HomeMy WebLinkAbout94-06641
-t-li
a"
{1
::S
~
V)
.
t/}
7'
~
t
~
,.'-
~
j
,]. --......
I
\
I
\
I
:
,
,
I
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Constance B. Shughart, ) civil Action - Law
plaintiff, )
)
vs. ) No. F.R.
)
Dale F. Shughart, Jr., )
Defendant, ) In Divorce a v.m.
COMPLAINT UNDER SECTION 3301(C) or THI DIVORCI COOl
1. Plaintiff is Constance B. Shughart
at 252 West Pomfret street, Carlisle,
Pennsylvania 17013 oince November, 1985.
2. Defendant is Dale F. Shughart, Jr.
at 252 West Pomfret street, Carlisle,
Pennsylvania 17013 since 1982.
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.
who currently resides
Cumberland county,
who currently resides
Cumberland county,
4. The Plaintiff and Defendant were married on November 29,
1985 at Hanover, York county, Pennsylvania.
5. There have bean no prior actions of divorce or for
annulment between the parties.
6. The marriage is irretrievably broken.
7. The Plaintiff has been advised that counseling is
available and that Plaint!ff may have the right to request that
the court require the parties to participate in counseling.
8. Plaintiff requests the Court to enter a decree of
divorce.
I verify that the statements made in this Complaint 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.
Qu~~.~\~
Constance B. shughart, Plaintiff
WALKER, VAN HORN & ASSOCIATES, P.C.
Dated:
\\_\~.tl~
By:
., \.
nn Y. Ha
Attorney
re
~
"=' ~:... ~
en
- ,.
= , ..
,.,
.ex L"-1 '..1'" ~~
U) '- ",', . \\
N
~ -
,
.'
.. ., ~\
....... .. ,"c', ~
....... ,. - ~
"
=- c.':'"
C> ;0
= ~
......
':7"
.....
~ .-
,
t,
'-:~
(T)
I.",
..,
u,
CJ
III
~
~ a
: ~ E
:.I ~ ~
=: ~ ~
g ~
~ 0 e
. ~ 0
III < Yo
~ a
z
.?,
~
!::
~
! ~
! ~
0; II,
llf
~
o
;I:
~
.:,,- ,..,.....
,~ -""'Jo
,'.--- .......
CONSTANCE n. SHUGHART
Plaintiff
vs.
DALE F. SHUGHART, JR.
Defendant
AFFIDAVIT
DALE F. SHUGHART, JR.
)
)
)
)
)
)
)
)
)
IN TIlE COURT OF COMMON
PLEAS or CUMBERLAND
COUNTY, PENNSYLVANIA
CIVIL ACTION - IAN
NO. 94-6641 CIVIL TERM
IN DIVORCE
, being duly sworn according
to law, deposes and says as follows:
1. I have been advised of the availability of marriage
counseling and understand that I may request that the court require
that my spouse and I participate in counseling.
2. I understand that the court maintains a list of marriage
counselors in the Domestic Relations Office which is available
to me upon request.
{) ~~ rl-...
3. Being so advised, I do ~ r~ue~t that the
that my spouse and I participate in counseling prior
decree being handed down by the court.
court require
to a divorce
I understand that false statements her~in are made subject
to the penalties of 18 Pa.C.S. section 4904 relating to unsworn
falsification to authorities.
SWorn to and SUbsc~'bed
hetQte,me th~s.~) ?FY
of ,..[)(( l rYlOi:(," , ~ .
!.
NOTARIAL ~[AL
WENDY~. [HAj~. ~L"ll\' rdllic
lernoyne UJro, Ct'J,ll":rl.:'l.J (() :11~Y. PJ.
___"'Y. eUUl/lli. ci...11 E' :11,1.': """"1 ~. 19','5
/
4.'~~it~~~~~t~~i1:,,;}~/'?~~~!'~':':::J\r~'Y::~'~2:~f'~~f{.~n~~f~~~f.
-:r
en
-
:"t.:-'
In
'.:>
0')
J
11,
..,
'"
c-,
III
~ ~
< ~ !:;
~ ~ <
~.:'i Ii:
... ~ " ;.l
~ < !! ~
G e 2:~
lJ z cl ~
~ ~ E ~ Po
ui~~ ~
III n >-
e ~ 0
~ ~
v: ~
--
.:.- -y. .
CONSTANCE B. SHUGHART ) IN THE COURT OF COMMON PLEAS
Plaintiff ) OF CUMBERLAND COUNTY,
) PENNSYLVANIA
v. )
) CIVIL ACTION - LAW
DALE F. SHUGHART, JR. )
Defendant ) NO. 94-6641 CIVIL TERM
) IN DIVORCE
PRAECIPE
TO: Lawrence E. Welker, Prothonotary
Please enter my appearance on behalf of the Defendant Dale
F. Shughart, Jr., in the above-captioned matter.
DATE: 2. ~~_~,~
~~
S L. AN S
-=-
<.7'>>
~ .......
..~
<Tl
",
u
,u
CO=>
~ ~
~ ~ ~ ~
~ .1 ~ ~
~ ~ ~ ~ ~
G e ~ 2 ~
~ ~ ~ ~ ~
1-.. 0 os .. 0.
"': ~ e ~
III <.. ~
III II 0
~ ~ 1Il
Z ~
<
~~........
~ '~
-~ --
CONSTANCE B. SHUGHART ) IN THE COURT OF COMMON PLEAS
Pli\intiff ) OF CUMBERLAND COUNTY,
) PENNSYLVANIA
v. )
) CIVIL ACTION - LAW
DALE F. SHUGHART, JR. )
Defendant ) NO. 94-6641 CIVIL TERM
) IN DIVORCE
DEFENDANT'S ACCEPTANCE Ql SERVICE
I, SAMUEl, L. ANDES, on behalf of the Defendant, Dale F.
Shughart, Jr., do hereby accept service of the Complaint in
Divorce in this matter.
ANDES, VAUGHN & BANGS
DATED: 2 D~ (J74
r@
, ~ I 1
~ 3 ~
~ f< ~ ~ ~
z < ~ ~
=: 1Il 2!"
g ~ d S
< ~ t .. Po
~ 0 0 ~
. ~ ~ ~
11l < .
~ n 0
~ :! ;
z
<
.
. .
I" !';'
-JI-
~. I " ~J
Ii' fl! ',;'..
....' ,_,.t
""
.'
..
,
CONSTANCE B. SHUGHART, ) IN THE COURT OF COMMON PLEAS
Plaintiff ) OF CUMBERLAND COUNTY,
) PENNSYLVANIA
v. )
) CIVIL ACTION - LAW
DALE F. SHUGHART, JR., )
Defendant ) NO. 94-6641 CIVIL TERM
)
ORDER
AND NOW this
cJ}/ / day of
I
CJ("c -rl'- \'-C '-
, 1994,
upon Motion of the Defendant Dale F. shughart, Jr., by his
attorneys, pursuant to 23 Pa, C.S. 3302(b), we hereby order and
direct as follows:
1. Plaintiff Constance B. Shughart and Defendant
Dale F. Shughart, Jr., shall attend three joint
counseling sessions which shall be completed within
ninety (90) days of the filing of the Divorce Complaint
in this matter.
2. Defendant Dale F. Shughart, Jr., shall pay the
fee of the counselor for such counseling sessions.
3. The parties, with the assistance of their
respective counsel, shall promptly select a qualified
professional to conduct the marriage counseling and
schedule the three sessions with such professional.
4. Defendant's counsel shall advise the
professional selected by counsel for both parties, in
writing, that he or she has been selected by both
.
parties, shall provide a copy of this Order to such
professional, and shall advise the professional of his
or her responsibility to file a written report with the
Court pursuant to section 3302(f) of the Divorce Code
and shall further advise such professional that all
confidential communications of the parties to the
counselor are privileged and inadmissible as evidence
in any proceeding related to the divorce, as provided
in 42 Pa, C.S. 5948.
5. If the required counseling sessions provided
for herein are not scheduled in accordance with this
Order within fifteen (15) days of the date of service
of this Order upon both parties, the Court, upon the
motion of either party, shall schedule an immediate
hearing to enforce this Order or take whatever action
is reasonably required to insure that the counseling is
completed within the time required by law.
BY jt:~~jJ-,j;::~
,
-----
/~
J.
DEe ~ IU 33 :.i\ '9l1
,.,:
.
CONSTANCE B. SHUGHART, ) IN THE COURT OF COMMON PLEAS
plaintiff ) OF CUMBERLAND COUNTY,
) PENNSYLVANIA
v. )
) CIVIL ACTION - LAW
DALE F. SHUGHART, JR., )
Defendant ) NO. 94-6641 CIVIL TERM
)
MOTION I2B COURT ORDERED COUNSELING
AND NOW comes the above-named Defendant, by his attorneys
Andes, Vaughn & Bangs, pursuant to 23 Pa, C.S. 3302(b) and moves
this Court for an Order requiring the parties to participate in
marriage counseling, and states, in support thereof, as follows:
1. On or about 22 November 1994, plaintiff Constance B.
Shughart filed a Complaint in Divorce alleging an irretrievable
breakdown of the marriage under Section 3301(C) of the
Pennsylvania Divorce Code (23 Pa, C.S. 3301(c)).
2. section 3302(b) of the Pennsylvania Divorce Code
mandates the Court to require up to three counseling sessions
upon the request of either party, to be completed within ninety
days of the filing of the Complaint.
3. Defendant Dale F. Shughart, Jr., requests the Court to
order the parties to participate in at least three marriage
counseling sessions as required by the Divorce Code and agrees to
pay the entire cost of such counseling sessions.
4. The Defendant requests the counselor be selected and the
counseling sessions scheduled with the assistance of counsel for
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Constance B. Shughart, ) Civil Action - Law
Plaintiff, )
)
vs. ) No. 94-6641 civil Term
)
Dale F. Shughart, Jr., )
Defendant, ) In Divorce a v.m.
NOTICE TO DErBNU 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 YOIl fail to do so, the case may
proceed without you and a decree of divorce or annulment may bo
entered again3t 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 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, Cumberland County Court House, Carlisle,
Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF
PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT
IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Court Administrator
Cumberland County Courthouse
Fourth Floor
1 Courthouse Square
Carlisle, Pennsylvania 17013-3387
Telephone: (717) 240-6200
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of Franklin county is required by
law to comply with the Americans with Disabilities Act of 1990.
For information about accessible facilities and reasonable
accommodations available to disabled individuals having business
before the court, please contact our office. All arrangements
must be made at least 72 hours prior to any hearing or business
before the court. You must attend the scheduled conference or
hearing.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Constance B. Shughart,
Plaintiff,
civil Action - La~
vs.
)
)
)
)
)
)
)
No. 94-6641 civil Term
Dale F. Shughart, Jr.,
Defendant,
In Divorce a v.m.
lUCDlDID COHPLAIHT
AND NOW comes the above-captioned Plaintiff by and through
her attorney, Lynn Y. MacBride, Esquire of WALKER, VAN HORN'
ASSOCIATES, P.C., pursuant to Pa. R.C.P. 1920.13 and says:
COUNT II
ALIMONY PENDENTE LITE. COUNSEL FEES AND EXPENSES
1. Paragraphs 1 through 8 of the prior No-fault Complaint
in Divorce filed on November 22, 1994, are incorporated herein by
reference thereto.
2. The Defendant has refused to enter into any reasonable
and fair property and separation agreement, and Plaintiff will
incur substantial legal fees in that regard.
3. Furthermore, the resolution of the issues raised by this
Amended Complaint will require Plaintiff to incur considerable
additional expenses and costs.
4. The Plaintiff is without sufficient means to adequately
support herself and to meet the costs and expenses of this
litigation and is unable to maintain herself during the pendency
of this action.
5. The Defendant is presently employed at Fowler, Addams,
Shughart and Rundle with an approximate net take-home pay of
$6,200.00 monthly.
WHIRE~ORI, pursuant to section 3702, et. seq., of the
Divorce COde, "Alimony Pendente Lite, Counsel Fees and Expenses",
Plaintiff respectfully requests your Honorable Court to order
Defendant to file within 30 days of service of this Amended
Complaint upon Defendant, a complete Income and Expense
Statement, and to require the scheduling of a hearing to
determine Plaintiff's entitlement to alimony pendente lite,
counsel fees and expenses, and if so, the amount.
WALKER, VAN HORN & ASSOCIATES, P.C.
By:
'"-...'
IJ"> ~
~ . ~ it
...", ~
E ",
.., t~~ ..:
<:> ~
~ , ""-
~ ~ ~
m , ~
"., I . .. ':J ~ ~
.. _4 ;'
= ,;..'-) (J
~ ~ ~
~
::s:::
0.- I
;',.
(T]
0,
Co'.)
D-
."
V'
. .
IN THI COURT OP' COHMOII PLEAS OF CUMBERLAND COtnfTY,
PENNSYLVANIA
****.*....
CONSTANCB B. SHUGHART, PLAINTIP'F
.
.
CIVIL ACTION-LAN
-VB-
.
.
No.
t,VII
1994-6H1 Civil
DALI F. SHUGHART, JR., DEFENDANT
.
.
IN DIVORCE
o PIN ION
This action in divorce was filed on or about November 22, 1994
in the Cumberland County Court of Common Pleas. Currently before
the Court is a request made by plaintiff, on or about March 31,
1995 for alimony pendente lite "APL", counsel fees, and expenses.
Constance B. Shughart ("plaintiff") and Dale F. Shughart
("defendant"), were married on November 29, 1985. At the time they
entered marriage, the parties were each about 39 years of age and
had each been previously married.
Prior to and during the
marriage, defendant had been a practicing attorney and partner in
a law firm.
Plaintiff had been employed by L.M. Berry Company
selling advertising for the yellow pages, and continued this
employment for the first five years of the parties' marriage.
During these years each of the par.ties was financially successful
in their respective careers, although defendant's individual
earnings were about double those of plaintiff over that five year
period. However, in September of 1990, despite having increased
her income to more than half of defendant's over the preceding 21
month period, plaintiff resigned her position with the approval of
1
defendant, due to the stressfulness of that particular job. After
several months off from work the plaintiff, with encouragement from
defendant, decided to attend college to obtain a degree. She
attended Wilson College part-time through November 1994, at which
time the parties separated.
After plaintiff resigned her position, defendant increased his
efforts and hours at the law firm. By 1994 defendant was working
in excess of 60 hours per week while plaintiff was still attending
school. Subsequent to the parties' separation, plaintiff
remained out of the work force but remained a part-time student,
maintaining an intention to enroll full-time in the fall of 1995
and to graduate in the spring of 1996.
Following the separation, defendant voluntarily provided
plaintiff with $1,500 per month, enabling plaintiff to continue her
educational pursuits. Plaintiff also has relied upon withdrawals
from her IRA account and student loan funds to sustain her college
and living expenses without having to re-enter the work force.
In the spring of 1995, defendant informed plaintiff that he
planned to resign from his law firm and move to the state of
Oregon. Plaintiff immediately filed this petition for APL, counsel
fees, and expenses. A hearing was held by the undersigned,
specially presiding, on June 30, 1995. Defendant represented that
the pace of work and the sepuration had caused him emotional
problems which made it difficult for him to practice law. Although
these representations by defendant were not disputed by plaintiff,
she adamantly maintains that she does not acquiesce to his
2
withdrawal from the work force.
DISCUSSION
The Divorce Code provides the following with respect to the
relief sought herein:
In proper cases, upon petition, the court
may allow a spouse reasonable alimony pendente
lite, spousal support and reasonable counsel
fees and expenses. Reasonable counsel fees
and expenses may be allowed pendente lite,
and the court shall also have authority to
direct that adequate health and hospitaliza-
tion insurance coverage be maintained for
the dependent spouse pendente lite.
23 Pa.C.S.A. S3702.
"Alimony pendente lite" is defined as "[aln order for
temporary support granted by this Commonwealth or any other divorce
or annulment proceeding". 23 Pa.C.S.A. S3l03.
Although the Divorce Code does not provide any standard for
determining this issue, the entire Code is to be applied in
accordance with the following express "legislative findings and
intent" which are set forth at 23 Pa.C.S.A. S3l02:
(a) Policy.-The family is the basic unit in
society and the protection and preservation of
the family is of paramount public concern. There-
fore, it is the policy of the Commonwealth to:
(I) Make the law for legal dissolution of
marriage effective for dealing with the
realities of matrimonial experience.
(2) Encourage and effect reconciliation and
settlement of differences between spouses,
especially where children are involved.
(3) Give primary consideration to the welfare
of the family rather than the vindication of
private rights or the punishment of matrimonial
wrongs.
3
(4) Mitigate the harm to the spouses and
their children caused by the legal dissolution
of t.he marriage.
(5) Seek causes rather than symptoms of family
disintegration and cooperate with and utilize
the resources available to deal with family
problems.
(6) Effectuate economic justice between
parties who are divorced or separated and grant
or withhold alimony according to the actual
need and ability to pay of the parties and
insure a fair and just determination and settle-
ment of their property rights.
(b) Construction of part.-The objectives set
forth in subsection (a) shall be considered in
construing provisions of this part and shall
be regarded as expressing the legislative intent.
The notion of APL antedates the Divorce Code.
In a case
decided prior to the current law's enactments, it was held that
[tlhe purpose of alimony pendent lite is
to provide a financially dependent spouse
with income during the pendency of divorce
proceedings to ensure that that spouse is
not put at a financial disadvantage by
reason of bringing such proceedings or by
being required to defend against them.
(citations omittedl.
Bees v. Bess, 255 Pa.Super.
19, 21, 386 A.2d 114, 115
(1978) .
Since enactment of the Divorc& Code, that holding continues to
be viable. In a recent decision, Superior Court held as follows:
The purpose of alimony pendente lite is to
sustain the dependent spouse on an equal
basis with the other spouse while he or she
maintains or defends a divorce action. The
simple fact that one spouse earns more than
the other spouse does not automatically en-
title the other spouse to alimony pendente
lite. Rather, the spouse seeking alimony
4
pendente lite must need such relief to
adequately defend his or her rights in the
principal litigation.
Butler v. Butler, 423 Pa.Super.
530, 544, 621 A.2d 659, 667
(1993), alloc. granted 535 Po.
629, 631 A.2d 1002.
Where an award of APL is appropriate, the amount of the award
lies within the sound discretion of the Court. Hill.r v. H111.r,
352 Pa.Super. 432, 441, 508 A.2d 550, 555 (1986). The application
of that discretion by the trial court compels the Court "to apply
the Divorce Code in a compassionate and reasonable manner to
effectuate the overriding goal of achieving economic justice
between the parties." Murphy v. MurphY, 410 Pa.Super. 146, 154-55,
599 A.2d 647, 651 (1991), alloc. denied 606 A.2d 902, cert. den.
113 S.Ct. 196.
For there to be a basis for an award of APL, the spouse
seeking the award must demonstrate more than a disparity of income
between the parties, it must be demonstrated that the relief sought
is necessary to defend his or her rights adequately. Butl.r Y.
Butler, 423 Pa.Super. 530, 621 A.2d 659 (1993), alloc. granted 535
Pat 629, 631 A.2d 1002.
In considering the factors that appear to be relevant, we note
that plaintiff has less formal education than defendant. Plaintiff
currently is attending college at Wilson College where she
anticipates graduating in May, 1996.
Defendant is a lawyer, so
obviously possesses both a baccalaureate and a law degree. Both
parties are approximately the some age, and appear to be in good
physical health.
Both also have been employed in high-stress
!5
positions which produced relatively high levels of income.
Although she did not possess a post-high school degree, plaintiff
was very successful at her former position in selling yellow pages
advertising for a five year period earning approximately $45,000
annually from that position, with income ~luctuating due to sales
commissions. However, defendant discussed the issue of her
continuing employment with plaintiff, and both agreed that her
poeition had become untenable due to a number of factors, but
mostly due to the presence of a supervisor who put such pressure on
the sales persons that virtually all quit their positions. Thus,
it is clear that the termination of this position was for reasons
that both parties agreed were compelling, and both agreed that
plaintiff could not continue in that position.
Plaintiff currently resides with a roommate in Chambersburg,
where Wilson College is located, and shares expenses with that
roommate. Her living expeneee appear to be the usual expenses for
anyone living in a rental unit, and include payments for rent,
utilities, and maintenance of $300.00 per month. Her tuition cost
is $6,000.00 annually as a full-time student, and she also was
paying $50.00 per month for her involvement in internships which
are part of her educational requirements at Wilson College. Her
other living expenses appear to be unexceptional, except for $65.00
per month for prescription medications, $25.00 for other medical
needs, $150.00 per month for an income tax obligation, and $25.00
per month for interest on an education loan. Plaintiff currently
has no employment, or source of income, except for payments
6
defendant had made to her voluntarily and for money Rhe has
withdrawn from an individual retirement account. Specifically in
connection with the instant litigation, she reported a $250.00 per
month obligation for payment of counsel fees, in addition to an
initial $1,500 retainer paid to her attorney. It ie apparent that
plaintiff is living the rather modest life of a college student in
preparation for the economic benefit she anticipates she will
obtain from the formal education she is now receiving.
Defendant is an attorney engaged in the private practice of
law, as a partner in the firm of Fowler, Addams, Shughart, and
Ruddle~ He is 48 years of age, and has been a partner in the firm
since 1974. His marriage to plaintiff was his second, his first
marriage having ended in 1982 following ton years' existence. One
child was born to that marriage, and aha is now a 19-year old
student at Shippensburg University. His former wife is a guidance
counsellor at Big Spring School District, earning about $20,000
annually. He is currently contributing 2/3 of the cost of his
daughter's college tuitioll.
Defendant testified, and w~ accept aD accurate, that when
plaintiff quit her job selling yellow pages advertiBing, the
initial understanding was that she would taka Dome time off, and
then seek other employment at a bank in Harrisburg, but that she
later changed her mind and decided to pursue a higher education.
He did not indicate his disagreement with those plans.
However, various hopes or expectations of the parties did not
pan out. Defendant had aRpirntlons of pursuing a judicial position
7
in 1991, but did not receive the party's endorsement, so he
withdrew from that endeavor. Financial pressure increased, and he
worked significantly longer hours, and involved himself in legal
matters that he did not have an interest in because of a need to
generate additional revenue. Thereafter, he found that he had not
been providing sufficient income for his firm to warrant the income
"draws" he had been taking, and he was required to borrow $5,000
from hie mother to repay the firm in mid-1994. Prior to that he
had borrowed $15, 000 for a similar purpose. He underwent a
financial re-structuring, and re-financed existing loans to payoff
these and other obligations with the result that his debt load
increased from $67,000 in September, 1991 to $107,000 by November,
1994.
Over the above period, defendant's income rose significantly
from about $46,000 annually when he married plaintiff to $108,148
in 1993, and $98,445 in 1994. Additionally, he earned about $2,000
annually from teaching a course at Dickinson School of Law.
However, to increase hie income to this level, he reported that he
increased his working hours from 45 hours per week to 65 hours per
week, and that he often would skip meals to complete his work.
As time went on, the parties' marital and financial problems
became deeper, and defendant felt his emotional state in decline.
Plaintiff withdrew money from an IRA account to pay for living
expenses. Defendant moved from the family residence following the
parties' separation, and went to live by himself in a cabin owned
by his family. By May, 1995, he determined that he did not have
8
the "emotional capacity to practice law at the present time", and
took a hiatuB from the law firm 1 to look for an opportunity in
Oregon that may provide h\m with relief from his current situation.
In the interim, defendant has arranged for a listing for snle
of the parties' former reBidence, from which debts will be paid,
and that his interest in his law firm's Keough plan, val\led at
$150,000 will be transferred to an IRA account, to be available for
payment of the parties' living expenses.
In determining this issue in the unusual circumstances of this
case, we will begin with the determination of the parties' earnings
and earning capacity.
plaintiff currently has no earnings, but
demonstrated an earning capacity of up to $45,000 annually in the
past. However, she could not withstand the pressure of that job,
and withdrew from it, with defendant's agreement, out of concern
for the effect this was having on her.
Al though she is not
currently employed, there is no reason she could not obtain some
form of employment, at least on a part-time basis, until she
completes her college education in May, 1996. No one provided any
evidence as to what employment may currently be available to
plaintiff, or what her rate of pay would be if she did obtain
employment.
However, given her current commitment, with
defendant's consent, to pursuing her educational goals, we think we
can safely conclude that her current earning capacity is quite
1 We understand that this break from the firm may become
permanent, but did not take him to state in his testimony, as
suggested in defendant's brief, that he has 00 resigned" from the
firm. We think that it is premature to draw any conclusion at this
time as to what his futnre relationship with the firm may be.
9
limited.
Similarly, defendant has a very significant earning capacity
based on past performance, but unfortunately he currently is in no
emotional condition to resume this employment. Plaintiff did not
challenge this position taken by defendant which is remarkable for
its eimi!arity to the difflculty which plaintiff herself confronted
in her former position, which she felt compelled her decision to
leave that position and the significant income it generated. While
she did not say so in so many words, it is apparent that she
recognized that her job was having an adverse effect on her
emotional health, and she felt the cost to her was not worth the
financial remuneration she was receiving. She also is now pursuing
an education which she acknowledged likely will not lead to a
position that will provide an income as great as her former
position, so she obviouoly recognized that other facta outweighed
the purely economic considerations.
In like fashion, defendant is now similarly situated in that
he feels emotionally unable to continue the practice of law. As a
lawyer, he is subject to the Rules of Professional Conduct which,
at Rule 1.1, compels "competent representation" of the client and,
at Rule 1.16(a)(2), compels declining representation or withdrawal
from representation of a client where .. the lawyer's physical or
mental condition materially impairs the lawyer's ability to
represent the client." The prior "earning capacity" of defendant
is bllsed upon his ability to do work as a lawyer which he has now
professed in a public proceeding that he can no longer ethically
10
perform due to his current emotional condition. We think it hardly
appropriate to ascribe to defendant an earning capacity based upon
employment he is currently not able to perform, and which he could
only obtain - if emotionally able to do so at all - if he were to
violate the Rules of Professional Conduct.
Plaintiff has taken the extreme position that we should impute
a zero earning capacity to her, and a $103, 000 annual earning
capacity to defendant, and then compute APL by utilizing the
support guidelines. We use the characterization "extreme"
advisedly, because she did not at the hearing challenge seriously
the sincerity or seriousnese of the depth of defendant's emotional
problems. In light of her own experience with the effects of
stress on a job setting that caused her to withdraw from the labor
market for a number of years, we find this position to b"
disingenuous anc inequitable.
Defendant's position is only slightly less unreasonable,
however, in suggesting, without any supporting evidence beyond his
own testimony, that he currently has no earning capacity at all.
While we accept that he is not currently able to perform the duties
of his former position as attorney in a law firm, this is not the
equivalent of saying that he is totally and permanently disabled.
He obviously is an intelligent, highly-educated individual who
will, after a period of recuperation, be able to return to the work
force in some capacity. However, at this time, we have no way to
determine when that may be, as it would take a professional opinion
to make that determination.
11
IN THE COURT OP' COMMON PLEAS OP' CUMBERLAND COUNTf,
PENRSfLVANIA
***..
CONSTANCE B. SHUGHART, PLAINTIP'F CIVIL ACTION
-YB- No. 1994 - 6441 Civil
DALI P'. SHUGHART, JR., DIP'ENDANT : IN DIVORCE
ORDER OP' COURT
NOW, September \ S-, 1995, after hearing and upon
consideration of memoranda of law submitted by the parties,
plaintiff's application for alimony pendente lite is DENIED. This
disposition is founded upon the availability to plaintiff of the
funds currently in defendant's Keough plan for use in the payment
of plaintiff'S living expenses. In the event these funds are not
made available immediately for this purpose, the Court will
entertain a motion for further hearing in this matter.
BY THE COURT,
cc:
kL-t--l . (/
William H. KayeP J.
3~ "'.J~4.""" l>"1 M<t--, rf.".....Uj/ ,-I;o(i."..
Lynn Y. MacBride, Esquire, Walker, Van Horn & AssociatEs,
P.C., Attorney for Plaintiff
Samuel L. Andes, Esquire, Andes, Vaughn & Bangs, Attorney
for Defendant
September 1.6 , 1995:
Copies of the attached Opinion and Order of Court were served
on the above attorneys for first class mail.
~'?( I 13 ~JJ-J.
-. ~'tary
Household
Week
EXPENSES
Home
Mortgage/Rent ........................................ $ .~_~n
Maintenance ........................................... $ ._. _....
Ulilllies (telephone, healing
LJl'f.re~~~I~~~ic.) ..........................."........... $ -..- no.
'ElIll'lvyl"elll (Iransportallon,
lunches) ............"""............................. $~. ~h.~ ~.__.
Taxes
Rsal Estate "............................. ...."........ $ ~.___.m___.~__..
Personal Property.."............................... $ on
Income ......."............................................ $ ___.._..._~..
Insurance
Homeowners ........"................................. $
Automobile .............................................. $
Llfe/Accldent/Heallh .............................. $
Other ............................................",......... $
Automobile (payments, luel,
repairs) ............"................................... $
Medical tc..r,,,,";f.</) PU-.sClltpt,.",1J'
Doctor, Denlist, Orthodontist ................ $
Hospllal ................................................... $
Special (glasses, braces, etc.) .."........... $ _
Education
Private, Parochial School....................... $
College ......................................."............ $
P I COuc<,T,.",..t Lu"", .I:N'("~T r'I",-t.
ersona
Clothing ....................."............................ S
Food .......................".."..........,.,............... $
Other (household supplies,
barber, etc.) .....".................................., $ ____
Credll payments and loans .................... $ _.~___
Miscellaneous
Household help/child care ..................... $
Entertainment (Inc. papers,
books, vacalion, pay TV, etc.) ............ $._____._.
Glfts/Charllable contributions .............. $~_______
Legal Fees ............................................... $ __~
Other child support/alimony
payments ...........".."............................ $ __._~.~_._~.
Other (specify) ::(~".T..~.9.K2............. $ ___~___
Child
Week
$.
$ -~--_.
$ --~--.-~--
$_._~---~
$ --_.~-~--~
$--~---.~-
$ ------~.
.
, I " ~
.
Household
Month
Child
Month
$ .J..{~,___O.o
$. ",.H:>-,..oP
$.~~c) ,_<<;1.9
$ _n~~"__~
$ .~__~. n~_
$ --.--
,/
$ .~ QLCW $ __on
$ ~_.~--------
$.~ ',-'-
$ ..Is P..!...QJ2
$ ._--~--
$ ---~_._-
$
$ $ ~o, 00 $
$ $ 70.00 $
$ $ $
$ $ $
$ $ ....2d , 0 0 $
$ $ b <. ()() $
$ L .). :{, 0 0 $
$ $ $
$ $ 5110.00 $
$ $ ... $
d-..:{. uo
$ $ _.. 7':;. 00 $
$ $ -300. 00 $__
,/
$_. $ ~o.oO $
$ $]:J...o.OO$
$ ----
$
$-_.~-~
$---
$
$ ----
Tolal Expenses ............................................ $ ___~_~ $ ______~~_~~
$ $ -~..,-,-
./
$ -- ~,-'5.LOO $ --~-----
$ ..X~~LOO$ -~--._,~
$__~9A).n $ __~.__~
$.. ~--~;.r~- $ ._~-~..~--~.
$ .~~~G1~QD $ ____.___m.
$
$ --.,--. ~.
PROPERTY OWNED Description
Chscklng Accounts ........ -p ,. IVl IA.1A.~T'
........ -E<."J\...rM.l.<. -~~ltt.! 'I-
Savings Accounts ........... C1IGLQ,1l "",
Velue
i(u, (l')
"'
\
r'
.
Owner.hlp.
H W J
-~v
==v.....
Credit Union ....................
$
$
$
$
S
S
$
S (
$ -LO Cf I{
$ ?
TJ
s~
S/J.,\Jl>t,)
$ /'10,000
.
"/"'--
~-~
-X- - -V
=:M.: :L:: ==
~--
Stocks/Bonds ..................
,,;'T~
..................
Real Estate ...................... 1-
...................... /'1'10 u ...
Other ................................ c.::.
................................ --l R A:
lelal, PrgplIrty ..................... _/( ('.0 U trh-r L (l10
INSURANCE Compeny
Hospital .........K..............
Medical ...............L~...'!:..!? S
Health/Accident ..............
Disability Income ............
Other (dsntal, etc.) ..........
(.H . Husband, W. Wife, J . Joint, C . Child)
Policy No.
Coverage.
H W C
==--L
SUPPLEMENTAL INCOME STATEMENT
A. This form must be filled out by a person who (check one):
__ (1) operates a business or practices a profession; or
_ (2) Is a member of a partnership or Joint venture; or
_ (3) Is a shareholder In and Is salaried by a clossd corporation or similar entity.
B. Attach to this statement a copy of the following documents relating to the business, profssslon, partnership,
Joint venture, corporstlon or similar entity.
(1) ths most recent Federal Income Tax Return, and
(2) the most recent Profit and Loss Statement.
C. Name and Address of business:
Telephone Number
D. Name and Address (If different than C) of accountant, controller or other person In charge I)f financial
records:
E. (1) Annual Income from business ............................................................................................. S
(2) How often Is Income received? ............................................................................................ $
(3) Gross Income per pay period ............................................................................:.................. $
(4) Net Income per pay period ................................................................................................... $
(5) Specific deductions II any .................................................................................................... $
CONSTANCE B. SHUGHART, ) IN THE COURT OF COKHON
Plaintiff ) PLEAS OF CUHBBRLAND
I COUNTY, PENNSYLVANIA
vs. )
) CIVIL ACTION - LAW
)
DALE P. BHUGHART, JR., ) NO. 94-6641 CIVIL TERH
Defendant ) IN DIVORCE
COHPARISON OF INCOKBS
From 1985 to 1990, both parties were employed. The following is a comparison of
their incomes fro. those chosen careers during the marriage:
YEAR
PLAINTIFF, CONNIE SHUGHART
FRCH W-~ STATEHENTS
DEFENDANT, DALE F. SHUGHART,
JR., FROM PARTNERSHIP K-I
STATEHENTS
1985
1986
1987
198B
1989
1990
1991
199~
1993
$~8,434.00
$~9,969.00
$31,80~.00
$34,773.00
$45,140.00
$41,990.00
(for nine months only)
$0.00
$0.00
$0.00
$46,031. 00
$64,467.00
$72,~35.00
$85,~18.00
$88,5~4.00
$9~,067.00
$84,450.00
$107,431. 00
$108,148.00
ANDES, VAUGHN & BANGS
\J
,,~~
Attorney for Defendant
Oitp&nm.n' of the T'''.''i'-lnt.,n.l Ma\,lenue S.Mca m <110\94
u.s. Indl'llduallncome Tax Return U@
For the 'fMI Jan. 1-oec. 3', 199C, ot olhef lI_ 'I'" ~tnnlno
Label y"", f.lIl\11Tlt1l111O 101\111 l.o.1 nom.
(800 ~ l-t 1'. Jj.\IIClIt~,. ~/l.
Ilt\rUetkx11 . II . toint Filum, .pay"', flrat n."... Ind Inill.,
on P'Ot 12.) f COr'J1"JYt.t I). Ifl""t\4iVr
~:~he IRS H '-0 oddro"ln~ ~ .....~. If Y"'.1' h.... P.O. bO..... paolO 12.
OthOlWIs.. E rJ.S'). ~ /'0/1,-/1.1.1( r.
pltau print = City, 'own Of POI' omc..J.l'le, ItI<I ZIP cod.. II you hive. fat'lOn add....., ... plOO U.
;;I~d~nllll C~j4..'jt,l 1'4. /701')
EllCllon Clmp,lgn lrr. 00 you want $3 10 go \0 !hI. fund? . . . . . . . .
SM . 12. r II e olnl r.tum. does our spou.. want $3\0 go 10 this lund? .
.1 Slngl.
2 Marrted IlIIng joint return (OVIII " only 000 had Ineomo)
3 MIniod filing _.to feiurn. Ell,,, opou.... lOCI" IOCUf1Iy no. .l>Ov. and lul name h.... ~
4 Hnd 01 houHhoId (wllh qu.lHylng p...on). (SH P'O' 13.1" 1110 qU.IlIyInO peroon iI. chlld!xlt nol vour a.pond""l.
onl.. thla chlla'. nfll11, h.... ~
5 Ouoll n wIdo with a.pond.nl child .ot 0 u.. dloO ~ 19 . SH
5. l&l v........lf. II )'0\1' plt""l (or .om""", ....) tItl cIoIm )'0<1 u . dopondonl on 111. Of hat Ill<
retum. do not chock boll ea. 1M b. Illre to chOCll the boll on IIno 33b on pogo 2
b Spou..........................
o Doponcltnlt: 141 De.._". I Of ~l/lt
(11 N1IIlI tlirsl, InililJ.1/Ill bll name) ..blJonl~.I' ::: lOO'
LlluM H"0\II/I.,\" ~l) Il"MI;lA- I')..
J1040
Filing Status
(St. p.Oo 12.)
Cn.ek only
011. bo..
Exemptions
(So. pega 13.)
II mort Ulan .1.
dependant.,
soe page 1".
Income
Altacn
Copy II 01 your
form. W.2,
W.20, and
1m-R h.",.
II VOU did nol
gel a W.2, .00
pag' 15.
Enclos.. !xlt 00
nOI .tIe.n, any
payment wilh
your r.tum.
AdJustmonts
to Income
CautJon: S..
Inlt/\JCtlons . . ~
11\5 u~ arvv-oo not ""I' Dt 1\aP't In thI, .~.
. lQQ4. Illdlng . 190MB No. 11l4H074
YDur 1<<1.. IltGunty numw
}..o :~c.: 1t.'H.
~." 'Oel" ~UIffV numb<<
/7'1 j')l. i-IIS1
For Pr1VIICY Act and
Paporwork Raductlon
Act NOlleo, toa p.go 4.
V.. No Note: Cn.d/nQ .Yea-
.... not ClUng. )'W'
r.... QI~. your
rellJn<J.
l.&Iln.m.
AQ1. no.
d IllW' cllnd dldn'lli" Willi Y'U bUlls c~lmld II your d,pcnd.nt under I .1t~1985 ~'..m.nl. ChICk hll' ~ 0
a Totolnumb4ror.. tlon.clolmod . . . . . . . . . . . . . . . . .
W.g... IIlari.s, tips, ale. Attoeh Form(I) W.2 .. . . . . . 7
Tuabf.lnlorOlt Income (He p.g. 15). Allteh Schedul. S II ov.r $400 Be
T....xemp\lntOfNt '"N peg. 16). DON'T Include on 11n. Ba Bb
Dlvldtnd Income. Attech Schodult B II OVOf $400 . . . .
Taxtblt "funda. Cf1ldit.. or off.ot. 01 ,tat. ana local lnooml ""01 (_ ~,g~ 1~) :
Allmonyrtctlved . . . . . . . . . . . . . . .
Buti1o" Incom. or (loll). AttlCh SChtdtJla C or C.EZ . . . .
Capil.1 geln 0' (loll). II required, t11aCt1 ScIladul. 0 ('H plOO 16)
0Ihar gains or (Iotael). Attach Form ~797. . . , . . . . . . . . . .
TotelIRAdlstrlbutlon.. ~ "5'.~ U bTIil&IlItIl11OUnl(IN~"7)
TOIll pendons.lId Mnullles l..1!!.J U b TIll'bl'IIflO\I1I (IN p.oo 17)
R'ntal rool 001010, rovaltll.. pllt1ntrthlp.. 5 eorporallon., lru.ls. .Ie. Att.ch ScheduIo E
FlITlllncomo or ~oa.). Attach Schedult F . . . . . . . . . . .
Unemployment componllllon (6M peOI 18) . . . . . , . . . . . . .
SOCiallOClJUIy banlnll 120e I I I b Tlllobls sl11OU1l (SH PllQl 18)
O1hor Incoml. Utt typo.nd .mounl........ p.go lS l~~!I.~...!t~~~......
Add Ih..mountsln th. I" II hI column lor Ilno, 7 th'Ou h 21. Thla II ou,lol./lncom."
VOUt IRA doductlon ('00 pogo 19) . . . . 23<l
SPOUH', IRA deduction (.... pOoo 19). . . 23b
Moving ..pon.... Altleh Form 3903 or 39Q3.F 24
Ono-hall 0' ..If.emplovm.nt lax. . . . . . .. 25
Sol'-emplov.d ho.llh 'nsu",nc. doducllon (... pogo 211 2&
KlO'lh rellremenl plan and sell.omploVoa SEP doduellon 27
Ponolly on oorly wlthdrewo! of ..vlnO', . . . .. 28
Allmon, p,;o, ROC'lllsnl'l SSN ~ I I 211
Add line. 238 ttvou h 29. Theil are our total R u.trnent. . .,.... 30
Sublracl ~n. 3D trom line 21. Thll Is YOIlr .dlutt.d g"..lncom.. 111m thin m.21S Ind, cnlla ivea
W1lh you I'" thin S9.000 II I ch~d dld.'llIy. W11h you. m 'Earned Income C..dll' on I '27 ..
Cat. No, 113200
7
ea
b
9
to
11
12
13
14
15.
tea
17
18
19
20.
21
22
23a
b
24
25
2&
27
2S
211
:JO
t.\1.
o
10
11
12
13
14
15b
1Gb
17
18
10
20b
21
22
13.
.... tt 'Utl
clIo",lOOO" _"
,.... ;.,
".. eI,,,,
c~II"" II Ie
"..:
.IIYohllll,o. I
. '1"'111" .n~
'" ..,,,
II.......
II",.IIM(II.
JlI.14)
O,,,".,al' .. I.
"..111I,.. ....... _
'" .m..,.
tit"" III
IIM'lhyt ..
5"')
1$7
500
8(f~
31
41.'"
'1'1).,\'1
Fonn 1040 If 0'"
g
,
.......1~(1~1
Tax
Compu-
tation
~1 page
H \'011 WIlli
lhIlRS to
ftgu/'I )'OUr
lax, ...
page 2~.
CredIts
~ pIO'
Other
Taxes
r,j' pIOI
Payments
AlIach
F_ W4..
W.20, II1d
I Q99-R on
lhIlrOnt.
Refund or
Amount
You Owe
SIgn
Here
~1I.r=
lor~
NeOIll..
PaId
Preparer'.
Use Onlv
87 Amount paid wi1h Fonn 4eeIl(extlnCion roquol~. . . .
III Ex....lOCIallOQUff1y ond RRTA I&ll wUhIlOld (... pogl 32)
&e Olhoqll''lIW1lI. ~ I fnlm .0 Form 208 b 0 Fonn 4138
eo Add IlnH 54 th S9. These ... total '" . . . . .
al line eo 1I_1!lIn" 53,IlblJIC1I1n153 fllllTlWlo 60. ThIIIs ltlIomount \'OU OVERPAID.
112 Amourll of IInl 01 )'OU wlnl REFUNDED TO YOU. . . . . . . . . . .
63 AmeIInl ollillC a, you Wlnl Al'I'I.IfD TD YDUIII"I UTIMAlfD TAt ~ 63
84 H IInl 83 II motl than line 60, lubtrlClllnl aD from IIn. 53. nu. " lho AMOUNT YOU owe.
For dollU. OIl hew 10 pay, lnoludlng what to wrile On \'Our Plrm"". "" p"g' 32 . . .
8lI EoIlmatod fa< PInalI\' (_ plga 33). Also Include on Iln. 84 I 8lI I _.._
Undtt I)tI\Il'UItI of J*1UY,1 dfClIt1lh1tl ha....~ \hit r.u.n and '~1'lQ ~. and 111'lINnll, and 10 U- but 01 my kno'/I'ttdoe and
bttftf. u..y are Wt, COtT'tCt.1nd compttlt. OtclltlUon 01 pr'PM'- (othef Ihln ~f) i, baNG on .. ,"'Ofl1\lUon of wNch pt'1p.vW """"" ~Ot.
~ V.... lIOl\IlUII 0'11 V.... OOCUPltJon
~ 8pouso'1 "19"'1.... II , "'" mum. BOTH ""It I .!gn.
I:or IF/'lErl flt:.F'Ll"':.
FFOf I 1.-(:1 :;:-5'':<::- 3t,':,o
~
32 Amounllrom 111\1 31 (.d).llod 0'011 Incom.) . . . . . . . . . . . .
33a Chock If: 0 You wore as 01 oIdo,. 0 Ollnd: 0 8pou1l Will 65 0' old..., 0 Blind.
Add 111. numoor of box.. chackod aboVI Ind anior Ih. '01.1 /Ioro. . . . ~ 33a
b II YOIll' panonl (or _n. .IM) can claim YOIl at I dopondenl, chock haI. . .. 33b
o If YOIl'" marrIod filing ..parlltly and \'Our &pOll.. Klmlz.. deducllon. or 0
you ... a dual-111M II""" "" pogo 23 and ~k her.. . . . . . . ~ Me
11_ deduction. 'rom Schedule A. line 29, OR
ltandard dlducUon lhewn boIow 101 your filing .laIUI. Bill If rou ohaokld
any bex on 11M ~ Of b, go 10 pag. 23 10 IInd yout atondard doduc1lon.
II you chtckad box 330, your oIandard dlduCUcn II zero.
. 6I11gl0-$3,800 I HNll 01 hcul.,.old-45,6oo
I MIn10d IItlng Jointly 01 Cluallt\'lng wtdow(~,35O
. MIn10d nllng ooparalll~,176
8ubtractllnt34fromllne32 . . . . I , t . . . . . . . . . . . .
111m 32 I. $83,a50 0( IaN, multiply $2,450 by tho total number 01 Ix.mp!lona ~lalmod en
Ilnl ea. H IIno 3215 0VfJ( $83,850, .oe lhI WOIkahooI en pogl 2~ '01 th. amounllo ,"tar .
Taxabll Income, Su/lttact lint 30 from Una 35. IIl1nl 38 Is I11OI1Ithon /In. 38, tiller .(). .
Tax. Chock II Item a ~1lI Tabto, b 0 Tax Rat. Scnad_, 0 OCIQIlaI Gain Till WCtII.
1hHl, or dO Form 6815 (... pIg. 24). Amounl from FO",,(I) 8814 .. I I
III Add/llonall&ll... Chock II ',om a 0 Form 497D b 0 form 4972 . . . . .
40 Add /I_ 38 and 39. . . . . . . ~
~1 ClodIt fot child and dlQlndon,..... _.... AIIICIl Form 2441 41
42 Clodll for 1M ofdtr1y or the dllablod. AlI.Ich Schedull R ,. 42
43 Foralgn lIlI c:ttdll. AlIlch Form 1110 . . . . , .. 43
44 0!hI, c;rodltl (I" pa91 ~). Chock lI'rom a 0 Fo,m 3800
b 0 Fcnn 8308 0 0 Form 8801 d 0 Form (lpocIly) _ 44
045 Add /lnal ~ll11rough 44 . . . . . . . . . . . .
4e 8ub1nlCl11ne 45 fnlm line 40. If line 45 Is more than lino 40, Inter .0- .
47 s.I'~ lax, AlIadI Sched<lla 6E. . . . . . . . .
4e Mernauva mlnJmlln I&ll, AlIIch Form 825 I . . . . . . . _ . . . .
48 Racapturlllll... CIIoc:k II fnlm a D Form 42SS bO Form 881' 00 Form 8828
10 llccIaI-..uy II1d t.4odlcoro lIlI OIl Up Incomo net ropottod 10 empley... A""eIl Form 4137
81 Till en qualJllod roII,,,,,,nl plans, Inckldlng IRAo, II roqulrod. attaell Form 8328 .
112 AdvInct .1mOd klccmo credll paymonla from Form W-2 .
113 Add """ 48 \Ivou h 82. Thll II ur total tax . . . . .
84 fadtrallnCClllllzufthheld.llaay Is from F1lrm(1) 1099. ClIlCk ~ 0
65 lH4 lI1maled lax pl)mlnts hlamcuntlPPled frcm 1m llturn .
III Eamtd Inooma mclt.1I roqlinld, al\aCh Schodult E1C (... Plga
27), NcnluIbiIIamod k1coml: IIllOlI1\ ~ I I I
34
Ent...
tho
laI1llt
01
your.
aa
aa
31
8lI
Ind type.. ...................................................
0.1.
ft'llOfVIll'/
Spouoo'I _hon
.sT'"
"-",,I~
l'ONlU" ,.
,m', name tOt ~ ~
., ..w-.mploywd) and
1M'"'
0011
(. vc.
;) 11"'" IrJ or>
L
F. ~~
Page 2
~~..'1'i
lIo,(f
:l5
8r~ )<0
38
37
1 >0
,og
:sa
3
40
l1'lo
.
~
045
4e 1105
47 ') 0)..
4e
48 '--
50
8 '5'0
112
113
,,).~1(,)
Prtplltr', IOQII Mew.t.,. no.
1~5' :YJ :'l8)~
\_.-
'1
''''~
-~
10:51
(01 lPI IE[, r IHFU:::
'SCHEDULIIS A&D
(Fonn 1(0)
lUll You
Paid
($H
pag' A.l.)
II
Int.rllt 10
You PaId 11
($H
pag. M.)
Mottl
Pmonal 12
Int.,."'a
not
deductible. 13
GlttI to
Charity
IfVOUmtCl.. 111
alft tnd got .
bentftt 101 n. 17
1M ptgt .w. 111
Cllu.lly Ind
Then Losm 111
Jab ExP'R'" 20
and MosI
alha,
MIIe.II.n.oul
D.duct/an.
($H
pagt A'S far
uptlI'UIO
G_h.....)
23
24
25
2Cl
Olhlf 27
MimI/annUl 28
a.ducllan.
Total
Itemized
Deducllon,
FF'Ol I 1-:::: 1'::-:.'~;::- ~~t;':.o
Schedule A-Itemized Deductions
Adcnin(;i's' itij.O'u' h' 8':'.:"":":" ':...:.. '0...:..:.. ':":"',
Hom. mortglg'J'l!~eallll~jo8tJ' rIPilJW!o you on Form 1093
Home mortglga~\.,Ji nOITePC/I\edloyo!f on Fonn 1093." paid
to \he pnOfl 'rom whom you bought the home, 168 page A-3
end thaw tIl., ptflOll'. ntmt, IdtnUfylng no., and address' ~
.................................................................
................................................................
................................................................
Polnta not r.porttd to you on Form 1098. See page A-3
for apeclal ruin. f!o ~<l. .;. ~ '1f1Jr-J. . . . . .
Inv.atm.ntlnlarnt. If requlrJa, allach Form 4952. (See
page A-3.) , . . , , . . . . . , . . . .
14 Add lines 10 tlll'o h 13. . . . . . . . . . .
111 GItIa by cash or check. "any ~Ift of $250 or more, see
page A-3 . .J.:t5..r, I')>.' ~ .l.-. -;.,.~. . . . .
Other lhen by cash or ch.ck. "any gift of $250 or mora,
saa pege A-3.11 over $500, you MUST allllch Form 8283
Carryover from prior year . . . . . . . . . .
Add lines 15 Ihl'Ou h 17. . . . . . . . .' . .
Cuua or \hsftloll!l(esl. Allach Form 4884. (Sea page A-4.1
Unralmburaed employ" expens..-/ob travel. union
dual. lob tducaUon. ele. " ruqulrtd, YOll MUST aUICh
Form 2t06 or 2106-EZ. (Sea PIg. A-S.) ~ ..............
.................................................................
21 ;.; 'p~'r~il~~';~~" :,' :...:"":...:. .:.......: ..:...:..:. ".
22 Other expeneat-lnvellmenl, lale deposit box, ate. List
type and amount ~...................t.....................
................................................................
12
13
, '\'1 e
r- .
OMI) No. 1545.0014
~@94
Art.ehmenl 07
&tqolllCt No.
y..,._ -UI1lV numbll
';00 l~" i "'ie.
5~~5"
~~ \ S'
H\'\ d'
..
Add IIn.. 20 through 22. . . . . . '" . . .
Enter amount Irom F1lI1l11040, line 32. 24
Multiply line 24 above by 296 (.02) . . . . . .. 25
Subtraclllne 25 'rom line 23. If line 25 Is molllthan line 23 entar .0- . . .
Moving .xptnllllncurrtd ba/o,,! 199~. Atloch Form 3903 or 31lO3.F. (See page A.5.1 . .
Oth.r-from list on pege A.S. Ustlype and amount ~ ..............................
29 la Form 1040, line 32, ovar $111,800 (over $55.900 II m.rrled filing leparately)?
NO. Your dtdUCIIon Is notllmlt.d. Add th. amounts In the far right column }
tor linea 4 through 28. AJao, entsr on Form lQ.40, line 34, the Ilrger or . ~
thll amount or your Ilendard d.ductlon.
YES. Your deducllon I1'Ill be limited. See a a A-S tor tho amounlto enter.
for P.parwork Rtductlon ACI NotIe.. _ Fonn 1~ In.truetlon.. Cot. No. II33lIX
(Schadulo B I. on back!
=- ~.=..... (1) .. AlIac" 10 Fonn 11140. .. 6<lt In.ltUctlon.lor SChedul.. A.oo 0 Form 1040).
Ntmt(.) IIlOWn on '""l1 1040
W. i,) eo,> J /l""<l (3. I v'"tW&-T"
M.dIOllI I Caution: Do nol Include oxp;lIlSllS relmbuffl1d orpsld byotherl.
end 1 Modlcal and dantal exponaSB (BOO pa a A'l). . . .
Dentll 2 Enltr amount trom Form 1040. lint 32 , 2
Expenee. 3 MultlplV IIna 2 above by 7.596 (.076). . . . . . .
4 Subtrect line 3 from IIno t. II line 3 IB mom than IIno 1 enter .0-
II Slat. Ind local Income tax'l . . . . . . . . .
II Re" ..lat. tax'l (I" p.ge A-2). . . . . . . .
7 Personal property taxll. . . . . . . . . . .
II Othar \axeB. Ualtypo and amount ~ ....................
SChadul. A (Form 1~111lD4
Ala If"'" 10401 '994
eme(IJ IftOWn on 'onn 1~, 00 not .,,1., n,fl\e ana aoc...1 HCuulV numl*' If lhawn on otllOf Nit.
1-\ f, .. (P"'Jl'Ar'''~ /'). JIi \J 1r11<Y"T"'
Schedule B-lntere6t and Dividend Income
NO~11l hIId ov.r $400 In lax.ble Intllllsr/ncome, mu.' aJiO complel. Pdrt /II.
1 Ust name of payer. If any Inlereslls from a aoller.lInanced mortgage and \he
buyer Uled the property al a perianal realdlll1co, see page D.l and lIatlhls
Intereatllrst, Also show that buyer's social secu~ty numbar and address ~
F'AlIV'IW 1fWJ( Gorl P1!:.1 ..............................................
.CltJiJ1O~'''' ..'';:..:.L.': :::"::::.: ::.:::: :................................... ...........
...................~.;:; .. jL&N"I)Lt
.......l-'ot, ..p.~..I/.I.I~~.......r.............................................
.I.-.......,...~"l r,{,.:
e Add lheamountaon line 5 . . . . . . . . . .
7 CIll<<a1 galn distributions. Ent.. hete and on Schedule O' . 7
8 NonlU&bl. diSlriblJlJons, (Ste the Inst, for FORn l00l0, line 9.1 e
" Add 11011 7 and 8 . . . . . . . . . . . .. ......
10 Subtract 1101 9 from IIna e. Enter the rasult here and on Form 1')40, 1101 9 . ~ 10 S-
." you do not nHd Schedul. 0 to repolf any other gell1$ or losses. antar your caplfal gain distributions on
Form 1040 line 13. Writa 'CGO' on the dort.d lirlll next fa IIrlII 13.
II you hid over $400 01 Interelt or dividendi OR had a foreign Iccount or were I grlntor of, or IItlllll18lOt
to, I foreign tru.t. you mull complete 11\1. part,
11a Alllny time during 1994, did you hive In Inlerlllln or a e'gnalura or othor euthOrity ovor I financial
account In a foreign country, luch as II benk account, I8cu~lIea account, or other flnanelal
account? Sae plge B.2 for eK~pllone Ind flllng requlremente for Form TO F 90.22.1 . . . ,
b If "V.S,' enter lhe name of the foreign country ~ .......................................................
12 Welfl you the grantor of, or tranaferor to, a foreign tru.t that existed during 1994, whelher or not
u heye an beneficial Intereat In It?1l .Yea' au ma have 10 file Form 3520 3520.A, or 926 .
:1 F~ Pepenvor1l RlducUon Act NotIc., ... Form 1040 InlINgUanl. @ ....... WI""- _ lIchadul. 0 (Fo"" 104011884
'112
!
i
iPart I
:Int.,.at
IncOme
(SOB
:pIOI115
lend B.l.1
Nalellf you
.-IY*I e Fonn
laoe-INT, Fonn
10000-otO. or
l\IbIutute
IIl1temant from
jllllokar'98 f\m1,
MIl tile ftrtn'.
, nema u tho
1 paytt' end ant.,
i the tOlellnterel1
! Ihown on \hI1
j form.
N_"you
rwoelved . Fonn
1099-01V Of
tubathute
8II\1m8111from
e broka..ge
ftm\, "I tho
ftmI'. name ..
the PBY* end
enter \he lDtaI
dMdendl
IhOWn on \IlaI
, fonn.
'I
Part III
" ForeIgn
, Accounta
, and
,'n'uata
, (Sea
page B-2.)
. '." " "10'. ,.~.. ....,._
OMa No, 1646.001' p_ 2
Your loe"" 1e<;lJri'f n~
~Q : 1(. : I('~('
AtttcntMnl
Stquonct No. 08
Amount
,\6'
~
/H,
............................................................................................
............................................................,...............................
............................................................................................
,
............................................................................................
.............................................................................................
............................................................................................
............................................................................................
.............................................................................................
..............................................................................................
.............................................................................................
............................................................................................
'\01
2 Add tl1e amounts on Iin.l . . . . . . . . . . . . . . . . .. 2
3 Excludabl.lnteresl on le~ee EE U,S. laving. bondlluuld eller lUB9from Form
e81S, IIn. 14. You MUST allach Form 66lS to Form 1040 . . . . . .. 3
4 S",btract IIna 3 from line 2. Enter the mlult hare and on Form 1040 Iina 60 ~ 4 ..
Note: If had 0"" S400 In to'" dlvld.nds and/or othlll' distributions on sfoe., musf else com I.le Par1/11.
Amount
8 Ult nama of peyer. Include gross dividends and/or other distributions on etock
hare. Any capitalualn dlst~butlons and nontaxable dlatrlbutJons will be deducted
on lines 7 and 8 ~ .~~$1-....~\~~...jt-ti~tr',...ft{...........
......................................................................,......................
o
')
'-'
............................................................................................
.............................................................................................
.............................................................................................
............................................................................................
.............................................................................................
5
.............................................................................................
............................................................................................
.............................................................................................
.............................................................................................
.............................................................................................
..
............................................................................................
............................................................................................
8
s
'"-
Supplemental Income and Loss
(From renlll' ...al .Ital., royoltlol, p.rtn....h/p.,
S corperaUonl, ea1alol, trulll, AEMIC., ole.)
~ Of "" fl'Maury Ailacfmtnt
....... -.. .-. · AlUloh 10 Fonn 1040 or Ponn I1W1. . a.. InOlnlotlono 'or 801Mdu~ E Form 1040 . -... No. 13
Nomo(oj -- on mum v__ ~ n_
p.,L~ F. l '-01'/1'+"<1 I}. JIfVt-'W'1' :lA... ~o. ; JI..! I4Y
Income or Lo.. From Alntsl Reol Eltsle end Aoyaltl.e Nole: R'POtllf1(;~ OIId '.<pfHlJef /tom your bu.Ir.... o( I8tIr/llf1
pots."O' propotty OIl Schoclul. C Or C.EZ I... f)lQ<I E.IJ R'{JOII (Inn ronl., Incomo or 10.. (rom Form 48J5 on POQ<l Z, lino 39,
~: 1 ':-~,::-, I U; '~-,.:
,
SCHEDULE E
(Form 104C)
'_'.'111 11l.1' IIHILL_
, t~ 1)/1 1 1 _' _'..:<1:';_ _~~~:i'u
P. .:.
OMll No. 1645-0010
~@94
1 Show th. kind end localion 0' each rentsl reel eetal. propei1V;
A ................................................................................
A
3
<4
5
6
7
8
9
10
"
12
13
14
15
18
17
2 For each (.nlal real eSlate
property listed on line 1, did you
or )lOur family use II for personal
PUl'pOhD for more IhlUllh.
groater of 14 daya or 10'" 0' tho 1_
total day. lenled al 'elr rental I B
valu. dun"llthe I4lc yeer? (See
""ge e.1.) 'e
Propertlol
B
v.. ~
8 ................................................................................
A
o ................................................................................
111 Add lines II through 18 . III
20 Depreelatlon expense or deple1Jon
(lOll pig. E.2).. " 20
21 Totll expon,... Add lines 19 and 20 21
22 Income 01 Ooss) from renlel real
..tete 01 royalty Properllel.
Subtract line 21 'rom line 3 (,enle)
or line 4 (royalties). I' the leeun Is
a 0011I). see page e'2 10 find OUI
il you m~1 file Form lUllS. " 22
23 Deductible "ntal leal eellle loss.
CIUllon: Your renl81 resl eSlete
1011 on line 22 may be limited. See
Pllge E-3 10 find out If you musl
file Form 86Il2. Roal ests'e
proleSl/onel~ mu~1 completa line .. \ )
42 on PIIg. 2 ...
24 Income. Add polltlve amounts ahown on line 22. Do notlncludo any 10ss.a . .
25 Lo..... Add roYllltylonel from lino 22 .1Id renlllr.el "r.I. losses from lin. 23. Enlo, the lotallo..... ho,e .
28 TOlal ronlal real eslOlo and royalty Income 0' (less). Combine IIn.s 24 and 25. Enlor tho 'osult here,
If Paris II, III, IV, ond line 39 on pogo 2 do nol apply 10 you. also onlorthls amount on FOlm 1040,
line 17. Olherwl.. Includo Ihls amounl'n tho 10101 on IIn. 40 on nono 2 , . . . . . . . .
n Fa; P,porworll Roduc:tJon Act NoUco, He Fann 11)40 In.lnJcUOtIt.
Income:
3 Rent. received .
<4 Rovallles AlCelved
Expen".1
II Advertlllng.. " .
II Auto and lravel (aee page e'2)
7 CI.enlng and maintenance. .
8 Commissions
D Insullnce. .
10 Legal and oth.r pro'osslonal '88S
11 Managem.nt feoo. . .
12 Mortgago Interost paId 10 banks,
ele. (SOl plge e'2)
1:.1 Olher Intoresl . . .
14 Repelre .
15 SUppila..
18 Taxes.
17 UlIlIUn
18 Other 0/11) ~........................
.......................................
.......................................
.......................................
c
TOI8I,
lA4<l COlumns A, I, ond 0,)
3 I
4
12
18
III
20
24
25 (
28
" I:" IfIlL! I I JI If I I
f f. 1"1/ 1 1 --.: 1 l .' ; - .~, . -' 1.1
f, '.
"u.cnINn1 U......tnClI No, 13 ".0. 2
Scn_ E (F'."" 10401IUU. ~ ~.
NIml(IJ .hown on relum. 00 nol .nlet n&lT\lI and social IOClJfl1v n1Jmbof If lnown on at"., IItM Your lode! lKU~tr numbet'
p~ t..l f, ~ CA-"J"rIY'CJ il frlv"'ll)"'r d-" <) !~t..! Il. 'l (,
Note: If you report .mbunts from Isrming or fishing Qn SchfKfu/o E, you must onter your gross income Irom lhose BCl/vities on lino
41 belo\\'. Real eslato profess/onms musl complota line 42 bOloI!'.
II/lIIIB Incom. or La.. From Partnership I and S Corporatlona No:.. /I)'OU mpotta /0$.1 (",",lo,ar.risk Ie/lvl/)', )'OU MUST chock
elthor column I.) 0( /fl 01 Jno 27 r. do.CIlbt your Inv..''''''''''' the a:rMty. SIte pig. E.4, /I you cMck _II), )'OU musr atlKh form IJlllIl.
(bJ Ent<< P fot (oj Chock d ld! Emplol'O' ' n1nI.ot AI RI,l!
\.114mo potIn...n'p; a Iottlgn Idtnllllcollon ('1 ~. I. 6""" It
lor S lion partn.l'1h numlMt .. rtlk nol at rt.k
')'\.~8 O,~
- . '1)'17
"-'
aT
c,.H'IA'i' t.
J\lVIrU4"'r
rPLL
I~
P..alve Income and LOll
181 P...,,,, loa - (hi PONiYo_
It- "',m _ W rtq\IIrtdl from _ K-I
Non
aaalve Income and LOla
UIC<<:flotll11lox_
doduc1lon
from orm .512
N NonpoU"" Incomo
rmm lIoIMduI. tc-I
,
(IJ NonpuaJ" ....
fltltl1 1Idlt</UI. K.I
211. Totals
b Totals
211 Add columns (h) and (k) of line 28a . . . . . . . . . . . . . . . . .
30 Add columns (g), ~), and Ol of line 28b. . . . . . . . . . . . . . , .
31 Total partnership and S corporlllon Income or Poss). Combine lines 29 and 30. Enter the resull
here and Include In the tOlal on line 40 below ,....,.,...... . 31
Incom. or Loa. From Estate. ond lhlats
folNtme
8i~'11
,
0>1 EIl'9Ioyot
lcltntJf1<I1""...mbor
'-
P.a.lve Income and Loaa
101 P...I... OtclUOlJon Of.... 01_ ldl PIdSM "-'"
lonach ,..... _ WIwquitodJ from _ K.I
N lalV.
