File by Mail Instructions for your 2010 Federal Tax Return
Important: Your taxes are not finished until all required steps are completed.
(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Jeremy J & Nancy S Koss
2251 N 66TH ST
WAUWATOSA, WI 53213-2037
|
Balance
| Your federal tax return (Form 1040) shows you are due a refund of
Due/
| $4,408.00.
Refund
|
______________________________________________________________________________________
|
|
| Your tax return - The official return for mailing is included in
| this printout. Remember to sign and date the return.
|
| Attach the first copy or Copy B of Form(s) W-2 to the front of your
| Form 1040.
|
| Mail your return and attachments to:
| Department of the Treasury
| Internal Revenue Service Center
| Fresno, CA 93888-0002
|
| Deadline: Postmarked by Monday, April 18, 2011
|
| Note: Your state return may be due on a different date. Please
| review your state filing instructions.
|
| Don’t forget correct postage on the envelope.
______________________________________________________________________________________
|
|
What You
| Keep these instructions and a copy of your return for your records.
Need to
| If you did not print one before closing TurboTax, go back to the
Keep
| program and select Print & File tab, then select the Print for Your
| Records category.
______________________________________________________________________________________
|
|
2010
| Adjusted Gross Income
$
32,083.00
Federal
| Taxable Income
$
0.00
Tax
| Total Tax
$
0.00
Return
| Total Payments/Credits
$
4,408.00
Summary
| Amount to be Refunded
$
4,408.00
| Effective Tax Rate
-1.90%
______________________________________________________________________________________
|
|
Changed
| You can still file electronically. Just go back to TurboTax, select
Your Mind
| the Print & File tab, then select the E-file category. We’ll walk
About
| you through the process. Once you file, we will let you know if your
e-filing?
| return is accepted (or rejected) by the Internal Revenue Service.
______________________________________________________________________________________
|
What You
Need to
Mail
Page 1 of 1
Hi Jeremy and Nancy,
We just want to thank you for using TurboTax this year!
your taxes easy and accurate, year after year.
It’s our goal to make
With TurboTax Premier:
Your Head Start On Next Year:
When you come back next year, taxes will be so easy! All your
information will be saved and ready to transfer in to your new return.
We’ll ask you questions about what changed since we last talked, and
we’ll be ready to get you the credits and deductions you deserve, no
matter what life throws at you.
Here’s the final wrap up for your 2010 taxes:
Your federal refund is: $ 4,408.00
We reviewed over 350 deductions and credits so you can be sure you
didn’t miss a thing, and that you got the maximum refund - guaranteed.
Your Deductions and Credits:
Your itemized deductions for this year: $20,695.00
You qualified for these important credits:
- Child Tax Credit
- Earned Income Credit
Your Guarantee of Accuracy:
Breathe easy. The calculations on your return are backed with our
100% Accuracy Guarantee.
- We double checked your return for errors along the way.
- We helped with step-by-step guidance to get your answers on the right
IRS forms.
- If you sold investments, our Cost Basis Lookup calculated cost
basis for those sales.
- We helped you out with extra guidance for rental property income,
expenses, and refinancing.
- We made sure you didn’t miss a deduction even if something in your life
changed, like a new job, new house - or more kids!
Also included:
- We provide the Audit Support Center free of charge, in the unlikely
event you get audited.
Many happy returns from TurboTax.
Consent to Use Your Tax Return Information
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your
consent, your tax return information for purposes other than the preparation and filing of your tax return.
You are not required to complete this form. If we obtain your signature on this form by conditioning our services on
your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you
do not specify the duration of your consent, your consent is valid for one year.
Before we continue, we need your permission to check your tax return to see if you are eligible for certain options
in our program. Specifically, we would like to check your age, whether you have a refund and the amount, your
state of residence, and whether you are a U.S. Resident.
The following statements apply:
I authorize Intuit, the maker of TurboTax to use the 2010 tax return information described above
to determine my eligibility to place all or a portion of my refund on a debit card.
Sign this agreement by entering your name:
Jeremy
Koss
Taxpayer’s First Name
Taxpayer’s Last Name
Nancy
Koss
Spouse’s First Name (if applicable)
Spouse’s Last Name (if applicable)
Enter today’s date:
02/28/2014
Date
If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law
or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by
telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.
CONSENT2
FDIY8001
10/12/10
Form
Department of the Treasury
1040
Name,
Address,
and SSN
' Internal Revenue Service
U.S. Individual Income Tax Return
For the year Jan 1 - Dec 31, 2010, or other tax year beginning
Your first name
MI
Jeremy
If a joint return, spouse’s first name
See separate
instructions.
Nancy
2010
IRS Use Only ' Do not write or staple in this space.
(99)
, 2010, ending
, 20
OMB No. 1545-0074
Your social security number
Last name
J
Koss
MI
Last name
S
Koss
387-82-7371
Spouse’s social security number
391-66-5488
Home address (number and street). If you have a P.O. box, see instructions.
