
of the party having possession of such property free and
clear of any and all claims of the other party.
d. All accounts, employee benefits, or other such
property currently in the possession of or held in the
name of each party individually shall be and remain the
sole snd separate property of the party in whose name or
for whose benefit any such account, benefit or asset is
currently held, free of any and all claims of the other
party.
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e. The parties shall execute such documents of
til:le or ol:her documenl:s reasonably requesl:ed by l:he
ol:her party l:o give full force and effect to the parties'
understanding with regard to equitable distribution of
marital prpperty.
f. The part,i as acknowledge that they have each
made a full and complete disclosure of their respective
assets and liabilities and each of the parties warrants
to the other that there are no debts or liabilities
heretofore created by either of them for which the other
is or may be responsible or liable nor any joinl:
obligation or liability of the parties other than the
mortgage on the marital residence. Each party hereby
agrees to and does indemnify the other of and from any
and all losses, claims, actions or causes of action
(including reasonable attorneys' fees) which may be
. brought against the other by any creditor of the
indemnifying party.
4. Michele A. Jones shall retain primary physical cusl:ody
of the parties' minor children, Mark B. Jones and Danica M. Jones,
subject to such periods of temporary custody and visitation by
Bradley T. Jones as the parties may hereafter agree. Each party
acknowledges that the provisions of this stipulation concerning
custody and visitation are or may be subject to further
modification upon the application of either party to a courl: of
competent jurisdiction with regard thereto.
5. This stipulation shall be filed along with a joint motion
by both parties' attorneys to seeK an Order of Bifurcation and each
,
'. .
party hereby instructs his or her attorney to proceed forthwith to
obtain such Order and to take all steps reasonably necessary to
obtain promptly a decree in divorce incorporating the terms of this
stipulation with regard to equitable distribution of marital
property and prD~iding for the Court's retaining jurisdiction as
to all other economic issues heretofore raised by either party.
6. Nothing herein shall be deemed to be a waiver of any
claims or defenses with regard to the economic issues as to which
the Court shall retain jurisdiction nor shall it be deemed to
effect, in any fashion, any claims or defenses of the parties with
regard to a pending spousal and child support matter docketed to
No. 220 Support 1994 (OR No. 22,401) in the Domestic Relations
Section of the Court of Common Pleas of Cumberland County;
provided, however, that the claim for spousal support of Michele
A. Jones in Buch ~atter shall hereafter be deemed to be a claim for
alimony pendente lite Bnd any order entered as to spousal support
in s~ch matter shall be deemed to be an order of alimony pendente
.
lite ~ t~iS divorce action.
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~frenneman, gAquire
Attorney for Defendant
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~dl T. Jones
Defen nt
.
Date:
Februarv 1, 1995
Date: E'ebruiJry 1, 1995
17U;~
Bruce F. Bratton, Esquire
Attorney for Plaintiff
Date:&' ~J;('4~) ;/J-
(Y))'J' / 1)/ /) / /)
'-Ll..Y..!J.!:g,lL. V( /}-7') lJ2"
Hichele A. Jon~i
Plaintiff TT
Date: :;'/~! f J .
. -
MIORILI A, JOIIII, I III THI COURT or COMMOII PLKAI
Plaf.ntUf I CUMBIRLAND COUNTY, '..IISYLVANIA
I
v. I CIVIL ACTIOII - LAN
I 110. 94-4.923
BIlADLIY '1', JOIIII, I
Defendant I IN DIVORCE
ArrIDAVIT or CONSIIIT
1, A Complaint in Divorce under Sections 3301(c) and (d) of
the Divorce Code was filed on August 31, 1994.
2. The marriage of Plaintiff and Defendant is irretrievably
broken and ninety (90) days have elapsed from the date of filing
of the Complaint.
3. I consent to the entry of a Final Decree in Divorce.
4. I understand that I may lose rights concerning alimony,
division of property, attorneys' fees or expenses if I do not claim
them before a divorce is granted.
5. I have been advised of the availability of marriage
counseling, understand that the Court maintains a list of marriage
counselors and that I may request the Court require my spouse and
I to participate in counseling and, being so advised, I do not
request that the Court require that my spouse and I participate in
counseling prior to the divorce becoming final.
6. I am not a member of the armed forces of the United
States of America nor any of its allies.
I verify that the statements made in this Affidavit are true
and correct. I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unsworn falsification to authorities!. _, J/
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Date: February 1, 1995 '>f: (<,;.ilf!'-<_
ra Ie. T. Jones
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MICHILI A, JOIII, I II THI COURT or COMMOI PLIAI
PlaintUf I CUMBIRLAMD COUITY, PIIIIYLVABIA
I
v. I CIVIL ACTIOI - LAN
I 10. 9.-49:13
BRADLIY T. JOIII, I
Defendant I IN DIVORCE
ArrIDAVIT or COISENT
1. A Complaint in Divorce under Sections 3301(c) and (d) of
the Divorce Code was filed on August 31, 1994.
2. The mar.riage of Plaintiff and Defendant is irretrievably
broken and ninety (90) days have elapsed from the date of filing
of the Complaint.
3. I consent to the entry of a Final Decree in Divorce.
4. I understand that I may lose rights concerning alimony,
division of property, attorneys' fees or expanses if I do not claim
them before a divorce is granted.
5. I have been advised of the availability of marriage
counseling, understand that the Court maintains a list of marriage
counselors and that I may request the Court require my spouse and
I to participate in counseling and, being so advised, I do not
request that the Court require that my spouse and I participate in
counseling prior to the divorce becoming final.
6. I am not a member of the armed forces of the United
States of America nor any of its allies.
I verify that the statementa made in this Affidavit are true
and correct. I understand that false statements herein are made
subject to the penalties of 18 Pa, C.S. Section 4904 relating to
unsworn falsification to authorities.
Date:
J /)}/ S
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MICHELE A, JONES,
Plaintiff
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IN THB COURT OF COMMON PLEAS OF
CUMBBRLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 94-4923 CIVIL TERM
IN DIVORCB
BRADLBY T. JONES,
Defendant
ORDER OF COURT
AND NOW, this \'3 t{, day of Septarnber, 1995, a pretrial
conference in the above-captioned divorce action is SCHEDULED for
Thursday, October 19, 1995, at 3130 p.m.., in chambers of the
undersigned judge. At least five days prior to the conference, the
parties shall have filed and served pretrial statements in
accordance with Pa. R.C.P. 1920.33(b).
BY THE COURT,
Bruce F. Bratton, Esq.
2515 North Front Street
P.O. Box 12106
Harrisburg, PA 17108-2106
Attorney for Plaintiff
Keith O. Brenneman, Esq.
44 West Main Street
Mechanicsburg, PA 17055
Attorney for Defendant
J.
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MICHELE A. JONES, I IN THE COURT OF COMMON PLEAS OF
Plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA
I
v. ~ 94-4923 CIVIL TERM
I
BRADLEY T. JONES, I CIVIL AC'rION - LAW
Defendant I IN DIVORCE
MICHELE A. JONES, IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
v. 94-220 SUPPORT TERM
BRADLEY T. 'JONES, CIVIL ACTION - SUPPORT
Defendant DOMESTIC RELATIONS SECTION
IN RE: TRIAL IS SCHEDULED
ORDER OF COURT
AND NOW, this 19th day of october, 1995, trial in
the above-captioned matter is scheduled for Wednesday, December
,
13th, 1995, at 9:00 a.m.
By the court,
Bruce F. Bratton, Esquire
Counsel for Plaintiff
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Keith O. Brenneman, Esquire
Counsel for the Defendant
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MICHELE A. JONES,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSVLVANIA
94-4923 CIVIL TERM
CIVIL ACTION - LAW
IN DIVORCE
v.
BRADLEY T. JONES,
Defendant
MICHELE A. JONES,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
220 SUPPORT 1994
v.
BRADLEY T. JONES,
Defendant
CIVIL ACTION - SUPPORT
DOMESTIC RELATIONS SECTION '
'.11
IN RE:
PRE-TRIAL CONFERENCE
A pre-trial conference was held in the chambers
of the undersigned judge in the above-captioned divorce case on
Thursday, October 19, 1995. Present on behalf of the Plaintiff
was Bruce F. Bratton, Esquire. Present on behalf of the
Defendant was Keith o. Brenneman, Esquire.
This is a bifurcated divorce action in which the
divorce has already been entered and the issues involving
equitable distribution have been previously resolved. Remaining
for resolution by the Court are issues of child support, alimony
for the wife, alimony pendente lite/spousal support for the wife
and counsel fees requested by the wife. with respect to the
issue of child support and alimony pendente lite/spousal
support, the effective date which the Court's Order will apply
to is September 1, 1994.
The trial in this matter is estimated to be of a
duration of one day, and by separate Order of Court trial will
be scheduled for Wednesday, December 13, 1995, at 9:00 a.m. It
does not appear that settlement is likely in this case
.. ....
MR. BRATTON I Your Honor, before we oall our
fir.t witne.., Mr. Brenneman and I met in preparation for
today'. hearing, and I think we've entered into -- or we'd
like to plaoe onto the reoord a .tipulation a. to .ome of
the ba.ic fact. in order to expedite te.timony in the
proceeding.. We have agreed that the following are truel
Bradley T. Jane. wa. born January 22, 1957.
Miohele A. Jane. wa. born on May 8, 1956.
The partie. for this aotion were married on
Augu.t 27, 1977, in William.port, Pennsylvania.
There were two children born of the marriage,
Mark Jones, who wa. born on October 27, 1980, and a girl,
Danica Jane., born November 1, 1986.
The partie. .eparated on January 10, 1994.
A divoroe wa. entered based on a mutual
consent in a bifurcation of this matter on rebruary 24,
1995.
Mr. Jone. had filed a Chapter 7 bankruptcy
proceeding on January 18, 1995, in the Middle Di.trict of
Penneylvania, docketed to No. 1-95-00095.
We al.o agreed that during 1994, Mr. Jone.
paid or otherwi.e arranged for payment of three credit
account. whioh were in both name. and having a total balance
of approximately $2,900.00, repre.enting debt accruing
during the oour.e of the marriage.
2
Simult.neou.ly with the divoroe, and by Order
of thi. Court, Mr. Jone. tran.ferred to Mr.. Jone. the real
property looated at 316 Wi.ter Cirole in upper Allen
Town.hip, Cumberland County.
That property wa. .old on April 38, 1995,
generating a total net proceed. of approximately $13,400.00.
We have al.o agreed that the joint tax return.
of the partie. will be admi..ible. The.e are for the year.
1987 to 1993 and .hould be admitted a. a joint exhibit,
Exhibit. 1 through 7, numbered in that order ohronologically
from 1987 to 1993.
THE COURT! Do you want that done now?
MR. BRATTON! Are they marked?
MR. BRENNEMAN I They're in order, but they are
not marked.
MR. BRATTON! It'. a hou.ekeeping detail.
THE COURT! Well, why don't we do it ..
they're admitted. I'd like to get the .tenographer'.
initial. on them.
(Whereupon, Joint Exhibit. No.. 1, 3, 3, 4, 5,
6 and 7 were marked for identifioation.)
THE COURT! Mr. Bratton, the item. you have
a.ked to be marked a. Joint Exhibit. 1 through 7 have now
been .0 marked. They repre.ent, a. I under.tand it, tax
return. of the partie. from 1987 to 1993. Are you moving
3
for their admi..ion?
MR. BRATTON I We are jointly. So moved.
MR. BRINNlMANI Ye., Your Honor.
THI COURTI All right. Joint Ixhibit. 1
through 7 are admitted.
(Whereupon, Joint Bxhibit. No.. 1, 2, 3, 4, 5,
6 and 7 were admitted.)
MR. BRATTON I Mr. Brenneman, did I mi..
anything else about our stipulation?
MR. BRINNEMANI I don't believe you did.
THB COURTI We'll enter this Order I
(Whereupon, the following Order wa. entered by
the Court I )
"AND NOW, thi8 13th day of December, 1995,
upon consideration of the 8tipulation of counsel with
re.pect to various facts in the above-captioned matter., the
.tenographer ift directed to prepare a tran8cript of that
.tipulation."
THE COURT I Mr. Brenneman, I assume that you
agree with the fact. a8 stipulated to?
MR. BRBNNEMANI I do, Your Honor.
(Whereupon, the stipulation was ooncluded.)
4
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CIRTIPICATION
I hereby certify that the proceeding. are
contain.d fully and aocurat.ly in the not.. taken by m. on
the above cau.. and that thi. i. a correct trMn.cript of
.am..
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iUlin L. Rice
Official St.nograph.r
.......--.----------------------.-
Th. for.going record of the proce.ding. on the
h.aring of the within matter i. her.by approved and direct.d
to b. fil.d.
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HICHELI A. JONIS, I IN THE COURT or COMMON PLIAS
Plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA
I
v. I CIVIL ACTION - LAW
I NO. 94-4923,'
BRADLBY T. JONES, I
Defendant I IN DIVORCE
AMENDED D~REE IN DIVORCE
AND NOW, this 2..7..,!day of ~, 1996, the Deone
in Divorce entered in this matter on February 24, 1995 i. hereby
amended to provide that the terms of that certain Agreement between
Michele A. Jones, Plaintiff in the above"captioned matter, and
Bradley T. Jones, Defendant in the above-captioned matter, dated
April 19, 1996 is hereby incorporated in such Decrea ae if fully
set forth at 1enyth therein.
Nothing herein shall in any way alter or change the
effectiveness of the Decree in Divorce as entered on rebruary 24,
1995.
The Court retains jurisdiction for purposes of enforcement of
this Divorce Decree as may be required.
BY THE COURT,
J.
, .
such settlement in a certain Agreement dated April 19, 1996, a
true and correct copy of which is attached hereto and
incorporated by reference herein as "Exhibit A".
6. The parties hereto desire to amend their Decree in
Divorce by incorporating the terms of this Agreement therein.
WHEREFORE, Plaintiff and Defendant request this Court to
issue an Amended Decree in Divorce which amends the Decree in
Divorce entered February 24, 1995 for purposes ot incorporating
the terms and provisions of their April 16, 1996 Agreement
therein.
Respectfully Submittod,
Date: May 8. 1996
By:
SNELBAKER & BRENNEMAN, P. C.
/
~~~
Keith o. Brenneman, Esquire
44 W. Main street
Mechanicsburg, PA 17055
(717) 697-8528
Attorneys tor Defendant
Brad ley T. .10nes
Date: /'7 )'0 'k
BYl
MARTSOLF , BRATTON
'/'
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Bruce F. Bratton, Esquire
2515 N. Front street
Harrisburg, PA 17108-2106
Attorneys tor Plaintift
Mlchole A. Jones
LAW Ol'I'ICI.
SNILBAI<EJt
I!It
BRENNEMAN
-2-
THIS AGREEMENT
I(}~fl
is made this f day of April, 1996 by and between:
MICHELE A. JONES of S. Washington Street
#11, Mechanicsburg, Pennsylvania, party
of the first part,
AND
BRADLEY T. JONES of 1913 E. Villa Theresa
Drive, Phoenix, Arizona, party of the
second part.
WHEREAS, Michele A. Jones (hereinafter "Plaintiff")
initiated the above-captioned action in divorce against Bradley
T. Jones (hereinafter "Defendant") by Complaint filed August 31,
1994;
WHEREAS, on December 5, 1994, an agreement of the parties
respecting equitable distribution of marital property was
approved by Order of the Court;
WHEREAS, by Order of Court dated February 9, 1995 and based
upon a joint Motion For Bifurcation submitted by the parties, the
issues of divorce and equitable division of marital property were
bifurcated from all other pending economic claims raised by the
parties in the divorce action;
LAW O",IC,,,
SNILBAKE"
eo
BRENNEMAN
WHEREAS, on February 24, 1995 a Divorce Decree was issued
EXH [BIT A
divorcing the parties from the bonds of matrimony;
WHEREAS, on March 9, 1994 Plaintiff had initiated a support
action docketed to 220 support 1994, seeking spousal support and
support for the parties' two children ?f their marriage: Mark
Jones born October 27, 1980 and Danica Jones born November 1,
1986;
WHEREAS, a recommended Order of Court was entered April 13,
1994, which was appealed by Defendant;
WHEREAS, the parties subsequent to the above referenced
appeal reached ~n agreement respecting said appeal and the
settlement of certain property matters which was reduced to the
December 5, 1994 Order of Court made reference to above;
WHEREAS, in accordance with the Court's December 5, 1994
Order, another support conference was held resulting in a
recommended Order of Court which was timely appealed by
Plaintiff;
WHEREAS, by Order of Court dated June 5, 1995, the pending
support proceeding and the divorce proceeding were consolidated
for purposes of having all issues resolved in one hearing;
LAW O"ICU
SNELBAKIR
a
BR[NNEMAN
WHEREAS, on December 13, 1995 a hearing was commenced in
front of Judge J. Wesley Oler, Jr. for purposes of resolving the
-2-
LAW O......ICU
SNKLIAKr"
a
SIUNNEMAN
appeal tor child support as well as Plaintiff's outstanding
issues in the divorce action of alimony, alimony pendente lite,
spousal support and counsel tees;
WHEREAS, during the hearing commenced December 13, 1995,
Plaintiff withdrew her claim for counsel fees;
WHEREAS, prior to the completion of the hearing commenced
December 13, 1995, Plaintiff and Defendant reached an agreement
to resolve all outstanding matters in the above captioned actions
which agreement they desire to document with these presents;
NOW THEREFORE, in consideration of the mutual covenants and
promises made contained herein, the sufficiency of which is
hereby acknowledged by the parties, the parties agree as follows:
1. The above preamble is incorporated by reference herein
in its entirety.
2. Commencing January 1, 1996 and continuing for a period
of five (5) years thereafter (i.e. to January 1, 2001) Defendant
agrees to pay the Plaintiff twenty percent (20%) of the net
income he receives from employment which is in excess ot his
gross monthly compensation of $2,000. All such ~avments to be
made by Defendant to Plaintitf shall be made within fifteen (15)
days ot receipt thereot by Defendant and shall be transmitted
accompanied by a paystub or other contirmation of such
-3-
LAW Oll'II'ICn
SNIL8AKI"
a
."INNEMAN
compensation received by Defendant from Defendant's employer.
The t'Brm "net income" shall mean the gross pay received by
Defendant, less deductions for federal income tax, social
security tax, medical tax, Arizona state Income tax and any other
applioable taxes. such net income shall be calculated from gross
income from any source, whether or not from employment.
3. All payments made by Defendant to Plaintiff in
accordance with Paragraph 2, above, are agreed to be allocated as
twenty-five percent (25\) alimony to Plaintiff and seventy-five
percent (75%) child support for the parties two (2) children.
It is the intention of the parties that all payments made to
Plaintiff which are allocated as alimony as set forth above,
shall be considered periodic payments in discharge of a legal
obligation, which because of the former marital relationship is
imposed on or incurred by Defendant incidental to a divorce, all
within the meaning of the Internal Revenue Code of 1986, as
amended, as now in effect and of similar proviBions of future
laws. Such payments will be included in Plaintiff's gross income
and will be deductible by Defendant in determining the parties'
respective taxable income.
4. In addition to any payments required to be made by
Defendant to Plaintiff pursuant to Paragraph 2, above, Defendant
-4-
II
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. ,
shall pay to Plaintiff the sum of Five hundred dollars ($500.00)
each month beginning January, 1996, for a period of five (5)
years (i.e. to and including January 1, 2001) as child support
for the parties' two minor children. Such child support shall
not be reduced during said five (5) year period by reason of Mark
Jones' attaining the age of eighteen (18) years.
At the end of said five (5) year period, Defendant's
obligation to provide child support for Mark Jones shall end, and
the parties agree to modify the child support obligation by
initiating a support proceeding in the Court of Common Pleas of
Cumberland county, Pennsylvania for purposes of recalculating and
determining Defendant's child support obligation for Danica
Jones, based upon the financial and other relevant considerations
of the parties then existing.
5. In the event Plaintiff shall seek to modify the child
support payable by Defendant hereunder during the five (5) year
period made reference to in Paragraph 4, above, then in such
event, Defendant's obligation to pay alimony as provided herein
to Plaintiff shall immediately end and forever cease and
Defendant's obligation to pay child support shall be determined
exclusively by the above referenced child support proceeding
initiated by Plaintiff in seeking such modification and
Defendant's obligation to pay child support to Plaintiff in
u.w 0"":..
SNILBAKIR
a
l'tlNNIMAN
-5-
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accordance with the terms of this agreement shall terminate.
6. The parties hereto acknowledge and agree that the child
support paid by Defendant in accordance with Paragraph 4, above,
shall reduce the support arrearage presently due in accordance
with the same amounts by which the payment paid by Defendant
reduced such arrearages under the Order of support that was in
effect immediately prior to this Agreement; that is, $477.00 of
the $500.00 shall be allocated to support and $23.00 to be
applied against outstanding arrearages. In addition, the parties
agree to share uninsured medical, dental, orthodontic, eye care
and prescription medication expenses equally. Plaintiff agrees
to maintain medical insurance on the parties' children as
available through her employment, at current rates. Further, the
parties agree to share equally all reasonable child care or day
care expenses for the children.
7. Defendant shall provide such evidence of income as may
be reasonably requested by Plaintiff from time to time. Such
evidence of income shall include, but not be limited to,
Defendant's W-2s, federal and state income tax returns, and
paystubs or other evidence of income received by Defendant from
his employer.
I.AW OP'P'ICIU
SNEL.AKER
a
BRENNEMAN
8. Upon the death of either Defendant or Plaintiff, or upon
the marriage of Plaintiff, or upon cohabitation by Plaintiff with
-6-
" ..
LAW O'lICI.
SNEL.OAKER
a
e"ENNEMAN
a person of the opposite sex not related by blood or marriage to
her, Defendant's obligation to pay alimony to Plaintiff pursuant
to Paragraph 2 hereof shall terminate, if said obligation is not
sooner terminated by the expiration of the five (5) year period
set forth in Paragraph 2 or the filing for child support by
Plaintiff as set forth in Paragraph 5, above.
9. Except as provided herein respecting alimony, the
parties release each other of and from any and all claims for
spousal support, alimony, alimony pendente lite and counsel fees.
10. The parties hereto agree that the Agreement shall be
incorporated in an Order of Court which shall amend or supplement
the parties' decree in divorce and that the parties and any court
of appropriate jurisdiction may utilize any remedy or sanction
then available under the Pennsylvania Domestic Relations Code, as
amended.
11. Plaintiff may modify the terms of this Agreement
respecting alimony if, but only if, Defendant has failed to
perform the terms of and pay the amounts required to be paid
under this Agreement, but in no event shall such modification
occur, take place or be effective after any proceeding by
Plaintiff is initiated to modify child support as made reference
to in Paragraph 5, suera, it being expressly understood that
Defendant's obligation to pay alimony is forever ended, released
-7-
[:I THE: COURT IJF COMMON PLEAS OF
CU:iIlERlAND COUNTY, PE.'lNSYL'/AN!A
Mlnl='II:" ^ . nJl:'''
Plaintiff
vs,
BRNllEV T. .xJlES
~O. 4923 CI vll Term
19..2L-
~OT!ON FOR ,\PPOr:lr.~'lT OF ~STER
(Plaintiff) OlW'~~)fI.lll(), moves the court to appoint
followin~ claL~s:
MichPlp A. Jones
& master with respect to the
( ) Divorce
( ) ,\nnulment
( X) Alilllony
( X) .Uilllony Pendent.
)
( X)
( X)
( X)
Distribution of Propert:,
S uppo rt
Counsel 'lSes
Costs and Expenses
Lite
and in support of the motion states:
(1) Discovery is complete as to the claillls(s) for which the
appointment of a master is requested.
(2) The defendant (has) ~X appeared in
(by his attorney,
(3) The staturory ground(s) for divorce (Ls
Divorce enterEd 2/24/95: ktloo bifurcated by Order dated 2/9/95.
(4) Delete the inapplicable paragraph(s):
(a)~~~
(b) An agreement has been reached with respect to the
following claims: Eouitnhlp distrihItim and divorce itself (see aOOveL
(c) The action is contested with respect :0 the following
cla1ma: ~DllOrt. counsel fees. costs and exoenses. alirrooy...ii.!lrrony ~enJgJj!~ maintenance of lIf; in~le:ance
(5) The action K~lllO (does not involve) ,:omplex Lssues ':1I: law c~lldrn,.
or fact.
(6) The hearing is expected to take 4 (hours) ~.
(1) .\dditional Lnformat:ion, Lf any. relevant to the motion: Bv Order of
.irlJe ress. allllDw [)enden~ l,~te and alirroov have been COOSOlitJg' ~~~:f il Sl~x:ort ~t~~ 1m 22401}.
Date: t J(.);,J l t ,I ___1& 0---
At oruey for (?1aL~t:if:)
XXl<<~
the action ~~~~
,Esquire) .
(are) Sectioo 3301Ccl.
\
,....'ID ~OW ~. ,.,: I I
is appointed !:I8ster with
ORDER ,\PPOr~ITI~G :!ASTER
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resp~t co-t~e following claims:
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obligations through August 31, 199.,
C. The Domestic Relations Office .hall hold a
conference as soon a. practicable to reconsider the amount of
.pousal and child support, such Order to be effective a. of and
to be calculated as of September 1, 199., neither party waiving
any claims or defen.es which he or ehe may have,
D. Defendant shall receive credit for all
payment. he has made after September 1, 199.,
E. Enforcement proceeding. shall be suspended
for a period of ninety days from December 1, 1994, provided,
however, that Defendant shall make payments of not less than
$125.00 per week commencing the week of December 5, 1994, and
continuing each week thereafter until Defendant finds employment
or pending further Order of Court.
2. The Court approves the agreement reached by
the parties to resolve the equitable distribution issue. raised
in the pending divorce action docketed to No. 9.-4923 Civil
Term, to witl
A. Defendant, Bradley T. Jones, shall transfer
and assign to Plaintiff, Michele A. Jones, any and all of his
right, title and interest in and to the real property owned by
the parties at 316 Wister Circle, Mechanicsburg, which shall
hereafter be the sole and separate property of Michele A. Jones,
B. Husband's office desk and chair, currently
at the marital home, shall be removed as soon as possible and
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MICHELE A. JONES, IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
v. 94-4923 CIVIL TERM
BRADLEY T. JONES, CIVIL ACTION - LAW
Defendant IN DIVORCE
MICHELE A. JONES, IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
v. 220 SUPPORT 1994
BRADLEY T. JONES, CIVIL ACTION '. SUPPORT
Defendant DOMESTIC RELATIONS SECTION
IN RE: PRE-TRIAL CONFERENCE
A pre-trial conference was held in the chambers
of the undersigned judge in the above-captioned divorce case on
Thursday, October 19, 1995. Present on behalf of the Plaintiff
was Bruce F. Bratton, Esquire. Present on behalf of the
Defendant was Keith O. Brenneman, Esquire.
This is a bifurcated divorce action in which the
divorce has already been entered and the issues involving
equitable distribution have been previously resolved. Remaining
for resolution by the Court are issues of child support, alimony
for the wife, alimony pendente lite/spousal support for the wife
and counsel fees requested by the wife. With respect to the
issue of child support and alimony pendente lite/spousal
support, the effective date which the Court's Order will apply
to is September 1, 1994.
The trial in this matter is estimated to be of a
duration of one day, and by separate Order of Court trial will
be scheduled for Wednesday, December 13, 1995, at 9:00 a.m. It
does not appear that settlement is likely in this case
, ' .
By the court,
Bruce F. Bratton, Esquire
Coun.el for Plaintiff
Reith o. Brenneman, Esquire
Counsel for the Defendant
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... Do you (or ~ 'IIOUI'l hIVt MlIlIIIr 'ItIlIolI .......... tor pnclI\II_7 .
.. wu your whIolIl'/llllllll lor U.. durtng oIl-1Iuty lloutl7
.... Do you ,..... I'IIOIrlOIIO IUIlllOn your dlCluCllO/l?
.. If"'( .lIl1le~wrlllIII1,
...
othll' Illpen.... WIt below buafn... up."," not Included on linn 1-215 or IIn. 30.
,
-
..... ..1f.y~iY1.!'1!-"""""'" ........,..... ... ....... ,.. ,.." ... ....... ....., ........... .......'. ......
I~ C)
............................................ ........... ...... .... ... .............. ...... ...~ ........ .............. ...
.....,.................".............................................................................................
......................................................................................................................
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...............................................................I...I..................I.I.................UIl........
.11.............,.....................................................................................................
oil
'"'1 011I.. ..""u.. EIII., "... ."a 0"
,1,11",21
I
e "",.,., M,.,.......
.;
, 'ICHIDULa II
(POrm 1040>>
.
S.If-lmploym.nt Tax
~.4
"".M" IN rr...,
---
IlIfIIOn wttn IIocIIll HClI/1Iy numb. a' ~
AjL5 wttn ""-lNlIp~lnaom..
, Who MUM FII. Schedule 81
You mUll nl. BoIIldul. 8111:
I \'aU ~U 1I1l6lPft1~al M ii~-imploym,"lllllm other Ihen ehuroh employ" income Oln. 4 a; Short SeI1tdul. SE or IIn. .-c 01
I.OnII SotIldul. lIEl of 1400 Of mol'l, Oil
, You hIcl otlurcll tmployee lnooml 01.101.28 or mol'l. Incoml flllm lervtCeI you performed U I mlnltler or I mamblr of .
Illllloul orcI... II not cIluroll employ" InoamI. Set PIOI SE.l, '
Nolle Ivtn If YOII "'ve I lOll or . amllll/flOUllI of Incoll'lt I'rom ,"f-ernploym"'t, It m.y b, III your IlInI~t III fill Schtdull SIn
UN ""'" 'optlorlll mt/tlod' In PIn /I of /.ong 'chldult BI. s.. /)IiI BI.Il,
IlllllltlOn. If your only MlI.amploymantlnoom. wu from lII'n1ngl II I mlnllttr. mamblr of . ""I;toue oraer. or Chrllltlen 8oI11Kl1
prlctttlOnar. IIId you ftllll Form 4381 end l'IllaIYtd IAS approval ncllo blllXlO on 11'10&I 'IInln;l, do nol ftll I!lctItduJ. SII.
fneCiNd. writ. 'ExemPl-Form 4311" on Form 1040, IIn. 41.
MIY I U.. 8hort Sohldull IE or MUST I UN Long Schedul. SE?
Old 1'0\1 _ WIllI 011111I il ,..., I---
Nt .- YII
....1'0\1. mtIlI... _.,...- 010... '" C/lII_ .,.. w.. "" IOIIl ., \'OUl' WIOII''''' 111lI1NbjIo11G IlOOIIIIIIIIIlIV v_
...~wtlt_...I...--'ntlllllDl_ QI ,1IIraId .._ lIIl '*" IOU' neI lI"lInlll fI'OrrI
llI__f_I","_i"'I'O\I_~~ UII-tIllDlOymllllmGl'l Ill.. 110,1500'
1M on 0IIlIr .......'
'!t-
:::. "'*" _ of Ill.... .- \G fIt\UI 'f'NI1lII '.,. ,..
<- ..... "'Il'
~ aiel you __ IIIDjIa\ 10 ~ lIllunty or M<<llon .. 1..-
!t- lllllyou"'net_lo>"ll'~
0ItI you /MIMI _ ImDIQyee inGQm. ,....,.. O~ ,_ 'II..
1M" 1101.11 '" """' . ' ~
~.
I --
YOIIIlAY uti ."0IlT IOHIDULlII IIUlW YOU MW!' uti UlHG IIOHlOULl .. 0" TIll IIACIC
-.otIon A-Ittot180llldlll, .1. CalltJon: Rad .bo..... to DI " you catl use Short Schedul. SE.
1 Net IlI'm prvtIt or 0011) trom &c/'1lOull F. II~I 31, and film pannlllhl!l'. Scntdul. 1<.1 I~m
'OIe). IIn' 10. . . . . I . . . . I I . . . , . , . . . . . .' , . .. ,
I Nil proflt or 0011) lrem &chIOu I. C. IInl 31: SC/'1l11ul. C.!%. IIn. 3: and I!lclltclul. 1<.1 (Form
1015), lint Ie. (Othll' tIlln filming), Mlnlatart IIId mlmlltra of rtllgloul ora.,. ... page 8E.l
tor amountl 10 report on 1/'111 IIn.. S" pig. SE.a lor other Inc:ome 10 IIIlOFt.
3 Combln' I/n.. 1 end 2. , . , , , , , , , . , , . , . . . . . , . . , .
4 Nee _mln" from ""oIIIIplo\lm,nl. Multi!)IY IIn' 3 by 82.35" (,g23&), If t... IlIan 1400.
110 not fill 11111 IClltdul.: you do nOI OWl IItt..",plovmtnlllll . , , . , , . . . ,..
I lIIf_ploym.nll... If tIl, .mounl on Iln. 4 II:
I sea.800 or IIN, mUltiply IInl 4 by 18,3" (,153), Enl11 iii. ,..ull h.,. Ind on }
~rm 1040,lIn. 47.
, Mor. Ihen seo.eoo. multiply IIn. 4 by 2,;" (.02g). Th.n, Idd 51.&14040 10 11'1.
,..ult. Inl., 11'1, 1011I 1'1,,. ano on 'arm 1040, IIn, 41, .
11'0' ,.oerw....,.I'( "lItljtlrtlo" Act ~,oUo., ~.. ,,,,,,, 1040 'rHUNcr10.,1.
~C"~GUII SI i~orm '0001 IBM
~;11t '10 .. ,~~Z
INCOME AND EXPENSE STATEMENT OF
____'__. m I.!.:he.l~.,_ (\. ::JOMl ..__ ,__. __ --.-.--.---'---,
SSN L9~_..'I'L~IS.__.._DRN..1~..401 ... ..DATE __6JMJclL-
THIS STATEMENT MUST BE FILLED OUT
(If you are self,employed or if you are salaried by a business 01 which you ara owner in whola or in part, you must
also 1111 out the Supplemental Income Statement which appears on the last pago of this Income and Expenle
Slalemen!.)
INCOME
(a) Wages/Salary I J JI-
Employer & Address _t!J V.-SP.uIL~k>>pi.IIlL.-5QL,rILal~t. )CLl1lfl}ltl'-IPJ:.-I~Q.I./-
Job Title/Description __,..___.~'lIjlll~_lI1:::. . _._
Pay Period (weekly, bl,weekly, monthly) (h~ut-- G,q ho...,1 .
Gross Pay per Pay Period .......".,."...,.................".................,............",..,..,......,................................. $....:{QJazlf'__
Payroll Deductions:
Federal Withholding "..........""..$_li.<L'iL , I
Social Security ..........,......,.........$__1SJL1 r; P-> fJJ q. f, . f
Local Wage Tax ...."""".............,$_. Go I q 'M....~.: i "~.i '... .. I....'~"
State Income Tax ...",,,,,,,,,,,,,..,,,$___Ll..3.1...__
Ret I rement ..,.,..., "."",,,'.....,,,,,,. ,,$ _,J~.,1!!______
Health Insurance ,,,......,....,,''''''',$.,J5.,JL-___
Other (specify) ....,Qoil,I,~,I......""..,$_J.0.34
... _____..._ ....,:iV.t......"....$_-'-1Q8
_____,___ .....r:~1f.J..i....,....,..$__~. g lJ
Net Pay per Pay Period ..............,,'............,......,........,......,..,..,..,..,.................................,..'................., $ l.j ~S~
(b) Other Income Week
Interost/Dlvldends ."",...,...".."",$_.___._
Penslon/Annulty..""""",,,..,,,,,,,,$
Social Security ....,....""..,....'''''',$_____ '
Rents/Royalties ..".""."......,,,,,,,,$
Expense Account .."'''......"........$____.____
Gifts ....nLI',"",..p.,M,(~n......$
Unemployment Compensation ,$_
Workmen's Compensation """,,$ _._,__,___.,..,_..
Month
$ .3~ '!:' 'I
$.._----
$____,
$
$.-.--
$_VA&\ I ~
$
$..._------,---
Year
L
$----
$
L
$
btP.wb/lJY- O~ Nl.t. r
$
$----,----
Total, Other Income ,.."'''''..,....''''..$_________...._,_ $._____,
$
INCOME AND EXPENSE STATEMENT OF
f ~r,~...-II~ o/,J;
I 'erllv Ihallhe 51alemenlS made In this Inr.ome and Expen.e Slale'
ment are tru. and correel. I undorstand thai false statements horein
aIV made sublacl 10 Ih. penalties 01 16 PaC S. 4904 relallng 10
unsworn 131sIIIcallon 10 authorlllos.
Dale
Pldlnli" C)I Oelr.nddnt
~ PLAINrI"'S
I ~In
,'-'5'')~ ..$(~
ORO H405
<# f.STI""'TI)/...."(l~ IeTt b
, -..
, ..'
IMI'I"'''' N<, ""',.,,, ',M," "11'1, III'" "'" "'''''""''1 ,,,)"., "".111"" Nu
['ii461iiliTlilC:HI f A JONES .. . I.... Ulj.I'~/011915...['.l/.~f,l/951I9J':'~6':~jI~]
tilll IIAI ANn ~ 'Jr1lltAIMjll j !\j"lflIIllljh r to/nIHil/'ll
i.r~,~:'~.ail,.jo.OIlJ;'TO . I' 7 10.70.0. 050326 (lm,,,r ..Oll/OOO . 15964
lULLUA.L,.H.oJ..lDAYS "Un..IE.UUD IYDf;Cfl'lJf:liJ1.}". "'''I',', 1. '1"66'-"'I"~","'I"O
EARNINOS DEDUCTIONS 11'^~ES OIl"61i no ..
.._.~..._._--~---.__.._----~- . ____'Au___._ ______._.__...__. .~._.,_..__.__. .___.~~~.___.
-!!!:!!!.....,. "--'.'!2~",.,,,,_ '." "'."". ,,,."" 'L "u,,"_, ."L':!,... ..'2":'" e"".. ".'I-"',!.I',,1I1~IL _ "" 453 , 6 1
Itll 1 "'.00 "",'4 10,060 IIIC 17.0' '81.71 ".r.r.':.~~__ 1111"",
VAC I 15,00 150.90 10,060 HIDI 1,68 229.59
FIT 51.3' 171'.16
STn 18.03 473.60",."
LOll 6 . 44 169 . 16
SO I . 71 1 8 . 61
O'T 10,00
DINT 10" 39 238. 02
TIA le.88 338.31
PHO 35.12 6J2.16
,OIAL..--.--"j-LII.o..L,6..'lJLU --"'-'---,_ ~L_eJ}~j ,-~:t;I TQL 190.23 5033,15"
'''I' ,,"', "'.IIMI I" '" ''''''''",.; M,O 0' ""'0",,,,, Ii'; ,,'"'' "I' '''l/'', HOLY 6."" H06P""
,,-
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UNITED CEREBRAL PALSY OF THE CAPITAL AREA
30763
1'1" II'
1'1'01
'ii
'.ill'
III II' I
,
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" I ,) .1" II '1'1"
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PROPERTY OWNED Dncrlpllon
Checking Accounts ,,,,,,,,,,1 B'l '"M't). u_ "---"'N- --."
.._~':JliDlS" . . m'I',l:wJ~__ ..
Savings Accounts "",,"'" _", ._.1 '3.cl J~ '3 ,,_ r~Jrlll\ .ClflhU.liil~"
"'"'''''' _ _D'J j(p;t ... .. . ."m_"_..'
Credit Union """"''''''''''''"
Stocks/Bol1ds ",',:: :",' ','.:'....,', ',', :,lQJ.(ll:~J,,;I_r'lll J
Real Estate """""""",,'''' ,.... _..
Other """,,1<;i:1(,;Oi',':',',',,',',: :",~.~lT~~:::'_-=-}.1gM~~~\ fl!":-l::~, r)~
Total, Property ,,,,,,,,,,,,,,,,,,,,,_ ____._"..._.__.____.._,_.___
INSURANCE Complny
Hospl tal '"'''' ,,,",",",,','" ,,---5p~\'\.._HLJ<1llHal~ -~tJLl.L-
Medical,,,,,,,,,,,,,,,,,,,,,,,,,,,, ..__.__...___",,""...____.__
Health/Accident ''''''''''''''. ..",__._"'m'."_
Disability Income "',,","".__.________..___________
Other (dental, etc,) "''''',,,J'\.k.flS,....:.Jt,IlJ.L._
('H . Husband, W ' Wife, J ' Joint, C ' Child)
Vllue
$ '. 't 10137
$ Lj9.::! LIS
$ Itl~J,"'''.
$IQ,~ni>,dL
$ ._" u__
$,. .....------
$~813:"1~..
$ .--"".----
$ .m__",,,__,,__,
$ ,--- -,-.--
$ _~.JiJ~~
$ -----
$
Policy No.
Jw1\LL'I~:rn
._L'l.Hb:.l.3l'i
SUPPLEMENTAL INCOME STATEMENT
Ownership.
H
W J
..,x.
__ .K,..,
.t.___
,._~_.
..--A.-
-4--
Covlrlg. .
H W C
_ -X- -"C_.._
~-X-.
..
A. This form must be filled oul by a person who (check one):
__ (1) operates a business or practices a profession; or
__ (2) Is a member of a partnership or joint venlure; or
__ (3) is a shareholder In and Is salaried by a closed corporation or similar entity,
B, Attach to this statement a copy 01 the fOllowing documents relating to the business, profession, partnership,
joint venture, corporation or similar entity,
(1) Ihe mas I recenl Federal Income Ta~ Return, and
(2) the most recent Profit and Loss Slatement.
C, Name and Address of business: _
.______.. ...,..__ Telephone Number
Q, Name and Address (if different than C) 01 accountant, controller or other person In charge of financial
records: .______ '''m.'' _____.__ .. __._._.___.. ___.._u._....,_ ., ..___..._.____
.
E, (1) Annual Income from business ".",,,,,, """"'" " "" ," '" " ""''''''''''','''''''''''''''',,''',,'''',,'',,'''''''' $_.
(2) How often Is income received? "'",,''' """""" " ,",," " '''''''''''''''''''''''''''''''''''''''''''''''''''' " ,,", $
(3) Gross Income per pay period """"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' $_.__.
(4) Net Income per pay period ""'" """"",,'''''''''''''''''','' """'''''''',,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, , "" $
(5) Specific deductions If any ""'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' $.
7':1 A, /-
tiI~7
c3
( t,7' f
---------..--.. ~_._..._..-.--.........--_.... -,~._- ~
t.....,............. Mf II''''
IHt Lu1A~ & N~TrLt'UN 'UM~ANY
OWl Nt, '.....
....,... . ...,.'..... .....
f;-Ll.l!ll9~i" f;ltUll"I.
L;,dl) ~ 11.l;MiY ",,1 'It:
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= 0 :..0 ::-0::-0 :0 ::0 :,,0
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L i. f... L J 1 ~ Ij J';
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10 w......... ..........
S.. ')'11,. ,.~
IS.............
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.\1.; ...l:.' ,;." l,..&Iw'~l.C 17",IncolNIU I............ II.........
',.I.I."MIII:~.IVK'./ ILI.7.LI> ~,)u'''.'',)I'h~'''.)YLVA
.IA I 11:) ';)J Nl.clUIftlaINlU 111.otIII....".. It............
._W.2 Wogtond T'~'.III_I1"7 ",,,,,,,,,tI.., ...., :> J o. I'> '53 'J If.. ",;, ..;i~. '11 L L
/ Thl. Inform.llon I. b.'n" lurni.htd 10 Ih, Inl.tn.1 Rev,nu. Servle. ~ rJ IN f'..., - _11II........
.,............ ......
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oUol.'\"
II.....llIWlIW.........
oL.H.7J
,........... ....
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1.".,.,..........MllZlP..
'''AC IIU COR' ,. ."0' ',/,1",
.561.
RD .,,)._.,:,,;'; ".'i." 9590
,~,,'., .:,. i '~;', I ;'...., '~IJC.......
'I K'~ " , I ~.:: "'. ,"'"..,'~' '.1 )' ,
I,Hi''''
.t;.;ni;ll.'o!', I "j,:;,,~I'J bnG ,llOVhl1"" .tJINnt:t
1~1J1~d L 1
'I Ii \ 'f \ ,$'k'
~1040
lIb.1
UIIIRS l.b.1
OI""WII.,
pili" ~lfInt 01
lyPl
flllna St.tus
ChIC' only
ani boa
Ex.mptlons
(5..
Inltructlona
on PI" 7 )
II mort th,n 1
d,p.ndtnl1. ...
In,tructlons. on
P.K' 7
Incom.
PlfI.,.tt.ch
Copy B 01 you,
Fo,m. W,2, W,2G,
.nd W.2P htr.
If ytJu do nol hav,
.W.2.IH
p.,. 6 0'
Inltructlons
~
PI'..,
Iltlch chick
or monly
order hit'
Adjustments
to Income
(5..
InsHucllon5
on p.,.12)
Adjusted
GlOSS Income
D'P"I,,""' 01 Ih. ""'UI,-. j"t"",1 ""~'IlI,l' b.'"",.
U.S. Individual Income Tax Return
~@87J",
P-f,
IftJSY
1
2
S
4
6
1.)..I.hDll~1f
./
'~ '(,
(~
,19 I OMI No 1114&007.
hu, MCI.' .....,"~ ........,
z", !.1" : 1SU
.,..,..', .....Hr.tt_..........
ItS! 'It. : lJlS-
I.. ""Ill Acl... ,........ It,
...1100 Acl NoI." ,.1"trocllOl'
.....: ,,,,,*,,,, "t'" " ",,,
"'" eN,., 1OU' "1"
,HIK' "'lHttl
(l)lIttl_..
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0111'
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N.oI.llId'..
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N. oIcllN,..
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I......ll.. .
_.1101
N"oI.....I,
k.,.....k .
N.,oIoI'"
r.r.."::"~ ·
fOl th, 'If J.n .Otc 31.1911.01 olhlll.. "' be tnn~__..:..!9.~!.:.'nd~_________
You' f'l.' ".m. .nd Inlh,l (i'IDlnl r.lurn, 'I'Dllv, ,pot,jll" n.m. .nd Inlll,'1 or L.ll n.m.
4RtIt/)L~Y To ""II P/IC/{UL'2:..._" DNIS
p,,,.nl ham..lJdr... (numbe' Ind ,trul 01 'vIII lout.) (If rou h,v, I P 0 801, '" pll' 6 ollnU"x:hon, )
3 /(, WIS'rER e "Ute
ell., lovwn 0' polt olllce, ,t.ll, Ind liP Cod'
I'll tlNA~1L St.U(?'
',,,ldlnUII ... Do you Wlnl Silo &010 1M fund?
[llcllon Clmpllrn' It olnl rolurn don OUII Dun wlnl Silo 010 1M fund7,
S,n,l,
M.rrI.d rihnllolnt return (.v.n It only on. h.d Incom.)
Mu'ttd hlln,Mp'nl' "turn. hill apoulI'lsocl.llICu,lty no .bov. .nd 'ull ...m. hit..
Hlld 0' houllhold (w,lh qu.hly,n, p.".n). (St, PI,' 7 01 In.t,uellon. ) IIlh. qU.'I'I'''' pe'lon I. lour child bul nol
~OU, d'ptnd.nt, .nl,r chIld', n.m. her..
u.1I1 In widow" wllh d. nd.nlchild II" UII dltd . 19 ) (Sttr pe.. 70Ilnll,ucllon.)
C.yU...: If you can be' cl.lmed II' d'ptndtnt on .nother p'r&On',I,1 retu,n (,uch., your parenti' IItur"),
do not ChICk bo. 61 Bul be' lure Ie chICk the bo. on IIn, 32b on ~I' 2
I. rn You'I.1I Ib OCJ Spau..
c Dep.nd.ntl U) C,*k W II qt h' M'. "".fllt
(I) N.Me Ih"I.IIIIIII,I, 1M 1111 ".IM) 1I11~ 1<<11I"'111, '11.'"
d If your child didn't 11'1' With you but II d,lmtd II your d.ptnd.nt und.r. pre' 198~ 'I,"m.nt. check hll'. .... 0
. Tot'l number of ...m tlonl c1'lm,d (.110 com 1.1. hnl 315
7 W.,.., 111."'1. liP', .'c. (,/toch Fo,m(.) W,2)
. T..lbl. Inl....t ,n(om./,',o .tltch Sch,dul, 8" om '400)
. ,......mpt Inl,,"t Incom. (Ill' PlI' 10) DON'T Inelud. on hn, 8 ,
10 Dlvld.nd Incom.(,',o .tt,ch Sch,du/, B ,f OVIf 1400) .
11 T'l.bl. r.fund, of ,t.t, .nd loc.1 Incom. 1'1111, If .ny, from workshtll on PlI' 11 ollnllructlonl.
12 Allmon~ rtClIVld
13 BUIIn.II Incom. or (1011) ('''IC'' Sch'dull C)
14 Clp,I.I,.,n 0' (10") (,tI,ch Schtdul, D)
16 Olhtl,.,n. 0' (Io....)('tllch 'orm 4797)
lIS. P.nllons, IRA dlstrlbullons. .nnUIIIII, and rollo't'" Tot.l r",lv.d 16,
b T.l.bl. .mounl (11f P'I' 11) ,
17 Rlnts, ro)'.III's, p.rtnershlps, '!IoI.I.s, Irusts, Ilc. (,ttIC" Sch,dul, E)
I' F.rm Ineoml or (1011) (,t,,,h Sch,dul, ')
19 Un.mpto)'m.nt comp,nllllon ('nsur.ne.) (I" Pili' 11)
20. Socl"s,curll)' ben.flb (1ft pal' 12) ·
b T,II.bl..mounl, It .n)', trom Ih. workshltl on pal' 12
21 Oth.r Incom, (hll type and amount-I" PII' 12)
22 Add Ih. .mounts shown In Ih. fir rI hi column tor IIn.s 7 8, Ind 10-21 Thllll our tol.llncom. ...
, 1 ,,('
23 R,lmbu'l.d .mplo)'1f bUSln.1S Ilptnllllrom Form 2106 v
241 Your IRA d.ductlon, 'rom IppllClbl. worklhllt on P'I' 13 or 14
b Spous,slRA dldutllDn. hom 'llphUbl, wo,hhHt on P'I' 13 or U
25 Sell..mplow.d h,.llh In,ur.ne, drducllon. tram wo'kshHt on PlI' 1.
26 K'OIh ,lIlrlm.nl pI'" ,nd ulf..mploy,d 5lP d.duchon
27 P.n.lt)' on 11,1)' wllhdrawal of IIvlnls
2. AItIMon)' p.ld (rtClpt'Mrll.st n.m.
Ind socl.lucu,.,y no .)
29 Add IlMts 23 throu h 28 ThtSt I't our tot.l.d uslm.n"
30 SublrlC1lln. 29 tram Iln. 22 ThiS II )'our ad)YII.. "'11 Incom., "th" 1m, 1$ I,u th."
'J5.432 ,nd, child I,v,d WIth you, J" "flrn,d Incom, C,14,t" (IIn' 56) on PI,' 180'
,h,'ns,ruc"ons II ou w.n"R to" u" our t'lI . ~ 150' ,h, Instruction.
M4 ".Mr'
..11IIIl1t
J In
Ie) (-1j,
I
rTI
GJ
D
D
D
fo"" lo.el)II~IPI
Tu
Compu..
IllIon
Clullon, _
1I,0u
chtck.d In,
bOI on 1m.
321. b, ore
Ind rou
don'
It.mlll, II.
.11" 1610'
th..mounl
to .nt.r on
Iin.33b
i ,,'1, ~
Crldlts
(SH
Inlilructlon.
on.I,.(7)
Olher
Tues
(lncludlnl
Ad"nc. EIC
P.,m.nl.)
Peyments
Attlch Forms
W,2. W,2G.
Ind W,2P
lohont
Refund or
Amounl
You Owe
PI.ase
Slen
Her.
hid
'''''''''1
U" 0."
--
31 Amollnl from 11'" 30(lcJIU~I'1.I11'()P>>' meum.)
321 ChIChil [)Vou."'6bo,0,,, 0 81"'0, [] 5po"" wlI6bo, 0'"' oHlind
~dd Ih. numb" albea., C~It(ltld 11\11 Inlrr Ih. 10t',1 h". ... LJ21,!
b /I ~ou Cln b. cltlm,d... d.p.nd,nl'on .nolh.r pi"on', rl!luln~ chIC'" h", .... .J2b
c II wo~ II. m,UI.d 1,lInK."p.r.lt "Iurn Ind youI .pous. It'mlr" d.du.ctID~al, \
or ~ou .r. I dUllilllu, Illtlt, It. Pll' 16 .nd chICk hlr. ' .. lie
33. Itlml.... ...ducllonl. Str P'lI' 1~ to IIf Ir)'DU i"ould It.mir. If ~oudOn" ...mll', .n'" IIro I'
~ou do It,mlll. .1I.ch Sch,dull.. ,~I" Ih,.mounl from Sch'dul, A. IIn. 26, AND 'kip hn,33b
b St.nd.rd d.ductlon, Rlld Clutlon 10 I,ft. It It Ippll", III P'I' 16 'or th' .mount to .nl.r
II elution do..n'l ( S"'a" 0' HIIO 01 hou..holo, 111111 $2.b40 }
Ippl, Ino IOu, t'lint MII,,"d "lin, 101nU, 0' QUllil"na W'dOW(II), .nl" $3,760 '
It.lua frum PII.111 Mllfled hhnll'PII.IlIIly, .nttt $1,880
Subtrle' IIn, 33. 0' 33b. whlch.~1t .pph.., hom Iln. 31 [nt" the ,.Iull h,r.
Multlpl~ $1,900 by Ih. 101.1 numblt 01 'll,mpllon, cl'lm'd on Im,6. or '" chlrt on P'I' 16
hubl.lncome, Sublr.cllln. 35lrom IIn' 34. Enl'r Ih, r..ult (bul not l.nlh." IIro)
e.utlon: II und.r .a' 14 .nd ~ou h.v. mort Ihln 11,000 ollOvlltm.nlmcam., chICk hit. .0
Ind "' p'a' 1610 "'1' you hlVI to IJII fotm 8616 to "llJltyouI till,
Enlf/ I.. ChlCk,lI,om 0 T.. Tlbl., 0 T.. RII. SCI1ld"llI. D!J' Sch.dul. D. 0' 0 fOlm B61~
Addl"on.II.... (m p.,. 16) ChICk Ill'om 0 form 49700' ClFo,m 4972 '
Add 1m,s 37 Ind 38 Enl'r th,lal.1
e"dll tOl chIld .nd d,p'nd~nt CI" 'llp,nl" (,""h Form 2441)
C"dll tor th, .Id,rly or for th, p'rmln'~Uy Ind tot.lI)' dlllbltd
("llCh SchOdul. R)
Add tlMea 40 .nd 41. Enl'r the 101.1
Subtrilct IIn. 42 from hne 39 Enler Ih. rnull (bul noll,n lh.n 11m)
Forllin till crrdll(,tt,ch form 1 J 16) 44
G'ntr.1 bUSlnUHr'd11 Check I' from 0 Form liDO, 0 form 3UI,
o ror" ~BB4, 0 101m WI, 0 form 676\, or 0 rOlm 1~B6
Add lIMn 44 .and 45 Enl'r the 101.1
Subtract hn.46lrom hn. 43. Ent.r the rlluU (but not I'll tntn '''0)
SIIl..mplo)'ment I'll (,fflCh Schedult Sf)
Allern.tlve minimum t'll ("tach form 6251)
Tllllrom IIC.ptUrt of Investment cr.dlt (,f'ICh Form 4255)
SuclIlsleutlty till on tip Income nol "ported to.mploy.r ('''ICh form 4131)
T'll on In IRA or I qu.lilltd r,tlrlm,nl pl.n (."ach form ~329) .
Add IInu 47 Ih,ou h52. Th'''. oUllolllll' Pbi.1Zro
F'd,rlllncom. t'll wlthhtld (IncludlnB lilt shown on Form(l) 1099)
1987 .sllmal'd tu p'1m,nts ,nd Imounl .ppll'd hom 1986 relufn
Earn.d Ir.comt credIt (SIf PIRt 18)
Amount paid wllh Form 4868 ('llt,nslon requ,st)
Eaceu socIal securlly till end RRTA rill wlthh.ld (It, P.R' 19) -'.I....
Cr.dlt lor F ed,ral till on BlSohne and speel.lluells fltt,," form 4J 36)
Rej,ula'ed Inv.stment compan)' credl! (,ttach Form 2439)
Add Imes 541hrough 60 Then are your tot.1 "Iymlnll
If hnt 6115 18'&lr th.n 1m, 53. Inler amount OVERPAID
Amount 01 hn. 62 to b. REfUNDED TD VDU
Amount of lme 62 to bt appll.d to your 1988 ,stlm.l.d till .