('1 DtG<Icllon ",1?0o
"0m IcM6us. 1(..1
Income .nd La..
III 01.... Iloomo from
_It-I
134
135
,
t~
,
Addcolumns(d)and(~ollln.33a. . . . . . . . . . . . . . . . . . . . .
Addcolumns(C)and(e)olllna33b. . . . . . . . . . . . . . '. . . . . . .
Tolll estate and ttuatlncome or ~OGs), Combine lines 34 and 35. Entel the mull hate and Include
In the 10111 on line 40 below . , .
Incomo or Lon From Reol Eatale Mort ~ elnve8t;"~nt'Conduila' REMICe
\Ill Emplojot 1.1 e."'..Inc....... "om (dl T.._ n.omo Inolloosl
(al Namt 6dtntlflClhon I\Unbtf loMdul" Q'i:: 2c (II'M from ktr..dr.IeH Q, Int 1b
:IS
oaldual Holder
(e) tncome 'rom 1oMctuM, Q,
Int 3b
37
~ Combine columns and eon, Enler the resull herB and Include In tho lotal on line 40 below 38
Summa
3D Net farm rental Income 01 Ooss) from Fonn 4835. Also. complete line 4 t below. . . . . .
40 TOTA1.lncome or Ooas). Combine hnes 26, 31, 30, 36, GJ1d 39. Enler thttesull here and on Form 1040 lne 17 ~
41 Reconciliation of Farming and Flahlng Income. Entel your groet
farming and fishing Income repol1ed on Form 4835, line 7; Schedule
K.l (Form 1065), line 15b: Schedule K.I (Form 11205), line 23; and
Schedule K,'1 (Form 1041),lInl 13 (see page E."). . . . . . , 41
42 Reconciliation for Re.1 Eatate Profestlon.la.lf you were a ,eal eSlato
proteulonal (see pege E.3). enter the net Income or (loss) you reported
anywhere on Form 1040 Irom all ronlal real estate acllvllles In whiCh
eu malerlsl arUcl .ted undor the ...Ive oellvlt loss rulos. . . 42
"'-
An""",,-. s.qy""," No. 17
Socl4l .o<:u,ily number 01 """""
whh ..II-emp!ol'fll""' Income ~ .;l 0':> i %! n'11.
Not.: If your only Incom. ,ublacl to ,a"-amp/oymonllax /3 church amploy.. incoma. sIl1p I/nu 7 through 4b. Ent.r .0-
en I/M 4c and go 10 I/nII 5IJ. Income lrom 3arvl"s you pedormlKl II . mln/llar or e mumb/lr of I rel/plou, ordllr II nol
church .mployee Incom.. S.. plpa SE.I.
II II you are a minis tar. mambal 01 a rallglous ardor. or Chris,:an Scl.nc. praClition.r .nd you filed Form 4381. but you 0
had $400 or mora 01 other nat earnings lrom self-employment. check here and continue wilh Part I. . . . . . ~
1 N.I farm profit or Qon) lrom Sch.dule F. line 36. and 111m partnership., Schadul. K.l (Form
lOllS), IIna 168. Now: Skip Ihls I/n." you U3. Ihe farm optional melhod. SIt page SE-3 , .
2 Net prolil or Q05$) lrom Schedul. 0, line 31; Schedule C.E2. IIn. 3: and Schedule K'I (Form
loeS). line ISa (olher than lermlng). Mlnl3teMl end membeMl of rellglou. Old." Me page Se-l
'0' amount. to report on IN. line, 6.. p.ge SE-2 for other Incoma 10 report. NOle: Skip Ihl3 1/n.
If you U3e the nonlum optfonal melhod. SM pege SE-3. . . . . . . . . . . . . .
.3 Combine Iin.. 1 and 2. . . . . . . . . . , . . . . . . . . . . . . . .
4e II line 3 Ie more than zero, multiply IIna 3 by 92.35% (.9235). Othelwl3e, enter amount lrom line 3
b II you elected one Of both of tho optional methods, Inter the tOlel 01 IInee 15 and 17 here. .
o Combine lines 4. and 4b. It leu than $400, do not file thI. schedule; you do nol owe selt.employment
tax. ExcepUon. II ltas than $400 and you had e~ureh employee Income, enter -0- and continue. ~ 40
51 Enler your church employee Incoma trom Form W.2. Cautlon: S..
pege SE. t for dennitlon of chun;h employee Income. . . . lSa
b Multiply line 5. by 92.~'16 (,9235). It Ie.. then $100, enler..(). . . . .
II Net .emlng. from ..1t-employmenL Add lin.. 40 and 5b . . . , .
7 Maximum amounl 01 combined wog.. and lell'employment eernlng. Subject 10 social seeur1ly
lax or the 8.296 port/on 01 the 7.85% rallro.d rellremanl (lI.r I) lilt lor 1994 .
8a Total eocl.1 eecurily weg.. and tip. (lotal 01 bo... 3 and 7 on Form(l)
W.2) and reJlroad retirement (lIer 1) ccmpellS8l1on. . . . . .. Sa
b Urveportod lips sUbJecI 10 aoclal securtty 18)( (Irom Form 4137, line 9) 8b
o Add lines 81 and 8b . . . . . . . . . . . . . . " '" . . , .
e SUbtract line 8e from line 7. It Zlro or leu, enler ..(). hire Ind on line 10 and go 10 line 11 . ~
10 MultIply th. .mllt., 01 Une 6 or line 9 by 12.4% (.124). . . . . . . . . .
11 MulUplyllnell by 2.096 (.029). . . . . . . . . . . . . . . . . . .
Nam. or potiOn With aelt.emplOyn1l11lllncom. (II 'hOwn on Fonn I~OJ
Ml.l F. fl/V1r :J(l.. .
&.oUon B-l.ong Schedul. SE
DIDII SeIf.Employmant TalC
2
3
4e
4b
~ 1.>'1 !f"
8c
g
10
"
12 Self-employment WK. Addllnel 10 and 11. Ent.r here and on Form 1040, IIno 47
1
'II>""
I
~ '\0
f'119~
""
60.600 00
"i1..1{
J' 1)..9'
~S'
~'l~1
'H~
13 Deduc\lon lor one-half of Mlf-emploV!ll.nt tax. Multiply lino 12 by
80% (.6). Ente, the result here and on Fonn 1040, line 25. . .. 3
DIIIIIII Optional Methode To FlIIU,.. Nat Earnlnge (5.. pago Se'2.)
Fenn Optional Method. You I1I8y UN t1tII method only If:
a Your grosl llI'Illlncome' w.. 1101 more thin $2,400, 0'
· Your grotelarm Income' was more thin $2,400 and your nel larm proflll' were less thin $1,733.
14 Maxlmumlneome/oroptlonllm.lhod. . , . . . . . . , . . . . . . . . " 4 1,600 00
111 Enter the amaH" 0/: two-third. ~) 01 OI'ON farm income' (not 'en then zero) or $1.800. Also,
Inelud. this emoum on line 4b above. . . . . . . . . . . . . . . . . . " 111
Nonfann Optioll8l Method. You mey use 1hI. method only /I:
o You, nil nonterm profite'were ",..than $1,733 and allO I... than 72.169% 01 your groll nontarm
Incoma." end
e You hid net earnlngl lrom lelf4l(pployment 01 atlel5l $400 In 2 olth. ptlor 3 ye.Ml.
'I. .
CluUon: You may III' th/, me/hod no mCllt Ihen we limes.
111 SUbtrlolllne 18 lrom IIno 14. . . . . . . . . . . . . . . . . . . . . " 111
17 Enter tho emlller 01: two.thlrds~) 01 groll nonterm Incom6'(nollelllluln zero) or tho emount
on line 16. Also. Include thle amounl on line 4b ebove . , . . . . . . . . . . .. 7
'From 5ch.dul. F. IIn. 11. and Sth.dull ..1 (Form 1065). Iln. 15b. 'From Sch.dull C, lin. 31: 6chldull C.El.IIn. 3: and Sch.dult K-l (Form 1065). Un. 1St.
'From Sch.dul. F. line 36. .nd SChedule K.l Form 1065), I/n. 15a. 'rrom Sthedul. C, Ilnl 7: Schedule C.El.llnt I: and Schedul. K.' Form 1065 . !Ine 15e.
@ ~... twrd<<i p..,
26
-
'.
:'1 . ':"_~, 11:1: '','",
<(II WI lEf' 111-,1" LL':
vr;I)I, I 1 _ '"" :-":1-":'1""
p ,~
,_ 4868
Application for Automatic Extension of Time
To F1le U.S. Individual Income Tax Return
OMe No. 160<5-01"
-"""-'
---
Y04It tlnl Ntnt anti II1I11al
~ f, .s\o\"~ :J/l.
.',,*,,__'tr"'_tnQ~
CDr'Jf4l"t.t. 1>, J~0t"^'f"
Horn, _ (nurnboI. ..-,1Ild 1jl4. no. Of nnl RlUIOj. " roo ho.. , P.O. boI. _Iho 1nolNel......
,S~ VI, fonfJl.i..'j iT.
CftV. _ ... pool _. oIIlt, Md ZIP ...,.
L.\1u. f;fJ, 10\
I requ..11Il .utamatla 4.rnonth exttnllon ot lime 10 AugUIl 15, 1995. 10 file Form 1040EZ. Form 1040A, or Form 10040 lor Ihf
OlIlendltyelt 1904 or 10 .10 , lor the lilC&l lwe year ending ,10
11IIII Inclly/dulllncoml TIII-YgU must compktle this part,
~@94
IMI.......
v__~_
..t... :1(.,! fl. ,t <-
...-'t........., _
'1"( ;,(.: , ')
PItIH
~
01'
Print
L.ul........
1 Tllllll tall lIabUIly for 1\l$4. Thll II lht emounl you elCjltcl 10 ant.r on Form 1040EZ.llne 9; Form
1040A, line 27; or Form 1040, line 03. If you I.peel WI emounllo be zero, enter -0.. . . .
CautlOlll You MUST 11I11' III .molInl 011 Nne 1 Of yow lKfelllion wUI be denied. You can est/mate
/his _nl, but be II ...act II you can wnh lhelnfOfmetlOll you 1181'1. If we laler Ond IIlaI )'llv,
Nflmale WII not ,"$OnabII. Ill. lXf.nlion wiU be nuU and void.
a Total pa)'lTllnlll for 1884. Thiele lI1e amounl you 0lCp1Cl to enter on Form 1040EZ, line 8; Form
104OA. line 28d; 0( Form 1040, line eo (excluding line 67). . . , , . . . . . . .. 2
3 BALANce DUE. Sublrlclllne 2 lrom lint 1. It line :I Is more Ihen line 1, enler .0-. It you are
making I paymenl, you mUSI ulllh. Form 4868-V althe bonom 01 page 3. For detalla on how '"l r. 7 ~
to PlY, Including whal to wrne on OUt' . tTl8nl. _ the Inlwellona . , . . . . . .":J 1 I
ImIJ alft or Oeneratlon.Sklpplng Trlnlfer lOST) Tax-COmplele Ihls port It you expecllo owe .,ther l4x.
;).$ 0 J1
J. L-l )'-J
4 II you or your apouH plan 10 Ille a glfll8JC ,.turn (Form 709 or 709.AJ lor 1994. } You"elt.. 0
generally due by AprIl 17, 1905, liD the instructions and check here . .. Spou.... 0
CautloN 00 not Include Income fI1X on /In" 6.1Ild 6b. See l11e Inswellons.
61 Ellter lI1e amounl 01 gill or Gsr III you lie paying with 1l1i1 torm. Also. you musl use Ilia Form
48e8.V althe bonom of page 3. . . . . . . . . . . . . . . . . . . . .. IlII
b EIIter Ihf IIllOUllI ot gift or GST lax your apou.. It paying with Ihls lorm. AI$O, you mUSI use
lheForm4S88.vallhebollomof ..3 . , . . . . . . . . . . . . . . .. lib
Signature and Verification
UncItt pontlUol o1l>1f1Ury, I _. tlIIll .... _""nod !Nt fonn, -.01"9 ~ _ .... t1a_,.. ond 10 "" _ 01 my _1Ild _.
8 111M, _Itld complttt: and, . P'1fM/Od by......... _Ihtn Iho Ia&pljOI, IlItII am """""""" \a .-- \lllo fonn.
~ V....&lgN'...
_~ "-",, 'ill"'", 1_ \hell IUort"l lloIe
It you want COlTlllpondanc:e regarding this extension 10 be lent to you al an address olhe, than that Ihown above or 10 an .genl
acting tor you, pl.... .ntar Ihe name of Ilia .g.nl and/or the address where II shOUld be lIe.,I.
N....
PI....
1\'Pe Numt>>t and au..' (""Iud' I4JIIt, room. Of apI. no.1 or P.O. bOx numbtt If mad" no1 0eI~ 10 It,", .041r...
or
Print CIIr, l4Wn Of pOOl Qff;ce. .talO, trod ZIP ccclI
L.
0.11
~ Spouw't 1l<gnO'.... . Nong ""IIy
0.11
Por P___lleduoUon Act N.~.., _ _ So
CI.. No. lJl'lW
F_ 4860 (1K<1
261
" .....-_..
Additional TaxGs Attributable to Qualified
Retirement Plana (Including IRA8), Annuities,
and Modified Endowment Contracts
__"... TrwNY (Und., hcUon. 72, 4813, ~IJ~, .nd ~8OOA 0111>. Inl.",.. A..."... COd.)
""""" ,.,..,..". lIMN ~ Attlch tD 'onn 1040. Sa. 1.pJ:,.t. InatruClUonL
_ oIlnclMduol 1WIK1 10 Iddl\lonll'u. (If Ill""'" 1~"'Il jaInI~. _ """,ClUon'.1
'0r'J1fjf"l a. J ijV~lI,r'1'
PIli In Your Add19uI Only ~ - --1- and .1tHO, Of P.O. be. ~ _Ix nol U.I_I<I 10 YI>I" ho....
ff Vou Anr 'IIIn" Thla ,).5). "', P'm r........,. ./'TM-ut"
Fonn bV IIllff and Not Clly, lown 0' POI' on~" 1111', IIIjt"ZIP ....
WIth Vour llIx Altum ~/l.I.'JL.1 I'~ no\,}
fOlm' 5329
OMe /10. 184$-(1203
~@94
Attaehm.nt
uonco No. 29
v... --11_
I' i 1b i 71~J
~'.no.
" IhI. II III1ltnandod
rllum. check hili . 0
If you are subJoct to the 10% till< on eBlly distributions only, see Who
MUlt 'lIe In the Inslructlons before conllnulng. You may be able 10
report thla tax directly on Form 1040 without filing Form 6329,
11IIII TIX on Earty DletrlbuUonl
compltra 1hI~ {WI If 1/ tlJlabll/ d/5ttlbuUon was made/rom your qualifl//{f retif/lment p/Ilrt (including en 1fl,4J, annuity controct. or
modln<<l Mdowmant contract bII/Ofl/ you reached age 6911I (or wa. Incorrectly Indiut<<l II such on your Form 1099.R-see
In5tJ1Jctlon5). Nora, You musllncluda the amount nl th. dlstrlbullon on II". ISb or 161> 0' Form 1040 or on the 'PProprll/te line of
Form 4972.
1 Early dlatrlbutlons Included In grosa Incoma (sso Instructloll5) . . . , . . . . . . . .
2 Dtst~butIonIll(c.pttd lrom additional tax (sol/Instructions). Entor appropriate oxcaptlon numbor
from IMlrucllc.ns ~ . . . . . . . , . .
1
Sou
2
3 Amount aubleet to additional tax. Subtract line 2 trom tine 1
3
151>.,
Tax dUI. Multi I line 3 10% .10. Enter here and on Fl>rm 1040. line 51. 4 5"1)
TIX on Exe... ContrlbuUone to Individual ReUrement AIr.noemente
Campllra /hIs part If, either In /his )'Nr or In ./lrll., YHfS; you contribut//{f mOl'/l to your IRA thIn Is or w1511/0WI/b1e and you havl/
an aKCeU contrlbu"on wblacllo tax.
II ElIcItS eont~bullons lor 1994 (see Instructions). Do not Include this amount on Form 1040, Ilna.
23aor 23b . . . . . . . . . . I . . . . . . . .. ... 'I . . .
II E.srIler year excess contrtbUtlone not previously ollmlnated (soe
IllItructtonl) I . I . . . . . . . . . . . . . . . .
II
7 Contribution credit. If your actual conl~butlon lor 1994 Is less than
your maximum allowable contribution, see InstructloM: othelWlsl/,
enter -0. . . . , t . t . . . . . . . . . . . . .
T
8 1994 dlstrtbutlons from your IRA account lhat are Includible In laxable
income. "" t..... I..........
8
9 1993 tax year excess contributions (n lII1)') withdrawn alll/r Ihl/ due
data ~ncludlng eXlenalons) 01 your 1993 Income tax return, and 1992
and eartlsr lax year 'XC'II cont~butlona withdrawn In 1994
II
10 Add linea 7, 8, end 9 . . . . . . . . . . . . . . .. 10
11 Adjusted ea~ler year excass contributions. Subtract IIno 10 from line 6. Enter tho resull, but not
lesslhan zero. . . . . . . . . . . . 11
12 Total excess contributions. Add lines 5 and 11 . 12
13 Tax dua. Entor tho smlller of 6% (.06) ot IIno 12 or 6% (.06) ollho valuo 01 you, IRA on Ihe
last da ot 1994. Also onler this amount on Form 1040. Iino 61 . . . . . . . . . .. 13
'0' P.pelWorl< Aod"cUon ACI NOIIeI, ... ""gl 1 or lIPI"tolnltrocllon.. ell. NCl. 1332110
,""" 5329 (In.)
263
COMMONWEALTH OF PENNSYlVANIA OIf1r:l.llUS[
. 1994 Rosldenllndlvfduallncomll Tax Relurn .
. o file" Yur fll., O'Olnnlno 100' "UHIITATUI: IC'''k 0"'1 DCCUrATIO.:
5 nSklgN 'fOUl OccuJUuon
Ending I99S '1\..0.,...., J ~alt/l'd, IllttU . Ioinl rth"n 1)-TT",vv".,
M MII'it(I,lllMg ItpalIII11
yoU'! .ocw. IICU"HY rw"'UI 1""'11" 1~'~lCu~l'I ~u"... T Cl JOWl! Cl.&lm for T&II 'Olgt..",.. SPOUtf', OuuPlllon
I \G. II ~'"i~ ''', -'i~ , n DtcIlUd. 011. of Ot.l"_ J7V'D/N'T
).OD 17'1 ,'- ;/$') "naJIIluu,
.... 'j 1t\lHW'-l' 1>1I/,1 ~.1I NW. lllll'll · ~~.. J 1',(1 ~ 1IE110fNCY UAJUI: IChtci Onty II A ',rt-'f'J' RUld.,U
. tIt!. d uu'J 4-"l P ,., p,. VII' R.......' "om "" ,.
"'" A~~ LoJ' r (J(1 Ftwr /'(. , IIit
~ 0 H.Ioll/ADORUI LAm OPTION
~\JI,L ft:t .~l. 1101') z,c.oo u CMO herlll 'lQI pald I '"'poIllt ancI you only Yfll1ll~ rlClIY. J nltTlf/lOcJfl1l
latllt nut Y"'.
I~A!.IIMi nWHOHi HUMBiR Of'IC,AL un
o ,All, "'" ~~~~' . ....,. II"",,,
.... *"..,,' 1m. 17n )J.'i'l.J'3,>;)
SCHOOl. Dl/}.R,lor .AloIllw'~, /VII ~ lIt<lmbo, II. 1Ii'11 ,
/Ls.IJw. ,;1./110 ~~CAII NOW...... fr I".
WOftKtlCO!A(1I IIACItID
I' O~OSS COMPENSATION...................................... .......................... ......... .. Lf(.;5 i Of '0Illl, W.~ .).
-
lb. UNRlIM8URSLD EIoIPlOVE DUSIHESS IXI'ENSn ........,........... .. .................10 , ., Scht<l('1 UE
'1l.,5 -
Ie. NET PA TAXAIllE COMPENSATION"............."...".. ...................................................... . .... ...."..... I.
I. TAXA8lE INTEREST ................~........................... ...... ...".......................................................... I .oJ ' ., ScOlol.) A -
n ' 01 S.h.o(.) B -
3. TAXAIlLE DIVlDE~DS. ...................................."..,............ ................. . ................,. ......... .......... 3 , 01 S.hl<l('1 C
8'6' '1) (. -
4- NET I~COME DR (lOSSI FRoM THE OPERATION OF A 8USINESS. PROFESSIDN DR FARM............... ............ , 01 S.h'd('1 RX.' __
I. NET lIAlN DR (lDSS) 'ROM THE SALE. EXCHAI/GE OP DISPOSITION OF PROPERTY ......... . . ................. ~ , ., Sc',ol'l , -
, 01 5<1Itd1') c-F -
SR. AIoIOUNT OF EXCLUSION FROM liNE 10 0' PA SCHEDULE PA.I9............ ...5. , 01 Se"o('1 0 -
(00 NOlI.cludt In Un. 8 '_1
8 NET INCOIolE DR IlOSS) 'ROM RENTS. ROVAlTIES. P4TENTS ANO COPYRIGHTS ............... ........ . ......."... 6 , of Selll<lls) [HI _
1. ESTATE AND TRUST ,.001011........................................ "................... . .................:................... 1 , ., Scn"(')19 -
e. lIAM811NO AHO lOmRY WINNINGS ........................................................ . ................. ... ....." 8 , 01 Sent"'1 E -
I. TOTAL PA TAXAOlE IHCOIolE fTolllll"" 'e ~. J. .. S. 8. '11108. DO NOT DEDUCT IlOSSESh .................9 '1')'1(,1 , 01 SCh""1 J -
10. TAX lIABILITY Muhlolv lln. 9 bu ~.1..1.0181............................................ . . . . . . . . . . . . .."..... ...... .....10 ~~(1
11. TOTAL PA INCOME TAXES W1THHElD............................. .................................................... ... ...... 11 \)1
II. ESTIMATED PAYMENTS AND CREDiTS
II, Of.lIIt'rom 19U PA Rllufn............................ ............. .....................l~. ..'
lIb 1994lnxllilnllnl P'jIlI..11 .................................... .......................... ..I~O :l.(.."
'.
12. P"m'n1 wllh 199. Rxqullllor fal...1on .................... ............................I~C
12d TOTAL PAYIoIENTS AND CREDiTS................. ............................................................................. 120 "l(,.."
13. TAX 'OROIVENESS FROM PA SCHEDULE SP
131 Dtptndlnll CUI""d from lint 1. Fan III of PA Sell..ult SP..........................13. ' ";1 "','
130 E~11lII11y Incom.'rom lint 3. Pan IV 01 PA Sch.dul. SP..............................13o "'." . ." ..
;" ;1.',:",
13e f.lltrxl Adius"d Otou In_ tflll11 lint 2. P.n 11I01 PA Sche<lult SP.............1Je
13d TAX fOROIVENESS FROM liNE 8. Pan IV 01 PA Sen..ult SP ...."...................................................... 130 , 01 Sclltd('1 SP -
14. TOTAL CUDIT 'O~ TAXES PAlO TO OTHER STATES OR COUNTRIES ......................................................... 14 , of Schl<ll') G -
IS. EIoIPlOYMENT INOENTlVE PAYMENTS CREOIT......................................"............................................ l~ , of 5<111<1(.) W -
11. lOTAL PAYMENTS ANO CREOITS IT.I,'llnos II. I~d. 1Jd. I. and 1~)........... ............................... ........ 18 ~1)1
IT. ".'. "'I Se. P.g. 3210f InlltllcllonSIOt PI,ing you, Ill< du.. II10ulhRn 51.00. no Plym.nlls requlred....................................17
HI. \1\1, :.I'j\,",U'.h '. ..".....",,,............................................,,,,,... ,..........". ..,.... .........." ."..,.,.. '" 18 1/'11 I"" I, tn.', '.
19a. Amaunt OilinG 1010 be REFUNDED ................................................................................................... ............19a
100. Amounl of lIn. 181001 CREDITED la YOUR 1995 ESTIMATED TAX ACCOUNT ................. ........... .................... ........ ..19b /IY
1ge. Amounl ollln. 18 la be IlONA TED 10 Ih. WilD RESOURCE CONSERVATlOII FUND ...~................ ..................... ............10<
IS.. Amounl ollln. 10 10 b. DONATED 1.lh. U.S. OLYMPIC COMMITTEE. PA DIVISION ............ ..... ........................ .. .... 19d
u.... ,.... .. ~. I _"latl \/Ill' ~"I~' W. lillii'll, Wtll'laf 1Kt..,_Jtllt 11M'., .114 ~1I1., .,..1. ~ IItM .. ., ,....w..... ...... It If.., nn"IIIlII UII......
...., INI.." t, s....,..,,~........NI.....,OIMIll'l..~.,..tIoUI,.IJI'IIDIltI'IIM...,...
1'.1.... "
)C
IN"" ...0I'llW'0t H""'fltl
,.
It . '"/~''''' ( '.0 pIllPy. " n~11 loQl'I It..." '" till I'll 11'lC1lo'll4l1
(s\
PUt J
COMMONWIALTH O' PINNSYLVANIA
Profit or (Lo..] from Bu.ln." or Prof...lon
(SOLE PROPRIETORSHIP)
9 ''1 Attach 10 form PA.40R, PA.40NR, PHS or PA.41
H...... ".."... " ..... .. lomI '..4011, PHDHft, fA'" II p~l,
",,1-1 f. j\.tv(r\llll'-f" :J7\..
A ... .........otlItl'I ~ fJ 4""'"
I ........ H_" J 4"....
~r s l'i1 .I1".......::r.: .
o ,_, ........ (...u'''' .\tMI1 -- -------- --------- -----------------
tIY.IlIlI'.' ZIf e...... ~"'I,.Il.l f" 11- ,
11I1ltM('1 ..... " ,.... ell.",. mtoIII'l:
1110 CMI (110.... .1...,,, lUlU! (110 0\Jl" (U Ill", ,",,' II,,,,,,,*,I
, ~I ......: 1'lo(CnII 1110 AomII (I) 0 0lM< (l,..uvl..-----------------..---------------..,- Y.. Ne
Q VIt. \IlIII ..., ....0111I .l\IIIlIII., ,.IIlUlloI, ct.1l1f ,....,... btIW". .pttkIQ 'N &11IIII-"'" .. . ..... .. .. ............................
d ""',n __ pPI....
"OW ....lICI........"'...IIcI..""'-'...............
*'
SCHEDULE C
P' DlPlJlllliNr D' l\i'/(N.i
:,,...,, " ..""" ..
...... -'Y ....., II "'.-
,.~\) '} (, ""'it
l-l-tA'l J/,A-VILI./
e h.'l'" .....1lUIIOO ..aMI
, . IIMI ~....".. ,......... to II' ..... ,.. ,..... ..0.. .... ", ...... 1.
.1ItU/1I............ .............................................. "
. II"""' (11lbll1lCl ... " lrtII III 1')" .......... .., .... . ...... ...... .. ..... .. ..... .. .. .. .., ........ .. ....
I CtIlII .....1IId .."" ,''''" IScl\I'.1I tol, Ill. II............ ..........................................
J ..... .... (.,.". ... 11rIlI'" II).......... .. . ..... . . ...... . ..... ...... ... .... .. .............. .. .,....
A ClIMl- (.\11III ."....111 \MIl" _" h. -" ~.bII, III..... cMlkIIt _Ill. ~r.:!. .I.~~":l.l'f(..
'" _ ...... _II.. ~ loCIll4' _ II .,.,-. ....... III I.~ IIIklItI.
I hlll- ....." J u4 4 .................................. ...... ...................... ...... .....
I "' ..bt. lrtII ..... ""Mea' ............
. ....."If9t..........,...........,......
11 Car....M. llpo.................... .....
\I C..IIb..... ............................
II DI'I.IIU............. ............~ ......
11 DlpIICiIIIM 1..,ill. II Itllfd... e.11 . . . . ,. , .
II _.11II""""" .....................
II ......,. oeMIIl ,ltOI'... II." m.. '" UlllII
II '1tIt1ll (ntI Iaclud.... kIltdWi e.II .......
17 '11\611I". 10' ,Ot .... ."" ..... .... ,.....
II 1_" II ,....." '".1ItN.... ........,..
\llI...ry'DHINDIII . ............... .....
IQ lIItllll' '''ltn..... 11..1<0.. .. .. .. .. .. .. .
11 O1lIIlI.~,,\lII....'"''''''''''''''''''''
II ...... ... ,na",''',", ,1... lor ,11I,,",,, . .
11 ...11.............. .....................
I' ~..II. ...11M" '''"Ily........ ~.. .......
11 RI....................................
II ..,pIIo' 'oil "'dud.." Ichld.1I CoIl......
IT T.... ..................................
I' TtiIJMM............:...... ...........
It Tr",I..d .nltr1tlllm..,...................
10 UIIlIIiI.........:........................
33 TlIII d.dUCI"ftI .dd "...nll I. tI,.m..lar IInl1l1h"" h n. ................. ....,.... ~.............
SA Nil ,..Ill " llOnll"b\Itc1 ilIlI ~ 111m In. II. 1J\1II "III "" .1Id ... 1M ."n,,,,III.. .1 yoll "". PA-AGI, '~DNR,
''--15 " 'A..U. If . net 'loll "."'." tntI' the '''lYnlin bnd.It'''' .r rttufl.. .. " " . .. . . ... . . . .. ... . , . . .. .. .. ' .
.. .
. MYor1IIlAt II II.. .....' ........ ..... .....
7~.............................
~" ,
"0<.
).01.1
110 W.,..
'1A;IoyI/\lIGI-
,.,..., eMII
m ...I'IIWICI'" '" ....
... 1111
II lIIlllf tJJIlIlII (.pociIJ1:
.. ~~c.------------
b___________________
''J)7
'II
c __________________
16l
~-------------------
-. --.--- ---
e_____________------
f ___________________
o
1-------------------
h_____~_____________
/1
I ___________________
/),0
I ------------------
k________________---
I ___________________
,
o $;
~ ------------------
It ___________________
. -------------------
Ir1
p -------------------
.. -----------------
') 0>
H(S'
r __________________
. -------------------
33
)5'1
81' '\.., "
..34
.:;1.,,:. '.:0":'.::(.- ~.!;:I':'L1
10 COH,n-nll, "'''UOf 01 flUHO. THI: "'....,u.. co,., twtr.. YAuu.UI
or lit. 8UAUU fO HAYI YOUft COllY VAIJOA'1!D " N.4JL., ftlflMN aDrN"
tlU"UU', AND "'.'AU"'I CO'III "LOtlQ wrYH AI In. '-00"1."
IYIMHQ lItVt.LOH.
":CI'-IF/IU' Il'll LE'''=':.
f.f"lJlll
KAHOWf..ST.. SUil& .02
tS~~,'PA Jl0JJ~3J3d
{]@94
LOCAL EARNED INCOME
TAX RETURN (FORM 531)
SEE BACK OF RETtJRN FOR
PHONE NUMIll!R AND OFFICE HOURS
JSnA/lD AIm Wlr!; MA Y UOTII'fllE ON' TllI~ fORM. HOWEVER. TAX CALCULATION~ MUST DE'
DilleD IN tifPAHATE COLUt.1NS, JOINT FILING (. u, COMDINING IN COM": ETC,) IS NOT PERMITTED,'
~.. \. , . .'. ,
:w-a,EA.R.HfNGS (Ffa.m-atllched W-Q'I) ...... ........ .............. ......... ........;... i. ..........
EMPLOYEE SUSINESS EXPENSES (AttIChF'dmI F~rm2106&Sllt. Schedulo UE.,)........,........ 2
rAXA8LEW'2~/NaS(SUb1rac1Un'2fiomUn")....., ,',..."....,.........,...."...",... 3
::lTHER TAXAllLE EARNED INCOME (NO INTEREST OR DIVIDENDS) ('.qmpleto SectJon 0 on Back. , . . .. 4
TOTAL TAXAOLEEARNED/;COME (Add Unt! 3 and 4) ,......"...,............., ."..,;,........ 5
NeT LOSS FROM BlJS/N~ROFESSION, OR FARM (USE LINE 8 FOR ANY NET PROFITSI, . . . . . . . . 6
SUBTOTAL (SJ!bCt.ct Un, 8 from Une 5) IF LESS THAN ZERO, ENTER ZERO.,. . , ....., .. .... .. '" .. 7
VET PROFIT FROM BUSINEBB, PROFESSION, OR FARM (USE LINE 8 FOR ANV NET lOSSES) . . , . . . " 8
IOTAL TAXAllLE EARNED INCOME AND NET PROFITS (Add Uno. 7 end B) . . , . . . . . . . . . , . . . . . . . . . . ., g
fAX lIABILITY: 1% OF LINE 9 (Mull/ply Una 9 by .01). . , ......... . ......... . . ......... . ..... '.... 10
'oTAl LOCAL INCOME TAXES WITHHELD (From attached W.2's, Oox 21). ..... . ...., ..... ..". ..,.. 11
lUARTERLY PAYMEI-lTS ANDJOR lAST\'EAA'S OVERPAVMENTCREOITEO TO THIS YEAR... ... .... 12
I
~EOITS FOR'rAXES PAID TO PHILADELPHIA AND/OR STATES OTHER THAN PA (ATTACH SCH. G),. 13
i '
pTALWITHHOLDINQS& PAYMENTS (AddUntt11, lhnd 13).......,.......................... 14
iuC BAlANCE DUe' (s';bii.CI line '14 irOn, Uno 10) PAYMENT NOT NECESsARV IF Lf5:l THAN $1.00.,. 15
,
ncREST& PENALTY(See'nallUCllonS).............................,......,... :......"..... 18
,
,
)TAL BALAN,CE OUE (Add U_ 15 and le) Mallo chICk !)iyablllo 'CTCB' . . . . . . . .. . . . .. . . .. , . . . '" 17
rERPAVMENT(SubnclUn.,0from Line 14)1FLESS THAN ZERO. ENTER ZERO .................. 18
: PAYMENT TO BE REFUNOEO ...............................,.................,..",..... lQ
'.
OVERPAVMENTTO BE CREDITEO TO NEXT YEAR'S TAX ,.,.....,................,.......... 20
'OVERPAVMENTTO BE CREDITED TO SPOUSE'S BALANCE DUE FOR THIS FILING yEAR.......,. 21
TAX omc!
lI6E ONlV
r. .l.-'
;....
.
. A
.
. E
200 36 U"6
YV1$r
" ,
.,
I,
11C.1'" '; '.
... I ,
t~o.{1(. I ' ,
)\il:1 ',;
I
I
':l}."
,~
J .,
. ,
",
".,
~ \1'.!
I
I
"Iifq:.
..J, ,.
"
.
~.
.'.....1
/.,
"1")\, I
11 I'
'Ill
I
I..
/i
.... r'1,.~
.... . '. ',1..,
'.
.',
.. ..... . ... ~1'. "... 4 _. .-.\,~
,". ...... .,". .:: I!. .
I".....
,,:;',
.~. .'
',':.1,' __
.:::<~: ; :~
,I: :'
. "':"
:."f
......
f ': ~ .
'1', .
"II ("
I'
"
. It: l't!:,~ .
. '" ~, .
,...
,'. .
,..,
. ,
"""!C:;'\J'l'+,;..
:1.":-1c), ... ~ .:.f
.:.:.,.~:..t~.~
.' .
I."~ i.,. :' ~~:.
..: .! ....
C1BYCDJ80" CAII..Rl,~fJ~,;.~ .COOI
. . " . ,'~ .',' ~ ,
VOUA/WE
ClAST. ,I\5T, UlJ
"
8l'OU5i'8 _
(lAS1.'IMT....,
lYIo'AQI; Tl<1 r-1 yes'
...."AX PtliNq""", ", . .._J.:wI... ......'.... .....
101(I. 0 1<0
. 'lt8. COMPLETE """E
I!CT1OH.A'CON.,.., ....-. ADOACII"
"lvt"SlOFTHIG~. ,
r._,..
. "
~@93
o...wtmefl' 01 lha h...ury-I",.,llal "''l/enue s.....k:.
U.S. Indlvlduollncomo Tax Roturn
Few lM y'II/ J.". '~Oec. 31. 19'93. Of olhet Il.llyPI btQkvllng
YOUI finl name and 1011I" UsI namo
Filing Slatus
(See pogo 12.)
;heck only
)fl' box.
Exempllons
(See pooo 13.)
II mo,o Ihan 01.
dopond"",",
"0 pogo 14.
Incomo
At10ch
Copy 0 01 your
Fonn. W-2,
W-20. ond
1099.R ho...
II you did not
gol a W-2, aee
pogo 10.
" you ..0
allochlng 0
chock 01 money
ptdOl, put lIon
lop 01 any
Forms W.2.
W-2G, 01
1099.A.
Adjustments
to Income
(See pogo 20.)
L
A
I
I
L
(5) IUS UM CX*t Do r.ol Wflll or tl.p. on II.. "'..
, 11m. ondlnO ' 19 OMO No. IMH074
You' .ocl.1 ..cutlty numb.,
.loa :)(,. ; I(,~t.
Spou.... loclll..curlty numb.r
11't i"'C. :115'
For Prlvlcy Act Ind
Pap.rwork RoducUon
Acl Nolie., I.. p.g. 4.
v.. No Nol.: ChtcAlI1g ~y,s.
w.u not c~"oe 'fOUl
',if 01 ,,"due. yOOf
'olund.
174.36.7153
B SHUGHART JR
26
5P
,--
Slnglo
Momed nllng lolnt 'alum (even II only one hod Income)
Manlod IiIIng sopatala 'olum. Enl.. IpaulO'S soclalltCUflty no. above and lull name hero. ~
Head 01 houa.hold (with qualifying porson). (See pogo 13.) IIlho qualllylng po~n Is 0 child bul nol YOU' dependenl.
wter thIs child', name harD. ... .
5 Quail In widower with do enl child oer a .. died ~ 10 . See e
tlII @ Voursell. II your por""IIOl aomeono elle) can claim you a. a dependenl on his 01 he< lilX
relum, do not check box 61. But be sure 10 chock the boll on line 3Jb on pago 2
b UM....... . . . . . . . . .
c o'JMndlnts: It I Ched 13) 1110' 1 or older. 141 Of:pendent'S
11) Name llitlt. InlllJl, Ind lul Nme) ll,u~:f d,pendln~~~~I:1 securilY "111~~hjP 10
/JfVM JllvG-ll~I\.:r ,1.0, !S4 !'i~l> OAvrrllTlA-
XF 200.36. 1646
OALE F & CONSTANCE
252 W POMFRET ST
CARLISLE PA 17013.2622
Api no
.abal
lee
IIlr\1Ci1OO1
" pogo 12.)
JH \1lIIRS
abol, H
lIhOtWt.O, K
,I.as, prin' : City. town at posl olliee, "'I~ and ZIP cod.. If)'O'J h.a...a I loreiQn .ddutU, see paOD 'l
"typo. (AtLl-IJLL If! 01
"lIldlnllal
"acllon Campaign lit..
See 12.) r
1
2
3
4
Do you wanl S3 10 go 10 Ihl. fund? . .
II I nt ",Ium, doe. our spouae wonl S3 10 go 10 Ihls lund? .
IS) No 01 months
kwdiA)'OUI
home in t99]
I
d II your child dldn'lllvs wilh you bulls ,~Imed II your drpcndenl undsr a prs.lg8S agletm.nl, the<:k "'" ~ 0
. Tolal number 01 exem tlons claImed . . , .
7
tlII
b
9
10
11
12
13
14
15
ltl11
171
18
19
20
21.
22
23
248
b
25
28
27
28
211
30
31
Wages, ..laMo., tip., ole. ","och Forml') W-2
Taxabl.lnlere.tlncomo (aee pOO. 16). Anoch Schedulo B II ovor $400
Tu...ompllnlOl1l.1 (a.. page 17). OON'T Include Ool IIno Sa 8b
DIvidend Incom.. An.ch Schedulo B II over $400 . . . .
Tuablo ,olunds, credit., 01 oll.et. of .Ialo ond lecallncomo laxea (s.. pOOo 17)
Alimony recolved. . . . . . . . ,
Suslno.. Incomo or ~o..). Anoch Schedulo C 01 C.EZ . . .
Capilli oeln 0' ~o..). ","ach Schedule 0 . , . . . , .
Copllol geln dl.lrlbullona not reported on IInol3 (s.. pogol7j
0Ih0r geln. or ~o..os). Anach Fonn 4707. , . . . . . . . . . . . .
TotalIRAdl.IMbullon.. ~ ;j.....D U bTuablearnountls..pagoI8)
Tolal pensions and annuities l.rr!.L U b Texabla amoool (see page 18)
Rental real ..talo. royaltl.., partnfltShlp.. 5 corporations. IlIlals, ole. Anoch Schedulo E
Farm Incomo or ~oss). Allach Schedule F . . . . .
Unemploymonl compensallon (.... p.ge 10) . . . . . . . . . . . . .
Social eecuMIy b""oPls I 210 I I I b Texable amount (... pago 10)
Olher Incoma. Ua! typo and arnounl-l8O page 20 .~:~.!~~.1:.~!r..~.~~.~~)i':'...
Add Iho amounlaln Ih.lor hI column'OI IIMS 7 thro h 22. Thlala our to"llnco"", ~
VOUIlRA deducllon (_ pogo 20) . . 240
Spousa'. IRA deduction (.ee pago 20). . . .. 24b
One-hall 01 eoll-omploymont lilX (... pego 21) 25
Sell-omployed heallh Inau..nco deduction (s.. pogo 22) 28
Keogh ,etl",mont plan end sol'.employed SEP deduction 27
Penally on eerty wllhdrawal 01 ..vlngs, . . . ., 20
AIrnony paid. Reclplenl" SSN ~ I I 29
Add lines 240 thro h 29, Those are ur total ad uatmentt: . . ....
SubtnlC111nD 30 from IIna 23. This Is your ~Iu.ltd gro.. Income. II 'his amount Is 10" than
$23,050 ."d I child lived with )'011. ... pal1" fIC.' to nnd 00'11 )'OU can cl.lm I,", "Eamad
lncomeCmdWOIlllno58 . ., ' . . . . , ....
'-\~Y.I
6000
Ca1. No. 113lOD
N,. '.'''11
,bllkd ....
Inll"
"I..f,..,
'1'I1I'rt... h
w..o:
.1""..IIlI.... -L
. 1I1d.'III" .11lI
ftll ... ~.
.-"
",lrtUH('"
,.,.1"
D"III4.oII .. k
not Imar" .bhl_
Md 11m""
Inl.,1I 01
IInll ,bDY' ..
4')..
)o;l.
;}.....
1
9
10
11
12
13
14
18
16b
17b
IS
19
20
21b
22
23
s'\
).000
'11..0'1
1'1
'1'1010
30
\~(,,'t I
\i''' 'I.,
Fonn 1040 (1993)
31
F"";'\0040I'83)
Tax
Compu-
tation
(See pOD.
23.)
35
38
II Vou wanl 37
tho IRS 10 38
1I0ur. yo"'
tax. lItO
POD. 24. 3a
40
Credits 41
42
~Soo paoo 43
5.) 44
Other
Taxes
Payments
Allach
Form. W'2.
W.2GI. and
1099'H on
Ih. 'ront.
80
Refund or 61
Amount 62
You Owe 03
1I4
65
Sign
Here ~
Koop . copv
of this return
for \'OUI ~
fecord..
Paid
Preparer's
Use Only
32 Amounl 'rom line 31 (adJu.lod ora.. Incorno) . . . . . . . . . . . .
331 Check II: 0 You w.r. 65 01 oldot. 0 Dlind; 0 8pou.o wa. 65 01 oldot. 0 Blind.
Add the number 0' boxes chocked obove and enter Ihe tolal here. .. ... 33.
b II \'OUI p.ronl(OI .omeono .1..) can claim Vou a. a d.pendonl. check hot. . . 33b
o II you ar. mantod 1I11n0 .oparal.1y and vour .pou.. lIomlu. doducllon. 0'
you ..a . dual..lalu. all.n. .ee p.g. 24 and check hare. . . . . . .. 330 0
Ilomlled deducllon. from Schedul. A. IIn. 26. OR
Slondatd cMducllon .hown b.low 101 vou, filing .1.lu.. Dut II you checked
.ny box on line 331 or b, go 10 pag. 24 10 find you, .Iond.rd deducllon.
II you checked box 330, your .Iondard doducllon I. UIO.
o SIngI.-$3.7oo 0 Head of hous.hold-$5.45O
o Mon1ed 0I1ng jolnlly 01 OtJalllylng wldow:.r)-$8.2oo
o ManIed nllng .opa,al.ty-$3.1oo
Sublrecllln.34fromlln.32. . . . . . . . . . . . . . . . . . .
IIlin. 32 I. 181.350 o. I.... mulllply 12.350 by th.lolal numb.r 0' ...mpllon. claimed on
line 80. IIlin. 31" over 181,380, a.. the work.heet on pOOl 25 for Iha amounllo 8Illar .
T..abla Income. Sublreclllna 36 'rom IIn. 35. IIl1n. 36 I. more Ihan IIn. 35, .nl.. -0- .
T... Check II from .lI(l T.. Tabl.. bOT.. Ral. Schodul... 00 Schedula 0 Tox Work-
.heet.OI dOForm 8615 (... p.g. 25). Amounl from Fo'JT1(') 9614 ~ 0 I
Addlllon.1 I.... (.ee p.g. 251. Ch.ck II 'rom 0 0 Form 4070 b 0 Form 4072
Addlin..38end39 ......... ....
34
Enl.r
Ih.
largo.
of
your.
41
42
43
45
46
47
48
4a
50
61
62
53
1I4
OS
50
67
58a
b
6a
Cradll 101 child and d.pendenl Clt' expen..s. Allach Form 2441
Crodlt fOl the .Id.rty OIlh. dl..bl.d. AIIoch Schodul. A . .
Forolgn I.. crodll. AII.ch Form 1116 . . . . . . .
Oth.r credlls (see pOOl 26). Check II from a 0 Form 3600
b 0 Form 6396 0 0 Form 6801 d 0 Form (.peclly) _ 44
Add IIn.. 41 Ihrough 44 . .'. . . . . . . . .
Sublracllln. 45 f,om IIn. 40. IIl1n. 45 I. mar. Ihon IIna 40. .nlo. -0- .
S.II..mploymenll... An.ch Schodula SE. AI.o. SOl IIn. 25. . . .
Alternative minimum tax. Attach Form 6251 . . . . . . . . . . . . . ,
Aocsplure 1....(... pogo 26). Chock II Irom .0 Form 4255 b 0 Fonn 8611 cO Form 6828
Soclsl .ocurtly and Modic... t.. on lip Incom. nol l.por1od 10 emplov", Anoch Form 4137
T.. on quallnod r.llr.menl pion.. Including IRAs. II ,oqulrod. allach Form 5320 .
Adv.nc. .amod Incom. crodlt paymanl. 'rom Form W.2 .
Add 11n.. 46 throu h 52. This I. our 101011.. . . . . .
Fedmllncoms we wllhheld. II anv Islrom FOlmls) \099. check ~ lfJ
1993 ..limalad t.. paymenls and amoonl applied lroml992 r.lum .
E.med Income credlL Allach Schodula EIC . . . . .
Amounl paid wilh Fa"" 4868 (o.lan.lon raquosl). . . .
hCllllOC~1 securily. Medicare. and RRTA lax w,lhh.ld (see page 281 .
00111II101 .ddlllonal 1993 I..... Msch Fonn 6641 . . . .
Othot payments (s.. page 26). Chock If from . 0 Form 2439
b 0 Form 4138. . . . . . . . . . . . .. 59
Add IIn.. 54 Ihro h 50. Th... or. ur lolal 0 .nl. . . . . . . ~
If line 60 Is more thin 1In. 53, .ublrsclllne 53 lrom 1In. 60. Thl. I. lhe amounl you OVERPAID. ..
Amount ollln. 61 you wanl REFUNDED TO YOU. . . . . . . . . . . . ~
Amounlol IIn. 61 you wanl APPLIED TO YOUR 1m ESTIMATED TAX ~ I 63 I /87 S' I
If 1In. 531. more thin IIn. 60. .ublrecllln. 80 Irom IIn. 53. Thl.I. Ih. AMOUNT YOU OWE.
FOI dol.lI. on how 10 p.y, including whallo wrile on you, poym.nl. s.. paoe 2D . . .
E.llmalod lox I so8 a. 20 . Also Includa on IIna 54 86
54
56
50
67
580
58b
~
~
45
45
47
45
48
50
61
62
53
Pooo 2
(.)t..1
p~~
1~tl)
30
37
30 00
38
40 0'"
1)'00
~H;).
).0,)
,;1')) ).
this "I\om and accompanying seheduta, and ltallmlnta. and 10 the best 01 my knowttdgI rd
01 prepatOt (Olhot It\ln lup.yet) I, based on II information or ~ prtpIflf hat any knowMdgt.
0.11 Your OCCUpl.llon
...rL1-
~
PI.pI'''' aoclaJ SecUflty no.
IU' :..,6' i 815
...... 4>-
(F<<!rm 1040)
..,"'................-..-....
""II~UUIt1 l\-n~ll1u:~u UtJUUCtlOns
(Schedule B i. Dn b.ck)
DttMMWll 01 h T,~
tne.". ............. 1tMc. pc)
Hame(I. shown on Foon 1040
P/lt.l f , ~Jrll"'l Ij fltUlrWl/l1
M.dlcal CoullDn: Do no/ ioe/udo erpanses ro'moo"ed Drpald by o/ho".
and 1 Medical and donlal exponso. (.ee pago A-I), . .
Oantal 2 Enler Imounllrom form 1040, hne 32. 2
Exp.n... 3 Mulllply IIno 2 abovo by 7.5% (.075), , , . . .
4 Sublract IIno 3 lrom hno 1. If lOro Dr loss, enlor -0- .
5 Slato and locallncDmo tax os , . . . . . .
II R.al ..toto laxo. (soo pago A-2). , . . . . .
7 Otho, loxos. L1st-lncludo porsonal proporty loxos ~
Taxa. You
Paid
(SH
p.g. A-I.)
Int....at
You Paid
(SH
p.g. A.2.1
NDt.:
P.,aonll
Inl.rest II
nDI
d,Juctlbll.
Glfta to
Charily
(5..
p.g. A.3.)
~ Attach ID F."" 1040, ~ 8H Inllrued.nl ,., 8chodulu A and B (Fonn 10401.
11
"1(,'1
8 Addllnos5throuh7............
9. Home mo~alae Interesllnd points repo~ed 10 you on form 1098
b Homo mor1gagolnllfosl nol ropot1od 10 you on Form 1098. If paid
10 lho peBOO kom whom you boughl Iho home, see page A.3
end ellow thol peBOO's namo. Idenlilying no., and eddress ~
., 5' oJ.
Point. nol reported 10 you on Form 1098, See page A-3
lor spaclat rule. . . . . . . , . . . . . . .
Investmontlntorosl. If roqulred. allach Form 4952. (500
pago A-3.) . , , , , . . . . . . . . . .
Addllnas9athrou hll. , . , . . . , . . .
Ceutlon: If you mads a chari/ob/o con/rlbutlon and
rocoi.ed a bonafi/ in ra/urn, '/HI pogo A-3.
Conlrlbutlons by cash or check . . . . . . . .
Other than by cash or.):tlock, If ovor $500, you MUST
allach Form 8283 . UJ. F.fo1~ ~F. X.T'I~I. . . .
15 Canyovor from prior yo or t~"'~Th!1 . ~ <;" ~ j\.!"'l .
18 Add lines 13 throu h 15. , . , . , , . . . .
10
11
12
13
14
Casually and
Then LOllu 17 Casualty or thoft loss(es). Allach Form 4884. (Seo pago A-4.)
Moving
Ex .n... 18 MDvln expenses. Allach FDrm 3903 Dr 3903-F. (See pago A-4.)
Unralmbursed omployoo oxponsos-job lrovol, union
dues, job education, elc. If required, you MUST attach
Form 2108. (Seo page A-4.) ~ ............................
...............................................................................................
~ 25
2lI Is tho amount on Form 1040, IIno 32, mDro than $108,450 (moro than $54,22511
married mlng separalaly)?
. NO, Yo~r deducllon Is nolllmlled. Add lines 4, 8, 12. 16, 17, 18, 24, and 25 }
and enler tha 10101 here. A1sD enler Dn Form 1040, line 34. the larger 01 Ihls
amounl or your standard deducllon,
. YES, Your deducllon ma bo Iimlled. See a 0 A-5 tor the amounlto enter.
for P.perwor1l Reduction Act NotIce, aM Form 1040 InltnJctlons. CII. No. ,1330X
111
Job Elpenln 19
and Mall
Other
Mllcelllneoul
Oeductlonl 20
(5H
plge A.5 for
expenses tD
deduct hlfl,)
21
22
23
24
Other 25
Mllcelllneoul
Dedu~lon.
Total
itemized
O.ductlons
Other expensos-Investmont, lOX preparallon. solo
doposll box, otc. Ust typo and amount ~...............
Add lines 19 and 20 . . . . . .
Enter lmounllrom form 1040. line 32. 22
Mulllply IIno 22 abovo by 2% (.02) . .
Sublractllno 23 lrom IIna 21. II zoro 0' loss onlor -0- . ...... ~
Other-lrom list on pago A.5. List typo and amount ~ ..............................
~@93
A.oc:_, 07
'-" No. _
Your toel" NCUrttw numbet
.;Iou ;'1..0 :/1.'1(,
5.).5'}
. ~ 18
;}'"\ go
. ~ 17
.~
1J.5~C.
8cMdule A (Fonn 1040) II1ll3
..................-..,....." '"''''
Schedule B-Interest and Dividend Income
Vow .ud.' MCwnty '""""*'
,)0.. : 1<.. : 11.'\1.
Attochmonl 08
5oquonce No.
Name(tllhO*,n on FClfm 1040. 00 nol .nlw nam. and lOCI&! MCUflly num~ .1 ahown on olhw lid..
WILl F. '(.0"'/1"11""'. !}. PIVlrl\l)f\.'-
I
Part I
Intereet
Income
(S..
paOli 16
and B.l.)
Nol.: II you
,,,,,.lVed a Fonn
1090.INT. Fonn
1099.010. Of
.ub.Ulut.
.,.,.menl from
. btok..OO. linn,
U'" Ih. linn'.
nama u IhI
paYI< and onll<
Ih. 101.11n1....1
.hown on Ihat
lonn.
Part II
Dividend
Income
(Se.
page. 17
andB.l.)
Nol.: II you
,,,,,alved a Fonn
l099.DIV Of
aub.Utut.
atat.monl Irom
a brok.rag.
nrm. 11.llh.
nrm's name as
Ih. pay., and
.ntar tho 101.1
dividends
IIlown on thai
loon.
Part III
Foreign
Accounts
and
Trulte
Nol.: /I you had ave' $400 in ,,,,,.bl. Int.",SI Incom., you musl also com .,. P.rt /II.
Int.rest Income
1 List name 01 payer. II any Inlerost Is from a seller. financed mortgage and the
buyer used the property as a personal residence. see page B.I and list this
Interest first. Also show that buyer's soclalllecurlty number and address ~
fowLl'- ~~\lI)I"1 H'''~II~(l..r " rTtW'l/l:l
. t~iV1i^.j' .,. '1;W j'f"" iii-i14';....'... J................... ...~ ............ .....
..........~................................1..............~.................................
Amount
~Slo
~&
................................,...........................................................
............................................................................................
............................................................................................
1
............................"..............................................................
.........................."................................................................
............................................................................................
............................................................................................
..............................,.............................................................
.....................................,......................................................
............................................................................................
............................................................................................
2 Add the amounts on line 1 . . . . . . . . . . . . . , . . .. 2 \0;).
3 Excludable Interest on serlas EE U.S. savings bonds Issued alter 1969 from Form
8815, line 14. Vou MUST atlach Form 8815 to Form 1040 . . . . . .. 3
<4 Subtract line 3 from line 2. Enter the result here and on Form 1040 line Ba ~ <4 ')o;lo.
01.: II u had avo' 00 In lOSS dlvld.nds andlo, ofh.r dlstribuflons on stock u musl also com 1.,. Pa /II.
Dividend Income Amount
II List name 01 payer. Include gross dividends endlor other distributions on stock
here. Any cepltel gain distributions end nonlaxable distributions will be deducted
on 'Ines 7 and 8 ~ .....................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
II
.... .......................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
6 Add the amounts online 5 . . . . . . . . . .
7 Capital gain dlstrlhutlons. Ent.r here and on Schedule D' . 7
8 Nontaxable dislributlons. (See 'he Inst. 10' Form 1040, IIn. 9.) B
9 Add IIn.s 7 and 8 , . , . . . . . . . . ., ..,.,.
10 Subtreclllne 9 from line 6, Enter th. result her. and on Form 1040, line 9 , ~
'I( you received cepl/al goln distributions bul do not need Schedula 0 '0 report
en other o/ns or losses. SO" Ihe Instructions (or Form t040, tines 13 end 14.
" you had ave' $400 of Inter.sl or dividends OR had a foreign account or were a grantor aI, or a transferor
to, a for.lgn trust. you must complete this part,
110 At any time during 1993, did you have an Intereslln or a signature or oth.r authority over e financial
account in a lorelgn countl)'. such as a bank account, sBCurltlas account, or other financial
account? Sae page B.2 for exceptions and filing roqulrements lor Form TO F 90-22.1 . . . .
b II "Ves," ent.r the nome 01 the lorelgn country ~ .......................................................
(5" 12 Were you Ihe grantor 01, or transferor to, 0 foreign trust that existed durln9 1993, wh.th.r or not
plIg. S.2.) ou have an ben.flclallnterest In II? ""Ves," ou ma have to III. Form 3520 3520-A or 926 .
For P.plIrworIl Reduction Ael Notle., ... Form tll40 In.\tuetlon.. SeMelul. B (Fonn 1040) 111II3
112
NJmo 01 perSon wllh ull..rnploymenlllu,ulIluIMt :>howll UIl fur", 10,1111
~1)l1. f /II vc,-II~"i 5(1.
~()(:Iill !CCUllly nwnhol 01 porson
wllh uU.omploym.nllncomo ~ ,}o~ ~1u! r ~ "tLa
Section B-Lono Schodulo SE
1lmDfS8"-Employmont Tax
Note: "your only Incomo sub/cella scll.omploymonllax IS c/lllfc/r amploycD lIIeome, skip linss , Ihrough 4b. 'Enter.o-
on lin. 4c and go to Imo 5a. Ineom. lrom senlleos you porlOtmod as a mmlSlo, 0' a m.mbo, 01 a ,.ligiou, ardor I. not
church .mployoo mcomo 500 pago SE- t.
A II you are a mlnlstor, membor ot a religIous ardor, or Chrlsllilll SClDnco praclltlonor AND you rllad Form 4361, bul you 0
had S400 or more 01 olh.r nel oarnlnos lrom sell.amploy,nanl. chock horo and conlinu. Wllh Part I. . . . . . ~
1 Nel larm pro III or (loss) trom Schadulo F, line 36, and larm partoorships. Schedul. K-l (Form
1065). line 15a Not.: Skip thIS Imo if you uso Iho la,m opllOnal mol/lod. So. page SE-3
2 Nel ptolll 0' (loss) !rom Schedule C, I,ne 31; Schedule C.EZ, line 3; and Schedulo K.l (Form 10651.
line 150 (olher Ihan larm,no). M,n"lo15 and members 01 relloious orders see paoo SE.l for amounls
10 report on Ihls line. See paoe SE.2 10' olher Income 10 repon. Nole: Skip thIS Imo il you u,e tho
nonlarm oplional method. 500 paoo SE-3 . . . . . .. ........."
3 Combin. lines 1 and 2. . . . . . . . . . . . . . . . . : . . . . . , .
4. II line 3 is more Ihan zo'o, mull'ply Iin. 3 by 02.35% (.9235). Olhorwiso. onler amounltrom lino 3
b II you .Iocled ono 0' bolh ollhe optional mol hods. onler Iho lolal ol',nos 17 and 19 hore. .
o Combln.llnes 40 and 4b. II less Ihan S400. do nOll,le IhlS schedule; you do nol owe sell.omploymenl
lax. Exc.pllon. II less Ihan S400 and you had church employ eo Income. onler .0. and conlinue. ~
5. Enl.r your church omployoo Incomo lrom Form W-2. Caullon: Soe I I I
peg. SE-' 10' delinition 01 chu'Ch omploy.e Incomo. . .. ~
b Mulllply line 50 by 92.35% (.9235). II less Ihan S100, enlor .0- . . . . . . . . . . .
6 N.t .arnlnOI trom sell-employment. Add lines 4c and 5b . . . . . . . . . . . .
7 Maximum amounl 01 combined wages and soll.employmenl earnings sublocl 10 social securily
lax or Ihe 6.2% portion ollhe 7.65% railroad reliremenl (tier 1) lax lor 1093.
Sa Total social ,ecutlly wag os and tips (from Formls) W-2) and railroad
,ellr.monl (Iior 1) compensation. . . . . . . . . . . " Ba
b U",.ported lips subject to social security lax (Irom Form 4137, lino 9) 8b
o Add Un.s 80 and 8b . . . . . . . . . . . . . . .. .....,.
o Subtract line 8c from line 7. IIzoro or less, entor -0- here and on Uno 10 and go'to line 12a ~
10 Mulllply Iho smaller of line 6 or line 9 by 12.4% (.124). . . . . . . . . . . . . .
11 Maximum amounl of combined wagos and sell-employment oarnlngs subjecl 10 Medicare lax
or Ihe 1.45% portion ollhe 7.65% tailroad rolirement (tior 1) lax lor 1993. .
120 Tolol Medicar. wao.. and tips (from Form(s) W-2) and tailroad
retlremenl (1ler 1) componsatlon. . . . . . . . . . .. 120
b U",eported tips subJ.ct 10 Medicare 10' (Irom Form 4137, Iino 14), 12b
o Add lines 120 and 12b. . . . , . . . . . . . . . . . . . . . .
13 Sublract Une 12c Irom line 11. IIzoro or loss. enle, -0- here and on Ii no 14 and go 10 line 15
14 Mulllply Ihe small.r 01 IIno 6 or line 13 by 2.9% (.029) . . . . . . . . . . . . .
15 Sell-employment tax. Add lines 10 and 14. Enler hero and on Form 1040,lIn. 47. (Important:
You are aUowod a deduction 10' one-hall ollhls omou"l. Multiply Ii no 15 by 50% (.5) and onler
Iha r.sull on Form 1040, line 25. . . . . . . . . . . . . . . . . . . . . .
o 1I0nal Methods To FI uro Not Earnings (See page SE-3.)
Fsnn Optional Mslhod. You may use Ihis melhod only if (a) Your gross farm Income' was not mare than $2,400 or (b) Your gross
ferm Income' wal mote Ihan S2,400 and you, nollarm profils'wero lass Ihan SI,733.
16 Maximum Income for opllonal molhods . . . . . . . . . , . . . . . . . . .
17 Enter th. smaller of: two-Ihlrds rI') of gross farm Incomo' (nolloss Ihan zoro) Dr $1,600. Also,
Include this amount on line 4b abov.. . . . . . . . . . . . . . . . , . ., 17
Nont.lm Optional Method. You may use Ihls melhod only if (a) Your nol nonlarm prollls'w.re less than SI,733 and also less
than 72.169% of your gross nonlorm Income,' and (bl You had nel oornlngs from solf-omploymont of atle8$t $400 In 2 at the prior
3 years. Ceutlon: You may use this mo/hod no mo,e than flv. tim.s.
16 Subtract line 17 from Iino 16. , . . . . . . . . . . . . . . . . . . . . . tJB
10 Enl.r tho Im.ller of: two-thirds rll) of gross nonfarm income' (nolloss Ihan z.ro) Dr tho amount
on line 18. Also. includo Ihls amounl on line 4b abovo . . , . . . . . . . . . .. 10
'flOm Sch.dul. f.llno 11. .nd Sch.dul. K.llferm 1065), IIn. 15b. 'from Sch.dul. C. IIn. JI; Sch.dul. C.fl.lin. J; .nd Sch.dull K.I (farm 1065).lIn. 150.
'from Schedule F.lln. 36. and Schedule )c.llform 1065), line 15a. 'from Schedule C. line 7; Schedule C.EZ.lin.l; and Schedull K.I form 1065, lin. 15c.
~r.:,
1~b
132
1
2
3
4a
4b
40
f1d'}6'
'17''1''
57,600 00
Be
9
10
;~G.
S"I1IY
'1;
11
135,000 00
120
13
14
15
~ ~8;).
16
1,600 00
t
Form
4868
Application for Automatic Extension of Time
To File U.S. Individual Income Tax Return
... This II not In ,.'.nllon 0' 11m. to pay your tax.