Make sure the SSN(s)
above and on line 6c
are correct.
Apartment no.
J
2251 N 66TH ST
City, town or post office. If you have a foreign address, see instructions.
Presidential
Election
Campaign
Filing Status
Check only
one box.
Exemptions
If more than four
dependents, see
instructions and
check here
WAUWATOSA
A
State
ZIP code
WI
53213-2037
Checking a box below will not
change your tax or refund.
Check here if you, or your spouse if filing jointly, want $3 to go to this fund?
1
2
3
X
6a
b
Single
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse’s SSN above & full
name here
4
5
You
Head of household (with qualifying person). (See
instructions.) If the qualifying person is a child
but not your dependent, enter this child’s
name here
Qualifying widow(er) with dependent child
X
X
Yourself. If someone can claim you as a dependent, do not check box 6a
Spouse
(2) Dependent’s
(3) Dependent’s
c Dependents:
social security
relationship
number
to you
(1) First name
Last name
Ethan J Koss
Owen J Koss
Samuel B Koss
Spouse
394-23-3867 Son
394-23-3868 Son
398-27-7637 Son
Boxes checked
on 6a and 6b
b
(4) if
child under
age 17
qualifying for
child tax cr
(see instrs)
X
X
X
No. of children
on 6c who:
? lived
with you
? did not
live with you
due to divorce
or separation
(see instrs)
Dependents
on 6c not
entered above
Add numbers
on lines
2
3
d Total number of exemptions claimed
above
5
7 Wages, salaries, tips, etc. Attach Form(s) W-2
7
45,453.
Income
8 a Taxable interest. Attach Schedule B if required
8a
43.
b Tax-exempt interest. Do not include on line 8a
8b
9 a Ordinary dividends. Attach Schedule B if required
9a
207.
Attach Form(s)
W-2 here. Also
b Qualified dividends
9b
203.
attach Forms
10 Taxable refunds, credits, or offsets of state and local income taxes
10
0.
W-2G and 1099-R
11 Alimony received
11
if tax was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ
12
If you did not
13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here
13
10.
get a W-2,
see instructions.
14 Other gains or (losses). Attach Form 4797
14
15 a IRA distributions
15 a
b Taxable amount
15 b
16 a Pensions and annuities
16 a
b Taxable amount
16 b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
17
-13,630.
18 Farm income or (loss). Attach Schedule F
18
Enclose, but do
not attach, any
19 Unemployment compensation
19
payment. Also,
20
a
Social
security
benefits
20
a
b
Taxable
amount
20 b
please use
Form 1040-V.
21 Other income
21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income
22
32,083.
23 Educator expenses
23
Adjusted
24 Certain business expenses of reservists, performing artists, and fee-basis
government officials. Attach Form 2106 or 2106-EZ
24
Gross
Income
25 Health savings account deduction. Attach Form 8889
25
26 Moving expenses. Attach Form 3903
26
27 One-half of self-employment tax. Attach Schedule SE
27
28 Self-employed SEP, SIMPLE, and qualified plans
28
29 Self-employed health insurance deduction
29
30 Penalty on early withdrawal of savings
30
31 a Alimony paid b Recipient’s SSN
31 a
32 IRA deduction
32
33 Student loan interest deduction
33
34 Tuition and fees. Attach Form 8917
34
35 Domestic production activities deduction. Attach Form 8903
35
36 Add lines 23 - 31a and 32 - 35
36
37 Subtract line 36 from line 22. This is your adjusted gross income
37
32,083.
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
FDIA0112 12/22/10
Form 1040 (2010)
Jeremy J & Nancy S Koss
Form 1040 (2010)
Tax and
Credits
Other
Taxes
Payments
If you have a
qualifying
child, attach
Schedule EIC.
Refund
Direct deposit?
See instructions.
Amount
You Owe
Third Party
Designee
Sign
Here
Joint return?
See instructions.
Keep a copy
for your records.
Blind. Total boxes
Blind. checked
39 a
b If your spouse itemizes on a separate return, or you were a dual-status alien, check here
39 b
40 Itemized deductions (from Schedule A) or your standard deduction (see instructions)
41 Subtract line 40 from line 38
42 Exemptions. Multiply $3,650 by the number on line 6d
43 Taxable income. Subtract line 42 from line 41.
If line 42 is more than line 41, enter -044 Tax (see instrs). Check if any tax is from:
a
Form(s) 8814
b
Form 4972
45 Alternative minimum tax (see instructions). Attach Form 6251
46 Add lines 44 and 45
47 Foreign tax credit. Attach Form 1116 if required
47
48 Credit for child and dependent care expenses. Attach Form 2441
48
49 Education credits from Form 8863, line 23
49
50 Retirement savings contributions credit. Attach Form 8880
50
51 Child tax credit (see instructions)
51
0.