II hn, 53 II lif~" than Iln. 61. ent,r AMOUNT YOU OWE. Attach check or mon'~ order tor full
amount pa)'able 10 "lnl"n.1 Rev.nue Servlc," Wnt' )'our soc'll SlCu'lt~ number, d.ytlm, phon.
number..nd"1987 Fo,m 1040"001t " '
Check .... o HOlm2210(2210F)IUlllth,d St,pI.'20 ,,".It: S
Und,r plnln 'QI Pfflur , I II" thlt I h.~,'a.mlnld thl' rllurn .nd .ccomPlnwin' &chtdul., .nd ,t.llmrnt" end 10 th, bill of mv It",MIIOI' .nd
1),11" Ih') ,II ,tOll ct d compl'lt OWI/.llon of pltp.,,, (olh" Ihln 1.~p.Wtr) I' I)...d on .lIm'ormlllon 0' which p"Plr,r h.. .n1 Itnowtl'd.'
~ Yo~. 0.1. 'f'out Q( up,tllon
V~..
34
3~
36
37
3.
3'
40
41
41
42
43
44
4~
45
46
47
4.
4'
50
51
52
53
54
55
16
57
5.
59
60
51
62
63
64
65
107
0.1'
Oll~'
FI",",n"tl,(o, -. --'-r-w~J<A~/,pfl 11',
you,. I' nil ,mplov.d) ---L_____~_I ---
.ndt,.2.d',n -- ,":.( ,teL j"lll?~ 1.1~~~7/i":
p
,,1' LL
,1./ S '(1
;r ~ 10-
II (,l~
lO .
10 ~ 3r
,l 3'1 '-
'i',?H
"1"'" 'I ~I.I Mtufll, no
IH
, .""
r.,., (f! G 3
Application for Automatic Extension of Time
To File U.s. Individual Income Tax Return
r~.!Ll~L:~
~@87
O.ptt1d'lnll'llLr IrlllU')'
Int"",, 'I. '/' ", t-.. ' I'Irr
I \ IJU' I,'" Mm"nd 11I,11.1 (1IIg,nl ,~ltJln, .I~g i"W"P-Ou~t ,".nll.no Inlll.I) L,,' n,."w
LE' . ,me! m JC.
P'~~I :JlhOm'l ddl'" (numbel.n" .1I1t1 0' JUI.I '011I1) (lI)ou hIVt' P O. lOt,.... ,"" I",Hu(110n. )
:>/LP I "1::(. ~ I U L~
CII., tu." 01 PO" O"'CI, .I,lt, In" ZIP codl
IGJ8 I Dr.';:
If you ..petl I? 1,111 alft 11".lurn (Form 70 or Fo,m 709'A) lor 1987, aener.'y due by April IS. 1988, check lhll bo, " ~ [1
Nol.: "ie ,to,. 10fm with Ih. Inf.rnll Rev.nu. Slfvi" Cen/If whlfe you musll,/. YOUf mcome I.. "fum Ind Ply Ih. ,mounl Ihown on
Ime (j b./ow, Thill' nol In ,"enllon of 11m. fOf p.ym.nl of I... roo .,11 be chlflled e p.n./Iy fOf I.,. plym.nl 01 I.. .nd I."
IlImr un'"I you Ihow ""on.b/e "U51 10f no/ p.ymll Of "'mi on lime (II' ,"S/fUCllonl/,
".u~
lrr'
or
"Inl
I ftquut nn .ulomlllc 4,monlh e.ten~lon oftlme to Auau~IIS, 1988, to f,l. Fo,m 1040A or Form 1040 fOf Ih. ClI.ndlr yur 1987 (or If I
flleel y.", Fo,m 104010 ..,.. ......................' 19...... .10' Ihel,pYllltndlni ...... ......... ........,.....19..... J.
1 Tot.llnconlt tit IIlblhly for 1ge7, You mUllenle"n emounl on line I. (You mlY IIlimllelhl~ Imount)
If you do nole'peello owe lit. enler zero (-0-).
2 Fede/ellneomB lit wllhheld
I'~ ...
2
3 1987 ullmBted tit paymenh (Include 1986 overpeymenlallowed as. CI.d1).
3
4 Other payments end credlls you ..petllo Ihow on Fo,m 1040A or Form 1040, 4
II Add lines 2, 3, end 4 II
6 Income 18> balance due (subtraelllne S from line I), In order 10 obllln thll IIlanllon, you mUll PlY In
lullthlbalanClduewllhthllform,(lfhne51~mo"lhenllne I,enlerztro(-o-,) , , , , , . ,
Complelo IIn. 71f you I.pocllo owe 11ft or l.neraUon'lklpplnllranaf" (GST) In,
7 Total ilft lit and GST In you ..pecllo owe for 1987. Do nollnelude Incoma
la' on Ihls line. (Seelh. Insl,uellonl,) . , . . , , , , . , , , ,. 7
"undlnl ono ch.ck lor Incom'.IIII. Ind GST tntl. allach I 1IIIemenlllhowlnl how much ollhe chick loolltl to each tyo. 011...
Slanlturl and Vlrtnutlon
~
I
Under penellltl 01 perjury, I declarelhall ha
my knowledge end bell.f. Illll'u~ cor I
preplre Ihl5lorm.,' "
./ ~
Slinalure of lIllp8yer ~ /..
I
Siinelure olspoult .
e. mined Ihls form, Includl,. ac;companylni achedules Ind alalamenls. Ind 10 Ih. bell 01
d plel.; end, II prepared br som.one other Ihan Ih.la.plyer.lhllllm aulho,lzed 10
, Del. .~ Islas
Oal. ~-A115/B8
,
'.
Slinature of preperer
olher Ihen lltpayer ~
Generallnstructlonl
Plplrwork Rlductlon Act Notlc.
W.nk for Ihll informaUon 10 Clrry oullh.
Inlernal Rlv.nu.laws of the Unll.d SlIlu
W. ne.d 1110 .nlure IhlllnplY.1I I"
complying wllh Ihese Ilws Ind 10 IlIow us 10
fllure Ind colleellh. rl,hllmount 01 tax.
You I" required 10 Ilv. us thla Info,mlllon,
Purpol. of Form
Ult Form 486810 Isk for In lutomlllc
4.monlh Illl.nslon 01 11m. 10 III. Form
1040A or form 1040. The 4.monlh
11lI.nslon period Ineludeslh. lutomllle
2,monlh 11lI.nslon ,ranl.d to U.S. clllzlns
Ind resld.nllll.nl who ..I living 0' Irlv.llni
olllJldelh. Un~.d Stllll Ind Pu.rto Rico on
Ih. dUI dllelor IllInglhel, relu,ns.
Do nollile Ihls fo,m If you wanl the IRS 10
f'lure your lit. or If you Ire under I court
order 10 file your return by the fliuler due
dll..
The e.tenslon will be iranttcl H you
complltllhls lorm property, ''''11 on lime.
Ind ply wllh Illhl Imount" tit Ihown
on IInl 6, We will nollfy you only II you,
rlqunt lor In .1lI.n~lOn la dtnitd,
Nol.: Any "d.nsion of 'ime ".n"d for fi/in,
your 19B7 ul,nder ye" IfICIlme ,.."Mn
./so ext.nds 'h. lime for ffb Illllt '"
,,'urn ('arm 709 Of 'ofm 1(j!J,A) fOf 19B1,
flllnl form 261I,--Except in ClIts 01
undue hlrdshlp. w. will nolaccept Form
2688. Appllcllion for Additional EllI.nslon of
Tim. To FiI. U,S, Indlvlduallncom. Tit
Relurn, unlil you have 11,1t used Form 4868,
Oete.
If you hlv, f,l.d Form 4868 Ind 11/11 need
more lime, Ult Form 26880' w,lle I I.ller
of ..pllnlllon (lee Wherl To fill), You
musllhow ..Isonlbla Clun.
Ask IOf Ihe Iddlllonllellllnllon .erly 10
Ihel.lf denied, you can 111I1 fll. your reI urn
on 11m.,
When to Fill
File Form 4868 by April 15. 1988, II you aI,
Ilhn, IlIscel yll' Form 1040. file Form
4868 by Ihl ",ula, due dill of your return
If you WI" Irlnl.d Ihe lulomlllC 2.monlh
e.tenllon beelun you were Ibrold
(..pllln.d lbovt). filelhls fo,m by the end
of Ih. 2,monlh pe,lod (Jun. 15, 1988,10/1
1987 celendl' y.er ..Iurn),
You mlY'I" Form 1040Aor Form 1040
Iny 11m. belor.th. 4,monlh pe,lod .ndl,
rorm48" (IN
SCHEDULES A&B
(Fo,m 1040)
OtP", "nl 0111'1. TII"U'~
Inl.",,' A.v.nUI 5'r'VIU m
N.m,(I).. .hown on fO,"111)(0
MldlCllud
Dlnloll.,.nlll
(Do nollndudo
o.,.nlll
lolmbunod 01
,old b, olhlll.)
(St.
1",trUtllO"'
onp.,.21.)
filiI You
'lid
(S..
Inltrucllo",
on p.,. 22.)
lnlll..1 rou
'old
(5..
Instructions
on p.,' 22.)
Conlrlbullons
You Modi
(SH
In.fructlons
on pI,. 23.)
CIIUIII, ond
Thlfllollll
Morini
I."nsls
MIIClllon,oul
D.ducllons
SubJ.ct 10 2%
AGllImll
(5..
1"ltructlons
on p.,. 24,)
Schedule A-Itemized Deductions
(Sch.dul. B lion blck)
~ Attlch 10 fo,.. 1040, ~ 5..ln,l,ucllonl 10' 5ch.du'" A Ind' ('o,m 1040).
,
I
You, Me
rlfrttDU,/
~
I,
", :jvlJl.l
/IIIU/lll,'
A"'~
Olhll
Mlte.lllnlluS
Dlducllons
Tollllllmllld 26 Add Ihumounls on lines 4,8, 13, 17, 18, 19,24, .nd 25, Enler Ih. total hereand on
Dlducllonl 'o,m 1040, IIn. 33., . 26
'or ",..wo,k It.ducllon AcI HolI.., It. fo,m 1040 In,l,ucllon,. Schedul. A (I
II P,..crlpllon m.dlClnn .nd d,ua" In,uhn, dacIa". d.nlllts,
nu".., ho,p""', In,ullnc. p,.m,um, you p.,d fa, m.dlC.1 Ind
d.nt.1 c.... .tc, . , , , , , ,
b Tran,port.llon .nd 10d,Ina
c Oth., (II,I-Includ. h..llna .'d" d.nlu,.., .y.alll'.', .,c,)
. , . . . , .. , . , .. .. , .. .. , , , , , , , , .. . . , .. , , , , , , , , , . .. , , , , , ,
......................................................
2 Add IIn., 10 Ih,ouah lc, .nd .nl., Ih. tot.1 her., , , . .
3 Mulllplythtlmounl on Fo,m 1040, IIn. 31, by 7.596 (,075) ,
4 Ira I 31, m IIn .11., 0' I nl., ,0" Toll m dlc.l.nd
Nol.: 5.,.. t.... "' no 10nB.' d.duclibl.,
5 51. Ie end 10c.llneom.I.... , ,
6 R.., ..t.I.I...., ,
7 Olher I.... (II.t-lnclude pe"ona' p,op.rty I..es) .,."""
8 Add' hie 'imounii' 0'; 'Iini, 5' itirou h '1', '[;,ii, itie 'Ioie" hi;e," Tol., t....
Nol.: If you borrow.d .ny naw .mount. 'Baln.1 your home
.ft., 8/16/86 .nd 'I.ny tlm. In 1987 Ihe 101., of .11 your
mortll'll. d.bls Wll more than wh.1 you paid for your ham. 0
plu.lmp'ovem.nts, .tt.ch Form 8598 .nd ch.ck here, ,.
91 Oeductlbla ham. morta'B' Inleresl you p.ld 10 f1n.nclal
Instllutlon. (,eport d.ductlble points on IIn. 10), , , . , ,
b Oeducllble homa mortBaBa Inlerlll you paid 10 individuals
(show th.1 person's n.me and add,.,,) .,."".."""""
......................................................
10 Oaducllble po,nt.. , , , , , , . . , .
II O.ductlble Invlllm.nlln!Ir..1 , , . . , . .
12. Person.'lnleresl you p.ld (see paBa 22), , I . I 0' f.,
b Mulllply Ihe .mounl on lina 12a by 6596 (,65). (nler the relull ""
13 Add Ih. .mounls on lines 9a throuah 11, and 12b, Enler Il!!.,total her.. Tot.llnler..I.
141 Cosh contrlbullons, (If you Bave $3,000 or more 10 anyone
orB.nllallon, report Ihose conlllbutlons on line 14b,) , , . .
b Cuh conlrlbulions tolallnB $3,000 or more 10 .ny one
orB.n'lat,on, (Show to whom you aav. and how much you
B.ve,) ..................".....,........,............
15 Olher Ihan clSh, (You musl.ttach Fo,m 828311 over $500,),
16 Carryov.,!,om Pllo,y.ar , . . , , , . , , , , . ,
h m nl n IIn 4 h h nl.r h lal h ,. .
18 ClSually orlh.ftloS5(..) (attach Fo,m 4684), (See paBe 23 oflh.
Inslruclions, , . , , . , , , , , , .
19 MovlnB ..penses (.ttach Fo,m 3903 or 3903F), (See paBa 24
oflhe InstrUClIons,). , ., """"
20 Unrelmburs.d employee bUSiness ..p.nses (attach 'arm 2106)
21 Olher ..p.nses (lIsttypeend amounl) .".,.""".."....,.
~ "I}
......................................................
22 Add Ih. .mounls on lines 20 and 21. Enter Ihetolal.
23 Mull'ply Ihe amount on Form 1040, IIn. 31, by 296 (,02), Enter Ih.
,esull here, ,
, in I, m IIn nt.r h , ull u n Ish n ,
Mlscelf.neous d.duclions not subJ,cllo 296 AGI IImll (see PIBe 24), (Llsl type and
.mount.). .. ... , .. , ... '" , , . ..... .. .. .. , .. . . . . ... ..' . .. , . . . . .........
5,h.dol..~U(I"'n1lo.011911
N.m.C,...,hOMOt\ 'orm lo.tO (Donol.nl., ".m..nd '0(1,1 "tulIl~ numb" II 'nQ"'" onolhtr lid')
~(,Mjll'l // ""1 /'II/III1/? II. JiN/.1
Schedule B-Interest and Dividend Income
OMINo IM5001. ,".2
Ytt,l, M'." "IV'U~ ",V"'Nt
c (''I ,:{e>' 'J'E,J
AIto,h...o' 01
&eqUIne. No
h" I
Inl'''11
Incoml
(Se.
Inltructlon. on
""" hod 24,)
A'IO compl.,.
,.rllll,
N,'a: If you
IK.lyld.,orm
109ll-1NT or
lo,m 1099-010
',om.
brok.....,lrm.
.nt., thl f.rm',
n.m..nd lh.
101.llnl"tll
Shown on Ih.t
'orm.
h,.1I
Dlvld.nd
Incom.
(Se.
In'truttlonlon
plllll0.nd
2~,)
AIIO compl.t.
,.rllll,
NOla: If you
r.ctiw.d I form
1099,01V Irom.
brok..... firm,
Inter thl firm',
n.m..nd Ih.
101.1 d"ld.nd.
shown on th.t
form.
II ~ou Ilc.lv.d mort Ihln t400 In II..bl. In II/III Incom.. ~ou mu.1 compl.l. Pllt I .nd Ult ALL Inl"llt
IICllv.d, II ~ou IIc.lv.d, .. I nom In... Inll/llt Ih.1 l"UIUy b.lon,llo Inolh" p"lon, 01 ~ou r,cllv.d or plld
.ccru.d Inl,,"1 on IIculllllllllnll.rr.d b.lwlln Inl"'11 Plym.nl dllll, "' P"I 24.
Inl.'.lllncom. Amounl
1 Inll/llllncom. "om IIlIer'lln.nc.d n,or1jlall, (S.. Inllructionl .nd lilt n.m. of
PByl/.) . 'H...... .... ....' , , ,......, ..,.., , , , , .......... , .. ....... ..
2 Olher Inll/'lllncom. (1111 n.m. 01 p.yer) ., .. .. , . , , . , , .. , .. , .. , , .. . .. .. .. , ,
.. .. .. , .. , . , .. .. .. , , /. ' , , .. , , , .. , .. .. .. .. .. . .. , , , , .. .. .. , .. , . .. .. .. .. , ,
.... ,1i~(I/!I!/I;../?!. p,I'!.(..""..,..........", , ,........""......",
.. , .. J1 n L ~!~ .. .. , .. .. .. .. , , , .. .. .. .. , .. .. .. , . , , , .. , .. , .. , , . .. .. .. , .. ,
"". .:J,/.f!..j:,....,.."".""..",..,..,.,.,.,.,."..".....,., ,..."
.......................................................................
2
.......................................................................
.......................................................................
.......................................................................
. . . . . . . . . . . . . . . . . . . . ~ . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................................
.........................................................................
.......................................................................
3 Add'lh~'~,;,~.u...l~ ~'nlinei i'~nd 2' 'Enli; ii.;'loie,.tiii. end ~~' Fo;';" i04o: ilni'li.'.';.:
II you IIc.lv.d mOlllhln t400 In .roll dlvld.ndl Ind/or olher dlllrlbullonl ,n Itoc:k, compl.l. 'Irt II. II ~ou
IIc.lv.d. II I nomlnll, dlvld.ndllhlllclu.lly b.lon.lo Inolher p.llon, III p", 25,
DIyld.nd Incom. Amounl
4 Dlvld.nd Incom. (1111 n.m. of payer-Includa on thll line c.pltal a.ln dlllrlbullons.
nontax.ble dlllrlbullonl, .Ic,). ,...........'...,..",.............,......,
::: :::r~))~:S~: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~
4
5 Add Ih. amounts on line 4, Enler Iha lolal he,e , ,
6 C.pllal a"n dlllrlbullonl. Enter hera .nd on IIna 13, SChedule 0,'
7 Nontmbl. dlstrlbullons. (5.. Sch.dul. 0 Inslrucllons tor Idluslmenlto bills)
8 Add Ihe .mounts on linn 6 and 7, Ente, Ihe totll hara ,
9 Subl,acl line 8 from line 5, Enlar Ih. ,nult hera and on Form 1040, line 10 ,~ J
'If you ""''I1d "pit" "m dlJI"tMlons bur do not "Hd Schtdult 0 to "pott ,,,y atll" I,m, Of IoUII " to fllu" ~l" '" ($II III' r" r/, Mild" C.,uM
I,/n did,ibllllln. all PI" /0), tnl" you, "pII,' "'" du'flbuluHf' on Form /040. 1m, 14 W"" 'CGO' on Ih, dolttd IlIfl 10 M,,,,, 0111", U
II you IICllv.d mort Ih.n $400 ollnllllll 0' dlYld.ndl, OR II you hId I 100.I.n Iccounl 01 WII. I
811nlor 01, 0' I lran.'"o, 10, IlolIl.n l,uII. you mUlt InlWII bolh qUIIIIO"II" PI,IIII,
l~
,.rt III
Forllln
Accounls
Ind 10 AI any tlm. dUrlna the lax Yllr, did you have In Interesl.n 0' I lianlluII 0' olher .utho,Ity oyar. II".ncl.1
Fortll" accounlln a for"an country (such IS a b.nk Iccount, SlCurll"l .ecount, 0' olher f,n.ncl.1 .ccounm (St.
Trusts paae 25 of Ih.ln.lruel,ons lorexceptlonllnd fdlna reqUIrement I for lorm TO F 90.22, I.), , , , , ,
(St. If "Yes." .nter Ihe name oftha fore'an country. .. . , , , , . , . .. .. , .. , , . , .. .. .. .. , .. . . .. .. , .. , , ,
Inatruellons 11 Were you the arantor of. or Iran.feror 10. a fortlan Irusl WhiCh .."t.d dUrlna Ihe curr.nl I.. y..r, wh.ther 01
on PII' 25) not ou have In benefiCial Intere.t ,n 111 If "Yes" ou ma have to lile lorml 3520 3520,A or 926,
'0' '."rwork R.du.llon A" Nollet, 1I11.'m 1040 In.tro.llonl, Schldul.. ('lrm 1040) ...7
Profit or (Loss) From Business or Profession
(501e Proprlelonhlp)
P.,'n,nhlpl. Jolnl V,nlur.., ,Ic.. MUll 'II' 'arm 1065,
AUtchmt
. AlIo.h '0 rorm 1040, fo,m 1041,0' ro,m 10411, . .n'.",u.Uo..lo, ..h..ulo C (fo,m 10401. 1Itq..""
IHI.. l"w,lI, ..u"'", (
ZC.?!J'c> I"~
. Pnnclpll bUlln... cod.
(110m P.rI IV) . I
I""I.~, ID ,,,.,nlt., ( ,I
!
(3[l~/)l( Y
It PrincIpII bULin'" en prof.lllan, 1"(ludl"a product 0' ..,~.ct hit Instrucllonl)
rl1/.J S , '"iAI
5CHEDULE C
(form 1040)
O,pll1m,"' 0' thl T"..I.I')'
Inl,m,l A'\lfnut s.''lo'U UI
N.me 01 ploplI,IO,
JONif
I,
O~'h.
'i!@
C BUlln.11 nlm. and Idrlr"I .. .. , .... .. . .. , .. .. .. ".. . .. .t;;,~. ('.t~.. .. ..... . ......,.. . . . .. ........
E M.thod(l) u..d to __.Iue clollnl ,"v,nlo,)'
(I) 0 COil (2) 0 lowtr 01 co.1 0' mork.1 (3) 0 Olhtr (otltch ..pl.n.I,on)
, Aceounlin. m'lhod (I) jllfCllh (2) 0 Accru.1 (3) 0 Olhtr (.p'elly) . ,,,,,,..,,,,.,,,,,,,,,,,,,,,,..,....
G Wu ther.lny chana' In d.llrmlnlnaqulnlltlll, cOlli, or v.lu'llonr. b.lwlI" op1ntna .nd clO&tnl lovlntor)'1 (II "V'I," ,<<,ch..pl,n.hon)
" Art ~ou d.ductlnl..p.nlll for In offiCi In ~our hom.? ,
I Did you III. ",m.4110, thll ~u"n...lor In, qUlnt"n 19871 ,
J Old you .m.l.u.lIy partlclp.t." '" tht Optrllion ot thll bUlln.u dUrlna 19871 (If "No," ".Inltruchons tor limitations on 10"",)
K Wu this bus,"lIs In oper.tlon at th..nd at 19871
L How m.n)' months WII thll bUllnli1 In operation durlns 1987? . ... I Z
M It thillch.dul. Includ.I.lon, credit, d.ductlon. Incom., or othrr tlk b.n,ftt r,lahn& to. r.. Ih.lt.r r.qulred to b. r'llll.r.d, ch.ck h.".
II vou chock IhiO bo., vou MUST otloch Form 8271
.. Ineome
, Advtrllllna '
7 Bid d.bll trom 1111$ or Ier~lcts (lit
Inltructlons.)
. B.nk urvic. ch.rilS '
t C.r and truck .ap.nlll J ""~. ", '-t I;
, (!. OJ'
10 Commlssionl
\I D.pl.!ion
12 D.preciltlon Ind IIctlon 179 deduction
tram Fo,m 4562 (not Included In Part Ill)
13 Outllnd public.tlonl
14 Employ.. b.n.flI prolrams
U ''''Ihl (nol Includ.d In pon III)
16 Inlurlnc.
17 Int"'lt:
I Marta... (pard to tm.nCill institutions)
b Olhtr '
1. L.undry Ind clllninl
1. L...land profllIIOnalllf'Jlc.1
20 O"IC' '.lIp.nll
21 P.nslon Ind prollt.sh.rlna pl.ns
22 R.nt on bUlln"s D'OD.rty
30 Add .mounts In columns tor IInll 6 throulh 29 Th.se ,r. the totll d.ductlons .. 30
31 N.t ,roflt or (lOll). Subtrlct Iln. 30 from 11n' 5 It. pro'lt, .nt.r h.r. .nd on Form 1040. line 13, .nd on
Sch.dul. S[, Iln.2 (or Iln. 5 of Form 1041 or Form 1041S) If I loss, YOU MUST 10 on tohn. 32 31
32 If you hl~' a 1011, you MUST .nlw.r Ihl!! qUI!!llon "Do you tla~..mounts for 'Which you." nOl,t rllk In thll bUlln.,,?" (St. Instruchon..) V
It "V.s: you MUST .tlath form 6191. If "No: Int.r lhl loss on Form 1040. Iln, 13, Ind on Schedul. SE, IIn. 2 (or IIn. 5 ot form 104
1~1~ '
II GrOll ,acelpts or 1.111
b L,IS: R.turnl .nd IUOWlne..
c Subtr.ct lint 1b Itom Iln. la and ,nter the bllanc. here
2 COlt 0' IOQdl50ld .nd/or operation, ('rom P.rt tll, Itn, 8) .
,J Subtract IIn.2 from lint Ie .nd ,nt,r th. Iron profit her,
4 Oth.r Incom. (lncludln& Wlndf.1I profit t.a credit or refund recel~ed In 1987).
5 Add Iin'5 3 and 4 Ttlil 15 the '011 Incom.
IIIDII Deducllon.
1
:%
ff<,'5
(r
01
fo, '.p.rwo," fII.ductlon Act Notice, "' Form 1040 Instruction,.
p"
1''1
.,
.
23 R,p"l"
24 Supp"" (nol Includ.d In Plrt III)
25 To...
26 Trl~el, m..II, .nd ,nt,rtalnm.nt
. Trav'l
b Tot.t mills and
.nlert'lnm.nt,
cEnt., 20'" or IIn.
26b .ubltel 10
Ilmltatlonl (III
Instructlonl)
d Subt,'ct Itn. 26c from 26b
21 Utllltlll .nd t".phone
280 WII"
b Job, er,dlt
c Subt,act Itn. 28b from 28.
29 Oth., 'llptnlll (hit t)'p. ,Jnd amount)
'i011~I/W;W"(1/ {Nlnl
f1 W//(;/lf/lW!/I,W}/1 '/" /
~ j, :'/0, ?j'p;/' ;//
10'
~I 'Ig
SchodulO C (fo,m Il
5CH[DUL[ D
(Form 1040)
Cepltal Gains and Losses
and Reconciliation of Forms 1099.8
. A\lI,h 10 fo,m 1040. . Itl '.,I,u,lIo., 'o,',h.du'. D (fo,m 1040.,
fo, P.p"wo,~ R.du,lIo. A'I Nolin, It. fo,m 10401.'1,.,110..,
or.'.No I~
']J@)I
Otp.t1m.nl 01 th, '"..ut)
InlllNI "''I',nu, ISII'I'I" (II
N.m,(t)."ho*nDfj 'o,m 1040
1~11C111 (i II. .j(JA/,Cj
t3 f''?rll'J tt Y
('(1'1
~.u
/,
I R.port h....th.tol.,..,n 01 .'ock.. bond., .Ic" IIport.d fo, 1987 by your brok.. 10 you on Form(.)
1099-11 0' .n .qulv,'.nl .ub.lllul. .,.I.m.nl(.), IIlhl. .mounl dllltr. f,om Ih. 101., 0' linn 2b .nd
9b, column (d), .\ltch . .I,'.m.n' IIP/olnln, Ih. dlll...nct. 5.. Ih. In.lrucllon. 10' IIn. I lor
,umpl... 00 nollnclud. lIal nt.l. I,.nllcllon.llport.d 10 you on . Form 1099.8 on IIn. I, 2',0'
9., , , . , , , . , . , , , . , . , , " .'",.. I
Short.term CI Itll Olin. Ind LO"I.-A...h Hlld Six Month. or LI..
~r.=~~; :~::~':l Clt) DtI'lCqulr" (t) ;.o.~~ 7~~ht' ,,(.) II motIU"" Cd ,
,'",tdo"Z' Co, (Mo, dl~. ~,,) Inlhunlon. lubtr.ct Cd frome. ....btrICH.
2t Form lOt." T''''lIcllon. "',"lSlock~ lond. .Ic,: (00 nol II ort r..'IIII'. IlInlll',on, h.lI, s.. Ih.'n,l,ucllon, lor IIn.. 2..nd
2b Tolal (.dd column (d
2c Olhtr T,an.acUon.:
.
Short,l.rm Il.in f,om IIle or IIchonlle of 0 princlpalll,id.nct horn form 2119, hn.. 8 or 14
Short,ttrm ,aln f,om In.tallmenl 11I111 f,om form 6252, IInll23 or 31
N.I.horHerm ,aln or (Iou) Irom partnershipo, 5 co,porationo, and flduclarlll
Short'lerm capltallooo carl'}'over . . . , . . . . . , . , ,
Add.1I of Ih.l"n'lCllon. on 1In11 2. ,nd 2c .nd lines 3lh,ouah 61n column. (f) and (a), ,
Nelohort,larm aln 0' 101S . combine columno f and 0' line 7 , , , , , . , . ,
Lon .tlrm CI Itll Olln.lnd LOIIII-A.llt. Hlld Mort Thin Six Month.
'I Form lOt9,' T'I.lIcllo., S.I.. 0' Slocks.lond. .Ic,: 00 nolll ort 11.' 11101. I,.n,ocl'on, hll', St. th.ln,t'"Cllon, 10' IIn.. 21 .nd
9b Totol (add column (d))
9c Oth.. Tran.acUono:
.
10 lona,tsrm I,'n f,om ul. 0' .,chana' 01 a princlp,' '1IIdenc. from Fo,m 2119, lines 8, 10. or 14
11 lon"term ,oln f,om ,".tollment sal.. from Fo,m 6252. IInll23 0' 31, , ,
12 N.t lon"term ,.In or (IDS') Irom partnership., 5 co,porallon., ond liduclarle.
13 Caplt.I,,'n distributions,
14 Enler ,aln from Form 4797, line 7 0,9
15 lon,.lerm ..pltalloss carl'}'over ,
16 Add.1I 01 th.t"nuclion. on hn.s 9. and 9< snd linlllO th,ouah I~ In columns (I) snd (a)
17 Netlonll,lt,m ,.in 0' (1055), comblnecolumn. (I) and (Il) of line 16
I D J
I N'5
Sch.dul. D (form 10
6<O,Oul,OI'0/"'10<0119BI
Nlm.(I... '''0'''"" on 'o,m lOolO (00 Mg! ,nl,' ",,,,, .nd 10CI,I "(I,j',I~ numb" lllhu"" un oln" III" )
~IW"",lnthqu'nnNu 12 '''' 2
Yeu, ..c1.11I1II1,U1 ...,mM'
I '
I
181II 5umm.ry 01 P.rl. I .nd II
11 Comblnl linn 8 .nd 17, .nd Inler Ihl n.t IlIn 01 (Iou) her., lI..oull'" i'/n, .100 .nler Ih. illn on
Form 1<)<10, IIn. 14, . , , , " "" . , , " ",'
Nol.: If Iml. 17 .nd 18 .rt nit I"n. .nd your t...bl. mcoml II tired OVIf thl 289/, tar "tl, ..I P.rt
IV billow You m.y bI.bl~ to r"duct your t.. " you qUI/lly 'or thl .ltlfn.t,vl t.. comput.tlon,
IIl1nl 18111 lou, "nler herllnd... 1051 on Form 1040,lln. 14, Ih. Imllll' 01:
Th. Imounl on line 18' or b 3000 1 500 If mo,,11 f11ln I.. orale raturn , ,
Altern.tlve T.. Comput.tlon
FI'BI complele FOlm 1040 Ihrough line 36,
U.. Port IV II both lin~o 17 Ind 181how nit gllno, AND:
~ND Fo,m 1040.lInl 3610 o'er' Vou ch.ckld tlllnlotlluo bOll ~ND
527,000 3
45,000 4
Vou ch.ck.d 'IIIOllllluI bOI:
1
20r5
20 Enler omounl from Form 1040, line 36
21 Enler Ihe Bmlller of Ihe goin on line 17 or the alin on line 18
22 Subl,.cl line 21 Irom 20 Ind enler Ihernull , , , , ,
23 Enll". 5 16,800 if you checkld liIini OIBlu. boo 1; b 528,000 II you checked filina slltu. boo 2 or 5;
C 514,000 II you checked lllina Blllu. bo. 3; 0' d 523,000 II you chlcked f.llna stolus bo. 4
24 Enter the I,uler of line 22 or line 23, , , , , . , , , , , , . , , . . , , .
25 Sublraclllne 24 from IInl 20, , , , , , . , , , , , . , , , , . , , , , ,
26 Figurelhe Imounl 01 I.. on line 24, U.e Ihe TI. Tlble or Tex Role Schedules, whichever oppllos ,
27 Mulllply IInl 25 by 2896 (,28) ond enler Ihe rnull, , , , , , . , , , , . , , , ,
21 Add linn 26 Ind 27, Enler the ra.ult hera ond on Form 1040 line 37 ond check Ihe bo. for Schedule 0 21
Compul.tlon of C.plt.1 Lou C.rryoven From 1987 10 1988
(Com lele Ihls arllf Ihe loss on line 1815 more Ihan Ihe loss on line 19,
2. Enler Ihe 1011 shown on line 8; II none, enter zero Ind skip lines 30 Ihrouah 33,
30 Enler illn .hown on line 17, II thotllne I. blink or show. 010", enler zero ,
31 Sublllclline 30 I,om line 29 ' . , , , , , , . , , . ,
32 Enlerlhumlller of line 190r31 , . , , , , , , , . , , , . ,
33 Subtr.ct line 32 Irom line 31, Thl. is your Ihorl,le,m clpllllloll carryover from 191710 1..1
34 Enter Iou from line 17; If none, enler zero Ind .kip lines 351hrough 38 ,
35 Enler il/n shown on line 8, II Iholllne I. blonk olShowsalo.., enler zero , , , . , , , ,
36 Sublract line 35 from line 34 , , ., """. """",
37 Sublract line 32 from line 19, (Not.: /fyou .~ipped line. 30 throulh 33, enra, the .mount 'rom Iina19,)
Subtllclline 37 from line 36. This is our Ion ,Iarm CI 11111011 car, OVII f,om 1.8710 11111,
Compl.te Thll Pari Only II You Elect Out of the In.I.llm.nt Method .nd
Report. Note or Olher Oblll.llon .1 Leu Th.n Full F.ce V.lue
Check here if you elecl oul olthe Insllllment method, , , . , , ,
Enter Ihe fecI emount olthe note or other oblliallon , . , , , , , ,
Enler Ihe ercent. e of voluetlon 0' Ihe nole or olher obli otlon
Reconclll.tlon of FormlI099,B for B.rlerlnl Tran.ocllonl
Complele thl. pert if you received one or more Form(s) 1099,B or an equlvalenl sub.litul.
Slllemenl(s) reportlni bartellni Income:..,
42 Form 1040, line 21,
43 Schedule C (Form 1040) ,
44 Schedule D(Form 1040) ,
45 Schedule E (Form 1040) ,
46 Schedule F (Form 1040) ,
47 Olher (id.nlify)(1f not I..able, IndlCal. r.ason-attach oddltlonal.heets If nec....ry) .. .... ,..........
...............................................................................................................
form 1040.110.1115 o"e"
522,500
38,000
V~
I
20, . le>
31
,.0
...
..
Amount of bll1.,,", IncorM Irorn
form lOH.lonqulY.l.nt
at.temenl "=: on lurm or
41 Totel(addlinos421hroulh47). ,." .,.""..""",,4
Nole: Tha .mount on IIn~ 48 Should b~ the same as the rolal bartering Incoma on.1I Form. 1099,8 or ,qUl..I,nt .t.t,m,n's ",,;ved,
Oelnlend LOIIII From Sele. or behen," of Allet. U.ed In a
Trede or Bu.ln... and Involuntary Converelon.
(And Computation 01 R,capture Amounts Under Slctlonsl79 and 280f)
. Atllch 10 ou, I.. '1Iu,o, all al 1'llololl,uclloOI,
Ll . '...IIfrI.. ..-,
1:>;?1i)Il,/ ..,-. 1M JII/{!(tO 1/, :]O"Lj lO' Io '!:tiS
~II or bchanlll 01 Prop'rt~ Us.d In a Trad, or Buslnlls an Involuntar~ Conv,nlons from Other Than
Cllu.lt~ and Th.It-Prop'rt~ H,ld More Than 6 Months (More Than 1 Vllr II Acqulr'd AIt,r 12/31/17)
HollI: 0 U.. Form 4684 10 llport Involunl.ry con.OIllonl from cllullly Ind Ihl"
01' you told proll'rty Ihll you clllmld In.nlmlnl erldll on, leI Form 4266 10 I" " you 1I1111bll for recoplullollh. clld,'
o F,I. Form 61981' you lIereportlnlllolllnd hl.1 Imounll In.nl.d In Ih. 1CIIVlly lor whICh you III nol II "lk (St. InII,ucllOnl
uoder "SPfC'" Rule. ")
o Compl.l. Form 8682 befoll you complel. Fo,m 4797" you III llportlOlllolI from I Pll"" ocllVlly (Stllnll,uclionl under
PIIIIVI LOlIl'mlllllOOI )
I [oler hell Ih. IrOIl proc.edl from Ih. III. or .achln81 0111.1.1111. IIported 10 you lor 1987 on Fo,m(l) 1099.B
(or In oqulVlleolllllemont) Ihll you will be IneludlntOn linn 2 or 10 (Column d), 0' 00 IIn. 20. (Form 1000.B
III SllIlmenlfor Reel 'enll 01 P'Ottedl From Rill 1111., BrokOl, Ind BlrtOl hehln TllnlocllOnl . , , ,
IllOtPlKlllron 1'1 Cool 0' olhl, OS
(.) OtKrlphon 0' (..) Dlt. .cquIFId (e) D,f. told (III) Gron ur" ,UOWICI b'III, plul ((I~:-nu, the
p,optrty (mo .dly. y,) (mo. dly. y,) pUtt (orallo..blt) Improw,m,nlund lumol(lI).nd(.))
'Incl.CQu.'ltlQn t.pt"" 01 MI,
Dtp.rtm.nl 0' 'hi r,..,ury
Int"NI ".wtnul5t~lct
N,me<.) ..'how" on "!urn
OMINo ,..50 M
'lI@87
Anl,hmonl 7
u.nu ~o
'o.m 4797
IhlGAIN
lid) p1U1 (e)
mlnul('))
2
3 Glln,IIIny,IromForm4684,StellonB,hne21 , , , , , , ,
4 Stellon 123181'n from Inll.llmenllllll "om Form6252, IIn. 23 or 31
6 Glln, Iflny, from Plrt 1I1,lIn. 32, Irom other Ih.n clSullly Ind Ihell, ,
I Add hnll2 lh'ouah 5 In columnl (shnd (h) . , , , , . , , . (
7 Combln. cOlumnl (&) Ind (h) of line 6. [nler Illn or (10&1) her., Ind on Ihe .ppropIIII. line II follows (partnerlhlpllII Ihl
InslructlOnl for your hner.f.rencII); , , , , , , , , , , , , , , , , . , , , , , , , , .
If IInl 7 II Dro Oil 1011. .nler Ihumounl on hn. II below ond Iklp hnll Bind 9 (5 Co,polltlOn&, .nler Ihe 1011 on Schedule K
(Form 11205), hn. 5.) IIl1n. 7 III lI'n Ind you did nol hlV' Iny pllor Y'" I.tt,on 1231101111 or they were recoplured In In
.lIher yur, onler Iho IIIn II I lonl.lerm clplll18llO on Schedule 0 Ind skip '10'18, 9, Ind 12 below.
. Honrecoplured o.l.eellOn 1231101111 from pllor ytlll. (SH Inllrucllons.) . " "".""",
. Sublreelllne8'romhn.7.II.eroorllls,.nlerrero ' , , , , , , , , , , , , , , , , , , . , ,
II hnl 91""0, .nler Ihumounl Irom IIn. 7 on IInl 12 below. If IIn. 911 more Ihln .ero, .nler Ihl Imounl Irom IInl B 00 II.. 12 below. Ind .nlll Iho
.mount from lint 9 II .Ionl.term tlpltll pin on Schedul. D. See specifiC instructions lor IIn. 9
~//filj,,'/"f 'II 1("1;
~:f;;'_lfI ,II I /,
!@}M I, ,
~'??fl,'1. I I /I; /
W',/II/0" 'I, I 1/1,
,y Df
,'/ .,
.-II Ordinary Galn.and Lon..
(I) OtItrlpllon 0'
p-rty
(.) 011. acqUIred
(mo"dI,..,,)
leI Clluold
(mo.,eII,,)'r,)
(41) Groo 111.1
pntl
(t)OtprIC1.hon
allowed
(or allow.blt)
IlntlacqUllltlon
('I COIIO. othtr
blIII,P(UI
ImptOYlm.ntl.nd
..ptnH of ull
III LOSS
((I) nil"" I..
..,m 01 (d)'ncl (e))
IhlGAIN
lldlplu"el
mIlNI(I))
10 Ordlnll ,nund losus not IOeludedon hnll IIlhrou h 16 (Inelud. propert h.ld 6 monthlo, IllS (\ '" or IlIlIf IC Ulled IIlII 12 31 87)
U LOII,IIony, lrom IIn. 7, , , , , , , , , . ,
U Gain, II Iny,lrom hn. 7, or .mounl from IIn. 8., opphtlbl..
13 Galn,IIIny,Iromlln.3l,Plrtlll , , , , , , , ,
14 NII..,n 0' (1011) 'rom Form 4684, Stel,on B,lInlS 131nd 201
la O'd,n.ry 81'n from Inllollm.nlults I,om Form 6252,lInl(s) 22 Ind/or 30 ,
11 ReClplulI olucllOn 179 deducllon for plrtners Ind 5 corporlllOn shlreholders f,om proll'rty dlOposltronl by
partn.llhlpllnd S torporlllons (III Inslrucllonl), , , , , , , , , , , , , , , , , ,
17 AddhnlSlOlhrouah 16 In eOlumnl (1)lnd (h) , , , . . , , , , , , . . , , , . , .
I' ComblnlCoIumnl (&) Ind (h) of hne 17 [nler ,.,n or (1011) hili, Ind on Ih. .ppropnlllllnusfollowl. , , ,
. For .1I..e.pt Individual returns: (nl'r thl pin or (loss) from lin. 18, on tht r.turn beln. fllld.
. For Indlvldu.1 r.turns:
(I) II tht lOSS on hn. II Includes I 1011 ',om Fo,m 4684, St<llon B, Plrt II, column (b)(II), .nler Ihll part 01 Ihllo>l h.1I Ind
on hn. 1801 Seh.duIIA(form 1040) Id.nl,fYllfrom"Form4797,hne 181>(1)" , , , , , . . , , , , ,
2 R t rmln.th. Inor lOll onlln.18 ..dudl" 11'te10&1 IlIn onlln.18 1 [nl.rh.r..ndonForm 040Iln.15
'"' ,.,...I,k IItt1ucU.o Acl Nolle., 11''''0 I 0111,.'11111II1'_'" ",m 47'70""
/o'm.787Cl9871
IIIIID Olin f,om Dltpotlllon 01 Propert~ Under Slcllont 1245. 1250. 1252. 1254. and 1255
Skip IIcllOn 1252 on IIn. 27 .nd In Ih. InltruCtlOnll' you did nol dllDOII 0' '.,ml..d 0' If YOU .,. I D.rtntrlhlr.
0Ilc"pllonollecllonI1245, 1260.1252,1254,lnd 1265p,oplrty 0'1' .c:qUII~ 011110"
It (lnD .d'1,~" (mo,d,/,/r I
RtA/rllt flIOP, f'" " !JI:( liS' , ,.", ~,Ip
A
.
~
D
Proplrty 'roPlrty P,tptrly ',tptrly
1l111111l.lIltA Ih,oUlh liD 10 IhlllColum.1 .. .. .. .. A . C 0
20 Grall 11111 prlct HO~('
21 COil or olher bllll plul "plnle of III., , , , ~7,: '~N~ 3" f,lo
22 OtpreClllion (ord.plllion) IlIowed (0' IlIowlble) (I'? , I'> II(
2J AdIUII.d bUll, lublrocl line 22lrom IInl 21 , lo.1g"
24 Tet.I_,ln, subtile I IIn. 23 hom 11".20 /1.1 Of"
Z5 It IIcllo. 124 5 prop.rty:
. D.prtcl.tlon ,lIowed (or ,lIow.blt) (5ft Instruchons) .
. [nler .mlllo, of IInl 24 O' 25.
2a It 1Ic110. 1250 proptr'Y: (1IIIr.'llhlllne d.preellllon WI' u5Id, Inler
"'O on IIn. 26. unl.51 you Irt. corpofltlon lublect to Ilctlon 291 ,)
I Addlllonll depllcltllon """ 12/31/75 , - 0 .
. AppllClbl. perc.nllle tlmu Ihe Imllllr 01 line 24 or lin. 26. (I"
Inllrucho"I).
c Sublllel IInl 261 from IIn. 24.11 line 24 II nol mOil Ihln IIn. 261.
Iklp IInu 26d ond 261 ,
d Addlllonll depllcllllon """r 12/31/69 Ind beloll 1/1(16 , ~o-
o AppllClble percentile Ilmll Ihe .mlller 01 1101 26< 0' 26d (lOt
1"ltructlona).
, Secllon 2911mounl (fo, eorpollllon. only)
. Add IInll26b, 26., Ind 261
27 It 1Ic110. 1252 prop.rty:
. Soil, wlt.r, .nd l.ndcl.,flMl..ptnslI
b lln. 271 tlmellppllcobl. percenlll' (Iltlnllruelionl)
c [nlo"mlller 01 IInl 24 or 27b
21 It IIcllo. 1254 properly:
o Inllnl'ble d"llIna Ind d,y,lopment costs deducled aft.,
12/31/75 (lit In.t,uel,onl)
b [nlo, Imlll.. of IInl 24 ., 28.0
21 It IICUo.125a p,operty:
I Applrcobl. Il'rc'nllle of poymenl. ..eluded from in com. und..
IlChon 126 (II. instructions)
b [nt.r th..mlller of IIn. 24 or 29.
Summlry 01 Part III Oalnt (Complete o,ooertv columnt A throulh D throulh line 29b belore acinI to Ilnl 30.)
30 TolIllI,nl lor III P'Opertlll (Idd columnl A Ih,oulh D, Iinl 24) 1,/,bN
31 Add columnl A throulh 0,11011 2~b, 261, 27e, 28b, Ind 29b. [nltr h." Ind in Plrt 1I,lln113. (Set IhlInlt,ucliOOI10 P,rt IV If
UII, II.n Inst.llm.nt nil.)
32 Sublroct hnl 31 from Iino 30, [nl" Ih. POrtiO. from cllullty Ind Ih.ft on Fo,m 4684, Stct,on B, hn. 15; .nltr the portion ',om '''',()I-/
oth"thlnululItYlndthlftonForm4797,Plrtl,linI5, , , , , , , , , , , , , , , , , , , . , ,
Complete Thl. Plrt Onl~ II You fleet Out 01 thllnltallment Mlthod end Report. Nota or Other Obllptlon.t
Le.. Th.n full f.ce Vllue
......0
~.................
I S"lion 179 "p.nn deduCllon Orl"',on 280F recovery deductIOns . , . . ,
2 O'~U'CI.tIO" or rlCov'r~ deductIon, (1IIInltructlonl) . . . . . . . . .
J R.ClDlurl 'Mount. (Subtll' lint 2 trom IIn' 1 St'lnltructlonl for wh.r. to,. ort
eu.& .........., ,...... Oft"'1 ,..,....., ....,,,..
.
SCHEDULE E
(fo,m 1040)
o.l)I"menl ollhl T,...u'~
Inl.,n,1 R,nny. r.t'rwlU m
N.m.(,).. .hown on 'oml lo.tO
Supplemental Income Schedule
(from "nil, roYIIU", pI,ln,,.hlpl.IIIIII.,lrullI, REMICI, Ilc,)
~ AlI..h 10 form 1040, hIm 1041, 01 fo,m 1001S,
~ Suln,l,uclllnl fl' SChldul1 [(Form 1040 ,
OMI N. '..1007.
(5RrlOU Y /, ~~a
frllUlll.i t1, .Jb#1 J
R.ntaland RouallY Incom. or (LOll) Caullon: VOU7 ,ental 1055 may be limited. See Instrucllons,
I In th. IPI" provld.d 2 for IIch prop.rty 1111.d, did you or a m.mber 0' you, 3 For tlch ,.nl.1 '111 "I.t. properly IIlt.d,
b.low, Ihow the kind family UII for p.'lOnal PU'POIII ony 0' Ih. p,oper11t1 fo, did you ICllvely p.r1lclpel. In Ih.
,nd 10callOn 01 tlch mo,.thln Ihe S'lIl., 0' 14 daYI or 10% 01 lh.lo'al da.. op.,allOn 01 Ih. ICllvlty du,'n. Ih...II!
,enlol p,op.r1y. ,enl.d II ,.,, ,enlol Vllu. dUrin. Ih. I.. ..a,? VI' No Vtl,? (S" Inll,ucllon..) VII No
Prop.rty A ...."I,n,J~:,..(!./':I,'!.'.~!.,....,,~,'.!,'~ ,."".,)!,'.'), ~:n ~ 'I ,~ JI
P,op.rty B ....../lt..H?,(~,~,'......,"',.............,',..,..........."..," ~ y ,~ If
P,oP.rty C "e, $" Wltl~//.{. TW ~ .." ,~ JI.
R.nt.land Royalt~ Incom. Proplrllll TolIII
A 8 C (Add columnl A, 8, Ind C)
4 R.nl$ "cllv.d 170tJ !,!Ol/ Ht>f. 4 I }2, l601
5 ROYlltl" ,.celv.d ,
R.ntaland Royalt~ bp."s.. II
6 Advertlllns.
7 Aulo ond l'ov,1 7
8 ClllnlnS ,nd m,lnl.nlnce 1 $3
9 Com millions , g
10 Inlu,.nct , 10 ,,0 U,I '13
11 L.sal and olh., plolelllonol f.n II
12 MortS'S' Inle'tll paid 10 financial /,31" nn 1.1'1" oW)
InllllullOns (lie Inllrucllonl) . 12
13 Olher Inl.rtll. 13 ,
14 R,pllrs , 14 G~
15 Supplltl 15
16 Taxtl (Do nollnclude wlndflll prolll 56 JO&
I'. hI/e. See Part V, line 40,). 16 'lOb
17 Ulllltles. 17 tS'l /(,!:
II WISII and sala"1I , 18
19 Olher(lIst) ~ ..'.............................,.,
....................................................
....................................................
....................................................
20 Tot81 exp.nll$ other Ihan deprecl,tlOn /,';0 ~," ,( I,S" , 20 IZ ,g,
end deplelion. Add lines 6 throush 19. 20
21 DepreclallOn expen.. (",'nslructlOns), 21 I Vn ! ,'13 I~,y (, ~~~
or d,pl.llon (III Publlcltlon 535). . 21
22 Tolll. Add linll 20 Ind 21 22 3.)S'1 l:Oe t."!!"
,
23 Income 0: (1011) from renlll or
royolly prop.rtles. Subl,acl line 22 23 (2,1)7 > < 2 '/src '> <,iP ')
from IIn. 4 (renll) or 5 (royallin) .
24 D.ductible renlallon. C.ullon: You,
ren:lllon on line 23 may b. limited
SII Insl,ucllOnl to d.ll/mln. If you (1I,5? < J,'/H <"I,"P ~
must fII. Form 8582. PUll.. AcllVlly > >
lOll Llmllatlonl , , . . , , 24
25 Prollll. Add renlaland roYllly proml from line 23, and .nll/ Ihe total proms here 25
26 LOll... Add royally 105511 from line 23 and renlallouts from line 24, and .nte, Ihe lotll (Iollu) her. 21( PIll )
27 Combine Imounll on 1101125 and 26, and enl., Ihe nel prom or (1015) h!!e . 27 ( '.JIlI 17
21 N.t fa,m IInlal prom or (1015) from Form 4835. (Also compl.te Part VI, line 43.) . 21
211 Tolal ,.nlal or royally Incom. or (1011). Combine amounll on linll 27 and 28, and enter the tolal here. If
Pertllf, 1I1,IV, and V on pale? do nol apply 10 you, .nler theamounlfrom line 29 on Form 1040, Iln. 17S <~/391 ~
Olherwise, Include the amounl from line 291n line 42 on pose 2 of Schedule E . . . , . . i D.S 211
'or '.p.rwork ".ductlon Act Notice. If' Form 1040 In"'lIctlon,.
Sch.dulo [('orm 1040)1"7
'Olm itl06f1VIP)
'....2
IIIlIIII V.hlele bp,nlu (UI. .Ith.r ~our aetulle.penlll (S.ctlon C) or the ,tllnd.rd mll...e r.te (Section I).)
Seellon A.-G.n.rallnlormatlon ,------ V.hlCle I Vehlcl.2
-----.-- ,',III1r"T'1'j'7-r!'iTi? ,.. "~$ ,
I [nler Ih. dll. vehICle wn placed In ...Vlce . I 0 , A 7
2 10lal mlleaso vehlClo WI6 U50d dUflnll1987 .
3 Mlllllnclud.d on IIno 21hal vohlClo woo ulod lor bUllnen
4 P,rClnl 01 bUllnll1 UIO (d'Vldolln. 3 by line 2) .
5 AverlSI daily round Irlp commullns dlllanco .
6 MIIII includod on line 21h,I vehicle was uled for commul,ns
7 Olh.r poraonll milooso (subl,acl I,no 6 plul line 3 !rom line 2) ,
I Do you (or your SpOUIO) havo Inolher vohlcle availablolor porsona' pu,posas? .
11. '2 'll , ~., mllll
''''''~:l, 2- mil
I 18iJ,g) mllll
t:Ii , '0
mil.. \ ~ ' "
:...."O,t.>ll, ..IC.7,"'~
ml .1 .,
10 ') ~ ,(,l--mlla <;;/,91
, )rill 0 No
, It your .mploy" proVided you with, vehICle, II p"lonal U50 durlni oil duly hours permitl.d?
tR-Ves 0 No 0 Nol IppllClble
10 DoyouhaveeVldencolosupportyou,doducllOn? ~'Ioo 0 No. If yes. II IhuVld.nce wflU.n? . Il(IV.. DNo
Section B, St.nderd MII"le Rat. (Do not ullthllllctlon unl.., ~ou own the vehicle.
U Enler lhumall" 01 Part II, line 3 or 15,000 miles . ~ ,'( 1(. ..'"
12 Sublracl line II from Part II, line 3
13 Multiply IIno 11 by 22'JIC (.225) (IPO inllrucllOnl for a fully depreclalod vehlCl.) ,
14 Mull'ply line 12 by 1IC(,II)
16 Galollno, 011, repa"l, vohlClo Inlurance, elc .
16
17 VehICle rentall .
17
II Value of employer, proVided vehICle (applltl only If Included on
Form W,2 aIIOO% f." rental value, lee Inllructlonl) . . . .
18
19 Add lines 16 Ihrough 18
20 Mult'ply line 19 by the percentage on Pari II, line 4
20
21 DepreCiatIOn from Secllon 0, column (I) (IPe Inllruellonl)
21
, "
o
II
VehICle 1
llt\
1-,4,,1
;kl c) '"
;z..<-?
o
'2. b 7
Vehicle 2
22 Add lines 20 and 2 \. Enler 101.1 h....nd on Part I, IIno 1 22 2.V S II
Section O. Oepreel.tlon 01 Vehlel.. (Deprec,allon can only be cl.,med for . vehICle you own If . vehICle is uSld 50 perc.nl or
11$1 In a Irode or bUllnlll, Ihe Secllon 179 deducllOn 1$ nol allowed and dep,ecl.llon mUll be \ak.n uslni 'h. slrlllhl IIn.
melhod ov.. 5 yea... For olh.. IImltallonl, leO Inllrucl,onl.)
Cost or 011'1" b"l~
BtSI~ lor d,pr'CI'llon
(BU'ln,u U$f only-'"
lnst'ucllonl)
1_)
te)
M,lhod 0' 'I,Urln1
d,prlCl.llon
tl)
Vehicle 1
Vehicle 2
DtPIICI.llon Otduct.on
Secllon 179 ..penH
t.,
tl)
Tot'l
toIumn (e1) . column (.)
(em., In StCtlOl'lC. tine 2.)
II)
11IIIII Vehicle bpena.. (Un either ~our aetulle.penna (Seetlon C) or thl atend.rd mllll.e rate (Slctlon I).)
Slctlon A._Generlllnlorml~on -=-=~=~=---== V.hlCl. Vehicle 2
"1"1'
I' I' 8~
'. .