... s., ..paral. InstlUctlon..
lasl nama
01040 No. 1~$.elOll
~@93
~ollNTrNIIUr;'
,",tnW~s.rric'
YOOI nnl name and lnihal
\lflt.l r 'IV (, \\')... r '311...
,
If . toIn' rtlum, JPOUI". IIIsl name lInd Ifllhal
Cor'S'(",-'(:t. P.>. 1IIIIIrIlnr:l
Home addfnllnombof. Il'ltGl, and .pl, no. Ot Mol loulel II you ha.....1 PO 0011. !lO Iholnslruchonl
~~~ 11-'. ronffLli 1'(I\-\..\..)
City. lown 01 posl OIlICI, slalo, and LIP coda
CA(tl..IILL (11\ /101')
.
I request an automalic 4.month ox tension 01 timo to August 15. 1994, to fila FOtm 1040EZ. FOtm 1040A. or Form 1040 for tho
calendar year 1993 or 10 ,19, for Iho lis~al tax yo or ending ,19
Lasl name
YOU( ,oci.. ..curity number
,I. 0 0 i (,,: If. Lj/,
SPOUII'IIOCI,IIIC1Il"tr 111m..,
11't :1(" :1/5)
Plouso
Typo
or
Print
ImI Individual Income Tax-You must complete this part.
1 Tot.ltullablllly lor 1993. This is tho amounl you ox poet to ontor on Form 1040EZ, IIno 8;
Form 1040A, lino 27; or FOtIo1 1040, IIno 53. If you oxpocl this amount 10 bo zora, ontor -0-.
d')OO.)
Caution: You MUST ontor on amount on IIno 1 or your ox/ons/on will bo donled. You can estimato
this amounr, bul bo os exacr os you con with Iho Inlormation you havo. /I wo la/or find thaI your
es/lma/e was nol reasonablo. Ihe oxlonslon will bo null and void.
2 Total paymenl.'or 1093. This Is tho amount you axpoct to ontor on Form 1040EZ, IIna 7; Form
1040A. IIno 28d; or Form 1040. IIno 60 . . . . . . . . . . . . . . . . . . .
2
;)50;';'
3 BALANCE DUE. Sublract IIno 2 from IIno 1. IIlIno 2 i. mo.. than IIno 1, onter -0-. For dotall.
on how 10 a, Includln what 10 writo on our a mont. .eo tho Instruction. . . . . . ~
3
-0-
ImII Gilt or Generallon-Sklpplng Transler IGST) Tax-Complete this part If you expect to owe Bither tax,
Caution: Do no/lncludo incomo rax on linos Sa and 5b. Seo Iho InsrNclions.
4
If you or y,'ur .pouso plan to fIIo a gilt lax roturn (Form 709 or 709-A) for 1993,
gon~rally 0".' by April 15, 1994, .00 tho Instructions and chock horo
} Yours.U ~ 0
Spouso ~ 0
50 Enter tho amounl of gift or GST tax you aro paying wllh this form .
50
b Entor tho amount of
5b
Signature and Verification
Und., pen_nil. of per!ury, I declare thai I hive ...mlned Ihl, larm, locludlno accompanying schedule' and ,talemlf'll., and 10 the be.t Dr mv knowledge and belltr,
It I, lrue. cOffeel, and complete; and. II prepvod by someono 01'* than lhe la;JIpay"" thai I am authorized to p'.~' this 'OIm.
~ I ~
, Your IlgnalUlI OaIO' Spouse's slgnalUlO. II riling jointly Oat.
... ~ c... ~_ cft} ,,/-S"-'l"j
J Preparer'llIgnalurllolhe, than lax;;;;- - --a / Oall
II you wanl correspondonco rogardlng this oxtonslon to bo sont to you at an oddro.s other than that shown obovo or 10 an agonl
ocllng for you, ploaso ontor the namo 01 tho ogonl andlor tho add...s whoro it should bo sent.
Name
Please
Type Number and slroel ('includo sulle, room, Of apt no.1 Of P,O. boll. numbor II maills not dellverod to alreel address
Or
Print CIIV, lown Of post Olllco, slalo. and liP coda
For P.".rwork Reduction Act Notice, seo soparate Instructions.
Cal. No. 1314'W
Form 486B 119931
Additional Taxes Attributable to Qualified
Retirement Plans (Including IRAs), Annuities,
and Modified Endowment Contracts
~ of IN T'......... (Und., Sections 72, 4873. 4974 .nd 4980A 0' thl Inllm.1 n.v.nua Cod.)
klWNI ~ $ttYIc. II- Attach 10 Form 1040. SI. ..pa,.'. Instruction..
Name oIlnd/Yld~ lub18Cl 10 .ddtllOnall.. III mimed hllflg IOinllV. I" trlll,uchonl I
Cor'lfll....U p, fIlUlrl\Itfl..,.-
Fiii In Your Address Onty ~ Hom. ~dt.n lnumbof .and "''''I. 01 PO boa ,I m." II nol delrvet'ed 10 you, horn.
If You -"- Filing this ,)5,). vJl...l1" POfl fTLJ. l' J r^ II T
Form by U..tt .nd Not Clly. lown 01 poll O"IC', 11.11. and Z%Cod.
WlthYourT..R.tum utllLI.l1.1 (~nOI)
Form
5329
II you ere subject to the 10% tex on early distributions only, see Who
Must File In the Instructions before conlinuing. You may be able to
report this amount directly on Form 1040 wilhout filing Form 5329.
o...e No. I $4S-D203
~@93
Al1lChmtnl
Sequence No. 29
Your 10c:1.1 MCurirr numbtr
11 :11. :lIS)
~I.NO
IIlhl. I. In Am.ndtd
Return, check hell... 0
... Tax on Early Distributions
Complete this part if a taxable dist,ibution wa. made from your qualified retirement plan ~ncludlng an IRA). annuity contrucI, or
modified endowmenl contract beloro you reached age 59'11. Nole: You mus' include the amount 01 the distribution on line 16b or
Ilb of Form 1040 or on the appropriate line 01 Form 4972.
1 Early distributions Included In gross Income. See inslructlons. . . . . . . . . .
:l Olst,lbutlons e.cepted from additional tax. See In.tructions. (Enler approprlate No. fo, exception
lrom Instructions ~ I . . . . . . . . . .
3 Amount subject to edditlonaltax (.ublractlin~ 2 from line 1)
01000
2
3
.loo.:)
Ta. due mulll I line 3 b 10% .10 . Enter here end on Fotm 1040. line 51. 4 Joo
Tax on Excess Contributions to Individual Retirement Arrangements
Complela this part If. either /n this year or In earlier yea"" you con'ributed more to your IRA than Is or was allowable and you have
en excess contribution subJoct 10 tax.
II Excess contributions lor 1993 (sea instructions). Do not Include this amounl on Form 1040, line
24a or 24b. . . . . . . . . . . . . . . . . . . . . . . . .
II Earlier year excess contributions not previously eliminated (see
Instructions) . . . . . . . . . . . . . . . '. . .. 6
7 Contribution credit. (If your actual contribution la, 1993 I. le.s than
your maximum ellowable contribution. see Inslructlon.; otherwi.e.
enter -0-.) . . . . . . . . . . . . . . . . . . .. 7
B 1993 distribution. lrom your IRA accounl thai a,elncludlble In taxable
Incom...................... B
II 1992 tax yeer excos. contributions 01 any) withdrawn efte, the due
date Oncludlng extension.) 01 your 1992 Income ta. return. and 1991
and eartler tax year excess contribution. wilhdrawn In 1993 9
10 Add line. 7, 8. and 9 . . . . . . . . . . . . . 10
11 AdJusted eartler year excess contributions. (Subtract line 10 from line 8. Enter Ihe result, but not
1~8Slhanzero.) . . . . . . . ., . . 11
12 Total excess conlrlbutlons (add lines 5 and 11). . . . . . . . . . . . . . . . .
13 ~ due. (Enter the smatler 01 6% 01 line 12 or 6% 01 the value of you, IRA on Iha last day 01
1993.) Al.o enter this amount on Form 1040. line 51. . . . . . . . . . . . . . .
Por Plperwortc. Reduc:Uon Act Nolle., ... ~g. 1 ot ..p.r.t. Instrucllon.. Cat No. 133290
347
12
13
Form 5329 I,m)
WigOS. lips. Olhtl tomponuOoll 2 fedoral incomtlu wilhhekJ
1200.00 28.44
3 SUeldl fiOCUlll1 WlIgOI . Soda! ,.cullly lax 'IVllhh.kJ
200.00 74.40
5 Mollic..." wagGl and lip' 6 MedIcal. tAll withhold
1200.00 17.40
1 Soclalllocullly lips . A1locatod tip.
0.00 0.00
. Advance Ele payment 10 Dependanl C41. ben.f.l.
0.00 0.00
" NOIlquollliod plans 12 Oonollll indud.d In 001 I
0.00 0.00
13 SOA 1051rs, for DOl t3 I. Olhor
......;-~~ llumhor
1460
~I
tr EmpJoyu,', IdllllllJllcaUon numbctf
:/3-0524700
, Emplov.,', name. addlGu, and ZII) coda
Th& Dickinson School of
150 8. College Street
Carlisl&, PA 17013
Law
d Emplo.rol'. sOCIal "CUrtly number
200-;36-1646
e Employe.'. name. .dd..... and ZIP code
Dal& F. Shughart. Jr.
Fowler Addams Shughart
28 S. Pitt st.
P. O. Box 208
Carlisle. PA 17013
Esq.
lc Rund Ie
1& SUIt EmploYf.lf" slato 1,0, No
.~~. .J.~.~.~:-:~~~~':'~.... ~..~
17 SI>>t WIQI1. 'Pt. tIC
1200.00
165{aleWlt01ltlll
33.60
19locar.ly namo
175
0.00
0.00
Dopilltmonl ollho T,easury Inlornal Revenue Smvlce
~ 'W 2 Wage and Tax 1993
of . Statement
Cop)' B To B. Flied Wllh Employ.... FEDERAL T.. Aelurn
~:r
..,
.""
This Illlotmalion is bolng lwnlshod 10 Iho InUllnal Revenuo SolVieD.
. ConIJa number VokI
123~1 4, ~ 0
b Employ.r'. ldellUflcallon number
l3-Uj':11'1
c Emp6oy.r'. name, .ddle.., .00 ZIP code
C~UNTr ~, CU1~.,L~.u
CUURT H0U5i-C~~T"r~L~RS
Uflt:
1 W.g... lip., other compellJ.ltlon
~~ 1. ":-'
3 Social socurlly wig"
(..:(S. j':.
5 Medicare wagos and Up,
to ""~; . ~.,
C,,/'LI.iL': ~.
1t .1.:
7 Social locurily lip.
d ErnP'oye.'. lOdallecurily number
, J'""-:;u-1 t:..:....
. Employ..'. nam.. Iddt.SI, llId ZIP cod.
9 Advance Ele paymonl
11 Nonqualified plan.
:);"L~
"] ~J .:
F. ""lJ~~:'-T
FJ':P'. r ,r
13 See Inll,., lor DOli 13
1\'-4.;',.1
w
, ~. il L r ., L
p'
11. 1 )
1& SlAlt Employer'. Ilal. 10 No
..~nj..1?-.~_~. :.~.~._~.t~~!?_~.. ...m.....
5 Slalulory OiICIISlJd Ptnsion
~. l'!n
o 0 I:J
1 a SUI. n:one lu 19 loca~ly namo
"..~. 11i:
17Sl.llt"IOI..~.ttc
... ,I L -I.;
.. --....
SuOWI~ o.",,1d
-
20 leU "19'1.1ipI. tk 21loc.tl i"lc:oIN t&I
1200.00 12,00
0.00
0.00
,'1'1
___'______Unno______ .....n.........__.. ____.On__._nnn__. .............___...._ ___...........____..
Copy D To Do Fllad With Emplova.'. FEDERAL To. Ralurn
Form W-2 Wage and Tax Statement 1993
OMI) No, 1!S<4S.0008
. -- -- ---....-
2 Flder.llncom. IU w11hh11d
4 SocI&I .ecutlty laIC wtlhhtld
1?:J, .D
S Medlcat' ta. wIlhheld
: .,. ~4
8 Allocated IIp.
10 Depend.nl cart beneril'
12 B.nellll Indudtd In 80x I
14 Olh.,
SUI
'.~ r
...... 4
l' !.. , :
0tpat1metw Ii ~ Treaur' lnIetNllltYenut SeMel
ThiS InlOlmalion is being IUfnlshod 10 lho Inlomal f1olJonuo 5of\lICo
L...,
o
."
."".
o
Subtolil Def.ntd
o ~"""'"
20lcullt",IpI.tt.. 21local~lI.
" ~ . l ., " :.-, . 7 y
1,', .
. . -
OMU 140. 15-45-0006
'1
~ ~
~ ~ ~ ~
clS '" ~ 18 :>
Z < M ~
II: ~ ~s Ul
Cl I&l III
~ ~ I'! ~ 1Io
'", 0 Iii
.... '" 0 N
iii ~ ~ ~
III 1) 0
~ n ~
<
-'
'-'
,-
..
.
-
...
.,;- A,'
.>
~
-
vs.
)
)
)
)
)
)
)
)
IN THE COURT OF COMMON
PLEA8 OF CUMBERLAND
COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
CONSTANCE B. SHUGHART,
Plaintiff
DALE F. SHUGHART, JR.,
Defendant
NO. 94-6641 CIVIL TERM
IN DIVORCE
INCOME AND BlPBNS8 STAT1lKIlN'l'
OF
DALE F. SHUGHART. JR.
INCQlIl
Defendant is currently a partner in the law firm of Fowler,
Addams, Sbugbart , Rundle from which bis cash draws and income,
for 1995, year-to-date, has been, prior to taxes:
$5S,366.49
Prom that a~unt be is Obligated to make the fallowing
payaents for income taxes and bealtb insurancB:
Federal incomB tax and Social 8ecurity
State income tax
Local income tax
Healtb insurancB
$17,SOO.00
$1,950.00
$460.00
$1,394.00
TOTAL INCOME NET OF TAXES
($21.604.00)
$36,762.49
Total taxes and insurance
BlPBNSBB
In 1995, to date, Defendant has paid the following expenBes:
A. Expenses for Marital Home:
Mortgage
Home equity loan
Electric bill
$3,983.00
$1,350.00
$167.00
1
~,
.
,..
Bellsr and vater $83.00
UGI $585.00
Insurance, taxes, clllaning
and repai rs $590.00
($6,758.00)
B. Harital Debts:
Hastercard $640.00
Visa $1,136.00
Heartland Visa $350.00
Farmers Trust line of credit $I,550.00
Hiscellaneous $55.00
($3,731.00)
C. Personal Expenses:
Gifts to children $1,789.00
Charitabls $185.00
Periodicals $124.00
Ani llIal s $131.00
Counseling $I,120.00
Groceries $1,317.00
Vehicle and boat $1,038.00
Insurance $542.00
Vacations $I,972.00
Hisc. laundry, phone, etc. $1,108.00
Clothing and c1saning $600.00
Cash $1,080.00
Attorney fees $2,500.00
Real estate partnership $537.00
($14,043.00)
BALANCE $12,230.49
Pat C.B. 4904, relating to unsllorn falsification to authorities.
I understand that false statelllents herein are made SUbject to the penalties of 18
DATE:
,/ , .
'~V,)lll
'(.) ~-,/ / 'j ".1
/) -........ ) I
.'\ ~/ ( , J (. .L
(). }U~ ..' . / y;?;'J
DALE F. SHUGHART, JR. /
I
}\
_J
~
:I
; I '
Il)
'1 t1 l:.1) U.S.lndl\'ic1uilllncomc TiI~ Return
II!.. ;'!'~""'l.'~' '. I' "I~" ~ . i'"
I~S Dr..! e r- ~ r: 1".1.': I,~i /':c c /
!,f>b,1. . r >
Oth.,. I ;'t,t"",,,"I...l~'t'\\II,~,.:.......,"~I',,,,U"~'. '1'.''') '1',.,' " 'I' .'
wia. I .::5~ !J). -<'lli.;.~r~i ~T
pI!",. r C 'I ,~.., lo' :';,. """I l',.'1 <t' ':' Ilf ',.1t
p'lnt ! t
o,typo. i. c;..';~/1"2J P.. fJf1
P~t.;jdH lio1l ~ Or 1'(\L. \', .In! ~ IICl C;" 10 I \,,~ l.,r,d'
C1tllion L:.;"ti.n Y II !V'flll(.IIJln d{'l'!. ,')'Jt ~,\OL;"(: ,'"II.t i ll<ll.v IIJ:'.
I X J ~;:,~,'.Otd !.I ,."",.: "'..n (I.",,' ("'1" ( '.:
I 1 '''.rHd ,.' . i ..; ~ '..~l Ifl\oln fr 't' ! ;,(., 't, . , ,"
]., ,.",,1,-
S I 1
6: I/~
: "1
filing SI, Ius
r: I .. ~.. '.1Iy
...',~ t'Ol
Exemplions
I
A'~.)', ,t,rck
th, bOI labeled
Yount".
Chick olher
bOIUiflh,y
.pply
Income
PIU~f JtI,ch
Copy B of your
fOlms W.2. W.2G,
and W.2P here.
II )OU do nol have
aW.2,ult
p'ee 4 01
Inslfuchonl
r
Pluse
atlach check
0' money
order here.
!'.; I. . :' ",' . .' :, ' ~, I I
I "7 '1 3 b I I ~~ ~
....... '(."";l:~'lI!,~r l~to;,t J J
,',J' :~.~~ 'el.J1n (~t':~ t,t-.t to
"1.' ";' rlo ;;, :", c. ~::.:t' ','rI . ..,j
. 1 ' .~' cr....,' J .."" O'
,'1 ! No If'!:';~ '."-. "4 lei
'.. I rt':I,'I..,,'lI..,: '.ClI.', ~h ,..~ \; '1,'11
---..-- --
..", : :.;, - :.,' J: ; ..'~, . ..'. ",,":',
.. r ..,_ _ ....... ... . ,.
- ,
.", f
.,.
;~
7,:,.:l
: .,
, '
1'1' '.,
Ii') 1'5
I!'.....l';
')'(
".!
:', 11'1 ,f ',tl'
. ~ i I' " , .:
'I" i. ;':.":'.I~! tCl.Jr.,.1
~ !.... If ;.a' I, , 1: I" ''1 .: .~
, ,
L'. .J
) ;~, to; :I.t r- ~f Ir !o'~I!.'.:"':~_~'J.
(1'1:" 'IIrT.tA, 01
~.IUtt,tthcl
0.', tJ t..d b ...
(n!tllli,.rr.bc.
01,1.,:.11'"
I ,lt~ on" ...
[:':"'oI",bcl
of,hildl'"
1'lltdo/l6d ...
(nlll ""rt,bI'
o! DI~tI
C"f;>t',denll ~
I.dd /l~IT.t.tn
,nlmdift
Wltl,oo." ...
7
8
_2.'Llrr.
!D
I
I
cI r'ISI nlllT".f"!l> 01 )OUI dt!; tr,Jtnl th,ldltn ...1.0 d,d no: lI.t v.,:h )OU (!oCt P":1;t 6) I
Illp'.I~j8S,s..tmtnl ch.ckh.'. ~IJ .l. ~ _ _~_~ _ ___~n
· Olheld-t-pendenls --. 1 - 11l'h\.w'Dtl{lln("jltl:tlllll~IDod'O~P'o.'~'l
(1) 'hl,llon,h,p n;l~!~II." '101.lltD-.' 01 j"'O' 11'11 0.".11 01
(1I';.m. r -- - """"" i11t!On,,,. i "::"~'!~~~~'
, To!.1 nurnLel 01 eu~m:.ol.on!l claimed (al!1o tOUlpltlt hne 361____ ~
7 Wages. ulalles. lips, elc. (attach FOlm(5) W'2)
8 Inlelfst income (a/5oa:tach SChtdu/~ 8" Ol.tr 1400)
9, Dlwid'ends (4'50.NtI'h5chedul~ 8 "O"~I $400) __ .__ !~ _~_ .9b Elclu\,on . .' i_'. J.(i'~
c Subllaclline 9b 110m I,ne 901 and enler lhe result. 9, ________
10 Tllable "fund\Df ,lair jnd localln(ome lales, II any, from It:, Voorh~.ttl on fo1,' 9oll"r.lIuCl,ons 10
11
1 1 Alimony,ecelved,
12 Busineu income Of (loss) (attach Schtdul, C). . . 12
13 Capital ialn 0' (Ion) (.t:ach Sch,dulr 0) . 13
14
14 40fJOot capI'al ,am dl,trlbuhon' nol le~lorted on hne 13 (set p'iie 9 of Instrucllons)
15 Ol~el ,ams. 0' (Iosses)(.:rach (olm 4197) 15 __ ________
16 Fully la.able ptf'lr.IVns. IRA dlr.trlbullons. ..nd annullln nOlleported on l.ne 17 hee page 9) 16
17, Olher penSlonr. and annultlfs. Including rollover' TOlar received 1.17.J ___ __~_ J ___ ;'~:#t
b Ta.able amounl, If any. horn thf Vo'orksheel on page JO ollrlsllutllons 17b
J8 Renl~, ,o)'alt.es, partntrshlps. er.I,le,. !rusts. elt (iHta;h Schrdule [) 111
J9 rarm Intome or (Ioss)(attach Sch~dul~ F) . 19
20, Unf:mploymenlcompensal,an(lnsulance) Tola1r,crlved L2_~.~.J ____
b la.able amount,lf any, fromlhr wOlk,heet on page JOol InSlrut\lons .
2b Social secu,ily benefl" (r.n page JO). . . . . .. ll.!..!l~___.
IlI.,..mPI I
b lalable amount, if 'ny, horn work,heel on pase 11. 'fll"UI__
22 Othel income (!illlfPt ud ,mOllnl-IH P'lr II ollnllhlthCUlI)
~t\r\ ..1\'\.: ~L\.. f, j'tt\lMt~ .~_(f'..v'1 'r"'W..,,;IDI~.!It'o<"W\1, r....."l
23 Add lht amounts r.hown 10 the ,,, Ii hi column 'or hnn 71h/ou h 22 ThiS I' Oul tolallnco';', ....
l,r.d'
"I'! :
""s:
-_<!:>..
101/
Sf:"O
24 Movi"S tlpensn (,ttach Form 3903 ot 3903') 24
Adjustments 25 Employee bU!lineu. e_pfnses (,N,ch (orm 2106). 25
to Income 26 IRA deduction, horn Ihe wOlksheet on page 12 26
27 t<eoeh ,eluement plan ,nd ,elf.employed SEP deduction 27 ~__~_nl.,. 0.5'0
(S..
In,truCho"' 28 Prnally on earl)' Wltndlolwal 01 savings 28
on P'II' 11.) y;;.,:0.- _._h n_. _ __+
29 Alimony paid llwp"nl'. tul n.mt ___ ____ ,nd 1.7.".7.1.
, I 29
'oti.IIKulil,no I )
30 Deducllon for, mar lied couple when bolh wOlk (Ifllct! S(I'tt(1IJIt W) 30 ~-~1,j~
31 Add Imer. 24 Ihro~~ 30 These ,'r your lolal.djulolmenh ~ 31 8111
Adjusted 32 Subllaelll"e 3) ',om hnr 23 Th,r.IS )'01.11 .dju'l.d .IOU intorn.." 'hIS Imr ,SlrU th,n
Gross Income $11.000 .nd a chrlc1ln,rd "'I,h yOIl. Jrr "Carnrd ,,,(pm,. C/r(1I1" (lint 58) on pagr 1601 32 16'i ~'l
InsltuctlOn5 /I ~ou .,lInt IRS In ('"11''' vOul '<!I Sf'f' pM'" 1.1 0' Ifl~"u(t'on! ..
1
2
3
4
ti,jli'
t)
I!..,.:;r.."
!'JI .. -,' 1 :-'~' ~,;, ,jell!. l '.:el . I,,'~.\ 1 .J "t " 'f'
.Q ;,'I,"E;' ::",;"')":,'Ul_\'~.;",',c~'r,l(,,,,~(,'.:I~;" ,~
"0..' ~ell I J CIS 0' o.e'
S;.{l.JIt J 65 o. ower
r"!iot r.lllr.t'S 01 )OUr d,.;.tfldcnl thlldttrl v,ho laf'd I'o'Ilh r(lU
.. :9
i
. BI,nd
I J a;,nd
'-11!t i? II, J/1 f....~IL
L_
.j
,
'.." 1"; ~ ',lid
I }-J
I~J
LJ
1- ]
""J
:=J
ral
CO~,?u.
!alion
(Stt
Ir.,lru(lIcnt.
or. ~"t:~ 13 )
Credits
1
,
(5e.
I"s'ructlons
o"p..e 14.)
Other
Tales
(Including
Ad\i1nrr [Ie
Payments)
Payments
AUach forms
W.2, W.2G,
and W.2P
10 honl.
Refund or
Amount
You Owe
Please
Sign
Here
,
..~" I' ,
,,'j .~
I J
IJ
I. "i
j ...... J
~,,'A
1 ;<d 1
!~J
I:~ I
I J7~ j
, . ~ . G ! 33.98'.1
",10. ,
... ,40 I
-~. 'I ~-T'i;.-.
",: i:!'
';-',1;,
'::'~';
; I:f~
,;:,~.;,':/
44
45
;-i~~7J;;
<));.1.
:'.~}~
'?~
-'f,z.,,,
48
... 49
50
51
52
53
54
... 55
56 5.; ?/~ w,!,~
rederalincom~ta.wilhheld. -----;___ f_
1986 estImated tal paymenls and amounl applied horn J 985 leI",," 5 7._---.:~___t~!1J! _._ }{~~1
[a,ned incoml' "edit (50ft' r:age 16) 58 --.-_. ____ .__.. _ _ }&~4
Amount paid .....Ith fOlm ~S68 59 .---_..___h '-1-' J/f.'~
[aeess sOCIal !le-CUllly lal ana RRTA la. WIthheld (fwD 0' more 14,:,,;:
60 '~0
employers) _____.___ _ k/IIZ-,
C,edt! '0' federalla. on Ea!.ol.ne and spPclalluels W:le" !cJlm 4JJ6) _61 1 :f:;'f:'4f
Regulated Investmenl company Cled.1 (attaCh 'olm 2~39) , 62 ---.- _.u-C~ 1tf1~
Add '.nes 561hrouih 62 ThesE" a'l! ~ou' 101., paymtnts ... 63
II line 63 is large, than hne 55, enle, amounl OVERPAID ... 64
Amount of line 6410 be RHUNOED TO YOU , ... 65
Amounl of IlOe 6410 bt appl,pd 10 your 1987 estlmaled 1". , ... ~ .
If hne 55 is larse, lhan Ime 63. enle, AMOUNT YOU OWE, Attach check 0' money o,de, for .%
full i!mounl payable 10 "'nlernal Re\/enUI ServIce." WIIIf' you, social Sf'CU"ty numbe,. 1~
~ayllme phone numbe" und" 1 986 form J040" on it , . ... 67
Check JI-o 0 Ilrolm2210(1i'lor)lullachll'd Sup'I.17 P,n.lly: S '~~% ~1. ~r:'%J.;rZfl,:~;,~A,'. @'r~
UnOIf fa"'U,,, of P"lury, I d,cl.II Ih.11 h..... ,..mlned lhls Iflu," Ind .ccomp.nr'"a schtdults .nd sl.l,menls, .nd 10 th. b"t 01 mr 6.no",I,11' .nd
bllI.,. ther ..elru., torltd, .nd compl,l. 0,,1'1.1'0" 01 pltplltr (Olh" lh,n 1'.Plyer) I' b'nd on ,1I.n'ormlllCln oll'o'hlch plC'~IIf hu .ny kno,,"III"dI"
II
H.
;...
, ',.. :.: ';, ~ . ~.. .. f':' '. ~ ,I.:; ., 1. I
'. 2
j)
;(.
'j ,. ,', -
. j
I'Jr_
.:, . ;. ':"~". ~ \", ,.,1.. l J, Fl"" : ;..::
.6
Ut./5j
~];" I
-"~~';-5.i~-~-
I (,,(. :
I
- =Wil.J__
I>~
u~-n~{t~c K r-~-=-
h C~II 1--=
____'1~_~:y~=
----..---1---
._- -----T.-
;llcllT-
"1o~1
))~Co
Plld
Plfpllrr's
Un Onl,
PI'Plle,', ~ 0,1, Prtp.'"., 'OCI,1 st'u"11 no
;'a",lure --.-- -.-__H._~_.____ i:'~~~!~._jJ _
:~;::~.t~!)~.'o"P) ~ -~-----~--._------------~. -- i-~p;o:, ~---_____L___
r._,_:I...n_II",~.' .t.. '''''''::'.<u'.I..'~'~ f'
r{-'...r, !l'~ r'1'f ~3,.!I'~~I\l:I.(-.~"r,o{'"" .~.. :.~; 'II 'l~' ;3,',,;\~'l'l
1,;,--.:. ( . 1-; " .,' \ 'I . '.;1 r ",.d )tn..' , :'~'_'~t' .... -. .-. '1 r,' 1.' _ ;,'( ;."
b l!)r'.r1,..;I'I:t'II"..!"~'ul..nuri,,1t'(I''''''r~_t~:.'''' .~ I..:~t
.(l'Jrr....~t'(e,.:..t.:~r.~t,tlt (IIyO..-[a.f!:(:1::U'I:;..tl:"ny I I
. ".1
\ 'I L " nk"" . ~ ell' )4 ) ,~ I
c rr:t"'~'.J!r,r,r,,,~t,c. Ir~J..I':Jr'~("'"".II"....,,( -t:J'(. .'.'[11, 3fc.
'-',
. l'n
d
35
36
J1
38
J9
:'!.;I;...!:':tl.J1'11::l":,
[n!t'r l~ t 10~al
~~.t.!',..:ll...(' :?':if "r k,~ ~.:~, ".h'C'_t-.(l i';;'''!
hT l."1f i3
',1;..1!;,I, 51 tJ,:.o t1) I tit' 1:.:,)1 r.U'-~'~'l:r 01 {,~rr I :.(;'! ('.:; .'.,,~ (,r.l.r,fo (,' '~d. ; -L~ J4)
T.' I.. ~.~c inc c,mt Su~lI,,'II,r.(- 3E- ~1,:Jm j,r,t' 3~ [;"'t': 'i!- I"~ ~i~ (~'..Il "O~ I ., !l : ~ ~:", ;l-re)
r r.: i'~ ~ JI ! .1 t" C~'I': i. .t h.r', ",~ T JI l' ;'~!e. I ~ 11. I :: :'~ t',:. -," ..:t' X. y. {)I 1. or Il r.
!..l'~' :"..1~' !.f'!. (.1 f' : .r:to I.: o~ ;..~lIv'.I...'!) r"'o' ~i.t ".\1,:'...-i.. II l'um I ] L.
/1 [,.," .'~n or I J ['''''' ;,44
!.lid :.1 ,,~?~ ..-,~'>9 (n~I!I n,t l('Ital.
~o
41
42
;;)
_~jOO I
Cr"C'd.1 lor (t'lie ,!HId ~f- .'i: 'rCt-r,1 ra:t: ~.I tJtn~l:~ (i:.':_C h r"/Ir ;.: 4 J)
Crl'dll 10f Itlr f'Tdet') Of lor the pi'ln,d:".t'I1I1} id.d 1.::I'i1I1) d.~i1~;t'd
(..!:ilLh ScI."dufe R)
P'-lr11,}' (It.d,l lOf ~lor.I.(,)1 ((or,ll,bul,on!. for 'o\h.(h )('1,; ~.d. e 1(" e.~l!.
Add 1I(of;,!. 411hrouGh 43 (nle-, lh€' lolal , ,
~"bl'.cll,", 44 1.000 'me 40 ("Iorlh. '..ull (bJI toO! 1m I',," '''Or) 461
f"orergnld.Cft-d,l{olt:,;,hrcJfmJJJ6)" " '- --
Ceneral busif foU cftdll Chtc!I I' flom rJ forn-: 3&00,
IJ r.,m3'68.IJ fo,,",eS4, LJ fo'," &<18,0' 1 Jfo",.,6765 ~7 ~~__~__
Add liw!!o 46 a;nd 47 (nlet the lolal .
Sub"act I.ne 48 from line 45. [nle, Ihe tesul! (but nollt-!.S than lelo) ,
43
44
45
46
47
j
48
49
50
51
52
53
54
55
56
57
58
59
60
Se:t.employmenlla. (,mach Sch~duft! Sf), ,
Alternalive minimum lal (4t:iJch FOfm 625J) ,
Tal hom t~Caplurt' of inH'slmenl credll (at:ach 'vfm ~25S).
Socialsfocurlly la. on tIp Income nol It-ported 10 f:mprO},tr (aN4ch 'DIm 4J31)
la, on an IRA (attach Form 5329)
Add lines 49lhrough 54, This is )IOU' lotal till
61
62
63
64
65
66
67
~ You' "an'lure
~
Oil.
YOU10CCuPIIIon
SPOu~,', "i:"a~lj~mii-~I~;;'eoiH-;;~I"a"' +-----
oili
h__ /jJTOI'J-'~:1'h_h__
Srou.,', orCul1jloon
s~ Ll..j
Schululc ^-~.ltUilil(:(J Deductions
~C~t(DlJl[~ MoB
(f~','" IC~o)
ft. ~" ~J~~ e ,', (d" t."r_~)
f.,," t"\':"".,.,I)
, . " .... =" I' ! (t'.,~ ~ (j ,
~. :!'...~"~r',,T, :,:0 ~. tf',:'.. "f',IL,"'"
d. ~ 'r
. !',.:Ol
r;. ,.'t~l . ~ \ ~' : ,.' 1..- 'v Ir J :..;0
1:.'A II':
.-.-....--.
'Ild"al.nd
O.nl.1 ['j"n,..s
(00 nol includ.
f1rtnH'S
Itililb!JoHd 01
p.i~ ~I "I~m.)
(!:e.
l"ilruc.
:.~"\ on
; .lit' 19)
h"s You
Paid
I
I
(S..
I"strue.
1ionlon
p...20.)
Inlertsl You
Paid
(S..
Instruc.
tions')"
P'.' 20~)
Conlrlbulions
You Made
(5..
I"strue-
110nloon
pag" 21.)
Casually and
Th.lllollu
Miscellan.ous
Deduclions
(5..
Instruc.
tionlon
pagI22.)
Summary of
lI.mlnd
Deduclions
(5..
Instruc.
tlons on
p.g.22.)
F
~'
<;
.../
oJI,
~c'.".-:..l/:'I./:: ~
e.
; I. ,- C
.'
1
2
rll.~:,.;,:,:.n 1I00..i,(f','.'! .:"~ I!"'i..'~ (:;.<1 ,'( .Jtln
(. J I
:-:. ,:~'-H~, ~:v;ll~!'). 1"." ':'), "'~;I ~i1I~, If < ~'":,,,,~
;,'C.IO"..J"lS
a
'10' (?
'IS'
b
: "'j I-lid f 01 ,~,"-" i,:: J I d' : (: l: r. ~.i 1 C ,J ~ to. t:I c
.... ," "Vf~I~,(In.; ,d ", :':;,l1g
C:'.d (hI '1I'~ I'j~~' I.; .J:.",' .:.!!o. t~l:i,!U'l.-!l, t:,:{.:, "':~. ':Ie )
:> ! II C'.'~'.;."'/
?b
~a
c
2c ~,
3 !.~~:. ~.s 1 P.,r":t;n ?c, ;:"'~ t;.'o..:~:1 :- 1:~i':! ~.:.-re 3 1 '11t-t.
4 I ,. ", ~J).
4 ,.~ A:' : 'i :' " .:f'-'( '-lId 'In r u' rn !:' :0. k.,: j 1. t,J' 5'~~ ( OJ) -1
5 !i~~,",..:: !.r!l."~ f101:1 h:,,~ 3 If ,'. '0 (1' :"~5_ HI!.:-r .0. TrJI,ll:: ".,~,:,:' r:Jd~ '~':'~<11 >
6 S:i.:c c:',d IL.:.)I i;., lJ!:<:: ~(..l'5 ! 6 J Jl' "'1
7 R(JIE:S~,::J!(>tJleS I 7 I ,~~ I'
8 a G,ne,"1 ,.:,., :.. ("'f ,.c,le, la, I,,~:'" ,n in<l,u,l,on ~oollel) ; ea I t':~g
b C:-f'cIJI Scll(.s 1";k (.In lilolor vehicles. _ 8b
9 ~11.e':":,,, ~I:'I. ~ .i'."I".,j~ ~~:~O':~I.p".~e~IY I::.,..,). .~.:: :::::: 19/ ~
10 Ad~~e~!2~!J_~._~.I!!~I_'5!~ .~_ t~'E~_t:!!-9~~~_~_rJhe IO~~~l!:"'n~_t:lr_:~~~_.-,- . .~. to
11 a Home mor1[;J&e inlen'sl f..lid to financial institulions (report I ]
df'ductiblepolnlsonhne 13). . . . . . . . . . , 11a. .):.cLj3
b Home ~1or1Galle Ir.:t:rest )'ou "aid 10 individuals (show that r
r-i:t500n s name and .-,ddfess) 11-........................
12 To:ai~,'e.d.ii ~~;d ~~d'c'h~r~~.~~c.~~~I.i~i~;~s't'}:o'u' ~~i'd:'.:' ~.... t!tf ~~_'-__~_-~=-~fd =-~
13 %e(,:,?:;:~~~ouf~;;,~:~~~:e!.{-:~;~t~.~~.o.u.n'~ .~'1 ~~:. U
.d(:~,:,.'l.tp!J. .(~a!!<........... ~ ~ ~ ~...~. .f!~.:
. C. ~(,!.,?"-.(,.":'.r/.if4:'.r-7.. "!~. .~0-. f?-.. ............ ~>...
............~........................................ 13 8'1$"
14 Add Ihe amounl' on hnes Ila Ih,ough 13. Enler the tolal he,e Tolal ir,:e,esl . ~ 14
15 a Cash conl,ibutlon,. (If you tave $3,000 0' more 10 anyone I I
o.gan.rntlon. report thosecontnbulions on Ime 15b.) . L~.5!1_~ ~ I) ?c,__
b Cash conlnbutions totaling $3.000 or more 10 anyone
organization. (Show to whom )'ou ga\,le and how much you
gave.) ~ .~~~..~~~..?F...~Yv.")....i1.,~:'.~.:i:'....
]6 Olh~"lh~h'~~~h~(Y~~ :~!JJ;~h ;:0',;'; 82'S3 ;f~~:;"$500:j'" ~ t~th.; - ~~~~
17 CallyO\er from plioryear ~ . L.IL1. __,_ ___~~
18 Add the arnounls on lines 15a thrOt:&.U7. Enter l~ lo~al h~re Total cQnlltt'i.Jt.~ns, Ill- I 18
19 Tolal casualty or thef1loss(es), (You must attach Form 4684 or similar stalement.)
(5eepage2101Inslruct,ons.). . ~ 19
20 Union and professional dues 20
21 Tax relurn preparation Ie. . 21 }} '}
22 01 her (li,1 type and amount) ~..........................
)0!::. .~~~~J.'f. i?~ .~. ~......................... .1.1.:
.....................................................
"
.....................................................
22
23 Add the amounts on lines 20 lhroueh 22. Enter the total here. Tot~1 mj~ceUanf"OUS." 23
24 AdcMhe amounts on lines 5, 10, 14, 18, 19. itnd 23. Enler )'our aos\',er here.
{ fll'ng 5lalu, box 2 or 5, enler S3,&70}
25 If you checked Form 1040 Filing 5lalu, box l 0'4, enle' $2.480
f'hng slatu, box 3. enler S I.B35
26 Subtracl hne 25 from hne 24 Enter )lout answer here and on F ~rrn 1040, line 34a.
hne 25 IS more than Ime 24. see the Im.truchons for I.ne 26 on pace 22)
For P.p.,wor" R"duclion Acl Notice, !.ell Form I040~trucllon.. .-_.
(If
.~
I
''';.', ;,,'.,...,,:
,~',; I) t:\
:'. (I \,
. 0,'
.'. CJl
YO',,' \". ~ \. ' _.'1', 1,_ ..:'U
;~
I ,~~
;,,' : ""f~
." ',! :.,r
-,;;0 . ',1
;" J ,I ' : ' ~,I
'S.j,,\ ,..."
.. .-...~.: :'.;.~
..: ,..~
1;:;/..:. <~s.I"'i~
'~"J' ,'"",-..' -;i;,"""'j-"1.
,/;;f:i.',;UJ':>~;~~f~t; ;;:IY
:>'~;.~ ::(~.:;:;.'/t,;',,' 1.:/ .
lip ,/<"'/:,.,, ",' I~/,~. ., 1
y.?j:SjJ.:/f/J~< i j~i~
"""/<i.""..n"i....I"I"
::.y:~~:e:~:Pt'.~.;~;~:,.tt.'~~
:n:'::;,,:~~. :,;';;.;;Vw'1 /1
:;/j,p:/;/ '".,,,,;w~';'l' ,;.
;;/.1.f;'1.iiL~~::~ d
,_"JI"i,.'dl." '/II,,~,:"1"'I'~"/':
(~""~ ""/'-'."'I/I~.~i.?' 'I''/.
:':~f/?/;W~~;~~:;f~Y5.(' i {~i1
,; y,.!.~:I~';;J;l:;'l'.'I:~
:,~'~;;~:.~dl.' 1/'. '~:"d:. iil'.
..I. "1' ': "';:";:,; ':;,;"';0''' ~"'~Z
'1:~!~'4?:',:rM':l.Y\1~:.t~'1 :';~~I"%
:f'....:I!.I'J",.I'.'''J''.~'..1
" ..,..,', .' r. ~1_' . j '."
,!".'.I/i,'!".,',....",',';~, ,~;. 1,
.. ."'.,~,,', '. ' , ", ,
':~;9<;;:;';?."~~Y/'ixtl1,:. '/~I
,(,~::.tr;U;:;,:.(t~:'\:.:! ~;;~~
""...I''''/i's'jl'/~
''''..''~;..q,'''..'../jij '.'.'.1,
',~/Mi,.~/,l,ZI/,/,i,.i2~/, ,."1,:,*04
t;~;'t'l/ji#Ml,.:;.t,/?~/m~;I~
'./0//1"0 ::tKf.' %(Io,y!t1. ~.. . 0,(
.J!/~I'"'''-;::';I;,;~''j:+"1
t1;11!/4~/fi/'-/"'''''th'll.~ f.i~),
Jilf&lJl~rfi;~J E;(1%l
.11.JI;J;~f~
'"l1il@r~1 :tj,
x11~.i$ti},~l~'I,yi.t.Q, I.W4Z(
tllt;Z@;>>&,;'a;;l.fn"lQ, "XIII",
}S<l-
j
i
j
ro:
24
i)~li
25 1 b 1 ~
26 IC>~'i ,
Sch..dulr A If DIm 1040) 1986
.d:.. CJ
Ifo"~ 1 O~O)
'_Il.rJI\dl G;j;.IS j",iIU Ll;.~,".,~'.;S
;Jnd [;c;(;e,nciliiltion of forms 10')9.13
.. J.!~ ,,(t, I c. r lo' ;1' l(~0
.. S((fr',~','k/,\f~,~..' ",I'D.r~. j',~O,
c:"c~ n~
o () l)
. , 12
t",":"','t'!""l"\"')
,.".,1J:,....\!t'..:r oJ,
r t>r i'" ; . '" .; p, " .' ~ . r f.t I ',' f-l,' I, ' 'I r: ,,, I . ~ (". t " I . \
C ':;1.;,::1 f..'). ~ C-
6
.-:) ", '11',,-,,' t) J r
: ~'~6 t,). )'(ltJ~"b'(;~ l." '0 }iN) v", tU'lII{\)
::'.)
......'.'.1,...;.,
~Ioa I ~ ~! ~
'. ."
I
f.'.' ds lIe1d s:, r,~ollths 'Jr I",s
I J (r) rl '.' c,' ~l'~' I
i ~) ( . " " ;,' ': ~ 1'1 r ~, 1 "'("
. 'l'l..I,,:,'n) ,"~l'.,. ~"",,) I
, ' ,
I I I I
i Ii]
i I I
I j j J
i I
~~:~~. - ~~~~==:... J I ..
.:: :::~.(;:::;~;,T:~~>> .u..1 · ~ ',,:;;:., ~,!t'f:ji:,Sillfu~c:2: F';:'};;~if!d~
===~~. .l~ ,H' ~ L~ -- ~ ~.- : ..:~1.~: ---~ :~ : =..... .1~.- .~. J_
._ , . .._ m._. I ~ . .... ~ . .._~ _.__ .__1..__._ 0,;--',7'0"'IT,-";;;1 ...--. ---~.. ~~ 1- ..
4 Short-term gain from installmt!nt sales from rOtm 6252, lines 22 or 30 _ . . _ 4~:~'B .:-.dJ.!:;:/;// _i /}t,1,/), __. ___ _ __J....._
5 Nelshort.termgain or (loss) ham partnershtps,SeorporallOns,an dflduciaries _ ~_ _._ _ __ __1___ ___ ____ J-..
6 Short.lermcapltallosscaf(yollerfrom)earsb~g,nn,ngaf1erI969 _ . . " . .~ ____L_ L),~:t;",;t;Y, L:.:~":~
7 Add.1I01 Ih.l..nsIChonson 1.."I..n/ Ie ond ,.." 311,loulh6.. [olumns(l)ond (I) ,7 __.---1 )f _____-1._
8 Nel shorHelm ain or (loss), combine columns (I) and Cg) of line 7 , I c I I
lpj;'\: Lan .term Ca Ital Gains and Lasses-Assets Held More Than Six Months ---
-9a form )099.8 Tranucllons 'Salts-of Slacks', Bonds, etc.):- ~~~:::;~~{(j,I{({~;:r0:~M1~;/ v'~i%4:{'11/;;t~:-4,%~{'(.: 'f,/{f!l., f(;;;~:'~','Y.', rvr~9:~~;f.0~;};:::.. --r::-:4
- .~_. .~ i.. u j~..__~-~.-~.; ;...j.~r~~.~~~: -
uJ____'n__ ---i- ---. -~-- ---.--->-------.-- .. __~__."~_--..l~_
_~l-_--J -~-_......-- -. -~ --- ~------- - -~. _u_~____~__~J_
-- --~:..-=~..::_~j===~~.:-.=~- .=~:=-~:=~~~~=-=~~:~~~.:. ::..:::=:~:::. ~~~ :",,~,~,<~~, !-,-
9b Total (add column (d)) ... {1~W,tt%$'r.?:?(,:#;.?i:f.~ #A'1,:':"j'~~:~~,;%,:rM,~: t :;,,;;,1-,;;,,:,':/1.00.,*&(*;.:,/,:. i~
9c Other Transactions: ~- ~:.j;;tl,f% !X~:(i,'.l';::;;: fjf'f,t}tl#:i4111l/l~,rfjJj; w.~';;,'.~ii',f:i/;/;Pl,';:: 1,<7/';/ ;~.::~;"~tfd{~f&@;r. .{:i
p....,r'..~..~ ~"l'...n IJr. r(\'m 1l>40 I
"':>",1",_ F ~
...-.-.....- -
1 Rt'pt1l1 t,,~re. ltlt !\ltJI !,,,1,-'!t 1I! !.'t,:~~, t)O:I{~!.. (.Ie . ~1';';J'~,.d lor
JO~9.6 or an t'Qln:t!t.1! ~~;!",!':l,'!' I_~::ll:'r l'-,t{!t)
If thi~ itlnounl dl~f~,,~ "oln It,(. I(~ifl of hr,,'s?l ,Jf'~ gL. (OI,Jll1n (ri). itl!,.c-h jl ~.~;dL'n,':n: (.,; :l;''':'i C,.. r;.':
for line I, ScI,,'(h.l(' o (rolln l[i"~a) fur '.'tl;";J'h\
('P:,";I'I.. S'I'~.;;t.".lC:-~ I~ C".;Jil.ll G ,I:n! ,'1nd I CJ~ ': '.'S
l'ICt'I(I'r~';'l'o'r"I';'tr1.1 Itl)~J'I..(~..,,.::l I Ic)r.,~!""I(l
I('.'! f1't, 100.",,,,t:.1'" ,,~ I "
,.t1rllPCOI'ZOCo) (..0 ..11,1 (_Cl ('01)' I')
""2a- rc;,m iO'99~B T'<t'rl.,ittl;{,.~' (S,i". H,' ~,':'t~\ r.", ~\. tl~ ),
, .-'\
! 1 I
''::'j(.~ ~,;: H.t u,~:',)r.~"j1!.
(I, l ~:~; S
l' r I . ~ ' . . t ~. .' '0).
.' ..';1 :~i "~ . ,It)
It) to:."
I!(dl'll' :,.t' ," ,,),
_~~'..:lh\' ~- ,.:)
.
..I'
,.
~
----- --
-"--.-- -.-.
10
11
12
13
14
15
16
17
lon&.I"m &.In ham ,,1'.1 ",honl' 01. plinclp.1 mid.." horn fOlm 1119, lin.. 6, S, or 12
Lang.term gain from Installment sales from falm 6252, lines 22 0130
Net long.term gain or (loss) horn partnerships. S corporations, and fiduciaries
Capital gain distribution's.
Enler gain from falm 4797, lines 6 01 B ,
Long.term capital loss carryover 110m )lears begmrunc af1er 1969.
Add.II .lth.t.."",llo", on Ii".. 9. ond 9c ond 11n" 10 Ihloulh 1\ in columns (I) ond (I)
Nellan.,term oain 01 (lass), combine columns (I) and Co) of line 16. , ,
1 0 r7$1/I,;~;;:";I,~i{,;)~~A~'"
11 W4*;~;;}'<<'t:~X.ul~:.:,
12
13;~zt?f;~' ; :~~'Y,~;{':Y~;"
14 !)" .<'.:;1g:...,
~
16 ,-
'''.1''
Ii/I,/.
'?:;I.
.,I;M
J/;'$/~
J "if.'
-
:~:;:!,~~y;j!fl/J.;;;:-+
-:-J
)
1,17
as~e
~SdK
Schedule 0 (rorm 1040) 1986
I.,
~t~tt:" .," ::.~:..!.CJ;;'~::!:'.~ ~_~~':,~.:d-'; !.~... .'il" :"!.
'. ., . "..' ..' l.i. , \;'1'" ; ~''';: ,>; ..' l' .... I, .'
. i :' ':"f ," ;,-':'
C':' r:l: C': -f';. ,-'~!- ,. c:~! II
, ~t j
"1
-. - I
~'"'" 1- , f'...
',-
'? ~-, -, . :"'... ~
'-
.. .
'.. ~
~;. .' ~ ,]
r : ~'!' :
Sur.lrn'-Iry vf P.ltl \ I i;. d II
18
Co,nblne !'/lO 3 ;,nd ) 7, ..".~ H,lt:t :~,'..: (,': l."" c...: (I','-~) ~ l:re
Nc.le: If 'one' J81~ d Ic'~5, 5~;p k,d II) UI'~'!;'~ 21.J ',d ,r. ...j,":" I, d ,;"2 J/ld 23. If line IS 15 J b.,in,
CDmp.'~'r(! 11:'('5 19 th';l~:bh? } ~"t..-I '~'_'P r ,"s ~"2 .J(,(j?J
If line 18 ~hO.'..~.l L,lin, t:r.:cl H~. .... :"'." ull.'-,~ 17 v'II;'f' ]8 rlo~l.;r It.'Iod U',,;:'e
is a less or no l.:l,lry un line 17 . , . . .
19
/19 J
:;s ~d
20
Enl.,60",,011"'eI9 .
If lin~ PO i~ jT'I'f{J N:ar. i~'O, J~"U II:.~) t.!.' I.:~, 'r.' r,.d II..' ,:".'d;.,:t.:..r: 1I:,ni,j}'JIn :!X [:te FiJ:", 6251.
~lJ~llfitctlin~20floUlI,rle 18 [n~-;rt.>~':;l ..1U1rUlln l('~O."r,e 13
If rille 18 ~t.o,';!. J lc'!,~, (:'11.::r (.;.17; (If n,:, k':("..>~ ,w'\' ;015:
a If linl1 B is i,'eIO or a r.el t;.,in. l-nlE:I ~IOI'\~ ,,(llf.t> 18;
b If line 17 is UtD or a nel Lain. fn:l.r l'fle J 8; or
c If line 8 ~nd line 17 iJr~ nt't 10H(>!.. E;r,:er arr,o...nt {lr. hrle 8 bddt'd 1050% of the Jnl(lUnt on line 17.
23 Enler h.,e and ,1> a 10" on FOlm 1040. I,ne 13, Ih, "r.,II.,1 of:
a The amount on line 22;
b $3,000 ($1,500 if fndrlied and filing a ~c'p.J(.j:c fc:lurn); or
c TaJ.able Income, as ~djustt!~~~~J~~tr!1.~lig~sJ.:_.._.._ .:.__ -.~___~_~_-:"____'_h___'_:
t:ttii[l"J Computation 01 Post.) 969 Capllal loss Carryovers from) 986 to ) 987
_ ='___~~:~~OI!!~~I.~i~ p.rUf.lhel~"~,,-n li~e ~2 js r~.'e t~..n Ih, lo"_,,-n .!i!~~.?_3L .. _ _~~~
21
22
24
25
26
27
28
29
30
31
32
33
Enter loss shown on line 8; jf none, enler zero and !kip lines 25 thfOUgh 28, then go to line 29.
Enter E;ain shown on line 17. If that line is bliink or !.hows a loss, e:nter zero
Subtractlinp. 25 from line 24. . . . . . . . . . . . . .
Ente, smaller of line 23 or line 26 . . . . . . . . . . . .
Subtraclline 271rom line 26. Thi, i. your ,hort.lolm c'pHallo!! calryovor from 198610 1987
Sublract line 27 from line 23, (Nole: If you s~.ipped lOne, 25 Ihlough 28, enler amount from line 23.)
Enler 1015 from line 17; if none, onlel lelO and 'kip line. 311hlough 34 ,
Enler E;ain shown on line 8, If thai line is blank or sho.....s a loss, enter zero
Subtract line 31 from line 30. .
Multiply amount on line 29 by 2. . . . . . . ,
,'. 12 I,.. 2
0' ~,_.~~; ;"'.7 il;.~ f:~'~'- -.-
-.".--- +--
I 'f ~. I :.~ I' l' (..' ., . .... "
'.;. ............ .?".t. .1'.. ,J!,
! 181
!
i
i
'r: ::> J
c ~ v..-
':'Icl!
r,
: '~
: .
j ,.
, 20 I
, II
Ie; 11
/01\
22
23
-~--_.-... j -~-
2.~ .J__
26 _ L_
2? J_
28
29
-~Q ------
31
32 L
33 I
_3L~_
34 Sublractline 33 from line 32, This i. your lon..term cepitallo," carryover from 198610 1987,
fP'.JiJ.~ Complete This Part Only If Y~uEi~ct Out 01 the Installment Method and
Report a Note or Other Obllgallon at les~rh~~n.full Face Value ______
Check here if you elecl oul of the in,tal/m,nt method. . . . . . ,. . . .. .......... ~ 0
Enler the face amounl 01 Ihe nole or othe' obl'.alion. ~ ...... ..~........ ........ ............ .................. ........ .......~....... ~..
Enter the percentall!e of valuation of the notE' or other ~ation. ~
[p~i:1J Reconciliation 01 Forms 1099.B For Bartering Transactl~ns
Complele this part il you received one or mOle Form(s) 1099.B or an equivalenl substilute
stalement(s) reporting bartering income. Enler Ihe amount on the line Ihal indicales Ihe form
or schedule you used to report Ihe bartering income.
35 FOlm 1040, line 22. , . 35
36 Schedule C (Form 1040) . 36
37 Schedule 0 (Form 1040) . 37
38 Schedule E (Form )040) , 38
39 Schedule F (Form 1040) . 39
40 Other (identily)(il nolla'able. indicale lea,on-altach additional ,heets if necessary) ~....... ........
...............................................,............................,..................................
Amounl 01 1"0111",,,, trorn
10fm J099.8 Of ,qu.,,~,n'
,111.mlnl
40
41 Tolal (add lines J5 through 40) , . . . . . . . . . . . . .. . . . . . . . 41
Note: The amount on line 41 should be the SiJme iJS the total bartering on all Forms 1099.8 or pquivalent stafementsleceived.
.i ~_ ~_~:~'_..:}::_~..__ _ _ _ ____. ._. . ___
'.,,-.."; ,'~':...:..f",,. ;~"'J'~~': t"" '~'.,,'~'"
-..... .: : ': t- .. ",;...,..,' _
. ..' . , I __ r. C "~'"
..,. . - - -----.- --.... .
"" ..11 In(;U:r.cor(I."',~}:.....,,1r.,,:;, r',l
I .
:' :ClU fC ~JUr. a rr'~~ t~~!CI" ilr,~ ~,i:.(.. '",',~~ t,~.' '.~
, .
,f. ~. r.,
. . ., , '.' I~,' ...', ~ .;,
'-. '"
.d 1-.:.' ;. ,. ~'~', f,:~~? ~,.!'
:"J:I"II!.,
:-',1'::-"'.1 .:;~ ;:rld S Cl11,Iu',lfions
',I" ;."!" ,<, c.: <~ II I r
_ (dl ":"".
I' ....' .'.' . I . (, . I It . I ~ ~ . tJ '. r " . : to'
, = I : r -: I' ~, p
/. I '.:'>
I
j :.? ~ : -) -: is'i 1 j
j
j
I
I
(.)':.IT>r
./~C4Jl~-r.11Jl_~~/r.~.;;/..; !Ir. r (r'1
t!I'.d<!u;, /;t//./.,/. /;'~ ~.../ ....,//.,,.
'S 1:. !')f~" r .J
J I.;
;' i
, ,
I I-
I
I
,
I
i
)
J
I
i
1
!
i
j
I
I
j
I C,jt" P 101 J:'41nt"t-,,~ 5 10' S (O';:".~'l.In
27 Arjd l1lnotJ,ils in columns (e) ar.d (f) ar.d <:nlt:' 111(' f(,Ljl(s) t.ue
, t I.t. ~ : :~~ I: ~\.\ I.... .1
j"P '-, 't' :.,-q .
I~ 11.1. I
j J
J J
j J j
n . _ ~ ___~.J .J ~_ _ _
.127 L.1D}J )). ?i]t;yL_
::t:,'j, .1
.3_oj ~ ~l~? L
",: "",
,', 13
, ".. .... ~t J
~ / .
. j-'
,
( .~ :.:
. ,l' (,: ", ). '.' . ~ .'''. c..r r, : ~l ~
..".' '.,Il ,-1: ','.
-.; ~- ij !-"7i
I
28 Combine dmounls in (olurnns (e) .irld (f), line 27. ~nd <:r,!.::r l~.e II!:t IIlCOlt1E.> or (Irlss) here . . . . . .
29 Oeducl;on for ..clion 179 P,of"rty (from rOfm 1065, Sct"dule K'J, ,nd rOlln 1120S, Sd,.dole K.I),
(See Inshuctions (or limilations.) '." .' . . . . . . . .
30 To:al partnership and S cCJrpori:tion income or (iC'!s). C.:,mbi:1e dmounls on lines 28 and 29. r.n!f:r lhe total
____.!!~~Dd incll!.Qe in line 36 ~~IO'l:". :n_~ _.. n__, _",,____... ..':._.._.. ~_-l-_'_,~ ~_~_~~.
,
1..." 2
. I:,. , U ....~..
,'":.,1
.: j";
I"'..'
:'":'11
.s 1 ~~ ~i
, j
J
I
i
i
J
~1
E,'ales and TrLl;ls
I' (~). -1"-' (C)_. . --(';;[mp~~;--'--[;:'~\~I~:TI~~I;~-] -- (I)I;';::~;-~-
.denh"c"l.on number .: "l~ I.mil.llonl)
LS:,,'7;cCCJi:TJ;Y ...._~-.~~~=--==i- -~~ ~_-=--"'--~L.=
I. /t~'~~'-.l.:;>L.,l{jf~. __U__U_~"___ - -t---
,.>''',;:: ;,1":' :.;";')1, i
-~-- ~~-~~ ---~-~---._- -"---1'--
.e;..:J~";;..',:,. E~:J:;;:~.~g1._______ ____ ___ '_
31 II I
I
I
31 Add amounls in columns (e) and (f) and enl.r thelola'(s) h.,.
32 Tolaleslal. and Irusl incom. or (loss), Cornbin. amounts in column. (e) and (f), hn. 31. Enter thelolal
here and inc.lude in line 36 below . , , , . . , , . . , . , , , , .
~!1T[l Windfall Profil Tax Surnma.ry.____, _~,.__ ___~_~ ~_. .~_____ .______ ______
33 W;ndfall profil fa, "ed,t or ,eful,d rec...,ed in 19S6 (se. In.truct,ens) 3}. --------,-
34 W,ndfall profillax wilhh.ld ,n 1986 (.e. InslruClion.), 34 I 1
35 Combine amounts on lines 33 and 34. Enter the tolal here and include in line 36 below. , . , . . . 35 L
~~, :":::~.~=; ,":.,,;;~,:":~,;:,:,,:,,; ;,,:,.: ::;:::,~;~ ,,:.~-~ ~: .. '" .,~;r
37 Farme;s and flSh.rrn.n: Enler ;;;;;;~h~;-;-G-R-OS~S- fARMINGANO'FISHING ------- ,.td'jf?1%1.~i.itz,.j :::$,
INCOME appl,cabl.,o Parts I and" (se. InslructlOn.). . , , . , , , , , . 37 N};N'f.<<''{fi:':~' 'ffJl
~Optlonal Depreciation Worksheet.-You may use thiS worksheet to figure dep'eclat1on only on property placed In servIce before
1981.11 you placed an)' property in service aller )980. you must use Form 4562 for all p,operty.
Cd) Otp'rclAhon (0
AUowrd0' Allo...abll I) 10I1t,..I,on
mtlhod
.n pllOf ,.nll
-'-----.-._-_._-----~---,-,_.
(A)N.me
(e) Dt'Kriphon 01 plopcrty
(b)OIIt'
.cqu"~
(c) Cosl or
othtl bAllS
A
Tolal (Property A)
~
Total (Property B)
~.
TOlal (Prop.rty C) , , ,
32
(t)lil.
0'''1.
(,) o,pflc."hor,lot
Ihll)'Uf
'E' , '~3' '_:_: --'-'-'-:['_'.---"n~:~-~:"J'-:--~_':"':"'~' ===t' ~~ ---~---
--_._~--, ----._--, ---- .- ----~-,,----- -------- ----- ---
, , ~:-~ ~ , ,--:-- -:--: -:-:--~ -:--:-- ,-:--~-:-,- , ~' ,
-- -- -~---
J~_._==t_ _-J~__ -~~f_-=-~~-:E_ _-=
I
:=:",;'*, ":,'..-; _ :&., (!.,
! ) ...J " ;. C t _ ~ ~ ~; ~ ""..
- -. -.
- - --- - -
I! I: :
: II ~ c~r:~' i!" ! I: i : ~ i i 11,.: I !
: 1-~':f~~L~v~l- .S.~J{!/I-\r 1~1. ,:! :; I !:
" f.:>..... Ll t. r O~Il"'J !!1"",'i'lff E- r .,,- '. LI. ' ,I' .. I
: ; I I I~ i I ! I' I;' r :~ I.
, "~. i:D1c.~ : fr-)''i I !:t.;;;, "I.-l K.. \ I, i i :,' (.'!'W7 i I~"
- j ~ I!: Ii' , i ji ! I i!
t '. I J:':.~~~UJV"I.~_LL.~?:~~':'_, i "i j: I: 1"
: ~J~._I!~L~"-~~.t~~lll~ ., i .,1. -H'Jl.. j.:/s.~.~ -"I: +- i
11 '_~j___.~.JH~r'\:,.Jt-11 ~I I_! I . lL("~'! j , ; . j'
2 I (2;~ I , . . I J; ;' ~
__ __~_;. .1 /I:I-.~ IT'(f'll...r~V[ "', , ;:':'1 s~~ ~ i ~ . . . I
3___.~,JI...:.[IJI/..~I~L.Ji 1.. i'l; !., i~;I'~'i"'!' ~ . 'L
'..~ ..,.j _~jr_tJ. I. ) ,: .1 I I., -~~'J21('}. -I: ; . (,
5 f--~- _ !_._L. '. I._.__.~~_ !__.__._~.-..+-+ I Si.J.9~~..1..-1-'~~)'li
: '-'J-'--~'+-ll'-'-'I' . ~j' ~.: :'~l-~'I'~~+~'~":-+ij=~.t:::],."_-!~~ !'
s -'r---;-T--~--'~-i' ~ i~~ i i . j~T-r~~ I"~T "f:' _1..._1 ' j..
2; -= -'J~~: :~'~"~~'''1:~'''; -~Ii--~-~ :~=-~':- ! -~ .l:' -. I' ":-j ~~.: . '.:~ i ~. : ~ r ~..-~; ~ r... 1;j~
~, -', TI 1 J-T--'- 11-"'---1--1'--"------,--'1-1"""' -... ....