52 Residential energy credits. Attach Form 5695
52
53 Other crs from Form: a
3800 b
8801 c
53
54 Add lines 47 through 53. These are your total credits
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -056 Self-employment tax. Attach Schedule SE
57 Unreported social security and Medicare tax from Form: a
4137 b
8919
58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
59 a
Form(s) W-2, box 9
b
Schedule H
c
Form 5405, line 16
60 Add lines 55-59. This is your total tax
61 Federal income tax withheld from Forms W-2 and 1099
61
62 2010 estimated tax payments and amount applied from 2009 return
62
63 Making work pay credit. Attach Schedule M
63
800.
64 a Earned income credit (EIC)
64 a
608.
b Nontaxable combat pay election
64 b
65 Additional child tax credit. Attach Form 8812
65
3,000.
66 American opportunity credit from Form 8863, line 14
66
67 First-time homebuyer credit from Form 5405, line 10
67
68 Amount paid with request for extension to file
68
69 Excess social security and tier 1 RRTA tax withheld
69
70 Credit for federal tax on fuels. Attach Form 4136
70
71 Credits from Form: a
2439 b
8839 c
8801 d
8885 71
72 Add lns 61-63, 64a, & 65-71. These are your total pmts
73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid
74 a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here
G b Routing number
XXXXXXXXX
G c Type:
Checking
G d Account number
XXXXXXXXXXXXXXXXX
75 Amount of line 73 you want applied to your 2011 estimated tax
75
76 Amount you owe. Subtract line 72 from line 60. For details on how to pay see instructions
77 Estimated tax penalty (see instructions)
77
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee’s
name
Phone
no.
G
Page 2
38
32,083.
40
41
42
20,695.
11,388.
18,250.
43
0.
44
45
46
0.
0.
0.
54
55
56
57
58
59
60
0.
0.
0.
4,408.
4,408.
4,408.
72
73
74 a
Savings
76
X
Yes. Complete below.
Personal identification
number (PIN)
G
No
G
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
A
A
Your signature
Date
Your occupation
Daytime phone number
Dining Manager
Spouse’s signature. If a joint return, both must sign.
Date
Spouse’s occupation
Implementation Specialist
Print/Type preparer’s name
Paid
Preparer’s
Use Only
387-82-7371
38 Amount from line 37 (adjusted gross income)
39 a Check
You were born before January 2, 1946,
if:
Spouse was born before January 2, 1946,
Preparer’s signature
Date
Check
if
PTIN
self-employed
Firm’s name
Firm’s address
G
G
Self-Prepared
Firm’s EIN G
Phone no.
Form 1040 (2010)
FDIA0112
12/22/10
SCHEDULE A
OMB No. 1545-0074
Itemized Deductions
(Form 1040)
Department of the Treasury
Internal Revenue Service
2010
(99)
G Attach to Form 1040.
Attachment
Sequence No.
G See Instructions for Schedule A (Form 1040).
Name(s) shown on Form 1040
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
Medical
and
Dental
Expenses
Taxes You
Paid
Caution. Do not include expenses reimbursed or paid by others.
1 Medical and dental expenses (see instructions)
2 Enter amount from Form 1040, line 38
2
32,083.
3 Multiply line 2 by 7.5% (.075)
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -05 State and local (check only one box):
a X Income taxes, or
b
General sales taxes
6 Real estate taxes (see instructions)
7 New motor vehicle taxes from line 11 of the worksheet on page 2 (for certain
vehicles purchased in 2009). Skip this line if you checked box 5b
8 Other taxes. List type and amount G
1
3,966.
3
2,406.
5
1,696.
6
6,658.
07
4
1,560.
9
8,354.
15
10,281.
19
500.
7
8
Interest
You Paid
Note.
Your mortgage
interest
deduction may
be limited (see
instrs).
9
10
11
Add lines 5 through 8
Home mtg interest and points reported to you on Form 1098
Home mortgage interest not reported to you on Form 1098. If paid to the person
from whom you bought the home, see instructions and show that person’s name,
identifying number, and address G
12
13
14
Points not reported to you on Form 1098. See instrs for spcl rules
Mortgage insurance premiums (see instructions)
Investment interest. Attach Form 4952 if required.
(See instrs.)
Add lines 10 through 14
15
Gifts to
Charity
16
If you made
a gift and
got a benefit
for it, see
instructions.
17
18
19
Casualty and
Theft Losses
20
Job Expenses 21
and Certain
Miscellaneous
Deductions
Other
Miscellaneous
Deductions
Total
Itemized
Deductions
Gifts by cash or check. If you made any gift of $250 or
more, see instrs
Other than by cash or check. If any gift of $250 or
more, see instructions. You must attach Form 8283 if
over $500
Carryover from prior year
Add lines 16 through 18
10
10,281.
11
12
13
14
16
100.
17
18
400.
Casualty or theft loss(es). Attach Form 4684. (See instructions.)