'-011"2106(1981)
I Enler Ihe dlt. vehICle wn placed In allVlce
2 Tolll mlltlge vehicle wn uud dUllng 1987 .
3 Mllea Included on lin. 2 Ihat v.hlcl. wn ua.d for bualneaa
4 Percent of bualn.u ua. (diVide line 3 by line 2) .
5 "'vIIIge da,ly round tllp commullng dlatance
6 M,lea Included on line 21hal vehicle wo. u..d for commuting
7 Olher peraonal mileage (aubt,acl line 6 plua line 3 from line 2) .
8 Do you (or your Ipouae) have anolher vehICle ava,lable for peraonol purposu1 .
:. ~' I , DO mllll
\ !.flff/3 II
." ,f;
1\, '" mil..
~ f'>.,f>>U mil..
~'H. z. mll.s
~V8I DHo
9 If your employer proVided you wllh a veh,cle, IS personal use dUllng 011 duly hoursll'rmltted1
o VII 0 No III NollppllClbl.
10 Do you have eVidence to supporl your deductlOn1 ~ VII 0 No If y85, IS theeVldence w/llt.n? . Ilil Ves 0 No
V.hlCl. I
.?C;'!
V.hlcl. 2
Section B.-Standard Mil.... R.te (Do not uaethlaslcllon unlell you own the vehicle.
II Enter Ihe smalle' of Part II, line 3 or 15,000 m,les .
12 Subtracl line 11 from Pori II. line 3
13 Multiply I,ne II by 22'M (.225) (see Insl,ucllons for a fully depreCiated vehICle) .
14 Mulllply line 12 by I Ie (.11)
3 and 14. Ent r t tal here and on Pa,t I line 1
Actual E.penaea
16 Galollne. oil, repal/I, vehICle 'nlurance, elc .
1
17 Vehicle renlals
17
IB Value of employer,proVlded veh'cle (appl18a only If Included on
Form W,2 al 100% fal/ rental value, lee InllrucllOns). ..
18
19 Add lines 16 Ihrough 18
20 Multiply line 19 by the percentage on ParI II, line 4
21 DeprecllllOn from Secllon 0, column (f) (see InslrucllOnl)
u(;. 1;.
. I).
~c;EJ
. C'
22 Add Ilnel 20and 21 Enter lolal here and on Partl, line 1 22
Section D.-Depreciation of Vehicles (DepreClotlOn can only be elllmed for a veh,cle you own. If a vehicle II UHd 50 Il'rctnt or
lell In a Irade or bUllnllS, Ihe Secllon 179 deducllOn Is not allowed and depreclII,on must be tlk.n u5I..lhellrlllht lin.
melhod over 5 yearl. For other IImllatlOns, 58e InllrucllOns.)
Cosl Of oth,r blSl!t
e'!lI!l.IOf dlpleellllon
(Bu'l"r" U'I onlY-I"
,"slruCllon,)
tb)
te)
Mfthod olIIIU""1
d,pII(I.llOn
t.)
Vehicle 1
Vehlcl. 2
O,prtCI.hOn deduction
Stellon 179 'Ip'n..
Tot.1
Columl' (d). colltmn (e)
(.t'II" '" Sechon C.1tnI21:
II)
I"
t.)
. ~ . .
1011I1 2119
UIP,'lm,,'! Illlh. h".uIY
1111,,",1 fIl,~'/1U' IS,I"YI[' 101
N,rn"t.Utho*nlln'glm 1040
Sale or Exchange of Principal Residence
.. Sit 1.llrucll~.1 on blCk,
.. AUlCh 10 Form 1040101 Y'" 01 IIII (I..lnll,ucllon '),
OMS No '''1-0077
()f.'tfIJtt'/ 7,
II~'J
", ICH'-t..l. If, Jf~r'J
~@87
Allt<hmlnl 22
Ie utnct No
Yew, NIl" ..cu,"~ 'n'....'
tr' i f.. '1J'~J
Do nol Includt t.ptnlt. Ih., you dtduct.. mo~ln, t.p...tl,
I. 0.1. former Itlld.nctlOld .. ~
b Enle, Ih. flc. Imounl of .ny morta'a~, nole (10' ..empl.. 'fcond I'UII), 01 olher fln.l1clll Inllrum.nt on which you wllll.etlve
,Iodlc m.nllof ,Incl .10' Inter III ',om Ihll &lIe" - C> .'
2 a If you bouahl or buill. n.w relldence, .nler dll. ou occupltd II, olherwllt .nler "Nun.".. VI. No
b A'.I.Y ,oomlln .lIhll '1IId.nct Itnl,d oul or ultd 10' bUllnll1 fOI which. d,ducllon II IlIowedl V
(If "VII," lit Inll,ucl~,)
_3 I Wereyou 55 0' o~eron dll. 01 &11.1 .
b W.I you, IpoUIt 55 or ove, on d.ltoll.lel .
If you anlweltd "No" 10 3..nd 3b, do nol compl.el. 3c Ih,ouah 31 .nd PlrllI.
cOld Ih. perlon who .nlwer.d "VII" 10 30 0' 3b own .nd ult Ih. p,op,rly lold.. hll or her p,lnclp.1 Itlld.net 10' I
101.10' Ille..1 3 y..rs (..cepl 'or Ihort ,bltnctl) 01 Ih. 5, ell ,Iod befolt Ih. 511.7 .
. Alllm. 01 &lIe, wallhe Itlldenct owned by: 0 you, 0 YOUrlPOUU,
Socl,llecu,lly numbe, 01 lPOUIt, olllme 01 Ille, If dllferenl from numbe, on Fo,m 1040
(Enler "Non." if you Wilt not mlllled.1 time 01 Ille.)
11IIIII Computltlon 01 Gain
4 S.iIIna p,lce of Itlld.nce (Do nol Includ. personal p,operty Iteml.) ., 4
5 bp.nlt of &lIe (Includu.leICOmmI5l'Onl, .dverllllna,leaal. elc.) ~ ...t!: . f'+1-J( ;. 'i' . /(11/).1. 5
6 Subl'lclllne 5 ',om IIn. 4. ThllII Iheomountreallz.d , . " ".,. 6
7 BIIII 0' Itlldenctlold . . . , " ..,., ....' 7
. Glln on 181. (lubl'ICI line 7 lrom line 6), If zero 0' 1,", enler zero .nd do not compl.Ie Ihe Itll of
form. Enler Ihe Illn lrom Ihll h~e on Schedule 0, line 3 or 10,. unltll you boulht .nother principii
Itlld.nce or checked "VII" 10 3d, Then conllnue wllh Ihll form . . . ·
If you h.ven'lltpl.ced you, Itlldence, do you plan 10 do SO wllhln Ihe repllcemenl perlod7 , . , .
(If "VII" lit Inll,ucllon B,)
IIIIIIIII A.e 55 or Over One' Time Exclullon
,'1'~ i A(, i t:a I;"
d If you .nlwered "VtI" 10 3c, do you ,1..,10 lok. Iheonce In o lifetime ..clullOn of Ihe aoln on Ih. 111.7
-0 -
, 0 VII 0 No
Compl,'. thl. pert only If you ch.cktd "y.." to 3(d) to .ltC' Iht once In. "fetlmo ..c'u,'on; o'htrwllt. dip to ,..rt 1/1,
II Enlerlhumallero' IIn. Bor $125.000($62,500, If m,"I.d flllneup.,.le relurn) , . , ,
10 Glln (lubl,.cIIlM 9 'rom I,ne 8). If zero, do not complel. relt 0' lorm, Enler Ihe aOln from Ihll line on
Schedule 0, IIn. 10,' unlell you bouaht .nolher p,lnclp.1 relldence. Th.n conllnu. with Ihll form
IIIIIlII G.ln To Be Postponed .nd Adjusted Bills 01 New Rllldenc.
Compltt. thl. p.rt If you bou,hl .nother p,'nclp.' ,,,'d..ce.
II FIXlnl'uP "penlll (See ,nllrucllOnl lor lime IImlll)
12 AdiuII.d $1111 price (Iubltlclllne II from line 6) .
13 COllofn.Wltlld.llce. ./Zl-,.",' '/'" ./,'",: ~ /ol8'
14 Glln t..able Ihll yea' (Iubtr.cl line 13 plul line 9 (I' .ppllcable) from line 12). If IIlulll. zero or Itsl.
.nler zero. Do nol enter more than line 8 or line 10 (If oppllcable). Enter the lain from Ihls line on
Schedul. D.llne 3 or 10.
U Glln to be po.lponed (Sublr.cl line 14 from line 8. However, If P.rllI applies, lublroct line 14 from
line 10.)
II
10
U
12
13
-
14
-0 -
15
"-" -
" t'{l.')
16 Ad ulled basIS of new reSidence (Iublrael line 15 from line 13) 16
. C.ullo.: If you comp/.led Form 6252 for Ihe reSldencI In la, do nol .nler your tauble !loin from Form 2119 on Schedul. D.
,.. Popl,wo,k Roducllon Act Noll..,.1I bock .lfo,m, 'orm 2119 (1917)
...",.,...;.~,...,' .
,I ~~,.\.,..;..._,,\oo'~~..,.. 1',\
. ',~ '.. :: '!~
. ~. . '., >..",..... 't '. 'fttt. ~
..
.
r '''''''''''f!:1~''~'r~~''"'~'''''''''''1' ~/.'l!\tI\'Im'!'''''\'Ift'l1'B
. "'.~~tt.'II~t,;':':ii'~1-' .'~.~i~I,"tI.\ " 0'/ i'!I:1~:;;:~~!.:,i:W'.:
t~~ I Ir,..;r.,.rr-I~"" ". ....... , ,"
'. .,~.~_...~'_" .' .".. .... ~ W.Zw....ln. ,,'1"
.J~t,t.'~. ' ',' ',; ....,,1.: .;. . " ' . I" . '. .'. ". '.' Tn .....manI1888
r,..jtn'"ntIUL' IS~VUIII ~...' "~' ,"'" :...
IDl tIJELLt"'DR' .' ," .';, . '. ,,.:W !.~~: . . " . .
\l....C.UU.V' ;,'\"','. 1.nn:.,:-",1.; '~l'" ',I '." .
'{ ~~:.)...;;;:':';' "";~~;...i ;\:::I.~;~ ::.:
Cf. ,..,....,....IlIIN....~...D'... ......MNU'.......
(:IlUOLU:'...Oln ,~. snu.n
t:1", " " .,. "
:It;~,i" ;w.r.~!t.....,.tlRtLEI ~',~I"
I ,I', C'. ""'.';'
~~I"Et.~aNi'ts"UIli;' P. 1JU5
~",.~~~~;,::~._","~~"~_,~':"'.... .~~i~:~I<6OOO1
. ..........,..........
. 1'15.'1
t .........,..
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.
.11 'MIl....... 1Rd. .,., t
SODD.DD
~..".. ...._.._.'-E;;;j;~i].;~~: ::,~
11r.".,..IWIIf,.......I:IGOdI . j.OI\l.lTJblf
11.':;'iA... ;.icJ~rL:I't uS," H.".
,
OM. No. 1 &d~Ooo.
:. ~,;..1 ;jl(~I'" Tl ,,"",
. t'I,; \lUX ~~Jc4..
,
I ~:.LL^~ I t,rl;A~
I.
,.
'= 0 ::..0 ::-0 ~O :0 ::0 ::0 . ...0
].,;,,-'',,
.-...
1 AOvwoIIIC...
,..,..netbenf/llllll/;lWlIo.'O
. '"
IllfllllO'rll" ~ NWJtY"""""
~ >, ',-:J . - '~ ~ ~ ,;
--
.~ :.: ~: .. :J
I '21,"~H.."l/IIt,I4clf"',1/'Icl11"co4f
,LNLl J'i H~~ 2H'
I ",1ljlI,0II'\,;r~
L 1,~dJ
ll,..,\J\.~Y T J\"~".
,.J1(, .1I~lLk ,,1;,~L;:
,It,;'..IIA'4 ~"'~I,vHi..
I ..,\ L I " :; -~)
,_W.2 w.g.o.ndT..81.t.m.nt1ea._....'--Ill' ._~-~.
,IIPNII,"aget
~ '1-1 ~ . . ~
LH. ~
I'1uc>"MC\IllY*
11:.lal'I/lCOII'ItLU II II........... IIC ItJWrlliol.....
~(J,o., 1/'9). ..!~t:I'r,.J.{L.~i-
2(1 Lcd II'ItOIIlIIU IILOCII........,-. "NIN"1Dl:IllfJ'
1/..,.; 4/.;,~JlI~.',..A'.,IJ I...~.t
JOG CORPORAlIOH D/B/A nAHPOUER
2~2~ NORTH FRONT STREET
PO BOX S01
HARRISBURG
06-1185521
CALENDAR
YEAR
1988
(OilY lJ In I fl 11..1 .,.,,"
l",..,phl,II" ,lllll HAl !/I. ,..t'JII'
Ih" ,.' ""~.,,, I" I r ",J~.I I,
IP.. ",,,,,,'I''',~ ,II .....
OMI NO 1141.0001
W2 WAGE AND
TAX STATEMENT
0000~1'1
PA 11108 3670
523-163'1'1"10
1N7ofANC101ICMYMlNT
"OIM.IO NO
1I0C. II NO
,
1~3-'+6-2315
~TlIONO
, nOlM. TAll WIMilLD
31'l. ~"
10 lWIllIIl '"' NCl cmIII tcWl~11lIt soc:W. UCl..RlTV ~ 'MTMiI1J) """'.. .
1f,550,17 3111.72 1f,5S0.1?
SfATI OR I.OCAL TAlI WlII...LD S1A11(:ALQC..l4.Wt.GlI _ DO LotI\UN
115,'+5 PA
51A11 OR Loc.H. 1M Wlnt<<LD IItl11OAlOCN. .,.., ftt.lTl CflI L.QCMlTY
115.'17 1f,550.17 HARRISBU
,MIIU1flIlS..,.., ADONIS 1HJ l1i' COOl
nlCHELE JOHES 1203
316 UISTE~ CI~CLE
H
..
"1'\' II I: l--.J.
II /1 " -l.,
. I'>
nECHANCISBURG PA 17055
38"1336
"'~I)I(WPU.N
ThI FICA "ta cA 161" tnckidlJ' 1 ,"~.. lot no
-, -..
",!II.mell'- 1I1t1/lllOt., and dlubllity lrIllUflttlCU
I 1 040 0.,. "'"*" 0' the ,,.......,-,'*""* ..~u. IwYice
.E ... r' R
,...1IlI ,",__. U ...-...
L Yw .......... 5-DIGIT
: 'HI 209-50-9583 193-46-2315 S28
~ ....BRADLEY T & MICHELE A JONES
~ 1316 WISTER CIR
R ClqMECHANICSBURG PA 17065
u,.llIa Ilbo!,
Olh,I'WI".
pl.... prt.1 0'
type.
I
,. \ 6.
"..ld.nUII .. DoyouwlntSlIolOIothlltund1 . . . ' , . , , , , ,
E1tct101 Ctlllptlln' If oint return do.. OU'I OUI' wlnt 110 0 to Ihll fund1. ,
I 1.&1' . .
2 M..riod ftll.lloIn' ,I!u,n (oven I' only 00. hid Incom.)
I Mlrried fllln.MIlI"1o ,,!Mm. &1. spouII',lOdalllCurity no. abovt I"" lulll'''''Iltrt._
4 H..d of hOUllhold (with quolllyt.. porIOII). (Set Pl8I 7 0' InllNctlon,,) If tho qUllllyt.. pononla your child but not
YOU' d.penden'. .nltf chlld'l nlml h....
a UIII I wIdo .. with dl nd.nl chlld"l dlld . 19 , 5tI 7 IlIIInIctlona
.. I9""VOUrII" l'tomoon.(luch"YOU'Plre.')Cln clllm you.. I d.po.d.n'. do not chICk baa... } ~.i.!!'\..
, aut be lure '0 chlCkth,bolI 00 II.. 33boo PII.2. , . . . .' , , . . .. a....
b I9"'Spoule': ". ,:; . . ... ..'., , , ,.', :'. : , , . ' , , . , , ,
. Depend."", w- (1)"...1......,_. ~"...,-
m_(nrll,llIitlll,tMlllh...) '1' JOiitI_~'"_ (I)RIII-. ~r.r.-
I
I
I
d lfyou,chllddlcl.'IUvtwilllyou bulllClalmodayourdtpondtnlundtrIP/l'I985..-.chtcilhtrt ..0
. ToIIl.umblt of...", llooa elalmed , , , , . . , , .
7 W.... IIl1r1e1, Upo. lie. (Itmch Fomtc'I) W.2) . . . . , ,
.. T.......loI-' Income (1110 lltiIch Schldu" B If _ $4(0) ,
b Tu.......ptInIItNtIIncome (HI PI" II), DON'T Indudl 00 IIn. It
I. D!vldendl.-n.(IIIOIItIC/tSchedu/lBlfove,$400). .., . ,:
10 Taxabll ..fundtohlol...dlocollncomt....., I".y, fromworiclhttlon PIlI II oIlnatruc1lon,.
U Alimony rocelvec1...-o. .... '. , , , .':-.., ,
12 Bulin... l.-n. 01 Oou)(IIfIdl Schldull C). , , . . . , ..
11 ClpU.lplnorOou)(,ttKhSchtdul.D) . , . . . . . . ..' ,'I. '" "" .'. . .': ',,'
14 Capital..,. dlatribulJon, not reported 00 11".13 (... pop II) . . ,. . .. '.. .'
II 0lh"..1.1 01 0-) (IltICh Fonm41117) . . . .,. ,'.... . , . , , ...'.
. I" TOllIIIIIII dlllllbullon,. . ..": 1.. : .: lib Taxable lmounI (HI po..U)
.' .. '_...17. TolIlpon.ionnndlnnulll. 17. /(~.."q7 81 17bTPlbl..mounl(...""" 12)
L .. '.'./ . I'. "'.II,nl)'.IU., portn"""IPI,"""..,lMh,etc, (IltiIcIl Sdtldu" E) ,.,' './. ,...,.,...
r-;-, , I "i .u..lt '.rm I.com. Of (l01I) (IltiIcIl Schldul.F) . . . . . ,;.'[l',.O,', )':,'.: ;,1 . .:;'.'" '.
20 U.,mptoymentcompo.llt1on (Intu.....)(a. pop 13)' :"',',"'.
21. SocIaI_uritrbenlfltl(,.popI3) .::..'.1'.'11),' )f.nWI;','
II TlXlbf..moIlIII\'lhny. from lht-"thMIoo p...I3" .\ '.' ";l .;.
22 0lIMlt 'ncom'OIatIypt I.d .mou.t-IM pop!3) ...........................................
U Add'hI.mounluhow.lntllllt,ri colum.forll_7t11 22. Tllltlo ,lMII_',,,'
24 RoImburMd ........ MI..........frorn Fonn 21oe.lI", 13. 24
Adtustm.nb 2S. You, IRAclIdUCtIon. from Ippllctbll'V.irtc",..fo.'pep i4 0/ '15
to ncom. II Spour.'IIRA'ciicIiicuOft:"OII\ Ippllcoblt worlcIhH' 00 PIlI 14 Of 15
.___... ,__, 2. 'StIf....pIoytd_l;....natilocl.;IrOrnIlOriol/llltOOPlPI5..
27 KlOIh ,tII,.......'.pIt..ii.II.lf.omptoytd SlPdlducllon, ,":-'
(See ____ 21-;Ptrl.1ly0n.tlil'iivllJJd,.W..0t1lYl....~;_~~_~
'.Itrudlool . 21 Alimony plld (r..:lplln,'IIII'.lmt ..1
o. pop 13,) .
..._---:.. ---,~por;I.!~~!.:......
dll 24 2t,Th... I ,A. . '
Id """ n.. " your.... /II
'7"Mri~/IvId ,",~JOU-__'&mIfi IrIciitmlI CtId/tU (IIH 51) ClII ".,.."
Llb,1
flllnl SlItuI
Check ooly
001 bO.,
Exemptions
(s.
Inatrudlo.1
00 P'I' a,)
" mo.. thl. .
d.pondonll, HI
'.ltrucllonIOO
P"I' 8,
Incaml
Pllllllllleh
Copy B of YOU'
'o,ml W.2. W.2G.
I.d W.2P hlrl,
"you do.ot hlVl
IW.21a.
P'I' 0 of
InaINctlona,
PI....
,lIIc1l chICk
01 mOOlY
orclI, hi.., ,
AdJust,d
r
17055 \
30
11'"
001
s
-
, .
,
,
, ..
,t. OlISHt,IS41HlO74T
Y_......~~'I\
,'_I ,I
'-'"......--.....
I I
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1!IlI1ICIlII"'1IIIIII..1~
.... Cttc*iw "tWi""
..,NriIt _laIr Of
o \ I'IIU:I tIlfWId.
;
.:l.
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. lIv.hlta,. ;l..
. j~.'lhtwll.
,1:'#.... _
Mo.oI.
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=.
:r.
g z.
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:z.
: ,
.. , ~ 1 i ;
. II
..,.1
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JI,;;:
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.1..1. I I 10 ~
.- '_::'-1'. ~
",''''''f.;Jf:iPCI O.
'MftlO4O(lNl), r""'~/;~"". . "'I",)~","',."'''I'T
'1 ._....,romJI-..'...'''.....-I-) ".: II, I' '.; ,t.'.' ,'n ~ '''.'''):1,,1...1.11;'
. ~...__.~_.. ~ ._"".....". . I.~.... "...~._. .--..... ..'I,;..i.;lu. _. ....J. ..,............ .......~ ,. _ ,...~...&.:...r_
'I.... .ChBc/Ilfl 0 YIIlIwwa6aoroldtt 0 1l1nd1..D ...-w,,1l5otolllw, D_,u.d~..:
Compu. '., "".IAddlhit~umber 0; boi,...checked.j,jj....., lilt lolal hole;' ;. " ", ":", . "..;.. .
bUon _ II ' 1110011_ (loch" YOU' ptlllll) con dolm you II I depond.... chock h.... -. -- .., 1111 0.. .
JjJ~ ,. "'" . ." '. .. I I. ' , .." ,. . f. ,t . '. "." I. I, ;.. " ,'.I ' '. .,
. If you '11 IIIIrrled """11 MllIr1ll1 NlUm IIld your IjIOUM ltam'- dedUction',
_". otyo'lIr.. dUIl-lllluuU.., III PIP III IIld efleck hili ,...."... .....-.,. _,lie D...
14' .' rnhrlht { . YOWl"""", N4111tl1n ('rom pop 1701 Iht IriatNctiOi.,), 011 . '}'" " ",'.
::. ::...,..,.... . . Vou,IIII1lIlMN4U1l11tM(framScheduIlA,II..26l:...----. ...-.--. .
;.. Oft., .' , lfyoulllmiu,.t\Id!Sc/lIduleA.ndchldt".,.. U ..., ';1':1' .: t~:I','
n... Sublr1clIlIl134IromU.d2, rnlerllll,.ullh.. ...., ~., ~.!':"'~..:.....::'-: F: c'_ ...., ,..
" MulllplyU,9501lyIhllolll.umberofUllllptlonacllllllldo.III1161, , . . , . .' ;'. .
17 T......I_m.. Sublrlct II., 311 from 1111I15, [ntor 11I1 rooull(1f I.. 1hI. 1IrG, ..lor 11IO) : , ".
.. ... Ctulllnllf und" ...14 Ind you h,ve mDrlllltn $1.000 Of I.-tonlnllncom., cheek hlrl . 0
. ,.d III pop 17 to III II you h,ve 10 UII Form 8115 to'!auIlYOU'IIJc. , .
.. . rntor II.. Chock If lrom: ET.. T.bll, 0 Till Rill Schedul.., or 0 Form HIS ,
3. AddMIon.11IlcII(...pop 17).Chocknfroml 0 'orm4970. : 0 Form 4972
'.~ - II AddIl,*47throu 52. ThI.I. rtotaltu . ...... . . .'..
114 FI/lerII~llIJcwilllholdOflnylsfromForm(,)I099,cIllCk. 0) 54
Parm.nt. II 1988l1llmolld tax poymtnlllnd lmounllpplltd from 1987 "tum 51
II .. Elmtd Incom. Uldll (III pop 19) . . . . , . , . , ,,. 51
.7 . AmountpeldwllhFonn48l5l(ulontlo.,oqunl). , , . . " a7
II, . ExCllllOCltlllCllrtty IIJc .lId RRTA IIJc wilhhtlcl (III PlI' 20) II
at ,CrIdMIorFed....llIJconluell('rt<<h'"""..136J, . , . ..',.,'. at
.1O...RIII/lIled InvIIlmllltcomPl.ycrIdM(,ffldl'orm24.J9)... ....~ 10
. Addll_lI4lh 10, .11 IotII .nII., ',' , , " .
. \ .a.._ltUnt6111I1rprthln lint 53. enttramount OVU'AID . .::; ..~ ....:'.: 'J
R.fund Dr 1I._Amou.IOfllnIl52toIllIlUUNOEOTOYOU...,.. '~".")".'.
Amount ., . .14_Amounto,an.152lObe.ppllldlDyGUrl989l1l1mo11dlu,,,.:, .. 84
You Ow. II If Ilnoll3la_,lhtn IllIIlll.IIIlIr.AMOUHT YOU OWL AlIIch cIltck or monoy order. lor full
...n _ .. _._ _nt PBI'.bIIlO "lnlImII R...nuo SeMel." Wrtll your IOClllucurity .umber, dtyllllll pit_
t -;-"umblr, 'ndd':J~~J9n'l.l~':.on It.."',,.._ ......... ~ l~r ....;il:; ~"'~'.."Il.:c.n(~p:* ~i.\.,.~.,:) j;1"~~'
, CIa. WF_2210(2210fl1l._.Sot_21,...,""'"" $"
u.- "'-";~:I-.lIItll "",,.~tIlII iolwiIlnrI_~_"" _...,...lht.... 01 my -",1IlIl
_.tIltyl.."""" . . ,~ppoI~j!(~"'tIltnl4"P'rl!l!t~on'~JnfonIIaIlOrl_oI!'!!!d'~hIIl"I~!Il.~
... Yow . ,(" _ . ' OIt. Vow OCCUPlUon I
,. ....."'.. ;1' ."..i.'.... ~ 'J.J. '8' . .. (t{(fc'! d :. :'JJ,1o ill
~ ~7 ~ S90uM;;::- ~s ..,
Credits
f~ltuctlo.,
on Pili 18,)
Olher
TulS
(Includlnl
AdYln.. lie
Plym..II)
An'.h Formi
W'2, W.20,
Ina W.2P
lol,onl.
PI....
Slln
Her.
'f, -'. fI\
z
'. ;'. ~ l , :, l . ... :.' l'; ..',
, "
40 Addllnn3h.d39.rntorlhllolll..,..,., .', ,.: ,.'..,'
41 CrocIII for chlld.nd dopond..I..II _n... (,tt.ch,,,,,,, 2....J)
42 CrocIM 'or lII..ld""y or lilt dlllbled (.fIIch $chlO'uf. R) ,
41 FOII\lllIlJcUldIl('ffIc{l'cnnJJJ6).. , .
44 0.....1 buII....credll. ChoCk II Ironi:' :.-...
o Form 3100 or, '- 0 Form (tpIClfy)
4a Credllforplloryurmlnlmumllll(,fIIch'onnUOJ). -,
41 Addllnn41lhroua/l45.Enllllllelolal.., ,.. . , .
4 I I h
41 StIl..mploym,nlllJc (,tfICIl $chedu/dE) .. .. . -..' ..' ,- .
4. Alllmotiveml.lmumllJc(,tt.ch'ormU"J): , ...., , . ., ,'. .', .
IQ . RlClplul'lllJcll(MePIIUI).Chldllffrom: DForm4255,.. DFOlmlllU ,
II, Soclthecu,lty IIJc on lip Incoml nol..portId loomplO)'ll' (.ltIclll'orm 4U1) .
12. Till 00 en IRAlll'lqUlII'1td ,1l1"montpl,n(,rtxlll'"",,".J29). ..... ;. . '"
.~ ,__..~_..._._. .~J. '" ....
1
..',
;)..."
7
. .
. --'.~--_.- -
no
',Id =.
''''lit''', ;:t, Firm'. .....(.. .
UN O.I,-yooro NIIIf..........t.
Il'Idtckt . ..
.. ~"..
._~ . - , \ \.~ '.
.1' '-", "1"
, ..
ChIdII' "):,{.
ItIl....pIoytcI".
I.
ZI
'-,. i,.'Il~:'
e.
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" ." . ~ .
... .'. ~...
Ir, ...
.. ..o.. . I..t ..,._.... ,~.,.' .....~. ...._ ., .~,~ '" '" ,'.'~.~...:..,.. .' _.....
':. ~-...." 1\ "r,' '" Ql .1........' ')'~ ,ll"",'-" ')"';".\~")~ ",)0,\' ~"!... \.l.il'\ '"f:l'1~.1~1", '~ro,
51i1~nl U013
. . L-vi.
" ',\" ~
,,'
'.,..,
Schedule A-Itemized Deduction.
~~..." ...
(ScIIlllul. . lion 1lecIl)
.. "u.ch N'_ 1040. .. ...11IIlNtIIIn1'" 1cIl.,.." .1IlI1 (,"'" 1040).
SCHEDULUA..
('011II1040) -,'.-
Do,II1mtnIlIIlIIt T,-,
1___ (3)
NIIM(I).._..'....I_
.DL~
Mllllalllll
11I...111,.....
(lit "otlaclH'
..,.nlll
rellllb.,. or
,.Id '" ItIIm)
(Set
In,lNcllOlII
on PI" 23.)
Tu.. TOll
,.Id '
(Set
InllNctlOlII
on PIlI 23,)
Int'lIIt TOll
,.Id
(Set
1..lnlcllOlll
00 PIli 24,)
&lib to
C~1ritr
(Set
InllnlctlOl1l
on PI" 25.)
CuuIIJ AIId
TIIlft 1.01III
M"'"I
bPl.1II U
lob II,.....
.nd MOlt Giller
M,..II._.
DIII,d1...
(SetJlllll26
fot _....10 - .
deduct h...,)
.,
24
0\111I 25
Mbctll._ ' -
Dllluc\loll
To..III.lllntI 21
DIII'dlll' :
..: , ,j . , 1 ~ ':
vaNS
la Pl'MCriptlon medlc:l_ Ind drup. Inlulln. doctol'l, d.nti.lI.
nu....., hospital.. mIdIClllnaur.nc. pr.mlu"" ~ou paid. IIc , ,
b OttI,r (I11t-lnclud. hilrlnl .Id., d.ntul'll. eyea!......
lranlportltk.n.nd lodlinc.llc,) ..........................
......................................................
.........................................................
2 Add linn l..nd lb. Ind tnlBr the total hll.. , . . . .
.1 Multiply th..mount on Fo,m 1040.lIn. 32, by 7,596 (,075) ,
r II n
5 SlIIt..nd 10001lncom. WIt . . . , , . . , . . ,
. RllllItIl.tax.., , , , , . , , , . . , , , ,
70th" tlX.. (1IIt-lnclud, pel'lOnll p,operty !lxu) .,.. . . . . .
. Aijii iti.'imoiij.ili'on 'Ii'n 5"ihrou" 'i:t;'iir' ili. 'IObi hi;.:' Totti lax..
Nott: New rulel IppIy fo the home morlpft Int.".t deduction,
SHln.tnJctlonl, .
II Deductlbl. home mortp.t Int'1II1 you p.ld 10 IIll1nclll
Inltllullonl (report dtductlbll polnll on lint 10). . . , , , II
b Deductibl. home mOr!p.t Inl,,1It you paid to Indlvldu,ll
(lhowlhltpel'lOn'S nlm.lndlddrlU) ..,........... .....
10 D.d~i~i.~~b:(~.ln~~;;ci,:;PK~i n;,ii:i '.' .:..:.:
U Deductlbl.lnYlltment Interot (IH PI.t 24). , . . . , .
121 Pll'IOrIIlln!llllt you paid (III PlI' 24) . 1"11,"
b Multiply th. Imount on IIn. 121 by 4096 (,40), Enter the l'Itult, 12b
1.1 Add Ih. amounts on IIn.. 911hrou 11 ,nd 12b, Enler Ih, loll hi", Totallnlll
14 Contrlbutlonl by caeh or ChICk, (If you pVl $3,000 or mOl. to
Iny ont orpnlzttlon, Ihow 10 whom you pVl Ind how much
you pVl.) ..........................................
IS Othl' thin wh or ehtd<. (You mUlllttach Form 828311 over $500,)
1. CIInyoverfrom prlory..r , . . . , , , . . , , , , 1
17 Add thumounll on IIn.. 14thro 16, Enlt' Ih. totll her.. Total contrlbutlonl .
II CIIlu.1 or th.ft 101I(.. (Ittach Form 4684). (SH PI
1. Movln IX nlll.ltIch Form 3903 or 3903 . StI 26 of th.lnatructlonl,
20 Unrelmburltd ImploYH IXpenlll-job I"VlI. union dUll. job
education, ttc; (You MUST Ittach Form 2106 In some e'ltI.
SM InslructlOlll,) .. ..................................;;
21 Olht, tllptllStl (InVlltm,nl. !Ix prePll'lllon, 11ft dtpoall bax.
.te.). Ust /YJl' '~_~!!!()\jnt . ........................... :'.
......................................................
~ 0'
11@
__...01'
.... ....:..::.;.:,..,' .,; '.' ..~~:,.................. :.~" .......,...., :'. .......... 211
Add th..mountton IIn..4, 8,13.17.18,19.24. and 25, Enllr Ih. lOla' her.. TIltn ,Y'
. .nl., on Fo;m'l040. IIn. 34: Ihe LARGER of Ihis total or )'OUr $land.1'd deduction "
from PI I 17 of lh.lnstructlolll. . ;.'. . . .... .,", , ,. : , .. 21'
'It "''''''''IlNuctItft Act HoIlct,-_";..... 1040 I..~ .11l4;,,~\llrli gO"l m\OI'... :0.>1/01 lIcIIHuIt " ('_1040.1'"
. .
..."..................................................
22
23.
Add thumounllon IIn..20.nd 21. Enlerlh.lolll, . , , .
MultJply Ihl. ImO-;nton Form 1040, IIn. 32, by 296 (,02). Enl., lhe
".ulth.,. p~,r...\'..I", .' .,. .;. . I 0' , '''I.~ . I. ~'~
Subtractlln.2 fromlln.22,Enlerlh"..ult IIztroorl_ ,"Ieruro '.'" .',"
Olher (from list on pelt 26 of Inslructlonl), Enler l)'Pllnd Irnount . .............
:11,;1,' ,I J ". , ,
:, .~/~
I
k1_AIII1...IOIO) 111I
'111IIO(.).._.. ,...10l0. (00................._11ICIlI1ly n...W ~ _... _1lIdI.)
...' .J
'1It1 .
fnlnt
fnCNII
(lito
1.._1011
llIIIIlO In<! 26,)
NIlIt If YD!!
,..eIvtd l'Otm
lott.IHT or
'ann 1099-oID
'rom I
)ro~er,," firm.
I,tth.flrm'.
"Imll,tIlI
OIyt1lnd ..I..
Ihl~lln'-'
lhown 00 11II1
'orm.
'sri II
DI,I~lnd
Incoml
.5"
""lUdIOOIOO
'111111 And
27.)
H,ltllf\'Oll
'eeelvtd, FOIm
lott'DIV from I
"0111'" ",m.
lit the trrm',
""mlll 'hi
)Oyer.nd ..I"
tIlI~I-
dlvldellds_
o. Ihll form,
I ~ f ." . . , 1\ I f
.:J;nt~ ~~H~J'" ...:-:, '~1' .....,'
'.
.. . ," ~
otMHe. i~~7,j I ",,.'2
,--......,-
. - Schedule B-Inter.st and Dividend Income'.
~o..:
II ~ re.1lI """ Ih.n 1400 In .....,. 'nllrllt hlcom. ~ mutt compllt. ...rt . an. I'IIrt III ..d IIn ALL
Intlll'tll r_I'td. You mu" '1tIfIl1a1llnllren '" 'orm 1040, I'," II ~ .,. not rIllul,.. tl comp'at.Part '11I.
,.rt III. If WOU ,..tlvlll, .. . nomlnl" 'ntlrut tIIIt .ctUlII~ IIIIonp to lIIoth., penon, or you ......ved ., .....
accrulll'nl.,..t '" MCUrtUlltr.IIII""ld IIltw_ In'-t ~mlnt datu, _ pili 27.
"
I.llr..llncoml Amounl
I 1.'''lIt IncolM f,om IBlI,r.'lnlneBd mot1iBI'I, (See Instrur:llool .nd list nlm. 0'
pI~.,.) . of '0. 00. Of... f. .......... Of...... ....... Of..... "............
1
2 Other Inll,..llncoml (1111 nlm. 0' PlY") ..... .J;,;.........................
....... ,,;..:... .......................... A~~1I;ir'i .l}:.x;ir-.........
........ ...... .......................... t/fIr!.If/l.I,.... ."'~.............
...... .... .......................,...... ~~,~.. ;$AVII!I.~..........
2
.......................................................................
.......................................................................
.........................................................................
.......i...... ....i.... 'in ..:'[ 'li;' heir ",' 'ii.in'; 0;'- Fo;';" i'" 'il~"":'" 3
II rou IICtlvlll morelh.n 1400 In.,.. dlvtdlnda .nd/o, otlltr dlttrtllull_ on BtocIl. complet. 'art IIl11d ,.rt
III. You must 'Iport III \UtIlI. dl,idlnds on 'orm 1040, ev.n If ~ III not 'llIu.....lo complet. ...rt IIl11d ,.rt
III. If you ,ec,lvld. "' nomln... dl,'dlfldllhlt .ctu.lI~ "'oncto anOlllt, penon, _,... 27.
Dlvtd.nd Incom. Amounl
4 Dlvldlnd Ineollll (1111 nlm. 0' Plyar-Includl on tIIll IIn. eapllll pin dlllrlbutlO/1l,
~~.b~~~.~l.ri.~~,~~~~..~I~:~~. ::Ii7;$::::::::::::::::::::::::::::::::::::
..........................................................................
.........................................................................
.........................................................................
.......................................................................
.. .-.." .
........................................................................
4
.........................................................................
. . -. .
...........................................................................
.,
.................................................~.....................
..............................................................................
........................................................................
.,.............................................................................
''II: ....
5 Add lhllmounll on Nnl4, Enlar lh. 10111 htrl , ., ...'.i " '. ..,.
. ClIpllll pl. dlllrlbullon.. Enler har. Ind on IIn. 13. Sc:hedul. D..
7 N.nlmbl. dillrlbul_ (Sot Sdloclull 0 Inllrucllons fOl tdlurlmenllo basil.)'
. Add lhl Imounll on II." 6 Ind 7, Enlar th. lolel hire' ; , ',' . ; , '. ...
t Sulll'Ktlln.81rorn1In.5,Enllrlh....ullh,,.lnd on Form 1040,11.,9., ....,..
,. )., ~ t ! '. .. " I . "
'/1,.,. _ up/IJI/ pl. dlff1lbv",,", bvtd.riilf_ Sdt<<Iu/t 0 ,ortport .""_ ,.1..' or'Iou... """1OfJ' upilM,.ln __ on 'otM /010, 11M /4.
. . , . ',' '.
" '
,lit III If WOU '_1'" more """ 1400 of Inl"lIt or d','dend.. OR " WOU hili I ,or...... ICCOUnt or _. .
'IIIicn . . .. "anlor of, or .1"~'I!Of to, .Iorell/l lrun. WOU mUlt an.w" IIOIh qUllllon.ln Plrt III., ~; .
AccIInb .Ii f,'",,,, ,I " ,',"" '"n 1'-'"'\ ;'I~
.1Id 10 At Iny tim. durinc \hi \Ix yar. did' you hBvI 1.,.ler.lln or I 1~lu,. or oIhti luthorlly over'l "",'ne11I.
'1(1I.n . teCOunt In I ~ toUnlry (Iuch u . !link aceount. IlCUlitl.. ICl:OUIlt. or othtr "",nellll_nl)' (SM'
T'nII - "-C PIli 27 O' lhllnalrucllonlror,letpltooUnd fillnlrequl'tmlnll 'Of'orm TO ,go.22.1,) ",-,-,-.-,-,~
,Sot. ". II..Y..... enterllit'ntmtoflhl'OIlll11eou,;\Iy'. '.; ..(.!..'.: ..'. ;'..: ;':'! :.'..:::';,:J!~'~.': :..t:~..'.. ~~....~
.nltnlcIiont27) . ,': II WtI.you 1h'IfI"'cWO', 0,'11I.11_10, IfOrl111111U11 which UlatBddurtnclhl cur;ent tUYII,;Whelhlfor
..,... . ". h I elall."r \I.,ll1"Y ~. 35 r
'..r...........IlMuctllnActHIlla,_'_I04OlnWwIlont. ""0'''.''",11 "... "".,... ,0)"0 ScIl'....I.(r_104O)I..
":i<"'~
...'~'_.
SCHEDULE E ,_..._ Supplemlntlllncome Schedule .. OMI Nt,IUs.oo"
(form 1040)", .'; ~ ('rom r,"1I, royeltlll, partnINhl,.. lltalll,lrlllta,'UMICa, .Ie.) ~@88
Otptrtm..lofllltr_UIY .., .-. ,. ,. . A...."..'w'"10000'wm1041!'!'_I0::4IL., ,..- ~ 1'.'
11I\_"......._ CJI .IHI.llIructlolllforlcMi..I.'_UI40L ...." , l.ll
N.mIOI__"rotum . ," " . '. 'J A I 'owIIIiIIMMtly_
ADLEY -r. .. M IC!lrEJ..iI! II-. 3OfoJ ~I'i '" ...' '.', '.201 I Go j, .
R.nt,'.nd Ro altv Incom. or LOll Clullonl Your "nt.lloS$ m.v be limited. SH In,'ructlon"
I. In lhI'plCI provided 2 FO'lleIl 'Inlll property 111110, did you or I mlmbB, 01 your 3 For..eIl renlll "II ..lIl. prOjllrty Iillld
bilow, ,hOW Ihll<ind '.mlly Uti II 10' plllonll pUrpotlllor mo.. thin th, .,..t.. In 111m I, did you Ic1lvlly plrtlclpllll" '"
I"d loc:ation 01 .Ich 0114 dlya 0' 1016 or thllolBl OIYI ,.nllO 111.lr ..nlBl v.lul oparello. durl.. thl III 11" (511
renlllDIOPlrtY. durI.' Ihllll v.rl VII No ,".Iructlo"., \'. VII No
PIOPlrlyA ...l.'I:.;.,.....k!(.U.U:...;n,fl.f.p;...C.t!lttJf..HtM,.;rfA... " ProPlrtyA., , ,. :Jr
ProPI~y ~ ...~fl&.....~.....,~ffm.(~,T(J~...ttr.';r.ld.fCH.''J..f.f1.... ~ P'OPlrty ~, . ,. X
P,OOOITY r: . Pronartv c , .
Pro"'rll.. Tllail
. C (AdO ~um.. A. '. Ind C)
0:;7 ~ Fl r-..;" .. I /I, 131J 100
20 TotallJlplnMl otI1" thl. d'Procllllon... . '40.11 7.01
Ind d'pllllon. Add IIn.. 6 throuah 19. _ Of"
21 o.p,eellllon IJlpIIIIt (IH l.slNctlonl). ~. j 1+3 00
or O,pletlon (HlI! Pub. 535) , , . .
22 Total. Add """ 20lnd 21. .,.,',.... 77/'2. 74-
231"com,'0r-(10II) from ,.nIIl'or. -.-.-.....,;,...--;. .., , . .....-.-
rOYII!y proPlrtJl.,.Sublrlct 11"1 22' :~; '.' ri'3'/2.:"'~ "11o:.,,'~ '4:':~' .. ,'"' ,,. L.
. from 11".4 (renta) or 5 (roYlnlll) "'" . ,-r {j ILl ~ /
24 Otducllbll rental 1011, CllIIlonr Your' . . .
- "nllllou on IIn. 23 m'r b.llm;tfd:' ,. . . . .. ,.... .-- .- .. .-
..., Set Inltructlons 10 dlterm'n'lf yw- ...' .. -' . ," ..
__=J:::,:rr;,~z..~,':.!.~~~: 24 . ('Z31'l..7~ (/1/441, ..
25 . Proflll. Add ,,"lIllnd rO)'11ty p!olltsfromUnl 23, Enter lhltofll p'Oflls hi" , .', '",('r,- .')u, ,J j" 2i',. ,'"
26 Lo..... Add 'O)'llly 101M' from ""1 23 InO ..nttllo.... from II". 24. Enter lhltotll (Iou..) til" .:,',~',~. ( ~2. 7 2.11
~7 Comblii;;mou"tlo"'ilnll 251"d 26. Enll/thl "II olOf" or (1011) herl : ':"':'.;-\ :;.:':,,:.< :' :'." 27 't40'Z.1' .ti)
2...NIIII,m ,.nlll profllorI0ll1!0.1Tl!~!.'!!.483.5,,(AIIO.complltl PlrlVI.Unl 43,) .' .' _ ' . '.., "n'. ..::',:._:.. ,. ."....' )'~ .
2t Totll.."... or roy.lty Incomlo; (loss), COmblnl imOU"lS on 11,," 2".d 28. E"terlhltolll hi,.. II PlrII c..: ,rt:'.. ..,. . ~;~
.._..It, III,IV, .nd V 0" pili 2 do "Ol.pply to you. 1"IILthl Imounllrom 11"1 29 on,"olfl:l.1040. IIn. 18,1 C .," :(",~"'.:;..' ..l
. Othlrwlse IncluOlthllmou.tfromU.1291"lln'420"ouI2ofSchIOUI.E, ',"...., .,..,',,,,....' 2' :l+vZr %,..
,..PI,.,.., ______... 011... _ ,._1040 ...... i<.1<'./JU"JI11 0''') ill Dns ,II .1 ,n.'! olll~.,lcIlt<Iult.I('."" 1*) "'
R.nt.llnd RO~II~ Incom.
A
'50400 la,
4 R.nlS rec;llvtd
5 Rovlltill ,...lvlO
R.ntaland Royal~ bp.n..,
I, AllYlrIl.l"1 ' .
7 Auto ,"d IIIVI'
. CIII"lnllnd mll"lln,nCI
, Commission., .
10 '"IUllnCl . , .
11 Llpllnd other p,olllSlonal ""
12 Morllll' 1"11...1 plld 10 !li"k_.
ItC. (IH '"UNctlon.)
13 Other Inlt".I, .
14 Rlpllre,
15 Suppll.. ,
II TIX.. (Do "01 '"cluOI wl"OIIIl
p,ollt III h.re, Stl P,rI V.llnl 40,), ... I
17 Utilltlll. 17
II WIIIU"d "'1"" ' ,"
19 Othll(IIII). .............................
..
,
.
,-
.n
II
.24-~ 00
12
11
lA
..
!J72.~ ,It:;
4H~,1
,Q., <12.
..............................................
19
</<1 00
!S IIA<tR.
I
1$3
~21(J"I
5";:W,141
1'114- 00
7 141
/0108 it.i
5o!Ji 00
20
. ~ "
21
,', Profit or Loll From Bu.ln... ~.., .. ,: ::- ~ n ,
(Sol. Proprfetor'hlp) . , " ,.
d', I' I
, 'Irtnlrlhlp.. Jolnl VlnlU'" [tc., Muat fll. Form 1065, I
~:=(J) . .......'.'_1_,'.""1041,"'....1041.. . ...,_lfwlclltrl....C('_I04O,. :="'Nt.09
-~-(IIII) ,
"2/) .!50 fS~~
n PI ....
(from Plrt IV) .
D ....._'D_II..UIII)
C lUIIn.. .a",,"nd add"'~"" ..'..........,................................................, I
SCHEDULE C
(Form 1040)
'1]@88
I M,lhod(l) lIMd IQ Vllu. clollnalnvlnlOl'/'
u>OColI (I) o Iowll of COl' or mllhl (JI0 Olht'(lnlChI.pltnlllon) ,", ,
, Atcounll.. m.lhod: (I) 0 Cllh (I) 0 Atcl'\JII (II 0 OIh.. (lpocIf)) ~ ,"............................ ..~... v" N.
o W..th... Iny cht...l. dll.""I.I.. qUlntlt''', COlli, ot VIIUlllonl __ openlnllnd clOllnllnvonlOl'/I (II 'V.... InKh .llplonttion,)
H A.. you dtducllnllllptnlll fot bull.... u.. 01 YOU' horn.1 (If'V..,'_I.IINC''oollot IImlt.llonl,) " , , , , , , , , , ,
I Old you "1IIIltrillly PlrtIclPlII"I. Ih, OIItretloo oIthll bUll.... dun.. 19181 (I' "Ho," IH InllNCUona 10' IImlt.11on1 on 10"",) , ,
J II Ihlllchedul.Includ...lou, crodll, dlducllo., Incom.. otolhtr In benl'" "lall.. 10 I III Ihtrllf ,oqul,ed.o be rlllotlled, <hock h..., . ~ 0
IIvou chICk Ihla bol. YOU MUSTeltoch 'orm '171,
11IIII Incoma
I. G'OII...llpta ot "III ,,',"'"
_ Leu: Rltu,nllnd IlIowlnclI , , . , , , .
c Subtract IIn. Ib from linl II, [mirth, ,..ult hI", ','
I COIl 01 aood' told and/o, optlllllona (From Plrt III, IIn. 8)
3 Subl..clllnl 2 ',om II.. Ic Ind ..II' lh'lI_ Pfoflt h... ,
4 011I11 Incom. (Includlnl wI.d'"1I prolllltx eredll or "fUnd ,ocelvtd In 1988)
eo
0(.)
00
IIn 4, Th Illh 0 Incom.
11IIIII D.ductlonl
I Advllllll.., , , .
7 Bed dobll 'rom II," Of' IIrv1cII
(1M Inll,UCllooa), , , , . ,
I link IIrv1cochorpe :Jl.~ r il4 i It
. Clrond 'ruck Upt""~ ,ZJC '
10 Commllllona , , , , , , ,
II Otph.llon"""..,
12 OtptIClation .nd uctlon 179
dlductlon 'rom Ferm 4562 (not
Included I. P.rt III) , , , ,
13 Du.. Ind publlcollono , ;'"
14 [mplDY"benorltproplms ,
15 ,,"I&IIl(nol Included In Plrt III)
II Insuron.. , , ,
17 In'-': ,
. Mortpa. (Plld 10 b,nks, IIC,) ,
to Olhll, ,".'. , , , , "
II ' lIundry a.d C111.,nl ' , ,
1. Lepllnd p,olllSlontlllrvlcts i.
10 OHlco_.... , , , ,',,11,
II Plnllon, ..d prortt.ah"lnl pIoni I .
22 R n ulln... I
.
44{, I 00
13 Repairs, , , , , , , ,
24 Supplltl (nollncluded In Plrt III)
2a TUII, , , , , , , , ,
2a Trovel. milia, ,nd Inlortllnm..t:
. T"vel, , ,
to M..la Ind
..,ort.lnmlnl
c EnI.. 2096 of lint
26b lubltct 10
IImlllllOlll (SH
fnalnlctlool), ,
d Subtracllln. 26< from 26b ,
27 UtllIlI.. Indlll.p/lOnl, "
2"W18fI, ",',
bJobHrocIll , ,
c Sublrtct lint 28b 'rom 28<1 "
2. OIhtt"_(II;\II\IP"nd~nI)::3
....... .iJlI:tfJ.1.m~..j8.i?.
, ".
.....................................
..,................................
,
. . . . . ,'..~ "f .... . . " .. .: . . . ~. ',:~'::' ~ . . . . . .
...... ...... ,.... _o...~........
".,:,
....r.. ,II ..
10 Addlmounblncolumnsforllnllethro h29.Th"u,,'h.lol.ldeductfo.., , ,,: " " ': ,';.. JO
31 Hal Pfoflt or (IMo), Subtllct lint 30 '""" IInl 5.111 praftt,'.,ter htrl In<! on 'orm, 1040, lint, 12, Ind on ,,;; '.';.:3 ~;'';;'/'" ""
h u I.. .1111011 M T oo.!olln 2, FlcIucierltllHinSlrucllON, , , , , " ." 1 ''',',,'I'.:1fI~
12 -" yo. hi.. I lou, y"; MUST chtcJt'"" bOx ~:~b.'. ~'I~;m~.lIn Ih~ ICllvi~ (~i.I~;"; . ,:.} ,J20 0 ,~:'~ lilt nail.
I .....J..~".:',.:,."..." ..:~\.'" '..'I.:. n" ''',''': ~~~~I JZ..C]SoNiI.....liI....rtIl
_.. II you ch_ 321, onlllthtlotaon Form 1040.11..12. Ind SchlduIoSE.II.. 2, II you CIIIcllod32.b, yoU MUShlltCh '_1111...... " ... !I'"
'OI '''''-_ 1I...1lCl1on Acl HIIICe, _ '_104011IIInIctltItt. IcIlMuleC('_llMO) 1118
~:f ..
..::.
..
,'-'" loclallecurlty lelf.Employment Tax
ClMINo.I 4..
. 11@88
.J r., ,,~ . I'
,. , - . ...,IIIIructlIN,., IkllllIuIllI (,_ 10401.
. AIllIcIIIe'_ 1040.
/IIIIII11lCOI!lt (II lhown on 1OCIoIIIICUrtIy r;Ml) lIoclaI NCUItIy number 01 ponon
7;., :ToNES wlllll.".......-.I_.
"158"3
Who MUlt fll, Schedule IE ' . ,
Vou mUlt fil. Schedul. Sf: II: ., , , _
. Vour n.l..rnlnp from 1I1f..mploym.nt w.,. $400 or mo,. (or you had WII.I 01 $100 or morelrom In electllll church or
church orpnl.attlon); AND ,
. Vou did not hava wII" (Iublect 10 IOCIIIIICurily or r.llrOld r'llr.m.nt IIll) 01 $45,000 or mor..
'or mor.lnlormatlon .boul Schedull SE. "' th.'nltructtona.
Not.: Molt tUplY'rs c,n now us. th. n.w short Sch.dul. SE on this pIg.. But, you m,y h,ve to use th.lol'lpr
Sch.du/e SE th,t Is on the Nck.
Who MUST u.. the Lonl Schedul. SE (S.ctlon B)
Vou mUlt UII Section B If ANY of th.lollowlnlappll..:
. You chOOllthe "option. I m.thod"to fllUr. your ia.II..mploymenllax. See Secllon B. Part II;
. You ar. I mlnllt.r. m.mber of a r.lll1oul order. or Chriltlan Science practltlon.r Ind recllved IRS approval (from form
4311) nolto be taxed on your ..rnlnp lrom Ih...lOurc... but you ow. ..1I'.mplo~lnt lax on other earnlnp;
. You I....n .mployee ola church Or church ol'llnlzatlon that chOl' by law not 10 pay .mployer 1ClC1.llecurity lax..;
. You hlv. tip Incom. thlt II lubject 10 loclalllCurlly I.., but you did not report tholl tips to ~our .mployer; OR
. You Irl llOvernm.nlemployee with wales lubjlCt ONLY to Ihe 1.4596 m.dlcarl part of th. loclallecu,'ty tl..
S.ctlon A-Short Sch.dula 51E
R...d lboYt to ...,1 ou mutt u.. th.lo Schedul. 5E un the back 5ectton B ,
I Nllllrm proftt Of (ioN) from Schldul.. F (form 1040), IIn. 39, Ind firm PoIrtn.l1hlPl. Schldul.. K.1
('orm 1065),11'" 141 . . . , . . . . , , , , . , . , , , . . . . . . . . .
""l::) -
2 Nit profit or (IoN) from Schedula C ('o,m 1040). IIn. 31. Ind Schldul. K.l (Form 1065), line 141
(otIlBrthlnllrmlna).S"lIIIlnatrudlonlloroth.rlncom.tor.port , , . , . . ,
3 Add IInt1l1nd 2. Entlr!hl tolIl. 11111. tobtlll IeII thin $400, do notfll.lhlllchldul... , . . . .
. Th.. IIIINt lmount 01 combined WI'" Ind .."..mployment ..rnlnp subject to aoclllllCurtty or
.lIl1rOld,llfrementllll(lIIr I) lor, 1981 II, . . . . . . . . ',' . . ,. . . " . .
II ToIIllOCIalllCurtlywaPllnd t1pi from Forma W.2 Ind Ill1roed ,Ilfr.mlnt compeiutlon (tier 1) . . . .'
" ~ I'
. SubtrBCtlln. 5 from IIn... EnWlIIIreault. (If!h.,..ult Is zero or ,... do notfileIhIlKhedul..) . ',. .
~' ;11 J(l'. . 'I. '. ..;,; .' . '.,
7 EnlBrthlllllllll.0II1n.30rllnee.",.,... ,.' .. . .' .', .", '. "'C'.' "',' . , . . .
~ 1 . I -:", .'"" . . .