,. __.J.n__. ! -'1----- . ~~..:-- ....ii-- i-~ ~;-- ---i-'~" r' . ~ r-'~"~" -: -- ."
-----1.-~_..~-~._-.~.-- ~--~-,"n - ...!---,.~~- I. .~~-, 1 ~i
4~ ' : I' j:' 1 I j I,'..
:. ~.- .,--. -i~..t-- ~ .-..-.. i' .. i:'~ ~ i ~.' ~I ':"
~~ -.+..--:- 'I-'-r- - I~ I.. :!. i ~ 1-' I --;. I ;.. ~!- - .-- - :.,
...J_~..___. ----.- ..---~-- .--!
2"__1___. L_~L~_:.._~! . !. j I.. I - ! ~ ~ .1: -1. !. .---. i:~
:7 J" I' I I' ..'
__,..m_ --- --- ~: i'- I "'.j. ';.... 'I" .,.~.
:1& ____1_.. ' ___.1 I I , i~
~: ~ ~-- -t- ~~:~~~~. - --- j-- .~~~. ::=~;-- . - -'i ~- I.~~~'~-~' ~~-- 'i~- f- 2>
:~ -;-~--N i;: ; .~-:-- -- " ,~- ~.._~ --~-i --j- -----T -~~-+-:~
I; ! i I .- --.. '-' -- --;.. - - - - -.-. --':'1- ~-- --...., -- -.-- ---,--- ---~. ..--\"-
I :; I; "I : ~ :: '- ~-- -- ~-'- ~~- ~ ~-' ! ..j- ~- .:~~- ~~~---"J- ~~
j, 35 : i ' j- ._- ----- ~---.-~-- ---- - --~ - -- - : -......:.. ---:- ---l---'--,~
1 ~.:; :: -T- : I : +~ ------t- ~- - -~l.~-:~;. ==:~- =:-:=.1= .-: ~"r ____:__L~;
~~__ ...... ~_ ___ _ .J__ ___ -_~~_ _-~.- --- I--
~: : -:-: -- ; ..-1~-- ==~~:f:::: i - ~"~~: --i-- --:~: - ~j~ ~~- -~-- =-~. =~T= J\
--- ---~-- --_._- --.----...-- --_._.. ..-.-....- +---_...
i I II!.. Ii, I
I
I.
,
j
I
I
I:
,
I
,
I.
;
~':"'~"'[, y,.)
\.~ ,n . '.:'~S)
Partner's Share of In,:oll1c, r.:r(;(lits, Dr;,hctiOi1s. (~tc.
r ~.' : t. '. ._ ., .1' . .. oJ'
,."~. I" . _ "OJ
:.';',. ~I ~\:: ',\ t: ;::,~../'
;.
:f.1
,,c ~ n~)
I .,.\
. ~..-' ..
~l~,.'.r,j:"lr. ..
- ~
!'.,t1.'.(:r'!. if.tn1~1)'int; nUr.l!,cr ~ 2(jO.. :; ~ . J ~ I} {;,
poJ{l.. "r'~ 1'"I;lIC, djJ:"',~, lIf.d liP (ode
P..,: r.I':.~, i". .-:. ..: 'I,r!, :.,j ,:.LI ~ ~'3 - "": .... u"j ;.C;
:-",;;,("~ 'i':,' ,t.,,' ....<,_,..;"cl..'"l,.',.lc
:,'_-1" '_'"--, J,.tL...,6"\',,, ~..JI_:(.JJJ;/i'- 1/~.~'J)''',L(
~'),O. I.~':')<. ;;:, (jG
b ~ l >"_ ,. ~ '~L1 (", p.\ I~'- :.f (l .
./.$ 'Z. ~'_'\ r'-"..,,;.t.i.'(" ~T.
(_I. . 1 .:. u:' ,J A /'I '-I ~
,
(. 1\ ,) 1.1 './.r'. r) 11
I
1 1';'/ .~
l "'-.11 I 1.'0 D t', I ., " . _ , .. .. I (I):' " t I:' ','1'"'' (ui r ',~ol
A(1)i5.I=-.,'l:':\.'fa{;(:".c:JI,.J1tlicr.. V':J '.,~ ,.,,'. 1,1""'_'r~ll..ll,,,,',.,;..l'(J, I,.,...;,',,:,U(\ .r'"
(f.Y F'd~:"'(;~~"'i'~ur.I)')Il")('~"loQ:J"":lunA(l). rl(!.l~I;:.Jf&. .........% .'.a'1.~1..9b
')..." ,
(2) D:"!' ;_.1Iir,(:117'.,O,:t:,.d:r r..:11.':lttltc ,t, :~lC I (" . < .1~,:IC . . _. ....% .. ...-..11..%
:I.h~':' 0: ~i:"'I;-,,'~~' ,1.:t:\,,:Y('l'!l) In;;lIl.:..(J III ('....... . ',.;. ~Jl,. ~',':JI I),) :: ?;H ~"
Ilr.l'~ la. 7. 10, .1nd 12? . I ] YI'!. I ] .~o [ 111'_ie,_..:..: "".l"(' I l~:;'l-':":"illlk'd'l',:.i~'~l'~ '.e)/I.'L'.~~'.~'~..
(3) D;.,e!. .,011:-,er iJr.llvely j:jiH':I':ljhlle In the f Till S~.._::( f "~'tl!-: ~.j:'un r~U;i,~iCI ~ . . .. .f: /I.".~ .'
ren:al real (;~:(l:c (}ctIVI:)'(IC!.) Ine Illded In fit 1) (LV. P.:s; :r~(:' !,t,:;,!>> tl:-.I)') Old nl(~ r,~rtflcr'50 0.',;.(': !.~,:p j:,:(lt:~lln
"r.es lband lId? . ,J I'es 11 No lI,er,"':,'e"!l'p;r,ure,ea::erOct 7.2.1936? 11\'eslJ No
PJlli.Cr'!. !.1:Jrc oll"lbdltl(~!' II 11'\. ,'::"':~ ...:.1:/.;..7,(::11 (~~i!; ji}! 12 oll!.e FOlm 1('1[,5 l!"' :r"i.:.on~)
Nor,lccour!.e. ' $ ..... ... . . .. (2) (F ,Y. r.lI:rd:r~!lIp~ onl)') Did the p.lltlll:l~lllp !.liHI (,: il( lj "te a
O:her. . . . ., ... $. ~." ~ . :-:",," ~.' o c.'" "ct:y,ly "fie, Ocl. n. 1986? . . . I] \'esl ] No
C Wha: Iype of entlly IS Ihls Pi1ltIICt' ~ -C.vt'\\ \.11 ~.....',-\ L II yr!:a .1::,.(h !.:rllf:r:1f:nl (~,. e j:,lbe 12 of the FOIm 10651 ~:'t,c:'O:'l~)
H -RE"co~c~~ill(m-of-Jlartii-er;~-cipllal "drcouiit . - -1' C), \0 ( r r,ll u., :.",(.:1 (('I tI~\\!\-t.r~ .,.(I,j-{lrdl-(ll~\" ,.... - .. 'n~dUl ~(~)'c -, ' ,- ,-
--- c -- -- -J .- ~ l~ J I)' J !,.."l""\,} & .......,(t.Un
("! ~;1 lAl,U (Ovnl,1 (bl \..01;1.:...' lClnlll~ull'r\ (e) (1I":. My .f.( (me If (; .. ~n(() r.l~' _'f' (to u;"" , P 1.1' d \11 ~ ..lion. .1 t-r ~ c.~ ,u'
_ _.. _,~t:: ~~~!".J~~ __. _ _.!!~L.l("'" __ u,.~].!.I:J.nl,,.!: :..l<c ."~ n . U '. (,fC." ,f' ,,~I.(........('t1('~1.,~,on~,. - ~- ~---- -- - - - - -~ -
__.__~~_$'.:J~_.-l..____ __ __.J!4, ~\'~l~ . ~ p _~.?:'../>~_ J___(.~?, ~'i().._ __ ..i!o.'C: q~I~--
C.lulion: Refe/ln J:factied P.Jf:.1f1"51n5J!.!!~/I~I_~ /01 Sc,'J['.f~:e_K.. J (~~Jfjn lOllS) t't"'ll((.' l~,,:e_/lr:g_l!!.'-E.!!.~,!!IQ-,1 f(o.j!~~1l:5 ~clu'E:~~ e!.1 }~(l.J~ :;;_1 ~Iu~
T. 1 (c)I~S610401,:"..nler
(a) Dlstubullvc sh.lrc lIem (b) Amount 1he amour:lln cvl....;-." (b) on:
-- 10 Oldlnary Incomelro,s) . . .~~~:-~.~- .----.--.~ ~ .-1 ~-.-; :T'f:~~~T~; . Sch. E. Part II. col (~)~,(i)
b Income 01 loss from lenlal real cslale act,v,ty(,e,). (F.Y. PJIlr.r.rsh,,,s f.:,,;,;..:,::-.., ::...:.:..;::...:..!.:;~.)
only). 1
c Income or IDS!. from o:her renlal actl\'lt}'(les). (F.Y. PJltne~shlp~ only) .~-~~~==_.~ (!.c"P...-:~t"~I"\h"'1 .a\llII)
',I",:"" ,', 'I ",11""7, ~~I.f(I~f'" Hfoll .J(i~1
d Por1foho Im.orne not reponed elsewhere on Schedule K.l. (LY, ,."1.'~I,III"'l.~{.,I"..::",,,~,,,,;.:,,Z..
Partnerships only) .
Guaranleed payments
Olv,dends qualil)'IO& for e,clus,on
Net ,hort.le.m ca",t.: Lain (loss).
Ne\lon&.lelm cap,lal La,n (loss) .
Nel C~Jln (loss) uncicr M.'cllon 1231 {oilier than due to CiI!oIJ,ll:y ur thell)
Olhe!jall.ch ~he~llle)-,---,--,-,_~, -,-,_.c-~-,- -'-_-' ---'-..c- ,~_.
Ch.ulable contubullOn' ,~l? '(''''.
ElPCn!oC deduction for reco\'cry p,ropcr1Y l~.Hllon 17,9) '. '- . . .
Olher (.tlac~~chedu~<u~ "~E.'.c. '-!..!.Mc!:_~': ~..r.~ -'-n-'-~~ - ----- - ---
Credlllor rncome la' w,\hheld
Low.income hou,ing credll (F.Y. Partnersh,ps only). .
c Qualified rehabilitation cllpenditurcs related to renlal real estate ';~z;:~:f:;r;;~2~i::~;'i:~tYd%:'irJ.fI'
aClivily('e,). (F .Y. Partnerships only)(allach schedule)
d Credlt(!a) relaled to rcnlal real estate activltY(les) other than llb and ~?::.~!/;}:f.i~}d:'Jl:/,;;}~:i/;>>"1.%3'.
Ilc. (F.Y. Partnersh,ps only)(allach schedule) .
e C,edlt(!a) ,elated to rental acllvity(ie~) other than llb, llc, and] Id, ~1i€[I;&;;;'I;'illZ%~%1Xji-~
(F.Y. Partnelship, only) (allach schedule).
12 Olher rre~,I, (allach 'ched,!I~Lc---'~__'----'~ _,_~,--~,._"~.c_ -'--'--'~-' ~ ~__u__'__
'C
E ~ 1 ~ Nel earnlOgs (loss) Irom .cll.employment .
~E
_ _ b Gras!. falmin" or flshin" income .
-;;.2 tJ Do
VI 0. C Gross nonfarm income
Fo, P.ge,work Reduction Act Noller. U'e Form 1065 In~\ruttions..
2 '!> ~'-
B
~
'"
'"
o
...J
-
Sch. E. Part II. co:"",n (I)
._____~~ _.._ Sch, B. Part II. hoc 4
_______ _.__ Sch, O.llOe 5. col. (Il or (g)
___~__~ _. ___ 5ch. O. hne 12. col. (I) or (g)
_~_~______ __'_~__~ Form4797.lme I
. __ _ _____._ ((~~O!~~l'~~~~~~~ a! ,nul Illlflfl)
..
E
o
u
C
2
3
4
5
6
7
B
9
10
110
b
)(S" r",~.., 1"1''''''""' I~)
!>4,ht'OIlIt'''' Il O"U 106~1
u
~'"
'Oc
"0
0'';:
___ _m'l_L:L_~ .
_____~:!(j_n_
""cc
See Form 1040 In.'rucllon,
(!>l.rr..rt.'. \IMUu'I.(..\ICW)
S,f'lod".t" 11''-''" .:l6~1
(~'2.c~o~ ~lt,~.l!..l:~ _~J~~I'hllfl)
See FOlm 1040 In'lrucllonS
'"
-
:g'
..
u
(..'!.>.B
-- -- --- - ...,,-_. --._-
([nltl('ln.l"l"l,t'hltl,~~~!~
Sch, SE. Part I
\ (~tt' roO'I...'" \In\''''II,,,,''IIlt)
I !ocl,rd..'f" Ilro'n'lo('~1
5th.dul. K.I (Form 1065) \986
~~...rt"
..
u
C
..
~ ..
."1 E
....
~ -
Q.-
w
'"
I-
~
..
~
~
.!:
~
e
..
S
~
..
>
.!:
~
..
.
N
l-
e
..
'"
~
o
...
~
..
=
o
..
1!
a.~
N'-
u"D
....
0:':;
0_
~c
-..
.!is
.<>~
~ ..
Ill>
..c
~-
~-
.. 0
a.
o
Ii:
:H,
1-':/,;'/2~
, ~1' 2
(.;:.. ~:':'.;I;.c ~. oUt illm
~~: J. -,~ ..nl
:~I :',1.(, :(..~C"';l'r~l-.:cr
:' ! ; :.r ..:-.: .:-. f (II" ~.., p'! lln.
114.
b
ro~ .,.;;..t;r1y ~:p;,(C .~. ~t;:,':1: l."vc :~b7, ,~:,t'( ,.'~': .'t...,: i:...:, t.:, I
r,...~I(''',,'C'Y /till VCj.(..::)' or 1 S, 1 S. or l~' ..{ ifr II J' i",;,c:r1y.
:~
ror ~1(.Jr,crty p~itc.,'~ In ~.l.::"'I((' tll.l,.rc 1~1&7, ;.rr"(::,J"'I~ (;, ;,~":i.:irln j.
or.I(J!.l'C: ;.e''.tor.a: ;.".jll'[1y or II ~1~.C'~ 1('([;..;::)' ;II(.;;C:, (~::,i.:; :~,..II' 15,
18,0,:9 year I(.'J: rl''::'j.lJI1y. .,
. I 6
c Dc;.rt(,J:,on ,Jd;u~lr.il:n: (or, f,r(,~.\!I~)' ,.':,c.f>d III :.cn';cC' '-I::cr : ~f3
d Ur.,l~J.J~:cd :l,':'~:\C lc~!t (LV. PoI::r.( ~',h';l:' ~nly).
O(';11c:,or. (olllel {t.Jf, OII,J;"H'~ L.:.1S)
(1) GtO!l.!. ImCJrt,C ~r':'m oil, 1.>1:', .J,.d t.:1'1.::.(-Ilr,11 ;'~";'l':i.P.S
(2) DrdiJc.llor!>> a:i,l:ab:c 10 (Jll. [.i!5, i,"~ ll':.:t,(.'::r,al p'u;"."~IC5 .
g (1) Q.;a:i:.ed 1:"....t'!I:::.(:r.1 H'Cu:~-'(' If :LH~':d In 5d:t"Ju1c K.] I I,r.c ! a ,
(2) Q.;al.!lcd m\'c~:r;',"nl c\;,c;;:.i.'~ ir.clllc:cd in S~~ ,,_'ju:c K.l.l.:'ic h
_._ ~_ _ q~r.:.~_r.!~.lI~f~1'c_~_(,_C~Jj~).
15. Irol....1 ..pen.e on;
(I) In,e.lmenl debl. inc""ed bcfo'e 12/17;69
(2) In,e.lmenl de~l. inculled bdo:e 9/11/75, bul "fler 12/1 C;69
(3) In,e.lmenl debl. inc,,"ed oller 9/10/75
b (I) In,e.lmenl income included ,n Schedule K.l, line 1 a .
(2) In,e.lmenl e.peMe. included in Schedule K.I. line ]a
o (I) Income from "nel lea.e properly' .
(2) E>pen.e!J!!lm "net 1('~~y!oEe!!y-=--,~_"__,_ :..~-'-_'-'_~'-,
Type 01 income..................... .. .........................
Name of foreicn country or U.S. possl'~!.ion ....................._.
o Tolal g'oss income from .ou,ce. oul.,de Ihe U.S. (atlrich \Ched"le)
d Tolal applicable deduclion. and 10"" (atlach \Chedule) .
e Tolallo,elgn I.... (check one); ~ 0 Paid 0 Accrued
Reduction in la... available for C1ed,1 (atlach \Chedule) .
Olher (atl.ch \Chedule) .-C.. -'--'--'-_-'-
!(.'.~, f.;'S). l,r,t.:,c
"";;;
-','\;
,:.;(;
c
f
_I r l,i". (J;:51, I,,',e ':d
J \ ('" ,.:.., ,,,,,,.,.... 'N)
i I :'.'..',.-.... Ill,,,,,, :lot'!'>1
rl~llj.IJ;'~ 1,llr,c 41
J ~..~C fl."n ()~~51111...11l,':I'CJns
J ~.H FO'lilu?SII:.,trl>,I.on.
1 } n:.: '.:'; .. .';i ~:::.".;:,:,n
. . ':,~' ,,::,X-:
..,,,,,,...., .......1.:'...'.."......,...,...,14
..I
',14
.......;;,../
16.
b
fOlln ~~J2.I,ne 1
fOlm ~~J2, lone 15
furm t.1J~2,llne 5
.. ~_(,.i.~~ }
__ ...___~ _.__.~~_.h (':' ".,,,". "",'''''''''::,'N)
...."tll..""' II '''''' j"" .
-.------,p.. .,-.-
.---.--..-....- ---. ---.,---.--.-- - ._- ----
/~},~'i;:Y)./~I..':"ii:;I;';\V;:'I,.., ,;{~ form 1116, CL,ec' Lu'.e.
,./. .,.1"".,,,,,,'/.,.,,...,,1. ,,'~;J fi "u
;:.t!~~:.: I. ,:,~'!;:x;; ',':~.': :/i~;;,' /;:,,:. ~~' J
../.'11.1.,''''""",...,..'/.....1."..."."....,. form 11 ]6, Part I
_____..~_.h_ form 1116, P.rll
form 1116, P.rt I
fOlm 1116. P.rl II
fOlm J 116, Pari III
fo,m 1116In.lru,IIon.
,
g
-;;:-~;r;;-~7ir:;rl .,;.. 'I.~ii ---------------
:/11''':'. ,.;'n '~I.U' . I,I';J (See Parlner's (nstruc.
'Y...t.:'I'1.....~.':./., :"f,1 ISh d I KI
::'."/, ;.'/:: ..~;,'(f,.':.tI',..::<:(!':~~.,.:.;i,./,J "on~ or t e u e .
..".: .,.J ;."'."':' ::"....;., .:( (folm 1065))
;'~:"":':"l;\ ;l;::1~1.:~:::~'/ .. '-~r-'. -:--:';T,;7r:-:.u'~-~
C I,':.;, r;{~;:'."'~>;f:4:w~.;.~a.;:;~.;.::.;..~,';'.ll;;~
1-..,.-II(/'11'."...Io"'.,,'.~'.'.,''''..,.'!..,,.'/~
'1..,-......;,:.,. ,'l.(" .:I.,....'..',...t'.','/I'.:~.".,':f,
; ....r:i.-;.;,;Y. ~:':~~",.~,:'i"li~ "'I.~ /f' .:.;.t"_7.. -:;, ~
.,-,..t .,..",. ..,d.,i'/II', .1,1"",'1/,_ "'d~.'r.~''''
"~'-"''il ..(..,p. '7.'....',Ii',.,. d.." ../,~
':; -;; >. '}~" ,; .~..{.'I,I;IJ.:"'- ,~' '/,:.':: :r/ ,:?tt
,,/......I.."-.'I'1.-..'-'/J.,:~I,/'.I:.. ".,.'11.
1~.~.;~'i/{:t!:...~~:J}[}irit;@~ii;)};.i;~~~
.', "l'hu",T:}I:' 'i,;",'.I..1'~/.I,I:i""''''/;(''?,{
:.,..~...f...~,,(?!...,/~"',.W';~J,/4 ~/I"o/." ..~
...,..'(.,}/..;.v..it<','l.k/~..:r,;(IW,.,.d..Z.Yi
r/;;~;jFl?;;;:;J;;::{:I.~fl.i.0';;:i'/;~;~;~;).;il...
17
Olhefllemsand amounls not included in lines 10 Ihrough 16g and 18
that ale required to be reported separ.lely 10 you
18
.
A
8
Propcr11es:
Oe1t11pt.on of prope,ly
(S:ale whelher Itcovety
or nonrecoyery
ptoper1y. II recovery
properly. 1~ale whelher
lecular pelCenlaGe
melhod or ucllo"
4S(Q) .ltClion u..d.)
b Dale placed in !lervice ,
c Co~t 01 olher basis. .
fo,m 4255. lop
fOlm 4255. linn 2
fo,m 4255.lme 3
',"'''. :..:./'1'J.....~./:: /f/'.'Iw/'''''''/14.//1I.:/0.1
':.'ei";:-'I.~;:';~~, ;,%I!~I/;I(,~. ,.;.",,:.'.:-
.1.1 P". '.,..1"".. '/'l.'" '.I/~',I.I. ';iJ'd' II,
".'.,.,/,." "'111''''.. _" 'Ir',",'''7, "I"
"~".J.:/,:y,1,'1.:, .'1Iij;.'~01/';z 1,?-:j; " 0~~:A
't.,'ilii/ll..'1I/".IIII/I.i'/.'/I'''I.V'''~;j\~.III''/IHIi:
Cia!.!. olleco~clY prop.
elty Dr orielnal
e$limaled u!.eful hfe .
e 0,1. il.m ",..d 10 br
investment tledil ploperl,
Othor Inlorm.tlon P,ovldod by Partnership:
d
FOlm 4255 lone 4
- ':"/';Zfllli(M:;q,:jy),~?Ii:;J/':'1fM}!'(I/1m~
r.MiuiZl&lni1/.Mu'IIMIH;:fQII,wilHXr.~/&
Form 4255. Iono 8
..(.,.; DUI( S( j Corr.putiltiun of Sucial Si';curity Sc;lf.Ell1plo)me:nt Tax
(rum ]040) to- "11- !',,:l ~..~,:..~.t.,~..'t !:.[/rl'rr H,t-OJ
:', ....t...f't...T"u'"",
1'1' :;..".1 ""'l.t I), > ,.....t It ft.'fr 1('010
r;::"'-~ol..-~.\;~-~..~'.U'I'ti""~I''''t'r'II''"t,'r', "~ " ..... ,,' t'~;""...::) ! (,," ,',.-." . "-,,,'" n
." ..'_ ,.. ,w .,... ' '" ..0 ..
J);;;\~ j:: ~r:..,...:>'.I.,rT ::-r :'o'..:.~rlf\,:;.':,~till,.,'.~_.!.~ .....'...d
t~:/;; -t=.~-~~-'~_r,~(Jrrl,p~~!~~i~~ of. tJd. r.-:tnir.I;~ rt~1n ~{:~I.f;nplo~lil(;nt
r:ote: 11 you {J(:dOIt:lf.d H'~''':e5 far ((-':1111. 0;,,'(; :",t I" ,'Itll';!; dF.:'lJt:.",d (J'i.::1 ...rt.on ane ,OU iJtt (l~:
J m/ni!.t~( Of J ffl~f1.t,t:1 of J 1(., ~",.'tl(, II'I~L", _If t' fI.I' I"~!,,J: '.)"~ :,O:;(uf(- ((/,,,,,-,':: ~I~i t,',(- .(,:.tl'-'C:i/~
r:et falm ~Ioflt or (It:~!t) {'c.m Sc.hl..rj.;le f (r(Jr/n lC..:O), lint' 3e, <:r1d fill/f, I'drll.(:'!,''':!\, Stt'I'(1~1(: K,l
(rolln 1055).1"..130 . ,
2 r:!:t plOfl1 or (Io!.!.) florn S~~.I:t111t(' C (rlJrm 10.1['1). l'llC 32, j:',d Sd.(,t1ulc Y,.1 (rurln IGfJ5). 1I",t" J3a
(ott,.:r It-,dn !"fl1llng) (:.r.e I:" :.ltlH. :i(JIl!. for {M;(:f II <:{Jl; ,(.10 If.;,(d ) Err'r,IO/{'!'!. 0' an c :HI.q~ eh'llth or
,tlulch.cCtllt!Olti'd {\'i:a.,i:a:,on no HOT t,:f,lcr )n;f rUIlr. \\'.2 \'''~i~': (,n lIne 2 Sf:(' Ih(. n'!iolqj(l,on!.. , ,
','o'e: ! ] Ct,{.c~ ,J,t-Ie il jOU dre C'H'/;:pt I..,rn ~.df l....ptt')/I.t:n.. ~aA on your (-,jtnl,'~lS as iJ m..1;5:er, f ~
ti;o3;mt,et of,j IL1!j;;"U$ Older, Uf c.'1~':.'.ill ~C,,"I~{' ;I"'C:,,",'-;;:' :.~( .')l:S(' )'ru f '('G (ofm ''361, See :
iI1stfUc(,'I:.tlS fJr ki:.ds 01 "'(011,(' to tt';'~lr1 If JI~LJ t:,?" ",','.!.! u;rnif'!.'s 01 !.JOO or '",Jle t,'.,Jt .He I. _: "
~~tJ~~':~.'?_:t~f ~~~~~[J 11;('11' :_H. l:i~/j.~:. :',;--c (,:.";I'I!.~ Of} k~~ 2. . _ i
Optional Cor.lpulatlon of Nel E.,"il';l from Solf.("'plo)'ment
(See "\'~~~o_C~n U~e~!!~~.edule SE" in Ihe Inslruclions. Also see Instructions fo,. olher Ifmltatlons.)
Gt:nf:rally, this part rna) be C!lE'~ only if you fIlC<l:1 any of tI,e follo'o'Ilflg "'!Its:
A Your trOlj~ falm incomel wzs nolmare tt~(jll S2,4(10; or
B Your &to!lS fatm income' wzs mate thitll ~2,400 and YOUI nr:l fdlm P'Oflt!.7 were It'~s than $] ,600; or
C YOUI net nonfalm profits' v.r:te It!:.s than S I ,600 an~ yow r:el nfJn~affn profils' W(:IE' also I("ss :han t"lo.thirds (~'J) of your t;.o!:.s nfJnfolln ir':fJme,.
Note: If line 2 above is tlvo.thi,ds (H) Of more of j'our .!ih~B lJoll!Jrm inC;OlJit". or, " line 2/5 $ J ,6000' more, you may no' use the 11ptiiJ!':.31 ,:-.~:~od,
'flOm Sch.dule f (folm 1040). lin. 12. and Schedul. K.I (rOlln 1065). lin. 13b.
'from Sct.edule f (form J 040). line 38. and Sched;l. K.I (form 1065). I,n. 130.
'from Sch.dul. C (rorm 1040). lin. 32. and Sch.dule K'I (fOlIO 1065). lin. 13a.
'from Schedule CJfolm 1040). line ~,-"nd S~~du~e~ K~'llrollrUQ6?).I,n. 13c.
3 Maximum income for optional methods ".." . . , . .
4 rarrn Oplional Method--II you m.el lesl A 01 B above. enl.r. Ih. smaller of Iwo.lhirds (!~) of grOlS farm
income Irom Schedule f (form 1040). lin. 12. and farm partn./lhips. Schedul. K.I (rolm J 055). lin.
13b;or$I.500 . . . . . . , . , , . . . . . .
S Sublraclline 4 from I,ne 3 . , , . . . ~. ....
6 Nonfarm Optional 1.\.lhod-1f you meel l.sI C abov.. .nler. the smallest oltwo'lhirdl ("~) 01 gross
nonlarm Income from Sch.dule C (form 1040).1,"" 5. and Sch.dule K.I (form 1055). line 13c (olher
Ihan f.rming); or $1.600; or. If you el.cled th. farm oplional melhod. the amounl on line 5. . . . ,
~1'.1jJ Computation of Social Security Sell. Employment Tax
7 Enter tho amounl I.om Part I. line I. or. if you .I.cled Ih. farm opl,onal melhod. Part II. hn. 4
8 Enter Ih. amount from Palt I. line 2. Dr. if you el.cl.d Ih. nonfarm optional m.lhod. Part II. line 6.
9 Add lin.1 7 and 8. IIlell Ihan $400. do nol fill '" Ih. r.11 of Ihil Ichedul. becaule you ar. nol subj.clto 1.1f.
employment tax, (Elceptlon: If you are an emplo)e~ of an electing chulch or Chutch,controlled organization,
see the instructions. You may owe self. employment lal on the amount you report on line 12c.) .
10 The largest amount of combined wates and sell employment e~uOlngs subject to social security or
raihoad relir.m.nll.. (Iier I) lor 1986 is
11 a Tolal socialsecuflly Yoages and lips from 'F'o;ms' W.'2 a'nd 'railroa'd r~lu~m~nt'
compensation (tier 1). Note: Medic.Jfe quahf,ed goveU1ment employees
whoJt wages afe only subject to the J .45% med,ca,e (hospitat in5utiJnce
bon."'s) tax and .mployees of c.ttain church 0' chu,ch.cont,oll.d
o,ganilalions should not include those ..ag.s on this lin.. (5.. ,"sfruct,ons.) lis
b Unreported tips subject 10 social s.curity tax from form 4137. lin. 9. or
10 railroad retirem.nt I.. (tier I) II b
e Add lines Ila and Ilb. , , . . . . . . . . . . . . .
12. Subtract line lie from line 10 . , , . . . . . . . . . .
b Enter your medicare qualified government wag~5 if you are required to use the worksheet in Part III
01 the inst,uctions. j12b I I I
c Enter your Form W.2 wages of $) 00 or more from an electing church ot church.conlrolled organiza.
tion, I J 2< I L..J
13 Enter the smaller of 1m. 9 or hne 120 . . . , . .
If lin. 13 Is $42.000. lillln $5.165 on lin. 14 Other"'le. mulhply hn. 13 by .123 and .nler Ih. resull on
line 14 . . . , . , . . . '. .... ,
14 Self.employmenl tn Enler Ih" amount on rorm 1040. I,n. 50
ror P.p~rwo,h Rrductlon Act Noliet, su rOlm 1040 Instrucllonl,
f~ '"
1~),.i_1
;
/501-
:'~~'~:8G
L'-,..' t-
. . '. 18
~ ~ l '.:: .~~
:&;
',,'Q.
2
S')1 . S
, ,
.I{%
'':~
'f~
,'l;~
:r" "".j'.':
5 _._:~:-:-~~-__L--=
6
~ t-i~fi~~.+ ~
.!:~IO~ !
IO-~:~. oo~~l~;
':l/A. '\i"'i/;'~';~ii,&.l,r:;~l-~
:;f/j{. (~:11{:/,;.:;,~~'I,;:~'L,:: .-. .WJ.
C#i5.~ ;~f;:lf.4t~M~,_l:, . -. I~~
~\ill'i.i ~"%I..WfI'I~tj;.;!",..}.....L.';;.li0
".i.'I~ :ri,1;.0~@W,'1IN."">""
y. ('P~'$fJf#f,';r!).
liiill W$1I(o/,j,mI~W,ijl<<f.&:;r:'I;;,
'MfA !Y/;@},i'$l#}i!~'i!' :.
WlllllllmZ'1 kWzP&Il<..,......
lie 15""-
12. '1"'''- B
Iq 7$i1!1~~Jft.i}i. '!:w;,
. f&Ij,WILil~/''J&;@':!~':';: 'f,1;'
I w/,% ,z r.,X1;~~7.. z 1/1..:.1 ";"
~' W.'" W w"yw"';b'" .,' .,,,
?1,'t,it;71, it'!!;: 1/1,;ltl"I'1I;;'."_'~:.;i' "o!
(I'/1,/1,1/7IA",1,;1IZ/..',,' 11 ,/~
.)zi;f:t :':i;"~/;I::}:j"j,~!'~~f'" ,:'~:4
"ff" iZ;(W:,;..~,~~>.,~
f0l
. :'1-,;
:X3~l~
14
9
.123
'1 ~ll T--
Scht"dulr S[ (form 1040) 1986
. Schl:dulc W
(rWn 10'0)
De:c1ucti0n for a r.iarricd Co:.:,Jle
\'r'I1',n ,,0tl1 Work
~. ...~ '.; : '_~: ',f.' ~
c~~~ 3-G~
~ ' ; .... i t ~,' ~':'-t 1..,.' ~l) ~ r ,../ r ..; '. .,' I :'I, :' ..I; ~< ~ ,. d I,. . . (. ... t r {, I ,n ; t.::, I' "... v'! : 1"'.
1~'IP',..'r:t.l',.1 !.v..tt (11 ~ :.....,t,lo:. 'L'll' J~,10
~~':lI~~e~~! '!J ~~:,; o~. r-~',~ 1':.'0
.. _.__~:l f ." ~ _~~r'rrt,,"'J'l (>. :.l,\."_;~\(_'-
Stcp 1 F1eurc your ~nrnr~r:l incorne
I
1
~ ':,,' ..,'
,,~. ,I, 20
I 't-u' ';l~..' IH,'';'''". -:,."
_.::'~""" ;'b: !_~Li'- _
1 WJ~('s, ",!"ries. lips, ctc.. (1010 fl,"n 10.10 hlle 7. (Do r,ol
illclud.; ~)'::r.1jioIlS Lr .illnlJiti':s H::I(JIII.,1 (JO r()lI~ 10.10, line 16 or
lilies 17d dnd 17b.) .
2 N.~t rJIUfl1 or (1055) frum ~elf'l:rIlplo)r;,d,t (f1tdn Schc.\1u!/!S C and
f (r'Jlln JO~O), S(.,..ju!~ K.1 (rolln 10(,;), ".,,~ ""I' (,\1.." I "r".d
inc(J!fle) .
nJ'!
(b) Your ~pou~e
Jn05l
-- -.-.- --_.-
(,,) You
1
1
~_~~~ 11~le~l__~J~)d..?:.. !~~_S._Ls_.ro.u.r. t<J.t.ll.'.dIYI.l'd irl((Jme.
Stcp 2 FI~ur~ your qUCJlifk:d earncd income
. -- ..... -- -.- -. ..- -_.-- .-.
4
2
3J
S'il~"l
, !1_!:j~_J~
2
1.31_?_ 11_05' r ~-~
---~- ---...
l
.
- -.. ..-..
Add .,nounls enlered on Form 1~0~0, lines-?5, 26, 27, dnd a~y
~cpaymenl ~f supplemental unell,pIOI'lIlenl t,,,r,efils (sub. pay)
rncluded on Irne 31. Enler the total (see in5truclion5 bclow) . . 4
5 Subtract line 4 frorn line 3. This is your qualified earned income.
If the amount in colum~ (a) or (b) is .ero (.O~) or less. stop here.
_V~,!,_~.notlake this dedu~.lio(1--,- ~~~_..~_~_"-,--,--,--:._-c-~'- .~.~ _~ 5' S- ~
Step 3 Figure your deduction
-------------- ----
6 Cornpare the amounts in columns (a) and (b)of1i~~ 5~~b~ve. Ent~; Ih~ ~,~~il;;;;_;;,-o_;,nt her~~
(Enler either amount if 5(a) and 5(b) are the same.) Do not enter more than $30,000 . .
(;..:.
4
_.--~------
-- -----.
5
rnJ 5"
-------.--
6 --~-~~: ~J -
7 Percentage used to figure the deduction (10%) . . . , . . . . . . , . . . . 7 x . 10
8 Multiply the amount on line 6 by the percentage on line 7. This is the amounl of your deduc.
tron. Enter Ihe ans.....er here and on rorm J040.line 30 , ,l> 8 () 1/ I
I nstructlons earnings dnd gains (other than capilal - Repayment of sub. pay included in
Complete this schedule and a\lach it to ga,ns)Irom the dlSposrtron. transfer. or the total on line 31. See Ihe instructions
your Form 1040 if you take the hcen5rng of properly that you created. on repayment of sub. pay on page 12
deduction for a married couple when . Earned rncome does not include of the Form 1040 Instruelions,
both work. You may lake the deduction rnler.sl, dlvrdends, social security Enler the lotal of any adjustments
if both you and your 5pouse: benefils, IRA dislributions.. Ihat apply 10 your or your spouse's
_ work and have qualrfied earned' unemployment compen5atron, earned income in Ihe appropriale
income, and deferred compensatlon..or nonla,able column of line 4.
_ file a joint return, and ~n~~~~t ~~~lrS~ do~es~ n~\:;c~~de any Step 3 .(lines 6. 7, and 8).-Figure Ihe
_ do nol file Form 2555 10 exclude C I' 0 P,P 'dY . deduction based on the smaller of:
. au Ion: 0 no consl er commumty th 'f' .
Inco~e or to e,clude or deduct certain property laws in fIguring your earned .- e qualr ,ed earned Income enlered
housrng costs, and income. !n column (a) or (b) oflrne 5. whrchever
~ do nollile Form 4563to exclude Step 2 (lines 4 Md 5).-rigure IS less, OR
IOcome. qualified earned income separately for - $30.000.
. There are three steps 10 follow in yourself and your spouse by sublracling Example.-Vou earned a salary of
flgurmg Ihe deduction On Schedule W. cer1ain adjustments from earned $20.000 and had $3.000 of employee
Stop 1 (IInos I, 2. and 3).-Figure income. business expenses (Form 1040. line
earned Income separalely for yourself Qualified earned Incomo.- This is Ihe 25), Vour spouse e.arned $17,000 and
and your spouse. amount on which Ihe deduelion is had an IRA deductron of $1,000 (Form
Earned Income.-This is generally based. Figure it by sublracting Ihe lotal ,1040.Ir~e 26). Vour qualrfred e~rned
income you receive for services you ~f cerlain adjustments from earned mcome rs $17 .000 ($20,~00 minus
provide, II includes wages, salaries. tips, mcome. These adjustments (and the $3.000) and your spouse 5 IS $16,000
commIssions, sub~pay, etc. (from Form related Irnes on Form 1040) are: ($17.000 m!nus $1~000). Bec~us~
1040,lrne 7).1l also includes income _ Employee bu"nes5 e'penses (from your spouse s qualrfred earned rn~ome
earned from self~employmenl (from line 25). IS less than yours. Ihe ~educlron IS
Schedules C and F of Form 1040 and . IRA deduction (from line 26). f,gured on your spouse s r~come.
Schedule K.1 of Form 1065). and net _ Keogh retirement plan and self. Therefore.lhe deduct ran IS $1.600
employed SEP deduction (from hne ($16.000 x .10).
27).
Sch.dult W (Form 1040) 1986
.
1:',''''..~ JJI", ,...~.,,' "",-...
,:~-:.:."! ~:_/lr"..!.'i
_ ____..___u__ _ _. _ _ _ ..
1 [.~...t I '.'~ .:"111 I"::" ('4If
r'
._----~-- -------
,.t':""._:...
1'~-:'
, .
W." \'.',,;! ,od
hr Sla:u;";llt _1_~36
;~f ;b~' ~l,.tl~J;:{~
J ~_~%?~~
7 "~,'''a f.C ,.".,,,,
II -, I ". ~.'
( '0:
... .
(~. _,~ T
~ L. ,t,,' . i.
CC
..:'
, ,
,',' .
,-.t,':J
'V
~, .. .
II'''~!. '! r
$'.....[A ";1'
1-,- ",..'d '."
(~':.T'..~l.l.t;:c, ,.:FrIC" .~ L..L..J
(:;- t t t,:" =: l /1, 11 ;', II',. .:".
~ -. .. r---'" " -_. -... ..-.... ,_.1.___.. -_. '--'.. . .
I ("': ':~ I .:.c I '......, ", . :;: I I,:. I , ..-. ',... .. t" )10 ..... ;., 'II ~""... .1'1..'....
1l..,: :.."'-, ..: ':. I.!. ___...._____... _____ ...._ '_,_._ J.:. _L~J ~._:_~
"r,-: ;.., I '.-, ':~'I'I ..: llrH'~ II'.." . u:~ 't ...... ,
II r ~~I!~!t,~~T j~lr.l.~.t\
;. " , -", r. T S T 11;; :', 1./ r' --- ! . ! h
:',: ,. ,\ j ."., I J " ~ r I ." ~ " T
. ~ ,J.~)~':',!Jl.~ .~ _ _~_ ____~ ~. ______.._~_
'.'.' ('4 1<'.'1 'n~ ~.~
Irfl~~;;'~"!.~f~=~ ;:rt."!~!i..!!t1.!fi:. "-';C;1'!ll:J.l1._
_'___.h____~________ ___. '--.;1l0.J"-it~':'::;CLi!!._ II..lFL~~r.!..!'1 rr!..~'~II!L..-
C'.'r111.tnt 01 If., T'''Sl:,)'lnlt,r..,PfI.''". S,.",. O'.'BNo H'~-6))lJ 1 t,. f.f' J ~'O 1 . ~O ell IS
(;"T )0.00
11!o<':.......r..II.>l...,W
,.!--..:..'..'....II"..
--- __~. J } .1_".. .~-F_
{'.<(
i"I.' j,~.,...t:~..-,T:j";:;~..-~-
"
--- .-._- _... __4 n_
-.- -.-. -. --.- - ~._-
._.. ._-- _.. - - -"-
, . . ~ ---r
. ~ .; r..." _.,__.______ :1'0"
2 {4; ~ .,. , . ,... .: :'11 I t.; l,r C 3"
..,..
-3.~'
,~
....-
j...... '--'-'- -J-
.!,., 'I... '" ___... _ ....:! '. ,,:f :-.' ';... . ":.'
\V-2 \','iq;t and ". ... h.','. "
TaIS:ali:r.'lenl 1S8S . -:.i"::."~'''I..~7.'.'
" - ....., -"-'. l' ...-,.... .
'1-""" r.. "i.:- ,"": (,"'~./.~ ,,'/.."X' Y$
., 'f' CUlt: ,-: I~~' w/.,",v/'r;!-;~"'~H/~:m
r... :0.'Zl'Y.'~"././';~':r/&'.
""K;".;-f,:'~i-f~:-<;(yj:
1":':a."'I'ol '7 .:....lfl.:a.-t~
,
.{., ,......., "'-.... '.-" ('0;;;";"'''',.... .:....
If{.I:.tI.......:~<..,._::,',_
-.-
1'0 "".". 1 =: '.....l~~ll... ;00.
1;150:,. ,,,(,,'',",;,,
11':-:, u:..'.'......,:
,. t~:,. It:..." ":1
II
'~h l' ';1 :'"f
,
I
,
'f.
~,..I' ""'1 .., -"Ih'.. ,. ,.", .t""Jll.',CI
--n--
'-
,
,.
"
"
o...a t.:. .~~ ~;J8
., - _ _4_... ..._____ _
.
"
,
,
!1040
Label
Use IRS 'lb,1
Oth.rwlse,
pleau print 0'
type.
D,p.'tfllt"' ollh. y,..,ww--1nlt'nal ".....flU. 5.'..-'"
i!@87
'"
U.S. Individual Income Tax Return
.1987,'O(lln,
fo. the yu' J.n -O.e 31. 1981,01 oth.r I.. yu, ~Imltnl
VOUf flfit (l.m..nd Iml'" (I'jolnl'llum, .1'OllvI.poust', nllme .nd IM..I)
1..\ ,<-0 l "Il r Jf/V~I~
PI".nl horn. .dd'," (')umbtl.n ,I'H' 01 11,11,1 roul.) (II you hive. P 0 BOI, U' pIa' Eo ollnll,uchonl )
'J1
lulnlm.
<I!. a \fl. fOil ((-II
C,ly, IOffn 01 po'l ollie I. 11.'t, .nd lIP coo.
VlI\\)\\ r0
11"'13
Presldenllal ~ Do you want $1 to go to thiS fund?
[1.cIlDn Campalan' If 'olnl r.lurn. does our sou,. wanl $110 0 to IhlS lund?
Filing Status
Check only
one bolt.
Exemptions
(5..
Instrucllons
onp.ge7.)
If more than 7
dependpn15, see
Instructions on
page 7.
.~
Income
Pleas. attach
Copy B of lour
Form. W. . W.2G,
and W.2P here.
If you do nol have
a W.2. see
page 6 01
Instructions.
~
Pleas,
attach check
or money
order here,
Adjustments
to Income
(See
Instruclions
on page 12.)
Adjusted
Gross Income
I
2
3
4
5
(4111:.I,llOfIl'lIlI
LA"M
l11 tl\~." \
S~"11l1~
!<'(l.IN\..J
d"
!,s't!'tH
Mv~'iVt.
Ol1"nl'\);'\'
d II your child didn.t live wilh you but is claimed IS your dependent under I pre.1985 aartement, check here. ... 0
. Tutal number of exem lions claimed (also com lete line 35)
1 Wages. salalles, tips, etc. (attach form(s) W.2) . .
8 T.II.bl. interest Income (also attach Schedule 8 jf over $400)
9 T....lImpllnterest income (see page IO). DON'T include on line 8 9
10 Dividend income (also attach Schedule 8 If over $400). . .. .......
11 Taxable relundS 01 state and local income taxes, ilany, horn worksheet on page 11 01 Instructions .
12 Alimony received. .......,
13 Business inco!'fle or (loss) (attach Schedule C).
14 CapItal gain or (loss) (attach Schedule D) . .
15 Other gains or (losses) (attach Form 4797)
161 Pensions, IRA distrIbutions. annuilies, and fotlovers. Total received
b Talable amount (see page 11). . . . . . . . .
17 Rents, royalties. partnerships. estates, trusts. etc. (attach Schedule E)
18 Farm income or (loss) (attach Schedule f). . . .
19 Unemployment compensation (insurance) (see page 11)
20. Social security benefits (see paae 12) 20a
b Taxable amount, if any, from the worksheet on page 12 .
21 Other income (hst Iype and amount-see page 12) {lll"\ 13 '1_ 1l\ Sl1'J~~'\',. 1r\",or
22 Add thl amounts shown in Ihe far ri ht column lor lines 7. 8. and 10-21. This is our total Incom. .,
23 Reimbursed emplo:fee bu!oiness elpenses horn Form 2106. .
24. Your IRA deductaon, from applicable worksheet on paie 13 or 14 24a
b Spouse's IRA dtductlon.llom Ipphublt works1'lttl on P'lt 13 Of 14 . 24b
29 Sell.employeo hralth Insurance deduction, from wOlhheel on paae 14 2!\
26 Keogh rehrement plan and self. employed SEP deduction. 26 "000
27 Penalty on early Withdrawal 01 uvings 27
28 Alimony paid (recipient's last flame N$M
and soctal secullly no ____ 8
29 Add IlOe\ 23 thloURh 28 Thcu' aft' your tol..l.dlustmenls .,
30 Subtract line 29 !tom hne 22 ThIS IS you1 .diult.d Irou Incom.. If thIS t,ne IS less than
1.' 5,432 dnd d child I,~('d WIth you. sre "earned Income Cred,'" (Ime 56) an (MEe J8 of
"It> In$lru(t,ons If all w,Mt IRS to " 'u'r OUf t.u StoP .1 'f' 15 01 'Ill' Instruc/lOns . II-- 30
,19 OMONo 1545.0074
You, IIKI.I.uUflt1 numM'
D.. i ,,,- i '~"\4
SPOUlI'tlocl.1 ",uI1I1 numIN'
/1'1 i)G. i 7,S)
ror ,.iVK, Ad and "ptfWOf' R..
dlKhon Act NoIKl, '" hlltfllchoftl.
Nol': Ch'dl/tl..y.....III
nor ctu"., 10Uf I'. 01
rtdln ,.Iund.
mNoof/MIIlh
hrtclII fOII'ADlIlf
1_1911
NO.olchlldrtn
onkwh.ll'Itd.
.;Ih,..
HO.olthildr.n
on6cwhodldn.t
Iiv.wilh JOIIdu.
tOdlYOIUor ..
up.llIhon
No. of p".nh
hsltdon6c ...
No. 01 oth.,
dtpendents ...
hsltd on 6c
SlOgle
Mamed Mini 100nt return (even il only one had IOcome)
Mamed Mini Stplr.l. "turn. Enter spoul,'llociallICullly no .bov. and lull nam, hlft
Head 01 household (With quahfylOa person). (See page 1 ollnslruchonl.) II the qualllYlng penon Is )'our child but not
your dependent. enter child'. name here.
uahf 10 widow or with dependent child (year spouse dIed'" 19 ). (Se. page 1 of tnstruction..)
Caution: If you can be claimed "' dependent on .nother person's tax III urn (Iuch.s your pafentl' ftturn), No of bom
do nol check bol6J. But be lUll tOCheck the box on hn. 32b on piS' 2. ChKhd on 61
r;:;;t r::;::>I 11.41 Ib ·
6. ~ Yourself 6b LC.,I Spouse
c Dependents (l) CMt. (JIII'I' S 01 Ow". dfPCMUI'.
at,. I
(I)H.m.1IIfll.I~11I,I.Il\dlllll\llIlf) II'S IOCllltCUfllrhlllNI
..
~
Addnumbtrl
.nlllldin
beuISabovt ...
... uO ~
,c.;).
7'156
(, o,,~
, ~ ~~ I
[2J
W
o
o
o
')
t FOfm 1040(l981)
TIX
Compu.
tltlon
e,ution: -
II you
checked Iny
ball on line
32., b, or c 34
Ind you
don" 35
itemizt, sel!! 35
p"a" 16 for
the .mount
to .nter on
lin.33b.
37
31
4 39
~o
Credits 41
(5..
lnst,ucllons ~2
on pia. 17.) ~3
44
~5
:
Other
Taxes
(Including
Advance EIC
Plym.nts)
Payments
Attach Forms
W.2. W.2G,
Ind W.2P
tohont.
Refund or
Amount
You Owe
Please
Sign
Here
P,ld
Prep.,.,'s
Use Only
Uooer p.n,'hfS 01 petlury. I d.cl", lhall ha.... Il.min~d Ihls "Iurn .nd 'C(omp'nrl", Khldultl .nd st.t.m.nls. .nd 10 the bes' of my knowltdl' .nd
bell.l, Iher 'If Itut, (ottfcl, .nd compl'I.. OetWlf,hon 01 pr.p,r,' (Olhff thin 1'.p'rIF)" blud on .1IInlotm.tlon 01 which p'lj)fIrtr NI' .n)' knowl~..
~ Vou,"'&",'U<I D.'. VOU' occupl"on
~
J I Amount "om line 30 (adjusled &ton Income)
321 Check II. 0 You were 6S or oyer 0 Blind; 0 Spous. Wit 6~ or over 0 Blind
Add the number of bolleS checked Ind enler the tol.1 her. . ... 21
b If you can be claImed IS' dep~dent on Inother pinon's return, check hefe. ... 32b 0
c II you "e mamed IIIln8' separate relurn Ind your SPOUII l1emlzes deductions,
or you art I t1ual.llatus allen, lee page I ~ .nd ch.ck here, , ... 32c 0
33. It.mlnd d.ductlons. See page 1510su if you should itemiZe. If you don't itemize, 'IOter zero. II
you do Itemize. .ttach Schedule A, enter th.,moun' from Schedule A.llMe 26, AND Iklp line 33b, 3].
b SI.ndard deduction, Read Clullon to left. II It .pplles, st. pase 16 for the .mounl to enter.
If e.utlon doesn't I SlOgle or Head 01 houlehold, .nter $2.540 l
.pply and your IlhnS M."ued flhna lomtly or Quahfyma widow(er), enter $3,760 ' , ,
stalus horn pag' liS: Marued flhna sepJr.l.ly,.nter $1,880
Subt,.ct hne 33a or 33b, whichever .ppllll, horn hne 31. Enler Ihe IIlult here.
Mulliply $1.900 by Ihe total numb.r of exemptions claimed on line 6e or III char1 on page 16
Tlllbl.lncom., Sublract hn. 35 from 11"1 34, Enter the relull (but no' leu than z.ro) ,
Caution: If under age 14 and you h.vl mar. th.n $1,000 of Inveltm.ntlncom., check here ....0
.nd Set page 1610see if you hive 10 use Form B615 tofigur. yourtu,
Ent.r tl'. Check II from Dr.. rlbl., 0 Tax RII. Seh.dul.., Ei!lSeh.dul. D. or 0 loom 86IS
Add,,,onll t.... (... pia' 16). Ch.ck Ilfrom 0 Form 49700r 0 lorm ~972
Add hnes 37 and 38. Enterthe tol.1 , """ ' ,
Credll for duld and dependent car. txpens.s ('filCh Form 2441)
Credit for the elderly or for Ihe permanently and totally disabled
(,""ch Schedu/. R) . , . . , , . , . . . . . .. ~I
Add hnes 40 and 41. Enler the total , , , ' , , ,
Subtracllme 42 from line 39. Enter Ihe r.sull (but not less than zero) . ,
foreign taa cltdll {att.'h rorm J116) . , , , . , . ,. 44
General busIness credit. Check il horn 0 Form 3800, 0 Form 3468,
o I~m IBB., 0 lorm 5418, 0 lorm 6761, or 0 lorm BIB! .. ~5
46 Add hnes 44 and 45. Enler the total , ,'. , , . , , , ,
47 Subtract hne 46 from Iin. 43. Enler the result (but noll.ss than zero) ,
~I Sell.employm.ntt.. ('''ICh Schedule Sf). . . . . , .
49 AlternatIve minimum laa{,ttach Form 625J) , , . , , ,
!SO Talllrom ,ecaplure of Inyeslment credit (attach Form 4255) ,
51 Social security tax on tip income not reported to employer (,ttach Form 4137)
52 Ta. on an IRA or a qualifled retirement plan (attach Form 5329), .
53 Addlmes47throu h52.Thisis ourtol.lt..
5~ ledorlllncom. t.. wlthh.ld (tncludlnat.. shown on lorm(s) 1099) S~ S (..
55 1987 estimated till payments and amount applied from 1986 return I (,po 0 0
55 Earned income credit (see page 18) " ",.",
57 Amount paId wilh Form 486B (eJ.tension fequell). , , , , , ECI.o
58 Eacess social security tall and RRTA tall withheld (lee page 19)
59 Credit lor Federal tall on gasoline and Ipedatruels (,ltlCh fOfm 4131)
50 Regulated investment company credit (.ttach Form 2439), 60
51 Add hnes 54 through 60. These are your total p.ymenls
62 If line 61 is large, than line 53. enter .mounl OVERPAID ,
63 Amount of hn. 62 to be REFUNDED TO YOU. , . . . '
64 Amount 01 line 6210be apphedto your 1988 estimated ta. Ii' 't&
65 If line 53 IS larger than lIMe 61, enter AMOUNT YOU OWE. Attach check or money order for full
amount payable to "Internal Revenue Service." Write your socl.l security number, daytime phone
number, and "1987 form 1040" on II , . , , , , , . , . , , . . . , . , , ,
Check Ii' Dilfofm2210 22)Of is.Ulthtd S.. .20, P.n.lt.
poun's Slinillutt (1110ml "Ium, DOHt musl ,Iill)
O,lt
)I'j t...\..)
PttPillf"S ~
\'i"oIh.lff ,
rl,m',nol",'(!)' ~
rou".'ull..-lI1pIOrtdl
''''"o1dI11~''
Oll~
ehtclll' 0
,,1I,employed
[ I No
ZIP cod'
10Sl'.
11 ~
/;
5oS6'
.l'\'St.
'18 t
"plfet 'IOCI.I -.culllr no
SCHEDULES A&8
(Form 1040)
D'piftmrnl ollh. T!lnury
Inll1n.1 R,v.nuI SeNlt. CJl
N.m.(.) ..,hOwn on fOrm 10040
V~(..l r , lUr,,-/I.
Mldlcelend
Dlntel Explnsn
(Do nollncludl
IIpensn
reimbursed or
peld bl others,)
(500
Instructions
onpas021.)
,
Tiles You
hid
(Soo
Instructions
on paso 22.)
Internt You
Plld
(500
Instructions
on paso 22.)
Contributions
You MidI
(Soo
Instructions
on paso 23.)
ClsullII end
Theft Losses
Movlna
Expensn
Mlscelllneous
Deductions
SubJett to 2%
AGI Limit
(5..
Instructions
on paso 24.)
Other
Mlscelllneous
Deducllons
Tolllllemlzed
Deducllons
Schedule A-Itemized Deductions
(Schod"l. S lion b.ck)
~ Attach to Form 1040. ... Sulns'rucllons for 5th.dul.. A and B (form 1040).
lit" 1111,"
Oil
OMB No 1~4!l(X)7.
1]@87
AIl.ehm.nl 07
5'QuClnc. No
Your 10(1.11.(urlly numb"
):> ~ ; ,Co ; I lj
v'lfJl!%I~'.~~.rf,jj111 WtJ
~'V,I"IIW,i "I'.
*l1.1!f1~IIP
"~f.. .
ifj.I:.~~%;itfJ
WiJJ,!:tdf$';)~ lfl'*~1.4
%'!ii!j)i!i.~A ~fl
;~J',J.I.~ fj
4
S
~
,~
1J Wi W4 f@.'~
_,WI!. i*:ffl.
r~IJWIY#11
,~I~
1Iw.11#21
~
26 Add the amounts on lines 4, 8, 13, 17, 18, 19,24. and 25. Enler the tolal here and on
Form 1040, hne 33a . , . . . ~ 26 10&6':>
For PIlf).rwork Reduction Act Nollct'. ll'l' form 1040 I"'tructlons. Schedult' A (Form 1040) 1981
1. Prescription medIcines and drugs, insulin, doctors, dentists.
nurses. hospitals, insurance premIums you paid for medical and
dental care, etc. . . . . , . . .
b TransportatIOn and lodg,ng . . . , . . . ,
c Other (list-include heanng aids. dentures. eyeglasses, etc.)
.. . " . .. .. . , . , , ~ , .. . ~ . . " . ~ , .. .. " " .. .. ~ . .. " " .. .. .. . .. .. ,
......................................................
2 Add lines lathrough Ic, and enter the tolal here. , , . . .
3 Multiply the amounl on Form 1040,Iine 31, by 7,5% (.075) . ,
4 Subtract line 3 tram line 2 If ,era or less enter ~O". Tot.1 medical and dental . ~
Note: Sales taxes are no longer deductible. ~ 1%
5 Slate and local Income taxes , , , . , , , , . . , ,
6 Real estate taxes , , , . , , . , , , , . , , , ,
7 Other laxes (hst-Include personal property taxes) ~........
7
8 AiM ihe "amo'u'n"t, "on "Iiries 5' itirou"1i 'i. 'Eni., iti. 'toial he;.:' Tot.llaxes , ,~
Note: If you borrowed any new amounts against your home 11<
.tter 8/16/86 and at any time In 19871he total 0!.1I your fIi.
mortgage debts was more than what you paid for your home .
pluSlmprovements, attach Form 8598 and check here, ,~D ,,,
9. Deductible home mortgage Interesl you paid 10 financial
Institutions (report deductible points on line 10), , , . , . 9.
b Deductible home mortgage Inlerest you paid to individuals
(show that person's name and address) ~...."...........""
......................................................
10 Deductible points, , , , . , , , , . . ,
11 Deductible investment interest , , , , , . , , , , ,
120 Personal interest you paid (see page 22), , 12a .s SGo
14. C.sh contributions, (If you gave $3,000 or more to .ny one
organi,atioll. report those contributions on line 14b,) , . , .
b Cash contributions totaling $3,000 or more to anyone
organi,alion. (Show to whom you gave and how much you
gave,) ~........"."...,."......"..........".. .........
15 Olhe, than cash, (You must attach Form 8283 II over $500.) . .
16 Carryover from prior year , , , . . , , . , , . , .
17 Add the amounls on lines 14athrou h 16. Enle, the otal here. Tot.' con rlbu Ions
IS Casualty or thelt loss(es) (attach Form 4684). (See page 23 olthe
Instructions. . . . . . . . . . . . . . . . .
I;}.I I
'\d',)
19 Moving expenses (attach Form 3903 or 3903F), (See page 24
01 the Instructions, , , . . . , . , , , , , , ,
20 Unreimbursed employee business expenses (attach Form 2106)
21 Other expenses (list type and amounl) ~...."...",.....,...""
......................................................
22 Add the amounts on lines 20 and 21. Enler the total. , . , ,
23 Multiply the amounl on Form 1040, line 31" by 2% (.02). Enler the
result here . . . . . . . . . . . , , . . . . .
24 Sublr ctline 23 tram line 22 Enler the result but not less han ,era . , , , . ~
25 MlScelianeous deducllons nol subject to 2% AGI limit (see page 24). (List type and
amoun!.) ~ . , . , , .. . . . , , , .. . '" ... ..... ..... . . , . . .. " "...................
"",:;,1.
:
SCHEOULE 0
(Form 1040)
Capital Gains and Losses
and Reconciliation of Forms 1099-8
OMBNo 1~~OO'4
[]@87
.. AIl.ch to Form J0.40. II> S..lnllrucllonl for Schldul. 0 (form 1040).
'or Pap.rwork Reduction Act NoUn"" form 1040 In.trucllon..
AII,ctlm,nl
~qurnuNo 12
Your IlKl,l lICUln.. ,,,,mb,,
~~"';.' :"Jl i IL'i ,
[)tp.r1m,nl ollh. t....uf)'
Inl,,,,,1 R,v,nu, SlNIU (31
N,m.(1) 1\ ,hown on r~'m IG40
\))~l f. f (..4r')'f1"'<t Pl"~1I1r.- :1f.
1 Report here. the tot. I sale. of slocks, bond.. etc.. reported for 1987 by you I broker to you on forme.)
1099.6 or an equivalent subslilule stalemenl(s). If thIS amounl d,ffers from the total of line. 2b and
9b, column (d), aHach a statement e,plaining the d,lfelence. See the In.truction. lor line 1 fOI
e,ample.. Do not include real e.late transactions reported to you on a form 1099.R on line 1, 2a, or
9a. . . . . . . . . . . . . . . . . . . .. ......
Short.term Ca Ita I Gains and Losses-Assets Held Six Months or Less
(.)COItOfOlhfl
b.I'I'(N'
Imhuchonl)
1
(.)OAIN
If Cd)1S mOt' 1I'l,n{.),
lubll.cI(')'lOm(d)
el) DesClip110n of pt~"r
(Ea.mpl.. 100 thl'" 1"
_ pttt.".d 01 'Z' Co )
(f) LOSS
1I('lllmol,thln(d!.
lubllul(dlllom(.
(dO.I.IOld
(Mo., d.,. rr.)
(d) S,lel PIIC'(U'
Inll/uclloni)
,
2. form 1099.8 Tranllcllonl (Slln of Stock I, Bondi, ,Ie.); (Do not report rul ulale transaelions her.. Su the Instruction I f01 hn.12..nd 9.,
2b Total (add column (d)) ~ ~~~ ~:> , ~
,
2. Olher Tronllctlons: , '0 ~/ f ~,: )/%,':/ , ~I/ ." , ,
: 3 Short.term pin from sale or exchange of a principal r.sidence flom Form 2119, lin.s 8 01 14 ~
..
4 Short.term gain Irom Installment,,'es from Form 6252, lines 23 or 31
5 Netshort.term gain or (loss) Irom partnerships, S corporations. and liduciaries
6 Short.le,m ClIpitalloss carryover .
7 Add.1I 01 Ihelllnsadions on Iin1l2. and 2c and linll 3throuih 6 in columns (f) and (i) . 7 )
8 Net short.term .a1n or {loss}. combine columns mand (0) 01 line 7 . . . 8 I T
. long.term Capital Gains and losses-Assets Held More Than Six Months
90 Form 1099.8 Tronsactlons ISoles 01 StockL Bonds ItC.): {Do not re.ort ,,"I e.tate tran.actlonj hlrl. See theln.tructions for lines 2a ond 9a.
9b Tolol (add column {dll . ~ m ~
9. Olhsr T,on18ctlons: 0 '.' ~
10 lon,.I...,.in from sal. or IIthani' 01. princip.1 ...id.." f,om Fo,m 2119.lin.. 8, 10. or 14 ,
11 Long.telm gain "001 Installment ..Ies Irom form 6252, IInos 23 or 31 .
12 Net lore.term gain or (loss) Irom partnerships, S <orperations, and liduciaries 12 1'1S(.
13 Capilalgain distributions. W. ,0
14 Enler gain Irom form 4797,IIne 7 or 9 4 ,
15 long.term capital loss carryover 15 ,1,', ,
16 Add .11 '" th.lllns"lions on linll 9. and 9c and linlllO Ihrough I~ in columns (I) and (il 161( ,., SI,
J7 Nello"".term Rain or (loss). combine columns (Il and (g) olline 16 . . . 17 ''1St- I
Sch.dul. D IForm 1040) 19B7
5Ch'IIu1r 01'01111 104011981
N.m,(,).' "10..1\ on rOft" 1049 1001\01 ,nlr' fUr'I' .nd '\lc..I IIC\JIII, "UIl1lH'111 ,hO,.., on othfl '111, )
l'i"'~1 (. . v"'J-~'1l ~ ~"Ir~"f. .:]1.