Unreimbursed employee expenses ' job travel, union dues,
job education, etc. Attach Form 2106 or 2106-EZ if
required. (See instructions.) G
20
21
22
22
23
Tax preparation fees
Other expenses ' investment, safe deposit box, etc. List
type and amount G
24
25
26
27
28
Add lines 21 through 23
Enter amount from Form 1040, line 38
25
Multiply line 25 by 2% (.02)
Subtract line 26 from line 24. If line 26 is more than line 24, enter -0Other ' from list in instructions. List type and amount G
29
Add the amounts in the far right column for lines 4 through 28.
Also, enter this amount on Form 1040, line 40
30
If you elect to itemize deductions even though they are less than your standard
deduction, check here
23
24
26
27
28
BAA For Paperwork Reduction Act Notice, see Form 1040 instructions.
29
FDIA0301
12/21/10
20,695.
Schedule A (Form 1040) 2010
SCHEDULE D
OMB No. 1545-0074
Capital Gains and Losses
(Form 1040)
Department of the Treasury
Internal Revenue Service
(99)
2010
GAttach to Form 1040 or Form 1040NR. GSee Instructions for Schedule D (Form 1040).
G Use Schedule D-1 to list additional transactions for lines 1 and 8.
Attachment
Sequence No.
12
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
Part I
Short-Term Capital Gains and Losses ' Assets Held One Year or Less
(a) Description of
property (Example:
100 shares XYZ Co)
(b) Date acquired
(c) Date sold
(Mo, day, yr)
(Mo, day, yr)
(d) Sales price
(see instructions)
(e) Cost or other basis
(f) Gain or (loss)
Subtract (e) from (d)
(see instructions)
1
2
Enter your short-term totals, if any, from Schedule D-1, line 2
3
Total short-term sales price amounts. Add lines 1 and 2 in
column (d)
3
Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824
Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1
4
5
Short-term capital loss carryover. Enter the amount, if any, from line 10 of your Capital Loss Carryover
Worksheet in the instructions
7 Net short-term capital gain or (loss). Combine lines 1 through 6 in column (f)
6
7
4
5
2
6
Part II
Long-Term Capital Gains and Losses ' Assets Held More Than One Year
(a) Description of
property (Example:
100 shares XYZ Co)
(b) Date acquired
(c) Date sold
(Mo, day, yr)
(Mo, day, yr)
(d) Sales price
(see instructions)
(e) Cost or other basis
(see instructions)
(f) Gain or (loss)
Subtract (e) from (d)
8
9
Enter your long-term totals, if any, from Schedule D-1, line 9
9
10
Total long-term sales price amounts. Add lines 8 and 9 in
column (d)
10
11
12
Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from
Forms 4684, 6781, and 8824
Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1
11
12
13
Capital gain distributions. See instrs
13
14
Long-term capital loss carryover. Enter the amount, if any, from line 15 of your Capital Loss Carryover
Worksheet in the instructions
14
15 Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to Part III on
page 2
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA0612
12/22/10
10.
15
10.
Schedule D (Form 1040) 2010
Schedule D (Form 1040) 2010
Part III
16
387-82-7371
?
?
Page 2
Summary
Combine lines 7 and 15 and enter the result
?
17
Jeremy J & Nancy S Koss
16
10.
If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then
go to line 17 below.
If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.
If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form 1040NR,
line 14. Then to go line 22.
Are lines 15 and 16 both gains?
X
Yes. Go to line 18.
No. Skip lines 18 through 21, and go to line 22.
18
Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions
18
19
Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in
the instructions
19
20
2.
Are lines 18 and 19 both zero or blank?
Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the Qualified
Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the
Instructions for Form 1040NR, line 42). Do not complete lines 21 and 22 below.
X
21
No. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the Schedule
D Tax Worksheet in the instructions. Do not complete lines 21 and 22 below.
If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:
?
?
The loss on line 16 or
($3,000), or if married filing separately, ($1,500)
21
Note. When figuring which amount is smaller, treat both amounts as positive numbers.
22
Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?
Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the Qualified
Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the
Instructions for Form 1040NR, line 42).
No. Complete the rest of Form 1040 or Form 1040NR.
Schedule D (Form 1040) 2010
FDIA0612
12/22/10
SCHEDULE E
Supplemental Income and Loss
(Form 1040)
(From rental real estate, royalties, partnerships,
S corporations, estates, trusts, REMICs, etc)
G Attach to Form 1040, 1040NR, or Form 1041.
G See Instructions for Schedule E (Form 1040).
Department of the Treasury
Internal Revenue Service
(99)
OMB No. 1545-0074
2010
Attachment
Sequence No.
13
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
Part I
Income or Loss From Rental Real Estate and Royalties
387-82-7371
Note. If you are in the business of renting personal property, use
Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.
2 For each rental real estate
1 List the type and address of each rental real estate property:
Yes No
property listed on line 1, did you
A DUPLEX
or your family use it during the
2251A N 66TH ST
Wauwatosa, WI 53213
A
X
tax year for personal purposes
for more than the greater of:
B Multi-Family 29.00%
? 14 days, or
2060 S 82ND ST
West Allis, WI 53219
B
X
? 10% of the total days
C
rented at fair rental value?