,_.11 line 711 $45.000. ,ntIF $11,859 on line 8. Oth..rwlae, multiply IIn. 7 by .1302 ond ent.rlh. reeullon
.. ...-... _. -.- -.. ~- .---. .. - .-.
. . IIntl.,.'. . . . . . . . .. .' .. . . . . . . . . . . . . . . . .,_ .":' ...
'-'-lC~uoa"":"
" ') .. ! 1',':011"+1"
. .-.' ,: _' ~ ',) ,:. ...... 1ch.lfult.I('....I04O)I...
. ,'" . j,"1 "'T'~ 1: '.I: (1' ;: ":.;;.! I'
a..il~~,i;C~).t'.:;-- .....
r...CJ':~h)(~;in~,j:h.~ 1,1.":' '.'! t'J',' 'J' "'. <.'i" .', 't._,rf',:..~rf;nolt~l)."'..,.",' ~l
':,':.;jJ:'('jr:~,(~::8: n. ,!,I~".,.'.(;'..,;.~'I... L':".'~: ".'1'--")." '/m~"'J~".'" "'~""',~,.
l'.:n')Oll,\ ,U .,n,1 t.,llnl....;.~) ~~t ,t:od: ~,r .. d,>.":) 'n:i.' '~11l ,J.H:>':f,oJ ~..;.~'t ~I..~~ '~~~~3,!?' 1~ ':,", ;,~;~t";a~'
, U,',lCdc:t: :I,"I...~'~. _":'"',~ !.,"
4MII:)II111nl 01)0' ",'01 ,., ,'IJI'o~ hA 'lolJ,)wb.R A1OtIlf114{6" 101
. ,.", ,
'I"
, '~,.I ,
'~.Jl'",
.........'
, .
I
r'
"'--"'~,"iI"
.' \
r,;
.. ',., ..,., "'" ..,,,,,
;:'-"'/(:,''':, "
'.' . - ':'. I".'" '
," L'~' .',',' ,', ','" '
I'. ';",,'" ";,$' I;' '
L; I;' ,b:~ ;:,4;: I- ' ,.-
, .. , ( W\ t I
II" ",' ,
;;;:,',Ill, ,] ]'(.
, , ,.,.!
.,'.. ~'J ' f
"
, It IlO .0
I~ '^
I ~ It 0 .
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1f.)Oint fttUI",IIJOU"', 'lilt ",m,.Ad InlU.1
M'c\...~~ A, 0
HomeICldtHl (num,* 1M .trlll). (It. P,O. boa.... pili 70' Intl,udlonl,)
1<' 1STif' 1U. ~
Cltr. town 01 poIt olllce. ltall and ZIP code. (I'. 'or'll" edd'H', ill PIP 7.)
~" ANlC'\&I.d! I 0'55
P,..ld.nllll .. DoyouwI.I$110aoI0Ihl.fund7. . , . , . . , . , .
[IKtlon C.mpll,n" II Inl relurn doel our. u.. wlnt 110 010 Ihl.'und7 ,
I Slnall,"",' , .. " ,~
2 Mlffled IIIlnllolnl ,tlu,n (....If ooly onl hid Incom.)
3 MIllItd f1l1nlllptlll.llluro, lnlll,IPOUII'1 1OC111....rlly .0, .bovt Ind '.110."" lit,.,
4 Hlld 0' houllhold (wllh qUllllylnl pI'lOn), (See pll' 7 0' In.tNcllon.,) II Ih, qUllllylnl penon I. you, child but noI
your d.pend.nt, .nler thUd', "1m. h.,.. '
a UIII I wid "wllhd. nd.ntchlld ...1 ..died .19 ,Set 70llnllrvctioo.,
II jijI Vou...1I IltomlOn. (Iuch II your peroni) con <101m you I.' d'll'.dlnl 00 hi. or h.. III 1!IM~
rolu,n, do nolcheekborc 150. But be Iuroto cheek Ihl boll on IIn. 33b 00 Pl8I2,. :nr.... J..:
b Ii $,ou..', . , , , , , , . . . , , . . , , , , , , . . , , . . ,
. D.pe.dl.ts: (l)C1Iotl (I) II... ",oIIor,.,...I', !2r"-
III_11II1t. IAlIIII,... ""-I h'1 1OdII."'lJ"" (1)1"'-. :r.:.-
o 2-
I
I
I
I
I I
d II yooao child didn't Uvt wllh you bulll cltlmod II your dtptndenl uncltr I pr.1986 11I_"", cIlIdl htrt .0
I Total.umber of...m 11001 clolmed , , , , , , , , ,
7 WII". ..'arl",lIpo, .Ie, (.tflch Form(.) W.2) ... . . . ,
It Tlulllllnllr"llncom. (.110 .ttlth Schlllul. 8 ,t 0VIf $400) ,
b Tu......pllnll'ttt I~ (III PII. 10), DON'T Includ. on IIn. 81
, DIvid..dlncom.(.IIII'itttchSChedul.Blto....'400), . . ,
10 T...bIIrolundlohlllllndloclllncomo 1ull,If Iny. 'rom_klhttlon Pl8l11 of lnatructlonl. .
II A1lmonyreellved. . . . . . . . , , . ,
12 BUllnlll Incorhe or (f...) (.tttch Schlllule C), , . , . , . .
13 ClpllIl..ln or (lOll)(.tttch Schlllule 0) , , , , , ,'. . .
14 ClplIII..'.dl.lrlbutlon.noIroportedonllnl13 (...pellII) .' .
la Olh....,..or(IotMI)(.tttchForm.791/ . , . . . . , .'. .
,III ToItllRAdl.lIibullona ... .1.J.II..l LI6llTuobll.mount(_PI8Ill)
,171 ToIIIpIIlIIonu"'...ultltl lJ.zaJ L17bTuobll.mount(__12)
,II Ron". roylltl..;partntnhlpl, ""IH,tNI". ale, (.ttacIISchIIIUME) '~l~..,,;, ; .. I. ..:'"
:,1' Fllml~~.~., <!-)('IfachSchlllul.~ .~~J ,\.r,u,OJI<lt,W... ',I~I\l)~\ljo,l"'J'\'I"'~"
20 u..m'lol'Jront~ponlltlOO(ln.uro.CO)(_""13)',f.: .' . '.....'" .! ., ~'.,". ;.~~
211 Socloliec~IiinIIIIa;:.....,121.1 I 2IbTuobII.mount(_PI8II3)
r22 Oth.. Incom.(lr.t typo'.... ,mount-lll pe.. 13) ............................... ............
23 Add Ih..mou.tllhown I. Ih. f.rr' t column 'Of IIn.. 71h,ou 22: T111111 , latalllICIlM .
124 You,IRAdlcl_1rom ,ppllctbl.worlIIhHton pili 14 or 15
I 'l"",'~I'" , "
25 SpoUIa'IIRAdtdiiCtIiln. f'omtppllclbll~taloo PI8Ilhll5
~ . "'l\lIb'\'W' ~ " ' , , ,,'.
21 Self,employld hIIiUlinlur.... dtd~. from wortIIhttI on..... 15
,27 " KtCeh ,1tI,i~tlit,..~ ,nd 1II1'.';p1oYid\~lP deducllon c .- .'.
,'D'jI~ J"\j
,21 Ptn'ltyoo..",WIlhd'IWllo'.,.vl"'l.~,:\", L, '..." ..",
,2' A1lrnonJ'pi~I.~"'etliM..t'lllIl.,lri. II',.', .
~..:" 'nd"~l.l~ecu~l'u~~. J, ':'~ I
I (TtlH.r until" "'."',.
AdJust.d, t. blroellln, om IInl ,hll 111OU'''' 11M .,...1_.1 Ih 11..11 ItIIrhtn
rOil Incom. .; ~; ,91=niI '''::"r:II'sr:''i ":,'E~n;:: ::om. ~T:r;~":.r:k,:'~ 20 0
Llb.1
U..IR51Ibt1,
Olh.rwl...
pili.. p,'nt
orlyp',
flllnl St.lus
Cheek only
onl boo, .
Ex.mpllons
(See
Inltructionl
00 P"I' B,)
II mort thin 6
dlp.nd.nll, ...
Inltructlonlon
PII' 8,
InCDm.
PI.... ItllCh
Copy B of you,
Form, W.2. W,2G.
Ind W,2P h...,
If you do nol hlVl
I W'2. I"
POllIo'
Inltructlonl.
'-
~'
PI....
Ittoch cht<k
or moolY
ord.. h"I,
AdJustm.nb
to Incom.
(See
Inltructlon.
00 Pili 14.)
L
.
.
.
L
M
.
M
.
T
UNn"",
~,,'" &oS
,19 I OM' No. 1541;'
1...__..._ , I
I 201150 i 15'.3d
.,.....1- .......,_
I ,.,3 14'. 1.23/5
I
\ For Prtvaq Act 11II.
PIDII'WOI'II "...ctIon
Act Notice, _
In.wellon..
La" "am.
Ij>t,no,
No tMtec CMc*1nt "YH"'"
N 1IDI........_""or
o ' rwdiI<f .-lund,
.......1
=-=..
I 1hM.. III d.-
I ..........
=~
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..
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.....
'''''',454
,
.
".~..'.
...."1.
'"
'DIm 10400Ht
32
.,.
,..
Compu.
t.tlon
Credits
(S..
Inltruclionl
on P"I' 18,)
Other
,....
(I.cludlnl
AdVlnCl [Ie
Plym.nll)
M.dlcare
Premium
'.rm.nts
AU.ch Forml
W,2. W,20.
Ind W,2P
lo'ront.
R.fund or
Amount
You Ow.
Slln
H.r.
(K"p ICoPy
of thiS ,.turn
tOt your
records, )
Plld
''''11I1''
U,.Onl,
I,'ot,', "'"
.tl'~;~,j
,.
,~OIIntlromll.131(ldlulled,,01lIncom.), ",'.'. "..,!,. ,<' ..
ChICk II: D You wo" 6&01 old.. D Blind; 0 a,.u.. "'.. 6hroldtt 0 Blind.
Add Ih. numbtrof boulChlCk.d Ind .nl.. Ih. 10111 h.", , , , , ,I , ,'..
( . I...
_ II tomton. (.uch II you, pII"nl) c.n clllm you III d'll'nd.nl. cheek hili, . ...
, '
. I' you '" mlrrled "lIn. I IIPIlII' "turn Ind yuu, IPOUII It.ml,.. deducllon..
Ofyou....du.I,llllullll...I..pll.16IndehlCkher., . , . . .' . '.' ~ lieD.
34 [nltt Ihl { . Vou, .11...'. .,.u'llo.llrom P"&' 1701 Ih.lnllruetlonl). 0" }
...... '. You, Il.mlll. ....ucllo.I(I'om Schedul. A, IIn. 26), ',H . ," ,> ,l,~"
0': II you lI.mlll. IlflCh Sch.dul. A Ind chICk h..., ,. D
Sublrocllln,J41romllnI32,[nl..thIIlIUllherl, , , , , . , , .. .,. . ','
Multiply S2,000 by Ih,'olll number 01 ..emptlonl c1llmed on IIn. So, '. .", '
TI.._III..oml. Subl"c1l1nl 36 I,om IInl 36, Enl..lh. "iull (I' 1..1 Ihln llro, 1.1.. '''0) , ,
!:aullo., II und....114 I.d you hlV' mort Ihln $1.000 0' Inv,,'m.ntlncoml. chICk h..e . D
Ind "'PII.1710 III II yOU h.Vllo UI. Form 8616 10 IIluroyour III,
31 [nl..llI. Checklffro,n: .jNTII Tlbl., _ D TII R.I, Schedulll, or . D Form 8616,
(lftnylllromFo,m(I)8814..nl..lhll.mounlhe".. I ,)"
Addltlonlllll.I(IIt. P'II IB), Check Iff,om: I D Form 4970 _ 0 Form 4972
Ad IIn Ind, [nl..lh. 101.1, , ,
Credll lor child Ind depll.d.nl eer. llpon..1 (,"tch Form 2441) 4
Credit for th. .Iderly or Ih. dlubled (,IItch Schedul. R) 42
For'l&n III credll ("ttch Form 1116) , , , , , , 41
0,,",1 bUllnll1 clldll. Check II from:
.0 Form 3800 Of _ 0 Form (,plClly)
Credll for plio' Y'" minimum III (,'IIch Form 8801)
Add IIn.. 41lhrou&h 46, [nlorlhe 10111. , , , ,
Subtr.ct IIn. ~6 from lin. 40, Ent.r thl r.lult (if 1.11 thin z,ro .nt., "ro
Stlf,.mploym.ntlll ('"tch Schedu', SF.) , , , , , , , ,
Mttnotlvo minimum tax (."tch Form 6251), , , , , , , , , , , . , , ,
Reelplu" '"111 (III Pili 18), ChICk Iff,om: 10 Form 4265 _ D Form B6\1
Soclllucurlly III on tip Incom. nolllported 10 .mploy.. (./ltch Form 4137)
T.. on I. IRA Of I qUllllltd "lIl1menl plln ('lItch Form 5329) ,
Add IIn.. 47 Ihrou 52, [nlorlh.lolll , , , " ,,','
Supplem.nlll MediCI" promlum (,lItch Form 8808), , , , . , ,
Add lint. 53 Ind 64, Thill. ou, 10111111 Ind.n IU '.m,nlll Medico" IImlum
Ftdt"lIncomlll. wlthh.ld (1Ilny I. "om Fo,m(l) 1099, :heck . D) 51
19891111011Ied... Plym..I. Ind Imounl ,pplled from 1988 "turn 57
[o,ned '.ComICrtdlt (II' PII' 20), , , , , , , , " 5.
Amounl plld wllh Form 4868 (1I1.nllon ,oqulIl) , , , " 511
[0(... IOClllucu,'1y III Ind RRTA III wlthh.ld (IH P"I' 20) 60
Credit lor Fedlllllll o. 'u,'s(,tllCh Form 4136) , , , 61
RflUleled Inv..lmlnl com pliny credll (.,ttch Form 2439)
Add II... 56 Ihrou 52. Thill III our 101.1 I m..I.
II IIn. 63111"1" Ihtn IIn. 55, e"ler Imounl OVIRPA'D ,
Amounlo' IInlB4lob. "lfUHD[DTOYOU ' , , , , , , . , .
AmOllnlollln.B4lobtAPPUIDTOVOU" IllllOISTIMAUDTAX ~ I B6 I
IIlIn. 65 1111I1..lh.n II., 63, enl.. AMOUNT YOU OWL AlIlCh chICk 0' moo.y order 10' full
.mount pl~.bl. to "Int.rnll RevenuI Servlcl." Writ. your lOCi,1 seCUrity number, dlliy1:lm. phon.
numbt'.lnd"19811Forml040"onll""""""., ,,," '...
iI Ptnlll 'orunder I m.nl 01 IIllmllld III (s.. P' .21), , ,
31
31
n
4'1t1J DO.
-a -
3ll
4
41
42
41
44
tJ
44
4
4a
41
47
4.
4t
ao
al
52
51
a4
II
II
a7
II
51
60
II
12
63
M
15
II
17
-() -
Under penilll.. of perjUIY.1 dlCl.,. thlt I h,v. '1lImlned Hu. r.turn Ind .ccompanY'"1 Khlduln .net ,I,I.ment., .nd to thl bett of my knOwltdp end
belllf, IMy.... truI, correct, Ind mplt'l. Otcllr.llon of prep,,,, (oll'l" thin 1.IPlYtf) I' Oiled on .lIlnform,tiOn of wnidt prtplltr M""1 Iulowlldp. _~ 10t \
~ Your I' tI O.t. Your OC(UPltlon ' ,
"I
I~ ".' "
~ SPOUII', occupelion
rIP.r.t 'lOCI' Mcunly no.
o.t.
Prepare,'.
Ilan.tur.
",m',n.m.(or ~
your. I' HIf..mploytd)
.nd .deI,",
Check I'
1.I"lmplow.d
UNo,
ZIP cod.
\
I
~
,...-....,..
.U,I. lIov.,_", "III"",O"t"l
:1
"
SCHtDUUS A.S
('orm 1040)
Dtpattm.nl 01 lh. rfl.ll,try
Inl"".1 RIYMU.lSerYIU 10)
Schedule A-Itemized Deduction.
(~chldull III 0" back)
. Alllch 10 'o,m 1040. . S..lnllructlonl'or Sch.dulll A Ind I (hIm 1040..
Nlmo(".ho>ononr..m 11)010
,,,. ,BtclrOL.; ., Mf"""U.1It A :JONES
M.dlc.llnd .. Plllerlptlon medlclnll and d,ugl, Insulin, doctors, d.nll.ls,
O.nlll [Ip.nlll nUIIII, hOlpll,ls, medlclllnlu'lnco premluml you paid, .Ic, ,
(Do nollnclud. b Olher, (lilt-Include hurlna lids, dentu/II, eyes'on",
..p.nlll IlInlport'tlon end lodging, elc,) ..,.....".,."".",.,..
"Imburlld 0' .. .. . .. .. .. .. .. . . .. .. .. .. . . . .. . . . . . . .. .. .. .. . . . .. .. , . .
p.ld b, olhen.)
(See
Inltructlons
on po.. 23,)
T.... You
'lid
(See
Instructions
on PI.' 24.)
Inllllll You
,.Id
(SI.
Instructions
on pile 24 )
,..
GUll 10
Chlrll,
(5"
In.tructions
on po.. 25,)
Cllulll,lnd
Th,lt LOlm
Morini
(Ipenlll
lob [Iplnm
and MOil Olh.r
Mllcellan'OlII
D,ducllonl
1St. pI.e 26
or ..p.nslI to
d.ducl her.,)
Othll
Mllcelllneous
D.ducllons
Tola' Itlmllld
D,ducllons
......................................................
2 Add the Imounls on IIneala ,nd Ib, Enler Ihelotsl here
3 Multiply lhumount on Form 1040,IIne 32, by 7,596 (,075) , ,
4 Sublllctllne 3 from line 2, "zero or-,!~s,.2!'!t' ,0" Totll medico I and dent,l
II Slolund locollncomel,.es ' , " II
6 Rul IIt,la tl.II, , , , , , , , , , , ,
7 Other tl..., (L1.t-lnclud. per.onol property IOMes,) . .".,..
I Adcj ihe 'imou~'ti 'on .li....5 5' ili;.;u..ti i,' E~ii; ili. 'loiel' hi;.:' , ,. I
91 Deducllble home mortgagelntere.t (Irom Form 1098) that you
peld 10 t1nanclalln.tllutlon., Report deductlbl. points on line 10, 91
bOther d.ductibl. homa mortglge Interllt. (II paid to an
Indlvldu,l, show that perlon'. nama and addrels,) . ..,......
.......................................................
10 Deductlbla polnls, (Seelnslructlons for special ruin), , , ,
11 Daductlblllnvlltmenllnter..t. (See page 25,) , , , , , ,
121 P,"onallnterestyoupald,(Sertpage25,) , 12 32.';0 ~
b Multiply Ih, ,mount on line 121 by 2096 (,20), Enter the resull, 12b 0
13 Add lhl amounts on lines 91 throu h II and 12b, Enler Ihe lolal here, Tol,llnlerut.
14 Contributions by elsh or check, (It you 118ve $3,000 or more to
any ona oralnlzellon, Ihow to whom you gave and how much
you gave,) . ...........,.....................,.......
15 Other lh,nCllh orcheck, (You must attach Form 828311 over $500,)
US Ca,ryover from p,'o,yea, , , , , , , , , , , , , ,US -~
17 Add Ihe ,mounls on IInasl4 Ihrou h 16, Enter the lotal hare, Tolll contributions, .
18 Cllualty or Iheft 10s5(lI) (attach Form 4684), (See page 26 01
Ihelnsl,ucllons,), , , , , , , , , , , , , , ,
19 Movlna .xpenses (attach Form 3903 0' 3903F), (See page 26
otthelnstructlons,). , , , , , , , , , , , , ,
20 Unrelmbursed .mployee e.pensel-job I,avel, union dues, job
education, ele, (You MUST Iltach Fo,m 2106 In some cases,
S.e Instructions.) ~ .................................... 2
21 Otha, e.penses (Inveslm.nl, lax prepa,atlon, sale deposll box,
etc,), L1sltype and amount. ............................
21
22
22 Add thean1ountson IInll20and 21. Ente,lh.tolal, , , , ,
23 Mulliply lhe amount on Form 1040, line 32, by 296 (,02), Enler
Iheresull hare, , , , , , , , . , , , , , , , , 2
24 Sublracllln. 23 Irom line 22, Enle, Ihl ,esult. It zero orlell ante, .0- ,
25 Olh.r (from IIs1 on page 26 01 Insl,uctlons), llsllype and amount .
OMI No, I~S'OO74
1~~~7
'i,wr ..,., MCwlt~ It""",
~" I 50 lUg"
.
215 Add lheamounls on lines 4, 8, 13, 17, 18, 19, 24, and 25, Enter Ihllolal here, Then
.nler on Form 1040, line 34, Ihe LARGER 01 this lolal or you, standard deduction
from plge 17 ollhe Insl,ucllons, " ",'."" , ,~ 1./
'or PlplI.llk R,ductlon Acl HoIiCl. I" 'orm 1040 Inll,ucllonl. Sch'dul. A ('orm 104011'"
I '("J nil,) 'I'
"",,' " '."V"
.~.. " J.
. .\:, I,
1-,1
khtllullllillt'"m 10.01111'
N.meC.t) Wwn on 'otm aCMO (00 nol,nl" M,m. .nd &~I.I'''UIIIV numbtt I' ahown on Qlhlt ,ute )
aMI No ".& 0074 PII' 2
hu, 'eelll '.CY,ltr nymH'
,,,tl
Int"lll
Incom.
(S..
Inllructlonlon
PlltllO Ind 27,)
Hol.. If you
'tc,'vod I Form
1099,INT or
Fo,m 1099,010
from I
brokerll,'lrm,
1Illlhlllrm'l
".m"1 the
pIV" .nd ,nt.,
lho 10111 Inllllll
Ihown on th.t
'orm.
,.,tll
Dlvld.nd
Incom,
(SH
Instructions on
PlltllO Ind
27,)
Hol.. "you
reCIIVld . Form
1099,OlV from I
broker'a' firm,
1111 Iho II,m'l
".m"llh,
pay.' Ind .nt.r
lhelolol
divldendllhown
on Ihlttorm,
Schedule B-Interest and Dividend Income
AII,chm,nl 01
Sequ.nu No.
If ~ou 'Icalved molt Ihln '400 In I...bl. Inler..1 Incom., you mUll compl.l. 'Irtl I .nd III. L111 ALL Inl"lll
r.cllvld In PI,t I. If you "celved, II I nomln.., Inl,,"llhll .clullly belon'l 10 anolher pinon, or ~ou "calv.d
or p.ld Icc,uld Int,,"t on IIcu,llllIlronlfer"a bllw..n In II rill pl~mont dll.., "' PI" 27.
Inlerlltlncome
I Inler'lllncom. f,om I.ller,fln.nced mo,tKIKII, (5.. Inllrucllonl ,nd lilt nlm. 01
plyer,) ~ ..........................."....."".."..........,..,....
2 Olher Inlerllllncom., (LIII namlOf p.ye,,) ~/' ~',':'."'" """..""" , ". ,..
...,...........,............,',..... .I.T.;RA.IW').," ~;Y!.I'18,~",.,....,
. . . .. .. .. .. .. .. . .. .. . , , .. . .. . , , . . . , .. P.lt:f.( tI., . . . , , . .. . . .. . . , . , . , .. .. .
Amount
I
1'2-
.......................................................................
........................................................................
.......................................................................
.......................................................................
2
.......................................................................
.......................................................................
.......................................................................
.......................................................................
.......................................................................
.......................................................................
3 Add.I;,~.~,;,~~...I~o.n.li~~~ i'~~d i 'i"te; ;hi.toi~l.h~r~.~~d on Fo;';" i640' ii;'~'8~:'. 3 2. ..,
If you ,",Ived more Ihln $400 In Iroll dlvldondl .nd/or olher dlll,lbullono on Ilock, you mUlt complelo ,.,11 II
.nd Ill. If ou rec.lved, II I nomln.., dlvldendllh.l.clullI b.lon lo.nother erlOn,... I .27.
Oivldend Income
4 Olvld,nd Income, (llll name 0' payer-Include on thilline capital Kaln dlllrlbullonl,
nont,x,bl. dlllrlbuliorl, elc,) ~ ..,........,....,...................'......
..............,....".......,... J/)~....".,.,.,.,...."..,...........
Amount
. . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................................
.......................................................................
.......................................................................
.......................................................................
.......................................................................
4
.......................................................................
.......................................................................
.......................................................................
.......................................................................
5 Add Ih..mounls on IIna 4, Enlerthelol.1 here , , , , ' , , , , , ,
e Clpilal Kiln dlsl,lbutlonl, Enler here Ind on Schedule 0., , ,
7 Nontaxabl. dlslributlons, (5" Ihelnllructlons for Form 1040. line 9,)
. Add th, .mounts on IInll 6 and 7, Enle, Ih. tOlal here, , , , , , , ,
9 Subt,acllin. 81,om IIn. 5, Enler Ihe result here Ind on Form 1040, line 9 , , ..
.If you rlcelv.d tlpi"''llin distributions but do not need Schedule D to report Iny of her "ins or losses. .., the
Inslr/Jct/ons for form 1040, IIn",13 and 14,
If you recolvod morl Ihln '400 01 Inter..t or dlvldondl, OR II you h.d . lorel.n Iccount or wer. .
.rlnlor 01, or I trlnllero, to, I foreign Irult, you mUII.n.wer bolh qUllllonlln ,.rt III.
'.,tlll
Fortlln
Accounts
.nd 10. AI.ny lim. du,'nI1989, did you hive an inlerlllln or a slgnatur. 0' olher aulhority over .lin.ncll/ ICcounl
FOrtlln In a fOlllan counlry (such 81 a b,nk ,ccount. SICu,,1111 accounl, or olher fln.nciallccounl)7 (See P'K' 27 of
r,usts Ihelnllrucllonllorexc,plionsand IillnK requlrem.nts for Form TO F 90.22,1.), , , , , , , , ,
(Ste b ""VII," .nler Ih. name olthe 'oreiKn country. ...........................................
Inll,ucllonl 11 Wer. you the K,.nlor of, 0' Ir.ns'.ro, to. I forerKn trust Ihll .xlsled du"nK 1989. wh.lher 0' not you h.v.
on P"I' 27.) Iny b,n,flcllllnler'llln 117 If "Yes." you may have 10 III. Form 3520, 3520'A. 0' 926, , , , , , ,
'or ,.,.rwork Roducllon A" HolI..,..e 'orm 1040 Inll,uctlonL Schodulo. (Form 1040) 19It
_u,s, COVUnIIlllt ',IIIUII,O"I<:.. ""'H'.IU
Nrm "" S(,~
Se4,JII/, "e'
5~htdUlt i 'Std?cf? 117 ?f()pt.r/y
b~JCA;ft;~(1 J/lk 11""J /~ flrv,'u (bsf ~/t{'1,J 6sr
-, - ..........,---
~<\> 1'0 C...... K<y..rJ ~ 1/29/61 1'18o,tJo IfS4.()()
>>~J Cil se.
MiJisf"r ftJ~I$
t<'yboJ,J ~r'flJ oj ("5~ 4/4181 f!J 3. ~o n,cso
Ch,ir 2jzlj/e9 110.00 110.00
~ I,chon i, C~~l,.s 1201'/81 18 ~1 ".'7
R"'fr1 t'M~:J1~ ~I ~ 1~1 45,00 45, ~d
~8 3dO AMp "IZ~'S1 414,15 41J1,1'5
- -
~ " 1$ ,. S~ Iii". 5"4
8rM~'~Y r. fOIol&r5
'X~, "a"
ilIIII D.pr.clatlon (Use Part 11/ lor aUfomoblles, ce,faln other vehICles, computers, and prrJperty used for entert.:!;nment,
recreation. or amusement, )
S.cllon A.-[llcllo. To bp...1 D.!J!!!cllbll AII,II (Slcllo. 17.
I Mlklmumdollerllmilltlon , , , , , , , , , , , , , , , , ,
2 Tol., COlt of leellon 179 prop.r1y pl.c.d In service during Ih. I.. Y'" (III Inl!ruetions)
3 Threshold COil of leellon 179 prop.r1y before reduction In IImltltlon , , ,
4 R.ductlon In IImltltlon (Subt'lcllln. 3 from IIn. 2, but do nol.nler 1.11 th.n ,0,,) ,
S 00111' IImlt.llon 10' Ilk Vllr (Subt'lcllln. 4 lrom Iln. 1 , but do nol .nterlmthln ,0"
(I) 0'1('11)11011 of ptoptrty (b) 0.11' pllt.d In "'YIC' (c) eQlt
,,1m 4562
Depreciation and Amortization
Dtpartment oJ th, rre.lury
Inll,n" "'VI nUl 5MYIC'
Nlml(l) .I.hown on retu,n
. S""'"lItll.lllucllon~
. Alllch Ihll lorm to you, ..IUltI,
IUlln'" 0' .chy11r to ""hlch Ihl,'OIm ,,1,111
e
7 L1st.d properly-.Enler Imounl from IIn. 28 ""
. T.nt.tlve deduction (Enlerth.llller of: (,) IIn. 6 plUllln. 7; or (b) IIn. 5,)
. Tlubl,lncom.llmlt.tlon (Enlerth.llner of :(a) Ta..ble income; or (b) IIn. 5) (see Inllrucllonl) ,
10 CI,ryoverof dls,lIowed deducllon from 1988 (se'lnstructlons) , , ,
n S.ctlon 179 .xp.nse deduction (Enterth. lesser of: (I) line 8 plus line 10; or (b) line 9,
12 Ctrryoverof dlllllow.d d.ducllon to 1990 (Add IInll81nd 10, I~ne II,), , ~ 12
S.ctlo. B.-MACRS 0, "cllllo.
(I) CI.u.he,lIon 01 prOCUrty
. 3.y.., prop.r1y
b !I'y'l' p,operly
C 7 'y,er prop,rty
d 10,y'" prop.rty
. 1!I,yeer prop.r1y
, 20.yeor property
I Rllld,nllll "nlll prop.r1y
27.Byrl. MM
27.By... MM
3I.h... MM
31.By... MM
laced In s.rvlc. ONL Y durin
h No.rllld,ntlll rill prop.rty
14 Altern.tlve D. "clition S st.m ADS
. Cllls UI.
b 12'Yllr 12 Y",
C 40. .Ir 40yrl.
IS Llsl.d proptrty-Enler Imounlfrom IIn. 27 , . , , , , , , , , ,
II GOS Ind ADS d.ductlons lor IISttS leeed In s.rvlce belo" 1989 (see inltrucllonl
S.cllon C. ACRS ..d or Olher D. "cllllon
17 Prop'r1)'subjocllo soctlon 168(1)(1) .Iectlon (see instructions), , , .
I ACRS Ind or other d. reclltlon Sll Inslructlons " , , , , , , , , ,
Seetlon D.-Summl
It Tol., (Add deducllons on IIn. 11 ,nd IInls 131hroulh 18,) Enler hire Ind on the ,pp,op,I,I,lIn" of
your retu,n (Plrlnershlps Ind S co,polllions-s.. instrucllons,) , , , , ,
20 For IIsttS shown lbove Ind pllced In service durlnllh. eurr.nt y.". enter the portion
oflh. b.slllll"bullbl.lo socllon 263A costs sltlnsl,uellons , , , , 20
'or '."..ork II.ducllo. Acl Nolle., "' '11' 101Ih.llplIll".II,ucII0...
MM
SIL
SIL
SIL
SIL
,.. ..rb
SIL
SIL
SIL
15
16
OMIN.llnol12
J!~IP9
1".ltI~I.. .._
Ze",. 'So.tf~8.!
(I) O~'.CI.tion d'ductlon
Innln in 1989
II
'orm 4562 (1989)
SCHEDULE D
(form 1040)
Capltel Gain. and Lo....
(And Reconciliation of Forml 1088.B)
. Alloeh 10 Form 1040. . a..ln,l,uello.I'or SchMUl1 D (Fo,m 1040).
. F.. mll..,lel to 1I111"nllell.n, flllln.. 2..nd ,", 1'1 Ichodull D.l (Film 1040).
OMlNo,IIIUOO'.
Otjlt~m..t 011/10 r....ury
1...'..I~..........1cO 101
N_.)_on'..ml~O
'lI@89
AttodImlnl 12A
SIQ~MI No.
UI ::JO .-5 ,cH,lI ;!ONE'S
I Report he.. Ihllolelul" 0' Ilocko, bond" .Ic" "ported fo, 198910 you Qn Form(,) 1099,B or on en
oqUIVII.nllub,lllulellol.m.nl(I), If Ihl, Irnounl dll(." ('om Ihelolll of IInea2c Ind 9c, column (d),
Ilteeh 111.I,mlnlex Illnin the dIH."nce, S"lhl Insl,uclionl (0' IIno I (0' ,Xlm I" , , , , ,
hort. .rm Ce Itll Olin. .nd LO..II-A...tl H.ld Ona V.lr 11! L...
(Il OIIcriptlon of ~ (4' 5.111 pnet I'" (t) Cc>>t Of other
(lHmDf., 100 Miltt. 1" ' bllIl (,..
f.fTtlClof'z'Co. (Mo"d.y,~,) (Mo.,d.y,..,') In,trycllonl tnllNctlonl} lublr.CI(d "om(1
21 Slock londl Ind Olher Soeu,llI.. Includ. III Fo,m 1099.8 Irln..e1lon,. S,,'nll,uellonl.
I
b Amounll f,om Schedul, 0,1 line 2b .lIlth S<hldul. 0,1
2e Tolel Idd column d Q' IInet 2aend 2h, ,~2e
2d Olher Tlln..ellonl ('nelud, R.II [11111
Tllnuctlonl F,om Forml 1099.5.)
Short.lerm pin from "I. orlxchang. of your home ',om Form 2119, line 81 or 14 ,
Short.lerm pin from Insl.llm,nl Slles (rom Form 6252, line 22 0' 30 , , ,
N.llhort.lerm pin or (lOll) (rom pertnerships, S corporllions, and flduclerios,
Short.lerm clpllllloss carryover , , , , , , , , , , ' , , ,
Add III of 1I1,lrtnllCllons on Iinel2" 2b, Ind 2d Ind Ilnll 3 Ihrou&il S in columns (I) Ind (I! '
N,llhort.lerm Iln 0' lOllS, combine columns 1 and of line 7
Lon .Term Ca 1..1 G.lnllnd LOIHI-A..etl H,ld MOil Thin On. V.lr
91 Stock.. 80nd" Ind Other Seeurlll'l (lncludl.1I Form 1099.8 Irln..e1lonl. S.. 'nltrucllonl.)
9b Amounll from Schedulo 0.I,line9b(,ttlCh S<hol,~ 0,1) ,
9. Tot.. Idd column d 01 linea 9..nd 9b, ,~9c
9d Olher Tllnllcllon. (Include ROI' [olalo
Tllnuctlonl F,om 'ormll099.S.)
10 loog.larm pin (rom III, 0' exchange 01 your hom, from Form 2119, lin. 8a, 10, or 14,
U lon..lerm ..In lrom Inslalim.nl salos I,om Form 6252, line 22 0' 30
12 N,t lon..lerm pin or (lollS) from pertnerships, S co,poralions, and fiduciaries ,
13 Capllll.aln dlsl,lbulions, , , , ,
14 [nl....,nf'omFo'm4797.lin.70'9 , , , , , , , , , ,
15 lon..II,m cepllllloss el'ryovar , , , , , , , , , , , , ,
I' Add III of tho trlftllCllonl on lin.. 9a, 9b, and 9d tnd lin.. 10 Ihrouah 15 In colum.. (I) Ind (I!
17 Nellon .I..m In 0' (loss . combln. columns (t) and ( )oflln.16 ' , , ,
For '",orwork IIMUctl... Act HOIIcI,..O Form 1040 In,I'uetlonL
.
~ttlChmtnl
2
.. Summ.ry 0' P.rt, I and II
I' Comblnl IIn.. I end 17, Ind Inl" Ih. n.1 pin or (loll) hi", II "lull II I 8Iln, Ilop hire Ind 1110
InltrlheplnonFo,ml040,lIn.13,lIlhtrflUIlIIl(101I),100nI0IlnI19, , ' , , , , , ,
It II IIn. 11111 (1011), .nl" herund III (1011) on Form 1040,IInl 13,lhumlll., 01:
I rhe(IOII)onlln.ll;or
II ($3,OOO)or,IIrnarrildllllnau.parll.r.lu,n,($I,eOO), , , , , , , , , , , , , , , ,
Not.: Whe/l lI/IIIrl", wlr.ff1., '" or J 9b I. ""."", tre.' boflr numbe" II II th.y.re poIltlvt.
Go on 10 P.rt IV II Ihlloll on IInl 1811 mOrt Ih.n $3,000 (Sl,eOO, II m.rried flllnl.llplrlll rllurn),
OR II luablllncoml on Fo,m 1040,IIno 37, II zero,
.. fl.ura Vour Capltll LOll Cllryov.rl from 1919 to 1990
Soellon A.-F' Urt Your Clr ov., Umll
20 [nl" IIUbl. Incoml or 1011 from Form 1040, IIn. 37, (II Fo,m 1040, IIn. 37, Illero, "I Ihl
Inltruellonllor th. Imounllo .nl".) , , , ' , , , 20
Notl: '01' 11/1112 J Ilrroui/r 36, frlll./I .mount. II poslll..,
21 [nl.,lh.lolllhownonlln.19, , , , , , , ,
Z2 [nler Ih. Imounllhown on Form 1040, IIn. 36
U Combln.llnll 20, 21, Ind 22, II zero or less, enler ZIIO
24 [nt., thl Imllllr 01 IIn. 21 or IIn. 23, , , , , ,
S,ctlon '.-FIIUrt Your Short. r.,m Clpllol Loll Clrryov"
(Com~j.lllhllllcllon only If th.r.ls I 1011 shown on IIn. 8 and lin. 19, Olh.rwlll, 10 on 10 S,cllon C,)
Z5 [nler th.losllhown on ""1 8 ' , , ' , , , , , ,
2' [nl., thl pin. Illny, shown on IIn. 17
27 [nl" th. Imounllhown on IIn. 24 , ,
21 Add linn 261nd 27, , , , , , , ' , , , , , ,
2' Subl,BCt IIn. 28 from line 25. II zero 0' lell, enler zero, This II you, Ihort.l.,m cepltelloll ce,ryov.,
from I'" to 1'10, , , , , , ' , , , , , , , , , , , , , , , , , , , ,
Slctlon C.-F1IUrt Your Lonl' r.,m Copll.1 LOll Cerryover
(Complelelhl, stcllon only II Iherels 11015 shown on IIn. 17 end line 19,)
30 [nler IhlloSllhown on IInl 17, , ,
31 [nl., tII. pin, lie ny, Ihown on line 8, ,
32 [nl., thl Imounllh~wn on line 24 , , , 2
33 [nler tII. Imounl,lI Iny, shown on IIn. 25
34 Subl,ect IIn. 331,om IIn. 32, II z.,o or less, .nler z,ro
35 Add IInll 311nd 34, , , , , , , , , , , ,
3' SublrBCt IInl 35 lrom IInl 30. II ZltO or less, enl., zero. This Is your lonl.lllm cepltlllOll Clrryovlr
from 1.ltto 1110 , , , , , , , , , , , , , , , , , , , , , , , , , , ,
Compl.te Thl' P.rt Onl~ II You [I.ct Out 01 the Instlllmlnt M.thod and
Report. Not. or Other Oblllltlon at LIIS Than full FacI Vllu.
Check h.rell you Ilect out ollhl Inslollm.nl m.lhod, , , , , ,
[nl., the flcl Imount ollh. noli orothll obllptlon, . , , , , , , , ,
[nl., the rClnte. of Vllulllon ollho not. or othll obll lion , , , , , ,
Reconcile forml I 99.B lor Blrt"ln. rrensactlon,
(Complele Ihis part II you received one or more Form(s) 1099,6 or an eqUivalent
substllule slalemenl(s) reporting bartering Income,)
40 Form 1040, IIn. 22, , ,
41 Schedul. C (Fo,m 1040) ,
42 Schldul. 0 (Form 1040) ,
43 Schedul. [(Fo,m 1040) .
44 Schldull F (Form 1040) , ,
45 Oth., form (ld,nllfy)(1I not lllllbl..lndlc.le reason-anach Iddillonal shttlllf ntcflSlry) ~ .... .....
, , , , , , . ~ 0
~
~
Amount of blrtlllnllncom.
',om Form 1099,8 Of
oqulv.lont II.tom.nl
reported on form or Khedul.
............................................................................................................... 45
4' rOllI (add IInll40 Ih,oulh 4e), , , , , , , , , . , , , , , , , , . , , , . .
Note: TIr. .mount on 11M 46 .Itould be Ih. 11m. II fh, fot.1 blrttrln,lncom, on .11 'orl'M J 099-8.nd It/ulVlI.nf .ttt,m.nts r...lved,
.U.I,COVlIIJIU.'" '1t1"JlItIf Q"IU""'4US-U,
SCHtDULIE IE Supplementlllncome Ind LOll OMI No ISUOO1l
(form 1040) (',om ,..... ,0vIIU... pI,I.trlhlpl. 111111.. hUll.. RIMIC.. ,Ic.) ~@89
D'P.rtm,,,t 0' thl r'..lu,., . Alllch 10 'orm 1040 or 'orm 1041,
. a..I..I,ijcUo.. fo, achldulll (form 1040'. ~,~hmlnl U
Inl.,",1 "tvtnu.I5.NICI to) utnCI No.
N.MI(.) tholll'n on ,,'u," YOl,l, 'MIIt .Kv,lll "Ym_
8~f.lO'l'I r. ~N15 ~ IvII'WIU II, :ToN'" %d11 Sf) I Q!l'A~
Income or LOll from Rentll. Ind Rovalll.. Clutlon: You, 'IIntallo.. mil"bllllmltlld, 5" In.tfllctlon.,
I Show Ih. kl.d .nd loclllon of ,.n~' p,oportV: (. 1. 2 For etch rtnlll prop.rtv 1I11.d on IIn, 1. did you or Iy~~ 'N8 .
A ....,H~.. ?~r.!-!lUf(,~~""""",'!rlJl~,,~!'.rl!; YOij, 'em,ly ij" 'I for por.on,! PWPOIII for mort Ih,. 1& )(
('~"'IJ 1/ '/1 p,.1 "01 ( th. &re.ter of '4 d'ylOr 10% 0' the totll dlY' renlod i. x
. ~o8. '~, Mi~lii"jIJII ~;, '''''Jk- f"",', .1 ','r renlal v.'u. durrnlllh. I.. yllrl C
......'M,~i;;;;;'i;~'[;:;~'.;i '?A";'7;;~'';;'''''' .........., f--- )( -
3 For each "nlll ,..111111, proptrlv lilled on lin. I, A
C ,..,'..,.."..""",..,'..'""",...'"""""""",..""..'.." did you acll..lv p.rtlclp.le In It I oporallOn durrnll Ih, . -X
lax veo,1 (See Inlt'uc~ C
R.nllllnd Ro~ally Incom.: P'OD.,U.. D Tolll.
A ~1' ..,.IB C (Add columnl A, B, ,nd CI
4 Ronll rectlv.d ~- ..,,,1; 00 <<; 744 00 4 'I 'A'tIBI""
5 Ro.,11I1I rectlved 5
Rlnlll Ind ROYIIIV E.p.ns..: lIi
6 Advertlllnll
7 Auto ,nd IlIv.1 7
8 CI"nlnll.nd mllnten'nce ~l
9 Cnmmi.llonl , 9
10 In.u,.n.. , In ?;/ I" 2- 28" 00
II Lellll.nd olher prolesllonal lees I'
12 Mort8l1l' Inleresl plld 10 b.nk., ALA- g~ ;"tf~ '7/_ 5"0 ,.
.Ic, (Ieelnll,ucllonl) 12 I
13 Olhtlln'tltll , 13
14 R.palrl ' ,~'~', b.~'~;~ 14 2.'5 '18
15 Suppll.1 l~
16 T"'I 16 54- .", ?j ~ :>~ erg-
17 Utlllll.. (see Inslrucllonl) , 17 -11 ,,:1..
18 W'lln Ind s.I"I'1 ' 18 -
19 Olher(lIll) . ........................,....
,.........................".................. 19
................................."...........
........................... ..,...............
20 Add Ilnll 6 Ihroulh 19 20 'l~1 '),q. <';72t. ~ 20 g
21 D,preclalion exp.nse or d,pl.llon '1 404- 172. Iql4 00 UI 72-
(lit Inll,ucllonl)
22 Tolll,.penltl, Add IIn'l 20 ,nd 21 22 I.~ t. 2- Sc.. 7f.:r. fA "II.
23 Incom. or (1055) 'rom IInl.1 0'
roy,lly prop.rtl.s, Subtrocl IIn. 22
'rom IIn. 4 ("nll) or IIn, 5
(roYlllitl), " Ih, ,..ull Is a (loss), k.~1 (,eR~ 7""
lit Inllrucllons 10 find out If vou 23 I,,; fA
muslflll 'orm 6198 , ' , , ,
...
24 D.ductlbl. "nlll 1055, C.ullo.: You,
"nfa/lou on lin, 23 may b. limlt~,
St./nsfructlons to lind out,l you musf 24 ( f457 5(.,)( / 1")( )
III. form "'2
25 I.com,. Add renl'! .nd roy,lly Income from IIn. 23, Enter Ihe lolallncom. here, 25
26 LOI..I. Add ,oyally 101s.1 from IIn. 23 ,nd r'nlallolstl from line 24, Enler the tolallo5511 here roa ( ~
27 Combine amountl on hnu25 and 26, Enler the nol Income or (I0SI) here 27 ( ,1.S4" u\
28 N,llarm renlal Incom. or (loSI) from Form 4835, (Also compl.te III\e 43 on palle 2,) ,.
29 Tol., "nlal and royally Incom. or (lOll), Combln. ,mounll on II nil 27 and 28, Ellter the relull here, It ( ~~4~ 31)
Parts It, III. and IV on pall' 2 do nollpply 10 you, .nler Ihe ,mounl from Iln, 29 on Form 1040, IInl 18,
Olh.fWII.. Includ.lh. .mounl from IIn. 291n Ih. lo'al on line 42 on paRe 2 29
'or'" erw.,k "oducllo. Acl Hollu.11I 'orm 1040 Inll,uell..I,
p
Sch.dul.l ('o,m 1040) Ita'
..
.
'..m
4562
Depreciation and Amortization
OMINo,ls.eol72
Otp.l1m.nt of 11\1 r'.lIl,Iry
Int,,.,,1 It.vtnu. S,rvlC'
. a.. IIpIIIIII.,I,ucllo...
. AII.ch Ihll 'o,m 10 you, rolu,..
~~,~.P9
N.mI(I) II ahown on "tu,"
SI<A-OLay 7: :!ON~
BUlm... or .tllWtlylo .h,d' th'IIOl'm 111.1.&
- M,'H_,r
iJ , .:rO AI Ii-.:s
'''nUIyt.. nu",",
~~5o~"S'J
::1~1( LluIU;" I 'Jr; , ,
11III Dlpreclatlon (UStt Part 11/ for automobiles. ce,taln other vtthicltts. computttrs, and property used for ttntttrt.Jinmttnt,
recreation, 0' amusement, ) ,
S.cllo. A.-Elecllon To bp.n.. Dlprecl.ble Anll. S.cllon 17.
I Mulmum dOll., IImlt,llon , , , , , , , , ,
2 Tolll cost 01 IOcllon 179 property placed In sal"llce during Iha ta. ye.. (lte Inalrucllons)
:s Threshold coal 01 secllon 179 prop.rty b.fore reducllon In limitation ,
4 Reducllon In IImlllllon (Subtllcllln. 3 from line 2, bul do not enter leu Ih,n ,0.,)
Dolla,lImlt.llon fo, I,. eo, Subtllclllne 4 from line 1 bul do not enle, leu Ihan ,0., ,
(.~ OtlCFlpllon or P,QP.r1v.. (b~ 0,11 pl,c.d In "'YICI
CC)COI'
c.) [1.dKCOII
6
7 Llaled property-Enler amount from line 28
I Tenlallv. d.ducllon (Enter the lell.. of: (0) line 6 plua line 7; or (b) line 5,)
. T'Xlbl,lncom~ limitation (Enler the I.sser of ;(,) Taxable Income; or (b) line 5) (see Inslrucllons) ,
10 Clrryover 01 dllOllowed deduction from 1988 (see Inat,uclions), ,
II Section 179 e.pens. d.ducllon (Enter Ihe lease, of: (a) line 8 plua line) 0; or (b) line 9,
12 CI' over of dlslllowed deducllon to 1990 (Add IInu 8 and 10, lellllne II" ~ 12
Socllon B.-MACRS De ,ecllllon
(.) D'p/fCI.llon dlducllon
b 5.ye.. property
c 7 .y.a, p,operty
d 10,y", p,operty
o 15,y..' p,operty
f 20.ye.. property
14 Allo,".llve De
o CIIss IIIe
b 12. e.' 12 yro.
C 40.... 40 yro.
15 llsled property-Enler amounlfrom line 27 , , , , , , , , , , ,
II GDS and ADS deduclions for ISs.ls laced In sel"llce before 1989 (Sll insl,uctlona
Socii on C.-ACRS .nd or Olhor Do recllllon
17 P,operty subjlCllo secllOn 168(1)( I) .Ieclion (so, inslrucllons), , ,
II ACR end or olher d. reclallon se, inslrucllons , , , , , ,
Mil
I Resld,nll.1 ,onl.1 property
21.0yro. Mil
21.0yro. MM
31.0 roo Mil
31.0vro. MM
laced in selViett ONL Y durin
h
II
:a/
:z.
Secllon D.-Summ.r
It To'" (Add deduclions on IIn. II and linea 131hrouMh 18,) Enter here and on Ihe Ipproprlalellne of
your relu,n (Partne,shlps and S corporallQns-sOl insl,ucllons,) , ,
20 Fo, Isseluhown above.nd plac.d i. s'l"Ilce du,lng the curllnl ye.., enler Ihe portion
ot Ih. basis ,ttrlbulabl. to section 263A costs SOl Inst,ucllons
fo, ,....,.... Reducllo. A" Hollco. "" P'I' I 01 Ih. IIpIIII.'.II,uollo...
'orm 4562 (1919)
, , "
2
(. V.hlcl. I
(b V.hlc. 2
14 Enler Ih. dll, v.hlcl. WII pl.ctd In Itrvlcl
14
I
I
I
15 TolIl mllllll v.hlcl. W'I ul.d du,'nI1989
, .,,",.
15
4- millS
mil
It Mlllllnclud.d on IIn. I~ thll v.hlcl. wn ul.d for bUllnns
It
17 P.rclnl 01 bUlln," UII (dlvid. IIn. 16 by IIn. 16)
17
II Aver'I' dilly round I"p cornmullnl distinct, ,
II
~
.4 millS mil.
q"o mll.s mlln
qB millS mil.
1. Mllnlnclud.d on IIn. I~ thai vehlcl. wn used forcommullnll
20 Olher pll'IOnll mll,IIl' (Idd lints 16 .nd 19 and lubtrecl Ihe
lolllfromlln.l~), , , , , , , , , , , , , , , ,
19
21 Do you (or your SpoUII) hlv, Inolher v.hlcle ..,II.bl. 10' personal purp05ls7
,~Vn ONo
22 II your omployer p,ovld,d you wilh I vehICle, is personal Ult du,'nll 011 duly hours permltted7
, 0 Vn 0 No 0 Nol.ppIlClbl.
231 Do you h..e evldenc. 10 support you, deduCllon7)ifVn 0 No, 23b 'f 'Ves, 'Is tho .vldence w,lttenl Ji4 Ves 0 No
S.ctlon B.-Stlndard Mil.... Rat. Do not UI' thla'lctlon un'.., ou own the v.hlc'..
24 Enler Ih.lmlller 01 IIn. 16 or I~,OOO miles (Rural mail carriers, see the seperlle Inslrucllons,) 24 ~ ~
25 Subl'lcI IIn. 24 from IIn. 16, , , , , , , , , , , , , , , , , , , , ,
2~ ..2536
2. .3132'5 00
27 .:1.7
Jfl ~ '!>
b Vehicle 2
21 Mulllply IIn, 24 by 25.,.,. (,2~~) (Se. the 5IparateInslrucllonsII vehicle IS fully deprecl,t.d,)
27 Mulllplylln.2~bylU(,Il), , , , , , ,
21 Add IIn,,26 .nd 27, Enler total here and on line I
S.ctlon C.-Actuel Exp.nll' (. V,hlcl, 1
2. G'lOlIn., oil, replllS, v.hlcl.lnsu"nct, elc, 29
30 V.hlcl. renllls, , , 30
31 Addlln'1290nd30. 31
32 Multiply line 31 by Ihe percenllll' on line 17 , 32
33 D.p,ecllllon from IInll 36 Ind 37, column (I) (See s,pI,atl
'nslrucllons,), . . , . . , , , , , , 33
34 Add IIn,,32 .nd 33, Enler 10111 her. Ind onlln. 1
35 Vllu. of employ.r.provld.d v.hlcl. mulllplled by Ihe percenlalll
on IIn. 17 St,'nsl,uctlons, , , , , , , , , , , , , 35
S.ctlon D.-D.pr.clatlon 01 V.hlcl.. (Vou can only claim d.precllllon for a v.hlcle you own. There Is . lImit on Ih. .mounl of
d.preclatlon and Secllon 179 deduction you Cln claim, Sit Ih. seplral. Insl,uctlons lor Ih. limit. II line 17 above II ~O
perc.nl or ,,", you clnnot claim Ih. Seclion 179 deduction and you must fllure d.preclatlon uslnll Ihe st'II&I11 IInl
m.thod ov.r IS Y.IIS,)
(0'
"'11 for d.ptltCl.llon
(lulln,.. UN onl~-,"
Mpe,.I.lnllructlonl)
(II
Mtlt'tOd 0' "SUM,
d.prtcl.hon
(e,
Olprec:l.tlon deduction
$.dlon 179 dldlKtlon
(.,
(.1
Tol.1
column Cd) t column (.)
(.nt., on lint 33)
(II
COlt Of oth., bllll
31 V.hlcl.
1
37 V.hlcl.
2
",m
2441
Child Ind Dependent CI,e Expen...
QMI No IMS.OQII
Otp.r1m.nl ollh. Ttt.,ury
Inlllfn.1 "rttnu. 5ttvlcl (3)
N.mt(&) ano.n on 'oun l040
~AbL"Y ,.. 'r,::)fJiS .... MIt.I;IiU; ,3"~:IIJ.S
. II you ar. cl.lmlnllh. child Ind d.p,nd.nl c.r. credll, compl.t. P,rtll.nd II b.low, But II you rec.lv.d ,mploy,"p,ovld,d
dlp.nd.nt.... b.n.flll, flrll compl.l. P,rt III o. Ihl blCk,
. If you ,r. not clllmlnlllh, cr.dll bul you rec,lv.d .mploy.r,provlded d,pendenl cere ben,fltl, only compl.t. P,rt I, below, Ind
Plrt 11/ on Ihl b.ck.
_ P.non. or Orlenllltlonl Who Provld.d th. CIII
need more space, attach a slatemenl,)
(b) Addresl
(number, slreel, cfly, stale, and ZIP cod.)
. Alllch I. '.,m lIMO,
. Su IIpI..II'.II,ucll..I.
'lI@89
Vou mUlt compl.t. thll part. (See Ihe Instructions, II yOU
I
(I) Nlm.
(c) Idenliflcolion numbe
(SSN 0' EIN)
(d) Amounl p.,d
(se. Inltructlonl)
t'o~NI~ A('I~/Jttm ........................................................".,'..',
(454 Lit
2 Add Ihumountlln column (d) ollln. 1 Ind enter Ih.total , " ,',",'" '" 4- Z
NoI.: "you ~/d ce,h w61" of S50 or mo.. '" I cal.ndar qu.rt" to an ,"dividual for s.rvices p.rformtcJ in your home, you mus' file
In employm.nt tl. refurn, Get Form 942 for d,tllls,
11IIIII Cr.dlt lor Child and D.pendent Call bp.n...
3 Enler Ih. number of quallfylnll person' who were clred for In 19B9, (See Ihe Insl,uclions for Ih. d.llnllion ot qualltylnl
parlonl,)C.utlon: Toqul/ily, th. plrson(s) mult hive shared fheslm. hom. with you in 1989 , "",.