AII.t hmrnl 5.qu,nu No 12 P'K' 2
'Iou, u,I.I.u"rU, "um""
dOC ; ~(, : ((.41.:
~ Summary 01 Parts I and II
,
\
18 Combine lInes 8 and 17. and cnte' the net Gain or (loss) here If result is a gain. also enter the gain on
Form 1040, hn. 14 . . . . .. .... .............
Noh: If Imes J 7 .nd J8 ,rf' net B4mS and your "..ablr mcomr IS taled over the 28% tal rate, s!e Part
IV below You may b. .ble 10 ..duCt you, ta> ,I you quaMy lor the .llem.I". faK compul.tron.
19 II hn. 18" a 10... .nt.r h.r. and.. ala.. on Form 1040,I,no 14. the .ma"., 01
I The amount on line 18; or b 3.000 1 500 If maUled fllln a Sf alate return .
Allernatlve Tax Compulatlon
First complete Form 1040 through line 36.
u.. Part Iv.1 both hn.. 17 and 18 ,how n.t sam.. AND.
AND form 1040.lIn. 361, oyer: You ch.ck.d ruln.,t.tul box: AND
$27.000 3
45.000 4
You ch.ck.d f11lnllt.tUI box:
1
20r 5
20 Enter amount frorr, Form 1040, Ime 36
21 Enter the smalier 011 he sain on line 17 or the Sam on line 18
, 22 Subtract hne 211rom 20 and enter Ihe result . . . . .
23 Enler:. $16.800 if you checked f,llnS status box I; b $28.000 il you checked MinS status box 2 or 5;
c $14.000 if you checked Wins slatus box 3; or d $23,000 il you checked MinS status box 4
24 Enter thel,..t.r of hne 22 or line 23. . . . . . . . . . . . . . . . . . . .
25 Subtraclline 24 from line 20. . . . . . . . . . . . . . . . . . . . . . .
26 Flsure the amounl of tax on line 24. Use Ihe Tax Table or Tax Rale Schedules, whichever applies.
27 Multiply line 25 by 28% (.28) and enter Ihe ..suit. . . . . . . . . . . . . . . .
:
Add Iin.. 26 and 27. Enter the result here and on Form 1040. line 37 and check the box for Schedule D
Computation 01 C.pltalloll Carryovers From 1987 to 1988
Com lete this art If the loss on line 181s more than the loss on line 19.)
Enier ih.,oss shown on line 8; If none, enler zero and skip hne. 30through 33.
Enter sain shown on line 17. If Ihalline is blank or show. ala... enler zero .
Subtractline 30 from line 29 . . . . . . . . . . . . . . . .
Enter Ihumalier ofline 19 or 31 , . . . . , , . . . . . . . .
Subtract line 32 from line 31. Thi. is your short.term capital 1011 carryover from 1987 to 1988
Enler loss from Iin. 17; iI none, enter zero and skip lin.. 351hroush 38 .
Ent.. sain shown on line 8. If thaHne is blank orshow.. loss, enler zero . . . . , . , ,
Subtract line 35 Irom line 34 . . . . . . . . . . . . . . . . . . . . . .
Subtract line 321rom line 19. (Note: "you .hlpped line. 30 th,ough 33, enler Iheamounl from line J9.)
"29
30
31
32
33
34
35
36
37
5ubtractline 371rom line 36. This is ourlon .term ca Italloll clr over Irom 1987to 1985 .
Complete Thll Part Only II You Elect Out of the Installment Method and
Report a Note or Other Obllgatlon.t less Than Full Face Value
Check here iI you elect out oflhe Instaliment method. . . . . . . . . . . . . .
Enter lhe faceamount oflhe note or other oblisalion . . . , . . . .
Enler the reenta e of valuation ofthe note or other obi; al'on . . . .
Reconciliation 01 Forms 1099.B lor Bartering Transactions
Complete this part If you received one or more Form(s) 1099.8 or an equivalenl substilute
statement(s) ..portins barterins 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(odentify)(if not taxable, ind,cate reason-altach add,tiona' sheel.1f necessaty) ~ ...............
...............................................................................................................
18 ,,\S
: tA~;;' ':;I/::'I;:,;:,;tI (:t;/~:~~~ . /'t'
In'l.'1L" 'I il',i'.'~:-',:%111. o/;:'ffi //'.' i
,~/.e.:i /?!k1',~ ~~:1f?:",.~~~ Il.:;;
'ltli~l Il'("I./lI.')Jj/;"f.it?f I.h.
z'*,1;:;,.:nffM;}0;~~~~J,HM. ;;i-}:,(,.
19
Form 1040,11"1 361, OWl':
$22.500
38,000
28
"'/1
3S
. . . . . . . .~O
. .. ...........................
...
Amour,t 01 blr1ttlnalncom. from
Form 1099.8 Of equivalent
II.t.m,nl "port.d on 'Otm Of
lChflSule
48 Total(.ddhne.42through47).... ~..............,.... 48
Note: The amount on Ime 48 should be the :tame as the 'ot.ll bartering incomt on all Forms 1099.8 orr-quivalent statements received
S(h.dull' l (folln 104011981 P.,. 2
N'nI'(')" \ho"n on r~1/1l 1040 (Uo nol ,"l.., n'nll' illld socl.-1 Sf(Ufll~ numl.lt'. .1 sho"n on 0111,., ~Idt' )
OI\U (. E l-,"'j"j "tt HV~'\\"ft Oil
Income or (Loss) from Partnerships and S Corporations
It you report a loss below and have amounts invested in ttlilt activity for which you are not al risk. you MUST check .Yes. in column (e) and attach
form 6198 OtherwISe, you mu,t check .No." Sei\ln,l,uctlon,
~
(b) [nl.,Plor -
(c)CIlIlCk .1 (d) Employ., (.) Not ,t,RIlk?
(.)N.m. palln",hlp,S 100..a" Ill.nhhuholl numbel
, . lor SCOfpOf.lloII pa'tn",'"p V.. No
A f-'.....l\~ r \l~"\ I~J,'".'f , PV4~l ( ~ t ~ ~.. itti "ll ) r ~~'~aSo,J , )<
B n\l{~\I'\ \\~''''vv,'' \\\\lc.."^"" , rl...~'\r . --=-=r-- '\'PJ~l"n '><
I
C ,
--
0
E
Pa..lv. Acllvlll.. Nonpa..lv. Acllvlll..
(lJ P.nl~.lon .lIow.d 'I) P.nl~'lIICOmll (h) NOllpaul''1' Ion (I) Slchon 179 (Jl Non~"lV' lIIConw
hom fOlln 8582 lOIllSch~ul.Kwl ham SChedul. Kw 1 d.ductlon 10m hldul. K~1
A l'l'}c.. t~:lYI
n , ~"1
r.
n
.
30. Tolal, ~
b Tolal, ,. ' I\, '-'i-i;:{"\(.
31 Addamounl,incolumn,(g)andm,line30a.Enlerlolalincomehere. . . . . . . . . . . . -..- "~')}1
32 Add amounts in column, (I), (h), and (i), line 30b. Enler tolal he,e 32 ( '!..S1 )
33 Total partnership and S co,poration income or (loss). Combine amounl, on line, J I and 32. Enle, Ihe 'J::>$ ~
total here and include in line 42 below ..
. . nm Income or (Loss) from Estates and Trusts
(.-)Nam. (b) Employ.,
Id.ntlflcation number
:.A .
-..
C
Paulv. AcllvlU.. Nonpaulv. Acllvlll..
(e) Pani.... deduction or Ion Cd) PlSslve income (I) Deduction or Ion (f) Oth.r Income from .
allowed horn fOlm 8582 from Schedul. K-l from Sch.dul. K-I Schedul. K-l
.-
B
C
34. Tolal,
b Tolal, ' ~
35 Add amounl, in column, (d) and (I), line 34a. Enler tolallncome here, ~ . . , . . , . . . . 35
36 Add amount' in columns (c) and (e), line 34b. Enler lolal (loss) here 36 II I
37 Tolal eslale and t,u,t income or (loss). Combine amount, on line, 35 and 36. Enle, Ihe tolal he,e and
include in line 42 below. 37
Income or (Loss) from Real Estate Mortgage Investment Conduits (REMICs)-Resldual Holder
(b) Employer (c) [acen inclu1oiOn from (d) f._.bl, ineome(rltt k>u) (I) Incom. from Schedules Q.
(.)N.m. Schedules Q,line 2c
IdenhltCltion number (1M InslruCtions) ham Schedultl Q. Iin.lb hne3b
I
3B Combine column, Idl and Cel onlv. Enle, Ihe total he,e and include in line 42 below, 38
. Windfall Profit Tax Summarv
39 Windfall p,ofil tax tred,l or relund received In 1987 (see In,l,uclion,) , -<ill
40 Windfall profltla. withheld in 1987 (,ee In,l,ucllon,) 4n ( )
41 Combine amounl, on lines 39 and 40. Enler Ihe lolal he,. and include in line 42 below 41
Summary
42 TOTAL income or (loss). Combine line, 29, 33, 37, 38, and 41. Enler lolal here and on form 1040,
line 17 .~ 42 to:;' ~ '-t
43 farmers and fIShermen. Enle, your ,ha,e of GROSS fARMING AND r{j;j(f% ,..;,:,,,,:.,,$#1 ' I .
fiSHING INCOME applicable to Part' I, II. and III (,ee In'trucI,o",) . ;{;i{;~ P%}J4,~
- 43 ''''/,'','_i .;,:;1i$%29); iJ ,v.
,
Computation of Social Security Self-Employment Tax
aMONa 1~.i!)OO14
... Sulnllructlons fo' Sch.dul. SE (form 1040),
1l@87
AlIlchmtnl 18
S,qu,nu No
SCHEOULE SE
(Form 1040)
Drplr\nll'nI01lh.1rI'UUIJ'
Inl"nIIR.~t'nu.S,'w'(' PI .. Attach to form 1040.
Name 01 person wllh ulf.employment Hlcome (as ,hown on lOCh,1 !lCCUflty co1rd)
SOCial 5.CCurlty number 01 persoll
~ l\ ( V(rIJ\,,~ ", \ w,lhltll.,m 10 m'ntlllCo",'~ ,,::0;'" ; (t.'i(,
A If your only seU.employment income was from earnings as a rnirusler, member of a religiOUS order, or Christian SCience practltlOner,
AND you hied Form 4361. then DO NOT hi. Schedul. SE. Inst.od, Wille -bempHorm 4361- on Form 1040, hne 48. Howev.r, il you
hied Form 4361, bul haye $400 or more of other .ornings sublect to sell.employment ta" continue w,th Part I and check here ~ 0
B II you hied Form 4029 and hay. r.c.,yed IRS approyal, DO NOT hi. Schedul. SE. Wille -E,.mpt.Form 4029" on Form 1040, hn. 48
C If your only earnmgs subject to sell.employment tax arc wages from an electing church or church-controlled organization that is
eKempt from employer socialsecunty taKes and you are not a minister or iJ member 01 a rcllClou~ order, skIp hnes 1-8. Entrr zero on
line 9 Continue WIth line 11 a
Re ular Com utatlon of Net Earnln s From Sell. Em 10 ment
I
I
I
I
I
I
I
I
1 Net larm prolit (or 10") Irom Sch.dul. F (Form 1040), hne 37, and larm partnersl1'ps, Sch.dul. K.I
(Form1065),hneI4a ' . , , . . . . .
2 N.t prohl (or 1055) Irom Sch.dul. C (Form 1040), Iin. 31, and Schedule K.l (Form 1065). hne 14a
(olher than farming). (S.. InstructIOns lor oth.r Incom" to report.) Employe., 01 an .I.ctlng church or
church.controll.d or ani,atlon DO NOT .nl.r our Form W.2 wa es on hne 2. S.. th.lnstructlon, ,,~ 0
o tlonal Com utatlon 01 Net Earnln s From Sell.Employment (S.e "Who Cen Use Schedule SE" in the In'trucllons.)
S.e Instrucl,onslor Iimilations. Generally, thi, part may b. us.d only if you meet any 01 the lollowlng tests:
A Your BrolS farm incomel was not more than $2,400; or
B Your gron larm incom.' was mar. than $2.400 end your nellarm prolits' wer.len than $1,600; 0'
C Your ntt nonfarm profits' were le$s than $1 ,600 and your net nonfarm proflts'were also lenthan two.thirds (~) of your Iroll nonfarm Income,'
Nole: /I Ime 2 above is two.thi,ds (~)o, more olyou, gross nonla,m income', or, ,1/10.215 $J.6oo 0' more, you may not use the optional method.
IF,om Schedule F (form 1040), lme 12, and Schedule K,1 (Form 1065), line 14b. 'Ffom Schedule C (form 1040), hne 31. and Schedule K.l (Form 1065), hne 141
'from Schedule f (form 1040), hne 37, and Schedule K.l {form 1065),line 143. 'from Schedule C form 1040 .Ime 5, and Schedule K,I Form 1065 line 14c.
3 MaKimum Income for optional methods ' , . , , . . . . . . . 3
4 Farm Optional Method-II you m..t t.,1 A or B obov.. ent.r the Imlller 01: two.thirds (0/,) 01 gro55
farm incom.lrom Schedul. F (Form 1040).lin. 12. and farm partnership" Sch.dul. K.I (Form 1065),
Iin.14b; or $1.600. . , , . , . . . . . , . , , . . , , . .. .".
5. Sublracllin. 4 Irom line 3. . . . , , . . . . . . . , . . . . , . . . . . . .
6 Nonlarm Optional Method-if you meet t.,t C above. .nter the Imlllest of: two.thirds ('h) 01 gro55
nonlarm incom.lrom Schedul. C (Form 1040). line 5, and Schedule K.I (Form 1065), line 14c (other
than larmin ; or $1 600: or if au .Iect.d the farm 0 tlonal m.thod the amount on Iin. 5. , . . . 6
Com utatlon 01 Social Securlt Sell-Em 10 ment Tax
7 Enter Ihe amount Irom Part 1,IIne I, or, il you .Iect.d the form optional method, Part 1I.lin. 4. . . , 7
8 Enter the amount from Part I.lln. 2, or. if you .I.ct.d the nonlarm optional m.lhod. Part 1I,IIne 6 8
9 Add hnes 7 and 8. 111m than $400, do not 1,Ie this schedule. (E,ception: II you are an employee 01 an electing church or church.
controlled organization and lhe total 01 hnes 7 and 8" 1m th.1n $400. enter leroand complele the resl olthi, schedule.)
10 The largest amount 01 combined wages end s.Il..mploym.nt .arnings subject to social s.curity or
railroad r.tir.m.nl ta' (ti.rl) lor 1987 is. , . , . , . . , . . .
III Total social security wag., and tip, Irom Forms W.2 and railroad relllement
compen,ation (tier I). Nole: Medica,e qualilied government employees whose
wages are only subjeclto the 1.4596 medlCa,e (hospital insurance b.nelils) tax
and employe.s ot cerlain church or church.cont,oll.d organizalions should not ;t () 0 "I
includ< Ihose wages on Ihisline. (Se.lnsl,uclions.). . . , . . . . , 11 a
b Unreport.d tips subject to soclals.curily to, Irom Form 4137, IIn. 9, or to
railroad r.tlr.menl ta, (t1.r I) . . , . . , . . . . 11b
c Add lines lIa and lib . . . . . . . , . . . , . . . . .
121 Subtroctline lIefrom lin. 10. (1I,.ro or I.ss. .nt.r ,.ro.) , . . . .
b Enter your medicare qualili.d governm.nt wag.s II you are r.quir.d 10 u,. the work,h..t In Part III 01
the Instruclions . . , 112b I I I
c Enter your Form W.2 wag.s 01 $100 or more from an .Iecling church or
orgalization. . . .112c1 I I
d Add lme, 9 and 12c. . . . . . . . . . ., .,. . . . .. ,...
13 Ent.rth. smaller 01 hn. 120 or line 12d. , , , . . . ., .... 13
II hnel3 is $43,800. ent.r $5,387.40 on hne 14. Oth.rwis., mulllply line 13 by .123 and .nl.r the @.,;
resullon line 14 . . , . . . . . . . . , . . . . . . . . . , . . . . . . . 'f,f!fl )( .123
14 S.Il.... 10 menl ta' Ent.r thi, amount on Form 1040 hn.48 . 14 S I 0
For p,plntOrk Reduction Ad Notice. see Form J040 Inltructlon.. Schtdult SE (Form 1040) 1981
I
I
i
OMS No a!.4!.ol6a
Application for Automatic Extension of Time
To File U.S. Individual Income Tax Return
r.,., 4868
Ot'~'tol.nl 01 Ih. ""Ult)'
101"1\11 R..-nu. $tN'U 1'1
'Iou' IIr\1 Mmt .nd lnill,f (II fOlOllttuln.,ISo 'lV' ,po",u', ".m. and !n'I"I)
IEle F. & Constance D. Shu hart
PI.."
,,,,
.,
','nl
1l@87
LJst ".m,
'toU' 1OC1.I..cu,", "urn"'
PIt..nl home.lkIl.u(numbfl .nd 11IHI 0' IUI.I,oul.) (II rou hl~ I P 0 BoI, I.. the lI'lstrucho"s)
252 W. Pcmfret Sl. \
174
i 36 !
lpou..'. Me'" Mc",II, "..
Crt,. lo.rn 01 potl offln. Ill'., Ind liP cQdf
Carlisle, PA 17013
II youup.ct to f,l.. g,M I.. r.lu,n (Folm 70901 FOlm 709.") 1011987. gene,ally due by "pili 15. 1988. check Ih.. bo, . ~ 0
Not.: F,le this form wIth the Inlernal Revtnur ServIce Center whf'ft you must fife your m(omt ta:r return and P4Y the .mount shown on
110.6 b.low Thl. I. no' an ,,/an.lon 0/ tlm. /0' paym.nt 0' 'n. You WIll b. chatged. p.n.lly 10' I.t. paym.nt 0' t.. .nd tar.
f,lmg unless you ShOW reasonable caust lor not paymJ; or fIImg on tIme (set instruct/orIS)
Ilequelt.n aulomatlC 4.month ..tenSIon oll,melo "ugu.t 15. 1988. to 1,1. Fo,m 1040".. Fo,rn1040 10' the calenda, Y'" 1987 (0111 a
f..cal yea' F o,m 1040 to . . . ... . .. . .. .. _ .. .. .. . .. .. .' 19 .. .... , fOf Ih. t.. y.ar endmE ..................... _ .... .. . 19 .. . .. ).
1 Tolal incom.la' liability for 1987. Vou mu.t .nlel an amount on Ime 1 (Vou may ..t,mate Ih.. amoun!.)
If you do not .,pect to ow. t.., .nt., Z.,O (-0-). 1 29,956
, ,;-:z"f.1:'
5,956 "i?j
2 F.d.ral Incom.la, withh.ld . 2 ';':~ '
I
3 1987 eslimat.d tll paym.nl. (,nclude 1986 ov.,payment allowed as a cr.dlt) . 3 16,000 .
~
4 Olh., paym.ntund cr.dil. you .'peclto .how on Form 1040A 0' Falin 1040 . 4 ~:
Add I,"", 2. 3, and 4 \ 5 21,956
5
6 tncom. tll balanc. due (subtract line 5 tram I,ne I), In o,d., to obtain Ihl. a,t.n.lon, ~ou mu.t pl~ In
'ulllhlbalanctdulwlthlhl,'0,m.(lfllne5lSmo,eth.nllnel,.nlerz.,0(-0-.) . . . . . . . ~
Compl.I.lln. 711 -ou ..p.cllo ow. lilt or I.n.ratlon..klpplnl tran., fer (GST) I... ,It;;! ;'j'W'@0"1jj'zi'l1W@.h
, 1if%;ZiI'<1.!i'#~ %', ,""
7 Total g,M t.. and GST I.. you .'pecI to owe 10,1987. Do nol Include Income o/,;i{-t:'tii"a;. 'I?)
'I.. on 1M IIn.. 5.. the in.lluctlons.). . . . . . . . . . . . .. 7 " W1I "
lI..ndlnl on. chICk 'or Income, IIN, and GST t..... attoch 0 .to:.m.nt .howlnl how much ollh. ch.ck appll..lo each I~p. of I...
Signature and VerUlcatlon
Und., penalties 01 pe,jury.1 decl..e that I have ..amined th.. lorm, including accompanying sch.dules and .tat.ments, and to Ihe be.t of
my knowledge and beli.l, il is t,ue, correcl, and complele; and, if prepar.d by .omeon. othe, than the t..payer,lhat lam authoriz.d to
pr.pal.lhis lorm. .
Signalul. 01 tallpll)'tr ~
Signature of spouse .
Oate ~
(Illiling jOintly, BOTH mu.t SIgn even If only one had Income)
Oate ~
Slgnalur. 01 p'.pa'.' AI
olh.rthant..pay.r. I~' C::.
General Instructions
Paperwork Reduction Act Notice
w. a.k for Ihls informal ion to carry out the
Int.rnal R.v.nu. lows 01 the Unil.d Stat..
W. n..d ,t to .n.ur.lhat ta,pay.rs are
complying with lhese lows and 10 allow us to
'Igu,eand coll.ct the r'iht amount 01 ta'
You are required to give us this information
Purpole 01 Form
Use FOlm 4868 tOlSk fo, an aulomallC
4.month ed.nSlon of time to fII. Fo,m
1040A or Form t040. The 4~month
e.tenslon period includes the automatic
2.month .,t.n.iongrant.d 10 U.S citiz.ns
and reSident aliens who are living Of traveling
oulSld.lhe Ul1Iled Sial.. and Puerlo RICO on
the due dalelo, flimg th.lllelurn.
(,
Do not f,le hi lorm if you want the IRS 10
'Igure your tall, or if you are under 8 court
order to 1,Ie youl return by Ihe regular due
date
The .,tenSlon w,lI be granted il you
complete th.. fo,m plope,ly. 'II. it on t,m..
and pl~ with It Ihe amounl of I.. Ihown
on IIn. 6. We w,lI nollly you only II YOUI
request for an eklenSlon IS denied,
Note: Any extension 01 tIme 8rdnted fOI "'mH
your J 987 ,./end., ytar IOcome t.lM letum
.'so extends the time 10f Itlmg a B'1t lax
..turn (Form 7090r Form 709 A) '0' J987.
FlUnK Fo,m 2688.-[,c.pt In C3Ses 01
undue hard~hlp. we WIll not accepl form
2688. "ppllcat,on 101 Md,l,onal [l<1e""on 01
TIme To flit' US, Indl\llduallncome Ta.
Relurn, until you ha~e IHst uud form 4868
Date ~ I
II you h.ve hied Form 4868 and sliII need
mo,e I,me, use Fo,m 2688 or wrile aleUer
of e'planahon (see Wh.re To file). Vou
mu!tt show reasonable cause.
".k '0' Ihe addihonal.d.nsion .>rly so
Ih.I,1 demed, you can sl,lI file you I return
ontime,
When to FII.
fll. Fo,m 4868 by "pili 15, 1988. II you a'.
flhng a I..cal y.ar Form 1040, III. Fo,m
48G8 by the ,.gular due date 01 your ,etu,n.
II you we,e granted Ih. automalic 2-monlh
e.tension because you were abroad
(e'plalned above). II Ie this 101m by Ih. .nd
ofthe 2.monlh pellod (Jun. 15, 1988. lor a
1987 calendar yea I r.turn)
Vou may 1,1. FOlm 1040" 0' Form 1040
any time before the 4.month peuod end~
l..m4868 (1981)
221
.
f'olV1
1'''' ;
IO'i~ -'~d'"}
~...''''14'/\
, .
a
i
1
1: . ! ! i ! i !:!! ! ,Ii : ! 1111 j, ~ : 11 I: i: I~ I [I' ! ,!:T~'
1~Il~t L frW\.,!I.~ L''''~ .~ 1 ! ;.. : ' il'! I :
I, I :.:" ' ,,' '! I '
~"'Ll-/.I ~I""J I 5ftVVll11Lf i ~!: "vrllll...\.;~ .'. ':
j ,; ~ I .' Ii! I
----. --- -- . --_._...~-----.. --..............---...-----..:..-..--.... ..~--------~........--... .J___ .--~_~-\t _~.-_....._._________._
,r'l,.OI'\t FMn y.. d ; ,,' I I ',,;1 ~i}-)S
L.\..H ~\l51r'~11' UP~S1..i :"1 i I 'I '!, i I" :' 'i i ' ,
I '.;~"T!I'" :I,;r..-~'-.~-..-.,
I ~ . ff.4f'lH ,.tJ/.} L. . f.\~~ I' ,: I' [ I': . ;]'; t- '.-;, ~:....! ~~: :.:fjl ! ;-R1 ~.: r~: :.-; ~ ~ . -'-,
II I \f~1I It\..'<.. __~J. pl,o.1S~ -1 I --.-i:- I '. I I oi\_.:_~ I I' ! I ! ','
:; ~-,; . ::~~~':. .~~::\ t~:tT~f,~0~d)I,J,~ !~~~.'O v..,) l~ --~. .~fr;~I. --; : 1::,"II:~1+~::==!:
11 T/l'lVl-(..." I i II;' 1,' I ' ; 1 ,: 'I
"I 1tU,oI\-o,.>(., I, I : h ~,. I ii' . ..! 1 ; '! : -- ~ : ..: ..... - L
II =r--~- ~~~.M~\~\.~_L_J~~ ~!: :;. I-~-~ I ~, j lols I '-:._;--;':---'-'~i
::=:-=_:~:-f:.;~;'J I. !+Hi:;J 'f~lt'!:~~! i ...........'+~:
11 ..c ~:. __~.:~:__._~ U:l~\..O'1\.\.. . f'lj,l-;''::1'11(. 1';:.l~'I_~ ..~-L--~~'f- - .~,: ILj'~~-I' '4'H . ___.~___, I
Ii' ' '1 ,; 11 " !. 11 i j '. I ',;. 11
11,""'-- ~-,~ i' :-.l~'ill;---':.:-;-l;-- --'!'--::-7 tS)"J:J --r.-;-:----.
-!~ I ,n i " ! I :.. ~ ~II' ..I'~:.I- -,!~-~~ i '-jU-i! ..-~,- . ',":"'_--'
, I l I I j " t I I I I i I I I : I t j , ; I ~
:~.~.:. :-'l'~" :-;- ,:t i J : "-'~' :' ~-- I ~ -f: --ll-r:'~ n-!-' , , ' I ;
--T'.' : ~ :- I~. ',' ~:~.:; -: ; -t '~-'I-~ -1-irJ-'~ i rr 1--"'-1-- ;
;; ;! I ' "-'~! -. 'I' -1: -. -rl Ii -.-; -f-~-; . --..-....-----~._- .
, , ..
J ,- ,~ .~.II. r~I'" -:.L._:_:~~..~.~ i----~ :
, ; I' , " 1; j':: ~ . I .
; il~'--I'-~ '~-I. .,;-II~-;",:-:~i-~'--'T'~"-~"
. : : j'" , :
I .. ~,I. .I~;I'~-r- -- ~TI' l;" i:;I -~rTT--.-:
-. -~I, .;:-r,--t-- , -~l-11- 'T: T I ; i' .- :
'i i I. :' ,I I
~!:---:---~I~I'-'''. i'+h-t~.. ~:'-:-~~-,--. )
I' ---~. ~I ,- 'I: . i' ....;.~-- '-;---~
; il-.. :+,' -I I..! '. -: -- -- -~-- ~-'
I r ,I ',t ,
I' I --r " ...._.........
It: !
._..._-----------,._..~....-,~
I .' ,.j I I
"
11 "
\ ,
"
,.
>
,
.
o
--. c.
i
r
"
"-1'
11
.. ~!-~ ~~,- ~_.. -
I
.--.--...- --...--.--
..
..
,
II I
....-..1--..--....-.--
,... ..-t'.-..-.. - .~--
.,
..
- ..j
I,
~-.,. '~"~i '
.. ...__j..._ ...L._
, I
~~ I~- ';-~~~ ~
, I
T" I .. ':-~i"
I ' I I
, r-
, ,I 11:
~~-;:-:~ ~~'~:-~~:::r:~'
..~: :-I~~
.r.----.--
Ii
,
.-"j
(,
"
,
--- ....-.....------...
(
II 1
---t- -.-......~_.--- .--.-.
Ie I
II 'I
_-1._...__.___
Ii i i
.'-..l.---~'.~._-- ...
II '
,.--- -------
H :
'-----r-'-.
H
If
( 'I
!I
.-!
,
I
"r . j-:
i:
H
I:
. --1-'.-~-~.------"
SCHEDULE K.I
(form 1065)
o.p.rtm,l'lt 01 thl fIUh.,.,
Inl.,,,.,A,,.,nu.5,,,,,u
Partncr'b .:ihare of Income, Credits, Deductions, etc.
for c.lcnd., )'Uf 19B7 or Ilieal )'11'
beglnnl"' .... .......... ..........1987. .ndendmg.. .............. ......... J9..
o'.n ~c I ~"!1 OO91J
'il@87
Pa,tner',ldenlilylng numbe,. "2 un - > Co - I L L\ L
p.iHtne,'s name. ,ddren, and ZIP COdE
9"L.~ ~ s.....,~~".,.... :rlL.
'l.'S"1- W~~ ~o_~A-~'-r S,R,o;-l.;I
G4w-\~,^,,7f"- no"
P"tner,hl '1ldentll In number'" 2,,- ,.n ."
Partner$hip'~ name, addreu, and ZIP code
~&..:l~\...linl A-vL;..^~~ ,~'~bH(4nT A a'-'1J~t..C
7. <:> .~~c., ")...::,..
c.....n..U~'""-.?A I, <::>'-J
A(I) b thi~ partner a general partner? . No DEnier partner'$ percentage of,el) Off 01' d,o..u (II) (1Id of
. O/I"ITI,n'hon r"r
""yU"IOQu.."onA(I). P,ofll.hallng.. . . . . .........% ..~~.,,!\..'"
(2) OldlhiIPIIIOIlmllerllllyplll"ipll,,"lh.llld. Lo".hallng . . . . . . .........% ..~.~..qo.'"
0' bUlinus 111",lr('II) of Ih. plllnlllh,p? (SI! Owne..hip of capilal . . . ........ % .. ~.s..l;l, . '1\
pi I' 12 of Ihl form 106\ Inslru,I,ons Lm. E IRS Cenler whele partne..hip lIIed ,elurn. ?~ ll-.~.. 7~~"
bllOkilnollldlOlbusinusltl",III1.). . . . IZJ Yes 0 No f Tax Sheller Reg'slralion Number . ........~.\f:..........
(3) Old Ihillllrlnelltlively pI,liClp.l. in Ih. IInlll G(I) O,d the partner'. ownership inle,ul In the partnership
,ullllll. 1,li,ilr(llI) of Ih. plllnmhlp' (SI! iliA - increa.e a~er Ocl. 22,19867 . . . . . ~ V..O No
Illl' 13 .f Ih. form 106\ Inslru,'i.ns. lelY! II yes. atllch slll.menl. (S.. page 13 oflh. Fo,m 1065 1",llucllonl.)
blInk II no nnlll rullllll.ltlivilill.). 0 Ves 0 No (2) D,d the partnership slart or acquire a new actlvilwflel
B Partne,'uha,e ofllabilllles Ocl. 22, 19861. . . . . . . . . . ~ VesU No
Nonrecours.. .' . . . .. . $................... II r's. alll,h slal.m.nl.(S.e page 14 oflh. Form 1065 Inslruclions.)
Other. . . . . . . . . . . $ - H Check here ~ 0 if thi. Schedule K.I i. for a shorl tax yea,
C What t e afentit is this partner' ... -;ro..!:';':~ .,':;.:: ~...... re uired b secllon 706 b
Reconciliation 0 artner's ca Ital account: d) Incom, nol u\(ll.Idtd (I) Lou" not Included
( ) ((f) Wlthd".....,t,.nd Ie) C"ll.l.ccounl
. pl' .,tDun. ,pll.lconl'l utIli c) ncomf(lou rom lncolumn c ,ptui Ineolum" cl,pluI di,lr.!lut,oru
innin of II' dO/m tit hnu 1 '1 3 '1'\11' btla.. nanl'llbl, Incom, ur\lllow.b1t d.ducliu"I .l.nd 01 ""
~"b'9\
11.,125
1,1.41,.
~ I.~S'~
JO,I. 77
(I' DI,lrlbullvllh.reU,m
information from this schedule on your tdK return.
(e) 1040 lIIen .nler th.
amount In column (b) on:
} (s"p"P1n'''~IIl'lrUCII(lfl'fOt)
$eft.""I, 1t.1 ('DIm 106!l)
(b) Amounl
e.utlon: Rele, 'o."ached Patlne,'s Ins/tueNtons lor Schedule K.} (Form }065)belote entetin
-
..
..
.s
-
01
E
o
u
~
Ordinary income (10") from Irade or bu.ines. activily(,es)
Incom. or 10.. f,om renlal reale.lale activily(,e.)
Income or losslrom olher renlal aclivity{ie.) .
Portfolio income (loss):
a Inlerell.
b Divid.nd.. . . . .
r. Royanie. . . . . .
d Nel short.term capilal gain (loss)
. Netlong.te'm capilal gain (loss) .
I Olher portfolio Income (loss) (allach schedule)
5 Gua,anleed paymenls. . . . . . . .
6 Nelglin (loss) under .ecllon 1231 (olher Ihan due to casualty 0' Ihe~)
7 h , a a h chedule
8 ChariUble contribulions . . ':i"!>'f. . . . . . .
9 Expense neduction lor recovery property (.ection 179 )
10 D.duclion. related to portfolio income ( . . . . .
II Other allach schedule )<::.;O~I+ \)5r- ~"'~
12. C'e~ for income tax wilhheld . . . . . .
b Low-in<ome hou.ing credit ......
c QUllili.d rehabililation expend'lures ,elaled to renlal real e.late
acli,;ty(ies){allach .chedule) . . . . . . . . . . . . .
d Cre~(s) relaled 10 ,enlal real eslale acllvily(ies) other than 12b and
12c(1llach .chedule) . . . . . . . . . ..' . . . . .
. CrecSl(.) relaled 10 renlal aClivily(,es) olher than 12b. 12<, and 12d
(alUch schedule). . . . . . . . . . .
13 Olh., credits allach .chedule . . . . . .
1
2
3
4
.,
.
u
"..
'Oc
010
c:;:
...
Sch. e, Part I, line 2
Sch. 8, Part II, line 4
Sch. E, Part I, line 5
Sch. D.llne 5, col. (I) or (g)
Sch. D, line 12, col. (f) or (g)
(bill Olllppl~bk ~Iltl 01 rOltl' Ilhllll)
) (.........'..'"/'.""'''''..)
ktw<"oIl.K.11 'fin lOCI!!)
(htIlOllllpbubllbnnol,ourrtIUIIl)
See Form 10~0 In.l,uctions
I ("",."""'""'''''''''''')
ktltd",.. tH I'"m IOt~)
See Form 1040 In.l,uclions
Fo,m 8586, line 8
"2..'0
l. 000
..
~
()
(kt P,l1n,,'1 InlllllC1oOlI) 10')
khtdlll, iii. I ( .,Ift 1065,
for P,p.rwor'" R.t.!cllon Act Nolle.. IU form 1065Inlt,ucllonl.
Sch.dul. K.l (F.rm 1065) 1987
.'
Dale F. Shughart, Jr.
Fonn 1040 - 19B7
SSNI 200-36-1646
Schedule E, Part 11, Line A
Fowler, Addams, Shughart & Rundle I
$72,235
Income From K-l
LeSSI Business Expenses
Depreciation - Sect.
Professional Fees
Vehicle Expense
Parking and Tolls
Meals & Entertainment
Travel
Telephone
Periodicals
Gifts
Postage
Employee Benefits
179 Expense (K-l)
,-
$1,436
300
1,099
147
2,013
647
587
257
338
35
1,475
8,334
$63,901
($2,516 @60%)
. ,Ill..... 'tll'JI
I PYu,enlhoml.dllt.U(nlll'\bf'" tl'nl..OO "'" no Of 11.1'1"0\1111 (If" 0 eo" Iff p'j,60f InU'\I(IClN)
L
)5~ ..... fOM ('/41 ~1.
H
I elf" &own 01 poll ofhu, ILl I., .Ild liP coo.
= (i\1-l.I)\,.L, fA n. I)
',,,Idlnllal .. Do you ....n\$llo 80 10 thll fund1 . . . . . . . . . .
(IKllon C.mp.alln' If 'oint relurn do... our I ou.e w.nt 110 010 thl. fundI.
I Sin.l.
a "'..rlld """Ilolnl ,.Iurn (."flll O<lly on. hid Incomo)
3 M,,,..s till". MpoIl'll "huII. Enlll ~It'. -.., MeU',ly no. lbovt ,nd It.ill NmI MIL
4 Hlad 0' houlehold (with qu.llfylns ptl1On). (Sol POSO 7 oIln.I,uCllons.) If tho qUll,tylOS _ Is your child but not
your depend.nt, ,nle, child'. nlm. hili.
S uJhtvlnll wKJow(lr) With dependent child (yur 'pouu dIed "19 ). (See p&Qe 701 Instructions.)
" 5Sl Yourvll "lOmlOn. (iuch II your plr.nt) tan clllm ~OU&l' dependent, do not check bo.lf..l.} No oltloJa
Bulbllur. 10 ChICk th. box on llno 33bon pIjI' 2. . . . . . . . . . .. d1"I.od..60
b ra Spau... . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....'1
c Dopond.nt.: III co.. ill II ",I M ol4lo. ......" III No. 01_". No.oI,..,
(I)1u..(hn1.latlltl M4uIUlat) if~ ~*1II111,,** (4)"lllnIIIp Ii"':rm.... =l'IllGlk
LAv"", Sllv~~"'''f .L )uP 1A . IMdwilll,.., _
. dij.U",will
yoo dill" d.....
1111IIII11101
Ho.oIo1l1or
do~b_
..Ie _
O Add ...... IT)
. · ..t."'.. .,
U....bowt ... :>
TIJ'l"
1/1..
U,,,, IRS 1.1>01.
Olh.""".
flea.. prlnl Of
./fIII. .
Flllnl StatUI
Chock O<lly
,,""bole.
uempllonl
f~uctions
on plS. e.)
II motll""n e
d.pendents, H'
IMI,uctIOfllO<l
-'.
Income
PII....lIIcn
Copy B 01 you,
Fann. W.2. W.2G.
nd W.2P "",..
'you do not hav.
W.2. MO
.60'
NlrLtC1lonl.
PIa..1
.lIIch chOCk
Of money
Older hlr..
AdJustmenb
10 Incom.
(Sol
IMltucllon.
on Pip 13.)
Adjusted
GlOSS Income
,
I
I I
d ")'OU'ch,~ doln'lliYo .rth you but w cYimod u yourolopondonl u_. pro.l98518'1IIlIInt, <hock hi..
. Tala' numb.r a. ....mpllonscl.imtd. . . . . . . . .
7 W.SII. "1a1l...IiPI. .Ic. (.N,ch Fo",>!,) W.2) . . . . . .
.. T.ublo Inl....1 incom. (,/so,tllch Schodull B ,Iavo, S4(0) .
b T.....amp! inlorelllncomt (lit I>ISe II). DON'T ,nclu<le on lino a.
. o;yld.nd Incoml(,Lso,N,ch Schadu/l Bilo...,S4(0) . . . . . . . . . . . , ,
10 Twbl. ,.Iunell ol.ull.nclIOClllncomo 1Ue'. d .ny. from workshotl on pIjIe 110' Inst'uClioN.
11 AllmonyrtcllVed. . . . . . . . . .
12 BUlIIlISI Incom. ot (IOSI)(.Nach Schodul. C). . . . . .
13 Caplul &lln ot (Iou) ("t,ch SclNlduht 0). .....
14 Capilli &lln diltribuliolU not r.portld on lin. 13 (_ POS. II)
15 Othor &I'M 0' (louis) ('NlCh Fo,m 4797)
I" TotaIIRAdlllribut.onl. . 1160 I 16bTwbl..mount(_pqo1l)
17. Total PI/lSlOnund ,nnuili.. 1170 I 17bTwblumount (MO pqo 12)
II Rents. roy.III.., plrtn...hipl. ..III.., trUlII. Itc. (,tlIch SclNltJulo E)
II f.rm Incom. ot ('OSI)(,/Uch Schadull f). . . . .
aD Un.mploym.nl compon""on (IOlur.nco) (... pas. 13)
211 Sac,"1 "currty I>onohll (III pose 13) . . . . . . .
b T.ubl..mount,lhny, 'rom Ih. worksh..t on pos. 13 . . . . . . . . . . . . .
22 OIhtllnc.om.(lIst type end amount-sM Plre 13) . L~I:!;..!~~..!:.!~!~\~..~:~:-A~:~:1~.~lu
2J Addth.amounls shown in thl f,r,1 hI column fOf lintS 7throu 22. Thliis urtolll lncome ,..
a4 R.imbulllll.mploYH bu~n... .,pon". lrom Fo,m 2106.I,no 13.
as. You, IRA cllducllon,l,om .ppllc.ble worksheel on PIlle 14 ot 15
b Spouu'IIRA cllduCllon. f,om .ppllc.ble _klh..t on l'IIe 14 Ot 15
U Sell..mp/o,ed h..1th i",""OCI ded"'t~n.I,om ._1 un P'If 15
27 KlOllh ..Urem.nl pion .nd "1I..mployed SEP cllduc'",". 1000
2. Ponalty on ..,1, wlthdr.w.1 01 "Ylnas . . . . .
a. Alimony paid (''''Pllnt',loll noma
and IOC~I security no,
30 Add lIoes24 throu h 29. The\l"e our tot.' ad'ullmflnh. , . . . . . , , , , .. 30
~l Subtlact lin. 30 f,om line 23 ThiS is your IdJUlltd lI'olllncoml, I thiS in, is '-$I l/Yn
118,516 Ind. child I,V<<J WIth you, 'iN!' "C"n<<J Incom. Cr--.1/t" (1m. 56) on P46'II J9 01
th,'nst,ocflOnJ /I OUW,"tlRStOf, ur" ourl~. SN ~16oltht'lm~I'lJcfiOlls ... 31
.... 11l. ; I~"\lo
SpouN', MdM MCUI ttr ..........
n'l ! 1(" ! ,'S)
lOt'I.oqAcI....'......_1
AId,,".n Ad ""'... III IlII'oa.L
No Nt,,: Clttd"'l ..r.......
ngf'''''WWjUltr..ot
No rHvc., "fund.
~
.. .
?U<
II
10 Ii
II
12
13
14
17b
7 I~>
4 a..-
1/. D)S'
- DD.)
It.'"t )~
'"",,1040(19&1)
U
U.
TIl
Compu-
tlUon
34
3S
3e
37
3.
3t
40
41
Credit. 42
~uctlonl 43
onp...U) 44
4S
46
47
Other 4.
Tlxes 4g
60
~'udl~ 11
.nca IC
P.ym.nls) 52
Plyments
Att.ch Form.
W.2, W.2G.
Ind W.2P
to fro""
Refund or
Amount
You 0...
Plelse
Slln
Here
Paid
Pltp.,.,'.
UII On"
2
Amount from line J I ('dju!lt.d I'OU income). .' ..,........
ChICk II: 0 You w." 65 or old., 0 Blind; 0 Ipou.. wu 6S 0' oldor 0 Blind.
Add the numbtr of boxes chlck.d and enl., thl tol,1 her,. . . . . . . . .,. 3
It IIlOm.on. (such IS your p.rent) eln cllim you IS I depend,nt, ChKk h.II . . II" 33b 0
c II you Ife married 'Ilinl' leperat. filum .nd your spouSlltemlrn deductions.
or you .r. I dual statuI ,Il,n, IN pa&.16 end chIck he'.. . . . . . , . .. 13c 0
[nlll 1M { . Your .I.nd.,d lNducllon (I,om p... 17 o'lh.lnllrucllonl). OR
.....r . YOtJ, lI.ml..d daduclloM (',om Schadul. A,lInt 26).
01: II you It.mlt.. .1I.ch Sch.dul. A Ind chICk Mr. ~ IiSl
Subtract line 34 from line 32. [nler ther.sult her. . . . . . . . . . . . .
Multiply SI.950 by th.lot.1 numbe, of IlIemptions clllmed on IIn. 6.. . . . . .
,..,bl.lncom.. Subl,aclUne 36 from line 35, [nl,r Ihl '"Ull (if Ins thin It'O, .nl.r Dro)
Clutlon: If under 'B' 14 and you h.ve morllhln Sl,OOOof Investmlnt Income, chICk here'" 0
.nd'N p..eI7 10 ,...11 you hlV.lo UI. Form 8615to',,"r. yourta..
Enl., lox. Ch.ck III,om: 0 Tox Tobl.. I'll T.. R.I. Schadul... 01 0 Form 8615
Addllionl' toxe. (... p.g. 17). Ch.ck 'f fiom: 0 Form 4970 0 Form 4972
10~ 0.,$
}
'10 $'\}
.""0
i'H
Add IIn.. 38 .nd 39. Emer thel.tal . . . . . . , . .
C,ad~ I.. child .nd d.p.nd.nl cor. ..ptn... ('fI,ch fOlm 2<<1)
CI.dlllo, the .Id,,'y 0' Ih. dlllbled (,'loch Schedul. R) 42
F..elll" I.. c,edll (ttttch form J1 16) . . . . . . 43
G.ne,,' bu.lne.. credit. Ch.ck II from:
o Form 3800 01 0 form (.paclfy) 44
Cradll for prior yoar minimum tax (,HICh fo,m 8801) 45
Add IInll41lh,ou.h 45. Enllllh. tolal. . . . .
Sub1,acllln 46 from lin. 40. Enler he result If len thin llro .nt.r zero
Sell..mploymentl.. (tHoch Schedule Sf). . . . . . . . . . .
Altern.livemlnlmumta.(tH,chform625J). . . . . . . , . . .
Rocaplur. t.... (..e p.ge 18). Check II from: 0 Fo,m4255 0 Form 8611
Soct.lllCurlly lox on lip Incom. not r.ported to .mploYII (.H,ch fonn 4137)
Tax on .n IRA 0" qu.llIl.d rellr.m.nt pl.n (tHlCh fo,m 5329) .
53 Addltnll47throu h52.Th;.1o u,Iot.lb. . . . , . ,
54 fedo"lIncom.loxwtlhhlIdQhny "'..mFo'm(I) 1099. chICk ~ 0) 114 ~ 'I 0 8
., 1988 ..'Imalad II. peymnls.nd .mounl.ppll.d Irom 1987 "lum sa .;10.....
5& [arn.d Income credit (." pa8' 19) . . . . . . . . ., S8
17 Amounlp.ldwllhFo,m486B(..tlnllonroque.l). . . . .. 67
!II [xCIII social security 11x and RRTA tlx wlthh.ld ('M pa"l 20) III
n CIodll lor Fode,,1 tax on lu.,.(,H.ch form 4136) . . . It
eo Rllul.led In'.llm.nt company c,adll (,",ch form 2439). 80
It Add lines 54 th,oURh 50. These.reyour tot.. plymlnt. ,
82 II IIn. 611.I.r.or Ihtn lint 53. .nl.' .mount OVERPAID .
13 AmOtJnl ollln. 62.. b. RHUND[D TD YOU. . . . .
14 Amoun.o'"n.6210bIlPf"adloyourI989nllmllodllX. ~ 114 ~)5"
IS II Hn. 53 10 la,.er thIn line 61. ant., AMOUNT YOU OWL AHoch chack 0' money Old., 'or 'ult
.mounl p.yabl.l. "'nl.rnal Rovan... SorvIc.... Writ. YOU' ...I.llacurlly number, "'yllm. phon.
numbe,..nd"198BFOIml040"onlt. . . . . . . . . . . . . . . . . . . .
Check ~ OM,orm2210(221llt')1o_Ilod.Stt_21. p-1tyI S
Under ptt\Ittln of perjury. I d.dlr. thlll hi.... t'lImlntd thlt rei,," .I'd ~... KhtduIH Ind ttaftmtntl. Ind to tht bla' 01 my knowttdl. .nd
MUtt. tht, ". tNt, ton.d..nd complet.. (,'<<"fllkwlot P"Plftf (olher Ihln ~,).. bntd on.n Informlllon of which pftplrtrNa.nyknow1edl'
~ 'tu llenllur. Oil. Your oa:up'lion
, fl".(\IJ
~ . .It;nalur. (i p:nl fllurn. H mUI 1'1") II. ~UI~~)CVplllOn
;1.'\01'
,J~
Prtpartf',
''''''hll
,paftf llOe . MCurtC, no
I'IS !1.f i1n5'
T~ L\;l-
FL
Schedule A-Itemized Deductions
SCHEDULES A&B
(Form 1040)
Otp.lrfmtn' of IhI r'''lury
Inl'lnal RlVln'" Servlct (]I
N.mt(')'Uhownon'~,"'1040
"IlLl f , <.-,,.,,,.",, " lI\V~\I""--r
,
MlIllClllnd II Pl1tscrlpllon medicines and drull'. Insulin, doctort, denlists,
Dlnlll [lpI..15 nurses, Il",pllals, medlcalln.uranc. pt'emlums you paid, elc. .
(Duollndudl b Othar (lIst-lnclud. Ilaarlng lids. dentuto., ayagl..s..,
Ilplnll1 lransporlatlon and lodging, etc.) ~........................
'1Imbu,," or . .. . .. . . . .. . .. . . .. . . . . . . . .. . . .. .. .. . .. .. . .. .. . . .. .. . ..
plld by olhers.)
~1~tKl'onl
on P'P 23.)
TIIII Tou
rlld
l~rucllon.
on POP 23.)
'nllrt,l You
rlld
i
J
~
~
I
lr:uctlon.
on P'll. 24.)
Gllllto
Chlllly
(5..
l"strunlons
on P'S. 25.)
ClIVllly Ind
Thill LOllIS
Mo,ln.
[Ipenlll
Job [Ipen",
Ind Moll Olher
Miscellaneous
beductlon,
(5.. PII. 26
for upen.., 10
d.duct h....)
Other
MllCtllulOUs
Deduction.
Tollllllmllld
Deductlonl
(Schedull B I. on hck)
~ A".ch '0 rOtm 1040. ~ S..'n,t,ucllon, rOt khldulotA .nd' (rOlm 1040).
2 Addl;nes laend Ih,andenl.rlh. tot.1 here . . . . . . .
3 Multlplyll1..mounl on form 1040, lin. 32. by 7.596(.075) . ,
4 Sublrlclllne 3 from line 2. If ZltO or less enler .C).. Tolal medicallnd dental
II Stalund loc.lincom.I.... . . . . . . . , . . ., II
15 Realeslalelaxes. . . . .. ......... 15
7 Olller laxes (list-Include person.' property laxes) 110........
8 Add itii 'imoiJnh 'on 'Ii~e" 5' iti,.o"''; :i.' Eniir' itii 'toiii he;i:' Tatallaxes
Nola: New rules apply fa fhe home mnrlgage In/etes/ deduction.
SH Im/roctlons.
lie Deductible home mortgage inter.st you paid 10 f1nanciel
Institutions (repon deduclible poinls on line 10). . . . . . 9a
b Deductible home mor1gese Inlerest you paid 10 Individuals
(show thai person's name Ind address) 110..................
.~
H'l
10 }i'
. . ~
s,(,;)..
10 Deductlbl. polnls. (See/nstructlons lor special ruin)
II Oeductlblelnveslmenl Inleresl (see Plse 24). . . . . . .
l2a Personal/nter.sl you paid (see PIlle 24) . 12a I 1 ~" .
b Multlplytheamount on line 12a by 4096 (.40). Enterlh. result . 12b l'
13 Add Ihaamaunls on lines 91 Ihrou 11 .nd 12b. Enter the total here. Totlllnlaresl ~
14 Contributions by cash or clleck. (If you gave $3.000 or moralD
.ny one organlzelion, show to whom you gava and how much
you gave.) ~............................ ..... ........
III Olhe, lhancalho,check. (You must attach form 8283 II over $500.) Iii
115 Corryov.r Irom prlorye.. . . . . . . . . . . . . . 115
17 Add the amounls on lines 14throu h 16. Enter the lotalller.. Tota' contributions.
II'"
~lc...
18 Cosually o,th.ft loss(es) (I<<ach Form 4684). (See page 25 01 Ihalnstructlon..) .
19 Mavin .xpenses (attach form 3903 or 3903f). See a e 26 ollh.lnstructlons.
20 Un reimbursed employe. expenses-job I,.vel, union dues, job
educallon. elc. (You MUST ettach Form 2106 In some c.....
See Instructions.) ~ .................................... 20
21 Other expenses (investmenl. tax preparalion, safe deposit box.
elc.). Lilt type end amount ~ ............................
21
22
22 Add Ih..mounls on lines 20 and 2J. Enlerth.lolal. , ., .
23 Multiply the amounl on form 1040, lin. 32. by 296 (.02). Enter lhe
,.sull here . . . . . . . . . . . . . . . . . . 23
24 Subl,acl line 231rom Iin. 22. Enler ther..ult If ZIIroor 'ess .nler lero . . . . ~
25 Other (Irom list on page 26 of Instructions). Entel type and amaunt ~ .............
........................................................................
~
26 Add theamounts on lines 4,8. 13. 17. 18. 19,24, and 25. Enter Ihetolal here. Then
enter on Form 1040, line 34, Ihe LARGER 0' this tala I or your standard deduction
I,om page 17 ollh.lnstructlons. . . . . . . . . . . . . . . . . ~
Far Paperwork Aeductfon Act NCltlC..... Form 1040 In.tructlont.
OMD No IS.!! 001.
1I@88
An,dun.,,'
SeQul'nu No 07
You, toe tl..cyrll, ""m'"
Jo~ ! 1c... i ,~.t(..
8
Schld.'. A (r.rm 1040) 1988
S<'........~o(r""" 104011...
flNmtc')Nlhownon'enn 1040. CDonocentlf l\Imt.nd weill M<UI'IC, numbtl " Ihownon "'hi' ~)
. l ~l.' . j. I.nr-J ,IIkt f'> ~It"vij.!(\
Schedule B-Interest and Dividend Income
OMONo I~~" ~... 2
Yew MeW NCWttJ ~
.N. i '1(' i 14'l~
rlrt I
Inllflll
I_I
(SH
Inllruc1lOnlon
_ 10.nd 26.)
NOll: " ,...
rlC'IYIG. form
1099-INT Of
Form 1099-010
from.
btokltl8l 'Irm,
hit Iht firm',
nam'.1 the
pI~" and tnler
1I101oll11nl.....
Ihown on Ihol
'orm.
rlrt II
DI.ldlnd
/_1
(SH
lnltruc:tlonlon
PlIH 11 .nd
27.)
Ho.e: II you
rec.ived. Form
1099.01V from.
brok.rJi' firm,
lia.lhI firm'l
l\lme .. the
PI",r .nd .nler
II1ololel
dlv.,..,d.I'-n
OIllhllform.
An.ch,,*,1
SoIl....... No 08
"r.OU recllv'" mon th.n $400 In I.ubl. Inl.'lIllncom.. you mU.I compl.le ...rt I and ...rt III .nd 1111 ALL
In .'.11 rlCllv"'. You mUI' ,.port .lIlnll"I' on Form 1040. oVln II ~... a.. not ,oqul,od 10 compl.11 P.rt I and
"art III. II ~ou rec.I...,. al I nomln.., In'otOlllh.1 .clu.lI~ belonll 10 .nolh., """on, llI' Y'" ,ectlv'" or ""Id
acc,ued Inl.,..1 on ..curlllll I,.nll.".d IMlwHn Inl.""1 Plym.nl d.'II. ... Pili 27.
Interest Income
1 Inl."sllncome Irom ..1I.r.llnsncw mor\iJges. (SIt Instructions .nd lisl /\Iml 0'
par",) . ... . .. . . . . . . . .. .. . . .. . . .. . .. . . . .. . . . .. .. . . .. .. . . .. . . . .. .. .. .
0"- tl (I' t , ) ~ 11'<14., \\,....,..,.. Ill","'.r .. J f
Z If..r Interes ncome I' name 0 paYeI ... ..or...... ... ..0.. "f .........
r.~WL ""...., 'n""""f'" jl""'Ll..
......O.O....................................,.......J.........,....... .
(.II"",,,'~-""'L-~ ,.,...-n......,.....
........................................... ...{............. ..... ......
... ................ ................. ..{?!::'!~I.. .":"!J.. c:?:fr..1... .......
Amount
1
.-
J
!>
II'}
15<.
2
.......................................................................
.......................................................................
.......................................................................
.......................................................................
.........................................................................
.......................................................................
.......................................................................
.......................................................................
.... h~..mo~ni~ o.n'ljri~;i.i,;,j 2' En'I~; ih~.I~i~l.h.;r~.~rido~. F~;r;;i04i)il~~.&.. -.: 3 II ~
II pi' rec.lv.d mor'lh.n $400 In "011 dividendi .nd/OI olh" dllt,lbullon. on Ilock. compl.l. P.rt U .nd Part
III. You mUll r.port all I....bl. dl.ld.ndl on Fo,m 1040, ...n If ~ou." nol ,oqul,.., 10 compl.11 Part Uand Part
III. II ~ou rocelv"'. ... nomlnH, dlvldlndl Ih.1 aclu.lI~ belonl 10 .noth.r porIon. ........27.
DIvidend Income Amounl
4 Dlvldlnd Income (lilt name of payer-Includl on this line capital pin dislrlbutions.
nonlaxabledl1lrlbutlons, .tc.) ~ .......................... .................
........................................................................
.......................................................................
..........................................................................
..................................................................................
.............................................................................
..................................................................................
4
...................................................................................
...........................................................................
..........................................................................
.........................................................................
............................................................................
...................................................................................
5 Add lhI.mounts on IIna 4. Ent.' the totll here. . . . . . . . . . . . .
, Capllal pin dial,ibulions. Enter her..nd on lin. 13, Schedule D.'
7 Noelwbll dialribolioos. (s. ScUdul. D Inst,uellOlls tor odjust"",1 to buill
. Add Ih. .mounts on lines 6 .nd 7. Enter Ihe lolal her.. . . . . . . . . .
. Subtract 1111I 8trom IIn. 5. Enl.r Ih. ,.sull h.re .nd on Fo,m 1040, linl 9 . . ..
ON,.., _co~/flllllflllnbutionJ llutdonot_ Sc/lodulo 0 to tlpottlny.,hot pm. '" _. .nr" ,.."coptlo11lIln CIrI/ributions 011 Fonn IDfO.Ione 14.
Pili III
forll,n
Accounta
ud 10 A1ln~ time durlnlllhe lax ~"'. d,d rou ha.e .n ,"lerestln 0' . s'gn.lu.. 0' olhe, authority ove, I financial
f..I',n lCtounlln . foreign counlry (such II a bank .ccount, SlCurilles accounl, 0' olh.. Ilnanclaloccount)1 (SIt
Trlllll PIll' 27 0' IhIlnsl,uct/ons tor IXcepllonund IiIiI1j requl/lmenulo, FOtm TO F !l().22.1.). . . . . .
(SIt II "Yes," Inler the nom. of th. 'oreign counlry ~ ...........................................
Insltuclk>n. 11 Wer~ you tha granto, 01. 0' trensf."" to. . loreign lrusl which ..ISled dunl1j Ihe cutlllnl III year, whether 0'
on PIlI 27.) not \'Ou ha...n. benef,c,.1 inlor..1 '" III II "YIS," .OU lNy have 10 IiIe Form 3520 3520.A 0,926. . .
'" '","'OIllleelIKttenAc1 Notice, ... 'Ofm 1040 ,".lruc'Jon.~ Scheelu" I ('Ofm 1040) 1811.I
II~... recllv'" mall Ih.n $400 oIlnl.'1I1 or dl.ld.ndl, OR II ~ou h.d a 10ll'.n acc...nt Of w... .
.,.nl., of, ..al,ansl..o, 10, .lo,.lgn Irul'. ~ou mUll .nlW.. bolh qUlSllonlln P.rt III.
SCHEDULE SE
(Forin 1040)
Social Security Self.Employment Tax
OMe No. 1~lro74
lIW88
Al\OdImtnI 18
ut"" No
Dtpo....nl 0/".. ''''''''1 . S..I.ltr...llonllo, SchHullU (,."" 1040).
lnt"III'R._uo_ (3) . A"ach 10""" 1040.
Nlme of po"" with .."..mplo_", Incoml (II ,hown ..1OC1"lfturily clld) Social Mcurttl .umbo, 01 po....
\)II L-l. Sl\v Ctll'l .J n . wlth MIl""",o)'lll.nI Inc......
I l' I I~~l.
Who Must File Schedule SE
You must file Schedule SE II:
. Vour net eernlnll' Irom self.employment were $400 or more (or you hed weges dl $looor more from an electlnachurch or
church orgenlzallon); AND
. Vou did not have wages (subject to social securlly or railroad retirement tax) 01 $45,000 or more.
For more Inlormation about Schedula SE, see tha Instructions.
i
I
I
~
I
Note: Most taxpayers can now use the new short Schedule Sf on this page. But, you may have to use the longer
Schedule Sf that Is on the back.
Who MUST Use the Lon, Schedule SE (Section B)
You must use Section B If ANV of the following applies:
. Vou choose the .opllonal method. to figure your sel'.employment tax. See Seellon B, Part II:
. Vou are a mInister, member 01 a religious order, or Christian Science practitioner and received IRS approval (from Form
4361) not to be t"ed on your earnings Irom these sources, but you owe sell-employment tax on other earnlnll';
. Vou are an employee 01 e church or church organization that chose by law not to pay employer social security taxes;
. Vou have tip Income that 15 subject to social security tax, but you did not report those tips to your employer; OR
. You are a government employee wllh wages subject ONLV to the 1.4596 medlc~re part of the social securltytex.
Section A-Short Schedule SE
Read .bove 10 lee If au must use the io Schedule SE on the back Section B .
1 Net farm profit or (loss) from Schedule F (Form 1040), line 39, .nd I.rm partnerships, Schedule K.l
(Form 1065). line 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Net prof" or (loss) lrom Schedule C (Form 1040), line 31, end Schedula K.l (Form 1065), line 14.
(other than larnllng). See the Instructions lor other Income to report . . . . . .
3 Add IIn.. land 2. Enter the total. IIlhe lotallaless than $400, do .ot file thllSchedule. . . . . . 3
4 The lelllest .mount 01 combined WISes and sel'.employment earnlnss subject to socle' I.curlly or
rallroed retlr.menll..(tI.r 1) lor 1988 Is . . . . . . . . . . . . . . . . . ..
"II 000 00
II Tolal social security Wlsel and tips lrom Forms W.2and railroad retirement comptnsatlon (tier 1) .. II
.;loa
. Sublraclllne 51rom IIn. 4. Enter the rasull. (1Ilhe resullluero or less, do not nla this achedule.) .
!j;}'l11
1.\)')'11
7 Entertheam.lI.r 0' IIn. 3 or line 6 . . . . . . . . . . . . . . . . . . . . .
II line 7 Is $45,000. enter $5,859 on line 8. Otherwlae, multiply line 7 by .1302.nd enter the resul' 'In
line 8 ................,.
)(.1302
SS'l7
. Sell..m ment t... Enter this .mounl on Form 1040 IIna 48 .
Fot P.potw.1to Rlductlo. Act Nollet.... ,.nn 10010 I.,trucll.n,.
"hodulo II (F.... 1040) I'"
1l@88
AIt.duM", 88
ueM' No
Soc1l1 MtUflt, Of .mploy.,- ld,nllliuhon numbtr
;)... )~'I~'11.
rOl'm
8582
Passive Activity L08s Limitations
. See lepa..le Inltructlonl.
. AlIech to Form 1040 orlO4I.
Orp.rtm,nl ollhl "",u'y
tnl,rn,l Rt~.nut S.NICI
Him.'" U ,howl1 on ,.Iurn
r. I '''^'J1I\''Ll ~. pl"HI""T
Com utatlon 01 1988 Paulve Activity LOll
CluUon: S.. the instruction. 10' Wo,luhee' / belo.. com letin Perl/.
Rlnlll Rul hllle AcUvlUII With ActlvI Partlclpetlon (5.. the d.linlUon 01 ecUve p.rtlclp.tlon und.r
Renlll AcUvlUll1n th.lnstructlon..)
Acllvltlll ecqultld bllotl 10.23.86 (Pre.eneclmlnl):
Ie Activ,I;.. with n.llncom., Worksh..II, P.rt I, column (a)
I b Activil,"s with n.t 1055, Worksh..t I, Part I, column (b)
Ic Combln.lin..laand Ib . . . . , . . . . . .
Acllvltlll ecqulred elt.. 10.22.86 (Poll.eneclmenl):
Id Activlll.. wllh n.llncom., WOlksh..II, Part 2, column (a)
Ie Actlvil'.s wilh n.lloss, Worksh..t I, P.rt 2, column (b)
II Cornbin.lin..ld.nd I. . . . . . . . . . . .