(See instructions.)
C
Properties
Totals
Income:
A
B
C
(Add columns A, B, and C.)
3 Rents received
3
1,500.
3,460.
3
4,960.
4 Royalties received
4
4
Expenses:
5
6
7
8
9
10
11
Advertising
Auto and travel (see instructions)
Cleaning and maintenance
Commissions
Insurance
Legal and other professional fees
Management fees
5
6
7
8
9
10
11
12
Mortgage interest paid to banks, etc
(see instructions)
Other interest
Repairs
Supplies
Taxes
Utilities
Other (list)
12
13
14
15
16
17
13
14
15
16
17
18
300.
275.
88.
87.
188.
359.
3,427.
3,543.
2,000.
550.
1,332.
1,149.
116.
38.
1,525.
461.
19
9,221.
20
21
22
12
6,970.
6,217.
19
15,438.
1,873.
11,094.
1,279.
7,496.
20
3,152.
-9,594.
-4,036.
24
25
-13,630.
18
19
20
21
Add lines 5 through 18
Depreciation expense or depletion
(see instructions)
Total expenses. Add lines 19 and 20
22
Income or (loss) from rental real estate or
royalty properties. Subtract line 21 from line 3
(rents) or line 4 (royalties). If the result is a
(loss), see instructions to find out if you must
file Form 6198
23
Deductible rental real estate loss.
Caution. Your rental real estate loss on line 22
may be limited. See instructions to find out if you
must file Form 8582. Real estate professionals
must complete line 43 on page 2
23
-9,594.
-4,036.
Income. Add positive amounts shown on line 22. Do not include any losses
Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter total losses here
24
25
26
Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the
result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this
amount on Form 1040, line 17, or Form 1040NR, line 18. Otherwise, include this amount
in the total on line 41 on page 2
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIZ2301
06/25/10
26
-13,630.
Schedule E (Form 1040) 2010
Attachment Sequence No. 13
Schedule E (Form 1040) 2010
Page 2
Name(s) shown on return. Do not enter name and social security number if shown on Page 1.
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II
Income or Loss From Partnerships and S Corporations
Note. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and
attach Form 6198. See instructions.
27
Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed
loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses?
Yes
X No
If you answered ’Yes,’ see instructions before completing this section.
(b) Enter P
Check if
(d) Employer
(e) Check if
for partnership; (c)foreign
(a) Name
identification
any amount
S for S
partnership
number
is not at risk
corporation
28
A
B
C
D
PTP-Ferrelgas Partners, L.P.
P
Passive Income and Loss
(f) Passive loss allowed
(attach Form 8582 if required)
A
B
C
D
29 a Totals
b Totals
30 Add columns (g) and (j) of line 29a
31 Add columns (f), (h), and (i) of line 29b
32
Nonpassive Income and Loss
(i) Section 179
(j) Nonpassive
expense deduction
income from
from Form 4562
Schedule K-1
(g) Passive income
from Schedule K-1
0.
43-1698480
(h) Nonpassive loss
from Schedule K-1
0.
0.
0.
Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and
include in the total on line 41 below
Part III
Nonpassive Income and Loss
(d) Passive income
from Schedule K-1
(e) Deduction or loss
from Schedule K-1
A
B
34 a Totals
b Totals
35 Add columns (d) and (f) of line 34a
36 Add columns (c) and (e) of line 34b
38
37
Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder
(a) Name
(b) Employer
identification number
(c) Excess inclusion
from Schedules Q,
line 2c (see instructions)
(d) Taxable income
(net loss) from
Schedules Q, line 1b
Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below
Part V
(f) Other income
from Schedule K-1
35
36
Total estate and trust income or (loss). Combine lines 35 and 36. Enter the
result here and include in the total on line 41 below
Part IV
(e) Income from
Schedules Q, line 3b
39
Summary
40
Net farm rental income or (loss) from Form 4835. Also, complete line 42 below
41
Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on
Form 1040, line 17, or Form 1040NR, line 18
42
Reconciliation of farming and fishing income. Enter your gross farming
and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065),
box 14, code B; Schedule K-1 (Form 1120S), box 17, code U; and Schedule K-1
(Form 1041), line 14, code F (see instructions)
Reconciliation for real estate professionals. If you were a real estate
professional (see instructions), enter the net income or (loss) you reported
anywhere on Form 1040 or Form 1040NR from all rental real estate activities
in which you materially participated under the passive activity loss rules
BAA
0.
(b) Employer ID no.
Passive Income and Loss
43
32
(a) Name
(c) Passive deduction or loss allowed
(attach Form 8582 if required)
39
0.
0.
Income or Loss From Estates and Trusts
33
A
B
37
30
31
FDIZ2302
06/25/10
40
G
41
-13,630.