4 Enter Ih. .mounl 01 qUlllfled ,xp.nlll you Incu".d and aclually paid In 19B9, Also 5" Ihe
Inllrucllonl II you rec,'ved .mployer'p/ovlded depend.nl care benalitl, Set Whll Are QUIIIII.d
Exp....57In the Inllrucllons, Do not .nl.. mOil Ihan $2,400 ($4,800 II you paid 'or Ihe CI,. 0'
Iwoo,mo"qualllylnlp..sons), , , , , " "" "',"",'
5 Ent"lh..xclud.db.n.lIll,iflny, lromlln.21 on POI' 2 ""', " ,,"
I Subtract line 5 from IIn. 4 and .nter Ih. relult. IIlhe relullls zero or less, slop here; you cln.ot
claim the credit, , , , , , , , , , , , , , , , , " "','"
7 You mUlt .nlar you, ..,ned I.com., (5.. the Inst,ucllons for Ihe defln,tlOn of larned Income,) , ,
8 II you Ire ma,,',d IIlIrll a joint return, you mUll enter you, spouse's earned Income, (II your spouse ... Zz.- ~ ""
WI" fulf.tlmeslud.nl 0' dlubl.d, s.a Ih. Instrucllons lor the amounllo enter,), , , , r ... ~"
9 II you a" ml",.d flllnl a lolnl ilIum, compere Ih. Imounls on lines 7 and 8, Enle, Ihe Im.lI.. 0' 7' 3- 0 ~.
Ih,twoamountshera , , , , , , , , , , , , , ,
lD . II you ar. m,,,led IIl1nlajolnl "Iu,n, compalllh.amounlson } 1"-'
linn 6 and 9, Enler the Im.lI.. of th.lwo .moun" here, -r"
. All oth..s, compo" the Imounls on lines 6 Ind 7, Enler
Ih. Imlll.. 0' Ih.lwo Imounts h...,
II Ent.. Ih. declmol amount from Ih. tlbl. b.low Ihal'pplltS 10 Iha adjusl.d 1'011 In com. on Form
1040, IIn. 32, , , , , , , , , , ' , , , , , , , , , , , , , , , , , , X I J.O
11110.32 Ie: O.elm,'.mou.I't:
Ov.r- ILlt not
over-
$0-10,000 ,30
10,000-12,000 29
12,000-14,000 ,28
14,000-16,000 ,27
16,000-18,000 ,26
18,000-20,000 ,25
12 Multiply Ihtamount on line 10 by Ih. decimal amount on IIn. 11, and enter Ihe rasult , , , ,
U Multiply any child and depend,nt cara expenses fo, 1988 that you paid In 1989 by the perct"'aga
Ihatapplles 10 Ihtadjusted gross Incomeon you, 1988 Form 1040, line 32, or Fo,m 1040A, IIn. 14,
Enler Ihe ..sull, (You must eompl.t. Part 'and attach a stal.m.nt. See th. Instructions,) ,
I' IIn, 3211: D.clma'amount II:
Ov.r- lut not
over-
$20,000-22,000 24
22,000-24,00023
24,000-26,000 22
26,000-28,00021
28,00020
2.90 i~
-0 -
14 Add the amounts on lines 12 and 13, See Ih,'nsl,uclions for Ih~ amounl 0' clldlt ou can claim,
'or Peper.ork R.ducllon Act HoIICl. '" "plrtlel..trucllonl.
2.'109S
'orm 2441 (1919)
,J;i,.
.
,- ,
.........--.
W" ,..,., PI"nl Copy
.- -
ROADV'~ MORTGAGE
OMPANV . .
- HIGH ST
WORTHINGTON OH 43085
I
-I I
1 I
I I - -
~ H7.2I 21 413.41 t
,,- I
1 '32.7' 21,157.17
- '"
t1 .. .....
D 1I04.1M
.. --"--"'~-
BRADLEY T. .JONES
3ftl WI8TER CIRCLE DR
MECHANICSBURG,PA 17055
.
....
103.01
1M
212.21
-..-
PA W.2
-..
CAMP HILL
'-
'0101 And
. , .,., ~-........... .
, r . ...__.r.... r, .
..-.---.-...., .,...-. ...
__ "**-rllt..... -
W!ST:SHOR! WAG! TAX BUR'AU
P.O. BOll 656
o CORRECTED (II dlIcIIIdl
t u_'.~_._ ~ 1 04600120
.
.
I ....... _ __...
-
~@90
Certain
Government
paym.nta
26.29
...-
'llIB.......ror
01
4__.'_
.
. -"-*
For Rlclplent
TNlI.....- ...
1.......l...111
btInO _10"
- .......
-.VOU"
........ 10 lit I
........ oJ'- -
pnlIy.. -
__be
"'--dlllVOU.1HI
-......."'"
.......".-
.... . hII noI boon
--
CA"P HILL PA. 17001-0656
- I -
2]-1699565 209-50-9583
"CI'IIHT'I_~""IIIII_"**-rllt,....tnd,,- I ~of..blll_
BRADLEY T
JONES
]16 IIlSTER CIR
'.
.
7 ~1lII-*
.
"ECHANICSBURG
__1_1
PA' 17055
,."" 1081-0
.rA..............,." II ~OYMIIY COIIPPMnoII IA...."
!
I
I
I
I
,
,
'-.,'u .
(~~
~ t
I
.
.' .' -..- .
-----.---
~.".....I '
" i1 ,~ -"'"' :
. ;~IJ,~,' I", r " #. ,
.'.'
.. ';' ..,::;. '.
,'r' ,'..,. ,.... .~:i.~i. ';
.1'n.'\,.'....'...~m~~.&L...'.'. ,1.'\.1 '
, "_......."t.'....,.._~.ll~.""'..,;;('".
. '" ..,' .',",,:"
lIb,1
(Set
Inll,ucllonl
on po," .,)
UII IRS libel.
OlhlrwlM,
plllll p,,"1
OtIyP"
r,..ld.nll.1
EllCtlon Campelln
.
flllnl St.tua
Cheek only
on. bOI.
Exemptions
(SII
InstructIons
on PII'
10,)
II motl than 6
d.pend.ntl. I"
InltrucUons on
po,. 1\,
Income
AttlCh
Copy B of you,
Form. W.2. W'2G,
Ind W,2P h...,
I' you do not
hlv, . W.2. H'
POI' B,
Attoeh chock or
money order on
top o. any forms
W'2. W.2G. or
W,2P,
f. i.
. \
",
.
Adjustments
to Income
(!4e
Instructions
on Ill"17)
Adjusted
Gross Incom.'
Doyouwlnl$1I01010Ihllrund?, , , . , . , , . .
II Inl, lu,n ours I wlnl 10 to Ihl fund
Sinai', (See pili 1010 fl.d DUll' you an fll. II hlld of hOUllhold,)
M.rrled IIIlnllolnl ,,'urn (even If only on. h.d Incom.) , ,
...,,11d fill.. "palll. rIM., Enlll 'poll"" ...1.1 ,",,"1, '0, ,boo. .114 f.1I AI'" ~"", ~
Hlld 0' hOUI.hold (wllh qu.llfylnl p...oo), (S.. p", 10,) If Ihl qUlhfylnlll'l1On II your eh,ld bul not you, d'll'nd.nl.
..,..,hl, ehlld'l nlml h,", ~
uIII I. wid .. wllh de nd.nl child ( "" DUll died ~ 19 , Set . . 10,
YOU'1I11 If you, lII"nl (orlomoon. .11.) an clllm you.. . d.pond.., on hll or h.. III
IIlurn, do nol cheek box So, Bul b.lu" 10 chICk Ih. box on IIn. 33b on pl.' 2
o.,.rtmenl of lIM ,,..~;~":'I"I',".I "...nu. iSen'kl
(5)
, In,,,
Yourrlrt"'",",.Mwtlll
othert..
.,
Ln.nam.
L
A
I
.
L
..
,.
~
.
""NNW" CAR-RT-SORT""RR06
NB 209-50-9583 193-44-2315 S28 50 ~
BRADLEY T & MICHELE A JONES S
314 WISTER CIR 002
HECHANICSBURG PA 17055
~pt, no.
v..
v..
I
2
3
4
S
II 12!1
blX!SpouM..., .
C D.pI.d..11l
(1) N.mt(r1r1t. inltl.l. .nd r'll nlm.)
(')-"'"
rtI'holllAl,IO,oll
mH..oflllOlll~1
IIrNl.pttlIfMI
l.lttO
lIle.., III '''ltl ,,_, '_I"
If .11II. Melli .lUlly "11mbii'
I I
It.
bAN I(A
. ONeS
M. :10'" l!:>
d If your<hrld dldn'lllve .,lh you bul II c1l1med "' YOU' dlpendlnl undl' . p,..198S '&lHm.n', check hI" .. 0
. Totll numbtrof ...m tlon. claimed. . . . . .
7 Willi, 11111111, IIp", ltc, (.fllCh 'orm(.) W.2) , . ,
81 T""bl.lnlll"llncom. ("'0 .fllCh ScIIldul. 8" over $400) ,
b TI.....mpllnlll..,lncom. (1tO 11I..13), DON'T Include on line So
t Olvld.nd Incom. (.110 ./ttch ScI"rtul. B II d." '400) .
10 TIUblor.lundl ohlllund locAl Income IIx".lflny, from wOlkshoot on pa.. 14 . . .
1\ Allmonyree,'ved,', . . , .,. . , ' . ..,. " .' ....
12 BUll.... Incom. o,.<lou)(.ff.ch Schedul, C) . .. . '.. . ' '. '. . ., '.
n Coplll1llln or (IOIl)(.ftlCh Schedule 0) . . . . . ',' .,...... .. ; .
14 Copllllplndl.lrlbullOOlnolreportedonllnl 13(.Hpll' 14). '. . ',' . .
15 Oth"8II..O,(looMl)(.II.ch',orm4797) . . "",. .,".rO'..;'." '. '. .H.."..:.
III TOllIlRAdlllrlbUUoii.. .l.1kl . _. L_l6b iwbl..mounl(1tO Pili 14)
171 TolII pontlonund Innultltt l..1za.1 L I7U.ubl..mounl (IH PII' 14)
II R.n'..'O'IIIIIII. plrtn.llhlp..III1'os. lrul15. .Ie, ('"tch $chldullE)".. '," ,'i.' ," '," '"
l' F.rminc~..~~~~l~'tt"~~f~~~/~.-F),~.. ,'It,, ""r' ',h':w~'I,~~~"~''i1,'j " j '..~ 1 ;".,',
20 un.mPloym~~.\S:':r.P,!~~t1~.(I~~U~!>. (~~.1~~16),..~ . " >, ~ .'IJl\'~" ","~ ,'\I~ 'It ,:I'k'
211 SOCIIIIlCU~llybe..'iII..:-,.1 211 [ I ... 2IbTlXlbl..mounl(lHpll.18)
ZZ OIh" Incoml (1I,llypl Ind Imounlr-.H 11I1' 16)1... ... .... ... ,........ ..... ...............
U Add Ih.......nb.lhowiiln tho ,",.,1 t'eolumn forllneo 7throU 22, TlIlI'li ,1.lll1ocom..'
241 Vou, IRA dedUdlOnr,,;;'.pp1Ic1b1I_kohell on pop 17 0' 18'1'. -0 -
b 5poulI'IIAAdtd_.fromlppllctble.orkJhoot""paI'170t18 . -0 -
\ ,'{ ,
Z5 , On.,h.II ol'III1....p1oym.nl W (... ~I~ 8).. I, . . . .
21 Solhmployed ",.IlIIIIIIUII... deduction, from _"Ion PII' 18
I' I-
27 KIOlh retlrem.nl pll. I.d ..II"",ployed 5[P deduction .
ZI p.nlllyon.i,lywlthd',W.lo'....ln..' '",..Ii : ..'. :~:,' '.
2t Alimony p.ld, Roclplon!'. SSN .. i
30 Add IInll 24. Ih,ou h 29, Th....'. ou, 10'"lld u.'m..II"'.. . 30
31 Sublroellln. 30, 'rom IIn. 3, Thill. your IdjullOd 1"" Incom., If thil.mou.' I,'outh..
..__ $20,264, .nd,.../IUdllved,wIUl >'OUL1t. po,. 23 to nnd ou, ,f you CIIlclllm 1Il.:ElfnOd Incom. -31"
C,fd". on IIn ,,,,...\..,,II,I..,..:......~...~.... GItIII.'.;J'" ..~... .... IoW..Ao .......1.. 't ljl,'I' .... l'
.'
-0 -
-
.,
,',"'.<t;.~','
.... ~ .
.
- ~.
- -
..~. -
. .
,':.
, I' l OMI Nt, I MS.oo7.
Your_1II1Ml1/f1r .-
I I I
.,...'111I'" NCWttr "_1M'
I I
for Prlvlq Acllnd
PlpllWork Rldllcllon
Act Nollc.. III
InllructlonB.
Nltel QtICIcIl" "YH"""
not ell"',. yout ,.. Of
'Nue. "lund.
No..I ".n
cMcled.. II
1lId._
Nu',....
dtlldrH .. II
.Ilt: 2-
. IIwod .111I ,.
1.1d.1I1nwllll
'" ...1.
.lttra If
..,,'ltIta(M1
".. II)
NI, .1011I11
.1....1.11 H II -
.... ........
..lored .
I
2..
,I
;1
..
~ -
'I'
\.1 ;z/ :11
- 41QQ2.B'-1
.~ . ... .. .........::.J
, If ,...,.."',,'.,...1'11'........ ' L I -~.\\,' 01',,,),,,""'~:6
'11m 10'0(1190) .\to.,....:..... twj:~ J."., ,,, ''','' ..,.' "", ., ';''-1~'''' ......,.1',....."...
n... Amounllromlln.3\(ldIUlledIll0llIncoml) , , . , , . "... ,: .,~.u.'''''''\N,.
Ua Chock II: 0 you_.6h,oId;r: O'Bllnd: 0 aPOUIIWII650rold,,.,:!;0 eiG;d,U':
..... "Add Ihl numbe, 0' boa.. chocked lbov...d ..ter Ih. 10111 hili ., . .'. .' ih
.:.: Ii. " yOU' poronl (01' ~'IIM) un c1llm you III depondlnl. ehKk hll' - ..'-"h~., n~ 0 -
II.".', ,... ....,' ,'" .,....""..", ....tIo-',', ..11
C II yOU erl mlllled fIIlnl' llpirotl ,00u,. Ind you, lpoult lIemllll deduction., 01' )'OIl' , '
~4:: ;~:,:::I'"I..t~~~~:~~~~~~;;;':;I::. e~~~;~ ~0'~~1; o:'~~' "'~]' :~~_ ~
':'." ""1" 0 Your Illmlud deduction. <f,om Schedule A.llne 27). ".,'J ' .".. ~", ":a' "
~,!o,. 0
_' , II you lI,ml.ll. ItllCh Schedul.Alnd ehlCkherl, .,...., . ..~.. .-
31 5ublroclllnl 34 from II., 32 .... . . . , , . , ,', , , . . .;..":'. .
36 Mulllply $2,0&0 by Ih, 10111 numbe, 01 tllm~t10nlCl'lmed on IIn. 6e , "" .,.:, ; . .
37 Tlubll'..om.. Sublroclllnl 3S f,6"; IIn. 3S,(II IInl 3611 morolh.nllnl 3S, enler,Q.,) , ". :. i
31 [nt.. III, Cheek II from" IKI TI. T.bl., bO TtI R.I. Schedulel, ore 0 rorm Mil 111I PIlI II)
(Ihny '11,om Fo,m(I) 8814, enl.. Ihlllmounl here. d I ,).
3' Addltlon.IIIl1I<II,pol.21), Checkllf,om; I 0 Form.970 b 0 Form.972.
40 Addlinll38tnd39 ,.'","
41 Crtdll f", child Ind dlpondlnl CIII tlponltl I,,,..h fOlm 244 II
42 C,edil for thl eldllly 0' Ihl dlllbled l,trlCh Sch.dul. R)
43 Forolanll.credltll"lChf",m 1116) . . ,., ' , ,
44 GI.lro' bUllntll credit, Cheek If from:
. I 0 Form 3800 0' " ~ 0 Form (Ipocily) 44
4a Credlllo, prlo, ye., minimum 1I.1."..h.form8801l . ", , 4
'a ""\.~. \ I' '. .\ " ' ,,' ,
. Addllntl411hrouih45 .,.. . '. . .' . , . . ' , , ' ,
47 Subtroctlln. 4Sfrom llrii 40, (II 11.14611 ";orllh.n IInl .0, Inter ,0,,) ,
41 Stll,.mploymlnttll (.".ch Schedule Sf), " .
4' AII...ltlv.mlnlmumll.(."..hf",m62511. ' , .' . ' , , .
ao RICIPlure"...(IHPI8l22),Cheekllfrom:o 0 Fo,m.256 b 0 Form 8611 ,
ai" Socllllltullly'" on tip Incom. not roportld to Imployo, (."..hform 4137) .
52 T.. on In IRA 0' I qUlllfled rlllrtm.nl plln (."..h form 53291 '
,53 AdVlnc""ned Incoml credll poym.." 'rom Form W.2 . -,
54" Add IInl. 47throu 63, Thlt II our lotatt.., , . ' '
55 ' Fedlrollncomlltl wllhh.1d (If I.Y I' f,om Form(.) IOt9.
chtcll.O). .__._...._,.....' .:.'.,;"". . ' . ., 6a
5a 1990 eltlm.ted III poymlnlllnd lmo'lnloppll,d "om 1989 return sa
paym.nts 57 [....d I..om. credit (I" P'I' 23) "!". '; '. ",; ., 57
5. Amount p.ld w,th Form 4858 (1.len,'o. ,oqutll). . . " 51
. 5' ' [aCllllOClllllturily "' llid RRTA ... wilhhold (," poal 24) . 5.
.; SO C,edllfOl'Fedllllt..onfullt(.rrlChform4136). . ., SO
61 Rlaull1ed InVlltmlnl compo.y .redlt (.tt.ch F",m 2439) -', 6
62 Add IIn.. 55lhrou&h SI. Thll..II you, ""I pi m..11 , ' . '... . .' .", .
13. "lIn. S21, mor.thln line 54. .nl."mciu~1 OV[RPAIO ."; ',..' '
,64 ..Amounloflln.S310lieR['UHO[DTOYOU '.--';"~'-; ". >:,(1,.:'-:" .'
R.fund or' : ,II _ Amounl of IInl 63 10 be A"U[D TO TOUR IHUSnMAUDTAX.
~mo~t ",,"6_. If IIn~'541' mOil Ihl~ IIn:62. ,nlll AMOUMTYOUOWL AltlCh'thoCk'';;';''onIY ~;d.,fo; full'
OU W." t---- Imounl PIYlbll 1""lnt.(~~I.RlVenu. St!'ic.." W,II. yo.;, n.ml: .ddllll~i<<illllCu'lly number. '1/
, .--dlytlm. phone numbef,~~'ltf199O '0I',,:,~104O~: on II +7"'-''''..,J.Al~ .,i: . '~I:,'!:~'~':i~ '
67 btlmlledlllll'"l'Iy(-PO .26).:".>.:.,. . ,..,ill~,",... - 7'
, t I "".t ,........... .....11". 'Al" ... ' ,,,.,;..",... ", .' ,..' IT""" .'", lot".".... ,.. . ~ .
". ilcllf p"'llb. 01 PIflury,I_" htvl l..mln",1I111 'oNr. Ind"'OIlIponyI.. ..-.1" Ind.lltlllllnti. Ind io thO tioIl 01 my trnowItdBt and _IT
,thl, III truo. t,,'Kt Ind e ,O\i;larlbon 01 prl_ (..... _"'1>1"')"- on .lIlnformlllonotwtilcttp/OpI,., N...., k-", . --,-~)}'
~ Your I I ~ 0." Voo. 0<'01>1110/04 n' D flil6#" ~;
H mUI' Slln) Spoult', OCtUj)lllon
'su:ref~
Tax
Compu.
titian
If you wlntlRS
10 "IUII you,
t'..IN
Inll,uellonlOO
poa.19,
Credits
(SII
Inltructlona
onPlal2l,)
Oth.r
TillS
AUlch Forms
W,2, W.2G,
.nd W,2P to
'ront,
SII"
Hlr.
Keep HOPy
ot thiS rlturn
foqour,
records.
11#507 20
4
"
. '
:.
.'
.
l~
I
:J.752.
i
,.t,
"
O~l'
t"', locl.l.-eyrlty no. :,
, Id Pr,p.,.,',
I 111/'l.1ur. '" f....
'"plIlI'. , ,
U 0 I -. I, 'I,m,n,m.(oryol.l" .
$I n, I' "U..mllloytel).nd -
.del,."
.\ ': ~~-.:.::.:...;.:~:~..
"
lINo. ,..' -j
ZIP cod. I ,
-- -- - . ..~"',~
-..----.-....---..-.. _.' .,.~.._.. ....
".
.. -
--"-;:;:-;---77-
"~~1~1 ' ,~
._-.:.....:....~..
""~'.,
.'., ,
'. .f' . ...~ .,. "
'~
-_._~;
_AUI'IIIIlIOlOlI-
11II(. .-on ... 100.01_............ numlltrlll".,wnon_.olIl
.,. " 6 3OIoJeS
Schedule B-Intere.t Ind Dividend Income
'Irtl
lolllllt
lollllll
(SH
InlltUcllo.1
on Ill... 13
Ind 30,)
Hilil'OII
tIC . form
I ,I I, Form
O.or
lulllVlull
IIJI.m.nt, f,om
I brOk.'I.o fI,m,
IIllth"I,iiI'.
n.m. I. th.
llIitt Ind .n",
IU 10111Inl,,"t
thawn on thlt
rorm.
'lit II
Dlvldlnd
In_.
f~ructlon, on
fl'l'l13 .nd
HOI"~' oy
r.ntV . form
1099. IV, or
IUIlIVlul.
11'ltm.nt, ',om
,brlk",.o tl,m,
1III1I1OfI,II1'1
nlmll,lhl
PlY" Ind .nt.,
th,'olJ'
dr.ldtnd'lhown
on IlIIt form.
AIlIc_I.01
........ N.
" ~OU recllvttl molt IIIln $400 In IIUb!1 Inl.'llllncoml, 0' ~OU I" clllmlnlllll l.clUllon ollnll,." "orn
..,111 IE U.S. ..vlnpllondll..uttllltl' "" (III pili 31), ~OU mu,l cornpllll 'Irt I. UII ALL Inll'lIl "cllvttl
In 'Irt I. II ~ou rlCllvld rno,.lhln $400 In lBlIIIIl,lnltrllllncorn" ~ou mUll II.. cornpllll 'Irt III. II ~ou "celvttl,
II I nomlnll, Inl.'1I1 1It111CluIII~ lItlonll 10 Inolhlr plr..n, 01 ~ou 'ICIIVld 01 plld Iccrued Inl.,..1 1/1
IIcurlllH 1'lnl'."tt1l1ltwlln 1.11,..1 I mentdel.. I" I I 31.
Inl""llncoml
I 1.1"..llncoml. (LIII nlm. 0' plytr-If Iny Int""t Incom. II Irom 1I11".t1nlnced
~~~~~.~~~: ."~~;~~~~M,~~ I~~~ ~~,t~,r.~~~ '~~~~'~, ~:::::::::::::::::::::::::::::,
,.,..,.",., ..~tf.,~~"""""""""""""",..""",..,.",..".."""""""..
..............!(tlf.~.,'I'..........,"',..,' ........ ....,.. ........,..,..,..,'..,........"
"...,.,",.,'p.1f.('.'<"""""""""""""""""'""""""""',"",',""""
...""",.", .lltrf.~t,I:;J'" ..f1."" r"""",..,""""""""""""",.,"""'"
..."""".. ..Cl+Ur !/~"" ~~ ,~$I"""""""""""""".,.""""""""""",
Amount
I
...........................................................................................
...........................................................................................
......................................,..................................,.................
..........................................................................,.....,..,.......
................................,.................",.......,.......................,."".
2 Add Ihllmountl on IIn. 1. Enterlh. lotel, , , , , , , , , , , , , ,
3 Enler Ih, .xcludebl, livings bond Inl.rllt, it ,ny, from Form 8816, IIn. 14, Altlch
Form 8816to Form 1040, , , , , , , , , , , , , , , , , , ,
4 ubl'lcllln,3 f,om IIn. ,Enter Ihe ,null her...d on Form 1040 11..8. ..
II ~ou recllv.d morllhln $400 In lroll dlvldlndl I.d/or olh., dlllrlllullo.1 on Ilock, ~ou mUll compl.11 PI,111l
Ind 11I.11 ou "..Iv.d, .. I .oml.... dlvldl.d.lhlllclullI~ 11,10. 10 .nolh.r per..., III I 131,
Olvld n Inc me Amount
8 Olvldlnd Incom.. (LlsI.,me 01 ply.,-Includ, on Ihls IIn, ctpltlllllln dlltrlbullonl,
nonll..bl.dlltrlbullonl, .tc,) .. .., ,..................",.. ...., .......... ...."".....
.....,.....Il)S"......."..,...""""""",....",.."""""""""""",',"','"
............................................."..........................................,.
..................................,...................................................,....
.............................................".....................,......................
............................................................................................
...................................................,.......................................
8
............................................,..............................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
1I Add Ihllmountson line 6, Ent.r Ih.tot." , , , , ,
7 Caplll' 1I0ln dlslrlbutlon" Enter her. ,nd on Sch.dul. O. .
a Nonltxebl. dlstnbulion" (Se.th. Ins!. for Form 1040, IIn, 9.) ,
9 Add thllmounts on linn 7 Ind 8, Ent.rth, lot., , , , . , , , ,
10 Sublracllln, 9 'rom Un, 6. Enter Ih. resull her. I.d on Form 1040,IIn, 9, . ,"
olf you r.celved ~plt"/l.ln distributions but dd not need Sch.du', 0 to report .ny oth" /llln. or IOUII, st. the
In.tructlons lorrorm 1040 II." 13 .nd 14,
,,~ou 'ICIIVld morllllln S400 0' Inl.'1I1 0' dlvld,nd,. OR II ~ou IIld I 'or"ln Iccounl 01 wtrl I
Irlnlor of, or 11'1.I'eror 10. I 'oro'ln I'UII, you mu.llnlwerllolh qUlltfonlln PIli III.
'Irtlll
rl,.'IA
Autun..
Ind 111 At Iny tlm. du,lng 1990, did you h,ve,n Inttrestln 0' Islln,ture 0' other lulho,lty over IlInlncllllCcount
rerllln In I 'or,lgn counlry (such as 0 blnk ICcounl, IfcurltleslCcount, or other tinlncllllCcount)1 (5.. Pill' 31 0'
Trusb Ih,'nst,ucllons for ,xcepllonund filing requlrem,nls for Form TO F 90,22,1.) , , , , , , , ' ,
f~l~uell~n. 1211 ~:;:Ir.~:lnhl:~:~t:::~:: :~:n:~~:~t~~~~:7.I; 'I;~'~I' ;h~i '~;I~i~d d~;I~~ 'i990,' ~h~i~~r ~;~~i;~~ 'h~~~' ~~'y
onllllO I,) benlf cl,"nltrest In 11111 'Yes." you mlY hlVllo file Form 3520, 352().A, or 926, , , , , , ,
,,, '""rwltk ~HuctlonAol Hollco,l" Form 1040 I.II,uollo.,. Sch.dulo' ('orm 1040) 1'10
ICHIDULI C
('orm 1040)
Profit or Lo.. From Bueln... 01olI.... '''WIll'
(Sola Proprl.tor.hlp) ~@90
Plrtner.hl,.. Jolnt Vlnturll, Etc., Mu.t FIle ,- 10'''. A.-
. AlIKIllo '"m 1040., '"m 1041. . lot I.tlnlcllonl f., lkIIMulo C ('o,m 100I0~ StoI~., 09
__wlIJ0""'" (IIH'
1M/) t: 'T. ES 020 0 5:3
PII.cIPlI bull."1 0' prO'"lIlOn, Ineludlnl prOllucl 0' IINIe. (...In.trucllonl) . [nl" p,'nclpll bUII.III eodl
lISICIIMJ ('romll'l.2)" 8
C lullnlllnom..ndlddr..I............ ,.1.1mf..."..,... ........... ......................... D lmtloYOfIDou_tHoIlIHI
(I.c UdIlUlloorroom no,) !
I Aecounll.lmllhod: (I) 0 Cllh (2)0 AccruII (3)OOlhtr(lpoc'fy).....................................
, Mllhod(l) ulld 10
VllulClollnllnVlnlory: (\) 0 COil
YoI Ho
(2) 0 Lowtr of cO'1 (3) 0 Olhtr (.lIleh (4) 0 0011 nol opply (II
0' mllk.1 "pllnlllon) cheek.d, 10 10 line H)
o W..lhll. I.Y chlnlo in d.termln,nlqulntlll.l, COil., or v.lu.lIon. bllween openlnl .nd clo.lnB Inventory! (II 'V".' .lIlth "pllnlllon,)
H A"youdeducllnl"pe.III'orbu"nell UII 0' your hom.! (II.V.......ln't'ucllon.'orllmll.llonl,), , , , ' , , , ,
I Old ~ u 'mlt.rllll rtlct It,' in the 0 .,.tion of this busIness dUrin 19901 If -No,' '11 Instructions for IImlt.tlon, on 101&".
J Iflhllll Iho f111I5chedull C flied for Ihl. bu.ln'lI ch.ek h." ,
Income
..
I 0'01' rlColpll 0/ 11111. C.utlo.: /I thll incom. w.. ..ported'o you on form W,2 .nd the 'SI.Mory
Imp'OyH' boll on th.llorm WII chock.d, OH tho 'nol,uclio.send chock hI.., , , , , " .. 0
2 A.tu,nllnd IlIowlnclI ,',",'
3 Sublllel 11.1 2 'rom IIno I, Enlllthe ,..ull h."
4 COil olloodllold (from IInl 38 on pile 2) , ,
S Sublllcl IInl 4 'rom IIno 3 Ind enlll the 1/011 p,ofll hll.
10th" Ineoml, Ineludlnl Federll.nd ,t.l. .."lIno 0' lu.II.' credit or r.lund (,oeln,lrucllon,) ,
..
o
. AdVlrtlllnl, , , , ,
. lid d.bll from 11111 or IINlc..
(lIol.ltrucllon.), , , , , ,
10 CotIOdINcII_(.ItIdlF....4S61) ,
II Commllllonund f"" , ,
12 OlplIIIO. , ,
U Deprocllllon Ind .",lIon 179
"plnll deducllon (1101 Included
In Plrt III)(IH Inllruellool), , ,
14 [mployoo benlfll prol"ml (othll
Ihl. on 11.0 19) , , , ,
la Inlullnct(olh",hlnh..llh), ,
II l.tll..l:
I MortP11 (peld 10 blnkl. ole,),
~ Olhll, , , , , , , , ,
17 Lellllnd p,ollSllonll SONlclI ,
II Offlell'll'nso, , , , , , ,
I' Pln.'" .nd profll'lhlllnl pllnl ,
20 Rlnt 0' I.... (Ioelnllruetlonl):
o Vlhlel.., mlChlnlry. ond oqulp. ,
~ othllIUII.III ro 0 , , , ,
21 Rtpai'l.nd m.int.n.nc.
22 Suppllll (nollncluded In Plrt III)
23 TI"und Ilcon..I, , , , .
24 T"vol, mllll, Ind Intert.lnmolOl:
o Trovel, :J17~ ,,,,It, i r,~ ';24
b Mlllund
entertainment . -0
73 ,2-
c Enll' 2016 olllno
2.b ,ubJect 10
IImititlonl (III -0 -
In,lructlonl), ,
d Sublrtelllnl 24c 'rom IIno 24b
2aUtllltlII", .,.,.
26 WillS (1111 lobi c,edll) , , ,
271 othl/ "'Pln_ (1I111yp, o.d omou.I):
.... .d.ry.~{N(lJ~..." '(.q.~."
,... pu.~I,.(.'m!".;L. ..t).:9.0...
m'Tolii ;'ii.i;'ii' ',;sis..".."..
21 Add Imounlsln column, '0' IInl. 81hroulh 27b, Th...." you, lotol.. .111 , , , . , . , , . ..
2. Hol profit 0' (Ioll~ Sublroclllno 28 from IIno 7, If I profil. ..ter hl/llnd on Form 1040.lIno 12, Allo .nll/
I~I nil profit on Schedulo SE. IIno 2 ('"lutory omployoe" ..oln,lruetlon,), If . Iou. you MUST 10 on '0 IInl
30 (lIdue,,,,.., 1..1.,I,ucllon,), , , , , , , , , , , , , , , , , , , , , , , , ,
30 If you hovI 11011, you MUST check Ihl box Ih.1 d..crlblS you, Inv..lmlnl In Ihllletlvlly(," Inlt,uetlon'),
If you checked 30., Inll/ IholOllon Form 1040, IInol2, Ind Schedule SE, IIno 2('~llulory .mploy""
,,"In,truetlons), II you ch",k.d 30b, you MUST .Itaeh Fo,m 6191.
'or Plptrwork Roducllo. Act Hollct,lH 'o,m 1040 I.t1,ucllo...
29 191+ B1
) 3000 Alllnvoltmlnlilll risk,
, 30~ 0 $0101 In...I,.", 1"01.1 ,1,1,
Schodulo C ('"m 1040) 1990
r"m
4562
Depreciation end Amortlz8tlon
(Includln.lnformltlon on U.ted Property)
. all IIPI/'I.I.llIucll.... . Alhlch 1II11'",m 10 you, "Iu,..
o.p.rtmtnt: at ~ rr,"ury
Int.,n.lI..tvtnUt 5tMc.
NemeCI) thown on return
LE
.7bN~
5tl~/)tJLE .. C ..
11IIIII lllcllon To lapenla Certain Tln,lbl. Prop"ty (s.ctlon 179) (Note: If you hive Iny "Listed Properly, " 11.0
complete Plrt V,)
I Mlalmum doll.r IImlbllon (SHlnll,uctlonl) , , ' , , , , , , , , 10 000
2 Tolll coot of ..c1lon 179 prop.rty pllctd In I.rvlco du"nlth,tlK yetr (1"lnlt,uctlonl)
3 Th'lIhold COIl of IIctlon 179 property before reducllon In IImlt.tlon , , , ,
4 R.ductlon In IImlbllun-Subtrectllne 3 f,om IInl 2, bul do nol enter I,U lh,n ,0.
S DolIl/llmlt.llon fo, I.. II/ Subl'lctllne 4 from line I but do nol Inter lellthln .0.
C.) OtKtlpllon 01 ptoPft1'V (~) COlt
'~'. !S
~3. .
'UlIM" or .cti~ '0 which Ihll hllm tllIl"
,
7 Lllt.d proll'rty-Enler .mount from line 26 ' , ' , , , , 7
. Tol.I,lecl,d coat of section 179 p,oporty-Add amounllln column (r.), II nil 6 ,nd 7
9 Tenlltl" deductlon-Enler th. Ilia" ollln. 5 0' line 8, , , , ' , , ,
10 Ca,ryover of dl.lllow.d deduction from 1989 (1",nal,uCtlOnl), , , , ' ,
U Tu,blllncom.llmllltion-Enter Ihe 1.llIr 01 t,a.blelncoma or line 6 (1,,'nllructiO"a)
12 Secllon 179 'apena' deduction-Add lines 9 and 10, bul do nol enler mOil thon II
U Car o"roldlSlllow,ddeducllonto 1991 Add IInll9 ,nd 10 IISIIInl12 ~ 3 '.0
Nole: Do not use Pe" 1/ 0' Pe" 11/ b,/ow for eutomobl/IS. celtlln o!her "hlc/lS. cel/u/er telephonlS. computers, 0' properly uSld for
,nfertelnm,nt. "c",tlon, or emullm.nt (listed prop.rIy), /nstlld, UI' P.rt V for listed property,
MACRS Depreciation for Allltl PIICld In S"vlce ONLV Durin. Your 1990 Till Y..r (Do Not Includ. L1lt.d
P'op"t~)
(.) (IINdicatlon of pr09lrt.,
(c) Bnlllord.prf(I.llon
(au"n.1I 1.1" onlW-Itt
INltuctlGnl1
Ca) Convention
(a) OtpflCi.lion d.d",Ulon
c
d
e
1
Rllldlnllal ,enbl prop.rty 21.&yr.. MM 51!.
I 1.evr.. MM 51!.
h 31.0y... MM 51!.
3l.&yrll. MM 51!.
SIL
12y... S/!.
.0 yr.. MM 51!.
IlIIIDI Othlr D.preclatlon (Do Not Includ. Lilted Property)
Ul ODS and ADS deductlona for "SIts pllced In lervlce In taa years beginning befoll 1990 (aee
Inatrucllons). , , , , , . , , , , , ' , , , II
17 Proper!)' aubJecllo leellon 168(1)( I) election (aeelnat,uctlonl) , 17
II ACRS and othe, dlpreclatlon (aee Inatructlons) , , , , , I
IlZIDD Summary
19 Llal,d prop.rty-Enler amount from line 25 ' , , , , , , ' ,
20 Tolal-Add deduction a on line 12, lines 14 and 151n column (8), and lines 16 Ihroullh 19, Enler here
and on Ih. approp,',le lines 01 your ilium, (Partnerships and S corporatlons-aet insl,uctlona , ,
21 For assell ahown ,bove ond ploced In lervlce during Ihe current year, enter the portion
0' th, baals att/lbulable to alCllon 263A coall se,'nalrucliona, , ,
'0' Pop..work R.ductlon Act HotlCl, III plCO lofth.llp.....ln.lructlon., /.,m 4562 O'l'lo)
Sa'" of Bu.n... Property
(AIIO, Involuntary Converalonl and Reu,tur. Amount, Und.r <1/'0\90
Sactlon, I 79and 2BOf) U~
D...ln_GllhtT....." A_
In'.,nll ft_" s.",," (01 . A_h I. WIW III ,otu,", .... ..palllll.ltructlon.. No, 2
N...I(,).-onrllum loltnIlfWIIII_
AILE 1" ELG :lONe:; .;2o'1-~" .1'583
_ SII.I or behan... 01 Property U..d In a Trad. or Bu,lnl" and Involuntlry Conv",lon, from Oth.r Thin
C..ulltv and Th.It-Prop,rty 1I.ld Mor. Thin I Y..r
1 [nl" her. IhlllOIl proc.edllrom Ih. III. or lI<h'.I' of rell "'111 llported 10 you 'or 1990 o. Form(l)
1099,S or I lubllitul.ltlt.m.nl Ihll ou w,lI be Includln on IIn. 2. 10 0,20 , , , , , , , , ,
(II Otp/Kllllon (I) Cool.. othlr
(I' OtIUl,'IOn 01 ,110I'lIe,..,ocl (el 01" oold (d) 0'0....," lllowocl IloIII, ''''' (II LOSS
. . , I~ ~ I ,~unmlnU'lhl
"'"~ (mo,. dl,. ,,) (mo, ~''f, ,r, pnu Of'_''''' mptaWlm.n ...'" tumor(.) lneI('))
IInCIIClllulllllon upen.. 0' III,
O"'No. I84S.QIM
rorm
4797
1
53 000,00
(~I GAIN
((dl pIuIl"1
_.,m
2
J Glln,ll.ny, IromForm 4684,SlCllon8,lIne21 , , , , , , ,
4 :jlCtlon 1231 &II" from !nal.lIm.nt nttS from Form 6262. Un. 22 or 30
5 G.ln, I'.ny, 'rom lin. 32. from oth.r thin c.lu.lty ,nd thin. . . .
. Add IIn.. 2 Ih,o.lh 6 In column, (&l.nd (h), , , , , , , , ,
7 Combln. column, (Ii Ind (h) 01 line 6, [nil' glin or (1011) here. .nd on Ih. .pproprl.le IInlulolloWt:
Plrtotrl~lpl.-[nl"lh'I,'n 01(1011) on Form 1065, Schedul. K, IIn. 6, Skip IIn" 8, 9, 11, Ind 12 b.low,
i eo,po'ltlonl,-R.port Ih. glln or (1011) lollowinllh.,n.lruellon, '0' Form 11205, Schedul. K,lIn.. 5 .nd 6, Skip IInll 8. 9,
11, ,nd 12 below, unl'lIl1n. 711. pin .no Ih. 5 co,polllion il .ubleel 10 Ihe Clpllll 8Ilnl I..,
Allol~...,-If IInl 7 111"0 or 11011, Inllr Ih. Imounl on IIn. 11 belOW .nd .klp IInll 8 .nd 9, If Iln. 7 1I'IIIn .nd you did nol
hive .ny prior Y"' I.ction 1231101111, or th.y WI" recaptured In In ,ltll" Yllr, ,nter th, pln.1 . lanl'tlrm Clpiul Ill" on
S<hed.le 0 Ind ,kip II... 8, 9, Ind 12 b.low,
I Non,o..plu,ed nelleetlon 12311011I1 f,om prior ye... (1IIInllr.etlonl), , , , . , , , , , , , , , , ,
it 5ublrtelll.1 8 I,om lin. 7, If mo or 1'11, enler ,(j., AIIOInllr on thllpproprl.I.linlll 'ollowl (... inllruellool): , , , ,
S corportllo...-[nlll Ihll Imount (If 1I"ler Ihln IIro) on Form 11205, Schedul. 0, IIn. 7, Ind .klp linn Il,nd 12 b.low,
Allolher..-If line 9 II 1110, ..Ier Ih. Imounl from IIn. 7 on IIn. 12 b.low, If IIn. 911 mort thin lero, .nter th. Imounl from
Iln. 8 on lin. 12 bilow, .nd ,nter thl .mounl from lin, 9 II .Ionl,tlrm Clplt.1 &.In on Sch,dule D.
.. Ordlnlry Oeln, Ind Lo....
10 O,dlnl'Y 8Ilnllnd lOll.. nol Includld on IInllll Ihroulh 16 (Includ. prop.rty h.ld I Y'" 01 "11):
11 LOII,lhny, fromlln.7, , . , , . , , , , ,
12 G.ln, Ihny, from IIn. 7, or Imounlf,om IIn. 8lftppllClbl.
13 G,'n,lhny.',omllno31 , . , , , . , , , .
14 N.III'n 0'(1011) lrom Form 4684, SlCtlon 8, IInll13 Ind 20a
11 Ordln''Yllln Irom Inltlllm.nllllll from Form 62~2, IIne21 0' 29,
1. R...pluII 0' IlCtlon 179 d.duetlon 'or plrtnerl Ind 5 corportllo. .hlrlholderl from proper\'f dllpollllonl bW
ptrtnerlhlpund S eo,pOlatlon, (.ttlnllruellonl), , , , , , , , , , , , , , , ,
17 AddllnIlIOlhrou&h16Ineolumnl(&llnd(h) , , , , , , , , . , , , . , , , , . ,
18 ComblnlColumnl(lllnd (h)01lInI17, [nlergll. or (1011) hili, and on Ihllpproprll,.lIn.1I foliowt: , . ,
a For IlItxcepllndlvldullrtlurnt: [nler Ihe Ilin 0' (1011) ',om IIn. 18 on Ih. rtlurn belnl filed,
b 'or Indivldu.l return.:
(I) If Ih.lolI on IInl IllncludllllOll from Form 4684, S.<tlon 8, Plrt II, column !b)(II), .nll' lhll p.rt 01 Ih. lOll her. .nd
0.lIn.21 0' Sch.dul. A(Fo,m 1040),ld.nllfy.. from "Fo,m 4797, IIn.18b(i) ,5ttlnltructlonl , . , , , , ,
(2) Red.lermln.th. "n 0' (Iou) on IIn. 18, txcludln Ih.IOII, if Iny, on IIn. 18b( I), [nter hll' .nd o. Form 10.0, line 1~
For P.porwo,kll.ductlo. Act Holle., "" P'I'1 o...plllll'.llIuctlO... Form 4797 (1910)
SCHEDULE t: Supplemental Income and LOll OMlNo "0,00'.
(Form 1040) (From "nll, roV.IU.., p.rt..,lhlpl, ..111..,lruII" RIMICI, .Ie.) ~@90
Oo,,_m,,'ollhl '..,OUry .. Atllc~ 10 '.,m 1040 or '.,m 1041. ~"Idl...n1
1.llInll "_..StIVKI III .. S.. In.lrucliool'or ac~..ulo [('orm 1040 , I... No 13
N.mt(l) Mow" on IIlu'" Ye", ..tal MClUltr .......,
elf'!;L y "Hi .JONeS .;Ja'lrS'or 5S3
Income or LOll From R.nlllllnd ROVIIUII Noll< R,po'f lerm renl., mcom, or /011 lrom Form 4'311 on p'" 2, IIn,39,
I Show the kind ..d IOClllon of ..eh ,..111 properly: f,. /J.)
A ..1:98..;",..W.~~!M.4l()#..~T..,..IJ!.W!t1NI{.~(Ji,l8.~jA, ,',Wi.!i.",. ,'(~i~k.., .(I!ltj..l?,,:.~'!r:f-.. ..... ....
I ............................,.................."....,..,...,',..,.,..,.."...."......,.................".....................
C
.
VII No
2 Fo, IIch IIntll prop.rty 1IIIed on line l. did you or your lom'ly u.. ,I 'or per.on.1 PU'POII' 'or more Ih.n th. Irlller A
01 14 d.y. or 1096 01 the 10111 d'yl rented 01 I." renlol .olue dUMB th. la. yto,7 (S.. InelrucllOne.) .
C
R.nt., Ind Ro~allv Income: P,o.trlltl D Tolll,
A B C (Add columna A, B. Ind Cl
3 R'nll received ' (".,",.5 ~ 04,7'7, ] ;.'174- otJ ] 1 .:1174-10 V
_4 Ro.,IIIt1 IICtlved 4 4
R.nlll Ind RO~IIIV Expenltl: o.n 71
5 Advertllln. 5
6 Aulo .nd lravel ,
1 Clllninl Ind mllntenanee 7
. Com millIOns , 8
9 Inluronce , 9 'lot) 00
10 L'8I,..d Olh., pro'uClon.' '.11 I.
II Mort"I' 1.lerlll plid 10 blnke, 3o<l1 43
.Ic, (I" Inslructlone) II II
12 Olhtr Inl."et, 12
\3 R.p.'rs ' I' l:iP]~ 'If/)
14 Suppllu 14
15 T.... 15 .~'i'I I/o
16 UIIIIlIII, 16
17 WOI" .nd sail"" ' 17
III Olher(lIet) .. ........'....................
........."..........."......................
18
..........,........."................,.....,.
.......................................,......
19 Add linn 5 Ihroulh 18 19 4'1211 1.~ II
20 O,precllllon ..pence 0' tPI.fon 2" 11144- ~5 36
(e..lnelrUCllonl)7fMS.IO, t', s.,..) "
21 Tol,ltkp.nces, Add II.es 19 .nd 20 2' t"91~ (2) ,~
22 I.eom. 0' (10") 'rom rent. I or
royolly propelll... Subtroct IInl 21
'rom IIn. 3 (rente) 0' line 4
(roy,ltles), If Ih. ,"ull Is . (lOll), (3014 ,3
e" Inctructlone to find out If you 22
mu,l III, Fo,m 61911 , , , , ,
23 Oeducllbl. IInllllo.., C.uUo.: You,
renl., /055 on 'In, 22 m.y b. limll.d,
Sit 'nstrue/lons 10 lind out il you must 23 ( 30/4- ~~)( )( )
1,I,Fo,m'II'2 , , , , , , ,
24 Incom.. Add renlolond roy.lly Income f,om IIn. 22, Enler the 101.1 incom, h..., 24
25 Lo..... Add roy,lly lo..es from line 22 .nd rent.llocclI from IIn. 23, Enter Ih. lolollolles here 25 ( ....~)
26 Tol.1 /lnl.1 .nd roy.lty Incom. or (10"), Combin. .mounte on lines 24 .nd 25, Enler Ihl IIsult h.re, If
P.rte II, III, IV, .nd line 39 on paB' 2 do nol apply 10 you, enler the amount from line 26 on Form 1040, /30 I 4- ~3)
line 18, Otherwle., Inelud. Ihe .mounl Irom lin. 261n the 10101 on Iln. 40 on pOle 2, 26
for '.,,,work Reduction Act NoUet,'" form 1040 In,tructlon.. Sch.dulo (('orm 10401 U90
ScIll<l.'1 [(,.... 1010 ItIIO
Nlmt(l~ Mown on ttturn. to. not IMIt "Im,.n4 IOCI.I UCU'lty number I' &hown on other 1Ic1..)
AHKhmlnlS Ulncl No, 13 2
YOUI ""01 "'.""._
,
,mounll (rom (,mlln Of (i,hln on,Schldul, E, yoU mu"lnc'ud, your ,rop /ncom. (ram fhos"cflvlfll. onlln, 41 bilow,
ncom. or Oil rom artnln Ip. Ind S Corpor.tlon.
"yOU reparlllOIl f,om In It'lIlk aCllvlty, you MUST chICk ,'Ih" column (.) 0' (I) of IIn. 27 10 dncrlb' your IIlVlIlm,nlln Ih. Icllvlly, Sit
Inllrucllonl," you check column (/), you mUII.ltlCh Form '''I,
'.)["1""0' (CJChICkl' (')[..,'o,lr '"VII'''''"' Atlt..r
27 (.~ Him. p.I1"."nIO; . ""'~ ('lAlli' (1)_11
'Of 5 (o,pot.hon p.""., Ip IdenllUullon number . ",II not., nil
A
II
t!
D
r
Pllllv. Incom. Ind LOll HonPIIII.. Incom..nd LOll
(.) ""'vIlo.. .Ilowld (h)P'''llwllflcom, (I) Non~'"lv'IO" (j) SKllon .79 ,_penM deduction (k) NonPlUlv. Incom.
(Alt.", ,.,m 1112 I' '"1,11'") "om Sch.4lIul. M... from Ie tll1ul. K-I Irom'.,.",415'Z lrom ""Hut, K-l
.&
.
t!
D
r
2.. Tol,ls
b Tol.11
29 Add ,mounlsln columns (h) .nd (k) of Iin. 28., Enl..lh.lolallncome here , 711
30 Add Imountsln columns <a>, (I), Ind fj) of Iin. 28b, Enl" Ih. tala I here ]11 ( -,
31 Tolll plrtn"shlp ,nd S corporlllon Income or (1011), Combine amounls on lines 29 and 30, Enl.. the
IIsull hell.nd 'nclud,'n th,'o'al on Iin. 40 b,low , 31
Income or LOll From EIIII.. and Trull.
32 {.)Ntm. (~)[mplo,,,
Id,ntlllUiUon number
A
.
C
PIIII.. Incomo .nd LOll HonPIIII.. Incom. .nd Loll
cc) P'IIIYI deduction Of 601. IlIowtcl (d) Pluiv'lncom, \,) O~ucuon 01' Ion (t) Oth,r Incom. from
(Anach '"'" ISI2 If reqUited) from SChldul, K-l rom Schlllul. K-l lkh.t1ul, K..l
.&
8
c
33. Tol.ls
b T ol.ls
34 Add Imounl, In columns (d) Ind (I) olllno 33a, Enler Ih.lolallncome h.re, , , , , , , , , , ]a
35 Add .mountsln columns (c) Ind (e) 0' IIn. 33b, Enler the lotal here ~!i)"
3. Tolll tllIl. and lrulllncome or (loss). Combine Imounls on lines 34 ,nd 35, Enler the result here and
In Iud. In Ih. 101.1 on IInl 40 below , , , , , , , , , , , , , , , , , , , , , , , 3.
Incom. or LOll from R..I Estll. Mort .,,'nv..tm.nt Condultl (REMICsl-R..ldull Hold.r
37 (~) [mplOYI' (c) (xtllllnclullon from (t1~ T.lIbl.lncom. (nit 1011) (.) Incom. trom Ictlttl..'n Q.
(.)Nornl khNUI.. 0, Un. 2c
IdentlflClllon nl.lmbef (,"In.truchO',.) rom IdI,"ute. Q. Unllb Iinl3b
I I
3. Combln. amounls In columns (d) and (e) only, Enl..lhe result here and Include In 'h,'olal on IInl 40
b.low, , , , , , , , , , , , , , , , , , , , , , , , , , , , , 31
Summary ' , , ,
3t N.l farm "nlallncom. or (loss) from Form 4135, (Also complete line 41 below,) . . . . . ,3lI
40 """ '"f:'.",'" ,-> """oo 'm~"" '" ,,_ 26."'. ". 3B. ,.. 39. Em" ,.. .."... ,.. ~
on Form Olin. 18 , , , , , " """"""""". 40 0 I "
41 R.conclllllloll of Farmln. Ind Flshln. 'ncoml: Enler your .roll
:~rmlnl and fIS~:nillnCOm. reported In Parts II and III, and on lin. 39
seelnsl,uctlons , , , , , , , , , , , , , , , , , , , 41
'..m
4562
Deprecl.tlon end Amortization
(Includln,Inform8tlon on L1lt.d Property)
~ See IIp..II.I..I'uell.... .. AI..ch Ihll '.,m II Y'U' "Iu,..
OMI No 1....0172
~@
All_I
Ot9.rtmtnt 0' Uti Tt..lu,.,
Int"n.1 "tYlnu. 6ttYlct
Namt(l) thow" on '''urn
1?t1-b
IUI""II OI.ctlVlty 10 which Ihl, form ,,1,1...
JOlJe.5
5~ HEbtll.4 liE'''
IIIDII Ellctlon To ElIplnll C.rtlln Tanllble Prop.,t~ (Slctlon 179) (NOllllf you hav" any "Llst"d Property, ",Iso
compl"t" Part V,)
I Mulmum doll..llmllJllon ("llnllructlonl), ' , , ,
2 Toll' cOil of lecllon 179 property plac.d In ""'"'' dU""1I Ihal.. y'" ($I' Inllructlonl)
3 Threahold COlt of 1"llon 179 proparty b"OII r.duction In 11m IIIII on ,
4 Reducllon In IImllalion-Sublrecllln. 3 'rom line 2, but do nolenle, leu then ,0,
5 00111' Ilmlt,llon 100Ial y,.. Sublraclllne 4 from line 1 bul dO nolenler lellthan ,0,
(.~ O"cflpllon 01 property (It) COlt
I
2
3
4
5
11 0 000
200 000
(c) Elter.d ealt
6
7 LIII.d prop.rty-Enler .mountfrom line 26 ' , , , 7
. Totllelect,d COil of lectlOn 179 prop.rty-Add amoun'"ln column (c), IInel6 and 7
9 Tenl.tlve d,ducllon-Enler thel...er ofllne 5 or line 8, , " ",'
10 Carryover 0' dlllllowed d.ductlon 'rom 19B9 (lee ,"llrucllons) " ,'"
II Tu,ble Income IImll.lion-Enlll Ih. l.uII 01 lu.blelncom, or line 5 (see,nllructlonl) II
12 Section 179 ..p,nse d.ductlon-Add lines 9 and 10, bul do nol .nler more Ihan IIn I 12
l3 CI,ryOvII of dlllllow.d deduction to 1991 Add lines 9 ,nd 10, 1111 line 12 ~ l3
Hotll Do not use Part 1/ or P,rt 11/ b,low lor automobiles, cert,m of her vehicl,s. cellular t"'phones, compuf./S. or property used lor
ent.rtamment. reerl,tlon, or amusement (lisfed property), Insfaad, use Part V lor listed prop.rty,
MACRS D.preclatlon for A...ls Placed In Service ONt Y Durlnl Your 1990 Tall V..r (Do NOllnclud. L11t.d
Proplrty)
(b) Mo. end ~" (e) B'llllor "eprfClltlon
(I) CIIUllltallon or property pltced (SUIIn... Ul' onlY-II' el) Conv.nllon (I) O.ptfC1.lJon deduction
1M MrYlct IMltructlonl1
14 General D. recl,lIon S slem (GDS (slllnst,uctlonl :
I 3.yel' prop,rty
b 5.y.., property
c 7.ye.. property
d 10.y... property
I 15. el' prop.rty
f 20.ye.. property
"/f/I/'W,H/I'/I$/I,' "/ ,I M
'llti,i'!;':!';tn /I;)'//i:' ! 1/1,
Residential renl., property 27.0yrl. 1111 S/L
I 21,~vr.. 1111 S/L
h Nonresidenli,l real property 31.0yr.. 1111 SIL
31.~Vro. 1111 S/L
15 Altern.tlve Depreciation S Item (ADS (seelnst,ucllonl):
I Cllss life S/L
b 12.ye.. 12 yr.. S/L
C 40. e.. 40yr.. 1111 S/L
IiIIIIIII Olher D.preclallon (Do Not Includ. L1st.d Proplrty)
15 GDS Ind ADS deductions for ass.ls placed In service In lal years belllnnlnll before 1990 (lei
Instructions), , . , . . 15
17 P,operty subjecl to section 168(f)(I) election (Ieelnslructlons) , 17
18 ACRS ,nd olher d,preciation (stelnslruclions 18
I2!DII Summary
19 Llsled propvrty-Enler amount 'rom line 25 ' , , , 19
20 Totll-Add deductlonl on IIn, 12, lines 14 and 15 In column (g), and lines 161hrough 19, Enter her.
and on the .pproprlalellnes of your relurn (Partnerlhips and S corporations-see Inll,uctlons ' , 20
21 For Issets shown abovl8nd placed In "rvlet during Ih. current ytor, enter Ih, portion
olthl bulsan"butlblelo sectIOn 263A COils Sit instructions, " ", 21
'or '.ptrworh R.ductlon Act Notice, ... Pl.t 1 of Uti ..p.re'tlns'ructlon..