I. N.lincom. or (1055). Combin.lines Ic .nd II. . . . .
Ih Prior y.ar un.now.d 1055's Irom 1987, Worksh..II, P.rts I.nd 2, column (c)
II Combln.lin.s I .nd 1h . . . . . . . . . . . . . . .
All Other PI..lvl AcUvlUII (S..lh.lnslructlons la, lin.. 2a Ihrough 2h.)
AcllvlUII acquired be loti 10.23.86 (Pre.enlclmlnl):
21 Aclivities wilh n.t Incom., Worksh..12, P.rt I, column (.)
2b Activltl.s wllh n.t 1055, Worksh..t 2, Part I, column (b)
2c Combln.lines 2a and 2b . . . . . . . . . . .
Acllvltlll .cqultld lit.. 10.22.86 (PolI.enlclmlnl):
2d ActlvlU.s with n.llncom., Worksh..t 2. Part 2, column (.)
2e ActlvlUes with n.llo55. Worksh..t 2, Part 2, column (b)
21 Combine lines 2d and 2e . . . . . . . . . . .
2. N.lincom. or (1055). Combln.lines 2cend 21. . . . .
2h Prior y.ar unallow.d 1055" from 1987, Worksh..t 2, Parts l.nd 2, column (c)
21 Combin.lin.. 2 and 2h . . . . . . . . . . . . . . , . . ,
3 Combln. lines 11 and 21. IIlh. ,"sullls netlncom. or .()., see Ih. Instructions lor lin. 3. II Ihls lin.
and Iln. Ic or line II ...Iosses 0 to line 4. Oth.rwlse enter .0. on lines 8 .nd 9 end 010 line 10 3
Compulatlon 01 the Special Allowance for Rental Real Eetate Wllh Active Participation
Nole: ~Iore com letin Parl.lland /II, see 'heln,',uctlon.lor how 10 lreal numbets..1I Ihe were all
4
Enter the smaller 01 Ih.loss on line liar Iheloss on line 3. II line IIls.()' or n.1 Income. enler .0.
and complet. lines 5 through 9 . . . . . . . . . . . . . . , . . .
Enter $150.000. II married IlIing separately, seelnslructlons. . .. 5 , So C><:>::)
tnler modill.d adjust.d gross Incom.. bul not 1.55 Ihan .0. (see In.
'tructions). II line 6 is equal to or grealer than line 5, skip line 7, .nter
.o~ on IIn.. 8 and 9, and Ihen go 10 IIn. 10. Otherwise. go to line 7. .
Subtract line 6 from line 5. . . . . . . . . . . . . . .
5
6
7
8
9
6
7
Mulllply line 7 by 50% (.5). Do not enter more than $25,000. II merrled IIIlng separelely. .ee
Ins\rucllons . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
Enter the smaller 01 line 4 or line 8 . . . . . . . . . . . . . . . . , . . . . .
Com utatlon of Paulve Actlvll LOll Allowed
Combln. lines Ic and 2c .nd .ntlf Ih. "sull. II tho "lull II -11. or nellncome, slip to IIn. 16. (Set Inllruellons.)
IIl1n. I, show' Incom.. h.. no enlry. or lhowl .0.. .nlor .0. on Iin. II. Olherwlse, anlor the Imlnor of Iln. Ic or line 8
Sublract line 11 from line 10. II line Ills equalto or greater then line 10, enler.()..
Sublractline 9 Irom line 3. . . . . . . .
Enle, the sm.ller olllne 12 or line 13 . . . .
Mulllply line 14 by 40% (.4) and enter the ,"sull
Enter Iheamounlfrom IIn. 9. . . . . . .
PI..lvl Activity La.. Allowed lor 1983. Add lines 15 and 16
Add the lnalme. if any. on lines Ie. Id. 2a, and 2d and .nler the result
Tot.llo.....llow.d I,om .11 pII.IVIICllvlll.. lor 1988. Add lines 17 and 18. Seelhe Inslructlons
to see how to re rt the losses on our tax return .................
for Plperwork RHuc:tlon Act Holle.,... ..p.r.I,lnltructlon,.
10
II
12
13
14
15
16
17
18
19
OMO No 1S45 1008
2
21
n....)
10 \))0
11 I '}o
12 -.-
13 -.-
14 -.-
15
16 '''')0
17 \))"
18
19 \Y,>D
r..m 8582 (1988)
"'
fo(l1) '~,\O _ I,U
- ------ ---..-..- .- ..- -.
",..: ~... -1c.-" 't,
I
.
.
.-
.
,
,
,
J
f
,
1
SC\\"v~ L (/tilT 11 \..\1"'1
~-- --
- ---
,
~"'UA.. ~n;\I';';~-r~ ~-"uN}i.l:
,
.
I-
'''(.Qr'\\. rlUlTl \(.- ,
----------.
.
I- -- ~
._ b
.
~l.ij.r._;jIV;~u ~'1-r~JjW
r"",(-'\..UIOI"II\.. ft......
rn~\l."'l- ,...... 1\lu..J
--- r\-l\.~ i \-''''''T.......~ (.~.." -
---,-'
_J~v/..1- ~_ ..
. __~JL.':.\~"(... _. '_~___
1'I-<<.~\tJl\.J
(i lfTJ i. r-t.>"'~1
..-. ---- . -
_r'Xr"tt- ~ ~-~--.
- f--
- ---
1---
I-
I
11
--
I _~~.._ ~_~ ~__
'Ir'l""'V"< ..
V~\\'C.L\
I
II
--
I
,
I
I
I
I
I
I
1
31
I
.-- -.
. -- -
I
I
3
I ___ __ ___
1-
I
I
-- - - ~-
-~ -1---
.
-.
J
-. .
---
~ --~ I
l-
I
8 ) I
I~
_ ! S I--- _~
1('! _
- ~ - - ..
-~~ - - -~
1--
~-"
- -.
.1-
-I-
.._~
,
~p.
~
--f-
. - -I- ---
-I-
~-
.-
- .._-. -.
-
-
I
--
--
- --
..--
- -f---
. --
-
-I-
~f-
I-.~ ~ --
.- - ~I---
-I-- -
. -I-- ~~~
.1-
.1-
l-
I-
--
_ __. _m ~
- - -
--
/'CBEDULE K.I
(f'o,ri1106S)
OtpIf1mtnt Q' lh. YIII1UI"J
"Mf """nut SfMC' in I'\ln
Pa,lnl,'lldlnllfylnl number ~ 7-=. '3(. - \ l. '-I l..
Partnlr's n.ml. .ddr.... .nd ZIP cod.
OA\.-:: t=' S~Ubul\nl,:rIl.,
'1.5'"'1.. '-UlfC"T ?o.....~n...r "t".
Q"'.......,\~" ,.;:>iL ''101''\
OMBNo 1~'.0099
Partner's Share of Income, Credits, Deductions, etc.
fot calendar yUt 1988 or fiK.1 Vel'
1988 Ind Indin
Partnlllhl '1ldlnll In number ~ 'Z.."}., 0 '10 "Z.
p.rtn.rshlp'. n.m.. .ddr.... .nd ZIP cod.
t=e.\.I.\~(t, 1\."i':)/W'r4',~t'U6tH,.r- ~ (.2.u.....i:)u.:
l'.o~o~ '").oll
CAJU-I ~ ""'-,?"" " 0, ~
A Is 'his partner a general partner'
No
i!@88
FIRS C.nt., wh.r. partn...h,p 'i1.d r.turn ~ .-;>,:"..~.,.~..:?~..
G T.. Sh.lt.r R.gi.t'ltlon Numb.r ~ ... .HI ~~....... ~.......
.......................................................0
H(I) Old the p.rtn.r'. own.rship Inl.rest in the partn.rship ch.nge
aft., Oct. 22. 1986! .' ..... 0 y", ri?l No
II yes. .tt.ch .Ial.m.nt. (Se. Form I06SI",lruclion.)
(2) Old the p.rtnershlp st.rt or .cqulr. . n.w .ctivity .fter
Oct.22.19861. . . . . . . . . . Dy",~ No
\I yes. attach statem.nt. (5.. Form IOGSln.truction..)
Ch.ck h.r.1I this partn.rshlp Is . publicly traded partnershl\L.,
as d.flned 1/1 s.ctlon 469(kX2). . . . . . . . . .U
Ent.r p.rtn.r's p.rc.nt.g. 01:
P,olitsharlng. ........." . ,:1.':\,1 A."
Lo...h.rlng . . . . . . .........". :z,~:~."
Own.rshl 01 c. Ilal ... .. .. __" .. ':\.~, 1;3." J Check her. If thl.l..n .mend.d Sch.dul. K.l. . . . .
econc at on 0 artne, sea ita account: If) Incom. not Includtd e.) Loon" not Includtd Cf) Wrlhdm....ls.rwt (.) Capilli_count
. pl' .<<oun. pt I ton n u c "com' I ~m N'lcoIumn(c),plus Incolumn(c).phn ditlllbuliont .trndofy'"
nnl of " url fit ~n" I 2 J Ind below nonl,uti, Income u",now,bll deductionl
(.) DI.trlbutlYl ShOll 111m
!
~
..
E
8
.!:
Ordln.ry Income (loss) from tr.d. or bu.ln.ss actlvlty(I..)
Net Incom. or loss from r.nt.1 r.al e.tala .ctlvlty(I..) .
Net Incom. or loss from oth., r.nt.1 .ctlvity(I..).
Portfolio Incom. (Ios.):
a Int.r.st.
b Olvldends . . . . .
c Roy.ltles . . . . .
d Netshort.t.rm c.pllalgaln (loss).
I N.llong.t.rm capll.lgaln (loss) .
1 Other portfolio Income (loss) (.tt.ch .ch.dul.)
5 Gu.r.nt.ed paym.nt.. . . . . . . .
6 Nil Ills (loss) u.dar section 1131 (olher Ihan dUIlo tlSullIy o'lhlll)
I
I Charlt.ble contributions . <:;07",. . . . . . . .
9 !Jplnst dtducllon 10rrtcoYllypropl,tr (setllon 119 )(.ltach schedull) .
10 O.ducllonsrel.ted to portlollo Incom,. . . . . . . .
II 0 h.r all.ch sch.dul. \-:<l'p.....L "ilc.F- .(1\"'" ..
121 Cr.dlllor Incom. I.. wlthh.ld . . . . . . . . . .
b low.loc.m. hOUlln. credl!: (I) 'a,I.lllhlpllo which 11,110' 41(j)(S) spplltl
(2) Oth.r . . . . . . . . . . . . . . . . . .
c Qualifl.d rehabltit.tlon expenditur.. r.lated to r.nl.1 r..1 est.t.
.ctlvily(I..)(.Il.ch sch.dul.). . . . . . . . . . . .
d Credrt(s) rel.t.d to r.ntal ,.al ..tale .ctivily(l.s) olh.r Ihan 12b
.nd 12c (.tt.ch schedul.). . . . . . . . . . . . .
. Clldil(.) ,,1.led 10 othl' /lnl.1 Itti,;lr(llI) (Itf Inslll.<li...) (.tla,h l<hfdu~)
13 Olhll cr.dits attach schedul. . . . . . . . . . . .
B
Partn.r'. .h.r. olll.bilitles
Nonrecourse. S ...... .............
Oth.r. . . . . $ .......-:7:.........
Wh.t typ. of .nlily Is this p.rtner! ~ l':-!~! y.'.,?~(l.~....
II this p.rtn.r. I2'l dom.stic or a 0 lor.ign partn.r!
\1,01.0
-W,a9f:
i,l.~~
C
o
(1) BfIOl'I dtc,....
Ol'll,minlllon
(III [ndor
''''
Rlmlndlr: If you r.c.l~d a 1987 Schedul. K.llhat was lor . short y.ar .nd you chose to r.port Iha 1987 amount. over a 4.y.., pellod,
be lur. to Includ. on..lourth 01 the short y.a, .mounts.ln .ddltlon to Ih.lI.m. r.port.d on this Sch.dul. K.I, on Ihe .pproprl.t.llnes of
you, 1988 Form 1040.nd relat.d srh.dul...
c.ulton: Refel/utl.ched Plttnel'l/ru/tUction. fo, Schedule K.j fo,m 1065 before enleri
E
\ 0,1.11
K!:,91l.
I
2
3
4
.
u
....
~~
n
'i
..
u
~~. r..".. _.1 fl." ...11.... '..1 tI..,t..,. ,,.,. r...... 1('11:1; 1",1'1,,1''''',
Inform. lion from /hl. schedule on UI ID relum.
(<)1040 nil......., thl
.mount In column (') on:
8:> 'Z..\lt }
('I:=~'I~I'l')
(b) Am.unt
Sch. B, P.rt 1,IIne 2
Sch. B, P.rt II, IIn. 4
Sch. E, Part I, IIna 5
Sch. O.lIne 5, col. (I) or (g)
Sch. D,line 12, col. (I) 0' (g)
(biB llIl.ppfiUblt... II,.. nil,.)
I ('I:~:~~l'1r=lr)
(Inl. .."pIublo loa """ ".,..)
Sch. A,line 140' IS
} ('I:=':~~I1J=-=,'i')
..........,'..-..
Sct\edw'tIl..IC,..",,10l5)
I Fo,m 8586, line 5
) < """""=Il'l
000
12d
12.
13
5,h.dlll, K.I (Form 101;5) 1988
f"W.'-\'" ,'"
jl
::Ii
141 Nel..rnings (loss) f,om .elf.employmenl .
b Gro.. f..mlng or fIShing Income. . . .
c Gron nonfarm income. . . . . . .
151 Acceler'led deprecllholl of ,..1 property pl.ced in "IVice berore
1/1/87. . . . . . . . . . . .. ....
b "ccelellled dep,eci.lion of Ie..ed pelSon.1 property pl.ced In
.er.ice berore 1/1/87. . . . . . .. ....
c Oepreclalion .dluslmt!nl on prop<'rty placed I" ..!Vice .~er 12/31/86
d Oeplel,on (01 her Ihan oll.nd S..) . . . . . .
. (I) G,oss Income ham oil.S", .nd seothermal propert'.. . ,
(2) Oeducllon. .lIotlble to oil.S". Ind seothermol properties.
f Olhe, (.!t.ch ..hedule) . . . . ' . . . .
141
14b
14c
~
h,_ 2
ee) 1040 fII.,. tnltf lh.
.moun' In column eb) on:
"3 Sch. SE, Section A or 8
I (St...."...,..ltoll.loIthOl'lltoo)
IchPd","1I If'o'mJot.~1
SC....d\lI'M l (tolm 106!1H19S8J
el) Ohtrlbullv. ,h,'1 Him
(II) Amount
..
u
c:
..
J?e
.....
0.=
..
{!
II 161 Inlere.t e.pense on In...lmenl debts form 4952, line I
b (I) Investment Income Included In Schedule K I. hs 4a through 4f I ( 'J: ".",' I ~"""~ too)
(2) Inve.tment e.pense.lncluded In Schedule K.l,lIne 10 ....lJ\Il' A I( o"nl 5)
171 Type 01 Income. ................ ...... ............ ......... form 1116, Check bo.es
II b Name of foreign country or U.S poueulon ................... form 1116. Plrt I
..
~ c Total gross Income Irom sources outside the U,S, (o!t.ch St~dule) fo,m 1116, Plrt I
~ d Tolallppllc.ble deductlonslnd loues (."ach .chodule) . form 1116, P.rt I
e . Tol.llorel&n t.... (check one):. 0 P.id 0 Acc,ued form 1116, P.rt II
.f f Reduction In ta... .v.n.ble fa, credll (.!tach .chedule) form 1116. P.rt III
. Olhe, (.!tach schedule 17 See form 1116ln.lructions
181 Tol.1 e.pendllur.. to which Ilectlon 59(e1eleCllon (,el.llng to 'he
~ optlonaIIO~y..r wrlleolf 01 certain t.. pre erence ~em.) may Ipply (See Partn..'s In.l,uc.
. (.!tach ..hedule). . . . , . . . . , . , . . . . . .
z:. tlon.lor Schedule K.I
0 b O1her Item"nd Imounts nol reported on line. I through 17S. 19. Ind (form 1065))
20 lhallre ,equlred to be ,eported .ep.rately 10 you
191 low.lncollll ~oo.lnl mdlt: Partnerships 10 which ..,II,n 410)(S) .pplltl
b low. Income hou.lng c,edll: Other
20 Invettment Tn Credit A B C
Ptoperty:
f . Oe.cripUon of pr'perty
(St,te wheth.. rKovery
or nonflcoY"~
~ property. II rKllYery
property. ,I.te whelhor
'5 ,elullt perclnl'lf
e m.lhod 0' IIcllon
I 48(q) election used)
b Olte placed In lervlce ,
C Cost Of ..hlr basi. .
..
d CII.. .1 roco...,
property Of .rilllnll
estimated uselullae ,
. D,II K.m (ll1Id 10 ..
....lIm..t endll plQ9trt,
Olhtr Inr.rmIU.n "'.v1dod by ""rtnlnhlp:
]1040
label
U~f IRS labfl
Olhll'lfIU',
plen. punl
0' type
Filing Status
Chick only
one bOI.
E1emplions
(See
Instructions
on page 8)
If ,"ote than 6
dependents. see
Instrucllons on
p.gea,
Income
Please .tllth
Copy B 01 your
Fo.m. W.2, W.2G.
and W.2P here.
If you do nol hav,
.W.2.lt'e
paal 6 01
Instructions,
f-
Pluse
Itlachcheck
01 money
ord,r here.
Adjustments
to Income
(S,.'
In\hurhol1\,
onpd.:t' 14)
. 1jusled
. ." '"rn"""
I .
i' ~'^\ //
.....-/
.19 .JtlMIJ No 1~4!) 0074
~--
YOUI loel,ll.cu,II, "umb.,
)00 ''\1. i 11."\1.
'O'lh'~"AIJA" .0.-. ]1 1989.010Ih",,, ,,'N IIIIIlO
You,lu\ll1oll1ll'..rullmh.1
(
~ ('~l'
(.fJ
Drl'"'''''''''' III ",.. ".'1\"" -Inl,'''''' "'n'''u'' S"'Ylll'
U.S. Individual Income Tax Return
.1989,nl1m'
L,,'n,mr
L
.
I
1
L
_l:..~_~ fS_~~~,1.r; :U...
lI.toml 'r'tj'U,IPU"\t"\ 1",1 n,lni' oIl1Cl m,t"l
l",'n.mr
Spoun', 10el.1 ..uun, numb.,
11'1 ''''1. ! "5)
\I\U~ij""''''
G.
(.J>r'~"I\""\..
ApI no
C,l"lown (II po'l DIll,., '1.'t IIna liP '00. (11.101.'1" .ad,,". ,.. P'I' 7 I
VI (lLIlLl fl1 /'0 I")
Pruldenllal .. Do you wanl $110 go 10 IhlS fund? . . . . . . . . . .
[Iecllon Campa1ln' 11 oinl..lurn. do.s our. ou.. wanl $1 to 0 to IhlS lund?
1 SIIll:le
2 Mamed lllinK 10lnt return (eyen ,r only on. had income)
3 Mllfl,d !illn. Hp,ml. r,lurn. Enltr ,pous,', aoclalucuflt., no .bov' Ind lull nam. hire.
.4 Head 01 household (with qualllyins persM). (See pas. 7 at Instruction,,) II 'he qualilYlns person II your child but not
you, dependent. .nler child', name hell.
S uaht In widower With de endent child ear s use died'" 19 See a It 7 01 Instrucllon..
6. ~ Yourllll If someone (such as your parent) can claim you as I dependent on hiS 0' her I.. I No. It MU'
relurn, do not check bOI 6a, But be sure to check the bOI: on Iin. 3Jb on paR' 2 . chtth4 on II
and 'b
b I2'f Spou.. . . . .
c Dependenh: wellt<' tJI II "II 01 oldll. dlpllldlAl'
(I) N''',llll'l. IR,lI,1 'lid 1111 ftlmU d,~~dr 'oUll Mt\llll, 1\lIllWI '&11,111101I1.'11
" Horn.. .alll.u(numbfl ,nd Itl"l) (II' P 0 001, H' P'I' 7 Dlln.llutllon, I
1 dS~ W, ror(-fU.f S-r:
.
1
I~) feCI ollllo~lh
lnldIII fOIll110IIII
111919
lJ\V~
~\IV(r"^jIJf'"
,).0' ,$'1 ,~...,
lr'l'f\Il-
d II rou1 'hlld didn't hve WIth rou bull' clalmtd IS your dependent under I ple.198S Igreement, check here" 0
. Tolal number at ellemptloM claimed. ...,.
7 Wages, salanes, lips. etc. (attach formes) W.2) , . . , . .
81 '.ubl. inte'est Income (also attach Schedule 8 if ovtr $400) .
b '......mpl int.rest income (lte page 10). DON" Include on line 8.1
9 OlYidend Income (afsoaftlCh Schtdul,Bifovrr$400) , . . , . . . , .
10 Ta-able relunds at slale and local Income tales, iI.ny, from wOlksheet on page 11 01 Instructions.
11 Alimony received. ....,..'
12 Businns mcome or (Iou)(.ttach Schrdu/e C). . . , . ,
13 Capital Rain or (loss) (,tlach Schedule OJ ...,..
14 Capilal gain dlstubutlons not repor1ed on line 13 (see page 11)
15 Other Kalns or (losses) (,ttach form 4197) ." . . , . . . , . . . . .
16. TolallRA distributions " . lJ!!J L-16b Talable .mount (see page. 11)
171 Tolll pensions and .nnultle\ l1.zeJ . L17b T..able .mount (see page 12)
18 Rents. royalties, partnerships, eslates, 'rusls, etc, (attach Schtdul, E)
19 Farm incom. o. (lon){,It"h Schedul. f). . . .. ....
20 Unemploymenl compensation (insur.nce)(ue page 13) . . , . .
211 Social secutlly beneflls. . 12.. I I 21bT,ubleamount(seepage 13)
22 Olhe' Income(h.llype.nd .mount-so. p.geI3) }I:':!~.~..~!~...~f...~..............
23 Add lhe amounts ,hown In the III flShl column for lines 7 'hrou h 22. thiS is our lol.llncoml ..
24 Your IRA deduction. hom .pphcable wOlksheet on pagr 140,15 24
25 Spouse's IRA deduction, ham .pphClble wOfksheet on pale 14 or 15 25
26 Sell rmplorrd hullh iniullncr dtduchon, Itom wOlhherl on pJir 15 26
27 Ke~h "Iuemenl pl.n and s~llemployed SE.P deductlo~ 27
28 Penally on eally wllhd,aw.1 01 sav1nKi 28
29 AlullOIl~ p.lld I RtClplenl's 1,1\\ namr %
alltlb\(U,hllirlulll~numhl'l ____._ 29
30 AlId ltne".. 24 Ihlou h 2~ Ihnr,11" OUl 101.I.d Ullmlnh
31 Subllac111ne 30 flam hnt. 23 thIS I' your .dlu.t.d .roulncoml." 'hIS lint IS Itss 'han
U9.340 ,nd. child l,wI',I wI,h )'011. srt' "CJrnrd III'Ollll' C't'd,," (Imr 58} on fJ61:" 20 p'
.. . ..,.. .. " Ir" '.' .'" ....'".,. ,,',"""/'"'11'''''1'''
r~...o
~
.
For Prlvlcy Act and
P.p.,wo,k R.ducllon
Acl Nollcl.."
Inll,ucllon..
NDI.: ChK.1III "r...."'.
no' eN",. yout r.. 01
"dUel out ,,'und
;>....
No. ,t,our
child"non "
.ho:
. 11,,4 .Uh flU
. didn't U'" wllh
,ou4u.to
dlYo,CI or
HpIfIIlDn(,..
P'I'"
No. or ,Ih"
d.ptnd.nll on 'C
Add numbers III
.nl.rI40n
IIn.. .bo" ~ ..,
'IS; ;a.S$'
'150
9
10
11
12
13
14
15
16b
17b
18
19
20
21b
22
23
IS
i8s~"
11
"',n">
form l040Cl989)
32
Tai
Compu-
tallon
Credits
(S..
Instructions
on page 18.)
Other
Taxes
(Including
Advance EIC
Payments)
Medicare
Premium
Payments
Attach Forms
W.2. W.2G,
and W.2P
to front
Refund or
Amount
You Owe
Sign
Here
(Keep a copy
at this return
for your
records.)
Paid
Pre parer's
Ule Only
II Iino.63 Is larger Ihan line 55, enler amounl OVERPAID .
Amounlofllne64lobeREFUNDEDTOYDU. '. . ..
Amourylolline 64 10 be APPLIED TD YOUR 1990 ESTIMATED TAX ~ I 66 I
II line 55 Is large, Ihan line 63. enle, AMOUNT YDU OWE. Allach check or money orde' for full
amount payable to "Internal Revenue Service." Write your social security number, daytime phone
number, and "1989 Form 1040" on It '. '. ". '.'. ; :;". ~', '. . . . . . . ;'. .
,'6'8 Penalt for'underpa ment of estimated tax (see page 21)... 68
Under PfRliij~ '0' perjury. I decllf' thlll hive .....mined this r.tum Ind Iccompln)'ir\l schldulu Ind stAt.mlnts, Ind to the best of my know'-dp and
bll)iI,lhlY .r. tru., corrKt, Ind completl.l2t:Claratloo 0' pflp.lrlr (olhll Ihln w.~r") is based on 11I1"'orm.Uon of which Pf.parll has Iny knowftdp.... t,.
~ Your silnlluf. Olt. Your occupation
~ pouse s Illnllu" (I lomt r.lurn. D ~t must foian)
Amount tram hne 31 (adjusted aron Income), . . . . . . .
33a Check il: 0 You were 65 or older 0 Blind; . 0 SPOUI' was 65 0' older
Add the number 0' boles checked and enter the totil here.
b If someone (such as your parenl) can claIm you as II de~nden1. check here ,
c: II you are mamed 'lh"S a separate return Ind your spouse llemlzes deductions,
oryouarea dual.status ahen, see p.ae 16lndcheckhere. . ..,.... 33cO
34 Enter the { . Your Itandard d.ductlon (from p,se 11 at the Instructions). OR
larl,r . Your Item lIed deductions (from Schedule A, Une 26).
01;, "you itemize, attach Schedule A and check her.. .... (2SJ
Subtract line 34 ham line 32. Enter th, result here , . . . .
Multiply $2,000 by the total number of elemptions claimed on hne 6e. . .
T.llbl.lncoml. Subtract Une 36 tram line 35. Enter the result (If less than ZIfO, enter zero)
Clutlon: If under age 14 and you have more than $1,000 or investment incom., check her. ... 0
and see page 11 to see If )'ou have to use form 8615 to fisure )'aurtn.
38 Enler la,. Check Iflrom: lOT.. T.ble. b r:ih.. R.II Schedules. or cO Form 861~.
. (If any is from Form(s) 8814. enler Ihat amounl here ~ d I.)
39 Add,lien.lta", (see p.se (8). Check II from: 10 Form 4970 b 0 Form 4972
40 Add lines 38 and 39. Enler 'he tala I . . . . . .
41 Ctedil for child and dependent care elpenses (.ttach Form 2441) 41
42 Cred'tlor the .Iderly orlhe disabled (att.ch Schedule H) 42
43 Foreign I.. cred,l (att.ch fe,m /1l6) . . . . . . 43
44 ,. General busineu credit. Check if from:
10 Form 3800 or b 0 Form (speclly)
Credit for prior year minimum tax (attach Form 8801)
Add hnes 41 through 45. Enter 'he total. . . , ,
Subtract line 46 from line 40. Enter the result illess than zero, enler zlro
o Bhnd.
~ 33a
~ 33b 0
}
35
36
37
44
45
45
46
47
48 S.If.emplovmentlax (att,ch Schedule Sf). . . . . . . .
49 Altlrnativo minimum tax (.ttach Form 625J) , . . . . . . . , .
5D Recaplure I.... (see page (8). Check II from: a 0 Form 4255 h 0 Form 8611
51 Social se'curUytax on tip Income not reported to IP1plo)'er(attach Fo. '. ~ .J7)
52 Tax on an IRA or a qualified reUrement plan (attach Form 5329) ,
53 Add lines 47 Ihrou h 52. Enlerlhe lolal . . . . . . . .
54 Supplemenlal Medicare premium (attach fo,m 8808). .'. .
55 Add lines 53 and 54. This is your totll ta. and an supplemental Medicare premium
56 Federallncomelaxwilhheld(UanylsfremForm(s) 1099. check ~ 0) 56 88')'
57 1989 estimated tax payments and amount applied from 1988 return 57 ~G D O~
. 58
58 Earned income credit (see page 20). . . . . . . . . .
59 Amount paid with Form 4868 (extension request) . , . .. 59
60 ucess social securlly lax and RRTA lax wllhheld (see pase 2D) 6D
61 Crediller Federal I.. on luels(.ttach fo,m 4/36) . . . 61
62 Regulaled Inveslment company credit (attach form 2439) 62
63 Add lines 56 throu h 62. These are our totll . ments .
64
65
66
67
~Iof
Spouse', occupation
Prep'r,,'s ~ ....1l
'.an.luI' , "/~
fllm's nlml (Of
rool\.1 leU..mployed)
,ndlddltlS
c.
.... i\W'Jl)
r 1:'1''>
lL.
fL
46
47
48
49
D
51
52
~ 53
54
~ 55
1~8'~Q
,,}'\ 0'>0
.:1'1 Q'}o
.N o}O
$' 6'f'
5' eS
~OOIB
:\10.0
'8;)'
TlPI'Ir lSOCil1 HCunty RO.
"1'\ ~;lo-'
SCHEDULES A&B
(Form 1040)
D'p'rlm.nl 01 Ih. '"uury
lotltnll Rn,nuI S.rvICI (1)
N.mt{'. ,hown on F()Im 1040
'M~l ~. I (.Ar'J'III"'t n s ItvCl1\JW\o(
M,dlullnd II Prescription medicines and drugs, Insulin. docto,s, dentists.
D.ntll [sp.nses nu"e., hospitals, medical Insurance premiums you paid. etc. .
(Do nollnctud. b Olher. (List-Include hearing aids, denlures, eyeglasses,
up.nses Iransportahon and lodging, etc.) ..........................
r,lmbumd or
pltd by othm.)
(St.
Instructions
on poa' 23.)
Tiles You
Plld
(5..
Instructions
on poa' 24.)
Inlerest You
Plld
(5..
Instructions
on page 24.)
Gills 10
Charity
(Se.
Instructions
on paS' 25.)
Casulllyand
Th.1I LOlliS
Movlnl
Esp.nses
Job Esplnlll
Ind Mosl Other
Mlse.lllneous
Deductions
\5.. poa' 26
or Ixpenses to
deduct her..)
Other
Miscellaneous
Deductions
Totalllemlzed
Deductions
Schedule A-ItemIzed DeductIons
(Sch.dul. B I. on b.ck)
... Attotch to form lQ.40. .... S..ln.lructlonl for 9ch.durn A and B (Form 1040).
II
......................................................
b
. ...
>''1'1
/0101'
B Add the amounls on lines 5 Ihrou h 7. Enler the Iota I here. Totollaxes . ...
9. Oeductl~le home mortgagelnlerest (Irom Form 1098) that you
paid to Iinanclal inslllutlons. Report deductible points on line 10. 9.
b Other deductible home mortgage Inlerest. (II paid 10 an
Individual, show that person's name and address.) .. .........
1,aGo,
10 Oeductlble points. (See Instructions for special rules.)
11 Deductible investment interest. (See page 25.) . . . . .
120 Personal Interest you paid. (See page 25.). 112.1 I) I ')
b Multiply the amount on line 12a by 2096 (.20). Enter Ihe result 12b ..,1(" 'Jo
13 Add Ihe amounts on lines 9a throu h II and 12b. Enter the total here. Totallnlerest'"
14 Contributions by cash or check. (II you gave $3,000 or more to
anyone organization, show to whom you gave and how much
you gave.) ....... . .. .. . . . .. . . . ... .. . . . . . .. .. . . . . .. .. . .
15 Olherthan cash or check. (You must attach Form 8283 if over $500.) 15
16 Carryover Irom prior year . . . . . , . . . . . .. 16
17 Add the amounls on lines l41hrou h 16. Enter the lotal here. Tol.1 contribution. . ..
18 Casualty or Iheftloss(es)(attach Form 4684). (See page 26 of
Ihe Instructions.). . . . . . . . . . . . . . .
19 Moving expenses (attach Form 3903 0' 3903F). (See page 26
of the Inslructions.). . . . . . . . . . . . . .
20 Unrelmbursed employee expenses-job travel, union dues, job
education, etc. (You MUST attach Form 2106 In some cases.
See Instructions.) ... .................................... 20
21 Other expenses (Investment, tax preparation, ..fe deposit box,
elc.). list type and amounl .. ............................
IfDD;
'-185"
. . . ...
........................................................................
..
26 Add the amounts on lines 4, 8,13.17,13.19.24, and 25. Enter the total here. Then
enter on Form 1040, line 34, the LARGER of this total or your standard deduction
lrom page 17 of the Inslructlons. . . . . . . . . , . . . . . . ...
For Paperwork Reduction Act Notlc.. set Form 1040 Instruction..
......................................................
2 A~d the amount. on lines la and lb. Enter the total here . . .
3 Multiply the amount on Form 1040, line 32, by 7.596 (.075). . 3
4 Subtract line J from line 2. If zero or less enler .0.. Total medical and denial
5 State and local income taxes . . . . . . , . . . .. 5
6 Real eslate taxes. . . . . . . . . . . , . . .. 6
7 Olher taxes. (Ust-include personal property taxes.) .. .......
......................................................
......................................................
......................................................
21
22
',:" .)."
......................................................
22 Add the amounts on lines 20 and 21. Entor the total. . . . .
23 Multiply the amount on Form 1040, line 32, by 296 (.02). Enter
the result here. . . . . . . . . . . . . . . . . 23
24 Subtract line 23 from line 22. Enter the result. II zero 0' less, enter .0. ~
25 Other (from list on page 26 01 Instructions). list type and amount ..
OMU No. IM~.OO74
~@89
Attachm.nl
S~u.ntt No. 07
VaLlr loclal..cYflly "UmN'
~o 0 i 11. i /I.~c.
4
...
...
~"
Sch.dule A (form 1040) 1989
'SchedulnA&B(F<<m 1040) 1989
N,ml(tllhown on Form 1040. (Do nol .nlet ".m..nd ,oc..1 s..cullly number., ,"own onolhl' sid..)
. Oll~L F. '. "''''JfIY'<L fl, I \IV(f1fotI'1
Schedule B-Interest and Dividend Income
Pari I
Inlerest
Income
(5..
Instructions on
POi" 10 .nd 27.)
Hot.: II you
received a Form
1099~IHT or
Form 1099~0ID
from.
broklrla' firm,
IIstth,flrm's
name as the
piyer and enter
the total Interest
shown on that
form.
Pari II
Dividend
Income
(5..
Instructions on
POies 10 and
27.)
Hoto: II you
received a Form
1099.DIV from a
brokerase firm.
list th. Ilrm'.
name at thl
payer and Iflter
the total
dividends shown
on thai form.
OMONo.I504'S.D074
Pip 2
You, MClalHcu,tty "umbtr
..." : 'Co i 11.'tt.
Attachmtfll
Sequtnc. No. 08
II you rec.lved mo,. than $400 In taxabl. Int.,..t In com.. you mu.t compl.t. Part. I and III. L1.t ALL Int....t
,.c.lv.d In P.rt I. II you ,.c.lv.d, II a nom In... Int.,..t that actually belongs to anoth., p.rson, 0' you ,...Iv.d
0' paid accru.d Int....t on ..curIU.. t,an.I.rr.d b.twun Int....t paym.nt dat.., ... pag. 27.
Interest Income
1 Interest income Irom seller. financed mortgages. (See Instructions and list name of
payer~) ~ . . . . .. . .. . . . . . . . .. . . . . . .. . . .. .. .. . .. . .. . . .. .. . . .. .. . . . .. .. ..
2 Othe, Inte'est Income. (Ust name of paye'.) ~ . !I.~~4f.1r ~'::':'! !~~:.!~
.............................. ....... ...~~I..!'!~~'t':\,.ll~~.~
c..u"".......\Ir1-f\\ I"Anl'~
................. ....................... ;;rMiA1..,,vj,,.................
:::::::::::::::::::::: :::::::::::::::::: :~A:: ~~;1i: :r~':"!f.i.::::::::::::
Amount
1
.......................................................................
.......................................................................
2
.......................................................................
........................................................................
.......................................................................
.......................................................................
.......................................................................
.......................................................................
3 Add.th~.~.;,~~~.t~ ~.';Ii~~~ i'~~d 2'. 'E';t~; ih~.t~iih;;.. ~~d ~~. F~;';" i64ii il~~'8~:' -.: 3 'I So
II you ,.c.ived mo,. than $400 In R,oll dividend. and/o, oth., dl.t,lbutlon. on .tock, you must complete Parts II
and III. If you ,.celv.d, a. a nomln... dlvld.nd. that actually b.long to anoth., e..on. .e. pag. 27.
Dividend Income
4 Olvldend income. (List name of paye,-Include on this line capital gain dlst,lbutions,
nontaxable distributions, etc.) '" ...........................................
Amount
.......................................................................
.......................................................................
.......................................................................
.......................................................................
.......................................................................
.......................................................................
4
........................................................................
.........................................................................
........................................................................
........................................................................
.. ... . ., . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . .. . .. .. . . . . . . . . . . . . . . . . . . . . . . ..
........................................................................
.......................................................................
5 Add the amounts on line 4. Enter the total here. . . . . . . . . . . . .
6 Capital gain distributions. Ente, here and on Schedule 0'. . .
7 Nontaxable d~tributions. (See Ihelnstructions fa, Form 1040,line 9.)
8 Add the amounts on lines 6 and 7. Enle, the total he,e.. .......
9 Subt,act line 8 from line 5. Enter the ,esult here and on Form 1040, line 9 . . . ~
'If you received capilal gain distributions but do nol need Schedule D to ,eporl any olher gains or losses. see Ihe
Inslructions lor Form 1040./ines 13 and 14.
If you ,.c.lved mo,. than $400 01 Int.r..t 0' dlvld.nd.. OR II you had a lo,.lgn account 0' w.,. a
granto, 01. 0' a t,an.I.,o, to, a lo'.lgn t,ust. you must an.wer both qu..Uon.ln Part III.
P,rt III
forelin
Actount.
and lOa At any time during 1989. did yoU have an Interest In or a signature orothe, autho,ity ave' a financial account
ferelln in a foreign country (such as a b.nk account. securities account. or olher f1n,nclal actount)? (See page 27 01
Trusts the Instructions fa, exceptions and filing requirements for Form TO F 90.22.1.). . . . . . . . .
(Se. b If "Yes." enle, the name of the foreign country ~ ...........................................
Instrucllons 11 Were you the granlo, of. or transfero, to. a foreign Irust that existed during 1989, whelhe, 0' not you have
on p'ie 27.) any beneficial Interest In II? If "Yes," you may have to file Form 3520. 3520.A, 0' 926. .....
for Paperwork Rlductlon Ad Nolle.,'" Form 1040 In.tructlon.. Schedule B (Form 1040) 1989
SCHEOULE SE
(Form 1040)
Social Security Self-Employment Tax
Otpartm.nl ollht r,.uurr ... S..lnlt,ucUonl lor Sch.dule SE (Form 1040).
Inl,fn.1 R.....nuf S.MU (I) ... Ahach to Form 1040.
Nlmt 01 person with Hlf..mploymlnt Income (as shown on socIal security card) Social security number of person
1>/t 1-1. f. fl\'l YWt>'-r :s "- . with ..,I..mploymontincome"
OMBNo.l!4,.oo74
~@89
Attachment 18
s~u.nc' No.
j,oo ; "lc. ; 1(,4"
Who MUlt File Schedule SE
You must file Schedule SE if:
. Your net earning' from self'emplo~ment were $400 or more (or you had wages of $100 or more from an electing church or
church.controlled organization); AND
. Your wages (subject to social security or railroad retirement tax) were less than $48,000.
Exception. If your only sell.employment income was from earnings as a minister, n,ember of a religious order, or Christian
Science practitioner, AND you flied Form 4361 and received IRS approval not to be taxed on those earnings, DO
NOT file Schedule SE. Instead, write 'Exempt-Form 4361' on Form 1040, line 48.
For more Information about Schedule SE, see the Instructions.
Note: Most people can use the short Schedule SE on this page. But, you may have to use the longer Schedule SE
that Is on the back.
Who MUST Use the Long Schedule SE (Section B)
You must use Section 811 ANY of the following applies:
. You choose the 'optional method' to figure your sell.employment tax (see Section 8, Part II);
. You are a minister, member of a religious order, or Christian Science rractltioner and you received IRS approval (from
Form 4361) not to be taxed on your earnings from these sources, bu you owe self.employment tax on other earnings;
. You were an employee of a church or church.controlled organization that chose by law not to pay employer social security
taxes;
. You had tip Income that is subject to social security tax, but you did not report those tips to your employer; OR
. You were a government employee with wages subject ONLY to the 1.45% Medicare part of the social security tax.
Section A-Short Schedule SE
(Read above to see II you must uselhe long Schedule SE on the back (Secllon B).)
1 Net larm profit or (loss) from Schedule F (Form 1040), line 36, and farm partnerships, Schedule K.1
(Form 1065), line 14a . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Net profit or (loss) from Schedule C (Form 1040), line 30, and Schedule K.l (Form 1065). line 14a
(olher than larmlng). See the Instructions for othor Income 10 roport . . . . . . . . . . .
3 Add line, 1 and 2. Enter the total. II Ihe total Is less Ihan $400. do nol file Ihls schedule; you do nol
owe sell.employmentta. . . . . . . . . . . . . . . . . . . . . . . . . . ~
4 The largest amount 01 combined wages and sell.employment earnings subject to social security or
rallroadretlremenltax(llerl)lorI989is. . . . . . . . . . . . . . . . . .
!l Total social security wages and tips (from Form(s) W.2) and rallrnad rellrement compensation (tier 1)
6 Subtract line 5 from line 4. Enter the result. II the result is zero or less. slop here; you do not owe
sell.employment tax. . . . . . ~
7 Enter the amaller of line 3 or line 6
8 Rate of tax. . . . . . . .
1
2
3
4 US 000 00
5 :J Ou'
6 L\S'l'l1
7 1.\5'\"11
8 x.1302
9 516'1
9 Sell.employmentt... II line 7 Is $48,000, enter $6.249.60. Otherwise. multiply the amount on line 7
b the decimal amount on line 8 and enter the result. Also enter this amount on Form 1040. line 48
For Plptrwork Reduction Act Notlet,... form 1040 Instruction.. Sch.dull SE (Form 1040) 1989
101
r~m 8582
Passive Activity Loss Limitations
~ See sepa'ate Instructions.
~ Attach to Form 1040 or Form 1041.
Dtp;1lr1m.nt ollh. r,.uuty
Int,,",1 R..-nue S.NK'
Id.ntifyln, numb.,
dO. - )c.-l~'tb
N.mt{l} lhown on ,.lu,"
\)ILl F. . CAr')1'II"<L () 11t"(r1I'Y'-J'
Computation of 1989 Passive Activity Loss
C.utlon: See the Instwctions fa, Worksheets 1 and 2 on pages 6 and 7 before completing Part/.
Rlntal Rill Est.te Activities With Active Participation (For the definition of active participation see
Actlvl Participation In a Rental Real E.tate Activity in the Instructions.)
Actlv'tles acqul,ed belotl 10.23.86 (P,e.enactment):
11 Activities with net income (Irom Worksheet I. Part I, column (a))
Ib Activities with net loss (from Worksheet I. Part I, column (b))
Ic Combine lines la and Ib . . . . . . .
Activities acqul,ed alter 10.22.86 (Po.t~enactment):
Id Activities with net ,"come (from Worksheet I, Part 2, column (a))
Ie ActiVities with net loss (from Worksheet I. Part2. column (b))
If Combine lines Id and Ie . . . . . . . . .
II Net Income or (loss). Combine lines Ic and If
Ih Prior year unallowed losses (from Worksheet I. Parts I and 2. coiumn (c))
11 Combine fines I and Ih . .
AU Other Pa..lve Actlvltle.
Activities acqultld belo,e 10.23.86 (Pre.enactment):
2a Activities with net income (from Worksheot2. Part I. column (a))
2b Activities with net loss (from Worksheet 2. Part I. column (b))
2c Combine fines 2a and 2b . . . . . . . .
Activities acquired afte, 10.22.86 (Post.enactment):
2d Activities witll net income (from Worksheet 2. Part 2, column (a))
2e Activities with net loss (Irom Worksheet 2. Part 2. column (b))
21 Combine lines 2d and 2e . . . . . . . . . . . . .
21 Net income or (loss). Combine lines 2c and 2f . . . .
2h Prior year unallowed losses (from Worksheet 2. Parts 1 and 2. column (c))
21 Combine fines 2 and 2h . . . . . . . . . . . . . . . .
3 Combine lines Ii and 21. II the result is net income or .0.. see the Instructions for lin. 3. II this fine
and line Ie or line Ii are losses 0 to line 4. Otherwise. enter -0. on lines 8 and 9 and 0 to line 10 3
Computation of the Special Allowance for Rental Real Estate With Active Participation
Note: Treat all numbelS enle,ed in Parts 1/ and Iff as positive amounts. (See Instwctlons on page 7 for examples.)
4 Entetlhe .maUer of the loss on fine II or the loss on line 3. II line Ii is .0. or netincome, enter .0.
and complete fines 5 through 9 . . . . . . . . . . . . .
Enter $150,000.11 married filing separately, see the Instructions . .
Enter modified adjusted gross income. but notle55 than .0. (see Instructions)
Note: If /ine 6 is equal to 0' g,eate, than line 5, skip /ine 7, enter .O.on
/ines 8 and 9, and then go to /ine 10. Othe,wise, go to /ine 7.
Subtract line 6 from line 5. . . . . . . . . . . . . . .
Multiply fine 7 by 50% (.5). Do not enter more than $25,000. If married filing separately, see
Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 Ente, the smaUer of line 4 or line 8. . . . . . . . . . . . . . . . . . . . . .
Computation of Passive Activity Loss Allowed
Combine lines Ic and 2c. If the result Is net income 0' .0.. skip to line 16. (See Instructions.)
If line Ie shows income, has no entry, or shows .0., enter -0" Otherwise, enter the smaller of line Ie or line 8
Subtract line II from line 10. If line II is equal to or greater than line 10, enter .O~.
Subtract line 9 from line 3. . . . . . . .
Enter the smaUer of line 12 olline 13 . . . .
Multiply line 14 by 20% (.2) and enter the resull
Enter the amount from line l;1. . . . . . .
Pa..lve activity 10" allowed 10,1989. Add lines IS and 16
Add the income, if any, on lines la, Id, 2a. and 2d and ente, the Iota I . . . . . . . . . .
Totallo..esallowed Irom all passive actlvlUe. for 1989. Add lines 17 and lB. See the In.truction.
to find out how to report the losses on your talC relurn . , . . . . . . . . . . . . . . 19
for Paperwork R.dutll,Jn Ad Nollee. see "partl'elnstructlons.
.
2b
2c
2d
2e
21
5
6
7
8
10
11
12
13
14
15
16
17
18
19
10
11
12
13
14
15
16
17
18
OUIINo. l~.~.l00a
~@89
AlIuhmenl
Sequence No. 88
,,-
_u-
-.
.-
lIS
-
115'1
r"m 8582 (1989)
263
RETURN BY APRIL 16, 19!JO TO: I
APITAL TAX COLLECTION BUREAU
., II P.OKFIIET ST
AlllISlE, PA 17013-1~q5
I iJ ~~~~)8 9
LOCAL EARNED INCOME
TAX FIETURN (FORM 531)
SEE BACK OF RETURN FOil
PHONE NUMBER AND OFFICE HOURS
36 164h 174 3~ 71-'
_~ _~_J._()7~L;_~____~?,5"GO
EMPLOYEE BUSINESS EXPENSES (Al1aCIl Ft'lhll.ll FOIIll ;;'llltj ,\ Sl,IlI' Scl1t!llulo U~I)
TOTAL BALANCE DUE (Add Lines 1.\ and 15) M.lku check PilViltJltl 10 "creu"
, , .
2
3 .300'1 'iSSoo
4
5 .;loc1 I.tS'S~o
6 '1'?:5~1
7 8'05')" "'\;. 5<>.,
B .
.
.
9 6'05% ',to
'I$'Soo:' ,
10 6'o~ I
'\55": '
.
11 J<> .
.
, ,
12 Sea , ~SS",
. ,
. ~S'~ ,
13 tJ ';'0 , ,
. .
. .
14 . 0 ,
, ,
,
15 I
.
16 "
, 0
,
17 15;"",
':
TAXABLE W-2 EARNINGS ($ubltilClllne f?lrUIll Llfltl I)
OTHER TAXABLE EARNED INCOME (NO INTEREsr on U1VIUENUSI Clll11pluh' Socllon 0 on Oack
TOTAL TAXAUlE EAnNED INCOME (Add Lllws J ;lml 4)
NET LOSS fHOM UUSINESS, PROFESSION. OR FArlM IU~a: LINE U FOH ,'NY Nt: r PROFITS)
SUOTOTAL (SublrilCI Unu 6 "om lllw 5) IF ll:SS THAN ZEfHJ UHUl LUlU
NET PROFIT FROM UUSINESS, PROFESSION, on FAnM (USE UNE'u fOR AN~SSESI
"-.
TOTAL TAXABLE EARNED INCOME AND NET pnOF,rs (Add l.uw~; ,-:;iici 8)
~.. .
TAX LIABILITY: 1 % OF LINE 9 (MulllplV Linn IJ bV 0 l)
TOTAL bOCAL INCOME TAXES WITHHELD IFfOm t1l1ilChl!lt W.~.~;]
QUARTERLY PAYMENTS I LAST YEAR'S OVERP,WMENf cnEnITED TO THIS Y~AR
TOTAL WITHHOLDINGS,\ PAYMENTS (Add Lines 11 ..mtl 121
TAX BALANCE DUE (Subllacllino 131ro01 LInt! 10) IF LESS THAN ZERO, ENTER ZERO & GO TO LINE 17
INTEREST ,\ PENALTY (See InstruclIOns)
OVERPAYMENT (SublraCI Lmo to horn Lino 13) IF LESS THMJ ZERO, ENTER ZEAO
OVERPAYMENT TO BE RE~FUNDED
OVERPAYMENT TO BE CREDITED TO NEXT YEAR'S TAX
,OVERPAYMENT TO BE CREDITED TO SPOUSE'S BALANCE,DUE FOR THIS FILI~ YEAR,
... YOUR RESIDENT MUNICIPAUTYl:.trJ1,'".-....
, (fOWNSHIP, BOAOUGtt. OR CITY) ,
.. .-.' ....... ...... . ." ...:
CARLISLE BOROUGH
. 7"'. .,t.... ............. .. :.lr.".<.-...".,:,~~ __;",,,...\" ........,:....;.t,4.;~!I,'~
rAXOf!I~;E I :l:I"~i!..,. :;~.lUOC~.'-.I. ~..i;~~...;;cl;~:ilL~h~~.:<H
USE ONLY , ' ~ '2603616\6eQ020'i6. ~ ",
~. . ,
'1\'-: -
,~ . .~......
36lM6
YOUf~e -..
(l.AST..~sr.J,lr)
spouses NAME'.
S~UG~lPT OAlf F JP
SHUGHA~T CONSTANCE
02
2001
17"1
36, 715'3
, ,
01
252 W PO"FRET ~T
CAIILT'SlF., PA
X: SPOUS~j;:IUiI[(otjLTif:-Ai5o f'JWW. ONT~F~Ofl~'I--.~'--- .
\IU PIIEf'AIltll'S il"M~'iI;lE;::;I:-"liit;li
----------.-
'.r' .
.
','
.
Partner's Share of Income,' Credits, Deductions, Etc.
.. See separate Instrucllons.
for calenda, year 1989 or fIscal year
1989 a dendlo 19
P,rtnershl 'sldentlf In number ~ 2.:,- -::10'<0 '1.
P,rlnership's name, address, and ZIP code
F="t>~,-"rl.I\1~""""!.., S....U..~T * '"K"...bL."
7.0.130'" ...0 ll'
c. (\.(Ll,.....l s. t.,.e . -P/~ ,-, O'~
OMONo.l'.'OO99
'SCHEDULE K.I
(Form 1065)
Dep.rtmtnl of the T,ulury
Inl.rn,,1 Re.enue Servlu be Innln
Partner's Ident! In number.... "2.(...)(..:>- ~ (,-
Parlner's name, address, and ZIP code
DA\..6"" F. ~H U b\-H\.Q...\.:rfL
L.,;,-l>>I.i~,-;:LI"F{t<-'- ,",T.
CArlL L-\ ~ L.t , .-? p". II 0 I~
~@89
II.LIt.
F IRS Center where parlnership filed relurn ~ Jh H..~ ,.,> J'~..
G(I) Tax shelter registration number ~ .. .......!'! It!:. ..........
(2) Type of tax shelter ~ .....................................
H(I) Did the parlner's ownership Inlereslln the parln.rship chanll'
aller Oct. 22. 1986? , , . , , . . . 0 Ves I2S1 No
If 'Yes.' attach statement. (Se. Form 1065Instruclions.)
(2) Did lhe partnership starl or acqulr. a new Ictivltuller
OcI.22.1986? , , , . , , . . . ,OvesOO No
II 'Ves.' attach slatement, (See Form 1065Instruclions,)
_ ~.':l,y k. '16 Check here If this parlnershlp isa publicly traded partn.rshl
.:L. "!,.~'?.. '16 as delined in seclion 469(kX2) , . . , , , , , ,
1.'-\,1D '16 J Check he,e if this is an amend.d Schedul K.
d) Income nol included (e) Loues nollOcludtd (I) WltheS/.WIII.nd (,)CJpll.lltcqunl.t
In column (e), plu, 10 column tel. plUI .nd of w'" (comlMnt
nonla.o1ble w::om. unolllowo1ble dtdutlionl dlllnbuhonl column' . Ihllw h I
. 181 Ves
No
Is this parlner a general partner?
Parlner's share 01 hab,lihes:
Nonrecourse. . . . .
Other. . . . .
What type of enlity islhis partner? ~ r~~.\.~!\'~~.':-;-....
Is this partner a !l5l domestic or a 0 foreign parlner?
(I) Deloft dtcrtu, (II) End 01
or lermmo1hon yur
A
B
$ ......~~~.........
$ ......!'!l~........
c
o
Enter parlne,'s percentage of:
Profit sharing . .
Loss sharing . , . , .
Owners hi 01 ca ita I . . .
Reconciliation of artner's ca ital account:
. 'PI' ICcoun . ,pll. conlll ul c ncome Ion) 10m
bl! IMin 01 e,1( dUlln ear I;nn 2 J and 4 bl!low
E
.........'l6
.........'16
'l.1.9~ 'i?'l,'"2.'3(., ( i oi ) ( 'I SI1-) c\ 140
Reminder: /I you received a 1987 Schedule K.j Ihat was fora short year and you chose to report Ihe 1987 amount. ov", 4,y'''ptrlod,
be sure to Include one-fourth of the sho,t year amounts, in addition 10 Ihe items reported on this Schedule K.l. on thllppropr/,', 1m.. of
your 1989 Form 1040 and related schedules.
Clullon: Refer to Partner's Instructions for Schedule K.l (Form 1065) before enterin
information from this sch.dule on ur tll IflufO,
Ie) 1040 lII.ra .nlar lh.
amounlln column (b) onl
(b) Amount
(a> Distributive shirl Item
} ('ff ,,,',*',III,II,,,,lllIIIl' '-)
k'*lIM" I t'IM'" 10"1
Ordinary income (loss) from lrade or business activilies
Net Income (loss) from rental real estate activities
Net Incnm. (loss) from olher rentalaclivities .
Porltolio Income (loss):
Inlerest,
Dividends, . . . .
c Royallies , . . . .
d Net short. term capital gain (loss),
e Netlong.term capital gain (loss). . . . . . , ,
f Other pori/olio income (loss) (aUach schedulej1l?jp.,.A \ll.",,!m
5 Guaranteed payments to parlner . . . . , . . , . . ,
6 Nel gain (loss) under section 1231 (other than due to casually or thell)
7 Olher income loss attach schedule . . . . . . .
U 8 Charilable contribulions . . . , . , ':i~l," , , ,
il:!l 9 EJpenll deduction tor mo,,,y properly (setlion 119) (attlth !Ch.dul.) ,
~,g 10 Deductionsrelated 10 portlolio income. . I . , . '....
11 Other deductions aUach schedule \(~""" \-1l,,~. C!-""!, J
12, Credit for income tax w,thheld . , . . . , . .
b Low.intom. housin. credit: (I) P"lnershipslo whith .lthon 42(J)(5) applies
(2) Other than on line 12b(l). . . . . . . . . . , ,
c Qualilied rehabilitation expendilures related 10 rental real eslale
aclivilies (attach schedule) . . ., .,.,
d Credits (olher than credits shown on hnes 12b and 12c) relaled
to rental real estate activities (attach schedule) .
e Credits related to renlal activities other than renlal re.ll estato
(see instructions) (attach schedule).
13 Other credIts and e. enditurcs attach schedule
For P~p'rwo,k Reduction Act Notice, see Form I065Inslructlo".,
1
2
3
4
Seh, D. Part I. IIn. 2
Sch, D. Plrlll, line 4
5ch, E. Part I, line 5
5ch, D. line 5. col, (I) or (i)
Sch, D. lina 12. col, (I> or (&)
(hlN III ,,,hc,Wt ~At' tf fOUl flllIlJ)
I (S..'''tMf'llnlhlllll9llll.)
1tJ\.4\M"" v."" 106\.
I(Altf."ptte,.-.....tf,Ott".hllll)
Sch, A.lln.14 or 15
~
..
..
Q
...
-
a
b
u
E
o
u
.5
;0
7
B
9
10
11
12.
J!1!1
Ii 'JJ,1.f~;tJ;?;~;fjj1 ' ;
,~'i "',!"",'7"1",~:1r,"'~,'..,-"", - " ,.
:*fh7ll4 ,i~Zf;;lX.i';~I:~J;iiN;4r;( ~~-'l.
'!>Ji
;'Il-
} (a.. ,,,llllf',IIIIIIIKI_, I.)
ktltdwlt.. I thl'" 106\)
,.."rtn.nlflJllIIlllO!'l'r
k/'l"vIf" l ( .m 100\
C.H10
Fo,m 8586, line 5
l (,..,,,,....'.,"",,.'_.,.)
Schfdlll.M-II'OIm 106\)
:l
:;;
u
~
CJ
12d
- -,.----~-
12'
I]
Sthedul. K.l (Form 1065) 1989
:l
'0
..
~
u
~~
'0
..
~
"
-
...
a
..
II:
I A
~hC'dul. K.acro,m 1065)(1989)
PI.12
(e) 1040 III... tnlor Iho
~mount In column (b) on:
Sch. SE, Section A or Ii
I ( s.. "I1Mf't1nll'lICtHlr'I"Of)
SchtdlM "'.l t'Dfm 1(65)
(.) Dlslrlbutlve shareU,m
(b) Amounl
-
'C
e..
.!!
- "
.;!'ii.
21 I'll..
141 Net earnings (loss) Irom self. employment ,
b Gross farming or fishing income. . . .
c Gross nonfarm income. . . . , . .
151 Accelerated depreciation of real properly placed in service before
1987 , , . . . . . . . . . , . . . . . .
b Accelerated dep,eciation of leased personal properly placed In
service belore 1987. . . . . . . . . . . . . .
, Depreciation adjustment on property placed in service aller 1986
d Depletion (olher lhan 011 and gas) . . . . . . , , . .
e (1) Gross Income from oil, gas, and geothermal properties . .
(2) Deduclions allocable to oil, gas, and geothermal properties.
Other adjuslmenls and tax preference items (attach schedule)
..
....
I-e
"'..
c_
..-
....
_ u
Cc
....
e ~
-"
..-
,,~
:on.
e(
'B
(See Form 6251
Instructions and Parlner's
Inslrucllons for Schedule
K.l (Form 1065))
-
C
..
~~
>~
.5.5
,1'1-
Form 4952,Iine 1
I ( s.. Plflnt",lll,IIUChonIIOl)
SchtdlolIK.1 lro,m 1065)
161 In teres I expense on investment debts , . . . . . . .
b (1) Investmentincome included on Schedule K.1, lines 4a through 4f
2 Investment e. enses included on Schedule K.1, line 10. .
171 Type of Income __. __ __. __....... . __..... __.................
b Name of foreign counlry or U,S. possession... __.... __ ........
c Total gross Income from sources outside the U.S. (attach schedule)
d Tolal applicable deduclions and losses (attach schedule) .
o Total foreign laxes (check one); ~ 0 Paid 0 Accrued
, Reduction In laxes available for credit (attach schedule) .
Otherforei n tax information a!tach schedule , . , ,
18, Tolal expenditures 10 whloh a section 59(e) election (relating 10 Ihe
optional 10.year writeoll of certain tax preference Items) may apply
(attach schedule). , . . . . . , . , . , . . , . . .
b Other Items and amounts not reporled on lines 11hrough 17g, 19, and
20 lhal are required to be reporled separately to you , , . .
19. Low.lncoma housina tredit; Parlnershipslo which section 42(i)(S) applies
b Low.lncome housing credil recapture olher Ihan on line 19a ,
20 Investment T.. Credit
Properly;
I Descrlplion 01 properly
(Slate whelher recovery
or nonrecovery
properly. II recovery
properly, slale whether
regular percentage
method Dr section
48(q) election used.) .
b Dale placed in 5e~ice .
c Cost or other basis, .
II
~
C
..
Ii
li
...
Form 1116, Check boxes
Form 1116, Part I
Form 1116, Part I
Form 1116, Part I
Form 1116, Part II
Form 1116, Part III
See Form 11161nslruclions
~
..
.c
-
o
(See Partner's Instruc.
tions for Schedule K.I
(Form 1065))
c
A
B
d Cia.. 01 recovery
property or orl~inal
estimated useful hIe .
o Date item ceased to be
Investment tredit propt,ty
Olher Information Provldod by P,rtnershlp;
J.1040
. Llbll
(Stl
Inslructlons
on pa..I.)
I UsolRS label.
OthOrwI..,
pl.... prlnl
..\ylII.
Flllnl Stilus
Chock only
OM bole.
Ellmpllons
(Sot
Inltrucllons
onpa..
10.)
II m,,"lhan 6
dopandlnll. ""
Inltructlons on
_II.
Incoml
Attach
Copy B of your
r..ml W.2, W.2G.
andW.2Pharo.
II you do nol
hive . W.2. ...
pa.. I. .
Attach chock..
money OId,r on
lop olony r.....
W,2~W.2G,..
W.2".
AdJuslments
to Income
~ructlonl
on pa..)7.)
AdJusled
Cross Income
. 19 10M..... ......0074
"W' MeW MWrttr.......
~.o I'" 111o"&.
s,....'._IoI-,-
11'\ 11(. 11'5~
For MVKY AcllIld
PlrlrwOrllllttluctlon
Ae Nollel,"1
In.truellon..
, ..... ., ,n.- 1990 orothe,t.. ..be Ml
'tOUt '''II NInt Ind tnIl1.1
Au'II\AT . fl..
".~, ,,'urn,lpout", flnl "'''MInd In"~l
Go,. JfRr'll 6. (1I11~ I\"~I
Home .dd,... (number ind 1""1>> (II rou hi",. po, bol, '" PIP 9 )
~ ~ w. ~nr~~T Sr:
CIty, town Of post olfk.Jtt'lf, Ind ZIP todt (11 you hive. tot'lI" tddllu. N''''' 9)
~(l.I.HLl f1j, /101
DoyouwlntS1lolotothlslundl. , . , , , , . " VII
II oint "turn dOls OUII USI win 0 0 to this lundl V
Slnll.. (SH pa.. 1010 find out II you can Ilia II h..d 01 hDUSOh<lld.)
M.nl.d IllInllolnlrolurn (IVan II only Dna had Incom.)
W.rrled fihlll "plflll IIlw,,, bill spouse', lOti,1 lItufll, 10 IbM 'lid full .,tI'It hUI. ..
H..d 01 houI.hold (wilh qUllllylnl person). (Sot pal. 10.) IIlh. qualllylnl person II your child but not your dapond.nl.
Inllf thl. child', nlml hi". ..
I u.1I wid ., wilhd. nd.nlchlld .." ..diad .19 . Sot 10.
ta 0 Vo...a.II If lOur par.nl (.. lomeon. .111) can cl.lm you II a d.pond.n' on hi. .. hit I.. }
b 0 Spouso r~tu~n, ~o ':'" C.h~k~~. ~UI ~ ',uro.'O~hO~k I~. ~.~n I~nl ~]b..n:~ 2, :
c D.pend.nh: mC>ltI (1)"...1....',_1'1 (0_'" 5)11...,_11.
(I) Him, (lll1t, IniU.I,lnd ."t RIm.) "..., _III ...11,..... rtIItieflu" I'''' = r:o....
Lll"/U\ ""~ ~ j\. 0 ,5 : "l) (, v~1t )-..
"i\@90
00
990 ....