42
43
Schedule E (Form 1040) 2010
SCHEDULE EIC
Earned Income Credit
(Form 1040A or 1040)
Qualifying Child Information
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
2010
Complete and attach to Form 1040A or 1040
only if you have a qualifying child.
(99)
Attachment
Sequence No.
43
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
? See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and
Before you begin:
387-82-7371
64b, to make sure that (a) you can take the EIC and (b) you have a qualifying child.
? Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social
security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or
SSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-772-1213.
CAUTION!
? If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the
instructions for details.
? It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
Qualifying Child Information
1
2
3
Child’s name
If you have more than three qualifying
children, you only have to list three to get
the maximum credit
Child’s SSN
The child must have an SSN as defined in the
instructions for Form 1040A, lines 41a and
41b, or Form 1040, lines 64a and 64b, unless
the child was born and died in 2010. If your
child was born and died in 2010 and did not
have an SSN, enter ’Died’ on this line and
attach a copy of the child’s birth certificate,
death certificate, or hospital medical records.
Child’s year of birth
4 a Was the child under age 24 at the end of
2010, a student, and younger than you (or
your spouse, if filing jointly)?
b Was the child permanently and totally
disabled during any part of 2010?
Child 1
First name
Last name
Ethan
J Koss
394-23-3867
Year
2002
Owen
Last name
J Koss
394-23-3868
Year
2002
First name
Last name
Samuel B Koss
398-27-7637
Year
2006
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
Yes.
Go to line 5.
Yes.
Go to line 5.
Yes.
Go to line 5.
No.
Continue.
Yes.
No.
The child
is not a
qualifying child.
No.
Continue.
Yes.
Continue.
No.
The child
is not a
qualifying child.
No.
Continue.
Yes.
Continue.
No.
The child
is not a
qualifying child.
Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, foster child, etc)
6
First name
Child 3
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
Continue.
5
Child 2
Son
Son
Son
Number of months child lived with you in the
United States during 2010
? If the child lived with you for more than
half of 2010 but less than 7 months,
enter ’7’.
? If the child was born or died in 2010 and
your home was the child’s home for the
entire time he or she was alive during
2010, enter ’12’
12
months
Do not enter more than
12 months.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA7401
11/04/10
12
months
Do not enter more than
12 months.
12
months
Do not enter more than
12 months.
Schedule EIC (Form 1040A or 1040) 2010
Form
8812
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
Additional Child Tax Credit
(99)
2010
Complete and attach to Form 1040, Form 1040A, or Form 1040NR.
Name(s) shown on return
47
Your social security number
Jeremy J & Nancy S Koss
Part I
All Filers
1
Attachment
Sequence No.
387-82-7371
1040 filers:
Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040, line 51).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040A, line 33).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040NR, line 48).
1
3,000.
2
3
0.
3,000.
6
6,368.
If you used Pub 972, enter the amount from line 8 of the worksheet on page 4 of the publication.
2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48
3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit
4 a Earned income (see instructions)
4a
45,453.
b Nontaxable combat pay (see instructions)
4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
X Yes. Subtract $3,000 from the amount on line 4a. Enter the result
5
42,453.
6 Multiply the amount on line 5 by 15% (.15) and enter the result
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of
line 3 or line 6 on line 13.
X
Part II
Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13.
Otherwise, go to line 7.
Certain Filers Who Have Three or More Qualifying Children
7
Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6.
If married filing jointly, include your spouse’s amounts with yours. If you worked
for a railroad, see the instructions
8
1040 filers:
9
10
Enter the total of the amounts from Form 1040,
lines 27 and 57, plus any taxes that you identified using
code ’UT’ and entered on the dotted line next to line 60.
1040A filers: Enter -0-.
1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27
and 55, plus any taxes that you identified using code ’UT’
and entered on the dotted line next to line 59.
Add lines 7 and 8
Enter the total of the amounts from Form 1040, lines
64a and 69.
1040A filers: Enter the total of the amount from Form 1040A, line 41a,
plus any excess social security and tier 1 RRTA taxes
withheld that you entered to the left of line 44
(see instructions).
1040NR filers: Enter the amount from Form 1040NR, line 64.
7
8
9
1040 filers:
10
11
Subtract line 10 from line 9. If zero or less, enter -0-
11
12
Enter the larger of line 6 or line 11
12
Next, enter the smaller of line 3 or line 12 on line 13.
Part III
13
Additional Child Tax Credit
This is your additional child tax credit
13
3,000.
Enter this amount on
Form 1040, line 65,
Form 1040A, line 42, or
Form 1040NR, line 62.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA3001
07/08/10
Form 8812 (2010)
OMB No. 1545-0172
Form
4562
Department of the Treasury
Internal Revenue Service
Depreciation and Amortization
2010
(Including Information on Listed Property)
G See separate instructions.
(99)
Attachment
Sequence No.
G Attach to your tax return.