'''OJ
11",4-.~C;:;
~I.III%~%:/ /11%,1@
~. W;!"';NM,;!,;
'olm 45112 (1990)
":' ,
Social Security Self.Employment Tlx
. ."Inltructlonllor .e11l11ull II (Form t040).
0II.Ne.II4..oo7'
~-
AIIId\IMIII
Soclllllcurily numblr 0' Il'IIOIl
with ..II,"m"ly~tlncoml .
593
Who MUlt FII. Seh.dul. SE
Vou mUlt III. Schedule SE II:
e Your n.t ..mlnp Irom ..11..mploym.nt w.r. $400 or mor.; OR
. You w.r..n employ.. olin ,'ectlns church or church.controll.d o'S.nlzatlon thlt plld you Willi (chu,ch .mploy"
Incom.) 01$100 or more: '
AND
e Your wIS's (subj.ct to scelll security or r.llrold r.tlr.m.nt tu) w.r.',ss than $51,300,
Ixcaptlon: II your only s.'I,.mploym.nt Incom. was from ..rnlnlllll minister, m.mber ola rellllous order, or
Chrlsti.n sCI.nc'8rlctltlon.r, AND r,ou tII.d form 4361.nd rec,'v.d IRS Ipprovll not to b.tlx.d on
those ..rnlnSI, D NOT lIIe Sch.du. SE,lnsttld, writ. 'Ex.mpt-Form 4361' on Form 1040, IIn. 48.
for more Inlormltlon about Schedula SE, .tlthe Inst,ucdons,
Not.: M"'t p.opl, c.n use the,horf Schedul, Sf on this p.,e, But, you may have to use th,/on,,, Schedul. Sf
on the becK.
Who MUST U.. the Lon. Schedule S[ (Section B)
You must use Section B if ANY 01 thelollowlnglpply:
. You .Iect the 'optlonll m.thod' to Ilgure your self..mploym.nttu (see Section e, Part II, Ind th.lnstructlon.):
. You Ire I minister, m.mber 011 religious order, or Christian Sclenc. practitioner Ind you recllvtd IRS Ipprovll (from
form 4361) not to b.tlxed on your earnlnp Irom these sources, but you owe self.employment tlX on other tlrnlnp:
. You hid church employtllncome 01 $100 or more that was r.ported to you on Form W.2;
. Vou hid tip Incom. thltl. subJ.ct to soclll security tax, but you did not report tho.. tips to your .mployer: OR
. You wer. Ilovernm.nt employ.. with wIges subj.ct ONLY to th. 1,4596 M.dlclre plrt olth. soclalsecurlly tax
(M.dlcare qUllllled governm.nt WillS) AND the totll 01111 01 your wIglS (subJ.ct to soclll securlly. rlllrold
retlrem.nt, or the 1,4596 M.dlcare till) plus all your earning. subject to sell.employment till 15 more thin $51,300.
S.ctlon A-Short Sch.dul. SE (Rtld abov.to 5.. If you must use the long Schedule SE on th. back (Section B),)
I Nit film profit or (loss) f,om Schedule F (Fo,m 1040), line 36. and form plrtn"shlps, Schldul. K.I
(Form 1065), line 15., , , . . , . , . , , , . ' , . , . , . , ' , , " I
2 N.t profit 01 (IOIs) f,om Schooule C (Folm 1040). line 29, and Seh.dule K.I (Folm 1065). line 150
(olh" thin II,mlnl), S"lnst,ucllons for other I"comelo "port. 2
.-0 ...
3 Comblnelln"llnd 2, Enlortho "suit . . , , . , ' .
4 Mulllply line 3 by ,9235, Enlor Ih. ,,,ult, If Ihe "suit Is 1'55 Ihln $400, do not fill Ihls sch.dulo; you
do not owe solf.employmentt,x , . , . , . , . , ' . . , . . . . . , , , ,~
5 Mlxlmum Imount 01 combined WII" Ind solf,employm.nt ....Ings subject to socl,l SICU"ty or
'11I'OId "1I,,ment (II" I) lox fo' 1990 . , . , . . , . , , . . . . . ' , , . ,
, Totll soclll socu,lty WiltS Ind lips (from Form(s) W.2) and "UlOid rellrement complnsatlon (II" I).
Do not Include Medicare qu,'lfI.d lovarnmont WII's on this IInl . , . . . . . , , , . '
7 Subt'lct line 6 from line 5, Enlor Ihe "suit, If the IIsult Is ZIIO or I.ss, do not file this schldul.; you do
not ow. ,,".,mployment Ilx. . . ' ~
I Entarthtlmeller olllne 4 or IIn, 7 .
I
g
)C,l1l3
9Rlttoftlx .".....
10 Sell.employment tex. II line 81s $51,300, .nlll $7,848,90, Olherwl.., multiply th. Imount on line 8 "15,1 4.3
by tile d,cim,l.mount on IIn. 9 ,nd enl" tile "suit, Also entll this .mount on Fo,m 1040, IIn. 48 do '"
Hote: Also en'" on,.h.1f o"hlumoun' on Form 1040, IIn,25,
rer Plp.rwllk lI.ducllon Act Holleo,'" 'o,m 1040 Inlllu,lIon.. achldullll ('o,m 1040) litO
, I I
2441 Child and Dependent Care Expen.e. 0111"" IM'_
Film . A<<lch II 'Of"' 1040, ~.O
Otlllnmtnl" lho r,uwy I ell ~~. Z 1
10Itmol~_It""'(1I . auu"..11 .11,u I... -
Nlme('I'-on'~lo.o r..'_.......,._
I,R4f>LI:Y '. :T()NES . ICo 'HE. :JONffJ ~()11~olt1SB
. If you I'. clllml.. Ihe child .nd dependenl cI'e <redll. compl.I, Plrt. I .nd II b.low, Buill yOU rocelved ,mployer.provldld
depe.denl..,. benellll, 11111 compl.le Pert III o.'he bock,
. If you e,e not clllmln.lhe cr.dll bul you received .mployer,provrd.d d,plnd.nl ..,. b.n,III., only eompl"1 Plrt I, below. end
Plrt III on Ihe bock,
11IIII P.rlonl or O'.lnlnllonl Who Provldad the c.re- Vou mu.t compl.l. Ihll Plrt. (5.. Ih. Inllrucllonl. If you
need mo,.lpoc'. Iltlch 1lllllment,)
(b) Add,." (e) Id,nlll'/rntnumber (dl Amounl p.ld
1 (a) Nlm. (numbo" 11,..1. City, IIBI.. .nd ZIP cod.) (SSN 0' IN) (lit 1..I,ucllonl)
tcJMAI ~ iJ1ttl1t/LWJ ............,........,..........,....,..,........,....
,
fJlJ
................................................................
.....................,................
2 Add Ih..mounls In column (d) ollln. I ,nd .nlll Ihe 10111" ,',',','" 2 00
Nole: If you paid clSh we." 01 S50 or more III I "'.nd,, qUI"er to In indivldulllor servicII p.rlorm,d in you, ham., you mu,! liIe
In m 10 m,.! tIK return, G., 'arm 942 lor d,flils,
Credit lor Child and De end.nt Care Expens.s
3 Enler Ih. numbe, of qu.1l1yln. per.ons who were cer.d for In 1990, (Sit Ihe Inst,uclio.s for Ih. dellmllo. 01 qusllfyln.
persons,) Ciullo.: To qUllify, the person(s) mull h.ve .h.rea the Jlm.hom, w,fh you III 1990, .
4 Enler Ih. ,mounl 0' qusllfl.d "pen... you Incurlld ond octuolly pold In 1990, Sit Ih. In.truclionllo
Ilnd oul which txp.nlll qUlllfy, C,ullo.: /I you compl.f,d P." 11/ on Pl,e 2, do .0' inc'ud. on fhll'lIl.
.ny 'Kclud.d "'.elituhow. on lin. 25 , . , , , , , , , , , , , . , .
15 Enler $2,400 ($4,800 II you plid lor Ihe cere 0' Iwo or more quallfyln. 15
persons) , , , . , , , . , , , , . , , , , , , ,
l5 If you compleltd Plrt III on p..e 2, enter Ihe tlcluded be.,III,. II ony, a
fromlln.25 . . . . , . . . . . . . . . . . . , , 'IJ -0 -
7 Subl'lcl line 6 from IIn. 5 .nd .nter Ihe result. (If Ihe resullls zero or 1'$1, skip IIn.s 81hroulh 13,
Enler zero on IIn. 14"nd.ololln, 15,) . . , , . . , , " , . , , . , . , .
. Compartlhe ,mounls on IInll4 Ind 7, Enlerlhe .mlller ofthe Iwo amount. here, , . , , ,
9 You mUll enter your ..,nld I.com., (S.elh,lnslrucllons 'or Ihe d.llnllion 01 ..,n.d Incom,,), ,
10 If you ere me"led IIlIn. . joint IIturn. you mUll .nter you, spouse', ellntd Income, (If you, SPOUII
was Ilult-Ilme atud.nt or dlsabl.d, s..the Inst,uctlons for Ih. Imounl 10 .nter,), . , . , . .
11 II you ere ml"led IlIIn. a jolnlrolu,n, compere the .mounts on lines 9 ,nd 10, Enlll Ihe ameller 0'
Ihe two .mounls hlro . . . . . . , . , , . . , . , , , . ' . , , , , .
12 . If you.,. m."led fIIln. e jOlntroturn, compere the amounls }
on IIn.. 8 end II, E.lerthe Imelter 01 the two Imounls hero,
. . . . . . . . . . .
e All others. comp.rolhe Imounls o.lInlS 8 end 9, Enler
the .mlller 0' Ihe two .mounts here,
l3 Enlll the d~clm,l.mount from Ih.lable b.low Ihat.ppll.s 10 Ihe .dlull.d .ronlncome on form
1040. IIn, 32, , , , . . , , . , . . . . , , , , . , . . , , , , . .
If IInl 321.: O.clmlllmoun' I.: If IIn. 32 II: Declmallmountl,:
0"'1'- lut not 0"'1'- lue not
ov.,-- ov.r-
$0-10,000 ,30 $20,000-22,000 ,24
10,000-12,000 ,29 22,000-24,000 ,23
12,000-1.,00028 24,000-26,000 ,22
14,000-16,000 ,27 26,000-28,000 ,21
16,000-18.000 ,26 28,00020
18,000-20,000 ,25
14 Multiply Ihe amount on Iln. 12 by Ihe d.clmalamount on line 13 end .nter IhorlSult . . , , .
)( 0
Q860
15 Multiply Iny chtld a.d d.p.ndent cere "p.nslS fo, 1989 Ihat you paid In 1990 by Ihe declm.1
amount Ih.tIpplllS10 thud/usted Irosslncome on you, 1989 form 1040. line 32, or Form 1040A.
line 14, Enler Ih. r..ult, (You must complete Part lend Itlach e slat,menl. S.. Ihelnllructlo/lS,)
n n IIn 4 n h n r I n f r h n r n I
'or P,plrwork R.ducllon Act Noll... "" sePlllt.I.II,uctlo.l.
Lab.1
(Set
In.tructIOn.
00 ptQt Iq
U.. Ihl IRS
I,bll,
OlhlllWl..,
pl.uo print
or typo,
p,..'denUII
ElutlDn Clmpllln
S.. I 11,
L
4
.
I
L
H
.
"
I
Filing StiluS
Cheek onlV
on. bo.,
Exemptions
(5.. plgl t2,)
" moro Ihln II.
dopondonll.
"" plgl 13,
d
I
Ineome 7
Ie
"!tech b
Copy I 01 you, .
'011II1 W-2, 10
W.20,lnd
10l11.R hlrl. 11
" you did not 12
get. W.2. III 13
p... 10, 14
15
411ICh check 0' lie
man.y ordor on 171
lop 01 onv
Forma W.2. la
W.2G, or 1.
10SS.R, 20
211
I 22
23
I 24.
f Ad\Ustmlnts b
to ncome 25
(5.. p.gl 19,) 21
27
21
21
30
1
,..1Ilt orJon,-tltc,31 '"',Otolh..11>
'tour IIrs' name and Inlllal
1M
III
161 oneil
, II OMa No, 1..5 ,.
y...._~-
;'0'1 :'0 i '1,33
1Ipou"'.~~-
/'13 !1ff4!J:J'S
for Privacy Act Ind
PIP.rwOrk Rlduollon
Act NoUee. HI
InllnlcUonl,
Lilt name
.....M CAR-RT-SORTM.RR06
NB 209-50-9583 193-46-2315 S28 50 I
BRADLEV T & MICHELE A JONES R
316 WISTER CIR 002 S
MECHAN ICS8URG PA 17055 III
~I,no,
00 VOU wonl S 1 10 go 10 lhll lund7 ,
" ul. filum dOli our II wont 1 10
thl. lund7
51"011
"'''"tel filing lolnl rolum (.Vln If ooly on. h.d Incoln.)
Momtd 111I00 Illjll/III ilium, Enlor 1pGUII'IIOClalUCUllty no, Ibo.. IlIld lull flom. h..., .
Hlad 01 houllhold (Wllh quollfylng poraofl), (SH p.gl 1 2,llIlh. qu.llfylng plllOO '" child bul nol your d.pondlnl,
"'I< Ihll child'. noml hll', .
5 Oulll In wldow.r wllh d. ..doni child ( II/ a al dltel. 19 ,(SH I I t 2,
Ie ~ YouneIf. II your poronl (or somoonl alII) con claim you .. I dapondenl on hi, Ot hor II>
rolum, do not chICk box 61, SuI bt lurolo cheek Ihl box on IInl 33b on poO' 2 ,
b u... , , , , ,
o Dlpendlnlll
II) Nlme 111111, Im".I, 'flO 1111 fI.m'l
ES
S
1
2
3
4
N., II "111
........ 1111 ~
I.. .. .....
lit, 01 y...
I'".''' .. ..
wtto:
. II... will YI. ~
. .1.., II.. will
'" ... I.
.I_or
1I,IIOIlII (III
1111101
lit, .......
..,.,.......... -
~'......II
...."""
IIHI I.... .
II you, child dldn, II.. wllh yOu buill claimed II your d.ptnd.nl undor . plI.I9I5 .glllm.nl, eneck nor. . 0
Totll number ol..om 11001 clolmed , , , , , , , ,
WIOII. ...11I.., t1PI, .IC. (./I.ch Form(.) W.2) . , , . .
T..lIbIe Inlll..1 Incom. (WIO ./I.ch Schodule B If over $400) ,
T"'IIIIII" Inlllllllncom. (see p.ge 16), DON'T Ineludl on IInl 61 8b
Dividend Incoml (0/10 ./llch Scll<<lule B /f over $400) , , .
T...b1. ,ofundl 01 11111 ond loctIlncomlll>... II ony. from worksh..1 on pogo 16,
Alimony ,ec'lved . , , , , , , , .
Bu.lneu Incoml or 0011) ('fllCh Schedu/l C) , , , . , ,
Cepltll goln 0' (10") (./llCh Schedu/l D) , , , , , , ,
Clpllll g.ln dlllrlbullonl nol roporttel on IIn. 13 (a.. p.gl 11),
Othl' golnl or (10....) (.ttlCh Form 4797), , . , , . , , , , , , . .
TOIIlIRA dl.lrlbullonl , l.1!!J /'l11t.2..18b Tmbl. amounl (III p,eg.17)
TQlol plnslon. ond onnulli.. l.1!!..1 I~ 17b Talllbl..mounl (ne pag. 171
Rlnts. roy'"I", pl11n."hlpl, .."I.., lruall, .Ic, (./I.ch Schedu', E) . , , , ,
FIIIm Incoml or (Iola) (./I.ch Scll<<lule F), , . . , , . , , , . , , ,
Unemploym..1 r.omp.n..lloo (Inlu,onc.' (I" p09' 18) , . , , . , , . , ,
Soclsl IICu,ity b.nlflll, I 21. I L- 21b Tillable .mounl (SII page 16)
Olhl' Incom. (1111 typo ond omounl-'" p.g. 19) ....................................
Add 111. omounlllhown In lilt lor n I column rOt llnoo 1 Ihr 22, TNIII our 1011I1"0"" .
You, IRA dtducllon, from oppllcalll. _shill on flIlle 20 or 21 4
SPOUII', IRA deducllon, f,om Ipplleable wortlslllllon p.gl 20 or 21 4
Onl.hl" of 1I".omploym..t 'ox (III pig. 21) , " 25
Sell'Imployed hlllln Insurane. deduellon, 110m wor'<shlll on p.gs 22, 2
K~h rollromln' pl.n ond .el'-employed SEP deducllon 27
Penllty on e'rly wllhdrow.1 0' IIvlngl, , , . ., 2$
Alimony p.Id, Aeelplonl'. SSN . 21
Add Un.. 2.1 Ihrou h 29, TheIl Irl ou, 1011I tel Ullm.." , , , , , . , . 30
Sublrlct IIn. 30 from Un. 23. Thill. yuur 'ellul'teI 8roll Incom.. " t/'lis .mount /s I.,s th.n
'2',2~O.nd. child lived With you, ,.. pogo.~ 10 nnd out /I you Cln cl.lm the 'E.mtd Incom.
e It.onlln.~B . 31
CII. No, 113208
~ 1-
8
11/ 5~
Form 10.011"11
31
~
Tax
Compu-
tation
II you want
\hI IRS 10
flgure you,
tP, II. pig.
24,
Credits
(5.. plgl
2&,)
411
411
47
411
48
60
al
52
53
Payments 14
55
55
a7
55
58
Other
Taxes
AtllCh
Forml W.2,
W.2G, and
1099.R to
front
60
01
Refund or 02
Amount 03
You Owe f4
Sign
Here
K..p I copy
or this return
10/' you,
records.
Paid
Preparer's
US, Only
:M
Enl..
Ihl
la'll"
0'
your:
Amounl Irom IIn' a, (11lUllod gro55 InCOlnl) , , , . , , , , , , , , ,
Cheek II: 0 You w... 6S 0/' oIdl<, 0 Blind: 0 IpoUII WII 6& 01' oIdl<, 0 BII"",
Add Ihl numb.. 01 00..1 chockod abovl and Inl.. Ihl IOlal h..., ' , , .. ~
b II you, par.nl (or IIOIT1lOnl 1151) con clllm you II I d""ondonl, chock h..I" iS3b
c II you arl mlrrled filing I I""arlll relum and your spoU5l1llmlzII doducllonl,
0' you arl >> dUtl'lllluI ollln, ... p.g. 23 Ind Chock h"I, , , , , .. 33c
.lIonl I,om $chodul. A. IInl 26), OR
S..ndard deduotlon (shown below 0/' you, flllng 1111uI), C.ullon, /I you
chee~od .nv box on llna 338 or b, go 10 poga 23 10 "na YOU' I/onalld
aaduCIlon, /I vou choc~ad box 33c, YOU' I/onalfrl atduc/lon 15 lifO,
I Slngl.....3,.00 . HOld of hou5lhold-S6,000
a MerrI.d IiIlng lolnlly 0' Ou.lIlylng wldow(..)-$6,7oo
a Mon1od filing 51P"ollly-S2.860
Subl"ctllnl 34 Irom IIn. 32 , , , , , , , , , , , , , , , , , , ,
IIlInl 32 II $7&,000 or II", mulllply $2, I 60 by Ihl lolal numb.. of ""mpllonl clllmld 00
IIn15., IIlInl 32 II ov" $75,000, III plgl 24 lor tha .mount 10 Inl" , , , , , ,
T..abll lneoml, Sublr.clllnl 38 lrom IInl 36, (lllIn. 36 II mOrt Ihon IIn. 35, ..I.. '0.,) ,
Enl.. to, Chock " ,rom . 0 Tax Tobia, bOT.. RIla $chldulal, 0 0 Schtdull 0,
01' d 0 FOI'm 861 & (III p.gl 2.), (Amount, II any, frOlTl Fonn(l) 8814 .. I I ,)
Addlllon.llaxll (I" pogl 24), Chock II Irom . 0 Form .970 b 0 Form 4972
Add IInll 38 and 39, , , . , , , . , , , " ..,.
Crtdll 101' child ond deplndlfll cara ..pon"l (.II.ch Form 244 I) 1
C,ldll 101' Iha eld.rly or Ihl dl5lblod (,"ach Schtdull R)" 42
FOlllgn I.. c,edll (.lIach Fonn "'6) , , , , , " 43
Olh.. crodlll (... plOI 2&), Check If I,om a 0 Fonn 3800
b 0 Form 0390 c 0 Form 8801 dO Fonn (Ipeclly)_
Add tlnll 41 th,ough 44 , , . , , , , , , , ,
Subl"clllnl 46 I,om IInl .0, (Illlnl 4& II morl Ihan IIn. 40, Inler .0.,
Sall.""ploymonl 10 (./tlCh Schadul. SE). , . , , , , . ,
A11"".lIvI minimum I.. (./tach Fonn 626 I) , , , , . , , , , , , . , ,
ReeoptUl.11IX1I (OIl Pill' 26), Chock If Irom 10 Form .256 b 0 Form 8511 0 0 Form 11628 ,
Socltl lICunly.oo MldlclI.l.. on lip Incom. nol reportld 10 ""ploya, (.II.ch Fonm 4137)
T.. 011 an tRA or a quolllltd "lIremont plan (.trach Fonn 6329)
Advanca lamed Incom. crldl' paymanll I,om Fonm W-2 ,
Add IInll .6 th,ou h &2, Thll II OU, 10'" ,.. . , , , .
Federal Ineomela' wllhheld (II any II from Form(s) 1099, check" 0,
1991 ..tlmaled I.. poymlfltl and ,mount applltd Irom 1990 ..10m,
E.mod Incoml c,odl1 (./tach Schadu', E'C) , , ' , ,
Amounl pold wllh Foom 4668 (axllnllon ,aqUIII), , , .
Excess social security, Medica", and RRTA lax wlthhald (see page 21) ,
Olher plymlnl5 (III p.go 27), Chock I' f,om I 0 Form 2.39
b 0 Form 4136, , , , , , . , , , , , ,. 58
Add lints 64 th,ou h 69, Thill a'l ou, '0'" Inll ' . , , . ...
II 11.11150 II mo..lhon Ilnl 63, lubl..ct IInl 63 horn IIn.I5O, Thll II thl omounl you OVERPAID, ,..
Amounl olllna 61 10 b. REFUNDED TO YOU, , , , , , , , . , , , ,..
Amount 01 IInl 5110 be APPlIED TO YOUR tltz ESTIMATED TAll.. I 03 I I
IIl1nl 53 II morl Ihan IIn. 60, sublr.cl IIn. 60 f,om IIn. 63, Thll Is Ih. AMOUNT YOU OWl,
Attach check or money order for rull amount payable 10 "Internal Revenue ServIce.. Wrlte YOUl
n.ml, .ddrlll, 10001.ls..unty ~umber, dlyllm. phon. number, .nd .,991 Form 10.0. on II, ,
55 eltlmllod lax panally (S" pogl 28), Also Includ. on line 64, I 61 I
Und" penallill or ptrtury, I dlel.,1 Ihlll hive .xamlned Ihll "Iurn and ar.companViOQ a.c!'\edutH and Itlllmtnll, and to t1'It bell 01 my knowIIdQI and
blll,r, Iney 1/ , contel. complel.. O~Iar.llOn 0' pl'tplltl' (olh" In,.n t8.llptyer) II baNd on IlIlnform'lion of whitn prepar. ha. any knowItOQt.
~ Yoyr II O"~ I '4 z, Your occuplllOn
~ Dill
, '1, '11,
:Ill
:Ill
37
:Ill
3.
40
41
42
43
41
41
..
14
55
50
67
55
Oall
Check I'
..II-Ifllployld 0
EJ. No,
ZIP cOd.
P'*PIfIf'" ICCIIIIICunty no.
p,tplllr', "-
slgnlluf. ,
FIrm's nlme (Of' your. ~
If ..If-employed) and
addre..
S<lHIDULIS MB
('orm 10401
__ 0/... r..-,y
InIWNil ~ lervke (&1
Nomtlll IIhown 00 li'1:' lo.d
OI(j/)LE
Mldlo,1 Clullon: 00 no/Include exp,nu. "Imburud or p'ld by OlhITS,
end 1 Medical Ind dental expensel. (5.. page 38,) , , , ,
D.ntal 2 Enter amount from Form 1040, line 32 2
Expan.,. 3 Multiply IIn. 2 above by 7,5% (,0751. , , , . , ,
4 5ubtrlctlln. 3 lrom IInl 1. Enll' th. resull. II less than zero enter -0-
5 5111e and local Income IlXes , , , , , , , " 15
. Rill elllle IIX's , , , , , , . . , , , " 8
7 Othe, lUIS, (Ust-Include pI,aonal p,oPlrty IlIlles,) .
Tax.. You
Paid
(Sot
P'Q' 38,)
Inte",.t
You P,ld
(St,
plgI 39,)
Hel..
PI"ooll
IntI/III Is
no longor
deductible,
Gilt. to
Chlrlty
(Sot
pIgI.O,)
CIIUIIIy .nd
Theft LO..I. 17
Moving
Ex .n.., 18
Job Elplnlll 18
Ind MOil Olhlr
MllCllllnloul
Deductions :zo
IS"
pog..1 for
l)lpenHI to
dlducl her.,) 21
22
23
24
Other 25
MllCllllnlous
Deductions
Schedule A-Itemized Deductions
(/Schedule B II on blc~l
001 No, IS.S.()()74
. ::JONE:~
8 Add 'lines '5' throuil'ti' 7: 'Enie; 'iti8' iOliii" ':":":" ':":"',
g. Home mortglge Inlerest and polnls reported 10 you on Form 1098
b Homl mortgage Inlerest nol reported 10 you on Fonn 1098, (If
paid to an Individual, show that person's name and addrass,l .
7
33:JS3 0
................................................................
Db
10 Points not reported to you on Form 1098. (See
InstllJcllons lor special rules,) , , , , , , , " 10
11 Inveslmlntlntlrest (attach Form 4952 If required). (See
pig. 40,). , . , . . , , . , , . , , " 11
12 Add lines 91 Ihrou h 11, Enler Ihelotal. , , , , ,
Caution: If }'QU made a ch.rif.b/e contribution and
received I benent /n return, aee pege 40,
13 Conlrlbutlons by cash or check , , . , , , ., 13
14 Olher than clsh or check. (You MUST atlach Fo,m B283
Ilov.,$5oo.). , . , . , . , , , 14
15 Carryove,'rom prior year. . , . , , , , , " 15
18 Add lines 13 Ihrou h 15, Enle, Ihfl tolal. , , , , ,
.. 1.
Casualty or theft loss(es) (altlch Form 4664), (See page 40,),
,. 17
-u
-0 -
Unrelmbur1ed employal axpansas-Job IravIl, union
l1ues, Jol:l education, IIC. (You MUST atlach Form 2106
If required. See Instructions,) . ...... .... ................,
Olher expenses (Investment, 'ax preparation, safe
deposit box. IIC,), L1sl typa and amount ...,..........,
Add lines 19 and 20 , , . , , , , , , . ,
Enter amounl from Form 1040, line 32, 22 I
Multiply line 22 above by 2% (.02~ ' , , , , ,,23 ~
Subt,act line 23 from line 21. Enter Iha result, If less Ihan zero enle, -0- ,. 24
Olher (f,om list on page 41 0' InslruCtlOns), List type and amounl . """"""".
';;1'1.
...............................................................................................
-0-
. 25
2e . It thl amount on Fo,m 1040, line 32. Is $100,000 0' less ($50,000 0'
less It married Ii ling sepa,alely), add lines 4,8,12, 18, 17. lB, 24, and I
25, Enle, Ihe tOlal hl'I, , .
. If Ihe amount on Fo,m 1040, line 32, Is more Ihan $100,000 (mo,elhan
$50,000 If married tiling aepa,alely), aee page 42 for Ihe amount to en'er,
Clullon: Be aure 10 enrer on Form 1040, Ii"e 34, fhe LARGER of Ihe
amounf on line 26 above or your standard deduct/on,
'or '"""MOrll Reducllon Act Notic., ... Form 1040 Inltructlonl. Clt. No, 113:\OX
Tota'
It.mlzed
D.ductlon.
Sch.dul. A ('orm 1040l1"1
Part t
Int.r..t
Income
(Set
pig.. 15
I/ld 43,)
NoI.t II you
reetlvtd . Form
lOGs.INT. Form
1099.010, 0(
tub.lllul.
.lllom..l, lrom
. brokerlllt IIrm,
11.1 Ih. IIrm'l
.Il/Tl. I. Ihl
plY" aIlII ..I.r
lhl 10..llnl....1
allow. on Ih.1
foon,
Part II
DivIdend
Income
(Set
Pill" 1 e
I/ld 43,)
Holt' II you
reetlvtd . Form
f099.0IV. 01
.ubllltult
I'etement, 'rom
I brok.r.g.
IIrm, II.. Iht
firm', name I.
th. P.Y" .nd
"'I" Iht 101.1
diVidendi
shown on thlt
romt
P.rt III
Foreign
Accounts
and
Foreign
fru.te
(Set
pig. 43,)
I' IhDwn on othlt Ikjl,)
:fi5Ne'S
If you received mo", III," IMOO In ....bI. In""'.1 Incom., or you ore cl.lmlng III. l.cluBlon 01 In......t from
BIlle. II u,a. ..vtngl bond.IHUed .ft., ,.1_ pogo ~), VCIU mUll compl.le Part I. U.t ALL In......t reoolvecI
In PII'II. II you ",c.lved m_ IIIan 1400 In ....bl. Inlorelllncom., you mUlt .1.0 compl." Part 11I.11 you Ncolvlld,
.. I nomln.., In.....t 1IIII1.0tuBlIy belong. 10 .nolll., pINOIl, or you rec.lved or p.1d ICCNed 1.......1 on ..curill..
Ire.lf.mld betw..n I........ ..1 d.l.. _ I . 43.
Inl.,..llncom.
1 Int"..1 Incom., (LIII naml 01 payer-II II1Y Inl"lll Incom. II from
~,~I~~,r:~I,~~~'~~~~~:~i}";~~c:~,~~, ~".d,",'I,I~I~ Inl~',.llli..I:),~::::::::
"., .....' ..,tr:;';"IUf.tI.'P.<I... ....f.!r.Vf^.... ,..', .."....""",..""".."".""",
..', ........../),ff.~~....,'" .........."", ,..,.."..'",...."""",...."""""""
.." ...... ..,])J1.f!.'1J"",.. ..........,........"""..", ,..,..,.." ....,....,..,,'....
.." ..........O'm;f{.."".., 'f1" iF" "it...."..,......,""',..,",..,"""',..
..,., .........DtI<<fHtI!J.. ,M.:~!.".., 13. ,~/(" '......'",..,.. ....""..""",..
Amounl
1
.............................-............,.........'''...'''''...........".......,......"
,.............................................,."......,.,.........,.......,...............
............................................................................,...............
..............................................."...........................................
............................................................................................
2 Add Ihl amounls on IIna 1 , , , , , . , , , . , , , , , , " 2
3 Enll' the excludabl. savlngl bond Inte'lll. II any. from Form 8815. line 14,
AIt.ch Form 8815 10 Form 1040 , , , , , , . , . , , . . . ., 3
4 ubl'l IlIn. 3 lrom IIn. 2. Enter the result he'l and on Fo,m 1040 IIn 80,. 4
II you recelvlld mON lII.n IMOO In 1I1011 dividend. .nd/or olll.r dlllrtbullonl on Itock, you mU'1 oomple" Pllte
II Ind Ill. II you r.c.lved, .1 . nominee, dlvklend. th.1 IcluBlIy belo.g 10 .nolll.r pollon, Ht pIli. 43.
Dividend Incom. Amount
II Dlvld.nd Incom., (UII name of payer--Include on Ihls IIn, capital gain
dlatrlbutlons. nonlaxable dlstrlbullona. elc,) . ........... .............. .... .. ......'
,.."..,.....,/./J,J."""",..""""",."""""".,...."""""",.."""""""
............................................................................................
............................................................................................
............................................................................................
............................................................................................
II
............................................................................................
............................................................................................
............................................................................................
............................................................................................
.........................................,..................................................
..................,.........................................................................
.............................................................................,..............
e Add thl amounls on line 5 , , , , , , , , , ,
7 Capital gain dlslributlons, Enter here and on Schedule 0' , 7
8 Nonlllllsbl, dlsl"bullonl, (SSllhl Inst fo, Form 1040. line 9,), 8
9 Add lines 7 and 8 , . . , . , , , , , , " , , , , , ,
10 Subt,aclllne 9 from IIn. 6, Entar Ihe ,esult here and on Fo,m 1040. line 9 '. 10
'/1 you received capital gain dlsfributlons but do nof nflfld Schedule D to report any Of her gains or loss.s.
". tha Instructions for Form f040. linas f3 and 14,
II you rec.lved mort thin S400 ollnl".lt or dlvld.nd., OR II you hid. lorelgn .ccount or w.r. I
gllnlor 01. 0' . .,.n"lror to, a lorelgn tru... you mu.t In.wer both qU.Illon. In P.rt III.
-0 ~
11a AI any lime during 1991, did you have an InlerSlI In 0' a Ilgnaturl 0' olhe, aUlho"ly over a financial
accounl In a lOlllgn country (such as a bank account, securlllel accounl. 0' othl' financial
accounl)? (See page 43 for exceptions and filing r8qulremenll fo, Fo,m TO F 90.22,1,)
b If .Vea,' ente, Ihe name of Ih. foreign country. ,...........' ................,........,................
12 Were you the g,an,o, of. 0' l'lnsfe,orto, a foreign lrult thai existed during 1991, whettlOr or nol
you have any benetlclallnlSlIsl In It? "'V.I,' ou ma have 10 file Fo,m 3520 3520.A or 926 ,
'Of '.petWork ReducUon Aol HoUc., "" 'orm 10olO Inllnlctlonl. Sch.dul. B 1'0"" 10olO)1"'
,.... 2106
Employ.. Bu.ln... Expen...
OMI"", '141.01:11I
. ISH I.perll. Inllr1loUon..
~ of 1M nNNY
1nI_.. ~ IItnrkI {Ol
v,,", nomt
8/1,f/)Lt' $,ve5
... Emplo~.. Bualn... Ellp.n..1 and R.lmbu....m.nt.
STEP 1 Ent.r Your Ellp.nl..
1
Vehicle e.pen5e 'rom lI"e 22 or line 29
2 Pllklng '"5, 10115, and locallran5portllion, Including t,aln, bIl5, elc,
3 Travele.pen5' while aWIY from homl overnlghl, Including lodging,
II,pllne, CII ..nlal, elC. Do nollnclude meala and entertalnmenl
.. BU51ne5a e.pen5el not Included on linn 1 through 3, Do nol
Include mella Ind enlerlalnmenl , , , , , , , ,
II Meall and enllrtalnment e.pen5", (See In5tructlon5,) ,
II Total ..p.nl.a, In Column A, add linn 11hrough 4 and ente, Ihe
rl5ult. In Column B, enler the amounl from line 5, , , , , ,
Column A
Olher Than MellI
and E"Ief1llnment
Column'
M.llaand
Enlef1llnmenl
Nol.: If you were not reimbursed for any e.penses in Step t, skip line 7 and enfer fhe amount from line II on line 8.
STEP 2 Ent.r Amountl Your Employ.r Gav. You for Ellpenlel Lllt.d In STEP 1
7 Enter amountl your employer gave you Ihat we.. not ..ported to
you In Bo. 10 01 Form W-2, Include any amounl ,eported under
code "L" In Bo. 170' your Form W-2, (5.. In5lrucllonl,), " 7
STEP 3 Figure Ellpenlll To D.duct on Sch.dule A (Form 1040)
8 Sublracl line 7 from line 6 , , , , , , , , , , , , ,
Note: If bofll columns of /lne 8 are zero, stop lie". If Co'umn A
is less fhan zero, report the amount as income and enter .0- on
line 10, Column A. See the insfrucfions for how fO report,
9 Enter 20% (,20) of line 8, Column B
10 Subl,act line 9 'rom line 8
11 Add the amounl5 on line 10 01 bolh columns and enler Ihe 101a1 here, Also enler the lotal on
Schedule A (Form 10401. line 19. (Qualified parfo,mlng artlsls and Individuals with dlsabllltlel.
see Ihe Inslrucllons for s eelal rules on where to enler Ihe total, ' , , , , ,. 11
for PlporwOrk ReduCllo. ACI Nolle.. "" 1.llr1lcllonl, ell. No, mOON
~()()
F.... 2108 1188"
Profit or LOll From BUlIn...
I" Proprielorthlpl ~@91
. Portn.r.hlpl, loInl wnllll'e., olD., mull nle ,""" loea. .. .0_
~l......"enl
. Allech 10'"",, 1040 or'''"'' 1041. .... I..InlcUonl 'or Schedule C ('''"'' , !\tQuon<t No, 08
_ NCUI1Iy _IBINI
fJ I I .3
. Enl.. principii bYllnul cod.
__ (fromPIgI2).~
D ImtliOY" ID _INoIUH,
",~~,,~"/~~,~~~
SCHEDULE C
(Form 1040)
- 01'" ,'..... ("I
Int..... "-wenue ISIMtI II
Name of proptletOf'
A
C
8.MI>LeYJ.
.:1ONE:5
,'J/~w.':~m
out No. la'l,oem
. BUllnl.1 oddltll (Including lUll. UI room no,) .
City. town or POll OfflC., 0111., ond ZIP _~!- _
Accounung mllhod: (II 0 Cllh 121 0 Accru.1 (3) 0 Olher (Ipoelly) · .. .... .. .. .. .... .. .. .. ..
M.lhod(l) ultd 10 Lower 0' cosl Olher I.Ulch Ooos nOI 'PPly ("
v.lu. clo.,ng Inv..lory: (11 0 Cool (21 0 or mllkll (3) 0 ..plon.lion) (4) 0 cheeked, skip IIn. H)
H Wlllhere Iny r,h,nge In delermlnlng qu.nltlltl, COIIO, 0' vllulltonl between opening IIId elo5lng Invenlory7 III "VIO," .1I.eh "pllnlllon I '
I Old you "mll'rllll'f plnlClplle. In Ihl operlllon ollhll bUilnlll dUring 19917 (II "No:' III InslfUelionl lor IImlllltonl on 1011I11
J If Ihll I. Ih. ""1 Schldul. C flied lor Ihl. buslnlll, chICk h... , , , , , , " "," ,,"
IIIIID Income
,
Q
Oroll roellp" or ..III, a.utlon, II Ih.. mcom' Wit ..porfld 10 you on Form W,2 .nd tho
"SIIturory ompioyoo" 1>0. on Ih.' lorm woo ch.dld, S" 'hI mOlrvcflon. and chlC~ h...
2 A.lurnl .nd .llDwoncII , , ' , , ,
3 Subtr.ctlln. 2 I,om IInl 1. , , , , ,
4 Colt or good. SOld (Irom II., 40 on plgl 2)
a Subl,acl IInl 4 ',om IIn. 3 ond Inl.. Ihl oro," pronl herl ,
a Olhor Incoml, Including FId..1i Ind .111. gllolln. or fu.II.. credll or r.lund ('" In.trucUoos),
.
.
10
11
12
13
14 Employ.. benlllt program.
(olh.r1h.n 00 IInl 19), , .
InluronCI (olh.. Ihan hllllh) ,
Int"'I~:
. Mortglge (plld to bankl, etc.)
b Olh." , , , . , ,
17 Legal and plO'elllonal SlIVIC,"
11 Offic. arp.nll, ,
10 '.nslon and p,ohl.shlllng pl.ns,
20 Renl or IlIIe 1111 InslfUclIonS);
. Vlhleles, mlchln"y, Ind Iqulpmenl ,
b Olher bUlln... ro ,
15
11
I YllfHO
,. 0
. 0 1 I~ 000
2
3
4
a
.
14
15
bM"II.nd
,nllr1.inmlnl
c(nllr20"'otlln.
24blubllCl10
IlmIIIIIOlU(S"
1M11,uCIIOnl), .
d SublraClllnl 24c trom line 24b
25Utlllllll"", ,
ze W.gll II'" 10~1 crodlt) ,
27a Olher "lllnSll QI.IIy,1 end Imo~.n!l:
, '" ", ,Jh't~.U/!11'rrJ.".... ':fa!!
Add II... 5 tnd.. TIlls II your orolllncom., , , , , , , , , , , , , , " ·
n... Caution: Enter ex enses for business use of our home on line 30,
AdVarllllng ,1'1t.l:Dj")I~" . 21 A,pllra on;;;;nl..onc:., ,
B.d d.bl. 'rom III.. 0' 22 Suppllas (nollncluded In 'In III),
..",Ic.. (_ In.trucllons),. , 23 Tim Ind IIcenlll, . , , ,
Cor and lruck ..pan... (... 24 T,avel, mills, and enlen.'nmlnl:
IntlNcllonl-llso .Il.ch
'orm 4N2), , ,. 10 a Tr.v.I, ,
Comml,,'onlond f..., . , 11
Oopl.tlon, , , , , , , 12
Olpreclltlon and mil on 179
"plnll deduellon (nollneludld In 13
Part III) (m InlllUetlonl). , .
'.a
lOb
17
,.
It
:lOa
:lOb
27b T,jiii ',jihti';,x' ;,n.i. '."':' '.'
28 Add Imounllln column. forlln.. 8 Ihrough 27b, TIl.s. I" you, 101., ..panNI befor. "p,ns.. for
OOlln..1 uti 01 \"lIJI homl , , , , , , . , , , , ' , , , , , , , , , ,.
T.nl.Uv. profit (10"), Sublrlcl IIn. 25 Irom IIn. 7 , , , , , , , , , , , , , , , ,
E.pan..1 lor bu,'n..1 UII 0' you, homl (1IlICh 'orm ll829), , , , , , , , , , , , ,
H.I pronl or 110111. 5ublrtet IIn. 30 Irom IIn. 29, II. profit, Inl., h." and on Form 1040, IIn. 12, Also
Int.' Ihl nil profit on Schedul. SE. IIn. 2 (".Iulory .mploy..s, '" InslnJcllons), If . 10", you MUS7
go on to Iln. 32 (flducl.".., s.. In.lruclloos). , , . , , , ' , , , , , , , ,
32 " you have I lOIS, you MUST check Ihl bOo lhlt descllbll you, Inveslmenlln Ih'l .cIIVlIy ISII InsllUellons)
"you chockld 32.. .nt., Ih.1D1I on Form 1040. lin. 12, .nd Schedul. SE, Iinl 2 1.1.lulory
.mploy..I, S" Inllrucllons), " you chlCked 32b, you MUST .Ilach 'orm SIIl1.
'or P.perwork Reducllon Act HoUc., ... 'orm 1040 InIINcUO.I. CII. NQ, 1133'P
29
30
31
7
21
22
23
24a
ze
29
30
31
} 32. 0 Alllnvulmtnlll a' flslI
32b 0 Some IMVlllm.nlll nolll firth
Sch.dul. a ('orm 104011"'
Schedul, C IFOfm 10'01 1991 P :I
CO.t 01 Good. Sold (See InSfNcllons,) ___
33 Inventory 8t beginnIng at Y'lr, (It dlNere"1 Iram 11151 year's dO~lng Inventory, attoch e.planOIlr,m,), 33
34 Purchase, 1851 cosl or u.ms Withdrawn tor perllonol Ulut. 34
35 CosIo' labo', (00 nOllncludo s.'.ry p.,d 10 you".'I ), 35
35 MII.r1lla and suppll.. , 3!.
37 Olher COilS 37
31 Add IInal 33 Ih,ough 37, 35
31 In...lory II end 0' Y'.', 31
40 COil 0' oodl lold. Sublllcl Iln, 39 "om Iln. 38, Enl.' Ih. r.Sull h.,. .nd on .. " IIn. . 40
Principal BUlln"l or Prol"llonal Activity Cod.. ____
locot. the malor category thai bllll descnbllS your activity. WithIn thl mSlor calltijory, select thl IIctlVlty cod. thai mOlt tlOllly Identl'I.. the
bUlllnus or prof.aslan thai II the principal source or your 611185 or receipts, Ent.r thl. "-digit cod. on page 1. IIn. 8. For ..,mpl., rell.."t.
.gent IS under tn. milO' category of />IRe,'..'.',,- and the cod"s "5520." tHollllt YOUI pr,:lclpaJ sourc. of Income IS from firming "tIVltl.', you
should "'0 Schedula' (Form 1040), Proftl ur Lo.s F,om F.rming,}
-
Agrlculturel S.rvlc.., 1662 011 &QIII 1260 Pubhc rfllllonl luildlng, HI,dwlr., . Qerdtn
Foraltry, FI.hlng Ill!) O'JUrrylrlO'& nonmltalllc mining 6~~6 Public WlllthQUlIol1l9 044 I ~ OUlldjnlJ mal.".tl dul."
7701 5UN'VU10 UNle11
!X.W RIBI e.late 67~0 Te8Chln~ Q' Iulorlng 04467 Hardwar'IIOIII
'91l0 Anlm,la."'lc". olher Ihan 6~10 l,Uh col Khon wllhoul own dump 4413 Nu,..,.1I 6 OardllllupplV alOt.
bI..(MO 6638 Ope,aloIl5'" le5l5WS 01 bUlldlngl, 669~ UIIIIII" ldumps, lVKJWplowlng, ,U32 p,mt, OI'It, & w'lIp.~ alate,
1933 Crop l.rvl(1I Inc:ludlng ,e111J11'I181 ,oad cll.rllnQ. tiC I food' ..'II.,....
2113 FUlm labot & nIltnaglmltnl 6663 Op.,.IOlI &. 1/1&50"0/ oth., ,ul 78BO Olhltl burtln'l5I IIl'\Iltll
IIr'oIlClI ptope,ly 68fl2 Olher PIlI150nlll "NICII O~ 12 SlklllOI aelhr\Q al tlllll
224~ Flihll1g, comm"clal ~~70 Relll .alal. agenls ,& brolt." Hol.11 . OUl... Lodging PI.c.. 308& C.I,'lno Hl'VICII
22:)8 FO"IUf~. ."c,pllogglng 6679 Real 11101' prOPlrt~"'.n.g,r, 3096 Ollnk"'Q pllcel lbl'l, Ilvllnl,
2.112 Hor1lCU lur. & landlcaplng 6710 5ub<1I~lderlS & de~1 pert, e)lcepl 7231 cam~5 & ClImpln~ Plrltl PUbl, Illoonl, tiC )
2"69 HVI'llng & IIIPPlng cemelellll 7096 Hol.lS, mol.ll. &. (jlJrl'l hQf11.1 ~079 Elling plle'l, 1"1111 & tnlClts
'914 LI~"lOCk breeding 61~~ Tllleeb&tract 0111('5 1211 RoonllrlQ & boarulng hOl.l1l1S ~~10 aroclry 1101'11 (genllf'lllInl.
01315 L~glng ~~Il llquot Ilorll
19~8 Vllrllnl~ "'Vleu, Inctudu10 Plt5 S.rvlc..: Per.onal, Laundry' Clllnlno S.rvICII ~n6 SpecllllZld 1004 110'" (mlal,
14M) CarpII & uphollSllry (11In1l1O prOduCI, canl1y, hlalln lOOd, lie)
Conltrucllon Prof"llonal, a BUlin... 7419 COln,operltltd Ilundn'l & d,., 'urnllurl . 0InIrM Merchencll..
0018 Opef,uv. bUlld.tS {lor own Service. 7436 cl.lnlr\9 3988 Compul., & IOft'W.,1 Ilor..
account. Amullmenl . Aecr..Uonll a.rvlc.. Full.Mt\lICI ~undry, dry cllanlng. 3910 FumllurI'IOf"
& ~armlnl servIC,
Build,", T'ld, Contrlc;IOf", Including 91510 Bowling cenl"l 7476 Janl orlll & rellled II/'Vlcn ..317 Hom. tumiantnQI ItorH (china,
A.p..... 91588 Mollon PlCtu'l & lape dllltlbullon (buildIng, hOUM, & Window "119 floor COVIfYlQI, d~IPIII
0414 Carpentering & 'Ioorlng & &!I\t(j seNltll ct..nlng) HouMhold _1InC. Itor..
9~97 Mallon pICtU" & Video .~33 MUSH: & 'IC~ 110tH
04~~ Conerlll worlt ~1l96 TV, audll) "_ironIC Ilorll
0273 Eleclrlcal work ~uctlon Modic" . H'5Ith _..
0291 MllOI1ry, dry Will. Ilonl, & III. 9639 ollon JlCtu,. Ihlll.,s ~716 V~ Itaro
6167 Physic litneaallcllrtill 9274 ChiroprlClDrI 3131 Olh., o.ntlll mllctlanclll.sto,"
0267 Plmltng & PIPtt haoglng 9233 Denhll'l o",Ie. or clime
0232 Plumbing, htlllnO, & '1' condllloOlng .696 PrO'HllOI1al aport. &. 'aCIng, 9211 Doctor'l (M 0,) ottiCt or clinK: MIICllllneou. ....61 'tore.
IIlCIUdl, prom"'''I & man.ger,
0430 ROOf'r\Q, sld'"O & IhtII mil&! 9811 ThlltrlC ptrlormlfs, mVSIC;lanl, 9.68 MedICal & dental laboralon.. '61~ Hotl d,.IotI
0886 01"" bUlkH"9 Irldl conlractOl'I agenls. ptOducers & ,elaled 9472 NutSlng & personal CIl'I '1CIlIt... ~17 8oolltofn, IICludlno nnllllnds
(,.Cilvlllon, glUing, Ilc,1 IIrvlCII 9290 Oplomlln,11 4863 Camera & photo aupply slortl
Olnltf'll ConnclOrl 961~ Video lape r,nlal 9268 OIIIO,,'lhlt phVIICI.n. .. surOlon5 ~~77 llrUQ SIOl"
0076 Hig"VI.y & at'H' con,lruChon 9B37 Othtt .mullment & recre.llonal 9241 Podlltnltl 5068 Fabric & nMdltwork Ilor..
0059 NonrlllCl.,,1I11 t)ulldlllg IIrvlCII ~415 R~llllI'td & prechcII nu,," 4666 Florlsls
0034 RIIldtnhAI bUIlding AulomoUvl Serv~l. 943' Offcel & cllnlCl of otherl'le.lIh 6090 FultI dllt." rllcePI glloun.)
3889 Oth,r hlavV eonslrucllon (pipe 8813 AulomollV' tlnlal or 11I6lng, PlaCllllon". (dl.tlclan.. .630 GIn. nov.lIv 1OUv<<tlr Ihopl
lll/Ing. bfICSg. ConllruChon, IIC,) 'WllhOul "tIV" mldwl~II, IPHCh pathOloglSIS, 4838 HobbV, 10V, & game Ihops
BG~3 Aulomollv, IIPII", gln"al & IIC.) 4611 JIWltlry ItOfIl
98815 OIher hllltt't HfVH:H .1I9~ Ll~1OI & IlIth., goodl Ilor"
Finance, In.uranca, & specialized
6B~9 Parking, Illeapl ~.III Mllelllln.OUI Rlptllr, IbcIPI 6074 M II. nome dllltra
Releted Servlc.. BB96 Oth., at.llomoll~' ler'olIC" (wuh, Compu'l,.. 41179 OpIICII goodl Ilor..
0064 Btok,,, & dllllt' 01 IlCurllin lOWing, elcl 90 19 AudiO equipment & TV ,epllr 4697 St:rtlng goodl & bK:VClt Ihopl
6033 S lllOOIIf'Y slortl
15080 Commodllt; conlrlcll b'ok"s & IUllnll, . PIf,onal SeNIC.. 9035 EltetnCl1 & IlecttOfllC r\Vpm.nt "014 Used merchandls. & .nllqUllto,"
dlll"I: HCurlly & CommodllV 70611 Accounhng & bookltHPlnq 9O~0 tlpalt, Illupl lVOla & ('llel,,1 mJlo, VlhlCle "lrtS)
l"e"lng.. 71115 AdvlrtlSlng, I)lClpt dl,ect mall Furnlturl ,epllr & r.uphollllf'Y 6BB' OIher retlll 1101'11
6148 Credllln,lttUlIon, 6 mottgage 71582 Archlteclutal servlCII ~BBI Othtf' IQUlpment 'epllr
blnktrlS 8318 Olrb., ahap lor bltCe" T,.d., Whollllll-S.lllng
670~ Inlur.nc. 1011111 or b,oker, 8110 elluly Shop (01 beaullClanl Trade, R.laU-Selllng
57.... Inll.lranc. &lNIC" (app'aI5l1. 8114 Child day Clr. Good. 10 Other BUllnIIllI, lIe.
conlulhr'lg. Inspection, lie,) 615715 Cl,')mmunlcshon seNICII Good. to Individual. & Durabll GOOdt. Inclldng MKhIntf'V'
6130 Invtllmtnl advllOtl & IINICIS 7872 Comput., l'Jf~rammlno, Houllhold.
6777 011'1" 'Inanel&! HtVICII proclSSlng, sll prep.tatlon & Iquipmenl, WOOd, M....., .10.
"lalld IIIf'.1lces 3038 Cal'l~ or mall ord.r 21534 Agent or broker 'Ot Olh., hrm.-
Manulacturlng, Including 79~~ Compu'" repal', malnlenance, & 3012 Selling 001 to door, b~ 1lllphon. nlOt' thin 60'6 01 grOIlIlI..
IllISlng or ".rty"l.n, 0' Itom mobll. unit on commllllOn
Printing a PubU.hlng 72B6 ConsulllM9 S'r'oIlCII 30~3 Vending machlnl stmng 2618 SltIllng lor vou, own "counl
01579 Apparll & othlr 1111111. products 7799 Conlumer erldll reportIng & Bolllnl From Showroom, Slo,., Nondur.bIe 000cIa, Including 'ood.
1115 Eteclnc & .teclnH'1C equlpmenl collecllon SINIClS or Olha, fl.od Location 'Ibar, ChelWcaI., .tG.
1073 Fabncat.-d m.laI products Bn~ Counseling (I.CIPI h,.llh 2075 Agent Of brc>>ttr 'Ot oll'ler 'I,ml-
p,acllhontrS) Applrat . Aceano,;..
0638 food prOducls & blv,rlgll S~9~ Courier at packag. dlllvery 3921 ACC"~ & speclatty IItOtlS & mo" Ihan 150,. 01 g,oll ..III
0810 Fut/1llur. & '1)llur.. on commlllllon
0095 L..lh" footW'IV, handb.gl, ,IC, 773~ Emplovmenl loanC11I & ruttl'" or women ~6S9 Selhng 'or 'IOU' own accounl
0838 lumOt' & OlM., wood products plrsonnel 'upp~V ~9~9 Clothing, I.mllt;
1099 MacIMI'';' & mlchln' shops 7~I8 Engln..rlng lItf'ylcU 3772 Clothing, men's & boVI'
0817 Po1Iper & Ilhed prOducll 7173 EQUIpment t,nlal & IIISlOg ~91~ CIOlhlng, women', Tranlportatlon Selvlc..
I OS 7 Prlma~ m".llnduSlrlll (I)lCIPI computlf or automollvel ~7~6 Shot slOIII 6619 AI' ttlnlportlllon
OlSS 1 PrlnMQ & pubtlSrllng B~~~ Funltl'al 5""ICII & cremalotl,s 39~4 O1htf' Ipparel & ICCllSOry SIOfIS 6312 BYe & IlmOUIIn. Iranaportauon
1032 Slone. Cllr- &. glalS P,Oducts 7633 Il1com. till pt,pll'.llon Automotiv, . Service ShlUonl 03ft 1 Hlgh'W.~ pUllngl, Iransportatlon
0653 Telllll, mil produCts 7914 In~'II!1gaIIY' & protecll\l' SINICIS (.IIClpICh.rlrrtdSlf'llICI)
1883 Oth,r mAnu'acluMg lI1dvn.l'11I 7617 legal SlN'ClII (Or lewyer) 3M8 Gasollnl I.NIC, 11.llona 11114 TI)llc.bl
785& Milling. reprOducllon, comme,cl.l1 3319 N.w Clf d.al." IltanChlllt<J) 6B~~ r'lvel agents & loor operltOtI
Mining &0 Mln".1 Exlr.cllon IIrt, phOlography, .1 3533 fir.., aCClllonll, & parts 63~B Trucking le)lceptlrlSh COllecllon)
"lnOQ,aphIC Slf'\tlceS 3335 UMd car dealers 666' Watfflransporllllon
n4~ Mftnagem'nl Slr'oIlCII 31\ 11 Olh., aulomotlvl dlll.rs 6610 Olhe, Itansportallon servICes
1 !!l37 COill mn'lng enT Mlnlslers & chaplal111 (mOlorcycles, recreallon41
1511 Met.1 mining 8334 PhQfOQ,aphlc STudIOS v.hlcllll. elc) BBB8 Un_bl. to cl"ll~
JIIlpp/y
.
lICHEDULI 5E
(form 1040)
Self-Employment Tex
OMI "
~@91
-
ItQuonct No, 17
4
. ... 1.llnIcllons '01' IIchecIllIe II ('omtlCI4Ol.