UII name
b., name
NIl. no
I
a
]
4
I
I I
d IllOUrchild didn'llivI with IOU but b c~lmod .'lOUr d'plnd.nt under a pI..1985 'l'umont, chtc.k h.r. ~ 0
. Tot.1 number of .um lions claimed. . . . . . . .
7 W'lel, ..1.,111, tip., Ilc. (.ltlch Form(.) W.2). . . . .
II TIUbl1 inl.relllncome (.110 .IIach ScII.du/l B /lovlI $400) .
b Ta..lllmpllntrrllllneoml (stl pal. I]). DON'T Includ. on IIna 80 b
, Dividend Incom. (."0 .It.ch ScII.dul. B /I over $400). . . , ,
10 T.ubla rotund. oht.lund IocIllncorn.IIIII,llany, Irom wo,klhHton pap 14
II Alimony roc.lved , . . . , , . ,
12 BU1lnlls lneoml.. (lolS)(lltlCh Schadulo C) . . . . .
U Capilal pin or (1011) (.ltlCh Schedulo 0). . , , , , .
14 Capll.1 pin dl.lrlbutlonl nol reported on Ilna 13 (," P'." 14),
II Olhlll.lns or (lolIlI)(llt.ch Form 4797) . . . . . . . . , , , . . . .
III TolallRA dl.tribullonl. . UbJ I_lib toublllmounl ("" pal" 14)
171 ToIalponslonSlnd.nnulllos LnaJ '-'l(, LI7bTlublumounl(...paII14)
II Rlnll, royalllll, p.rtnarshlps, IIlalll,trultl, ate. (lltlCh ScIIoduII [) . . . . . . .
It rorm Incoma or (101l)(lltlCh Schldulo f) . , . . . , . . . . . . . . .
20 Un.mploymlnt compon..Uon (In.ur.ne.)(... pa.. 16) . . , , . . . , , . .
211 S<lclllllCurilybon.f1I1, .1 ala I L-21Ulllblumounl(..ap,,"16)
U Othor Incoma (lIsllypund amount-III pa.1 16) .f.~..!(J.L.~f.'.~;.~.{~.'7.
n Add thO amountl _ In thO I.r r I column I.. linn 7thr 22. Thllls r tolallncorn. ~
241 Vour IRA d.ducllon,lrom appllcabl._lhtIton pap 17..18
b Spouso'.IRAdrductlon. trom .ppIlcabltworlJhtot on pap 17 or 15
21 Ooo.hall ol..II..mploymonlla. (III ..pll). . . . .
at IoII..mployod hO.llh insUla"" clIductlon, m -"ohIoI on.... II
17 KIDIh retlr.mlnt plan and "U,"mployod 5EP deduction
at Panally on ..,lywllhdrawll ol..vlnp , . . . , . ,
2. Alimony paid. Rltlpl.nl'. SSN ~
10 Add IInla 24athrou 29. Tholl". r 'O'"lld u.lml.l. ·
ubtflct IInl 30 rom IIn. 23, Thlt II your adlu,..d ,r.n ncoml. 'hi. .mount , ,,, Ihln
'20,264 Ind 1 child 'Ivod wllh you. s.. pi" 23 10 nnd oul II you con c,,'m 'hi '["n.d Incom.
Credil' on "n.57 . 31
'l,,1
1000
39
No MolII CIIo<lA'W ..1'01.....
IlIIc/OItIfO_/U"
N noM.
..... MI"
dlIdof.. II "I
..." -2:-
... .. ,..,
_,....k
-
I Iln4 IK_ III --1-
"""..11....111I
,.dll II
_If
__(III
_Ill
.....-
'.,.IIIIb.k -
M" .......
III""'..
.
8f.
'1
b
7b
I
II
(. "ll.
l)
t
I \ 'I S\).
)_ICMDhttOl
II
110
'II' ,
Compu.
,.1I0n
II ~ w.nllRS
,. fiCur. your
'....H
In.lrucllon. .n
poco 19,
Cr.dlts
l~nlCllon'
OIl pap 21,)
tlthlr
,...S
"rmlnts
AtI.ch Form.
W'21~.2G,
and ...2P I.
Ironl.
IIlfund or
Amount
You 0.1
Slln
Herl
ICIIp . copy
01 \hll ,aM"
lot YOU'
IICOtda.
,.14
,",.,.,',
UN On"
Amounllromllna31(ldlutlld.r...lncom.) .'. . . , . , . ,
Chack II: 0 v.. Wlra '5 or .Id.. 0 Blind: 0....... wal '5 or old.'
Add lho numbo,.1 bo... ch.ckld .bovund .nlor Ih. lolal hor. . ." ..
_ II your paronl (."om..nu''') can cl.lm you au clopand.nt, chock hor.. , . ..
c If you Ir, m.rrled fill".. "p.r.t. "turn and your lpouttlt.mllls d.ductlon., or 10U
.r,' du.l.llltUI .Ii,n. ,.. pia' 19 and chICk h", . . . . . . .. ... 33c 0 .
I. Y.ur .Iandard doducll.n (Irom Ih. chart (or _""hHI).n po.. I
J4 [nlor lho , 20 Ihll Ipplle.l. you), OR
Iar... . Your 1I0mllld dlducll~a (Irom Schodulo A.llno 27).
.1 II you Illmill. allach Schldule A.nd chock h..... .. Cll
n Subl.aclllna 34 Irom IIna 32 . , , . , , . , , . ,
JI Mull.pIy $2,050 by Iho lotal numbor .'...mpllonl c'.lmod on IIna ea
37 Ta..blolnc.m., Sublllcllln. 361.om IIno 35, (IIIlno .610 mort lhan IIn. 35, onlor .()..). . .
JI [nlor III. ChIck ilfrom: a 0 To. Tobl., b!liS T.. RII. SChodul....r c 0 '"M Hll(Ift"l'll)
Illlnyislr.mf.rm(I)8814,.nl.rlhallm.unlhora .. d I ,).,.
n Add'".nalta... (... PO'. 21). Ch.ckllfr.m: . 0 Form4970 b 0 form 4972 .
40 Add II... 38and 39
41 Crodil lor child and dlpond.nl CI'. ..po.... (.It.ch rOtm 244 I)
42 Crodlt 'Otlho .ldorly or Ih. dl..b11d (11t.ch SchoduIo R)
43 f.rolan In c.ldll (.ltl<h rorm illS) , , , . . , .
44 G,..III busln... crldll. Chock II 'r.m:
a 0 Form 38oo.r b 0 Form (.podly)
45 Clldillor prl.r yeor minimum In (11t,ch rorm 8801) .
46 AddlinIl411hr.u.h45 , . . , . . . , .
47 Subtracllln.46'r.m Iinl 40, Iltln. 461s mort Ih.n Iln.40 .nt.r -0.. .
41 Stlf'lmploym.ntt.x (,ltach Sehadult Sf). . . . . . .
49 AIIomallvo minimum tn (11t.ch rOtm 625/) , . . . , . , . . . . . ,
80 RKlplu.a ta..s(... PI" 22),Chocklffr.m:. 0 Foom4288 b 0 Form8611.
81 Soclal.ocurlly In on tip Inc.mo n.1 llported ,. .mployer (,rrlch room 4137) .
52 Tn.n,n IRA or a qualifild r.llr.m.nt pl.n (./llch rOtm 5329) ,
53 Ad...lnCl,.rn.d Incom. credit p.ayments from Form W.2 .
54 Addlln,,47Ihr.u h53.Thl.l. .ur'.'""". , ,
51 fodlrollne.me tlx wllhh.1d (II In, "/r.m f.rm(a) 1099,
ch.ck.. 0). . . . . . , , , . , . ,
56 1990 IIUmllld I.. poymlnl, ,nd lmounl ,ppllod 'rom 1989 r.lur"
57 [arnld Inc.m. cradll (SI' PO'. 23) . . . . . . . .
81 Amoun' pold with F.rm 4868 (alllen.lon rlqulIO. . . . .
" lIc... ""1' HCurlly lox Ind RRTA In wllhhlld (see poaa 24)
60 Cradillor FId"allax on lUll. ("Ilth rorm 4136). . .
61 RtlUlal,d Inve.lm.nl complny credil (.Il,ch room 2439)
12 Addllnn55throu h61. ThuI.r. ourtot.1 I mints.
63 IIlInl 6210 mort Ihan llno $4, Inler am.unl OVERPAID .
64 Amounl.lllne63l.boRlFUNDEDTOYOU. . . .
15 Amount olU.. 63 I. bo APPLI[D TO YOUR IHIlSnMATlDTAll"
16 I' llno $4 II merl thin IIn. 62, .nl" AMOUNT VOU OWL AII,ch chock or money order for lul
.mount pay, bit to "Intlmal Revenue Strvicl.f1 Writ. your Mini, addrtlS,lOc:lalltCurlty number.
dawilmtphont numbtr,lnd "1990 Form 1040"ontt. . . . . . . . . . . . .
.7 laUmaladtnponally(...pa,.28), . . . .' . . .. 67
..
4
44
..
.
51
56
57
51
"
60
II
S)).S'
;l~aoo
3.115
I 155"15'
~ S
~ IS'
S
'!I:l.. S03
Ba,
,....
\Jo.
Undor _loSoI...rtury.1 dt<~..I"'11 hive ...m1nodlh_ rolum,"",,_nrinlKhoduloS,nd.III_.. ,nd 10 tho....1 01"." ~ ,od_.
ther 'fl 'rue. untct. Ind compill.. Decllr.tlon of pr.pe", (oIhtf theft ta.,...,,).. IlIMd on ell k'lforrnlUon of wtlk!1 Pf'PI'1f hll''''~.
~ Yo.......11lfI Dolo YOlO OC;:;illon
Prepe,,,',
.....Iur.
'6rm......"" (OI)'OUf'
i1..1I'0~1,""
tddt9U
C.
J l..
Sf V
L.
40
')')'1'1)"
. ..-.....(1'.....1040) 1190
) 1ft .".10.0. (Oonot,nl"ntm..n4tocltlttcurtlynvm,*tflhownonolhef tide,)
l)'lt.t F,'; ,,"r'J11Jr'q f), "V6"'l~T o{i..
I
'trtl
Inltrnl
IlIUm.
~ruc\Ion'
00 Plpa U
and 30,)
H:~~
iil:S1~'. r;;.
lllbotllul.'
i'&'F.
~1t~
,.rtll
DtrkI.nd
1-
~Ionson
_13and
;Sl.)
Bat.1I onm
1 ."
IIIbs a
!fI..L~"&'.ll,
LT~.
namanlha
=andlntar
="Ws~
Schedule B-Interest and Dividend Income =,":;:n~.. 08
If ~ou racalv.d mora than $400 In t..abla Int..a.t Incem., or ~eu art clalmln. th. ..clu.lon 01 Int....tIrom
..rl.. [[ U.S. .tvln.. bend.llluad all.r 1919 (I" pa.a 31). ~ou mU.I complola Plrt I, L1.t ALL Int....t raealvld
'n P.rt I. II ~eu "cllv.d mora than $400 In ta..bl.lnt....tlncom., ~ou muatallO compllt. P..tlll. II ~ou racalv.d,
II a nomln... Intar..t that Ictuall~ balon.1 to anolhar paraon. er you r,cllnd or paid accruad Inta,.at on
ttCu,ltI..tranlllrrld batwlln Int.,..t a mant datil all a 131.
Int.r.stlncom.
Amount
1 Inlar..llncom.. (List 11Im. 01 payer-lIln~ Intertstlncom. b Irom seller.llnanc.d
mort&IIl.~...,nslrucllon. Ind IIsl1hal Iqt.rtllllrst.) ~.................... .........
..~~.,:,.~t..,. 8.~.I);l~J", $.I".'f.~ I!~..~.. .l':~::'.{lJ~...............................
.....o/.'.~/....~!r:...~~t?l~],.,.......,........,.....,......,......... ..........
.. ~~.0.~~...!f.\.... I:':'. T."~,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, .....................
.. ~~!\\ ~~:.!':'1h~"" M.T..!:-............ \..........................................
.. ~~.'.~.~:(...... .I~e!~::)..1. tl.':'~.~~Ti...~/.1. ~~ ~::'!~T.......,....................
....6(..
dot.
!.
1
...........................................................................................
............................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
2 Add lhetmounts on IIna I, Ent.r the tolll. , . . . . . , , . . . , . S"
3 Enl.r th. .xcludabl~ sevlnss bond Inl.r.st. lI.ny, Irom Form 0815, line 14. Att.ch
Form 8815 10 Form 1040. . . . . . . . . , . . . . . . . . ,
4 Sublr.cllln.3 'rom IIn. 2. Enl.r lh. r.sult h.r. .nd on Form 1040 IIna Sa ~
II you racalv.d more than $400 In .roll dlvld.nda and(,or othar dl.I,lbutlon. on Itock. ~ou mUlt complall Partlll
and III. II ~ou rec,'v.d. II a nomln... dlvldanda that ac ullI~ bll~n.to another paraon, ... pa.. 31. .
Dlvld.nd Income Amounl
II Dlvld.nd Inc~m.. (llsl n.me 01 payer-Include on thlslln. capital pin dlslrlbullons,
nontaxlble dlslrlbutlon., .tc,) .. .......................................................
...........................................................................................
...........................................................................................
............................................................................................
.....................................................................................; ~.....
...........................................................................................
...........................................................................................
II
...........................................................................................
...............................................'............................................
............................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
. Add lhtlmounts on IIn.lI. Enter th.totll. . . . . .
7 Capital pin dl.lributlons. Ent.r h.rtlnd on Schedul. DO .
. Nontaxabl. dl.tributlons, (Set lh~ Ins I. lor Fonm 1040,lIn. 9,) .
. Add lhtlmounts on IIn.s 7 .nd 8, Ent.r Ih.lotal . . , . . . . .
10 Subtracllln. 91rom IIn. 6, Enler the rtSu" htrtlnd on Form 1040,lIn. 9. . ...
." you rec.lv.d c.p/lII ,IIn d&lrlbullon. buI do not n.1d Schldul. 0 to report Iny olh" pIn. or loss". ... Ih.
lrulrucl/on. ,.,Form J040 lines J31nd 14.
II you rec,'v.d mora Ih.n $400 el'nlare.t or dlvldandl. OR II ~eu hid Ilortl.n account or ware a V.. No
Inter 01 0' "ranlleror 10 aloral n Illlat u mualtnlwer bolh uHtloftlln Plrt III.
,.,1111
flrtllll
Accti.b
.. Ua Ahn~ lIm. dur'nlll990, did you havlln Intar..tln or tI!enllurt or other luthorlty OYIrt flnlnclallccounl
'...... In ,'oralll1 country (.ucn II' bank .ccount. stCurltl.. Iccoun!l or other fllllnclalaccounl)l (Sa. pa,. 31 01
Tmb thtlnslrucllonslortxclpllonundfllln.raqulr.:ntnlalorForm 10 F 90-22.1.) . . , . . . . . .
fSH II ".V.... .nler Ih. nlml olthalortl.n country ~ .............................................................
~truclPI_Iona.) '12 Wart you th'l'anlor of, or transferor 10, alor.lan trusllhlttxlsttd durin, 1990J whalhtr or not you hive Iny
..31;: btntflclallntorllt In Itllf 'Vaa . ma hive 10 fila Foom 31120 3520-A or 920 ,
'er '"ptrwtJllIlHuc1l.n Acl Nollca. all Fo,m 1040 Ino'ruc1lonl. Ichldull I (form 1040) UIO
108
. . ICHlOULUl
(Form 1040),
~oIl11OT.......,
_R__ Oll .. AtlaehloForml040, ,
Name 01 ptllOll with ""....,Ioymtnllneome (1Ilhown on form 100t0) SoelallKurl11 number 01 person
l,..L It"lr1/'rIl-r: .:J7\.. with 1I"....pl.ymanllneoma ..
Who MUlt File Schedule SE ' I
You must lilt Schedule SE II;
. Your net Itrnlnp lrom ..11.employment were $400 or more; OR
. You wtre In .mploy" olin .Iectlnll church or church.controlled orgenlzatlon that paid you Willes (church employee
Incom.)ul$l00ormore;', . . ,
AND "
. Your Will'S (subject to socllllecurlty or rellroad retirement tax) were less thin $51,300,
IIc.ptlon: Ilyour only lelf.employmentlncome was from earnings as a mlnlstar, member 0' a religious order, or
Christian ~lence8rlctllloner, AND you lIIed Form 4361 end received IRS epproval notto be taxed on
those earnlhp, D NOT file Schedule SE,lnstead, write "Exempt-Form 4361" on Form 1040,lIne 48.
For mort Inlormltlon lbout Schedule SE, lee thelnslrucllons, ,,' . , ." .
Hot.: MO!t people an use the .hOlt Schedule SE on this /JBge, Bul, you may h4ve to use the longer Schedule SE
on the beck. . : , . I , ' I Cf ,.,; .
Who MUST U.. the Lona Sch.dul. 5i! (Slctlon B) ; ': ,:; . : .:" -
You must use Section B If ANY 01 tht lollowlns apply: ., '. .'
. Vou elect the "opllonal method" to figure your self. employment tax (see SKtlon B, Part II, end the Instructions):
. You are e mlnlsterr member ot a religious order, or Christian Science practitioner end you received IRS approval (Irom
Form 4361) not to be taxed bn your earnings Irom these sources, but you OWl self-employment tax on oilier larnlngs:
. You had church arl1p1~elntclmeol $100 or more that was reported tl)~oU Oi{Fornl W.2;' ',.., ,..',
. Vou hed tip Incom. t~t Is 'UbJatt to sllclalseeurlty tax, but you did not ~e~11~~~ 11~~:,I~ yoi,};,~in~lpy&h .b~
. Vou were a llovemment employee with wages lubJect ONLY to the 1,4596 P:lldleare part of the ioclal ;Wturlty tax
(Medlare quallllell government wald) AND the total of III 01 your wages (subject 10 social S'f!!rlty) rellr.Qed
rltlrement, or the 1,4596 Medicare tax) plus III your earnings subJect to s~!r1~pll'lm~r\t ~x ~ ~.~~},Ha,~,~5,l,300.
Stctlon A-Short Schedule SE (Read above to see II you must use the Jons Sch.edule SE 01) Ihll.back (Section B),)
1 Nel firm pront or (loea) froM Schlldult F (Fori'll 1040), line 36, Ind firm parln~~hl/ls; Sch.clulel<~1 .' ','
(F 106") II 1"- . " ,.". ,
orm ~ I ne OHI. . . . . . . . . . . . . . . . . . : . . . . .' . .
'J . . I.. .
2 Nel pront or (Iou) from Schlldult C (FOIl'll 1040), line 29, Ind Schedulel<'.I,~FO(":'II,065),U,~t ISe :. .
(othtrlhanfarmln&), Ste Inslrucllons for other Income toreporl, . . , . .. ,', . . " 2
.1111"1" ,.. 1" ,
.' ' ,.j Ii ,I, ":-.' ~
J COn'blntlintsllnd2,Enlirlheretult"..."."... '11..1';'" ',' ",
.. Multiply line 3 by ,9235. Enter Ihe result. If the resulllsless than $400, do not ~Ielhli '.c:htdule: you
do nolowllelf.employmenttax. , , , " . , , , , . , , . , , ,'.... , ; ,~ ..
II Mlxlmum emount 61 conlblnlld Wlaei llId Wlf-employmlnt ..mlnll' subfel1'tll tOdlil .kuHly or'
rlUrOldretlrement(tl.rl)la.forJ990. I......... .;I,;~'.i~.~;~:'~:,"",'~':
I TotalsoclalltCurlty waae. and Upt (Irom Form(s) W.2) and rellroa.d retlremtn\ to~'1'~1sa~ 61~r 1),
Do not Include MedlClre qUIUned lO'fI'rmtntl"'lles on this line , '. , .. "f.. d I .' ,... ,
7 Sublrlct line 6 from line S, Enter thi result, II the rlsultls lerO or leu, d6 not nlel~s ichtdule: you do' ,
notowe..lf..mpJoyminttu. . .: . ~'. . . . t . I . , . ,,~:~: ':,'.: . :'~'.'"
I' :-:. ",
Social Security Self-Employment Tex
OMe Ho,II4S-oD74
. Ittlnllructlonl for SehlduleS! (Form 1040).
.i....' .
815',"7
. ,8'Stl
8~:11
. Enter Ihelmaller allin' .. ot llrie,. , 'I " ' i
, , , , , . , . . , "
. ,: . j'
. Rate ollu ,. " I .
, , , . . . . , , . . . , . , . . . .
p' 1"1 , ,
lC.1113
10 ItH..mploplenl tax. IIII~' ~ IJ $51,300, enltr $7,848,90, Oth.rwlsl, multlJllY lilt lmount online 8';
by the dtcImallmo\Jnt 6n line 9 tnd enter thl rNult, Also Inter thlllmount on Form 1040, IIn. 48 .
Hele: Abo,nrer_Mlfoflhlumounlon Form 1040,/Inl25,
F"Pe,o,...u...ucIlonActNotk......ariO 1040InaltueUena. .'
"
::JS~k
.. .
'I' 111":
; 1cho4.1e II (form 1040) I.to
,
1~1
a$Uc~lIt90) "" 2
Computation 01 tha Spacial Allo"anct for lit habilitation Inv.stmant CrHlta From Rtntal Rill Eatatt Activit'"
, and Low.lncom. Houaln, Credits For Property Plac.d In Strvlct B.lon lHO(or From PlSs.Throu,h Int"""
Acquired Btlore 11190)
Nota: Comp,.l. Plrt 11/1/ you h,ve,n ,mounl on II.. 2d. Oth.rw/J',10 10 Part IV,
17 Enter thelmountlrom line 7 . , . . . , . , , . . . , . . , . . . . , .
.1 Enter th. Imount from line 16 . . I . . . . . . . . . . . . . . . .
l' Subtract IIna 181rom line 17. II.()., anter .(). hera and on lines 30 and 36, and than /lO to Plrt V .
20 Enterthtsmaller ollln. 2d or line 19. . . . , . . . . , . .. ... . .
21 Enter $250,000, II mlrrled flllnll separately, Ha Inslructlons, (S..
Instructions 10 ..ell you can skip lines 21 throullh 26.). . , . . . . 2
22 Enter modified adjusted Iron Income. but not len thin .0., (S..
Instructions lor Part II, IIna 10.) II line 22 Is equal to or Ilreater thin line
21, skip lines 23 throullh 29,and enler.(). on line 30. . . . . , . . 22
23 Subtrlctllne 22 Irom line 21 . , , , . . . , , , , . . . . 23
24 Multiply line 23 by 5096 (,5), Do not .nter mora lhan $25,000. II married
IIl1nllltparltlly. Hllnstructlonl . . . . . , . . , . , .
n Enlar thumount, Ita ny, from line 9 of Fonn 8582 . . , . , .
26 Sublrlclllna251romllne24 . , . . . . . , , , . . .
27 Enter lh. tlx allrlbullblelo the amounl on line 26, (Se.lnslrucllons,)
21 Entertheamounl,ltany,lrom line 18
2' Sublllctllne281romllne27 , . . . , . , , , , . . . .
24
n
2
27
17
II
20
2'
1(,$'
IlIr
_.-
30 Enler lhesmaller 01 IIn. 200r line 29. . . . , . . , . . . . . . . . . .. 30 -~-
Computation 01 the Special Allowanc.lor Low.lncom. Houaln, Creell" For Property Plac.d In Slrvlc. Alter 1989
Note: Com leI. P.rt IV /I ha.un .mounl on line 3. Olherwlu, 10 Part V,
31 Enler thumountfrom line 1911 you completed Pert III. Otherwise, subtract line 161rorn line 7 .
32 Entar Ihumountfrom IInl 30. . , . . . , . . . , .
33 Sublllct IIn. 32 from line 31.1I.()'. .nter.!). herund on line 36. .
34 Enlerlhesmalleroflln.30rllne33 , . . . . . . , , . .
35 Tu allrlbullble to the remllnlnll special allowance. See Inslructlor.s
36 Enter thesmallar ollln. 34 or line 35. . . . , . , . .
Im!I Computation 01 Pan Iv. Activity Credit Allow.d
37 Add lines 16,30. and 36.11 this IIn. shows the sam. amounl as IIn. 7. /lO to line 47 .
38 Add lines It,2a.and4., 1I'().,lotollne47. . . . . . . . . . . . . .
39 Enler th. lax ,Ilrlbullble to passlv. Incom. from activities acquired belora
Instructions.) . . . . . . I . . . . . . . . , . . . . . I .
40 Subtract line 391rom line 38, IIl1n. 391s equllto or llT.ater than line 38. .nler.(). .
41. IIlIno lall'()'or blank. .nler.()., Olherwlse, H.lnstructlon. .
. . . . . .
. . I . . .
1()'23.86. (Sea
. . . I . .
. If IIna 2a II.()' or blink. .nter.!).. Otherwise, H.lnstructlon. .
42 Addlln..41.lnd41b , . . t . . . . . . . . . . f . . . . .
43 Subtllct IIna421rom IIna 40.lIlIna 421a equal to or araalarthan IIna 40. anter.!). .'
44 Subtrlct IIn. 37 from IInl 7, . . . I . . . . I . I . . . . . I .
411 Enter the.mallerol IIn. 43 or IIn. 44. . . . . . . . . . . . . . .. ..
41 Multlplylln.45byl096(,I)and.ntarther..ult. . . . . . . . . . .. . ...
47 I'...lv. Activit)' Credit Allowed. Add IIn.. II, 37, and 46, S.. the Inslrucllonl for Crtcllta From
I'ubllcly Tredtd I'.rtn'lIhlpalfyou havun)' cradllsi from a publicly \reded parlntrahlp . . . . .
. .
. .
. .
Nol.: UJ' Worbhttt. 51hrolllh 9. whlcMvir .pply. 10 allocll. /ha ,"owed and UMIIoMd Cl'Idlts If
you hlVl elldlt. from more tMn ona pi"" .cIM/y, Aho uu /h. worltIhHtI "you mu.t ./1ocI1. /ht
etedlll blcauJl ''''y.re reported on dlff,renl form.,
344
311
4
-~-
Ifr.S-
1"1"" ,. . ~'''.Jl'''''''L ", ,,,......,,...
foI'-l'I 10'\" - ,,"'"
SJrJ: h. .)t..'.'" '.
..j,.,:"" I"'''''' U''''.U'' It.. "I .-........
,."..~____,.IlI'!"".~.,.........-..,. ...--.",....
__.~. -r-T'" -..-::: .-.
..
,
~
,.
':
I:
'--
"
.
\
'-
"~.-::=-:. -....._.
S", ~Lt. t. /lit /L T :u:.
t'~~r\L I:~..K-I (ro
l,.\.))
l'IIJJ,"'\J)
~PII'\..j
,10,-,.:. ,....
! rl.r....,II, I '
I ^"IO'f"II,
1""_...-.., ':r-T';.'
.. ~:"... ~-.~'-' ',;:; ., :=-'....'...:~_ " ~:.r.''''~', ~ ..-~~.~;~~
.."."."."
I r:r-l~-II';~-
I ,.: I I"
I I!
I: 'I i, I
, I .It' ; I
.. 'l~I).1..0_~ ~/~_.tL'_'? ___:..__
~~ - --I -- ~~~-~. - ',' r---' I"
, I '
~r! A I
I
, ..~~), !w.6-#1'"f,'
I
1t~'fO/"tl,l..\. e ~Io.j: tflll.l.
_._..64~_ _~!:r).. . ---- h -..---.- .
f'P,lf1JII'''''''L. ft.\..J I
.
Itl""....~ 10 71>1..l..1
. I
f"Ilo<t 1-' t- u'T'/l11t1
1'1'4"'1..'
TW.PIk,.J",
.... .,....---.-..--... ._-_.-,
<;-1 F'O
r"l'flllrY
rlM..ll'''....5
!r>I"Mi"C-\.
_.__}''''JL.t l:-L.._ _____
'\l'Il,.
l/>Ir (l"~,)IS e8D "I.)
,. ..,--L-o-_.
I
,
'/>.),
\t I: I
: :.: 1"~iD:C.:l
i~:i 1:1:1
I' . ~ . . I
__,.. ~. I '_
, , I
, i I
I ',I i
I J .
, I I
: : i i.. : I j I
-'-I' ;-;-T-. '-1'- "1'-~I--1'-'-"':"':"'.:
i . I' . I: I; I:
f' . '. I I
:: ' !' ! I:: I
.1 ~ : ll; '!:
I '. I I I i I I
. ':': i
....J____~- _. ~.!_:_ - >_-...~.,
. I ---;1 !' I .
. I' 1
I I
I
. I
~_.-----_.
! ;
I
-I.-._-~.-
, I
i '
I ' I
:' I I I',:
_.~-, ~~~_.
, I! I
I
.._.._ ...__. .~..__.:_J.
, I
I I
I
; ,
:
I _ ~:-J .
:' I
, ,
,
it
: I,"',
__ J .. _.~~.~._
, :").
, , '
. ,,~'
I'$~
~6';
_.L..2LL.
~"i
, '36';
~s
, ;l-'ib}
I',
I .
! I; I I; I' !
I
i
I: I I
: :: I I. '
_..:_-~--- i-C.~-~-I~..
" ,
! I:
I I !
, I , i
; I
, : :
-- -
, I I . i
!. i ,
I 1 , I ,
, , I ,
I i I :
, ,
,
,
i.
i.
i :
i l!' i
. l...--L._
II !
I I
! I
I.W__
I I
! I
, I I I ,
; ,I I ,
. I, i 'I: I
:
I I
,
,
i I; ,I I ' i
: ,
I
: I
"
SCHIDUL! K.l Partner'. Shall of Income, Credits, Deduction., Eto,
, (Form 1065) ~ S.. '.pmtaln'trucUo~..
o.,M"," "t.... "-1WfY r........,., ,... 1"0" t.. ,..,
,.. .. "',,' IttO Ill' , .t
. , 'attn,r',ld'nU~ln. number ~ 1.0:> - ul. - \ '" "l t.. 'artn.rahl ',Id,nll In numb.. ~
plrtnar'. nlm., address, and ZIP cod. Plrtnmhlp's nlm., addreSl. Ind ZIP codl
":t>AI..,," f', S>t"c;,KAll--r I -SA. F=-..L"'lt., f\r;)'I)A~" ,,sl-lU'\lAAT' . KUu'bl.li'
... 'z.~2.. \N1l"T-Vo",ft:cr c;,'l'. ll,o.~",... "2.0e.
~
.~. CA~I..\:!>l..c,"'i'A "QI"!o CAItI.."I.e'.~A- \'o\~
. .
.' A Ilthll partn" Illtn",1 partner1 . " Val No , IRS Ctnl"whtrt partn.rshlp flIadl1tum ~ :>>l\~I\,...~...
.. Plrtn"'1 shlr. o'llabllltlll (...Instructlons): G(l) Till shclter rc&lstrltlon number~ ........,t!tll-........,...
NontICOU'H. . . . . . . . ,. .....MltJ........... (2) Typa of tu sh.lt"... .....................................
Quallllad nonrecourse "nand", . ....,.. N.lIL....... H(l) Old th. partn.... ownership Inltmt In lilt ~p c/IInp
Dthtt. . . . . . . . . . .. .""'.J...Q.~~..,.. Iller Oct, 22.19867 , . . . . . . . DVtI S No
What type ohnt!!y'!s lhll partnar1. ~.'li.'Jll~{t\-..... If 'VII, 'IttJch ltal.ment (5te Form lD65Instruct1ona.)
Is this partn". ~ domlltJc Of' 0 lor,lan partn'" (2) Old thl partntrshlp slllt or ICqulrl I new ICtlvlty Ifter
I~Btlolt.,..... tIlWol Oct,22,I9861 . . . . . . , . . .DVu 181 No
lEnt" plrtnar's parcentlp 01: "1_"" II 'VII, . Ittlch ltallm.nt (5te Form lD65Instruc\lOn1.)
Pro",lhlrlnll . . . . . .....,...ll.7:~' '}J:!.ll Check hcralllhll partn.rshlp II I publicly trldad partnershlP.O
Lou shari nil . . . . . .........ll ..;~~.ll udellncdlnsecUon469(k .........
Ownershl olcl ltal. . . .....,...ll ..l1,}."?ll J Check I llcabllboxn: 1 F1naIK.12) AmendedK.l
KO/IC I ono ner ICI Ilccoun: 4)1ncomt....- (o)l.o&MOnaI~ lll-.... lalCool\ll_1l
o pi "'". _ Ill""""""'),"" In"""""',.... __ ....01,.., -
of I'lOf1t.aublt Incame unanowatlll ClCIIl.fnN ·
o ~S(.. \,'5"" 1 e-
(.) DI.lllbuUvnharl Ko.. "') _ (e) 1040 IIItnlfttor Iht
'" amount In column!') en: .
} (~I=.:a'j)
.
0l0t.....114'~
~@90
- 0 0
C
D
J
00J
.
~
c
-
1 Drdln.ry Income (loss) Irom trade or business actMtles
2 Net Income (Iou) Irom rcntalrealestateacUvlUes .
3 Net Income (loss) lrom other rentallcUvitles .
4 Portlollo Income (loss):
I Interest. .
II Dividends. . . . .
C Royalties . . . . .
d Net short.lerm capital pin (Joss).
Netlonll.term capital pin (loss) . . .
Othcr portlollo Income (loss) (I~ch Khedule) .
Guaranleed paymcnts to partner, . . . . . , , . , .
Ncl pin (loss) under section 1231 (othCf lNn due to CISUoIlty or theft)
Olher Income .tt.ch Kh6du/. , . . . . . . .
Chlritable contributions . . . . . . . . . '.;,01D. .
Section 179 expense deduction (Ittlch Khedu/e) . . . . .
DeductlOlll related to portlollo Income (llt.Jcluchedula). '..... .
Olherdeducllons IttachKhedul. l<.........~~".!'-~~.....
00
1.1.
,
Sch. Il, P.rt I, Unl 1
Sch, B, Part 1I,IIne 5
Sch. Eo Part 1,1In1 4
Sch. D,.UnI 5, col. (I) or CIl)
Sch. 0, Jlne 12, col. (I) or CIl)
(tIla'.,IfIIulla"''''''''-)
} (............-..)
_1lo117_10I5)
(hlor. JHIulla"''' "",_I
Sch. A, IInl14 or 15
o } (~.tl~'j)
I
f
5
6
7
.
,
10
11
.:.
":!
l!
"2.
J iJ 121 Interes\elpense on Investment debts , . . . . . . .
.!I II (1) Investment in(omelncluded on lines 4llhrou&i1 4hbovI
~ 2 Investment.. nses Included on line 10 above. . . .
131 CredltlOf Income \ale withheld . , . . . . , , , ,
.. Low-Income houslna credit:
(1) r,om sadloA 4Z(j)(S)p.Irtlltfllllps 101 propat) p1Ke4 I. MlYkt belolll990 b t
(2) Othtf lNn on line 13b(I)lorproparly pllcedln servfcebtIOl.I990 b 2
JS (3) rrOlllacllol4Z(j)(S) p.II\lItnlllps lor pIOI*ty p1Ke4 lu,nkull" 1m b 3
iI (4) Other lhan on IInl 13b(3) lor proptrly pllced In HlVlcufter 1989 b 4
cj . Qu.lilltd rehlblllt.llon tlpcndilures rallIed to rantal realest.11
IcUvitlts (st,'nsttuctlon.) t . , , . , . . , I . .
d Credits (othar IIltn crtdill shown on lines 13b Ind 13c) rtlated
10 ranlal rulutatucllvlllu (SH Inslructlons). . , ,
I Cradils rtllted to olhar rentallcllvltla. (satlnltrucllons) ,
14 Olher crcdils scalnstructlons , . , , , , , , ,
'If 'aper"orb IltdueUon Act Halle.. .It 'orm Ion I.,lluellon..
Form 4952, nntl
I (~=":O:s'j)
(~I'J~)
} form 8586,IInl 5 ,
(............-..)
......._.IV...1lltl)
"".4.lt K.t ('1111I 1015) IHO
I
).,
" a
Ie) 10401""...,.IIh.
Im...t III .e1.m. I~) "'.
,
-kllt4WlCol ,_IOIsllttO
(a) 01.1,".11.. .1..,. ""..
~.J
./ SJ
, 1-
II
151
,
.
I"
N.tllmlnp (loss) 'rom SlII.employm.nt ,
Grota '"rml", or nshlnclncom.. , . ,
Gross non'"rm Incom. , ,..,.
Accel.raled dapleclltlon 01 rill ploperly placed In IIMc. belOle
o
Sell, Sf, Section A 0111
I ("-'--"')
k'*hIIIl,.",...IOUI
, .
, . .
, .
, ,
1987 . . . . . . . . . . . . . . . . . . .
J
i
&I Acc.lllaled dapleclallon ollllsed personal properly pllCed In
seMC' before 1987 t . I . . t . I I . I , . . I
. Depreciation adjustment on properly pllCed In SlMC..tttr 1988
. DeplttJon(otIllIlJlanoll and pa) . , . , . . . . . .
. (I) Grou Incomllrom 011, PI, Ind Iltotharmll plOpIItJet . .
(2) Dtductlonsallocablt to oil, PI, and atoth.nml propertllS .
, Othll' Id ustm.ntllnd lax l.renc.'I.ms Iltlch schldule) .
17. Typeoflnconll" ..........................................
.. Nam. 0' !oRlan counlly 01 U,S. possasslon ~........,.....,"
. Total IVOII Income lrom sourclS oulsld. th. U,S, (elt,ch
IChldul')..........f. ,.
. Tolal.ppllcable deductlonllnd losses (Iltlch s<:hldu/e) .
. ToIIllorel&n laxlS (chtck on.): ~ 0 Paid 0 Acctued
, Reduction In laxlllVlnlblt lor credit (Iffach schldule) .
C1her lore lax 'n'oRnlllon ,ttach schedule , .
'orm 1116,PIIt.
Fann 1116, Plltl
'ann IU6,Paltll
'ann 1118, Plltlll
See FORn 11161nslrucllons
(S" Pll1nt/'s Insll\lcllons
rorSchtdul. K.I ('orm
1065) and 'orm 8251
InslNctlonl)
'ann 1116, Check bollS
'orm 1118, PIIt I
I
18. ToIIl expenditures 10 which. section 59(e) election mlY .pply .
II Typl 01 upendltures t:................. ......,.............
19 RlCllpture ollow.lncome houslnll credll:
. 'rom section 420)(5) partnerships .
II Olher lIIIn on line 19, .
20 'lWtSlmllll ""'" A D C
proptr\los:
2 . Descrfption of properly
(Stat. 'Nhatlw IICO'IIlJ
or nonllcover,
! properlJ, If IICO'IIlJ
properlJ, ltate 'Nhalher
'll ralullr pllc.nta.e
i m.thod or Slcllon
48(q) election used,) .
II Dal. placed In SlMe>> .
01: c CostIWothetbasls. .
. CIIII el /lcovar,
properly or orIalnal
nllmatad _fullfl. .
. 011. It.. casad 10 be
Iavastmlnl cttdIl proptr!y Form 4255 IIn.8
21 Suppl.m.ntallnloRnlllon required to be reported seplrltely to tlch partner (,ttach 'ddllion""hedu'lllf rrwre spl" Is
nHdld):
j
I
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
~ \I lI"""HT H
ADl J~l ". PA l1n13-3?9!1
1JW~U
LOCAL EARNED INCOME
TAX RETURN (FORM 531)
HUUH~ I:lY At-'HIL 15, 1991 IU:
CAPITAL TAX COLLECTION BUREAU
SEE BACK OF RETURN FOR
PHONE NUMBER AND OFFICE HOURS.
......."..............
1
2
3
4
5
.' .
6
7
6
200 'I.. '''4~
--...--- .
Jo01~
,
,
74 'f ? 1"
-r-
l i). :\~G-
2
3
4
5
6
7
6
W.2 EARNINGS (From eaachod W.2'al ..... ' .... , ... .............
EMPLOYEE BUSINESS EXPENSES (Altach Fedolnl Form 2106 & Stale Schodule UE.ll...................
TAXABLE W.2 EARNINGS (SullCrIld line 2 from Line '1"..................... ......................
OTHER TAXABLE EARNED INCOME (NO INTEREST OR DMDENDSI Complele Section B on Deck .......
, ("f' :" Ii
..... 1-'.
'''I s .'!,V .I:\;>-!\\Y'
TOTAL TAXABLE EARNED INCOME (Add Unes 3 and 4)................... .
'w'~
NET LOSS FROM BUSINESS. PROFESSlO~, OR FARM (USE LINE 8 FOR ANY NET PROFITS)..........
SUBTOTAL (SublJ.d Uno 0 from line 5) IF LESS THAN ZERO, ENTER ZERO......,., ,."" ".,.,..."
NET PROFIT FROM BUSINESS, PROFESSION, OR FARM (USE UNE B FOR ANY NET LOSSES) "."...
d:~~. l...: _ ..
8V\sS":
.',
TOTAL TAXABLE EARNED INCOME AND NET PROFITS (Add Uncs 1 and 0)..,........................ ,,9 <f S'lt. '1 :,
,
TAX LIABILITY: 1% OF LINE 9 (Mulllply line 9 by .01) ....... ................................ ......... 10 I" ~ ~ r _b'~i("l ;
TOTAL LOCAL INCOME TAXES WITHHELD (From .nached W.2's) ........... ...... .................... 11 ;).0 :
aUARTERL Y PAYMENTS AND/OR LAST YEAR'S OVERPAYMENT CREDITED TO THIS yEAR..,.,......, 12
TOTAL WITH HOLDINGS & PAYMEmS (Add LInes 11 and 121.........................................13
TAX BAlANC DUE (SublJact Uno 13 from LIne 101 PAYMENt NOT NECESSARY IF LESS THAN $1.00 .. 14
, -
ImEREST & PENALTY (See InstnJc1lonsl.............................................,............... 15
TOTAL BAlANCE DUE (Add line. 14;.00 15) Make check payable 10 'CTCB. ..........................16 ,"-4i": q.~," ~,!''''~ '~.:;..:
OVERPAYMENT (SublJact line IOfromYne 131 IF LESS THAN ZERO. ENTER ZERO.................... 17' ::.... .+,~}~~ t~;~:~. ..~. :~.
OVERPAYMENT TO BE REFUNDED .............., ...... ....... ............... ....... ............ 16
OVERPAYMENT TO BE CREDITED TO NEXT YEAR'S TAX......................................... 19
OVERPAYMENT TO BE CREDITED TO SPOUSE'S BAlANCE DUE FOR THIS FILING yEAR..,....... 20 I
~A~LI~lF po~nu~~
TAX omCE
use ONLY
.: ..U611C.... ~.Al!.;;"" St1ltrl..
1 U00161646Cl(10210~i .. . ::
SHUG~'AT OAlE F JP
~HUGH'PT CDNST.NCf
lUA &OCW. SECUFlTY NUIolOEA 0
'OUIn socw. SECURTY NUMOER 0
IAVI YOU MOVED FROM THE
,E~ Of THE TAX n.JHO
EAR TO PRESENT?
200 I 3f1 I 1!-41J
174 136 171"3
VOUR NAME
(lAST, FIRST, JoUI
SPOUSE.S NAJ.lE
IlAST, FIRST, MIl
IF YES, COUPlETE
SECTlOH9 A & C ON
J1(vEnSE Of' nls fOfV,l.
HO~E
~;~ W POHFPr-, ~1
r.Ul Bl' Pi
j, :
X SPOUSE'S SIGNATURe (ONlY IF ALSO FIUNO Off THca FOJU.rJ
AID PREPM\ER"9 NAME IPlEASe PF'Nll
11\0""1 (, f\ U~1l- L ~'1. t.-fJ:l.
.
OAlE
fllU.. 9 HAI.lE: lOR ENlER .'S f ~ IF !iElF EMPlOVEDI
$,~,
TAXPAYER'S COPY
"
,.
r
1 I
"-------..
-------.--- .---.-...-. - .-- - ._----_..*..~
, .
._ _ _'_ _0 ____.._______.._._ _.0 _.__.--0.________0'___
--..--"-
.
.
OIol'Ho.I~'-OO9I
SCHEDULE K.l Partner'. Share of Income, Crodlte, Doductlonll, Etc,
(form,1065) ~ S.. ,t~...t.'nllructlon..
U".,.t1I11'"'' II"'" ""'.UI'/ ,. ul,"4., ,..,1190 0' 'u ,..,
11114,,,.111...,,...141'11<' ~. 1ft"1,, . ,,')0. '''''''i'''" . l'
Parlner'aldtnll In number ~ '1.cx>-~1. - Il.~(. Parlntllhl '.,dtnlllylnlnumber'" '1.~-20eo'2.q
Plrlner's nam., address, and ZIP cod. Parln.rship', nam., addr.ss, and ZIP cod.
. .1:lA\..... r S>\"C",II(lIl.T, 'J"P., ~v-.,L."'~, A-,,~A!n~ ,.s.....'\iAIlT' . ~u~,,~.:
. z..S1.. IN~'" Vo",f~<<T "".... \"C;),-a",-. '2.08.
CI\"'L\~'-t:-.fA no\'"!. CA~L\~\.e',1>1\- \1a\~
I' thi, parln.ra Ilen.rol partner I . " VIS No FIRS C.nt.r wh.r. parln.rshlp filed r.turn'" J}J\~(\1 ,]~...
Parln.r's share 01 liab/lilin (s..lnstructlons): G(I) Tax sh.lt.r relllslralion number'" ... ...... (':I).It............
Nonr.cours.. . . , . . . . . $.....t'!l(\......,... (2) Type of la..h.ll.r......................................
QUIIIII.d nonrecourse nnlnclnll . . $ .....~.LIt......... H( I) Old lh. partn.r', own.rshlp Inter..11n the ~onhIp chonll'
Olher. , . , , . . . . . . $ .....~.,.Q.~~..... all.rOc!.22,19861.. . . . . . . OVa, ~ No
Whatlype o"nl~' this partn.r1 .. 1#Jl.'~.'J?~ !\'r..... II 'Vet,' atl.1ch ,tat.ment. (5.. form 1065 Instructions.)
I, lhl, plrlner I ~ dom.stlc or. 0 for.lgn portner1 (2) Did the partn.r'hlp st.rt or Icqulre . nlW ICtlYity Ift.r
(1)lItr"tc"'. (Ul[ndol Ocl. 22,19867 , , . . . . . . . ,oVes 18I No
E Ent.r parln.r', perc.nlage of: ..1"miNl,"" .'" If 'Ve,,' attach statement. (Se. Form 1065InstM:lion,.)
Prolit sharing , , , ., .... ....." . h ~\:)R. '16 Check here II thi, partn.rshlp lu publicly traded partnershlp.O
loss sharing , . . . . .. .. , .. .." ..1,- ~ ~~ . '16 as defined in section 469(k 2 . . . . , . . . .
Own.rshi ofca ilal. ., .........'16 ..l'J,~.'?'16 J Check a IIcabl.boxes: 1 FlnaIK.1(2) Am.ndedK.I
artne' sea Ila account: d)lncomenotlnctuded (.)LOlM'Inolindudtd (f)WithcSmnaund tJ)CaoitIIlCtGWflllt
IpI con C rtldI' lncolumn(c),pIUl Inc.olumn(c),~ disIrlIlutIonI Indol,.., combine
du If' IMs 1 '1 J and" be... nonluabl. Income uNlkM,b'- dedlJt'tlont c:oIurMI (. (0)
Dc> ~S~ ( \0 .,.,.,. ) I (. 1 B
(e) 1040 PI... .nl.' Ihl
Imounl In ..lumn (b).n:
o } (~~I~"iO:,~)
A
B
C
D
(I) DI.lllbuUv. .hot. n.m
(blAlnounl
-=
~
-
..
E
o
u
.5
Ordinary income (loss) from lrade or business activities
Nellncome (loss) 'rom renlal real estate activilies
Net income (loss) from other rental acllvilies .
Portfolio Incom. (loss):
. Interesl ,
b Divld.nds. . . . .
c Royalties . , . . ,
d N.tshort.term capital gain (loss).
e N.Uonll.l.rm capital gain (loss) .
f Other portfolio Incom. (loss) (aH.ch schedule)
5 Guaranteed paym.nts!o parlner . . . .. .
6 Nel gain (loss) under sedlon 1231 (other than du.lo casualty or the It)
7 Other incom. loss aH.ch schedule . . . , . . . .
8 Charltabl.contribullon, . . . . . . . , ,S.o,/o. .
9 S.cllon 179 expense d.ducllon (.Hachschedul.) , , , . ,
10 Deductions related 10 portfolio Income (atl.clnchedu/e), " .
11 OIher deduction, .Hach schedule \<e.o...... ~~'fT. f.~T'!-~. oj .
I
2
3
o
I
2
3
4
1.1..("
U
::I"
'Uc
"0
C;:l
"a
.
.!l il 12a Int.re,texpens. on Investment deb Is , . . . , . , .
i!.3 b (I) Investm.nl income Included on lines 4a lh,ough 41 above
.!!.!! (2) Inv.stment.x .ns.. includ.d on line 10 above,
13. Creditlorlncom.lax wlthh.ld . . , . , , .
b low.lncome houslnll credit:
(I) from ",110ft 4ZOJ(S) pJrln,"l1lps for properl, plmd in ..IVI.. bslora 1990 b I
(2) Other than on IIn. 13b(1) for properly ploced In service b.lo,. 1990 b 2
(3) from ",lIOl14ZOJ(S) pJrlntnhlps lor proptlly plmd In ..IVI.. 01111 1989 b 3
(4) Other lhan on Iin. 13b(3) for property placed in s.rvicealter 1989 b 4
e Qualified rehab,litallon expenditures related 10 rental real eslat.
activities (seelnstrucllons) , , . , . . . , . , . .
d C,edils (oth.r Ihan credits shown on lines 1Jb and 13c) relaled
to rental real.state aclivlli.s (seelnslructions). . . .
. Credils r.lal.d to oth.r rental aclivities (see instrucllons) ,
14 Olher cnc.Jih 1ce in~tructlon' . . . . . .
ror PlptrWO'''' RtducUon Act Nollce,." fo,"" l065In,lruct!on..
6
:I
:a
..
~
u
~@90
Sch. B, Plrt I, IIn. 1
Sch. B, Part lI,lin~ 5
Sch. E, Plrt I, IIn. 4
5ch. D..lin. 5, col. (I) or (g)
Sch. D,lInel2, col. (I) or (g)
lEo11I Gt ."""bIt...".... IIhm)
I (...........,..............)
Sdltd\lltK'l(l'onnl065)
(!AlII Gt.ppllublt...".... IIh..)
Sch. A,lIne 14 or 15
} (...............-..)
~"'L(I'.."'I06SJ
Form 4952, line I
I (... -'.............)
:sc...... It. 1 vorm 106')
(~~I'(I~'r.lll')
} Form 8586,li"8 5
} ( ... ....,.'. ....""".....,.)
ScI*lwl.lC. t (r.", I06S)
5ch.d"l. K.I (Form 1065)1990
.~abe~'.
IS.. ~ _]llll.~____f. JlIlI(rll.....r,__-?~_________
Inslructions 0 II ill pnl'"hHn. spOUS.', lusl nam" and ll'Nhal l asl ".llnO
onpegtll) ~ 6:>r'Jfl\r"\. Co, III"fl\,,"f ___ ____ ________
~=I~h8 Ins H Home addres'lnumhe, alld Slfooll 111 YOll ha.... a P 0 tX)I, sn page III . [API n"
Olh.ow"o, . .1 S" ~ w. r 4n f /li T j.... _______ L____
please prlnl : City. lown Of post ollice, ,Ialo, and liP eoelf! (II you N.... . IOflllCJn nddle!.!. !litO Pol9ft III
or Iype. (II t-I",l...\.. f~ "01
Presldanllal
EI8cllon Campaign ...
Seeaell) r
1
Filing Status 2
3
4
Chock only
one boll,
Exempllons
(Seo pago 12)
It more than sIll
dt\pendenls.
see page 13.
· Income
Attech
t Copy 0 of your
Forms W.2.
W42Q, Bnd
l099-R h.re.
If you did nol
get 8 W.2. S&8
pogo 10
Attach check or
money order on
lop 0' any
Form. W-2.
W.2G.or
1099-A.
Ad\UstmenlS
to ncome
(Se. pogo 19.)
A lusted
Gross Income
-
U.S. Individual Income Tax Return
fOlIM 01' J.n.Oac 11, 1991, ~ olhtU lo1~
Your Ilfsl name antJ ifllhal
,199I,llfldUl(
l ....'JJ. r .
,'''----.-!O...ONo~
Your loci" ..curtty numb.,
~~)(, : '~'14
SPOUI'-', Bocla...curity numbe'
---'2.!....~;_:!'SL .
For Privacy Ac' and
Paperwork Reduction
Act Nollce, e.e
Instructions.
Single
Married filing jolnl rolurn (even if onlV 000 had Income)
""anted filing separate relu,", Enler spolj'~e's social secullly no abo...e and lull name her.. ...
.leod 01 household (with Qualifying person), (See page 12.1111he qualifyIng person is 0 child but not your dependent,
enler this child's name here. iii"
QuaIl in widow III wllh de endenl child ( ear 5 OU58 died" 19 ). Sea a< 8 12.
6a f8] Yours,U. If your parent (Ot someone else) can claim you 05 i1 dependent on his 01 her lax
,alum, do not check boll 6a. Out be sure 10 check the bOl on line 33b on page 2 ,
b ~ Spouse .
c Dependents:
III Name (Iilst. indlal. and Int Nine)
Bt
"'"
lll$1 n.lIll1t
Do you want S 1 10 go 10 Ihis fund? ,
If 'oint relurn does our 5 OU58 wan I SliD 0 to Ihis fund?
5
ill t..,.
~IlMt.
!!I"
(3) I '0' I Of old".
dl'Pfnd.nl'I soml ucull1v
numbrr
141 Depend'"!"'
.ellllOfI\/lIP 10
_ YOU
'"vIIITi (l
(5) No 01 monlhs
!Md.....
homt WI 1991
I;)"
L/'rv M
J II"~ 11.~,..r-
.)0) :s
:_~'L
d II your child didn'llive wilh you but is claimed as your dependenl under a pfe.1985 agl.em.nl. check hell! .. 0
. Tolal number 01 ex em lions claimed
7
8a
b
9
10
11
12
13
14
15
160
170
18
19
20
21a
22
23
248
b
25
2iI
27
28
29
30
31
Wages. salarIes, lips, ele. (attach Form(s' W-2)
Talloble Inlerest Income (also altlJch Schedule B it ovor $400) .
Ta.-'.Imp' Inlelesl income (see pagIl16). DON'T include on line 8a 8b
Dividend Income (also altach Schedule B if over S400) ,
Talloble rerunds 0151al8 and local Income tall US, II any, from wOlksheet on page 16.
Alimony receIved
BusIness Income or ~05S) (attach Schedule C) ,
Copllol goln or pos.) ra"ach Schedulo DI .
Capital goin distributions not repOIted on line 13 (s8e page 11).
Olher gains or Oosses) (alt.lch Form 4791), , . , , , , , . , , , , ,
TotnllRA distributions, ~ C 10b fa.able amounllsee ~lJe 11)
Tolal pensions and annuilies 17a l' '"\ 0' l1b T,uablct amounllsee p.llJe 17)
Rents, royalties. partnerships, eslallJs. husts, elc, (aUach Schedule E)
Form Incomo or lloss) (attach Schadule FJ I
Unemployment compensation (insurance) (see paL' . . , , . . . . .
Soclol security ben.ms. 121a I 21b '",bl. .mount (... I>'oe 16)
Other Income (lIsl type and amount-see page 19) J~~..I...11.:.~_~..~'.-;~~.~~.~.~?..
Add lhe amounls shown In Ihe for r' hi column 'Ot lines 7 Ihr h 22. This Is lolallncoml ~
You< IRA deducllon. from ,ppl~able worksheet on page 20 Ot 21 240
Spouse's IRA deduclion,lrom .ppllcabls worksheel on P'O. 20 or 21 24b
One.holl 01 .el'.employmentlo. (see page 21) 25
Sell.employed helnh Insullne. deduction. 110m .~,Isheel on p.ge 22. 28
Keogh retlremenl plan ond self-employed SEP deducllon 27
Penalty on o.uly wllhdrawal of savIngs , 28
Alimony paid. Recipient's SSN ~ 29
Add lines 240 throu h 29, Those ore our total adjustments . ...
Sublraclllne 30 Irom line 23. ThIs Is your adjusted oro51 Income. 11 this BmOUfJ' Is leu than
12',250.00 it child Ijved WIth you, see page 4S to find out if )IOU can claim the ~Eamttdlncomff
CfU{1It" on IInfl 58, ...
000
Cal No 113:<'00
ND.lllto..1
chuk" Oft'1
Indllt
No, 01 vour
chlld,.n.n"
who:
.UYI'wUfrl,ov ~
. dldn'llI.. wll"
,01l1l..la
III'Of&l or
upI"lIon(,"
,a,. 14)
No..f olhlf
'1,plfld.ntlln'l_
Ad' n",lblfl
.nl.,,, Oft
IIn"llIo" ~
lof
5;;1
:l.
9
10
11
12
13
14
15
16b
17b
18
19
20
21b
22
23
10 r.lo
7 ~%
J S'
31
7J,.(.J'J'
r.,,,,, 1O,tO II!J'J"
32
Tax
Compu-
tation
II you wanl
tho IRS 10
figure you,
In., see pnqA
24
35
38
31
38
39
40
41
Credits 42
~see pogo 43
5) 44
Other
Taxes
Payments
AUach
Forms W.2,
W.20, .nd
1099.A 10
fronl.
60
61
Refund or e2
Amount 63
You Owe 64
Sign
Here
Keep e copy
0' this retum
for your
records,
Paid
Pre parer's
Use Only
ArnOllnl from linn :1 I (ndju!lled oroS! Income)
Chock II. rJ You wefe 65 or nkJOf, r-J nUncl, LI Spouse wAsil!) Of' olde" LJ
A(td Ihn nurnbnr 01 ho.n~ r.hnr.ked nhovn nllel (lI1lm Ihe lolill h",n . ..
b II your pnrnnl lor !1omeonn al!\n) roM Cllliltl ynu n, n lIepmutcnt, chock hern ..
HilmI
33.
3:Jb
p
'/":.1U
:l
35 5'1 t..5 7
38 "~I SO
5 J..,
38 /0 . ~
.
K
/0 "',
&'} c:; I
lOb")
I' DJ..
Under pena!lIts of perjury, I decl.ve that I have e.amlned tN, fth.wn and aecompanyW1g ICheduIn and stalemenls, and to the besl of my knowttdge and
belt', lhey are true, cooecl, and complete, Declaration 01 prtpiJIer (olher lhan tiJllplYef) II based on allnlOl'maUon 01 wtIlch IJftplf8fhasanyknowfedOt,
Your slgNturlt Dale Your occup.lIon
33.
34
c II you nro lI1R1flOd IIUnO iJ !utpnrnlo rolllfO nml your ~I)()II!'O Iternllo!l deducllon" 0
or VOu Rte 1.1 (JuRI. sinh", nlinn, !HHI pngn 23 nnd c:hock h'HII .. 33c
lI.mlnd deductlona (lrhlll fichftlluln A, linn 26), on
Sllndard deduction (shown below IOf your filing slnlus). Clullon: " )'Otl
ctluc/(8d .ny 00. Oft Ij,ut 3Ja or b, go tl) plJrJf1 23 to find your stalldiJld
dootlctlOn, " )'0(1 chndml tXJIf 3.1c, )'OUf stand.lrd dvduction Is zoro
. SinOllt-$J,400 . Hend of hotJsehold- $5,000
. Mauled hUng jolnlly 01 Qualifying wldow(er)--$5, 700
e Marrlod hUng separalely-S2,850
Subtracl line 34 horn line 32 ,
!lUno :12 Is $75,000 or 1055, multiply $2,150 by tho lolnl number 01 exemptions c1almod on
Iino 60, !lUna 32 is over $15,000, selft pogo 24 for Ihe omounl10 enter
Tuublelncome, Subtrocl IIno 36 horn IIno 35. (!lUno 36 Is more Ihon line 35, onler -0-.) ,
Enler trlle, Check II from 8 0 TRI( Tobie, b Ii?] Tax no Ie Schedules, a 0 Schedule 0,
or d 0 Form 6615 (see page 241. (Amounl,lfany, from Form(sl 0014 ~. 1.1
Addilion.lla,es (see p.ge 241. Che<k If Irom . 0 Form 4970 b 0 Form 4972
Add lines 36 and 39.
Enle,
Ihe
larger
01
Vou,:
45
46
41
46
49
50
51
52
53
54
55
5&
51
5&
59
C,edlt for chUd and dependenl care a.pense, (attach Foon 2.f.f') 4
Credil for the elderly or tho dIsabled (attach Schedule n), 42
ForeIgn tox credil (iJttach Form" '6) , ,,43
Olher credlls (580 page 25). Check If from 8 0 Form 3000
bD Form 0396 c 0 Form 0001 dO Form (speclly)__ 44
Add lines 41 through 44 , ,
Sublri1ctllno 45 horn IIno 40, If IInu 45 Is mOre thnn line 40, enler .0.. ..
SoU-employment lnx (atlnc!1 Schedule Sf) .
Alternallve mInimum tBx (attach Form 625'J ..,. " , . ,
Aec.plurel...s (s.e page 26). Check II Irom .0 Form 4255 b 0 Form 6611 c 0 Form 6826 .
Social security Bnd Medlcaro la. on lip Income not reported to employer (altach Form 4'37J
Tax on an IRA or n qUBll1led reUrement plan (attach Form 5329J
Advanco oarnod Incomo credit payments 'rom Form W.2
Add lines 46 Ihrou h 52. This is our totell.x ' ~
feder.1 income'.. withheld (II any Is horn form(sII099, check ~ 1811 54
1991 estimaled lax paymenls and amount applied from 1990 relurn . 55
E.med Income credit (.U.ch Schedule fIG) . 56
Amount paId wllh Form 4868 (ox tension requosI) , 57
E,cess socl.1 securirv. Medicare. ..d RRTA I.. wilhheld (see p.g. 27) . 56
Olher p.ymenls (see page 21), Check IIlrom . 0 Form 2439
b 0 Form 4130. . . , , . . .. " 59
Add IInos 54 Ihrou h 59. Thoso are our total 0 ments ~
If line 60 Is nlOfe Ihan line 53, !lublractllne 53 trom IIno 60. ThIs Is the amount you OVERPAID,
Amounl 01 line 61 10 b. AEFUND~O TO YOU.
Amounl of II.. 6110 b. APPLIED TO YOUR 1992 ESTIMATED TAX ~
II line 53 Is more Ih.n line 60. sublraclline 50 Irom line 53. This ,. Ih. AMOUNT YOU OWE.
Altach check or money OI'der lor full amount payable to .'nlemal Revenue SeMce,. WIlle your
name, address, socIal securlly number, daytime phone number. Bnd .1991 Form 1040. on It.
Estlm.led I.x enel see. e 20. Also Include on line 64. 65
65
~
~ Spouse'SI9nllur. iii taint relum, OOTH mus' sign)
=:~. ~ I~ C.
Firm', name (Of vours ~ "TU. Q t"'\ , (.
If NlI.employed) and ~
eddress r , \\\1""
Dale
/l11'f'-t' !::1
Spouse', DCcupallon
o.o'11t"ll4A-
O"t
L\\ 'i IIj.)-
-I-
~
45
46
41
48
49
50
5\
52
63
P'epal'8f'. socl.I s8Curlly 1'10.
\'\S :~
<<,r:'
")'\ -\}-
(Schedule D Is on bock)
~,,*",oflhe"."UI'Y
. "".,... ~ SeNc4 II) .. AtlRch 10 Form 1040. .. Se. Inslructlons for Schedulll A gnd 0 IForm HMO).
N.vne'tl ihown on FOlfn HMO
jt.L- {. l (0" JfJlr'(l
.
Medical Clullon: 00 110/ /IIc/ude e'pellscs rel/llblJlsed or p,lld by a/hers
and 1 Medical and dental Axponsos. (500 paue 38.) .
Dental 2 Enler amounllroOl fOlm 1040, line 32 U_L_____I_
Expensas 3 Mulliply line 2 above by 1.5% (.075). . . , . ., 3
4 Subtract line 3 from lino 1. Enter Ihe resull. II less Ihan zero enter .0-
5 State and local income taxes . , . . , . 5 JoB",
6 Real estate laxes . , . . . . 6 ''\10
7 Other taxes. (List-include personal properly taxes.) ~
~,
JttV~II"""l
J(l
Taxes You
PaId
(Se.
page 381
7
6 Add 'li~;;.5' iti;ouglii:i:iii.;.iti.iota'.....:... ":"',
Oa ttome mortgage inleresl and poinls reported 10 you on form 1098
b Home morloage inleresl not reporled to you on Form 1098. (II
paid 10 an individual, show Ihat person's name and address.) ~
(,1.'\\
Intllrest
You Paid
(SIe
pig. 39.)
Nato:
Personal
Interaslls
no tonge,
d.ductlble.
..............-........... .........,..........................