67
Name(s) shown on return
Identifying number
Jeremy J & Nancy S Koss
387-82-7371
Business or activity to which this form relates
Sch E DUPLEX
Part I
Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1
2
3
4
5
6
Maximum amount (see instructions)
Total cost of section 179 property placed in service (see instructions)
Threshold cost of section 179 property before reduction in limitation (see instructions)
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions
(a) Description of property
(b) Cost (business use only)
1
2
3
4
2,000,000.
5
(c) Elected cost
7 Listed property. Enter the amount from line 29
7
8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7
9 Tentative deduction. Enter the smaller of line 5 or line 8
10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs)
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
13 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12
13
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
Part II
500,000.
8
9
10
11
12
Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)
14
Special depreciation allowance for qualified property (other than listed property) placed in service during the
tax year (see instructions)
15 Property subject to section 168(f)(1) election
16 Other depreciation (including ACRS)
Part III MACRS Depreciation (Do not include listed property.) (See instructions)
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2010
18
14
15
16
17
If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here
Section B ' Assets Placed in Service During 2010 Tax Year Using the General Depreciation System
(c) Basis for depreciation
(a)
(b) Month and
(d)
(e)
(f)
Classification of property
year placed
in service
19 a 3-year property
b 5-year property
c 7-year property
d 10-year property
e 15-year property
f 20-year property
g 25-year property
h Residential rental
property
i Nonresidential real
property
(business/investment use
only ' see instructions)
Recovery period
25 yrs
27.5 yrs
27.5 yrs
39 yrs
Convention
Method
MM
MM
MM
MM
S/L
S/L
S/L
S/L
S/L
1,873.
(g) Depreciation
deduction
Section C ' Assets Placed in Service During 2010 Tax Year Using the Alternative Depreciation System
20 a Class life
b 12-year
c 40-year
Part IV
21
22
12 yrs
40 yrs
MM
S/L
S/L
S/L
Summary (See instructions.)
Listed property. Enter amount from line 28
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on
the appropriate lines of your return. Partnerships and S corporations ' see instructions
23 For assets shown above and placed in service during the current year, enter
the portion of the basis attributable to section 263A costs
23
BAA For Paperwork Reduction Act Notice, see separate instructions.
FDIZ0812 10/29/10
21
22
1,873.
Form 4562 (2010)
Jeremy J & Nancy S Koss
387-82-7371
Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment,
Form 4562 (2010)
Part V
Page 2
recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b,
columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section A ' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24 a Do you have evidence to support the business/investment use claimed?
Yes X No 24b If ’Yes,’ is the evidence written?
Yes
No
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Type of property (list
vehicles first)
25
26
Date placed
in service
Business/
investment
use
percentage
Basis for depreciation
(business/investment
use only)
Cost or
other basis
Recovery
period
Method/
Convention
Special depreciation allowance for qualified listed property placed in service during the tax year and
used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a qualified business use:
Depreciation
deduction
Elected
section 179
cost
25
27 Property used 50% or less in a qualified business use:
CHRYSLER TOWN AND COUNTRY 03/01/05
23.91
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
28
29 Add amounts in column (i), line 26. Enter here and on line 7, page 1
29
Section B ' Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other ’more than 5% owner,’ or related person. If you provided vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
30
31
Total business/investment miles driven
during the year (do not include
commuting miles)
Total commuting miles driven during the year
32
Total other personal (noncommuting)
miles driven
33
Total miles driven during the year. Add
lines 30 through 32
(a)
Vehicle 1
(c)
Vehicle 3
(d)
Vehicle 4
(e)
Vehicle 5
(f)
Vehicle 6
600
200
1,500
2,300
Yes
34
(b)
Vehicle 2
No
Yes
No
Yes
No
Yes
No
Yes
Was the vehicle available for personal use
during off-duty hours?
X
35
Was the vehicle used primarily by a more
than 5% owner or related person?
X
36
Is another vehicle available for
personal use?
X
Section C ' Questions for Employers Who Provide Vehicles for Use by Their Employees
No
Yes
No
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than
5% owners or related persons (see instructions).
Yes
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,
by your employees?
No
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners
39 Do you treat all use of vehicles by employees as personal use?
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
vehicles, and retain the information received?
41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)
Note: If your answer to 37, 38, 39, 40, or 41 is ’Yes,’ do not complete Section B for the covered vehicles.
Part VI
Amortization
(a)
(b)
(c)
(d)
(e)
(f)
Description of costs
Date amortization
begins
Amortizable
amount
Code
section
Amortization
period or
percentage
Amortization
for this year
42
Amortization of costs that begins during your 2010 tax year (see instructions):
43
44
Amortization of costs that began before your 2010 tax year
Total. Add amounts in column (f). See the instructions for where to report
FDIZ0812 10/29/10
43
44
Form 4562 (2010)
OMB No. 1545-0172
Form
4562
Department of the Treasury
Internal Revenue Service
Depreciation and Amortization
2010
(Including Information on Listed Property)
G See separate instructions.
(99)
Attachment
Sequence No.
G Attach to your tax return.