=-":~~II) . Altlchlo'onn ICMO.
Nom19! Wllh Ief!..mploymenllncomo (n thown on Fom ,~) SocleINCUrity number of '*""
/) l~ wlllllelf-employmenllncom.. .:lo'/ i G'o i '5/3
Who MUlt File Schedule SE
You mUllt file Schedule SE If:
e Your nef 8Imlngs from se/f.employmenl from other then church employee Income (line 4 01 Short Schedula SE or
line 4c 01 Long Schedule SE) were $400 or more; OR
e You had church employee Income (as defined In the Instructions) 01 $108,28 or more;
AND
. Your wages (and tips) sublectto social security AND Medicare taX (or railroad retirement tax) were less than
$125,000.
Exception: II your only sell-employment Income was from earnings as a minister, member of a religious order, or
Christian Science practltlol1er, AND you flied Form 4381 and received IRS approval not to be taxed on
those earnings, DO NOT IlIe Schedule SE,lnstead, wrlto "Exempt-Fonn 4361" on Form 1040, line 47,
Note: Most people cen use Shoft Schedule SE on fh/s page, Bul you mey have to use Long Schedule SE on fhe back.
Who MUST U.e Long Schedule SE (Section B)
You must use Long Schedule SE if ANY of the following apply:
e You received weges or tips end the total of ell of your weges (end tips) sublectto social security, Medlcere, or
rallroed rellrementtax plus your net eernlngs from self-employment Is more than $53,400;
. You use either "optional method" to figure your net earnings from sell-employment (see Section B, Part II, and
the Instructions);
. You are a minister, member of a religious order, or Christian Science practitioner and you received IRS approval
(by filing Form 4361) not to be taxed on your earnings from these sources, but you owe sell-employment tax on
other earnings; .
. You had church employee Income of $108,26 or more that was reported to you on Form W-2; OR
. You received tips subject to social security, Medicare, or railroad retirement tax, but you did not report
those tips to your employer.
S.ctlon A-Short Sch.dule SE (Read above to see II you rnust use Long Schedule SE on the beck (Section B).)
1 Nel farm profit 0' (Ion) from Schedule F (Form 1040), IInl :j7, and farm pBrtnlrshlps, Schedule
K-1 (Fo,m 1065), IInl 15e. . , . , . . . , , , , . . , , . . . . , , , ,
2 Nil profit 0' (loss) from Schedule C (Form 1040), line 31, and Schedule K-l (Fonn 1006), line
15e (olher Ihan farming), See Instructions fo, olhe, Income 10 report , , . , . . , .. 2
3 Combine lines 1 and 2, , . , . , , , , , , , , . , .
3
4 N.t e.rnlng. from ..II-employment. Mulllply line 3 by ,9235, II less Ihan $400, do not file
Ihls schedule; you do not owe self.employmenltax. C.utlon: If you received w.ges or tips, end
fhe 10181 of your wlges find flps) subject to social security. Medicare, or rei/road reflrem,nt fax
plus fhe Imou", on line 4 Is more fhsn $53,400 you canno' use Short Schedule SE, Insfeed,
use Long ScheduleSEon the back ' . . , , , , , . . . . , . . . , , ,~
4
1014
:;'0
5 S.If-employment till. If the amounl on line 4 Is:
. $53,400 or less, multiply line 4 by 15,3% (,153) and enle, Ihe result.
. Mora Ihan $53,400, but less than $125,000, multiply Ihl amount in excess of $53.400 by
2,9% (,029). Add $8,170,20 to Ihe result and enle, Ihe lolal,
. $125,000 or mo,e, anler $10,246,60.
Also enler Ihls amount on Form 1040, line 47. , , , , , , , , , , , . , , . ,
5
6} 59
Note: Also enter one-half of rhelmounf from line 5 on Form 1040, fin. :a.
'IH Plperwork floduoUo" Aol HoUo., He'orm 1040 1.IIrUCltonl. CII, No, '13~Z
Ichedul. al ('onn 104011'"
_ No. 17
Soc"" -untv numbtt 01 ~
with ...,......,menllncomt ... i
Sectlon B-Long Schldule SE (Belore compl.llng, ISM II you can UN Short Schedule SE on the olher aide
(Secllon A},)
A II you are I mlnlller, member 0' . religious order, Of Chr1sUen SclllllCe prlctllloner, AND you filed 'onn 4381. bul you 0
hid $400 Of more 0' oth.r nal ..mlngs from H1f-employmenl, cha<:k h... and continue with Part I . . , , . ..
B II your only Incom. sublecllo IIII-employment lax Is church employ.. Incom. end you are not" mlnlltll' Of . member
0' a rell lous order. ski IIn.. 1 throu h 4b. Enter -0- on line 40 and 0 10 IIn. 51.
-moentx
1 Net'arm prolll or (lOll) from Schedull F (Form 1040), line 37, and 'arm partnll1hlps, Schedul.
K-l (Fo,m 10615), IIna 151. (Noll: Ship this I/na II you use ",e larm opl/onel method, S..
requirements In Pm /I below and In tha InsfllJcflons,) , , . . . . . , . . , . , ,
2 N.t profit or (10118) 'rom Schedul. C (Form 1040), line 31, IIIld Schedul. K-l (Form 106ll), line
15a (olher than farming), S.. Inslrucllons for olher Incoml to report, (Noll: Sldp thl. I/ne /I you
usa the nonllrm opl/onsl mathod. See requlreman'. In Part /I below IIIld In file In,'rucflon.,) ,
3 Comblnl IInls 1 IIIld 2, . . . . . , . , . , , , . , , , . . , . . . . ,
41 IIl1n. 3 Is mo,a Ihan zaro, multiply line 3 by ,9235, Othlrwlll, enter the amount from IIn. 3 h...
b II you elected ona or both of thl opllonal mlthods, enter tha total ollln.. 17 end 1 Q h...., .
o Combine lines 4a IIIld 4b, II less thllll $400. do not file this schedule; you do not owa 1II11-employmll11
tIX, (lbo.ption: 1/185' than $400 IIIld you hid church employee Income, enter -0- and conl/nue,) .
51 Enle, you, church employ.a Income trom Form W-2, Caution: S..
tha ;n.frucl/on. lor dellnll/on 01 church employee Income , lie
b Multiply line 5a by ,9235, (111111 than $100, enler -0-,) , , , . , l5b
8 Net eamlngl from lell-employm.nL Add IInls 4c and 5b , " ,.",.,
7 Maximum &mount of combined wages IIIld sell-employmlnl earnings subject to social security
lax or the 6,2% portion 0' the 7,65% rlllroad ,ellrement (tier 1) tax 'or 1991. , . . . . .
BI Totllsoclal security wlges end tips (110m Form(l) W-2) and ,allrold
retirement (1ler 1) compensation. , . . . , .. ,.,. lie
b Unreported tips IlUbject to social security lax (trom Form 4137,
IIn. 9) Of '111 road retirement (tier 1) lax . . . , . . , . .. 8b
o Add IInas 81 and 8b. . . . . . , . . . , . . , . .. ,."...
II Subtract IIna 8c 'rom IInl 7. II zero or I"s, enler -0- here and on line 10 IIIld go to IIna 121 .
10 Mulllply lhe am.lI., olllne B or line 9 by 12,4% (,124) . , . . . . . . . . , . . .
11 Maximum &mount 0' combined wagls and IIII.employmll1t earnlngl IlUbla<:t to Medicare tlllC
or the 1,45% portion at the 7,65% ,a1lroad retirement (lIer 1) tlllC lor 1991. .
128 Total Medicare wagas and tips ('rom Form(s) W-2) and railroad
rell'lm.nt (lIer 1) compensation. . . . . , . . . , , . . 1211
b Unreported tips subject 10 Medicare lax (110m Form 4137, IIn. 14) or
railroad retirement (tl.r 1) tlllC. . . . . . . , . , . , . . 12b
o Add lines 12a and 12b, , . . . . . . . , , , . . . . , , , . .
13 Subtr.ct line 12c from line 11, II zaro or less, enter -0- here and on line 14 end go to line 15
14 Multiply Ihe .m.ller of line 6 or line 13 by 2,Q% (,029) , , . . . , . . . . , . .
15 Salf-employment tax. Add lines 10 IIIld 14. Enler Ih. f'IIult h.... and on Form 1040, line 47
Not.: AI.o anler ona-hall of fha amounl from I/ne 15 on Fonn 1 I/ne 2lL
Option.' Method. To Figure Net Earnlngl (Sea .Who Can File Schedule SEw and "Optional Methods" In
the Instrucllons.)
Firm Optlona' Method. You may use Ihe tarm optional method only II (I) Your gro.. farm Income' WI' nol more thll1 $2,400 or
(b) Your g,oll farm Income' w.. mora than $2,400 and your nlllarm proflt..w....l... thllll $1,733.
18 MlllClmum Income for opllonal methods . . , , , , . . . . , . , . . . . "UI 1 600 00
17 Enler Ih. Imall" 01: two-Ihl,ds ('h) 01 gross larm Incoml' or $1,600, Also Includa thl. lIIT10unt
on line 4b above, , . , , , , , , . , , . , , , , . , 17
Nonflrm Optlonll Method. You mlY use the nonfarm optional method only If (al Your nil nonfarm profitl' we,.. 'ellS thllll S 1. 733
and allo less than 72.189% 01 your gross nonlarm Income'arld (b) You hid net SE IlI'nlngs of at le..1 $400 In 2 of Ihe prior 3
y,a,s, Caution: You may use the nonfarm optlonel mafhod no more thin "va '1m.,.
18 Sublrlct Iha amounl on line 17, If any, trom IInl 16 and Inler Ihe re.ult , , , . . , . . t:tl t
18 Enler tha .meller 01: two-third. ('h) of gro.. nonfarm Incom.' or Ih. lIIT10unt on line 16. Also
Include this amount on line 4b above, . . , , , , , . . , , . . . , . . '. 111 _ ,
",om Sell.dule f (form 1040), line ", .nd Schedule K.l (form 1065),lIne 15b, 'from Sehedull C (form 1040),lIn, 31, Ind Sehldule K-l (form 1065),1101 151,
rf,om Schedule f fo,m 1040, line 37, .nd Sehedul. K.l form 1055 , IIn, 151, 'From Seh.dul, C (Form 1040),1101 7, Ind Sell.dul. K.l (fo,m 1065), IInl 15c,
.
6chooMo II <'oml 1 1 III
Nwn, 0' ~ with ""~I Income (lIS IIhown on Form 1040)
II
1
2
3
.q
4b
$53,400 00
$125,000 00
'orm
2441
OMI No, ...5_
Child and Dependent Care Expenlla
. AtlBch 10 form 1040. ~@91
"II_I
~:::':':~ ~ (0) . a.. I l,.teInIInlC1lonl. IIequtnct No, 21
Nomtltl_n on 'W'....'~ M Your........-.riIJ.-
oKlIDL -r: +' ""'It'Lv :::JOAJe:5 ,,;l13"!Sdi 583
o II you .,. clolmlng Ih. child II1d dopondonl cor. cledll, complel. PIIIII I II1d II below, Bul If you I.CelVed employer. provided depend..t
cor. ben.fill, nral complet' Part III on tho blCk,
. II you .,. not clBlmlng Ih. cr.dll bul you rocelv.d employor.p,ovlded dependent c.,. benelitl, only complll. Part I below 111<1 PlII1l1l
on Ih. blCk,
elullon:lfyouMVOa child who w.. born In '991111<1 fh.In,ounton FOlm '040, IIn.32,1./o., thon $2',250, ...pog. , ollholn.fl1Jcf/on,
be/oll com leUn Ih'.,orm,
P....on. or Organlutlon, Who Provld.d the Clre-YOU mu.t compl.t. thl, plrt. (See the Instructions,
II ou need more s ace, use the bottom 01 page 2,)
(b) Address
(II Nam. (number, ol"et,' apl. no.. city, olale, II1d ZIP code)
....' .I. i;'~'''ii.5~1f//t.., ,(" ,Q ,~..,
1
(clldentlrylng number
(SSN 0' EIN)
(dl Amounl paid
(SOl Inolructlonl)
5'5
tJO
.................................................................
.................................................................
2 Add Ihe amounts In column (d) of line 1 ",. , , , , , , , , , , . , . ,
Not.: If you paid clsh wlges of $50 or male In I celenda, quarte, to an Indlvldulllor sarv/ces perfo,med In your home, you
must m. an am 10 m.nt fax return, Get Form /iI42 for dOlalls,
Cradlt for Child and D. ndant C.... Ex .n"1
3 Entor Ih. numb.r 01 quBllrylng poroono cared 'or In 1991, (See Ihl Inslructlons 10' Ihe d.flnltlon ot a quBlltylng
p.mn,) Caution: To qUI//fy. fhl person(s) mu.t hive shared fhe same home with you In '99f
4 Entllthl emounl 01 quolllled e~pensll you Incurred and actually paid In 1991, See the InotlUCUons
10 nnd out which I~pen... quality, elution: If you completed Pari III on pegl 2, do not incJudl on
fhls line lilY excludld bene"" shown on IInf' 25 , , . , , , , , , .
5 Enlor $2,400 ($4,800 If you paid '0' Ih. carl 01 two or mOla
qUllltylng personll. , , . " . , , , , ' , . . , ,
. "you compl.ted Part III on plge 2. enler Ihe .~cluded ben.fitl,
II ony, lrom line 25. , , . , , , . .. .'", 8 -0
7 Subl'8ctlln. 6 from line 5. (IIthl ,elult II zero or I.SI, skip IIneo 8 th,ough 13. Enter .0- on
line 14, II1d go to IIn. 15,). , . . , , . . . , , , , . , , , , , , , , ,
Compare the amounll on linea 4 and 7, Entl"he Imanll of the Iwo amounts he'l
You mu.l.nter you, .arn.d Incom., (581 Ihl Instructlonl for the dollnltlon of earned Income,)
Noll: If you are not IIlIng ./olnt refum, skip IIn. 10 end go /0 line II,
10 II you are married filing a Joint ,eturn, you mUlt entlr you, spouse's earned Income. (II you,
spou.. was 8 lull.llml &lud.nl 0' dloabled, SOl Ihe Instrucllons lor the amount to enter,) ,
11 . II you ar, married filing I lolnl return, compare thl arnounls on I
lines 8, 9, and 10, Enler Ih. amln..1 of Ihe Ih,ee amounts h".,
o All olh.,s. complre Ihe amounts on lines 8 and 9, Enler Ihl
.manll 0' Ihe Iwo arnounls her.,
Enter Ih. Imount I,om Fo,m 1040. line 32 , , , , , " 12
Enler the decimal 8mounl f,om the lable below thaI applieo to Ihe amount on line 12
If IIn. 12 'II D~lm.l.mount II: If tine 1211: Declml'.mount II:
Ovor- lul nOI Ov.r- Bul nol
over- oy.r-
$0-10,000 ,30 $20,000-22,000
10,000-12,000 ,29 22,000-2.,000
12,000-",000 ,2S 24,000-26,000
14,000-16,000 ,27 26,000-26,000
16,000-18,000 ,26 28,OOG-No limit
18,000-20,000 ,25
Mulllply line 11 above by Ihe declmBl amount on line 13, , , , , , . , ,
Multiply II1Y qualified expenses for 1990 Ihat you paid In 1991 by the decimal amount Ihat
applies to the amount on you, 1990 Form 1040, line 32, 0' Form 1040A, line 17, (You musl
completl Part I and attach a slalement. See the I~struclionl,), . , , , , , , , ,
18 Add lines 14 and 15, See th.lnstructions for lhe amount of c,edil ou can claim, , , ,
'or Pap.rwork R.duellon Act Notle., '1' ..par.tl Inltrucllons. Cat. No, 1I882M
tfffJl 6D
5
8
8
.:J. 00
00
If
10913 07
r;t5~ 00
12
13
x ,,2.0
,24
,23
,22
,21
20
14
15
()
--0 -
o
Form 2441 (1991)
! 1 40
Label
(Set
InltNCbOnI
00 ".g. 10)
U.. IIle IRI
I.bel.
Olh.rwlll,
pl.... pnnl
or Iype,
p,..ld.nUII
Ellcllon Clmpllgn
(SH 110,
Filing Status
(S.. plgl 10,)
Chac:k crnly
onl 00.,
Exempllons
(SH p.g. 11.)
" mort lhon II.
d_nd..tl,
... peQI 12,
Income
AIt8Ch
Copy B 01 you,
'onn. W.Z,
W.:ZO. and
lOH.A hera,
" you did n~1
gel. W'2. 1M
p.g. 9,
An.ch chICk or
money order on
lOp 01 any
Forml W.2,
W.2G,0,
1099.R,
Adluslments
to Income
(S.. pIg. 11.1
L
A
.
I
L
H
I
..
I
-DoNI"'" or.... ~WI
, II No, "" '4
y..,--~-
'ZcIf : 5" i f/ tj83
___'I_IMUIiIY-
1f/3 , 4":Z~/5"
'or PrivIoV Act end
PIjIII'MIil Reduotlon
Act NoliN, _ pel' 4.
o.pw1.,,*,,1 0' the rrNauty-ln'.,,," A~enu. a.vtc.
U.S. Individual Income Tax R.turn
For "" Jon, 1-000,31, '"2, or _ IU year
Your rlf,t ".m. and InUlaI
~@92 II)
Nolel ~ .YI.- W"
no' ct'llttge ~, ,.. QI
....... ^,nd
Slngll
M.med nllng loInl rtlum (.ven II ooly 001 hed lnooml)
Monied "ling upIIIlt rotum, Enlll tpOUII'l 1Od~ IICIM1Iy no. tbOVt tnd fuI nome hilt, ·
H..d 01 houuhold (wllh quBlllylng pII'IOl'I), (SIt pog. II,) "till qU.1l1y1ng ptrIOII ill c1111d but not your dtpendtnt.
..III tIIll chlld'l naml hera, .
1 Qu.1I In wtdo wllh d .., c11l1d ,., I .. died. 18 ' Set
.. fiI YourwoIf." YOII' poronl (or ..."..",. tIN) CIf1 ciIIm you u . dlptl1dtn1 on hi, ot her lu
..rum. dO .01 ehtcll box e., But be lure 10 chick lhe box on lint 33b on pogI 2
b .., , , , , ,
o Dependl.IO:
(11 Nlm. (fl"l. InllI.l, and Inl nlmlt
1"1 U..
I '812. end
UII naml
...... CAR-RT-GORT..RR06
NB 209-50-9583 193-46-2315 528 50
BRADlEV T & MIChELE A JONES
316 WISTER CIR 001
MECHANICSBURG PA 17055
I
R-~
S
10,
o 10 Ihll fund?
d If your child dldn'IIIVI willi you bul I' claimed U yOllr c1aPtf1ll1lll undll t prt.l915aQltltllll1l, cIltdl '*' . 0
e TolBl numb., 0' ..em llonl claimed , , , , . ,
W.gal, ..ltrllI, IIp", oto, Anach Fonn(l) W-2
T....... 1.'II..t Income, AnlCh Schedul. B II ovor $400
TII'tUII,. Inllllll Incomt (III ptgt 16), OON'T Includt on lint II 110
Dlvldllld Income, AlIBch Schedul. B II ov., $400
T..- rlfundl, Clodltt, or offutl 01 ltall tnd IoctIIncomI tull from wor1<thttI on pogo 18
Alimony '1C.lved . , ' . . ' , , , , ,
Bullnl.. Incom. or (1011), An.ch Schedul. C or C.EZ, , .
Copllal g.ln or (10"). Anoch Schedul. 0 , ' , , , , ,
Copltal goln dl,lrlbutlOOI nol reported on IIn. 13 (I" poga 18)
01het' galnl or 00_), Anlch Fonn 4797, , , , , ' . , . . , . . '
TolilllRA dlllrlbutlcrnl , l.1!!J U b T_ tIIlClUIlI (III pogo 16)
Tol1l ptnsionl ..d tnnulllel lJ1!.J U b T_ - (III pogo 161
Renll, roy.III.., ptI1t1IIIhlPl, .."1M. lrulll, lie, Altlch Schedul. E . , , . .
Farm Income 0' (1018), AnlCh Schedull F , ' . , , , , , , . ,
Unemploym..t componllllon (_ POOl 17) , , , , , , , , , . , , ,
Social _urlly b..lflll 121. I I I b Tutbll - (III pogo In
O1hll I.com., Ult type and omounl-O.. ".ge 18 , ' , , , , , , , , ' , ' . ,
Add !hI omounllln "" I. I columll lor IInII 7 I 22, ThI1 "
Y"", IRA deducllon ,rom Ippilcllllt worl<Ihttl on Pllll19 or 20
Spoult'IIAA dtduCllon from IppllClblt wo~a!l"1 on ploe 19 or 20
On..hlll 01 ..1I.omploymtnl ". (S" pig. 201 ' , ,
SeIl.emploYed h..llh Inlurlnce deducllon (_ plgt 20)
KlO\Jh rlllrem.nl pion Ind ..1I.employed SEP deducllOO -," -
Penalty on .arty withdrawal of .Ivlng. . ..,. -" -
A1lmooy plrd, Roclpltnl'l SSN . -"
Add IIn.. 24. Ih,ou h 29, Th... or. ou, total .d Ultmlll" ' , ·
blrlellln. 30 'rom line 2. hie II your lei Itld grOft OIM. this tmOUnf Is . thin
122,370 end 0 child II.ed wllh you. "" pogo fIC.' rO"nd oul H j'OU con c/llm'IIt 'fomtd
'nco~ cr<<Itr* on f,ne 55 ....
7
It
b
I
10
11
12
13
14
la
1..
17.
11
II
20
21.
22
23
24ll
b
2a
2t
27
21
21
30
ell. No, I 13208
11,
MI, .. .....
..... II II .~
... ,.,..
MI. "'"
...... .. IIltIIit:
.,......,.. ~
.11IIII,11II..
III ... "
jIIont II
--"'11I
_111 -
MI. ......
.'n.......... II _
...-
--..
'''O.,llt
-
..... -
...,
-.:1
-
2(,. u.,
tlo SIt> I
Form 1040 11H21
~011"~1
T8X
Compu-
t8tlon
(S.. pig.
22,1
II you w.nl
Ih. IAS 10
flgu,. you,
I", I.. pogo
23, 31
40
41
42
~
44
Credits
(Sea pogo
23,1
41
41
47
41
411
so
It
Il2
51
Payments 1I4
15
15
57
15
II
Other
Taxes
AIt.ch
Forml W.2,
W.2G, ond
1099.A on
Iho fronl.
10
Refund or It
Amounl 52
You Owe 51
1I4
Allaeh check 0'
money order on
lOP of Form('1
W'2, lie., on
th. ',ont
Sign
Here
K..p . copy
0' this return
for your
records.
Paid
Preparer's
Use Only
U AmoUnI from II.. 31 (.dlu,lod grott~) , , , .. . . . . ';':. ,
De Chock II: 0 You wore 55 or old", 0 Blind; 0 .,.u.. wlll5 or older, 0 1IIInd.
Add Ih. numba, 0' be... chockod above IInd ont.. 111I10111 ,*-, . . ,. De
b ")'OUt parenl (or oom-.a 11111 can cl.1m you II . d~I, chock'*- . . NIl
o "you we mlllriod nllng otptrallly and YOU' lpoull lIomll.. doduotlona or you
In . dual'II.luI .11on, _ p.g. 22 and chICk h"., . , . . , , .. UO
Ilamlud dedllOllonl from Schtdul. A, IIn. 21. 011
.wndard dadllOUOIIlhown bllow for your nllng 11.lu.. IuI II you ohecked
any bel on Una :I3a or b, go 10 page 22 10 nnd YOU' llandard deduction.
II you chacked bel ~, you, IllIldll'd doductlon I. IW.
. Slngl-'3,600 . Hud of hOUHh~,250
. Marrlod '1IIng jointly or OUolllylng wldowfll}4S,OOO
. Mlllriod filing lop....I.Iy-$3,OOO
SUblrlctlln,3AfromllnI32 . . , . . , . . . . . . I . . . . . "
IIlIn. 32 II $78,950 or I..., multiply $2,300 by Ihl 101.1 number of Ilemplionl clllmlld on
IIn. Be, 1111.1 32 la over $78,950, "" Ihl worklh.., 00 page 23 for the IIIIlOUIlI 10 onler .'
r....bIe Income. Subtract IInl 38 from IInl 35, IIlInl 38 II ~ lhan 11n. 35. onl" .(). . '
Enl., I... Chock II from I .iii r.. robll, b 0 r.. R'II SChlldul... 0 0 Schodul. D.
Of d 0 Form 8815 (I.. pogl 23), Amount, II lilY. from Fonn(l) 8814. . I
Addlllonall."" (_ p.g. 23), Chock II from I 0 Form 4870 b 0 Form 4872, , ,
Add IIn.. 38 IInd 39, , . , , , , , , , , ·
Crodll for child IInd d~,"1 CIII8 .lpan..., A\llch Form 2441
C,tdll for Ih. IldOffy or tho dlubl.d, Att.ch Schtdul. R , ,
FOIOlgn I.. credit. Altach Fonm 1 I 18 , , , , , , ,
Oth" c,adlll (_ peg. 24), Chock II from .0 Form 3800
bO Form 8398 0 0 Form 8801 d 0 Fonm ('POCIfy)-- 44
Add II... 41 UllOU8h 44 , , . . . , , , , . , . .
BublrlClllnl 45 from IInl 40, 1111.. 45 II mo.. th.n lint 40 ,"I" .0.
Be/'.employmonl I.., MIlCh Schadul. SE, A1ao. a.. IIn. 25, . . .
A1lom.Uv. minimum I... MlCh Form 6251 . , . , . . . , . . , . .
RtctplUrI tax" (III pogtI25), ChIck II trom. 0 Form m5 b 0 Fonm 8811 0 OFonm 8828
BocItlllCUrtly IInd Medic... III on tip Incoml not roportod 10 ompIoyar. AI\ICh Form 4137
r.. on qu.llnad ..tlremonl p111l1, Including IRAa. AItICh Form 5328
AdV.nce .amad Incoml crodll payrnonll f,om Form W.2 ,
Add 1_ 48 Ihrough 52, Thll II you, totalW , . , . ,
Ftdlrallneomt tax withheld, If Iny II from Formll)1 099, ehec\. 0
11192 eotImllod tax peyman1IlIld omount oppIltd !rom 1991 rtIum .
I.Bmtd Income oradIL A\lach SChadul. EIC , , . , ,
Amounl paid w1lh Form 4888 (1.'"""100 ,oquIIII, , . .
ExctIllOClaIlKurtry. Mldlcal1, Ind RRTA tax wllhhlkl (HI plQt 28) ,
0IhIr poymonI' (III page 25), Chock II trom . 0 Form 2439
b 0 Fonm 4138 , , , . , . . . . , , . , .
Add II... 64 th, h 69, Th_ .... r lotal on.. ",.,.
If lint eo 10 more \hNlllnt 63, IUIltllClllno 63 !rom lint eo, TNt 10 tho omount you OVERPAID,
Amount 0' II.. 81 you w.ntlllPUHDID TO YOU, . , , . . . . . , ,
Amounlof IInl 51 you Wlnl APPLIED TO YOUR llA ilmlAnD TAX. I 51 I
If lint 63 II mort thlll IIn. 80, lubtract lint eo lrom lint 63, TllIIII "" AMOUNT YOU OWl.
Atuch chock or money Old.. for full amounl plytbll 10 'Inlomtl A........ SaMca,' Writ. 'fO'JI
nam.. ...d'.... aoclll lIICultty number, dlyllm. phone nu"-, Bnc:I '1992 Fonn 1040' on II
U Eatlmllad I.. nil ,.. . 2 ,Aloo Includ. on lint 1I4 88
mot
Enler
thl
1arV"
01
you~
iI5
:l8
37
38
00
4
~
-"" ~
.
''0
'-l.."">> --
Under penaltl.. 0' J*1ury. I deClar, that I hive .ltImhlld lhls '.t~n and ~ ICheduI...nd "IIementl.1nd to the.. of my knowledge Md
b11lef, they ." we. correct, and compl"'. Oeclarluon 01 P"'Plftf' (olP'llr thin tupayer) I, biNd on alIlnrOlTnltlon of whICt'I ptIPIrW hM any knowIedQI.
~ Vour nalur. ~~ Dill You, occuplllon
,. . ..~~/t:Jh... - .::II 1..3 k'~ "lte.
~ " II tu. II a urn, 80TH mu&IIIQn O,le Spou,&'1 occupthon
,. .;) (J 3 <::P~,
Pr,parer', ~
5lgnlltur. ,
Firm', nome (Of yours ~
Ir seU-employed) IInd
address
0...
Prepa,.,', IOCIII MCurUy no.
Check It
nil. employed 0
__ EINo
liP c:ooI
Schedule A-Itemized Deductions
SCHEDULES A'B
(Form 10401
Till.. You
Paid
(S..
pig. "'-1.)
Inter..t
You P.ld
IS..
pig' "',2,)
Hol.'
P,rlOnal
Intlr"115
nol
deducllbl.,
Gilt. to
Cherny
(S..
plgl "'-3,1
CIIUIIIy Ind
Th.1I LOIIII 17
Movlnll
Expen... lB
Job Elplnlll 111
Ind Mall
Olhll
MIIClII.nloul
Olducllonl 20
(5..
pig. A-~ lor
Ixpense, 10
deduct here,)
21
22
23
24
Othll 25
MlsClII.nIOUI
Olductlons
Tota'
itemized
Deduction.
(Schadule B lion backl
r+11(.1f~ LE A,
.:TO", if? $.
~ Allach lO '0"" 1040, ~ ISH ,..Inlcllonl '0' Ilehedut.1 A and B (,""" lIMO.
-
5
II
1
. . . , . . . . . , . . . . . . . . . . . . . . . , . . .
......,............
DepenrneN 01 tttl r,........,
InI.NI ~ Ikmc. (61
Nllno(l/ '""""" on F"'m '0.0
'BtfAbL-r. ::raN,. '5
Medlcel Clulion: Do no' mc'ude .rpen... fl/mbursed or plld by o'hara,
and 1 Medical and denIal e~plnua (aee ploe A-l) ,
Dental 2 Enllr amountlrom Form 1040, IInl 32, I 2 I
Expenl.. 3 Multiply line 2 above by 7,5% (,076), , , ,
4 Subl,act line 3 I,om line 1, If ze,o 0' leaa, Inler -0- ,
II Stall and locallncornl la~ea , , , , , , ,
II Real eat ate ta~ea (ale page A-2) , , , , , , ,
1 Othe, la~ea, lial-Include peraonal p,operty la~e8 ' ·
~ 25
211 Is Ihe amounl on Fo,m 1040, line 32, mo,e Ihan $105,250 (more Ihan $52,625 "
married filing sepa,alelyl?
. NO. Your deducllon IS nolllmlled, Add lines 4, 8, 12, 16, 17, 18,24, and 25, } , .
. YES. You, deduction may be Ilmlled, See page A-5 10' Ihe amount 10 ent."
Caution: Be sure 10 en'er on Form 1040, line 34, Ihe LARGER 01 'he amount
on Ime 26 above or your s'andard deductIon.
'or p.perwork ".ductlon Act Notice. s.. form 1040 l"e'Nctlonl.
II Addllnes51hrouh7"",,"""
III Home mortgage Inllrest and points reported 10 yOU on Form 1098
b Hom. mortg.g. Inl.r.al nol ,.ported 10 you on Form 109B, If
paid 10 an IndiVidual, show Ihal peraon's name and address, ·
....................
,..................................
...........................
..........." ..... ....
lib
...................
10 Polnls nol ,.ported to you on Fo,m 1098, Se. page A-3
tor apeclal rulea, , , , , , , , , , , , " 10
11 Investment Int~'eat. It raqulred, attach Form 4952, (See
plge A-3,) , , , , , , , , , , , , , 11
12 Add lines 9a Ihrou h 1" , , , , , , , , , ,
CIUtlOn: /I you mlde . charI/able contribution and
recelvad a benefit In refurn, see p.ga A-3,
13 Conl,lbutlons by cash 0' ch.ck , , , ' 13
14 Olher Ihan by cash 0' ch.ck, If over $500, you MUST
attach Fo,m 8283, , , 14
15 Carryover I,om prlo, yea, 15
111 Add lines 13 Ih,ou h 15 ,
Casuall 0' the" loss(.s), Attach Form 4684, ISae pa e A-4,)
Moving e~pensea, Attach Form 3903 or 3903F, (See pa e A-4,),
Unrelmbu,sed employe. e~penses-job Iravel, union
dues, job educallon, ete, II required. you MUST attach
Form 2108, ($ae page A-4,) ~......,.......... ,..........
............................,...........................,',.....
Olher e~penses-Inveslm.nl, ta~ prepa,alion, sale
deposit bo~, elc, LlsI Iype and amounl ~ ............,..
.................. ....".... .................... ............
............, ...................
............ .............
Add lines 19 and 20 , , , '
Enler amounllrom Form t040, line 32, 22
Multiply line 22 above by 2% (,02)
Subtract line 23 I,om line 21, If zero or less, enler -0- ,
Other-from IIs1 on page A-5, UsI Iype and amounl ~ """",.
e.l No. 11 nox
-0 -
....,
OMI No, '14&,001.
~@92
AIIIC",".n~, 07
VourlOCltl -oy-
.).0'1 : So : ,~-;! 3.
.-t:J -
92-
'/ B'lO 7'-
,. 111
00 00
,. 11
-0 -
-0 -
24
-~
-
'-0 -
aohodul. A ('0"" 104011112
OMI No '1l<l&'OOU 'ogo :z
Yout - MG""!l-
201 : ~o : 'f~-83
AIIICIvntnI 08
~No
" you had OVI' $400 In I..abl, Inl..I., Incoma OR arl claiming Ihl I.clualon 0' Inl.,111 from
.arI.. EE U,S, .Ivlng. bond. I..uad """ '989. you mu.1 compllll Ihl. pari, UII ALL Inlar..t you ,acllvad, "you had
ov.. $400 In II..bll Int..ullncom.. you mUll a110 compllll Plrt III, " you lacllvad, I. I nomln", Inl..11I IhlllCluaJIv
~Iong. to anoth., r,raon. or you ,.Clived or paid IccnJld Inl.,... on ..c::urill.. Iranlferrad betWHn Inl.HI plyment
dal... .11 pagl B. ,
Inlere.t Incoma Amount
ISc_AIIlII'OIm 10401 1091
NIINJ(II Iho'wn on Fonn HMO. Do not ,nltt nlm, and r.oc:l.1 IlCutlly number II lI\Qwn on oiNt ~..
AbLE T. ::TONI:. S ' "ll € .::tDI'IE 5
Schedule B-Interest and Dividend Income
Part I
Inlerelt
Income
18H
ptgll '4
II1d B. I ,)
Hole. II you
racllvld I Form
l0i9.INT. Form
,099.010. or
lubllllull
Ilalam"" from
I brok..lgI firm,
1111 Ih. flrm'l
naml II thl
P"V" II1d enl"
Ihl tOlallnl"ul
lhown 00 Ih.1
form,
Part II
Dividend
Income
(SH
pogu 18
end B.',)
Hole, " VOU
rac.lved I Form
, 0i9.01V or
lubllllul.
l'ltement 'rom
. brok.r.g.
flrm.lll1lh.
firm'. name II
th. P'Y" Ind
.nt.r thl lolal
dividendi
Ihown on Ih.t
form.
Part III
Foreign
Accounts
.nd
Foreign
Trult.
(5"
pOOl B.2,)
1 U.t name 01 pay~r-I' any Inll"ll Incoml II from .elle,."nanced mortglgu,
lie plge B., and 11.1 lhlllnle".1 fi..I.....,..,..,........,......,..,......,......
""",..".", ff1f!'{(W,,~If'll~N.~7"'" -'k')'~,.,"'~':t,', i!.~~,~'~~~~""",.,."
'..",....,.... ,(MMI", J/I~f..,.., ,..~1~1.., ... ..,"...,"""',.,",....,"", '..
"",....,..,.. J>H.f((",. ,J.n.' "(.'."~"~ ~/M.'I, ,~),8"(J',,, ,,',"""""
..",..,.,..,.. ,J:tff.!flflt'" }f:;f<J,Hr., Uhrt.L:':l1. .,'...., ,..'".."",
1
a Add Ihe amounll on line, , , , , , , , , , , , , , , , , " a
3 Excludible Inle,e.1 on .erie. EE V,S, laving I bond.I..ued 1111,'989 I,om Form
8815. IIna ,4, You MUST attach Form B815 10 Form 1040 , , , , , ,,3 -tl
4 Sublract line 3 110m line 2, Enla, the relull here Ind on Fo,m 1040 IIn181. 4 :l '
If you had ov.r $400 In gro.. dividend. .ndlor othe, dlllnbullonl on .Iock, you mU.1 complll. Ihll part and Part III, "
you racllvld. al a nomlnl., dividend. Ihat aclually b.long 10 another pI,.on, ... p.gl B.l.
Dividend Income Amount
II UII name 01 paye'-Include on Ihls line capital glln dl.t,lbutlons, nonllxable
dlllrlbutionl, elc, ." ","" .""""""""""""" "',,'" ""." """ """ "','
""""""""'~J,"""""""""""""""""""'"
!i
5>
.......,.......................,.............,..........................
,
II
e
5
I
e Add Ihe amounl. on Iina 5 , , , , , , , , , , , , , , , , , ,
7 Capllal gain distribution., Enler here and on Schedule D' ,~..., .
B Nonla.abla dl.lrlbullOns, (See Ihl In.!. for Form '040, line 9,) L..!...L.-_~' .
Ii Add line. 7 and 8 , , , , , , , , , , , , , , , , , , , , , ._,) -
10 Subtracl IIna 9 from line 6, Enler Ihe ,a.ull here and on Fo,m 1040, line 9 , . 10 S 5 t;
'II you receIVed capItal gain distributions but do nof need Schedule D /0 report any other 91m. or losses.
see the insfructlons lor Form 1040, lines 73 and 74,
If you had aVe' $400 of inllre51 0' diVidend. OR had a fo'elgn accounl or were a g,anlor 01, or a I,an.lero,
10, a foreign l'U51, you musl complele Ihl. part,
lla Al any time du,lng 1992, did you have an Inle,e.1 In 0' a .,gnalu,e 0' other autho,lty over 8 Ilnanclal
accounl In a lo,elgn counlry, such as a bank accounl, secur'lre. accounl, 0' 01 he' financial
accounl? See page B.2 fa, e.cepllons and filing requlremenls lur Form TO F 90.22,1 , , , ,
b If "Ye.: enla, the naml of the 'o,elgn country ~ " , .... .. , . .. .., .. .... .. ..
12 Were you Ihe gran lor at, or Iransfero, to, a foreign Iru51 Ihal e.,s,ed dUring 1992, whelhe, 0' not
you have any beneflclalrnle,e.1 In "? If "yes," you may have 10 Ille Form 3520, 3520.A, 0' 926 ,
'or '.parworll Rlducllon Act Nolle.. Sit fo,m 1040 Inltrucllon., Bchldull I ('orm 1040) 1"2
[)epattmenl olin. fl.uury
lnl.r* .....~ SaMe_ 1&1
NI,"' of pr09fltIOl'
81Mb /..e' Y r: :1011I E; 5
A Principii bUII""S or prallnlo", Including produ~1 or lIervlc. (ISI. pDO' C., I
IA.U LilnCf! MU5/:</J'1
C BUlin,.. naml
'Bft!l1iJ L €'I -r: 'J7:JN E; 5 Mil s,' 11M)
BI/llnllllddllll (Including lull. or ,oom no,l . ",. ~/f?", W I ~ r.. ~, , q~~ !"..~ , ' , " , , ' , , , . , ,
CIIV. lown 01 poll oHIC', Itlll, .nd ZIP Codl tH~(HI1IV/(~ 8/1tf". I'1f /1t.J 5!!>
Ar~ou.llng m.lhod: III 0 Cllh (2) 0 Acc,uol 13) 0 Other (lp.CIIy). ........,..' ' .... ..' .. .. '
o Mlthodll) ulItd 10 Lower 01 cool Olhlr {llIlCh 00.. nol IpplV (II
Vllul clOllng Invonlory: (11 0 Call (2) 0 or mo,kll (3) 0 ..pllnIUon) (4) \i(l ch,ck.d, Iklp IIn. HI
Wlllhere Iny ehlnge 10 delermln'ng qUlnlll,n, cool., or v.'u.llons between openlOg and closing mventory'llI "VI!: allach upllnlllon
[)Mj you "m.tlnally p&r1IClPII," In the operation of this bU51nell dUring 19927 If "No," llee pl&Q' C.2 fOf' limitations on 10UI.
Wlllhll bUlln.llln cperlllon Illhl .nd 01 , 9921 ,
How many monthl WI.thl. bUllneas In operation during 19927
IIlhll II 'h. 11'" Schedul. C 'lI.d for Ihll bulln..., ch.ck h."
ncome
Advertlllng
Bod dlbll from ..I.. 0'
"IVlc.. ("" pig. C.31 '
10 Cor lII1d lruck ..ponl.'
(1M plgl C-3-IIIO .lIlch
'orm 4a4I2), , , , , ,
Commlnlonl end 'HI, '
O.pl.llon,
DeprlClltlOO II1d II<llon 1 79
",pen.. doducllOO (nollncluded 13
in Port 1111 (III pig' C.31 '
14 Employ.. benllll progr.m.
(oth.. Ihln on IInl 191, ,
Inlurlne. (oth.r than health) .
Int"lsl:
I MOIIg.ge (paid 10 b.nks, lie )
b Olher,
17 llgal and professional "Mcn
18 Offlc' .xpense .
10 PenSIon and proIHh'r1ng plans,
20 Renl or I.... (!Ie p.ge C'41
. V.hicles, machinery, and equIpment
b Other business property ,
21 Total .apenl" b.ror" .xpenses 'or business us. of home. Add hnes 8 through 27b in columns
21 T.nlahv. pro'lt (1055). Subtroct hne 28 rrom line 7
30 Expenses ror businelS use of your home. Attach form 8820 .
31 N.t profit or (lOll). Subtract Hn. 30 rrom line 29. It a profit. enter her. and on Form 1040. line 12. Also,
ent.r the net proflt on Schedule SE. hne 2 tstalutol'y employe'lI, s.e page C.!>). It a loss, you MUST go
on to hne 32 (',duclones, 51. page C.~) . . , , . . . . . . , . , . . . . . ,
32 If you have 11055. you MUST check th. bOlt Ihal describes your ,nvealmenlln l~jS actiVity (SH page C.5)
If you checked 32a, enler the loss on Form 1040. hne 12. and Schedule SE, hne 2 (statutory employ.es.
s.e page C.5). It you checked 32b. you MUST aHach Form &198.
for Paperwork R.ductlon Ac' Notlc.. 511 Form 1040 Instructions.
Profit or LOll From Bueln.e.
(aoll Proprillo..hlPI
. Plrt.l....lpl,loI.1 VI.I..,.I, 110" mUll fil. form IOU,
An_I
. A""ch 10 form 1040 or 'orm 1~1. . Ie. 1.11N0Uonl '0' Ichldull e !fonn 1 Ilequonc. No, ot
Ioclol..curtly _11lN1
:u , : 50 !'1,3'3
BEnter prlnclpol bullnlll Codl
(Irom plgl 21. ., s I
D 1Itnplo~., 10 _ (NolllNl
Gro.. ,lCllpll or ..I.., e.uUon, IIthll Incom' w.. "porlod 10 you on Form W-2 .ncll'" 'SI.,ulOry 0
lIl1p1oyeo" bOx on '''" form w.. ch.c~ec1, ,.. p.gl C,2 .ncl ch.ck ".re ·
Rllurns and aUowl&I1cl. ,
Sublrtcl IIn. 2 110m IInl 1
COil 01 goodl told ("om IInl 40 on p.g. 2)
0'0" proftt Sublrlcl IInl 4 ',om IIn. 3 ,
Oth... Incom.. Including Fod....1 Ind .1111 g"olln. or lUll 10. crldll or ,.fund (II. plgl C.2)
01010 Income. Add II... 6 and 6 '
Ex .nnl Caution: Do not enter ex
I
SCHEDULE C
IForm 1040)
I
,
1
2
3
4
8
8
7
I
o
11
12
13
18
18
OMI_No IU',OII"
~@92
. . , . . . . . . . . . . . . . . . . . , . . . . . . .
Y..~
--
....
.
-
lz..
, ,.
.187500
00
00
,-
o
Repairs Rnd mlintenanCI .
Supplln (nollneluded In P.II III) ,
Taus and lIcenses .
10
11
12
241
93 U.
b Meals and en-
tertainment ,
c Enler 20~. 01 lin.
2.b 5ubltcl 10
limlt.llons (set
p.g. C'4) ,
d SubtraClllne 24e !rom line 24b
25 Ulllllle.
25 Wlgll (I... lobI crldll) 21
271 Other ..pens.. (11.1 typl lod ,mounl)
"'~'1d/I1.~(kJ-'''''' ,IM.~
14
15
27b Tal.1 oih~i ~';p~~~~i"..""'"
.
I
31
} 328 0 ,-,lIlnVellm."t II It 'IP
32.b 0 Some mv..lmtnll& nolll flsll
Coil No 11334P
Sch.dul. e I'o,m 1~011"2
OMI No, '''&,0172
~@92
~""c/,,,,,nl 81
,. Altach Ihll 'onn 10 ou, relum. 5tq...... No,
.. Idtnlllylne_
JcI/QbUL€ C 2o'1'5"o.'1'5B3
BuINtI 01' acllvily 10 whICh Ihlt 1000m relit,.
BArll>U':Y T: :JONES ~U~I(1 ,IN 5cI-I, Co
Electlon To Eltpen.. Certain Tangible Prop.rty ( .otlon 1181 (Note: " you have any "Listed Property, "
complate Part V oefors you completa Part I,
1 MIlllmuM doliII' 11m lilt Ion (see InslNctlons) , , . , , , , , , . , , , , , '
2 Totll cOil ot secllon 179 property placed In service during the tax yea, (see Insl,ucllons) ,
:I Threshold COil 01 secllon 179 p,oPlrty befo,e ,educllon In limitation, , , , , , , ,
.. Reducllon In IImlllllon, Sublraclllnl 3 lrom IIna 2, but do nol ente, leiS thin .0.
II 001111' IImllallon fo, lax el', Subtractllnl 4 from line 1, bul do nol enl8r Ins than -0-
(.~ Dflcnpllon 01 property (b~ COlt tel Elteled COlt
Depreciation and Amortization
(Includln. Information on U.ted Property)
,'"'" 4562
OrIrptttmlrltofthl r,..""Y &
InlIrNl """"" 1IintIc. lul
NIIMCI' iho'Mt on ,eturn
,. a.. II ...1. 1.llnlcUO.I.
1
2
3
..
II
10 000
$200,000
II
7 Usled property, Enle, amount f,om line 26, , , , , , , , " 7
B Tolll elecled cOil of lecllon 179 property, Add amounts In column (c), lines 6 and 7 8
8 Tentlllve deduction, En'e' Ihe Imlller of IIn" 6 or line 8 , , , , , , , , , , 8
10 Carryov"r of dlsBllowed deducllon from 1991 (see Inllructlons), , , , , , , , 10
11 Tillable Incoml IImllltlon, Ente, the smlller of Is. able Income 0' IInl 6 (see Inslrucllons) , 11
12 Section 179 Ixplnsl deducllon, Add lines 9 and 10, but do nol enle, mo,e Ihan line 11 12
13 Carryover 01 dlullowed deduction to 1993, Add linn 9 and 10, less line 12. 13
Not.: Do nol use P,rt /I or Pert III below lor automobiles, certain other vehicles, cellu'ar felephones, computers, or
used lor In..rtBlnment, recrelrlon, or amusemenf msted ro e }, Inste'd, use Pert V for Iis'ed ro e .
MACRS Oep...clatlon For Aa..te Placed In Service ONLY During Your 1882 Talt Y..r (Do Not Include
Usted Pro
IcfI RlCo,1I'(
".nod
tl) Convention
III OtprlCltllon dOCluCtlon
14
S
b
c
d
.
I
II
~ L.
"3~
h
27.5 rs. MM
27,5 rs. MM
3\,5 r" MM
~.
:11,5 rs. MM
S/L
SIL
S/L
SIt.
111
a
b 12 rs.
.10 rs.
IIIIIIIII Other Depreciation (Do Not Include L1at.d Prop.rty)
SIt,
MM
S/l.
SIC
111 GDS Ind ADS deducllons 10' assels placed In service In lax years beginning belo,e 1992 (see
Inslrucllons), , , , ' , , , , , , , , , , , , ' 18
17 PlI)perty subjecl 10 section 168(n(1) elecllon (see Inslructions) , 17
111 ACRS and other de ,eclallon S88 Instrucllons), , ' , , 18
11!111!1 Summary
18 Llsled property, Enle, amounl Irom line 25, , , , , , " ""','" 18
20 To..'. Add deducllons on line 12, lines 14 and 151n column (g), and lines 16 Ihrough 19, Enter he,e
and on Ihl! approprrale lines of your relum, (Partnerships and S cor~orallon&-see Inslrucllons) 20
21 For asssls shown above and placed in service du,lng the currenl year, enle,
the rtlon 01 Ihe baSIS atl,ibulabls 10 section 263A costs Isee Inslruclions
'or Paperwork R.d~ctlon Act Notlc.. ,.. pig. 1 of the I.p.rat. Inltructlon.. Cal. fIlo. 12906N
(ru 2.
Form 4582 11992)
SCHI!DULE BE
(1'0",,1040)
Self.Employment Tex
OM No 11",007.
~@92
~1I",hmonl 7
StqutnI:' No, 1
~ s.. I..truOUr)n1 '0' Sc:htdull 8E (''''" 10401,
=r..::.:....=-- III ~ Alt80h to 'orm 1040,
Homl 01 perlDn wllh ..II_.mployrlll.tlntOm. (II ,hown on Form 10401 6ocllll",urlly number 01 "'''00
l..E . ' N 1:5 wllh ,,"-Imployml.llncom.. 20'1: 50 ; q ,83
Who Must File Schedule SE
You mUlt fll. Schedul. SE If:
. VOU7 wages (Ind tlpl) lubjeclto loclallecunly AND Medicare la. (0' ,allroad rellremenlla.) we,e lelllhln $130,200: AND
. Vr.lur n.f elmlngs from II/f-employmlnf from olher Ihan church employee Income (line 4 01 Short Schedull SE 0' line 4c of Long
Schedule SE) wI,e $400 0' more:
OR
e You had church employee Income (al dellned on page SE-I) ot $108,28 0' more,
Exc.ptlon. If you, only lelt-employment Income wal from earnlngl al a mlnlsler, member ot a ,ellgloul order, 0' r,hrllllan Scllnce
praclllloner. AND you lIIed Form 43111 and ,ecelved IRS app,ovII nol 10 be la.ed on those elmlngl, DO NOT 11I1
Schedule SE. Inltlad, w,111 "E. em pI-Form 4361" on Fo,m 1040, line 47,
May I Use Short Sehedule SE or MUST I Use Long Schedule SE?
Old you receive wages 0' lips In 19921
VII
No
Are you I mlnlller, member 01 a religious ordar,
0' Chriltlan Scllncl prlclltlonlr who ,ecllved Vel
IRS IpprovII not to bllaxed on IImlngs t,om
thl.. lourcel, but you OWl self-employmentla.
on other .arnln 11
Wal the lolal 0' you, Wlgll Ind tlpl lubject 10
social securlly or ,all,old ,ell,emlnltax plul your
nel ellnlngl trom sell-employmenl mO,1 thin
$55,5001
VII
No
No
Wal the lotal of you, wagel and tlpllubjecl to
Medicare II. plul your n'l IlInlngl from Illf.
am 10 menl more Ihan $130,2001
No
No Old you rlcelve IIpllubject to loclallecurlly or
Medlca,e la. Ihat you did not ,eport to your
em 10 er1
VII
Are you using one 01 thl opllonal mllhodl to Vel
figure your nil ellnlngl (lee plge SE-3)1
you receive church employee Income
ed on Fo,m W-2 of $108,2B 0' mO,11
No
YOU MAV USE SHORT SCHEDULE SE BELOW
V..
YOU MUST USE LONG SCHEDULE SE ON THE BACK
Section A-5hort Schedule SE. Caution: Reed above 10 see if you musf use Long Schedule SE on Ihe back (Secl/on B),
1 Nil la,m p,oflt or (loss) from Schedule 1', line 36, and la,m partnerships. Schedule K-l (Form
1065). line 15a , , , , , , , , , ' , , , , , , " ,,','" 1
2 Net profit 0' (loss) from Schedule C, line 31; Schedule C-EZ, line 3; and Schedule K.l (Form
1065). line 15a (olhe, Ihan farming), See page SE-2 lor olhe, Income 10 'eport 2
3 Combine lines 1 and 2, , ' , , , , , , , , , , , , , , , , 3
4 Nel I.rnlngl from .."_employment. Mulllply line 3 by 92,35% (,9235), II less Ihan $400,
do not file this schedule; you do nol owe self.employmenl la. ' , , , , , ,~ 4
5 SI,,-.mploym.nt I... IItM amounl on line 4 Is:
I $55.5000' less, multiply line 4 by 15,3% (,153) and ente, the resull,
e Mo,e Ihan $55,500 bul less than $130,200, multiply the amounl In excess of $55,500 by 2,9%
(,029), Then, add $8,491,50 to the ,osull and enle, the lolal.
. $130,2000' more, enle, $10,657,80,
Also. enter Ihls amount on Fo,m 1040, line 47, , ' ' , , , , , ' 5
Note: A/so, enter on.-"'" of the amount from line 5 on Form 1040. IIn. 25.
,.. P.".rworll R.du.tlon Att NOtltl, ..e Form 1040 In. IN. lions. Cat No 1 mez 8thedule 8E ('orm I04011l1l12
Il<:hodult IlIl'",," lo.OIIIlt1~
Nomlol petaO/l wll/1 ..1I..mplo~I.II"com. (81 shown on Fo"" 10.01
fU, LE T: 'JON E 5
Section &-Long Schedule SE
1-lItth...nl floq,*",1 No, 11 p :I
SocI.1 _unlv numb.r 01 p..aon
with leI,.""'ploymanllncom.. 2 0"1 :50:" 5' 93
A II you I" a mlnlale" "'Imba, 01 a ,ellgloul o,d.r, 0' Ch,lllIan Scl.nce pracllllon., AND you IlIed Form 4311, bul you 0
h.d $.400 0' more 01 other n.t elrnlngl lrom .al'.smploymsnt, check ',.,e and conllnue wllh PBrt I , , , . , ,.