10 Points nol reported 10 you on Form 1098, (Sea
Instructions lor special rules.) . . , . . . . ,. 10
11 Inuestment interest (atlach Form 4952 If required). (See
page 40.), . . . , . . 11
12 Add lines 90 throu h 11. Enter Ihe total. , . , . .
Cautlon: " you m,1de 0 cllerllable contribution and
received a benefit In return, see page 40.
13 Conlribulions by cash or check . . , . . . ,. 13
14 Olher than cash 0' check. (You MUST atlach Fonm 8283
If over $500.). . . . , . , . . . 14
15 Carryover from prior year, . , . . . 15
16 Add lines 13 throu h 15. Enter Ihe total.
. ~ 16
0111810
Charity
(Se.
page 40.1
175'
Casually and
Th811loSS8S 17
Moving
Ex enees 18
Job Expenses 10
and Most D1her
Miscellaneous
Deductions 20
Cesually or then toss(es) (attach Form 4684). (See page 40.).
.~ 17
.~
Unrelmbursed employee expenses-job travel, union
dues, job education, etc. (You MUST attach Form 2106
II required, See Inslructions.) ~ ...........................
Other expenses (investment, tax preparation, sele
deposit box, etc.). List type and amount ~..............
(See
pege 41 for
expenses to
daduct here.) 21
22
23
24
Olher 25
Mlscellane~us
Deductions
................................................................
................................................................
Add lines 19 and 20 . . . . . .
Enter amount ',om form 1040, line 32. I 22 I
Multiply line 22 above by 2% (.02l. . . . 23
Sublroclllne 23 Irom line 21. Enter Ihe result, If less Ihan zero enter .0. , ,~ 24
Other (from list on page 41 of instructions). List type and amount ~ ...............
...............................................................................................
~ 25
. II the emount on Form 1040, line 32, Is $100,000 or less ($50,000 or
less If married filing separately), add lines 4, 8, 12, 16, 17, 18,24, and I
a~~~~ .~
. If the emount on Form 1040, line 32, is more than $100,000 (more then
$50,000 if married filing separately), see page 42 for the amount to enter.
Caution: Be sure 10 enler on Form 1040, line 34, the LARGER of Ihe
amount on lino 26 above or your standard decuction.
For Paperwort( Reduction Act Notice, see Form 1040 Instrucllons. Cal. No. 11330)(
Total
itemized
Deductions
26
~@91
."..""*', . 07
SeQuenc:.o No
..11'\
Sch.dule A (Fonn 1040) 1091
~IlItIUlVS IIbU ~I ....1111 IU"lil '.1.1 I
.....,.." ,.., '''''.'.1 U\1I"1
""lJ" ...
Schedule B-Interest and Dividend Income
You, toclal ..eUflty numbe,
Joo : ,to : ''''1 l.
AUlIC_' 08
~.No
.~I. thown on F()l'm to<40 roo nol en'''' name Iud IOCI.,I seeullly ntKnlNtf II shown on olhef Ilde.
1)I)l-1 F ~ c.o"'JfI\~c1 IJ J"u~""'T :11L
.
,
Part I
Interesl
Income
ISee
pig" 15
end 43 I
Nole: II you
received e Form
1000.INT, Form
1099.010, or
lub.llIull
IlallMenl. 'rom
e brok...oga IIrm,
U.llhe IInn'4
name 8S Ihe
payer and Inler
the lotallnle'811
shown on thai
lorm.
Part II
Dividend
Income
(See
pages 16
and 43.)
Nole: If you
'ecelved a Form
1099.OIV, or
substitute
slatement, from
a brokerage
fl,m,llsllhe
r1rm's nsme as
the payer and
ente' the 10101
dividends
shown on lhal
rorm.
Part III
Foreign
Accounts
and
Foreign
Trusts
(Sea
page 43.)
U y")u received more than $400 In taMoble Inle,est Income, or you are Claiming th. ..cluslon 0' Inler..t from
..rle. EE U.S. savlnge bondelasued alter 1909(aee page 43), you muel complete Part I. Llat ALL Inter..l received
In Pari I. I' you received more thon $400 In tallable Inter.atlncom., you mUlt 1110 complete Par1l11, U you r.celved,
as II nomine., Inter"st thol actuallv belongs to anolher perlon, or you received or paid sceruld Interest on .ecurlU..
lranlfened between interes~-E.~y.!!'en~Bt.s. lee page 43.
Interest Incomo Amounl
1 Interest Income. (Lisl name 01 payer-il any Interest Income Is from
seller-linanced morlgages, see instructions and list this Interesl firs!.) ~ ..
.f'!~~.~.fl:,.IIOOIl~I/.... S II V41\'~'~'J' .i{. .1'-.v::'Jl.k........ ......
..fij r.;~N..'/r~ ..~r.1 r.~~~/.. ~ i''i..wiiA:f......... .........
.A..~...\A,-1, ~1I1~. ...1. (IIVllt~A.T J'."............".............."" .
)1)
If
................................ ..........
1
.............................,... ..,.......................................................
.............. .................. .............. ...........................................
.............. ................. ...... ....... ............................................
".............,.............,... ..........................................................
"..........""................. ........"...."..................-....................".
................,............... ...........................................................
.................................. .........,...............................................
2 Add lhe amounls on line 1 . . . . . . , . . . . . .. 2 S
3 Enter Ihe excludable ,"vings bond Interest. if any, from Form 8815, line 14.
Attach Form 8815 to Form 1040 . . . . , . . . . .. 3
4 Subtract line 3 from line 2. Enter the resull here and on Form 1040 line 8a. ~ 4 S
If you received more thon $400 In gross dividends and/or other distributions on stock. you must complet. Parts
II and Ill. If you received, os a nominee, divider. dB that actunlly belong to anolher person, see page 43.
Dividend Income Amount
5 Dividend income. (list name 01 payer--Include on this line cepllal gain
distributions, nontaxable distributions, etc.) ~ .. ............"......................
.................................. ...... ..................................................
............................................................................................
......... ..................................................................................
....................................,.......................................................
............................................................................................
5
..........................................,.................................................
............................,...............................................................
............................................................................................
......................................,.....................................................
......................,...............................................................-.....
............................................................................................
............................................................................................
6
6 Add the amounts on line 5 . . , . . . , .
7 Capital gain distributions. Enter here and on Schedule 0' .
6 Nontaxeble distributions. (See the inst. for Form 1040, IIna g.),
9 Add lines 7 and 8 , .......,
10 Subtract line g from line 6. Enter Ihe resull here end on Form 1040, line g . ~ 10
'II you received capital gain distributions bul do not need Schedule 0 10 report any olher gains or losses,
see Ihelnstructlans far Fonn 1040, lines 13 and 14.
II you received more than $400 01 Interest or dividends, OR II you had a foreign eccount or were a
grantor of, or s trensleror to, e lorelgn lrust, you must answer both quesllona In Part III.
lla Al any lime during 1991, did YOll have an interest In or a signature or other euthorlly over a financial
accounl In a loreign country (such as a bank eccount, securities accounl, or other IInanclel
account)? (See page 43 lor exceptions and filing requirements for Form TO F 90-22.1.)
b 11 'Yes,' enter the name 01 the loreign country ~ .......................................................
12 Were you the grantor 01, or transleror to, a lorelgn trusl thai existed during 1991, whether or not
au have an bennficlal interest In It? If .Yes,' ou ma have to file Form 3520, 3520,A, or 926 .
For Paperwork R.ductlon Acl NoUc., see Form 1040 Instructions. Schedule B (Fonn 1040) 1991
No.'," ot person wllh IIU..mplovm.nI11lc;(JIllfl fa.. ~hn'Nll f)I~;-~'-;;;I(j:tlil- - --Ginn.11 5Pr.tmly numb", 01 p""on
O~t-l F. Jllu~111/1f :if\. __ _____J~,ItI..,f..mploYm.nl ,"como. Il'\l
S'lctlon B-long Schedule SE (fleforf! """'pleh"", """ ,I YOlJ "<I,, ,"n Shorl Schedule SF. on Ihe other Side
(Secllon A).) .______u__ ___
A II you mn a ffll0l5ler, member of i\ mllqlOlJS orelP-f, or Chfl'1l1i1l1 ~r:lencn prilr.lllloner, AND you '1lod Form 4381, hut YOll
had $0100 or mnm of olher nnl fliHnln01 from ..rlf f'rllplllyllu1nl, dll'~(;k hmo .lnd conllnuo wilh Part I .... I I
D If yow only lllcorne 5uhjeclln self oll1ploynwllllalC I", (;fullfil Ptllployoo Incomn and you am not it minister or a rT1mnhm
of R rehgious order, skip hnes 1 Ihrou9h 4b. Enler .0. 011 Ilflt~ .11; ilnd HO to line 5a.
m'JDI Sell,Employment Tax'~=-=-:=__
1 Nel farm profll or (loss) 'rom Schnrtulo r (Form 1040), hnn .1/, arid farm partnorships, Schodulo
K.I (Form 1065), IIno 153. (Note: Skip this Imn " YOIl llse 11m f.lml opt/onnl method Soe
roqlllremonts If) Part /I below lImi /Il tho mstrlJcllOn.'i J
2 N.' pro'" or (loss) from Schoduln C (Form 100\0),11110 31. "n<l Sr.hndlllo K-I (Form 1065), line
153 (olhor than farming). 500 Instruction !I lor olhnr Income to report. (Note: Skip this 1mB if you
use tho nonlnrm optionnl mothod. See raqwremcnls /fI Pol,t " IlS/ow lJnd m tllft instructions.)
3 Combine IInos 1 and 2 ,
4a "lIne 3 is morn than loro, multiply IIno J by .9235 Otherwlso, enlor tho amount from lino 3 hero
b If you elected one or both of the ophonol ,"othOlls. .nler Ihe lolal 01 hn.s 17 and 19 here .
c Combine lines 4a and 4b. II less Ihan $400. do not hie this schedlllo: YOll do nol owo self.employmenl
lall (E.ceptlon: II less thlJn $400 lJnd YOll had chmcl1 employee IfIcoma, anter .0- and continuo.) ....
5a Enter your church employee income from Form W.2 Caution: Sea l:tb
tho instructions for definition o( church amp/oyne incornn Sa _
b Mulhply Iino 5a by .9235. (If less Ihan $100. .nler -0..) 5b
6 Nel earnings 'rom soli, employment. Add lines 4c and 51,
i' Mallimum amount of combined wagos nnd soll.employmenl el1rning~ !liubject 10 social security
lax or tho 6.2% pori Ion 0' the 7.65% rmlroad reliremon' (1'01 I) lax lor 1991
80 Total social Gecurity wages and lips (from Forll1(s) W-2) and railroad
relirement(lier I) compensation.
b Unreported tips subjecl 10 social securily lax (Irom Form ,1137,
line 9) or railroad retiremenl (tier I) lax
c Add line. 8a and 8b , . . . , , .
Sublract Iino 8c from line 7. If zero or less, onlOl .0- here and on line 10 and go to line 120 ~
Mu1\iply the smaller 0' line 6 or Iino 9 by 12.4% (.124) . . . . . .
Maximum amounl of combined wage. and sell-employment earnings subjecl to Medicare tax
or lhe 1.45% porlion of the 7.65% railroad retlremenl (tier I) tax for 1991.
12a Total Medicare wages and tip. (Irom Form(s) W-2) and railroad
retirement ('ier 1) compen.alion . 12a
b Unreported tips subjecllo Medicare lax (Irom Form 4137, line 14) or
railroad relirement (Iier 1) tax. 12b
c Add lines 120 and 12b , . . , , ,
13 Subtracl line 12c from line 11. If zero or less, enler -0. here and on line 14 and go to line 15
14 Muiliply Iho smaller 0' line 6 or lino 13 by 2.9% (.029) . . . . .
15 Self,employment lax. Add line. 10 and 14. Enter Ihe resuil here and on Form 1040, line 47
Note: Also enter one-hall or the amount Irom line /5 on Form r04O, line 25.
ImlI Opllonal Methods To Figure Net Earnings (See "Who Can File Schedule SE" and "Opllonal Methods" In
the Instrucllon..)
Farm Optional Method. You may use the farm oplional melhod only il (0) Your gross 'aom income' was not more than $2,400 or
(b) Your gross faom Income'wa. more Ihan $2,400 and your nel farm prolits'were les'lhan $1,733,
16 Maximum Income for optional method. . . . . . .. 16 $1,600 00
17 Enter the emaller of: Iwo-thirds (V,) of gross larm income' or $1,600. Also include Ihi. amounl
on line 4b ebove. . . . , . . . . . . . . . .. 17
Nonlann Opllonal Method. You may use Ihe nonfarm optional melhod only II Ie) Your net nonfarm profil.' were less Ihan $1,733
and also les. Ihan 72.189% 0' your gross nonfarm income' and (b) You had nel SE earnings of et leas I $400 In 2 of the prior 3
yoars. Caution: You may use fhe nonfarm optional method no more than five times.
16 Subtract Ihe amount on line 17, If any. 'rom line 16 and enler tho result . . . . . . . . WB
19 ~nter the emallerof: two-thirds ('Il) 01 gross nonfarm income~ or the amount on line 18. Also
Include this amount on line 4b above, . . .. . ............ 19.
;from Schedule F (Form 1040),lIn8 11. and Schedule K.I (form 1065). hlle 15b 'Flom Schedule C (form 10401. Ime 31. and Schedule K.I (Form 10651. line 15a
F,om Schedule F Form 1040). line 31, and Schedule K.I (Form 1065). hne 15.1 'Flom Schedule C (Form '0401. hne ,. and Schedule K.I (Fo,m 1065). hne 1St
..!- ----- --. .
8a
Joo')
8b
9
10
11
JOOf'1
120
13
14
15
130
2
3
40
4b
-'Ibe.
-I'I~X.
(.~5_.7f_
~~~1E:. _
(.~n.
$53.400
110
80
9
10
)00
5") ,
4,}1~
11
$125,000
00
Jaa'
I)) I'll
J'If/
SH.'
t
Qualified Retirement Plans (Including IRAs),
Annuities, and Modified Endowment Contracts
lI"pol'Jm..... "l"~ "fin.'.., (Undor SltcUOf1!1 72, 01973, 4974 nnd "900A 0' the Intornal Revenue Cadet AUachmllnl
~..,"~ fl"......". !O~".u ~ Allnch 10 form 1040. Soe !leparnllt In,lrur.t1on!l. SeflUftoce No 29
N.,,"" (II "'lllvI(IUill suhlOC:IIO AlIlM,(Wt;lII,u lrnlm!lln 1l.1mtl III Olln Ullh"'IlIIl,lIcmlV !lfm UUlIH",hul:!tUll!o 1m "Jomll'rlwns', Your locl.1 ..curity numbe'
t"r'Jfj)r~':.-____I)-,-____j-'.I."~'\~(lI___._ -LTIi. )(,,_~~~)__
^;l~j,-~~;Mtf And Iltanll IEfll~f f' 0 bo~ 110 II m.,.1 I" J\(lllll!hvf'fmlIn \lrl'lll .lclclrl!n I ^pl No
JS~ (,oJ. por1f/l-lr j1!l_~~.f___._ ____________
Cuy,lown, Of post olllee, Ilale, and lIP code IIth!s Is an Amended
(II jl..L.IJ 1.1.- PI) /1 . \) R.lum, check here" 0
Excess Contributions Tax for Individual Retirement Arrangemenls (Section 4973)
Camp/eta this par' if, eithor in this year or in o.1rlicr yellr~, YOIl conlribulm} more to YOllr IRA limn is or was al10wable and you
have 811 oxcoss contribution subject to '11X.
~@91
Excess contributions for 1991 (soo Instructions). Do not includo Ihis amount on Form 1040, IIno 24a
cr 24b. . . . .
2 Earlier yoar excoss contributions not previously elimlnaled (see
Instructions) . \ 2
J Contribution credit. (II your actuat contribulion lor 199t ,. less Ihan your
maximum allowable contribullon, see InstrucUons for Ilno 3; olherwise,
enter -0-.). J
40 1991 distributions from your IRA account that arc includible In taxable
Incomo 40
b 1990 lax yoar excess conlributlons (if rmy) wilhdrnwn niter tho duo dato
(including oxtenslons) or your 1990 income lox return, and 19B9 and earlier
laK yoar excess contributions withdrawn in 1991. 4b
c Add lines 3, 4a, and 4b . . . 4c
5 Adjusted earlier yo", excess contributions. (Sublroctline 4c lrom lino 2. Enter the resull, bul not less
than zero.) . . . . 5
5 Tolat excess contributions (add lines 1 and 5). . . . . 6
7 Tax due. (Enter the smaller 01 6% of line 6 or 6% of the value of your IRA on Ihelast day 011991.)
Also enter Ihis amount on Form 1040, line 51 . . . . . . 7
Tax on Early Distributions (Section 72)
Compld,1I' ,hi:: pnrt jf a touble d;s'nbu'iOll W3S made (tom yout quaM/eel retIrement plan (7ncfudlOg an IRA), modified endowment contract, or annuity
con'tacl before you reached age 59'/,. No'e: You must ef1ter 'he amount of 'ho dislnbulion on tho appropriate line (or Hoes) of Form 1040 or Form 4912,
8 Early distributions included in gross Income allributable 10:
a Oualified retirement plans (including IRAs) . 6a
b Annuity conlracts . , 8b
c Modified endowment contracts 6c
d Prohibited lransactions . . . 8d
e Pledging of accounts as security 6e
r Cost 01 collectibles . . . . 81
9 Total dislributions (add lines 8a through 80
Note: Include this amount on line r6b or r 7b or Form 1040 or on the appropriate line of Form 4972
9 Exceptions to dislribulions subjecl to additional taxes (see Instructions):
a (Jue to death (does not apply to modified endowment contracls) . 9a
b Due 10 lotal and permanent disability 9b
c As port 01 a series of substantially equal life lime periodic payments 9c
Lines 9d fhrough 9f DO NOT apply to distributions from IRAs, annuities,
or modified endowment contracts.
d Due to separation from service in or aller Iha year 01 reaching age 55 9d
e Distributions to the extent 01 deductible medical expenses . . . ge
I Made to an allernale payee under n qualified domeslic relations order 9f
9 Other (specify)... .................................................. .............. 9J
h Total amount excluded from additionallnx (odd lines 9a through 9g) . 9h
10 Amounl subject to additional tax (subtroctline 9h 110m 8g) . , . , . . , . . . . 10
11 Total seclion 72 lox muiti I line 10 b 10% ,10. Enler here and on Form 1040, line 51. 11
For Paperwork nedu~lIo" Act Nollce. site pago 1 or soparalo In,trucllons. Cat No. 13329Q
0(.')0
10(,,)0
10(.)
Fo'm 5329 (\9111)
267
f'
SCtlEOUlE K.1 Partner's Share of Income, Credits, Deductions, Etc,
(Form 1065) ~ Se. lep.ra!. In.wcUonl,
~"""' 01.'- f,"*'f
w.Nl.....-.,. 5...0(' '01 eel.ndll w..t '"' or I.. vUt b.gl,w"V . '"1. .nd .ndlng .18
p.rtner'sldenll In number~ l,,,:>-~C.- ItLll. Partners hi 'sldenll In number~? -1.oe-a''''
Parlner's name, address, and ZIP codo Parlnershlp's namo, address, and ZIP code
'\)o\-L' r. :S"'U'l"AI\'.SIl.. 1=.......1.1:"- ,.......,-n"........ ,5,...."...lIl\r _'"F,,,,..,i::>l,.C
2...-.. \uE"'-T"'~",,,,,-"T' ~T ----y!o,we.. LoB
C,....'-.~L" :<~ ,,01> Cfl<Z...tJ~u:;-,7.... nu,3
~@91
A
B
Is this parlner a gener!ll parlnor7 . at Vos 0 No
Parlner's share of liab,lilies (seo Instructions):
Nonrecourse. , , . . .. . $ ....,..............
Qualified nonre<:ourse financing. .$ ...................
Other. , . . . . . . . . . $ .....!,S~.t\...
Whatlype olenlity is thIS par1ner1. ~ 'M.!Il'.~.'.\>.~~.!-:..
Is this parlner a I8domestic or a 0 foreign parlner7
IRS Cenler where parlnership flied return:
H' 7~ 5
Analysis of artner'. ca ital account:
Enter parlner's pe,cenlage of: ~I 01''''' chango l\Il End 01
01 tllmil'l.lliOn )'!II
Prolil sharing, , . ......... " .1-S'J.Il"
Loss sharing , . , . . ......... " .?:~.~!'!"
Ownership 01 capilal ......... " .i\},~3 ,.
Tax sheller registration number ,~ .H).~..................
Typo 01 tax sheller'" .........................................
Check here II this parlnershlp Is a publicly traded
parlnership as defined in section 469(1<)(2) . . , . 0
Check a licable boxes: 1 0 Final K.l 2 0 Amended K.l
C
D
E
F
GIll
(2)
H
I.' C'plIIIICCOl.lfl1 .1
beginning of )'tAl'
:l >
(hI Capll,l c:onlflbuled
dutlOQ vur
J
(a) Dlslrtbullve share lIem
i
o
c!.
II
E
8
.5
1 Ordinary income (loss) horn trado or business activilios
2 Net income (loss) from renlal real estate activilies
3 Net income (loss) from other rental activities.
4 POr1lolio income (loss):
a Inlerest
b Dividends: .
o Royalties. ,
d Net shorl.lerm capilal gain (loss)
. Nellong.term capilal gain (loss).
I Olher porllolio income (103S) (aNach schedule)
5 Guaranleed paymenls 10 parlner
6 Nal gain (loss) under mtion 1231 (olher Ih,n due 10 c,sually 0' lhell)
7 Olher Income loss attach schedule . . . . .
6 Charitable conlributions (see inslruclions) (attach schedule) .
9 Section 179 ..pense deduction. . , . . . .
10 Deductions relaled 10 portlolio income (attach schedulo) .
11 Olher deduclions (attach schedule. . . , . .
.
U.,
::J C
-g .g
C
c
..-
E~
_ .. 12a
....
==c b
c-
Inlerest expense on Inveslmont debts. . . . . . . .
(11 Investment income included on lines 4a through 41 above
2 Investment ex eoses Included on line 10 abovo
13a Credil for income tWl withheld . . . . . . .
b low-Income housing credit:
(1) From section 42liJ(5) parlnerships for ploperly placed in
service 001011 1 990 . . . . . , . ,
(2) Olher than on line lJb(l) lor properly pl'ced in service belore 1990
l! (3) From section 42(j){5) parlnershlps lor ploperly placed in
~ service aher 1989 . . . . . . . . , . , . . . .
o (4) Other than on line lJbl3l lor properly placed In service ,lIer 1989
c Qualified rehabililation expendilures relaled to renlal real estale
Bctivilies (see Instructions) ...........
d Credits (olher than credils shown on lines 13b and 13c) relaled
10 rental real o!alate activilios (see instNcUons). .
. Credits related 10 olher renlal activitios (see Instructions) .
14 Other credils see instructions . . . . . . . . ,
For Paperwork R.ducUon Aet NoUe., see InslnJcUons for Form 1065.
1
2
3
rx
4a
4b
4c
4d
4e
41
5
6
7
8
9
10
11
lei) Wllhdflwals and
d.slllbulions
(b) Amount
8'\ q >0
1'00
B DO
l'
13d
130
14
CII. No 11394"
(I) Capll.llccounlll end
)1IlIlcombine colUfMI tA)
llv h
, (..
(c) 1040 nr.~ In tar the
emountln column (b) on:
} (... .",...', ...""'Ii"''' ,,,,)
~.K,I (Form 10651.
Sch. B, Part I, line 1
Sch. B, Part II, IIna 5
Sch. E, Part I, line 4
Sch. 0, line 4, col. (I) or (g)
5ch. 0, line 11, col. (I) or (g)
(Enl" OIIlppllClbl. ......ol)'OUl' nl\lln.)
} (... .""",', ...""'"... ..)
ScNdIH K.llfOl'm 1065). '
(En", onlppliclbl'liN 01 , nMn)
Sch. A, line 13 or 14
} (... ."'..... ...""',- .. )
ScNd\ll. K.I'onn 104$1.
Form 4952, Iino 1
} ( s.. P",,.,'I Ir1lltUCllOl'\t 101' )
Sd~. K.1lform 1061).
( s.. P",,*'t antMlionIlor )
SchtdIJI K.' ,ann 10651.
Form 6586, line 5
) (... .",,,,,', ...""'.....'... )
ScMd\H K.I CFcwm 104$1
Schedull K.l (Form 1005) 1991
.
. '
Lanel
(Set L
^
inllructJQOI . tf . )eM"1 "lurn, 'POUlt'S Iltll name .nd In/hll
01\ pIQI 10.1 ~ COr' j'o'ArL l. I), (11 v(, q~(C-r
Un theiRS Homt ackl'n' '"Umbel .nd ",..I). II you ha__' . PO bolo '" pag' 10
~~~IS', ~ ;)S;l. IV. por.FfLl.T JT/1..L;"
please print : City. lown 01 POll off"', 11111. and z~ cod. "'tOU hlv' 11011'0" tClor.". 'M plO. 10,
or typo. UtJ7..l-f } (.l rflt /1 0 I ')
P,nld.nllal '
EI.~lon Campllgn II.. Do you want 51 10 go 10 thi.lund? . ,
(See 110. , II. Int relum does Yf I use wlnt 51 to 010 ttllS fund? .
1 singl.
2 Married filing }oInt filum (IVI" It only onf had Income)
3 Mimed fihng taplra1. filum. Entl' IpouH'IIOCI.l HCUnty no. lbo\l' and lull name her,. ..
4 H.ad 01 household (wilh qualifying personl (5.. page 11.)lIlhe qu.lifying peroon I. I chlid bu1 not your dependent,
.nt.r this child', nlml her.. ~
5 QUlli In wldo . with de nden' child ur I aus' died II- 19 . See 8 .,1.
81 r8 YouI"IIH." your parem (or IOmeont ,II') can claim you II . dependen1 on his or her tax
return. do not check box 61. But be SUfi 10 check the boa on line 33b on page 2
b Su....,...,
c D.pand.nll:
(1) Nam. (11111. 1011111. aM Lasl AIm.)
Filing Status
(5.. page 10,)
Check OI\1y
on. boll.
E:wmptlons
(See pege 11.)
If more than sIx
dependents,
... plge 12,
Income
AlUch
Copy B or your
Fonna W.2,
W.2Q, and
101lQ.R h....,
II you did not
get I W.2, ...
pege 9.
",nach check or
money order on
top 01 any
Form. W'2,
W'2G. or
1099.R.
Adjustments
to Income
(See page 18.)
U.S. Individual Income Tax Return
IRS U.. Orl,-Oo not ..m. (II .laplt '" IhIt .~c:t
.1992. ,n(SinO .18 OMS No '~$.OOU
Your locial Meunty number
, 01 th. yea' J.n 1 -DtC 3', 1;12, Of olNf t&ll VII' bt9'MI~
VOUf fll"ll Mm, and 1t\l\1.1 lU' n.me
'\)/lL-l f JH"(,-4"r1-T J(l..
Joo:11.:1~~(,
8pou"', ,ocia' aecl,lt1ty number
U,il name
1'7'-1 :'\1. :1/ S ')
For Prlvlcy Act and
Paperwork Reduction
Act Notice. aee plge 4,
Apt no
Hot.: ChocIvnQ .V.S- WIN
noI chin" roo' l&f 01
rtdvC. refund
III "'"
rtUndll
"\
(3IUagllDlold'l,
depend.nl , ,Ot1,1 utumy
numbt'
;10): Sy :y.t.
14) DtpcndlnU
Ifllhon,hlp 10
u
1>AvnrTVL
III No ~ "",,\III
~1ft}'OJf
homIln 1991
,,..
N,. ,I '0111
dI"'" .. .. "'\
Ifl'" a-
N,..I,tuf
cttll,,.n 1ft Ie
wh.:
. IIn' wnh ,ou
. "'"'111" wllh
rot Cu. 't
IIly!IfUOI
IIplrll10A (lit
"" 131
N'.,'oUler
1lI.,.n..nbonlc_
All' ..m~'rI
IftllrtlllOfl
IIn".bow,"
'toO'
Llo'
L~v1\..
IHV' ~~,...,
d II your cnild dldn11M wtth you but 1\ :lalmed 11 your dependenl undlll plI.1985 .glllmenl, :heck hell .. 0
. T01al number of uem ltons claimed
5J
7
81
b
8
10
11
12
13
14
15
1111
17.
18
18
20
211
22
23
Wlges, IIlerles, tips, etc. Anech Form(s) W.2
TUlbl. Int.resl Income. Attach Schedule B If over $400
T......mpllntmSI incoml(m p1ge 15). DON'T ,"clude on line 8. 8b
Dividend income. "'lIech Schedule B II over S4DO . . . .
Taxlblt rtfunds, credits, or offsels of Illle and ~l tncome taxes from wo~sheel on page 16
Alimony receIved ........
Buslne.. Income or (10")' ",nach schedul. C or C,EZ , . .
Clpllal gain or (10")' Anach Schedule 0 . , .
Capital oeln dislr1bu1ions nol reponed on \Ine 13 (s.. page 15)
Other geins or po..es), Anlch Fonm 4797. , . , , . . . . , . . . .
TotellRA distribu1ions . ~ (.; '> J:" U b Taxable amount I'" page 16)
Total pensions and annuities l..1!!..l- U b Taxable amount (see: page 16)
Renls. royatties, partnerships, 8518tes. trusls, etc:. Attach Schedule E
Fenm Income or ~o..). ",nach Schedule F .
Unemploymenl compensatiOl\ (see plge 171 ' . , , . . , , . . . . .
50ciel security benefits I 211 I I I b Taxable amounlls" pege 17)
Other Income, US! type and emount-s.. page 18 ~.'~~.~.-:-.!-!~..~)::-,),~~~.!,~,..
Add thl amounts In the tar t column 100bne! 7 Ihrou h 22. This is total Income . ."
8
10
1
12
I,}.
14
15
18b
17b
18
18
20
21b
22
23
Go'} s
'n IYo
241 YcurlRA deduction !rom applicable wa<t<sheel on page 19 or 20 241
b Spouse's IRA d.duclion Irom applic>ble wor'un", on page 19 or 20 24b
25 ene.hell 01 ..If-employment tax (s.. pege 20) 25
211 Sell.employed heellh Insu..nce deduction (s.. pege 201 211
27 Keogh retiremen1 plan and lelf~employed SEP deduction 27 3o.:J 0
28 Penalty on .ar1)' withdrawal 01 savIngs. , 28
20 Alomany paid. Recipienl'. SSN .. 211
30 Add lines 248 thro h 29, These are our total .d ustmenb . ' . ..
31 Subtract ~ne 30 from hoe 23. Thll IS your adjusted gro.. Incom.. " rhls amounl is IeSJ INn
122,370 Ind. chHd lived wirh)'OLl, see PlgfI f/C-' 10 find our If you can cWm eM -Eamed
Income Cred;r- on 'fne 36 . ..
ell No 113208
31
30
I). 1.1\
31
'10,-\50
Fonn 1040 11992)
,..... '000 1'"21
Tax
Compu-
tation
lSee page
22.)
II you wanl
the IRS to
lIgur. your
talC, ... paga
23.
Credits
(See paga
23.)
Other
Taxes
Payments
Atlach
Forms W'2,
W.2G. and
1099-R on
\h. ~ont.
eo
Refund or 01
Amount 02
You Owe 03
AlIIch check 0' 04
moner order on
lOP 0 Form(l)
W'2,l1c.,on
the Iront. 05
Sign
Here
Keep a copy
of this return
for your
tKOI'd..
Paid
Preparer's
Use Only
32 Amounl !rom hne 31 (adjusted gron Incomel
33a Check I' 0 You were 65 or Old,r, 0 Bhnd. 0 Spou.. w8S 65 or older, 0 BlInd.
Add the number 01 bo.e. checked above and enler 1h. tolal here. . ~ 3O.e
b If your parent (or lomoon, else) can claIm you I. . depend."I, check he" . .. 33b
c If you .re mamed flhng alparalely Ind your .poUII l1.mlzlS deduction. or you 0
Irl . dUII..tatus ahen, lee pag' 22 and chOCk he" . . 33c
It.mlzed d.ductlon. horn Schedule A. line 26. OR
StAndard d.ductlon shown below fat your filing stalus. But tf )IOU checked
any bo. on IIn. 33a or b, go to page 22 to find your standard deductlon.
" you checked bo. 33c, your standard deduction illlro.
. Singi..-$3,600 . Head 01 househoid-$~,2~0
. Married filing jointly or Qualifying widow(lr)-S6,OOO
. Married filing aeparll.ly-S3,OOO
~ Subtract hne ~ from line 32 . . . . .
:sa II hne 32 II $78,950 or leiS. m.Jltlpty 52,300 by the lotal number of eump1ionl claimed on
line 61. If line 32 is over $78,950, I" the worilsheet on page 23 for the amount 10 entlf .
rauble Income. Subtract line 36 flam line 35. If line 38 II more than Un. 35, enllr -0. .
Enter tax. Check If lrom a ~ TAll Tlble. b 0 TAll Rite Sch.dules, 0 0 5chedula 0,
or d 0 Form 861~ (... p.ge 23). Amounl, n Iny, from Fonnls) 6614 .. . I
39 Addllionll tax_s (... pig. 23). Check n Irom a 0 Form .970 b 0 Fonn .972 ,
~ Add hnes 36 and 39 ,
34
Enter
lh.
larglr
01
your:
..
~
.~
45
45
47
45
49
eo
51
52
03
P. 2
'10YS-O
11 ~,\
35
1'1151
37
3lI
41
42
43
44
CredIt fOf' child and dlpendent care Ixpenses. AnBch Form 2441 41
Credit for the Ildlrty or the disabled Anach Schedule R . 42
Foreign tax credit. A"BCh Form 1116 43
Oth.r credlls (se. pege 2.1. Check IIlrom aD Fonn 3600
b 0 Fonn 8396 c 0 Fonn 8801 d 0 Form Ispetllyl_ 44
Add lines ., through .. . . , . . . . '
Subtract line 45 from line 40. If line 45 Is more than line 40, enter .0. .
3lI
'-'100
.,,, .. ,
4B
411
47
411
49
eo
01
02
o:l
04
56
50
07
58
09
Self.employment tBJt. A"ach Schedule SE. Also, I" line 25.
Alternative mInimum tax. A"ach Form 6251 . , . .
Rec.pture taxes ISH page 25) Check IIlrom I 0 Fonn .255 b 0 Form 6611 c OFonn 8826
Social .ecurity and Medicare tBJt 0,' tip income not reported to employer. Anach Form .137
TAll on qualllled retiremenl plans, . ICluding IRA!. Anach Form 5329
Advance earned Income credit payments from Form W.2
Add lines 46 throu h 52. This is our tollll tax.
F.deral incom. tax wlthh.ld.11 sny illrom form(l) 1099, ch.ck ~ Ilil
1992 "limaled tax payments .nd amounl applied ~om '991 rl1um .
Earned Inc,,"," cmlL AnICh Schedule EIC , . . . .
Amount paid wllh Form 4868 (extension requesl). .
ExceSllocial mUrlly. M.dicare, and RRTA Ux wllnh.ld 1m PolO' 26) ,
Other payment. I.H page 261. Check H ~om . DFonn 2.39
b 0 Fann .,36 . , . . . . . . . . .
Add lines 54 through 59. These are your tolal payments
n I.". 60 is """. than line 53, subtract lone 53 ~om line 60. This is the emaunl you OVERPAID.
",""unl clline 61 you want REFUNDEO TO YOU. . . . . . . . . . .
Amount 01 Ion. 61 you want APPLIED TO YOUR 1m ESTIMATED TAX ~ 03 I ~ "I
n line ~3 i. mOl'e lhan line 60, .ubtr.ct line 60 from line 53. This Is the AMOUNT VOU OWE.
Anach check Of money order fOf' full amount payable to "Intemal Revenue Service," Write your
name, Iddress, &OCtal security numbo<, day1lme phone numbo<, and '1992 Form 10.0' on "
Estimated t8.l na see 8 .27. Also include on line 64 as O~ t,...
$00
.1.100'
54
BB
BB
57
58
~oo
~o;l,
5'0.;
;lol-l
)
Under penaJtlft of ptf'jury, I dKllI' \hit I hi.... 'Umt/'led thil r.tLKn and ~nyv'Ig schedules and I1.IterntntJ, and 10 the bell of my knowttdOt and
b.b,f, they II' true. COl'ftc1, and compt.". OecllrJltOn 01 prtpar. (other thin tIJl.PlY-") it baNd on .. "'orma1JOn of wNch pr.p&tlt his any knowtIdgI.
~ Your Ilgn.tur. " Oal. Your occupation
,.. ,/ I tile'
t.. 5 se'l nal f U. pinl 0I.1t'1 '
,..~ mu
c.fh (;-10-'"
NIl , r.UC\<.L.I'1 t';r..
""'li""I.1>N ~(l "A fL.!.) rl.
32
59
Pttp.ar.,', toC1aJ MCurtTy no.
j~5":1i:i)5"
11'l~;l-
SCHE~ULES A&D
, (For,m 10401 ,
(Schedule B 10 on bock)
Schedule A-Itemized Deductions
04p.t~ of..... 't_"", I'tn
htamel Aewnut StMce ,..,
Name(11 shown on FOfm 10;10
/.-l F f c..ol" Ilr'l( O. JllvC,"I)(I,
Medlc.1 elution: Do not irn:/ude expenses roimburstJd or paid by olhors.
.nd 1 Medical and denIal expenses (seo page A-I). . .
O.n'.' 2 Enlll amounllrom Form I~O, line 32. 2
Expenoe. 3 Multiply line 2 above by 7.5% (.075). , , . . ,
4 Subtract line 3 from line 1. If zero or les. enter -0. .
5 Slel. and locellncome taxes . . . . . . ,
5 Reel .slate laxes (s.. page A.2). . . . . , .
7 Oth.r taxes. lIs1-lnclud. personal properly laxe. . ~
T.... You
Paid
(5..
peg. A.I.)
Int.,...t
You P.ld
(See
pogo A.2 )
Nole:
Peraonl'
Int.,..tl.
nol
deducllble.
Gift. to
Chartty
(See
page A.3.)
0"'0 No. 1545.00/4
~@92
AltlChmen' 07
&.quenc. No.
Your .ocl" Nc:unl1 number
JOo : 1G. : 11.'11:.
~ Alloeh 10 Form 1040. ~ h. Inllrvcllonl ror Schedul.. A ond B Form 1040 .
................................................................
8 Add lines 5 throu h 7. . , , . , . . . . , .
III Home mortgage Inleresland points reported 10 you on Fo,m 1098
b Home mo<tgegelnlerlst nol reporled to you on Form 1098. If
paid 10 In individual, show thai person's name end eddress. ~
...........................................................,....
................................................................
................................................................
10
Polnls nol reporled 10 you on Form 1098. See page A.3
forspeclal rule. , . . . . . . . . . . , . ,
Investmentlnleresl. If requlrod, ettech Form 4952. (See
pego A-3.) . . . . . . . , , . . . . . ,
Add lines 9a throu h ". . . . . . . . . . .
C.ulton: If you made I char/loblo contrlbullon end
recelvod a benent /n return, see pege A,3.
ContrlbuUon. by cash or check , . . . . . , .
O1her lhon by cash or check, If over $500, you MUST
Ittach Form 8283 . * ,F':'...,of ~(''l')'). I.n.n~
Canyover lrom Jlflor yoar .
Add line. 13 lhrou h 15. . , . . . , . .
5
II
7
lib
10
11
13
14
15
CIIUIlly and
T11ln lo.... 17
Moving
nle. 18 Moving ex n.es. Attech Form 3903 or 3903F. (See a e A,4, .
Un",lmbursed employee oxpenso.-job travel, union
dues, job educaUon, etc, If required, you MUST ettech
Form 2108. (Seo page A.4.) ~ ............................
Job Erpln"l lD
Ind Moll
Othlr
Mlle.Ulnloul
D,duetlonl 20
(See
pogo A.5 fDf
'.p<<\HS to
doduct hlte.)
21
22
23
24
Othlr 2lI
MllelUlnlOUI
D.ductlonl
Tolal
"emlzed
Deductlona
11
12
13
14
15
18
................................................................
Other eKpenses-lnve.tment, tax preparetlon, oafe
deposit box, etc. Ust type and amount ~ ...............
................................................................
lk
.
"
/705
'-1es
,~ 18
. ~ 17
. ~ 18
.................................................1..............
Add line. 19 end 20 . . . . . . . .
Enter smountlrom Form HMO, line 32. 22
MulUply line 22 above by 2% (.02) . '. , .
Subtract line 23 from Une 21. If zero or Ie.. enter .0. , . , . . . ~ 24
Other-from 11., on pago A-5, Usttype and amounl ~ ..............................
,........,....,................,.......,................................'.....................,: 25
lie I.lhe amounl on Form 1040, line 32, more than $105,250 (mo", Ihen $52,625 If
married "ling seperately)? .
· No. Vour dtJducllon Is not limited. Add line. 4, 8, 12, 16, 17, 18,24, Ind 25.} . ~
e YES. Your deduction mey be limited. See page A'5 for the lmounllo entlt'.
CluUon: Ba sure 10 enfer on Form r040, line 34, I"" LARGER 01 ''''' Imount
on IIno 26 above or ur standerd deduct/on.
Fot PePltWO<k Roductlon Act Hollce, _ Fonn 1040 In.welton..
117
Cat No 113.10)(
16' J...
(. '\I 1
J. '10
!"'l;)'\'
Schedule A (Form 1040l 11102
: Sc.....u.:.. AID (form '0401'll91
N.m.ct' shown on Form 1040 Do t'IOl -",,, name .nd IOCI.I MCUI'lty num~ ., shown on othef ,Id.
t>'l LL f i c..or-Jf'lr-''' ,.,. If/V' 1/1)1' r
Schedule B-Interest and Dividend Income
OMD No. '~Hor4 PIQi ~
Your lOCI" MCUrtty numbet
~"O:,(" :14'1(,
An.."'-' 08
Sequence No
Part I
Intarest
Income
(See
page. ,.
and B-')
Nol.: I' you
received I form
1OOO.INT. Form
l099.()ID.OI
lubstltul.
Illlement from
. broklflge nrm,
Nsl 'he firm'.
name IS the
pay.r Ind enter
the 'ol.llnt...sl
.how" on thai
lorm.
Part II
Dividend
Income
(S.e
peg.. 15
.nd B-'.)
Nolo: If you
received 8 F onn
l099.DIV 01
.ub.lIIut.
Itatemenl 'rom
II brokerage
ftrm,lIstthe
nnn's na",' '5
the payer .nd
enter the tolal
dividends
ohown on th.,
lorm.
Part III
Foreign
Accounts
and
Foreign
Trusls
(See
peg. B.2.)
If you had ove' $400 in tBlCable Inltuesl income on .'0 clalrning (he exclusion of k1leres~
..rl.s EE US ..ving. bondslnued .Iler 19B9, you must complet. this pe~. lI.t ALL In'er..' you received. II you had
over 5400 In hl)cabl8lnleresllncome, you must also complele Par1l11, If you received, I' . nominee, int.r.st that actually
belongs te anothor person. or you received or paid acr.rued Interest on securities transfefTed bel ween Inler,st payment
det.., .eo pege B.l.
Inlere.t Income
1 List neme 01 payer-If eny Interesllncome Is Irom .eller.flnanced mOrlgnge.,
s.e pege B-1 and lI.tthlslnt.rssl firsl ~..... ...................... ..........
..r.":'.':~~.~!.J...(!.~.~~.'.~/.J~~~t~ ~.1 ....t.. ~~.~Il~.........................
. .r1(l(.U.I.J ...Y.:n.... .~~.':!.'I!!':'.1.... ..'.....................................
. ~v~lJ.1/' ~~I~'0':'I... (!l"!t. >>.?.'~:!.,......~.) .11~T....................,.".
I
Amount
...............................................,............,...-...........................
1
............................................................ ...............................
............................................................................................
................."................................... .....................................
............................................................................................
...........................................................",.....,......,...,.............
.."..........................................................,......,......................
....................,..,............................................,.......................
2
..
2 Add the amounts on line 1 , . . . , . . . . . , , . . , . . .
3 Excludable interest on serle. EE U,S.savlngs bond. Issued aller 19891rom Form
8815, line 14. You MUST aUach Form 8815 to Form 1040 . . . . . " 3
.. Subtraclllne 3 Irom line 2, Enter the result here and on Form 1040 line 8e ~.. 01
II you hod over $400 In gross dividends end/or other distribution. on .tock, you must complete thl. par1snd Perl tll. If
you received, as a nominee, dividends thai act\Jally belong to another person. see page 8.1.
~ividend Income
5 List neme of peyer-Include on this line capital geln distributions, nontaxeble
dl.tributlons, etc, ~ ..... ......... ............. ... ............. ........ ..... ............
Amount
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
II
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
II Add the amounts on line 5. , . . . . . . , .
7 Capltel geln distributions. Enter here and on Schedule 0' . 7
8 Nontaxeble di.tributlon.. (See tho in.t. fOl Form 1040. line 9.) 8
D Add lines 1 and 8 , . . . . . . . , . , " ......
10 Sublraclllne 9 lrom line 6, Enter the result here and on Form 1040, IIna 9 . ~ 10
"II you recalved capltel Qaln distributions bul do nol need Schedula 0 10 reporl any other rJB/ns or Iossas,
see the Ins/ructions lor Form 1040, IInas '3 and 14.
II you hed OYO< $400 of Inleresl 0/ dividends OR had s lorelgn account 0/ were a grantor 01, 0/ a transfo<O/
to, s'O/elgn tru.t, you must complet. this pari.
11. At any time during 1992, did you have an Intarestln 0/ a slgnalure or other authority over a financial
account in a foreign counlry, such as a benk account, s8Curtlios account, 0/ other financlsl
account? See page B,2 lor exception. and filing requlrem.nts lor Form TO F 90-22,1 . , . .
b U -Yes" enter the neme 01 the lorelgn country ~ .......................................................
12 Were you the grantor of, or transferor 10, slorelgn t",sl thet existed during 1992, whether 0/ nol
ou have an boneficlallntere.t In It? II'V.... ou ma have to file FO/m 3520, 3520,1\, 0/ 928 .
for P.perwot'tt Reduction Act Notice, ... Form 1040 m.tNc'lon.. Schedul. B (fonn 1040) 1802
118
Ik_~ "",,104 11m
NIlme(II.lh?wn 01'1..1\1," 00 nol enllf n&mf and IOCIaI HCUflly numbet If Ihown on other IIdt
~I\LI.(i c.~'J1n"'ll I}. /I\\J(.~n"f
I -
NOI': " re r1 amount, from ',rmin 01 (,shin on Sch<<fu/e E, must e"tor ur
Income or Loss From Partnerships ond S Corporations
II you reporl a los, from en at.rlsk activily, you MUST check oillle, column (e) or (I) of line 27 to describe your Invest men I In the
activity See p!lle E-3 II you check column (I)tlou must attech Form 8198
AU.chm"lI uenc. No 13
Your loclel ..curlly nun6et
_____ 1.0 i 11.: 1(,'(10
ross Income 'rom th058 set/vilis! on line 4 r below.
2
---- ----- -.-._-_._-- - ----" .-.- tnYfllm,nl AI....'
tbl Enle' P IOf tc)ChtKk If ldl Employ"
21 ee) Him, plrtner,hlp, II IOlllQ" Id.nllhcallon I.) """ (n_l,
!Of ~~f!~ ~_p.r1net'lhip__ number ,1,t,1t nol II ",It
I X
A; (,"'li' I1PMt.~ jll"~II1I'f I pw'Ht ~ n',lo6oT~'
... I 1'_ )l- clo1y J '17
B il\o,,,." "LIf"I......... l..v~~'I'L-r j plw'l~l. ><
c · ,
D
E
Pllel.e Income end LOll Non asel.e Income and lose
lal r,,,IV't to.. ,UowMl lhlfl.",.,.lnC:ome It) NonpIUIV. ton 01 SKllOt1 1'9 ..pen.. (k' Nonp.nlvl IncOIN
deducllon
t.llach Fonn lsa2 il flQUlfltd) 'rom Sch.dul. K- t 110m Schedul. K-t _~~'" Fonn .582 "om l!Ich.duf. K-t
.--
... )."'" &." 1~ 8st;,
D
C . -
0
E
28a Totals % ,
b Totals _d1/..1 , % _ __-.-J>.!.S- _ -
29 Add columns (h) end (k) of line 2Ba . 29 " ttSI. .
30 Add columns (g), (I), and 0) 01 line 28b . 30 I ~ ,7Co I
31 Tolel pnrlnership end S corporation Income or (loss). Combine lines 29 and 30. Enter the ,esult '/16'6'0
here and include In the lotel on line 40 below 31
, lIII Income or Loss From Estotes ond Trusts
32 t.J Hlme (b) Employer
'd.nUnc.Uon numbet'
A
R
r.
Pilssl.s Income ond loss Nonpaselve Income and loaa
fel Pnslv. deducllon 01 Ion allowed IdJ PISS'.... Income I') ~ucllo" 01 'ats ftl Othtt 6ncome from
(.lItch form tsa2 tf required) "om Schedul. K-t ',om Schedul. K-t Ikhedul. K.'
A-
D
C
33a Totnls "
b Totels
34 Add columns (d) end l~ 01 line 33a 34
35 Add columns (c) end Ie) 01 line 33b . 35 I
38 Total estate end trust incoms or ~oss). Combine lines 34 end 35, Enler the result here and Include
In the total on line 40 below . . . .,. . 311
. Income or Loss From Reo I Estote Mortnone Investment Condults/REMICs Reslduel Holder
37 e'l Nam. (b) Employer ~el elcest 1nc)an1On f,om IdI '...b~ ncomt (no' 10..1 tl) Incom. hom Schedut.. O.
idenllllc.llon number Chtdul~~. 11,7; :lie {see "om SctMdu", O.Ane lb """ 3b
It E..
I T
311 Combine columns Cd) end (e) onlv. Enter Ihe resull here end Include In tho tolol on IIna 40 below 38
. Summorv
39 Nel lerm rental Income or ~oss) from Form 4835. Also, complete line 41 below . 39
40 TOTAL Income or (loss). Combine lines 26, 31, 36, 38, end 39, Enter Ihe resull here and on Form H 6'6'0
1040, line 18 . . . . . . . . . , . , , . . . . . . . , . . . , . ,~ 40
41 Reconclllallon of Farming end Flahlng Income: Enter your gross
::rming end ~tlng Income reporled In Paris II end III end on line 39
see Clioe E.4 . , 41
AU.chln_"' StQU8f\CI No 17 p 2
Social aecUflly number of person
wllh ..If_tmploymtnllncomo" ;I 0 0 : 11. : , t.'-l ("
,!!lc:....... 5E 11''''"' 10.011ll')l
~f perlOn with ..If.lmplovment Incf')me (n shown on form 10040)
fl Ll Jtlu~II'1~-r J(l.
Section B-Long Schedule SE
A II vou ere e minister, memher 01 e religious order, or Christi en Science praclltioner AND you filed Form 4361, but you
hed $400 or more 01 ~ther net enrnlngs from .ell.employmont, check here and continue wllh Pari I. . . . . . ~ 0
B II your only Income subject to .ell.employmenlt.. Is church employee Income and you are not a minister or a member
of a teli lous order, aklp lines 1 th,ou h 4b. Enter ,0- un line 4c and 0 to line 5e
Sell-Em 10 ment TI1X
1 Net farm profll or Ooss) from Schedule F, line 36, and f.rm perlnershlp., Schedule K.l (Form
1065). line 15a. Note: Skip this line Ir you use fhe farm opllonal melhod. See requlremenls In
Pari" ba/olY and on page SE-3. . , , . . . , . . . . . , . . . . , . . .
2 Nel profit or Oo.s) Irom Schedule C, line 31; Schedule C-EZ, line 3; end Schedule K.1 (Fonn 1065),
line 15a (olher than larming). See p.ge SE.2 for other Income 10 report. Note: Skip Ihis line i/ you use
fhe nonrerm oplional me/hod See requiremenls In Part" below and on page SE.3 , , . , . ,
3 Comhlne lines 1 end 2. , , . , . . . . . . . . . . . , , . . . , . , .
4e II line 3 Is more Ih.n zero, multiply line 3 by 92.35% (.9235). Otherwise, enler emounl from line 3
b II you elected one or both 01 the optional methods, enter the lotal 01 lines 17 and 19 hera, .
o Combine lines 4e and 4b. If less than $400. do not file lhls schedule; you do nol owe self. employment
tax. Excepllon. II less Ihan $400 end you hed church employee Income, enler ,0. and continue , ~ 4c
III Enter your church employee income from Form W,2. Clullon: See
pege SE. I lor denni/ion 0/ church employee Income. . . . Ila
b Multiply line 5a by 92.35% (.9235). II laos than $100, enter ,O-
Il Het earning a Irom ..II, employment. Add lines 4c and 5b .
7 Maximum amounl 01 combined wages and sell-employment earnings subjecllo social security
tax or the 6.2% pori Ion of the 7.65% rellroad retiremenl (tier 1) tax lor 1992,
8a Tolal soclel securily wages end tips (from Form(s) W,2) end reliroed
retirement (tier 1) compensation, . . , . . . , . . . ., 8a
b Unreporled tips subject 10 social security tax (from Form 4137,
line g) . . . . . , . . . . . . . , . . . . . .. 8b
c Add lines 8a and 8b . . . . . . . . . . . . . . ., .,.... .
D Sublract line 8c from line 7. II zero or less, enler ,0- here and on line 10 end go to line 12a ..
10 Multiply Ihe amalter of line 6 or line 9 by 12.4% (.124). . . . . . . . , , . , . .
11 Maximum amount of combined wages end aell.employment earnings .ubjecllo Medicaro tax
or Ihe 1.45% pori Ion 01 the 7.65% railroad retirement (lIer 1) tax for 1992, .,.,
121 Tolal Medicare weges end III'S (from Form(s) W.2) and railroad
rellremenl (tier 1) compensallon, . , . . , . , . . , ., 12a
b Unreporled tips subjecl to Medicare lax (from Form 4137,
line 14) , . . . , . . . , , . , . . , , 12b
c Add line. 12a and 12b. . . , . . . . , . . . . . . , . . . . ,
13 Subtract line 12c lrom line 11,IIzero or less, enter .0, here and on line 14 and go to line 15
14 Mulllply the emaller of line 6 or line 13 by 2.9% (.029) . . , . . . . , . . , , ,
111 Sell-employment ta.. Add lines 10 and 14. Enter Ihe result here and on Form 1040, line 47
Hota: Also enler one.hell o/Ihe amounl/rom line 15 on Form 1040 /lne 25.
Optional Methods To Figure Net Eernlngs (See Who Can File Schedule SE on page SE.l end Opllonal
Methods on page SE.3,)
Fenn Optional Method, You mey use this method only If (a) Your gross larm Income' wes not more than $2,400 or (b) Your gross
'arm Income'was more than $2,400 and your nel farm prolils'were lesslhan $1,733.
18 Maximum Income for optional methods . . . . . . . . . . . . . . . . . ., 18 1.600 00
17 Enter the .."sller 01: two-thirds ('1>) of gross ferm Income' or $1,600. Also, Include this amount
on line 4b above. . . . , . . , . . . . , . . . . , . . , . . . . .. 17
Hcnlaml Opllonal Method, You may use Ihis melhod only II (0) Your net nonlerm profits' were less Ihan $1,733 and also less
than 72, 189% 01 your gross nonlarm Income,' and (b) You had nel earnings Irom self,employmenl of alleast $400 In 2 of the prior
3 yealS. Caution: You may U5e Ihl5 melhod no more Ihan nve rimes.
18 Sublracl line 17 from line 16. . . . . . , , . . . . . . . . . . . . . . . t:j8 ,
111 Enler the amaller 01: two-third. IV,) of gross nonfarm Income' or the emount on line 18. Also,
Include this amount On line 4b ebove, , . . . . . . . . . . . . . . . . .. 111.
,
,from Sch.dul. f,lIn. 11, .nd Schedul. K.Ilform 1065), line ISb 'I,om Schedul. C, IIn. 31; Schedule C.ez, IIn. 3. .nd Schedul. K.I (form I06S).lIn. ISo
f,om Schedul. f, Hn. 36, ond Schedule K.I form t065 ,lIn. ISo 'from Schedule C. IIn. 7, Schedule C.El.lln. I; ond Schedule K.I form 1065 ,110ft 150.
1
2
3
4a
4b
dO""
;J.oo'l
138
11
120
13
14
111
81c>S;).
d"l~.s;)...
55,500
00
).00'
S'} '-1'1 I
" (,;) 1
130.200
00
.;l00'1
I e I
~Sli'
(n~1
t
~oI.....,,,.tl"'"
~..,...Art...,.5ro-lc.
Heme 01 tndivkJual lublKllO addlllon.lla, (fnll" lIut nlme 01 one indIvidual only SMlhe InltrUCllon, lOt -JoInl Relu,nl-'
(or'Jfq"'tl '" SI\v~\\tl'T
AddrM' lnumbef .nd It'tet) CEnt" PO 001 no II mltllll nol dfl"".,ed 10 11r..1 ~fe" I
~S;). v', l'.,flrJ1lf S1/lIlT
CIty, town. 01 POlt oHICI. till.. Ind liP code If this I, In Amended
( 1I1lLl)t l I'l'," t) Relum, check h.,. ~
Excess Contrlbullons'Tax for Individual Retirement Arrangements (Section 4973)
Camplele this part il. eilher In this year or In earlier yea~. you conlrlbuted more to your tRA than Is or was allowable end you
heve en e.cess conlrlbution subjecl to!'!.~
1 Excess contributions for 199< (see Instructions). Do not Include this emount on Form 1040, line
24e or 24b. . . . . . . . . . , . . . . . . . . . . . , , ,
:2 Earlier yeer excess contribulions not previously ellmineted (see
Instructions) . , . . . . ., .......,..
3 Contribution credit. (11 your eclual contribution for 1992 Is less than
your maximum alloNable contribution, see Instructions for IIna 3;
Iltherwise, enter ,0-.) , . . .. .,..,....,
4a 1992 dislrlbutions from your IRA account that ore Includible in taxeble
Income. . , . , . . . . , . . . . . . . . , .. 4a
b 1991 tax year excess contribulions (if any) withdrawn aller tha due
dete Oncluding extensions) 01 your 1991 Income lox return, end 1990
and earlier tex year excess conlributions wllhdrawn In 1992 4b
Return for Additional Taxes Attributable to
Qualified Retirement Plans (Including IRAs),
Annuities, and M!ldlfled Endowment Contracts
tUnder S.cUons 72. 4V73t 4874 .nd 4DGOA of the Int.m.l R.v.nuI Code}
.. Attach to Fonn 1040. See II .r.t. In.tmeUon..
OMa No .545.0203
",orr" 5329
~@92
All.c:hrnenl
Sequence No 29
Your loclll ..curlty number
J'''1 :"11. ,liS,)
.Api No
o
2
3
o Add lines 3, 4a, and 4b . . . , . . 40
II Adjusted earlier year excess conlribulions. (Subtract line 4c from line 2. Enter the resulI, but not
less than zero.) , . . . . . . . . , II
II
7
8
Total excess contributions (add lines 1 and 5)
Tax due. (Enler the .mall.r of 6% of line 6 or 6% of tha value 01 your IRA on the last day of
1992, Also enter this emount on Form 1040, line 51, , . . . . . . . . , . , . .
Tax on Early Dlstrlbullons (Section 72)
CornpIII' this ~rlll . 'lX.bIt dlsrribullon Wd' mId. from your qu.lifiMl nt,lrwmctn' pttn (Including In lnA), modIffftd endowment con'/8C', or ,nnulty
con'l1IC' belotw you re.ched. 59'1,. Nol.: You mus' ent,r the .moun' 01 ,he distribution on tt'/fJ ~,. lne (or lines) 01 Form 10<10 or Form 4912.
8 Early dlslrlbutions Included in gross Income allrlbutable to:
. Ouelllied retirement plens Oncluding IRAs) e.
b Annuity contrects . . . . 8b
o Modilled andowmenl contracts . 8c
d Prohibited transactions, . . . 8d
. Pledging of accounls as security e.
f Cost of collectibles. . . . , 8f
II Totel distributions (add lines 8a through 80 . . . . . . .
Nol.: Include Ihls amount on line r6b or '7b 01 Form 1040 or on rhe epproprlate Rne 01 Form 4972
II Exceplions to distributions subject to additional taxes (s.. Inslructlons :
. Due to deeth (does not epply to modified .ndowment contracts).. lIa
b Due to tolal and permenenl disability. . . , , . . . . ,. lib
o As pert of a series of substentlallY equal life lime periodiC payments, llc
Line. 9d through 91 DO NOT apply to distrlbullons lrom tRAs,
annuities, or modified endowment conrracts.
d Due to separalion from service in or eller tha year of reaching ege 55
. Dlstrlbulions to the extent of deduclible medical expenses. . , ,
f Mede to an alternale payee under a qualified domeslic relalions order
II Other (specify). . . . . . , , . . , . . . . . . ,
h Totel amount excluded from eddilionaltax (add lines 9a through 9g) ......,
10 Amounl subject to addilional tax (subtract line 9h from 8g), . . . . . . , . . ,
11 Totalseclion 72 tax mulli I line 10 b 10% .10 . Enter here and on Form 1040, line 51
For Paperwort!. ReducUon Act NoUce, Ie. page 1 of ..pi rat. In!ltructJnn". Cal No 133190
289
7
,,))!;'
lid
ge
lit
IIh
10
11
(,')').
I.)
Form 5329 119971
,
., .
v.,....
(ntl.fl
HtJ:
,. .. ,"-UI .1 "" L.,"
10'10'_ 111?-
.loo~H.- ,,'11.
II. ) II"''' ,,',t'-. I
~ ---
--~._~ I -----
.-
~ -- :J
.. 4
. -- ~~.I' - O'I!:]
.!tlp.,td I, _ .,.. __ .
~."'Oytd I, __
"AnI"U ...
5 .-
. .
'" Ml "ON JnNU courANt'
~--
nnfl. c:~._..'. '"
,.
- -----.--.. ...... . ..... - .'" .-..- . - ..- =
- .....-.... .- -p- .. -- _... ..
.. - .-.. -
.. _. - .. . ._.. - - . ..
,
, , 'hYV~1 t. PA":T.. 1l. I d
..
,
, 11"10,",' r /l.n K-\ ( 0," I ) ) I 1
I I
--- ,.~ ..
l-....ll .~_VJlr'l-}j l- I
. .. . . -
. It'P (ll-Sr c!h.~
. fill r Ilor'!. ",
. .
,. e:, ]: F-T J I~
._- -- -. {J"l\ Il..r itl"" '" l,J]' ( !. js -
.. ,
/l1)ClUA"'l'o"J I ,
I rl~\O\)\U1 L.J ...
" _!J.lt. ,
. ... -
lllpn/I.-J I ,
..
_~~,.rfflL.-j 1 1
..- -
- 1r')v/.'l,.J.\. H', ,
{I ~I I
1l1fJ\>"....Il-\. eo , 1
, ~l)JflJ'vt.- 1 1 ,
, rfl(l-~V",- " I
.
. fbf"L ILl.f-V1~l<>1/1 ~ I ~ .
, = ,
.. - . .. _. ~..- . -.
,
.. -- .. _.
, ,
. .. - - .. -
, ,
, J('~DVI\. Sl SI t 11, If I I C/o
. I
Fo(ll1 101'1 - ~' tJ 1- 1\\1 ,
0
.. : fo'[llL HL.f-V1r (J: ~ '1' ,.
1 ,
, L\.\\ 11'110"", , j.oJ L " ) .,
.. 1 ,'/ ~
.--- -- - . - .. -
I 11
.. -.
"
. 'I
I "
".
._--- --
."
, "
"
"
"
.. . ..-
_.~--- - .. . . .. .- .... u .. u_ u...___
"
"
"
'"
~
'.
v
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
~'II
1994 --6#1 CIVIL
IN DIVORCE
DALE F. SHUGHART, JR.
ORDER OF COURT
AND NOW, this 12th day of June, 1995, the Honorable William H. Kaye
of the 39th Judicial District, Is hereby appointed to preside over the above caplloned
divorce mailer. The Court sets a hearing date on the Plaintiff's Petition for Alimony
Pendente Lite of Friday, June 30, 1995, at 1:30 p,m. In Courtroom #5 of the
Cumberland County Courthouse,
By the Court,
H ro
Bill Sheaffer
Court Administrator, Franklin County
Samuel Andes, Esq.
Attomey for the Defendant
Lynn MacBride, Esq,
Attomey for the Plaintiff
Honorable WIlliam H. Kaye
<--
~
.-7)
':_~ 'I
,.L~ -'
'.;.;\','\1
.. ."..-"
~-.l;~
,',r,"./':: 0
....
~
::z:
-
cr>
..r=-
!.' .
. 'r ,',
'!"
~ J" -
~.'; ~
:kbm
~U.
-- If)
l 1'-
-.
\ t:l
\Ill
(."
C:' ('...
\' .1
t "' ,
ii:, ,
~ -!, , 1
1..1. U..
i --.
\I. r-'
u o' ,~)