8 II your only Income .ubject 10 .ell-smploymsnl tax I. chu,ch employee Income and you are not a mlnlller or I membe,
01 a...1I 10uI Ordl'. .kl IInl. 1 Ihrou h 4b, Enle, -0. on line 4c snd 0 10 line 5.,
I. m o~m.nt Till
1 Nel fl,m prolil or (lOll) 'rom Schedule F, line 36, and la,m partnlrahlpl, Schedull K-l (Fo,m
1065). IInl 151, Notel Skip thl. Ime 1/ you use the farm optlona' msfhod, See requirements In
Pert /I bl'c'W end on page SE-3, , , , , , , , , , , , , , , , , , , ,
2 Nel p,onl 0' (1011I) ',om Schedule C, Ilns 31; Schsdul. C-EZ. IIns 3; and Schedul. K-1 (Form 1066),
IInl 151 (olherlhan larmlngl, S.e psgs SE-2 to, olh.r Incoms 10 ,.port, Note: Skip thl5 IIn.1I you U5.
the non/arm optlonl' m.thod, See requlrem.nfs m Part /I be'ow and on pag. S/:-3 , , , , , ,
3 Combln, IIn.1 1 and 2, , , , , , , , , , , , , , , , , , , , , ' , , ,
4a IIl1n. 3 II more Ihln zero, multiply line 3 by 92,35% (,9235), Olhsrwl.., .nler .mounl troll' line 3
b II you el.cted one or bolh 01 the opllonal mllhod., .nl., the lolal of line. 17 end 19 here, ,
o Combln.lln.1 41 Ind 4b, 111..1 Ihan $400. do nol III. Ihll Ich.dul.; you do nol ow. ..If-.mploym.nt
tllC, ExcepUon. III.as Ihan $400 and YOll had chu,ch .mploy.. Incom.. ..Ier .0- and conllnue, ·
51 Enler you, church employ.. Incom. troll' Form W-2, Caution: See
pege SE- f lor dennlflon 0' church .mployee Income, , , , 51
b Multiply IIn. 5. by 92,35% (,9235), 111.11 Ihan $100, .nla, .0- " ,','
II N.t aamlngl from ..If.employment. Add IIn.. 4c and 5b , " ",'
7 MlXlmum Imounl of combln.d wage. .nd ..II-employm.nt .arnlng. .ubjeclto .oclal .ecu,11'{
IIlC or Ih. 6,2% portion 01 Ih. 7,65% ,allroad ,.lIram.nt (II.' 1) lax lor 1992 ,
Be Tol.1 social lecUril'{ wlge. and tip. (',om ForII'll) W-2) and rall,oad
"11,,m.nl (II., 1) companllllon, , , , , , , , , , , , , Be
b Unreported IIpl subJect 10 .oclal .ecurity tax (troll' Form 4137,
line 9) . . , , , . , , , , , , , , , ' , , , , , Bb
o Add line. 81 and 8b , , , , , , , , , , , , , , " ,','
8 Sublraclllnl Bc 'rom IIn. 7, II zero 0' I.... enle, .0- here and on line 10 and go to line 12a ·
10 Mulllply Ihe amlller of line 6 0' line 9 by 12.4% (,124), , , , , , , , , , , , , ,
11 Maximum amounl of combined wage. and .elf-employmenl earning. .ubjecl 10 Medicare lax
or the 1.45% portion 01 Ihe 7,65% ,allroad ,ell,emenl (lie, 1) tax '0' 1992" ,'"
128 Total Medlclre wagel and lip. (f,om Fo,m(.) W-2) and railroad
retlremlnl (lIer 1) compen.allon, , , , , , , , , , , , , 12a
b Un,eported lip. subject 10 Medlcar. lax (t,om Fo,m 4137,
line 14) , , , , , , , , , , , , , , , , , , , , , 12b
o Add line. 121 Ind 12b, , , , , , , , , , , , , , , ,
13 Sublraclllne 12c Irom line 11. If zero 0' Ie.., enle, -0- here and on line 14 and go 10 line 15
14 Multiply Ihe emaUer 0' line 6 0' line 13 by 2,9% (,029), , , , , , , , , , ' , ,
111 s.It.amploymenlla.. Add IIn.. 10 and 14, Enl.r Ihe ,..ull h.re and on Fo,m 1040, line 47
Nota: Also .nfer one-he" 0' the .mounl ',om 1m. 15 on Form 1040 /lne 25.
Optlonal Method. To Figure Net Earnings (See Who Can FUe Schedule SE on page SE-l and Optional
Methoda on page SE-3,) --
Firm Opllonal Method. You may use Ihls m.lhod only II (II You, gross la,m Incoma' was no' mo,e Ihan $2,400 or (b) You, g,o.s
'I,m Income I was mo,ethan $2,400 and your nel larm p,oflts'w.rele.s Ihan $1,733,
111 Maximum Income for opllonal mathods , , , , , , , , , , , , , , , , , ,,111 1,600 00
17 Enter the ImaUer 01: Iwo-Ihlrds ('h) of gross la,m income' or $1,600, Also, Include this amounl
on II!!! 4b above, , , , , , , , , , , , " "","',' 17
Nonfarm Opllonll M.thod. You may u.e thiS melhod only II (al You, nel nonla,m profits' we,e less Ihan $1,733 and 1110 le.s
than 72,189% of you, gro.s nonta,m Incoms,' and (bl You had nel sarn'ngs IraII' s.'I-employmen' of al lea.t $.400 In 2 0' Ihe prlo,
3 yellS, Caution: Vou may use this method no mo'e than /Ive limas,
111 Subtraclllne171'omhne16 , , , ' , , , ' , , " ' , WB
18 Enle' Ih. ,mlU.r of: Iwo-Ih"ds ('II) of gross nonfarm Incom.' or the amolJnt on line 18, Also,
Includa Ihl. amounl on line 4b above, ' , ' , ' , , , , , , , , , , , ' , , 111_
;From Schedule F, line II. and Sr.hetlul. K'I (Form 10651, II"e 15h :F,om Sr.II.dul. C, line 31. Sehedul. C.fZ, line 3, antl Schedule K.IIForm 1065), line 15.
From Sehedul. F,II", 35, and SCh'dlll' K'11FollO 1005). Ii", 15, From Sclledlll, C, line /, SClledlll' CEl,I". I, and Sch'dule K,I (Fo,m 1065), line 15e
1
-D -
2
3
41
4b
-D ,.
55,500 00
~
-0 -
(,045' ql.o
-0 -
-0 _
130.200 00
e
~o -
120
13
14
15
t
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BROADVIEW MORTGAGE
115 E, WILSON BRIDGE ROAD
WORTHINGTON OH 43085
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315 WISTER CIRCLE DR
MECHANICSBURG PA 11055
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95 E, WILSOH BRIDGE ROAD
WORTHINGTON OH 43085
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us'i.in.".. '01 10. U
1993 W-2 and EARNINGS SUMMARY
Thl. blul III"'." lu,","...., ""llon ','"clucled wflh you, W.llo hflp "'..... plII1loftll" 11IOI. clllBU,
Thl "Villi Ilclll.cIUcI" ,1",,111"'o',"llIon .hl' you mlY oliO "1llI hIIpf\II.
" Th. ,otkwrinl Infotm.tton ,1ftH,. VOU' "n.' ,.n Plv.h.". plu. tnV' ....."'*'" .uIIifNttM Itr WOW ...."'.
aron "Y lltI237 , 3a 1Ioc1"ltcurlljr 3171 20 PA,IIIl1 ""'-7.. Inl,13
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10.. '" W'2 LOIollncomo r..
1o'2101W,Z
IUI/IDI
1o.1401W'2
"d, Incom.
T.. Wlthh.ld
80.201 W'2
20242,7&
Medin.. Tn
Wllllh.ld
8o.loIW'2
1182,37
1438 93
l.e,lle
f, YOUr 0'011 P.v W'I AJlulltd II tollcwa to produca VOUr W.R Bt.'em.nt,
W.g.., npl. oth.r SocI.I6ecurllV Medicare
Comptnll"on Wig.. Wig..
Bo. 1 of W.2 80.:1 of w.a 80115 of W.2
UI,88 SUI
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BRADLEY T, JONES
316 WISTER CIRCLE DR
MECHANICSBURG PA 17055
1.'Pli..~. ~~ ~tr~i._l,~a~~'~'~~.~_.. .I~.I.._ _;-..I:i_~~_.._-~.-....;_. ~il~ji~i$..
" 511'.1"1I01l'lIt.. " Nlm.oflQO,lIfy
.,_ _______~!~.:!~_ m _ . ..l:.AMP HI~~ B
20 locll ,,"IQ", 11,.. .'11, 21 loc.llncom.-..i - .
882'7,35 992,37
------.PA~S1iiI.Fillng-Cu.i>y - _m_ -
I W-2 W;~a~o::n~" :1~$3 it
PA. Itltt WI,",
np.,IIC,
Bo.17 o' W.R
CAllPHlLL I
LOI.' w....
n,l,IIC,
Bo. 1100' W"
lltI,237 .
N,
",237,3
99 237 3~
.'637 3~
17,800,00
99,237 35
NIA
88,237,3&
lltI,237 31
N/A
II,U7,3S
01011 PlY
Wig.. Ove, Umlt
Report.d W.2 Wig..
99,237 3~
NIA
",237,3&
3. Employ.. W.. P'ofll. To th.ng. VOUr EmplQVtl W.". P,oW,ln'o,m.llon. ru.. n.w W.,f with YOUr p'yroll dlPt
SocIal StlClJllty Numbet 20'.50.t513
Mdtil., StalUI MARRIED
I: ~"mphonIlAllo'l\"IICtl'
FEDERAL: .
STATE:
LOCAL: .
.--.....-....---....-.. -.......................-.
T- WIf'I, tl,.. oeM' 110M"
"237,35
3 lOCI" I""r!tv w....
___57'00,00
1M...... "'.........""
"237,31
'---
"'M""" w.-~
20242,71
lOCi" "I"nt; In w.....w
IlL1!...
, ........ ,.. w.w..w
143',13
BRADLEY T. JONES
316 WISTER CIRCLE DR
MECHANICSBURG PA 17055
, ",...)lluIOhl""'C Dlltll ~"l)(;f~~n.l. iI,l;
.... _ _. _. _ _.. _ f:". ~~~~.a_~~ .~~I",.C!~ ~~~r~_~!_ ... .
-, W...., II.., .......... - 1'.,-...;;;;.................,..
88237,35 20242,71
SOCI., hlUfl'Y w.... .. SOCIIIIICUI'My I.. wMheW
57800,00 3171,20
"WltdIUllflm\....ndJlpI 'M~ICII.I'.wlth~.~-
.' 11,31 143',13
'.oo~~~~~mr~r:oi~~ -~~[i~I~..~~!t
C hlptoyll" n'lM, addrl'l, Ind lIP cod.
BROADVIEW MORTGAGE
95 E, WILSON BRIDGE ROAD
WORTHINGTON OH 43085
b-'-I!M~r" ,ffio "UMber d (ii1p.OY:H'.IiA-nu,!,be'---
. 3 .12873.0 .08-10.8113
75oci.rs....-cufiiv-.ip.--------. i'''lIoclt.dIi~-'''' - - ------
'oo~r~4"'~mr' D~~' C....' A1...1ow.....j\l
C Illlp6oyIJ'. n.",., ...,.....nd ZIP c-.
BROADVIEW MORTGAGE
115 E, WILSON BRIDGE ROAD
WORTHINGTON OH 43085
b"-imPiOY,,~'iD 10 nil....'
31.1217310
,'-Soci','lft""'" II,.
iMpMy""11A "'*Mf
201. 0.8113
'-Ai6oe.~--
10 D'plnda"' Uf. be~.jii.- -.- . AlIv.rK, (IC p.y_"1 --, ;O-O",,"nl CII' banii~-.-- - ,"-"diiti.-C:e (IC- p,v",.nl 10 D..p....... """"lfltl
t2 .,nl'fltllncliidedTn-liio'ii - II-NonqUiiiiiiiipj."....----- f:fii.-n.-iiti'j,iclUd.i1n-.Oi"',--- if-'Nnnqii'ltflM pi.;;.-- ti-.."IIII. Nl.IUlI.dtn'o~t
14 Oth.,--.--~--'_.-- 13 ~.5.i.,".I,..-,0t' iiii''i3- '-'-011'1.'-_._' --,-~.- i"J+-i..-ini,,"--iiHi';.-i'j-- i.-Cllh.'.-----.-
''',88 SUI
.~~~IE~-~IC.... P'~-pA." L"~tf,.r.l.:T:~~~~mp
., ("'play..'. n..., ..,,,.. and ll, Codl
BRADLEY T, JONES
316 WISTER CIRCLE DR
I MECHANICSBURG PA 17055
'1~~liiiI!ir2'7~i~".elo f7-i"T.'\lrIQ.9~~~;~;
I' $I.i.uico-';;....--'--' 'ii-N.;;.-~ii~;.tY--
277',83 CAMP HILL B
20 - i.iX,iW-.'9t2S, ~3f--- 2i-loullricO;.~r.;; ~
.. -._------jf.doral IIIng opy - -,-
W-~ w;~~oa':::n~" 1~,$3
141,.. SUI
.'S"Si.i f""TDiU~ 1j;i;ft~IiOR;ii; l"'ij-t1iij"" T ,."11I' rotl.rr. -C-"III
-_. --L_-L---L._L_L_,
.if .lftJHoy"', n.",. .ddr"'Ir\4 liP code
BRADLEY T, JONES
316 WISTER CIRCLE DR
MECHANICSBURG PA 17055
1}.~"i~.~~m. .~~~?~. '~.~_'.~'. I~ -.Ii.-~ '_f~.".~~~mji~~~
I' 5111. IncoM"" It H''''I of loc.11tt
2771,83 CAMP HILL B
2O'loc11w-'Q.;t.p_,-,la-" --. 2'- LOcli"ii1tciM-.-iu'--- -
982'7,35 .U, 37
-W.'- H:2f2y-or~~o~c:.~~~i~~~CO.;Y9--9-3.
S.alemonlW , . "
Label
ISIt
inltrucllOnl
on PIGt 12)
U.. the '''1
libel,
Olhlrwl..,
pi.... Pfl.1
0/ Iype,
P,"ldl,,1I11
1111110" CampIlg"
IStI .12,
Filing Stltus
(Stl p.g. 12,)
Chock only
on. bo/IC.
Exemptions
IS.. p.gl 13,1
II moro Ih.n .1.
dlplndlnll.
III p.gl 14,
Ineome
Allach
Copy B of you,
'0,.,1 W-2.
W.20, .nd
1081," h....
II you did nol
gll . W.2, ...
p.gl 10,
II you or.
.1I.chlng .
check or money
Old", pulll on
lop 01 eny
Forms W-2,
W'2G,o,
1099-A.
Adlustmlnts
10 Income
(Seo pogo 20,)
~
A
I
a
~
H
a
"
a
o.pwtmenl of the ',......,..-I"'.n.-l Revl/ll" a....le. l(1t'O\93
U.S. Indlvlduellnaoml Till Return U~
'0/ Iht Jon, H).o, 31, '"3, Of oIhoIt..
Your '1tII n.-n, ancJ IniUII Lilt nam.
1&1 IAI U..
, '"3, ono
.UunQtMII''-'' tn'"
, .. ',1
Vour 10..1I"""'"Y_
NB 209-50-9583 193-46-2315 528 50
BRlDl.1Y T & HICH!l.1 A JON!5
316 WI5TER Clft
HICHlNIC5BURG Pl 17055-6151
1---
R
S apI no,
11I.12.
1
2
3
4
d 1I1OUr cIllld dldn'IIIVl WIth you bul II t~l1lId u your d.ptn<ltnl und.r I prl'I985IQrNm.nl, thttk 11111 ~ 0
. ToIII number 01 ..... Ion, claimed , , . . , . , , . .
W.got, aa111111, lip., Ilc, Alllch Form('l W.2 , , , . , , .
TIIIIbI. Inl.,..1 Incoml (1M POOl 1 S), Alllch Schedul. B II ov" 1400
Tu..umpt 1.1....1 (1M plgl 17), CON'T Includl 00 IInl Sa Ib
DIvId.nd Incom.. An.ch 5chedull B If OV", 1400 , , . , . ,
TIllIbI. roIundl. credlll, or offsel. 01 .1.1. .nd locallncom. IIll.. (1M page 17)
Allmclny r..lived , , . . , , . . , . ,
Bullnlll Incoml or (Ioaa), Antch Schedul. C or C'EZ , , .
CIpIttI galn or (lOll), Anach 5chidull 0 . , . . . , ,
CIpIltI gdln dl.lrlbullool not llported on IIn. 13 lall plgl 17)
Oth.. gllnl 0' (10111", Alllch Form .797, , , , , , , . , , , . , ,
Toltl IRA dlllrlbullooa , l..!!!J l---1 b T..IbI. omounl lall POOl IS)
T.lil p,"~onl and InnullIlI l11!J U b T..lblo tmGUnI (1M pllgllB)
R..III raal 11111., roy,"I.., plrtn""hlp., S corporollona, lrull., ole, Attlch Schedull E
Form Incom. 0' 110111, Anlch Scllodul. F , , , , , , , . , . .
Unemployment compln.llIoo (SH pig. 19) , , , , , , , , , , . . ,
SoclllllCurtly b..lflt. I 21. I I I b T..1bIt omounl (1M pogo 19)
Othlllncom., Lllllypl .nd amounl-all p.gl 20 .,..................,..............,
Add Ih18mounllln Ih. far rI ht column fo, IInll 7 Ihrou h 22, Thlt la our tolallnoomo .
Your IRA deduction I... pig. 201 ' , , , 240
Spouse'a IRA deducllon (aOl p.g. 20), , , , , , 24b
On.-h.1I of ..U-employm.nt tAM (... p.g. 21) , " 2.1
Stlf-.mploytd he.lln Inaullnc. dtduCllon (aOl pIg. 22) 2tl
KlOllh ..tlrement pl.n and IIIf.omploytd SEP deduction 21
P..ally on ..rly wllhdr.wal of alVlngl, , , , " 2.1
Alimony paid, Recipllnt'l SSN . ' 29
Add IIn.. 24a Ihrou h 29, Th.1I or. our 10111 tel ullmlnll , , , , , , ,. 3Q
Sublraclllne 30 rom lIn. 23. his Is your IdJUltect gro..lncOI'M,1f this .mount Is leu ,h.n
123.050 .r'td . child IlvfJd With )Iou,S" Plge f1C.1 to find out If you eln c~/m th. -EImed
Incom, Credit" on 1m. .56 .. 31
7
..
b
8
10
11
12
13
14
15
1..
11.
la
18
20
21.
D
23
:M8
b
25
25
27
25
28
3Q
31
Cat. No, , 13208
1pou1l'IOOCItl """'"Y-
I '
, I
for Priveoy Act 11III
PllpWWortl RIduGtIon
Act Nolloe, _ 4.
V'I No NoIoI CIlIcbIg -YOI'
"II nD/ c/ItnvI your
,.. Of tWduc. ~
"lund,
~
.13,
MI, II ...
...... II II
....
MI. II ,.,
....... II II
...:
~
J...
Slngl.
Mltrrled flllng jolnl ilium (tv.. If ooly 001 h.d Incom.)
_ ""no IIPI'III rllum, Enlor 1poU1I'. IOClaIlICunly no, tboVt end lull n.... htrt, ~
Hood 01 houuhold (wllh qullllylng ptrIonl,ISoo plgl 13,) If 1110 qutlllylng pnon II a child but not your dIptndenI.
..lor till, chlld'l naml h..., ~
5 Quill In wldow( with d. nd..1 child.., .1 died ~ 19 , Soo
.. CB'vourttlf. II your p"..' (01 110II1.... tllIl Cln clllm you U I dopondonl 00 hi. 0/ hot tax
rttum, do .01 chick box BI, Bul be lUll 10 chlCll lilt boo 00 Ilnl 33b 00 pig. 2
b Ull", , , , , , . , , , , , , ,
o Depend..1I1
mNam.(llrJl, lnIU.I,.ndluln.m'l
. IhoN.. 'II
. IIIU' lilt ..
III ... 10
__or
.......... 'III
_"1 _
DI'II... II It
----
MIl .....
_II
8
10
11
12
13
14
15
Ulb
l1b
1.
18
20
21b
o
II/' 0''1 /,2-
~orm 1040 1111:I1
;.z
,""" IlMOII_
le.
Compu-
tation
(8M pig'
23,)
II you wonl
the IRS 10
IlguII you,
'.....M
~.24,
Credits
(8M pig.
26,)
Other
Ta.e.
Payment.
Alllch
Fonno W-2.
W-20. end
10000-R on
lhe "001.
Refund or
Amount
You Owe
Sign
Here
Koep I copy
0' thla rllum
'01 you,
'....do,
P.ld
Prep.rlf'.
U.e Only
.....-
U Amounl from line 31 (ldjulled 11'0II1-1 ' , . . . , , , , , . .
UII Cher:k II: 0 You __ 611 or oIdtt. 0 Blind; 0 IpOlIN wu 611 or older, 0 BlInd,
Add 1110 numbot 01 bo... chocked lbovl end ..I" llIolottl h,,", " . UII
b 1I)'OlII peroni (or oomoon. ti..) CIII clolm you U I dopond..l. chock h,," , . _
o II you .... mented nllng oepetlltly IIId yout opou" lIomll.. doductlonl or
you .... I dUll-llalul 01"". a.. pogl 24 end chICk hili, , . . , . .. UII
1_ -.otlont from Schtdull A. II.. 21. Oil
14 Int" ...... dIcIuotIon Ihown below 'or your flllng alalu" BuIll rou -.....
the 11I1 box on line UII 0' b, go 10 peg. 24 10 ftnd you, llIIIdBrd dlductlon,
~ . II you checked bo. UII. yout alllldBrd dlducllon It 1110,
. SlIlgI...t3.7oo . Hied 0' houothol~.460
your. . MIITted flllng joinll'f 01 OUollfylng wldowlll}-4e,2oo
. Minted flllng oepetlltly-$3,I00
BublrBctIIne34fromllne32 , , . , . , . . , , . . , . . . . , .
II line 32 II 111.360 01 1_. mulllp/y 52,360 by the 10101 numbot 0' lumptlonl cIBImed on
line 61, II 1In. 32 I. over II t .360, _ 1110 _..Ion page 25 lor Ih. IIlIOUIlllo "'I" ,
T...... ~. s.e<llIne 38 trom IInl 38, II line 38 II more I"." line 3&. ..I" -0- ,
Tu, Chock II from .~ Tu Tlble. b 0 Till R.1a SchedulM. 00 Schedule 0 Tu WOlle.
aheII,O/ dO Form 61115 (1M PIll. 25), Amou.lfrom Fonn(l) 61114 . . I
AddllJontl \Ill.. (_ page 25), Ch..k II from . 0 Form 4g70 b 0 Form 4872
Add I'"" 38 end II
Ctedlt for child end dtpondent .... 1._, AIW:h Form 2..,
Cted/t lor the tklttty 01 the dlublld, AIIIch Schedul. R , ,
FOfIign \Ill CtICIII. Attach Form 1115 . . . . , , ,
0IIw CIIdJIt (_ PIQt 25), Chock II ',om I 0 Form 3800
b 0 Form 113M 00 Form 8801 dO Form (opocIf\')- 44
41 Add I'"" 41 tIvough 44 . . . . , , , . , , .
41 Subt1Ict line 46 from line 40, 1I11n. 45 It more thin line .0. ..lit -0- ,
47 SeII.omploy....1 ..., AItach Schedul. SE, AIao, _ IInl 25. . , ,
41 AItamaIIve minimum ..., AIIach Form 5251 . , , , . . , . , , , , . .
41 Rectpbn..... (1M pogo 21), ChIck II from 10 Form 4255 b 0 FOITII 8511 .0 Form 8521
SO BocltI MCUI1Iy end MIdIcIIa \Ill on Up Income no! ,tpOItod to ompIoyer, Attach Form 4137
al Tu on qutllned ""","",1 pi.... Including 1/lAt. II ,oqul,td, llIach Form 5328 ,
12 Adv.... NmId IIlCOIllI <*III paymonlt from Form W-2 ,
U Add I'"" 46 52. Thll II tolII ... , . . . ,
1M FtdmllncomllU wtthhtld, II any Illrom Fo'mll) 1099, chICk. 0
II 1 PlI3 IlIImtItd .... paymonlt end omount tpp/ltd from 11182 rlllum ,
II ........ IMMnI 0I'IdlI. Attach Schedule Ele . . . , ,
17 Amounl poId With Form ollIS (o.IDIIIIon ,oq_'). . . ,
III EllceA IOCiII -rttv, MaclIClII, and RRTA IU wttllhlld (IH PlOt I!) .
b 0afwrtI of BddIlIonIII883 \Ill., Attach FOITIIIB41 . . . .
II 0tIw ~ (1M pogo 21), Chock II from . 0 Form 2438
bO Form 4135 . . . . . . . . , . , , , ,
10 Add "'* 54 III 511, Th_ .,. , total II ."",
.1 II lint 110 II ""'" I"," II.. 113, _ II.. 53 from II.. 110, ThIa II tho omount you OVIIIPAlD,
12 Amount 01 line ~ 1 you WillI lllPUNDID TO YOU, , , , , , , , , . ,
13 AnIounl 01 IInl61 you wanl AnUIO TO YOUR llMllnllAnO TAll . 63
1M If 11n. 53 Is more I"." line eo, aublrlCllI.1 60 from IIn. 53, Thll It the AMOUNT YOU OWl,
For _It on how 10 PlY. Including wIIt110 _. on your paymanl, ... PIQt 28 , , .
III Eallmaltd \Ill I _ 28 , Alae Includ. on line 54
lJndor ...- oIl*1IMY, I _. "'" I _ ......_1hII rllum 1M ICCOIIlIlIIlY'n _ 1M ltat_.. ond 10 tho _ 01 my knowItdgt ond
-,lhty... , c....." .. Otclortllon of 1>1__10''* 10.. "'poytt) II _ on II_lion 01 wllIcII_ hII Illy knowItdgt,
~ Your IUI. V 0,1, You, OCCUpil1on I/:
, ...... /Ojlll I"fTCei.
Spou..'. uccu lion
~t'{', 'tfr
s
III
31
rr
31
31
40
41
41
63
44
.
DO
41
4.
63
.
.... ....
-
....
.-0 -
. If . IOInl r.lum. BOTH mUll Ilg"
Oil.
Prep.,.,', ~
lignllur' ,
'Irm', nam. (Ot vours ~
I' M"-empIOYed)'nd
,
Oat.
ChICk If
lIIf.emplOvld
IE I No
lIP Cod.
Prep.,.,', lOCI" Mturlly no
~, 1I..."'Vlt "lIMY (")
....trMI ~ a.w. "
NomoI __ on''''''' 10.0
-r. at ;~NE.5
CautIonI Do no/Include expens.. reimbursed or pIki by o/heII,
Mldlcllllld dentll ..pen... ('.. j:)a'" ".1), , ,
fnlar lIIIOunl Irom form 1040, lint 32, LLJ
Mulllply IIn. 2 above by 7,5'16 (,075). , . , , ,
Subtract line 3 from IIn. " If z.ro 0' 1.11 enllr .0. ,
Sial. and IocBIlncom. 11Il<.1 . , , . , , . ,
R.II ..1.1. IIll.. (III p.gl ".21, , , , , , ,
Oth.r 11ll", UII-lnclud. PlJ'IOnll prop.rty tlllll .
ICHIDULII A&I
1'_ UMO)
Medllllll
end
Dentel
IxpenH.
'nix.. You
Plld
(See
plIgt ".1.1
tnterelt
You Paid
(511
peg. ",2,)
HoIII
Peroonli 10
Inllllll I.
nol
deductlbll, 11
12
Gift. to
Chlrlty
(See 13
peg. A'3,1 14
11
11
Ca,ullly Ind
TIIall LouII 17
Movlnll
Ex nHa
18
Job Expln..1 18
Ind Moll
Olbl'
MllIIUlrolOUI
OlductlOllI 20
(511
pag. A.' lor
'X"""I" 10
deducl hit.,)
21
22
23
24
Olhl' 21
MllIIUlnlOUI
Olducllona
Total
Itemized
Deduction.
Schedule A-Itemized Deduction.
(lahedule . I. on b.ckl
.. AItIoh 10 'orm 1040. .. IN I INcUon. for 1oMduIa. A and. 'orm I
1
2
3
4
I
1
7
a Addlln.15Ihrouh7"."",.",
Ie Hom. mortglOt Inlerllt and polnl. reported to you on form 1098
b Home mortgage Inl_1 not rlpOlled 10 you on Fonn 1098, II paid
10 IhB person !rom whom you boughl Ih, homl. ... plgl ".3
and allow thlt perIOII'. nlllll.. Idtnlllylng no" and IddrlH .
Polnll nol rtporlld 10 you on Form 1098, 51e pig. ".3
10r.paclllrul.I, , . ,. , , . , ., , "
Inv.llmlllllnl....1. If required, al1lch Fo,m 4951., (Sat
pag. ".3,) , , , . , , . , . , , , . . ,
Add IIna.91throu h". , . . , , , , , , ,
CalutIonl If }'OIl mlde . cherlf.ble con'r/buflon IfId
received I beneflf In ../urn, IN PIt/I A.3,
Conlrlbullonl by cuh or check , , , . , , , ,
Oth.r than by cuh or check, II over $500, you MUST
.l1lOh Form 8283, . .
ClIl'yOv., from prior y.ar , ., . ,
Add llnel 13thro h 15. , . . , , , , ,
10
11
14
11
.. 18
Cuull or lhefllou(e.), Al1ach Fo,m 48B4, (See
,. 17
.... Attach Fo,m 3903 or 3903.F, (5.. I I A.4,
Unrtlmburaed emploYN .xpenles-job tr,vII, union
dU'I, lob educallon, .Ic. II required, you MUST al1ach
Form 2108. (Sat pege A-4,). ......,....................'
Olhlr expen.ea-lnv'.lment, II. p..pltlllon, sale
depo.'t box, Ilc. U.t type and Imount . ..............'
-
-0,-
Add IIn.. 19 and 20 . . . , , , . , . . , ,
Enter amount Irom form 1040, line 32, 22 .
Mulllply IIn. 22 above by 2'16 (,02) , . , , , , ,
Subtracllln. 23 lrom IIn. 21. If zero or Ie.. enter .0. , . , , , ,.
Other-from 11.1 on page A.5, UII type and Imount . ..............................
z?l/o
...............................................................................................
. 21
21 '.th. amount on Form 1040, line 32, more than $108,450 (more than $54,225 If
mllrrlld IllIng .lpltallly)7
. NO. You, deduction II not limited, Add lines 4, 8,12,18,17,18,24, and 25 }
and enter the lotll here, Also enle, en Form 1040, line 34, the '.rg.r of Ihls
amounl 0' your .Iandard deduction,
. YES. Your deducllon may be limited,S.. page A.5 lor Ihe amounl 10 .nl..,
For P....rwork Rlducllo. Acl Notice, ... Form 1040 Inltructlo." C.I No. 11330X
OMIt No, 10.45.007.
3'13 So
~
"
-() -
-0 -
1~/1tf- if-'5
':I
Sch.dul. A (Form 104011813
1\c__~Dm\ 10.01 tlt3
NImI(~ Ihown on'Otm 11).40, 00 not Int., name ~ aoclal MCunl)' numbet I' Mown on olMt lid.,
'+ MI :JD
Schedule B-Interest and Dividend Income
P.rt!
Interelt
Income
es..
pagtl 1 e
Ind B.l,)
Notellf you
,ec:olved . Fonn
loeG.INT, Form
loeG.()IO, or
IUblllfull
1..,.....1 lrom
. bIokIrogl linn,
III' tho IInn'l
nama II Ihl
pay. I/ld ....
Ih. 10101 Inlorlll
Ihown 00 Ih.1
lorm,
P.rt II
Dividend
Income
(s..
pagal 17
and B.l,)
Notelll you
,acllvod. Fonn
1099.0IV or
lublllfull
11.I.monl lrom
. broker.g.
lI,m.lllllh.
firm', name 8S
the poyer and
.nter thl 10111
dividendi
shown on that
form.
Part III
Foreign
Account.
end
Trultl
A.lChmonl 08
Soquonc. No,
Notelll you hid oyer $400 In '1Il1b1e Inlerelr Income mUI' eJlO com ere Pelt 1/1,
Inlerell Income
1 Ust nllTlI 01 pIve" II II1V Inll,est Is 'rtlm I slller.llnll1ced mortgaga II1d the
bUYlr used Ihl prtlPlrty II a palllonll resldlnce, see plge 8-1 II1d lilt 'hll
~?7~~?;1i~~~~~:r's ;;:'~~:~:I:'~ :~~~:7~: ~~d: ~~~~~:~::~:::
...1JJR.MI.., ....iflR!f.:'II......."....,.."..,....", ......""""'...."""",,
...'/)/JE.a<<........j)Mll~I:!...."....,' ......" ...."" ........,..,....""..,..',..,
.., .~f.I.'lJ.,."" .IlIW(U,~""""",.."""""""".."""""""""""",
..., '/tf.t:u....... ..Ptf..~ ,.......... ............".., ............'..,..........'",
,." .'N(tI.tN" ,p"p/1$/."""""""""""""."".,..""",.."""",.""",
Amounl
1
.........................................................................................,..
........................................................,...................................
............................................................................................
.....................,......................................................................
............................................................................................
............................................................................................
2 Add the &mounts on line 1 , , , , . , , , , , , , , . , , ., 2
3 Excludlblalnle,.st on sa,l.. EE U,S. slvlngs bondllssued lite, 1989 from Form
8815, line 14. You MUST ellBch Form 8815 to Fo,m 1040 , . . . . " 3
4 SublrBct line 3 Irom line 2, Enler Ihe resull here Ind on Fo,m 1040 IIn.88 .
I1!!!Il..I! ov 00 I dl dend ndlor her dl 'fib /Ion on stoe au mus'
Dividend Incoma
15 Ult nllTlI 01 pave"~ Includl gross dlvldlnds lI1d!o, olher dlst,lbutlons on stock
h.... MY capltll glln dlstrlbullonl and nonllXlbla distributions will be dlducled
on IInel 7111Jl 8. ............'j!;.....................................................'
. ...l>>.s..., ,~fFUit:m/~"", ilNQ""",.."",.",..."",.""""",..""."
.,. ,~p.,~,.... ,M.~,~~",.,..,.."..".,..,....."""""",...""""""""""",.,
-0 oJ
W JI
5
e
'7
I
e Add Ihe amoun's on Iinl 5, , , , , , , , , ,
7 CapillI 911n dlstrlbullons, Enler here and on Schedule O' ,
B NonlIXlble dlltributlons, (See the Inst. lor Form 1040. line 9,)
o Add lines 7 and 8 , , , , , . , , , , , , ,
10 Sublraclllne 9 I,om IIn. 8, Enle, Ihe resull here and on Fo,m 1040, line 9 , .
'If you received capital gain dls'rlbutlons buf do nof need Schedule 0 fo report
en orher alns or losses, see rhe Insfrucllons lor Form 1040, 'mes f3 and 14,
II you hid OV81 $400 01 Interest or dividends OR hed a lorelgn account or we,e a granlo, of, 0' a l'lnsle,o,
10, a lorelgn Irust, you musl complell Ihls part,
11a At any tlma du,lng 1993, did you hava an Inle'lstln 0' e slgnatu,e 0' othe, aulhorlty ove' a financial
account In a 10'llgn counlry, such as a bank account, securilles account, 0' olher Ilnanclal
accounl? See pagl B-2 lor excepllons and IIlIng ,equlrements fo, Fo,m TO F 90.22,1 , , , ,
b II "Ves," enter Ihe name 01 the fo,elgn country. ,.......... ........,.., . ......,. ,..,.... ,.. '..,
(S.I 12 Were you Ihe g,anlo, of, 0' Irans'ero, 10, a lorelgn lrusl thai exls'ed during 1993, whelhe, 0' nOI
pagl B.2.) ou have an benellclallnlereslln II? II "Ves," OU ma have 10 tile Form 3520 3520.A. 0' 926 ,
'0' '.porwork "educUo. Acl Nolle., I.. 'crm lIMO 1.IIrucUc.I. Schedule' ('orm llMOllf1t3
Profit or Lo.. From BUlin...
ISolI ProprlllorohlPI
. Plrtnorahlpl, lolnl vI.lurel, 110" mUll m. ,""" 1015,
=:'7": ~'::'" (I) . AllIoh 10 'orm 1040 0' Form 1041. . IlH InllNcllonl '0' llcIIodull C
Nom. 0' proptIttor
/J,f/lhtY -r: $Alc.s
A Pt1nclpll bUllnll1 0' pro'.lIlon, Including p,OOuCI or 1.....lc. (I.. pig. C,I)
jlftlS/~,,4N
BUlIn,.. "1ITl'. It no IIparal. bUlln... nam.. 1.lv. blank.
NAlhE'!'" :7VAI~
Bulin... .ddr... (In~IUdlng lull. 0' ,oom no,). '.. ,:!IIt..!!!!.!. r1!<../.(~~~((,........,..
City, lown or POll olllc" 11.1., Ind ZIP COOl _AfIit'flA~I{Jf!.tl,f6, AI 170'5'3
AccounUng mllhOO: III il COlh (2) 0 Accruol (3) 0 Olher IIP'CIIy). ",.,..",.,
Mllhod(ll ullod 10 Lower 0' COIl Olhfr I.n.ch 0011 nol .pply III
VolUI cao.lng Inventory: III 0 COlt (2) 0 or m.rk'l (3) 0 ..pl.nollon) (4) ~ chec..d, Iklp IIn. H)
Wu Ihore any chong. In d.t.rmlnlng quanUUII, COllI, or VolUIUonl b.lw.on op.nlng .nd clollng Inv.nlory1 II 'V'"" onlch
..plenallon, , ' , , , , , ,
Old you "mllerlolly p.nlclp.I." In th. op"oUon 01 Ihll bUlln.11 during 19931 II "No." "" p.gl C,2 lor IImll on 1011'",
I' ou .tarted or acquIred this bUlin.51S dunn 1993, check here , . , , . . , ,
ncome
1 Groll '1CIIp.. or .11.1, Clullon, 1/ /hl. Incom. was repo,fecl /0 you on Form W-2 and the 'S"/ulory
employee" box on rh.r form w.. chec~ecI, ,.. page C'2 and check h.,. . 0 1
R.luml ond .1I0wlnclI , , 2
Subtrlct IInl 2 from IIn. 1 3
eolt 0' goodl sold ('rom IIn. .0 on pogo 2) 4 ~ 0
Gro.. .....flL Subl'lcllln. . 'rom IIn. 3 , 5 15 0 00
Other Incom., Including Federat and st81e gllSollne or fuel tax credit or refund (se. page C-2) . e -0 .
Grote lnoome. Add IInas 6 and 6 , . 7 0 0
Ex .nu.. Caullon: Do not enfe, ex enses fo, business use of ou, home on lines 8-27, Ins'eld see line 30,
Advenlling , ,a 18 P.n,lon and proh...h.nng planl 18
Bed dlbll Irom ..III or 20 R.nl or ,.... I... p.g. C,.):
11IM... (I" pogo C-3) " 8 I V"'.III, mtchInery, end equlpmenl ,
10 Cor and lruck upen,," b Olher bullnlll property
(lit pegtt C-3) , 10 21 R.polrs ond mllnlen.nce ,
Commllllon, ond ,..., 11 22 5uppllll (nollnckJded in PII1I1I)
Otpltllon, 12 23 TOll" ond IIc.n,," ,
Depreciation and sectlun 179 24 Travel, meals, and entertainment:
..pen.. deduction (nollncluded I Tr.vel ,
In PII1II1) (I" p.g. C-3) , , 13 b MIIII ond .n-
14 Employ.. b.n.1I1 p'ogrornl t.n.'nmlnl ,
(olher Ihan on IIn. 19), , , 14 0 fnllr 20% 01
HI line 2~b lubjecl
Inlur.nce (other than health) . 10 hmitallonll
Inter..l: 111ft p.g. C'~) ,
I Mortgog. Ip.id 10 b.nk., olc,) , lIS1 d 5uOlr.clllll. 2~c from IIn. 2~b
b Olher, ll1b 25 UIIIIII..
17 legal and profesSional 2e Wages (I.ss lob!l credIt)
s'Ni'.. . 17 27 Other expenses (Irom line 46 on
OfficI" .n.. , 1 a pogo 21
SCHEDULE C
(Form 1040/
c
I
,
o
H
2
3
4
a
a
7
8
8
11
12
13
15
18
18
28
211
30
31
Tota. ..pen... before IltpenS8S ror business use of home. Add lines 8 through 27 In columns,
1enllllvo prollt (lol'), Sublr.Cllln. 2S Irom IIno 7
E)lPf"sl' tor bUlln"s! use 0' your home, Attach Fonn 8829 .
Nil profll or 110111. Sublracllln. 30 Irom line 29,
. It. profit, .nler on F'onn 1040, lin. 12, and ALSO on Schedule SE, IIn. 2 (statutory employees,
s.. page C.S). FidUCIaries. enter on Form 1041, line 3.
. 1'110", you MUST go on to IIn. 32.
32 It you hIve 8 loss. check the box that describes your investmentln this acllvlty (see page C.SI,
. " you check.d 320, .nler Ih. 10.. on Fonn 1040, IIn. 12, and ALSO on Sch.dul. 51, II.. 2
(IIt.tutory employees. see page C.S). FidUCiaries, enfer on Form 1041, line 3,
--! If you checked 32b, you MUST attach form 6198.
For P.p'l'Work Reduction Act Nolle., s.. Form 1040 Instructions.
Cdl rlo 113J4P
OMI t;o, I .',0014
~@93
A1tochm'"1
'onn , Iltquonco NIl 01
loci.. "'UIIIy ......., lIINI
'kJC1, '" 5"83
...,
111I c,e .
D lmt>Iqy" ID n........ (1lN), " ~
_L-Ll_lLLLU
I:~
,.
201
20b
21
22
23
2-
24.
2...
2
25
.
2T
28
211
30
}
}
31
32.0 All lnvestmenl II al risk,
32b 0 Some inVlStmenl Is not
at risk
Sch.dul. C l'o,m 104011883
,..., 4562
Depreciation and Amortization
(Includln,lntormltlon on U.ted Property)
......-.....',.......(.)
InIwnal ~ SeMet U
Naml(l) Ihown on reMn if
:MM)U'l- 'T. 'JON e-.5
Bur,lnH' 01' .cUY4lv 10 which Ihll 101m '''II"
, - -r.::rc l::'S
Election To expen.. Certain anglble Proparty (S.cllon 1781 (N
complete Pert V belore you comp/efe Part I,)
1 Mllllmum dollar IImllltlon (II an enterprise zonl business, Sle InslrUCtlons,1
2 Tolll cost of aectlon 179 property pieced In service during Ihe lex yea, (see Inst,uctlons) ,
3 Thnlshold cosl 01 secllon 179 property blfore ,educllon In IImltellon, , , , , , , ,
4 Reduction In IImllltlon, Sublrsctllne 3 from line 2, bul do not enle, 1188 then .0-
5 Dollar IImllltlon for till yeer, Subt'lcl line 4 from line 1, bul do nol enle, less than -0., (If
married III In se aralel , see Instrucllons" , , , , , , ,
(II OI"l1pllon 01 property
. II... 1111. In.lnJoUo.., . Altech thla lorm 10
CSt!/fO,LIL,g
our r.turn.
OMII No "'S'017~
~@93
AII.thmlf1l .
5t<lU,",CI N. ..7
Id..Ufylng .umbet
,~
~H. C)
.: If you have any "Lls/ed Property. "
1 $)" '>00
2
3 '200 000
4
5
IllIG.II
(e) Elected COit
e
7 Usted property, Enler emount from IIna 26, , , , , , , " 7
B Tolll .Iecled cosl of secllon 179 property, Add emounts In column (c), linea 6 end 7 B
8 TentaliY. deducllon, Enler Ihe smelle, of line 5 0' IIn. 8, , , , , , , , , , 8_
10 CarryoYlr 01 disallowed deduction from 1992 (see Instrucllons), , , , , ' , , 10
11 TIll.bl. Income IImlllllon, Ente, lhe smalle, of taxable Income 0' line 5 (see Inslruclions) , 11
12 Secllon 179 expense deducllon, Add lines 9 and 10, bul do notenl" mo,e than line 11 12
13 C yer of dlslllowlld deducllon to 1994, Add lines 9 end 10, less IInl 12. 13
Nol.t Do no' us. Part 1/ or Part III below lor listed property (automobiles, certain other vahle/es, cellular telephones,
certain com u/ers, or ro e used lor Intertalnmenf, recreallon, or amusemant), Instead, use Pert V lor lis fed propl
MACRS Depreciation For A..eta Placed In S.rvlce ONLV Durlnll Your 10113 Tax Ye.r (Do Not Include
L1ated Pro .
(d)RKOVI'V
potlOd
14
a
b
c
d
.
I
II
2'/ ,,> rs,
2". I) , r [i.
MM
MM
MM
MM
~/1.
SIt.
:.)/1,
~i / I.
h
15
.
b
1 2 r ~i,
40 . r I"
MM
!;/r,
~) II,
~i II .
IIIIIIIII Other Depreciation (Do Not Include Listed Property)
UI GDS and ADS deductions for assets placed in se",'ce In tax years beginning before 19931se. Instructionsl 111
17 ProPlrty sublecl to seCllon 168(n(1) elecllon Isee Instructions) 17
lB ACRS and othe, de r.clalion Is.e Inst,ucllons 18
IiIIIID Summary
19 Llsled property, Enter amount from line 25, , , , , " 19
20 TOtll, Add deducllons on line 12, lines 14 and 151n column (g), and lines 16th,ough 19, Ente, here
and on the approprlale lines of your return, IPartnershlps and S corporat'ons -see Instrucllon$) 20
21 For assets shown above and placed In se""ce dUring the currenl year, enler
the ortlon of the baSIS allrlbutable to secllon 263A costs Isee Instructions) 21
For Paperwork Reduction Act Notle., St. pagl 1 ot the IIparat. Instructions. e,lt No 1 J!)ObN
Fo.m 4562 119931
ISCHIDU~ II
(Form 1040)
Self-Employment Tax
0MlI No, I 1-00'.
. Be. 1.lltuollonl for Iohlldul. II ('ann lIMO).
DIptftmenI 01 the r,eIIroIy
.._ -.......... 1&) . AlUoh 10 'onn 1040.
N.",. 0' prwaon wllh ..".omplovm""llncom. I" shown on Fonm 10401 80cltJ slOCUr1ly num~r 01 porion
wllh IIII.employmenllnc0II11 ~
~@93
An_morn
lSoquoncl No, 17
Who Must File Schedule SE
You mUll IlIe Schedul. BE I':
. Your wag.. (and lips) lubJec:llo soclll sec:urlly AND Medlcl,e tax (or ,allrold ,ellremlntIQX) werellSllhen $135,000; AND
. Your nil ..rnlngl from slll.employmlnt from olher than church employee Income (IInl 4 of Short Schedull BE or IIn. 4c 01 long
Schedul. SE) wire $400 or more; OR
. You had church employee Income 01 $108,28 0' more, Income I,om s.rvlces you performed as a mlnlst.. or I member of I
rellgloul ord.. II not church employ.. Incom.. See plgl BE.l,
Nole: EIIf/IIIf you hive a I~ or e small.mounl of Income from s.".ernp/oymlnt, 1/ mlY b. to your b.n.nt fo m. Schedule SE IIIld
us. siltier .optlcrW mefhod' In Pm /I of LOllg Schedul. SE, See pag. SE.3,
Exc'fltlon. If your only HII'lmploymlnllncome w.s lrom elrnlngs IS a mlnlstlr, memblr of a religious ordlr, or Chrlstllll1 Sclene.
plICIlIIon.... AND you med Form 4361 end received IRS Ipproval not 10 be toed on those elrnlngl, DO NOT III. Schedul. BE,
Insteld. wrll. "Exlmpl-Form 4361" on Fo,m 1040, line 47,
May I U.. Short Sehedule SE or MUST I Use Long Schedule SE?
DId)lOU recli~. w.ge_ or up, In 19937
No
v..
NI YOU. m6n6lt., member l,)f. r116gk)u1 onw. 01 ChntUan
Selenc, practl160ntf who recetYld IRS 1ppfOY.1 nollo be taxed V..
on earnInIII from !.heM IOUrcM, but you owe HIf-employment
I.. on other utnlng17
W.. lhe 10111 0' your wage. and UPllUbjtcllO IOCIII MCunty
or ,.llroad "U''''."I lax pk.Ia your net ,armngs rrom
sett.employmenl mot. than $e7,6001
V.
No
No
Nt you uting one olllle opIlonII _ 10 fig"" you< not VII
oomIngo 1_ pogo 11.3)7
W.. the folll of vour WIQII and Up, IUbject to Medical. lu
...... yoU< not __IIIQI lrom ltIt.omploymonl mot1I lhon
$ 13&,0007
VII
No
No
Old you __ churc/l omploVOllr<:omt ,-,td on FDml
W.2 01 $101,21 0( mot1I7
0kI you r~II~' tip. ~t to IOdaI uc:unlV or MedICarI lax VI'
'1101 you did not '-' 10 you< ompIoyot7
No
YOU MAV UllIIlORT ICHIDUU II _OW
YOU MUIT UII LONG ICHIDULI II ON THliACK
Section A-Short Schedule SE. eeutlon: Read abova fo see If you cln us. Short Schedula Sf.
1 N.I fwm profll or (1011) from Schedule F. line 36, and farm partnerships. Schedull K.l (Form
IOB5). line 15a , , , , , , , , , , , , , , , , , . , , , , , , , " 1
2 Nel profll or (loss) 'rom Schedule C, line 31; Schedul. C.EZ, line 3; and Schedule K.1 (Fo,m
IOB5). line 16a (othe, Ihan larmlng), Mlnls'e,s and members of religious o,de.. HI page SE.l
lor lJTlounll 10 report on Ihls line, See plge SE.2 '0' othlr Income 10 'eport , 2
3 Combine IInls 1 III1d 2, , , , , , , . , , , , , , , , , , , , , , , " 3
4 N.t ..mlnlll from ..If-.mploym.nt Multiply line 3 by 92,35% (,9235), If less Ihan $400,
do not file this schedul,; you do nol owe aell.employmenllo , , , , , , , , , ,.
5 Self-employm.nt lex. If the amounl on line 4 Is:
. $57,800 0' less, mulllply IInl 4 by 15,3% (,153) and ente, the result.
· More Ihlll1 $57,600 bull.ss thlll1 $135,000, multiply the .mounlln excess of $57,600 by 2,9%
(,029), Then. add $8,612,60 10 Ihe ,esull and enl.. Ihl 10'.1.
. $135.000 or more, enler $11,057,40,
Also enter on form 1040, IIn. 47. (Importllnl: You are allowed a deduction 10' on.-hllf 01 this
amount. Multi I IIn. 5 b 50% ,5 and enler Ihe lelull on form 1040 IIn.25,
'0' P.perworll Reductio. Act NOllce,... Fonn 1040 Inlltuctlo.., c.. No. tlJ58l Schedul. &1 ('orm 104011883
~ ISI ~0Im 10.01 1813
NII1I1 01 ptIIOIl wllh ulI..mptormenl Incom. (II Ihown on Fonm 10401
IJIlIj)u'l ...,-: S
S1cUon B-Lonll Sohedule SE
11IIII Self.Emplo~m'"t lex
Not.~ II your only Incom. sub/.ct fo s.II-.mploym.nf tlll/S church .mployee Income, Iklp 11M' , through 4b. Ent" .0-
on 11M 4c MId QO fo 11M 6., Income from salVic.. you perform<<J IS . mlnl.far or I membar uf . ""11100. oro.r It not
church employee Incom., s.. page SE- f.
A II you 811 . mlnlal", mflllbe, 01 . ..lIgloua order, or Chnlllln Selenc. praclllloner AND you filed Form 4361. bul you 0
had 5400 or more of olltlr n.t IlII'nlnga from Illil-fIIlplo menl, chack hit'll and conllnu. with Part I , . . , . ..
1 N.t IIII'm prolll or (Iou) from Schedul. F, IIn. 36, and larm partnllWllpa, Schedul. K.l (Fo,m
1065), IInl 15a. NOt'l Skip this IIn. If YQU us. fha farm optlonBl m.fhod, See page SE-3
2 Nil profil or (Iou) 'rom Schedul. C, IIn. 31; Sehedull C-EZ, 11n. 3; and Schedul. K.l (Form 1065),
IInl 161 (Othlr Ihan fllll'l1lng), Mlnlslllfl and mflllbera of ..llgloul ordlll'llll pig. SE-' lor amounla
to ..port on Ihll IIn.. SM plge SE.2 for olher Incoml 10 '.port, Nota~ SI<Ip this line If you use the
nonfBrm optional m,thod. Sae page SE-3 , . , , , . . . . . , . . , , . . . ,
3 Combln. IIn'l 1 and?, , , , , , , , , , , . , , , , , . . , , , . , ,
4. If IIn. 3 la more Ihan zero, mulllply IIn. 3 by 92,35% (,9235), OtherwlSl. .nl.r amount ',om line 3
b If you .Iecled on. 0' bolh 01 Ihl opllonll melhoda, .nl" Ih. 10111 01 IInla 17 and III h.I'II, ,
o Combln.lln.a 41 and 4b, If I..slhen $400, do not 1I1.lhls schedul.; you do not ow. stll-employmenl
IIX. Exception. If I.u Ihen $400 and you had chu,ch Imploy.. Income, enl" -0. IUld conllnu. , .
~ Enl" you, church fIIlploy.. Incom. from Form W.2, Ceutlon~ S..
page SE-' for d.flnltlon of church employee Incom., , . . ~
b Mulllply IIn. 5a by 112,35% (,9235). III.u Ihan $100. enler .0- " ., , ,
8 Net ..mlngl from H11-employm.nL Add IInls 4c Ind 5b . " ,,"
7 MlXlmum amounl of combined wag.a and a.If-.mploymenl 'III'nlngaaubJecl10 ISOI;llIaecurlty
,ax 0' Ih. 6.2% ponlon of Ih. 7,65% ,allroad ..1I..m.nl (lIer 1) tax lor 11193. , , , .
III TOllll\OClllaacunty wlg.a and IIpI (from Form{a) W-2) and rlllroad
rellremanl (II" 1) compenllBtlon, , , . . , , , . . , ., III
b Unr.ported IIpaaubjBCt 10 aoolll security lax (from Form 4137, IIn19) 8b
o Add IIn.. 61 and 8b . , . . . , . . . , . . . , .. ., . . .
g Sublrlcllln. Bc lrom IInl 7, II zero 0' lesa, .nllr .0- hel'll and on IInl 10 and go 10 IIn. 12a .
10 Mulllply the Imaller 01 IInl 6 or IIn. 9 by 12.4% (.124), . , . , . , , . . . . . .
11 Maximum amounl 01 combined wlges and allf-employmenl elrnlngaaublecl to Medlc8l1l tlX
or Ihl 1.45% portion 01 Ihl 7,65% rlllroad rellrlmlnl (lI.r 1) IIX lor 1993, , , , , ,
128 TollI Medicare wagea and Ilpa (Irom Form{a) W.2) and ,all road
..1I..mlnl (lIer 1) compensallon, , , , . . , , , , , ,
b Unreported t1paaubjecl 10 Medlc8l1llax (Irom Fo,m 4137, IIn. 14) ,
o Add IInla12a and 12b, , . , , . . . . . , , , , , .
13 Sublracllln. 12c lrom IIn. 11. If Zlro or lua. Inler .0- h.relltd on line 1411td go 10 line 15 ,
14 Mulllply Ih. am.lI.r 01 line 6 0' IIn. 13 by 2,9% (,029), , , , , , . , , , , . , ,
15 Salf..mployment tax. Add linea 10 and 14. Enler here and on Form 1000,lIn. 47. (ImpotUnt:
You III allowed a deduction for one-hall 01 Ihla amount. Mulllply line 15 by 50% (,5) and enllr
Ihe ...ull on Form 1040 IIn. 25. , , , , , , , , , _ , , , , , , , , , " III
o tlonel Method. To FI ure Net Eamln . See a. SE-3,
Farm Opllon.1 M.thod. You may us. thla method only If (I) You, g'ou f8lm Incoml' wu nol mort Ihan $2,400 or (bl Your gron
fa,m Incoml'waa more Ihllt $2,400 and you, n'l 181m prollta'were 1.11 Ihllt $1,733,
III Maximum Income fo, optional melhoda , , . , , . , , , , , , , , , , , ,,18 1,600 00
17 Enter th. .man.r of: two-Ihl,da ('!o) 0' g,oa5 fa,m Income' (notlell Ihan z.ro) or $1,600. Also,
Includ.lhI5amounlonllnI4babov., , , , , , . , , , . , . , , , , " 17
Nonl.nn Optlona' Method. You may U5e thla m.thod only II (., Your net nonl8lm prollt.' we.. 1.51 IhIn $1 733 and 1110 '"a
9' '
Ihllt 72.18 % 01 your grou nonfarm Incom., and (bl You had n.t.81nlnga ',om alII. employment olal '.aal $400 In 2 01 th. prior
3 Yllrs. CluUon: You may us. this m.thod no more fhan nve times,
18 Subl,actlln.,7 from IIn"6 , , , , . , , , , , , , , , , , , , , , , , , t:J=8 t
III Enter Ihl .m.n.r of: two-thirds (%) 01 g,osa nonfa,m Incom.' (notlell Ihan zero) or the amount
on line 1B, A1ao. Include Ihla amounl on IIn. 4b above , , , , , , , , , , , , " III
;F,om Schedule F, line 11, and Schedule K-\ (Form 1055), IIns 15b :'rom Schedule C, line 31; Schedule C'f~, Iln. 3, .nd Schedule K.l (Form IOS5), IInl l!a
!.!2!!' Schedule F, line 36, and Schedule K'l(Form 1065 ,lln. I !a, F,om Schedule C,lIne /, Schedule c.EL, IInl I; and Schedule K'I Form 1065), line 15c
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Social Itcunty number 0' _
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'2C1'f !!!lJ ! 'fig 3
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128
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120
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