67
Name(s) shown on return
Identifying number
Jeremy J & Nancy S Koss
387-82-7371
Business or activity to which this form relates
Sch E Multi-Family
Part I
Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1
2
3
4
5
6
Maximum amount (see instructions)
Total cost of section 179 property placed in service (see instructions)
Threshold cost of section 179 property before reduction in limitation (see instructions)
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions
(a) Description of property
(b) Cost (business use only)
1
2
3
4
2,000,000.
5
(c) Elected cost
7 Listed property. Enter the amount from line 29
7
8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7
9 Tentative deduction. Enter the smaller of line 5 or line 8
10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs)
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
13 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12
13
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
Part II
500,000.
8
9
10
11
12
Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)
14
Special depreciation allowance for qualified property (other than listed property) placed in service during the
tax year (see instructions)
15 Property subject to section 168(f)(1) election
16 Other depreciation (including ACRS)
Part III MACRS Depreciation (Do not include listed property.) (See instructions)
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2010
18
14
15
16
17
If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here
Section B ' Assets Placed in Service During 2010 Tax Year Using the General Depreciation System
(c) Basis for depreciation
(a)
(b) Month and
(d)
(e)
(f)
Classification of property
year placed
in service
19 a 3-year property
b 5-year property
c 7-year property
d 10-year property
e 15-year property
f 20-year property
g 25-year property
h Residential rental
property
i Nonresidential real
property
(business/investment use
only ' see instructions)
Recovery period
25 yrs
27.5 yrs
27.5 yrs
39 yrs
Convention
Method
MM
MM
MM
MM
S/L
S/L
S/L
S/L
S/L
1,279.
(g) Depreciation
deduction
Section C ' Assets Placed in Service During 2010 Tax Year Using the Alternative Depreciation System
20 a Class life
b 12-year
c 40-year
Part IV
21
22
12 yrs
40 yrs
MM
S/L
S/L
S/L
Summary (See instructions.)
Listed property. Enter amount from line 28
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on
the appropriate lines of your return. Partnerships and S corporations ' see instructions
23 For assets shown above and placed in service during the current year, enter
the portion of the basis attributable to section 263A costs
23
BAA For Paperwork Reduction Act Notice, see separate instructions.
FDIZ0812 10/29/10
21
22
1,279.
Form 4562 (2010)
Jeremy J & Nancy S Koss
387-82-7371
Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment,
Form 4562 (2010)
Part V
Page 2
recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b,
columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section A ' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24 a Do you have evidence to support the business/investment use claimed?
X Yes
No 24b If ’Yes,’ is the evidence written?
X Yes
No
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Type of property (list
vehicles first)
25
26
Date placed
in service
Business/
investment
use
percentage
Basis for depreciation
(business/investment
use only)
Cost or
other basis
Recovery
period
Method/
Convention
Special depreciation allowance for qualified listed property placed in service during the tax year and
used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a qualified business use:
Depreciation
deduction
Elected
section 179
cost
25
27 Property used 50% or less in a qualified business use:
2005 Chrysler Town and Country 03/01/04
2.77
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
28
29 Add amounts in column (i), line 26. Enter here and on line 7, page 1
29
Section B ' Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other ’more than 5% owner,’ or related person. If you provided vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
30
31
Total business/investment miles driven
during the year (do not include
commuting miles)
Total commuting miles driven during the year
32
Total other personal (noncommuting)
miles driven
33
Total miles driven during the year. Add
lines 30 through 32
(a)
Vehicle 1
(c)
Vehicle 3
(d)
Vehicle 4
(e)
Vehicle 5
(f)
Vehicle 6
175
6,150
6,325
Yes
34
(b)
Vehicle 2
No
Yes
No
Yes
No
Yes
No
Yes
Was the vehicle available for personal use
during off-duty hours?
X
35
Was the vehicle used primarily by a more
than 5% owner or related person?
X
36
Is another vehicle available for
personal use?
X
Section C ' Questions for Employers Who Provide Vehicles for Use by Their Employees
No
Yes
No
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than
5% owners or related persons (see instructions).
Yes
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,
by your employees?
No
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners
39 Do you treat all use of vehicles by employees as personal use?
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
vehicles, and retain the information received?
41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)
Note: If your answer to 37, 38, 39, 40, or 41 is ’Yes,’ do not complete Section B for the covered vehicles.
Part VI
Amortization
(a)
(b)
(c)
(d)
(e)
(f)
Description of costs
Date amortization
begins
Amortizable
amount
Code
section
Amortization
period or
percentage
Amortization
for this year
42
Amortization of costs that begins during your 2010 tax year (see instructions):
43
44
Amortization of costs that began before your 2010 tax year
Total. Add amounts in column (f). See the instructions for where to report
FDIZ0812 10/29/10
43
44
Form 4562 (2010)
SCHEDULE M
OMB No. 1545-0074
Making Work Pay Credit
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service
(99)
G Attach to Form 1040A or 1040.
2010
G See separate instructions.
Attachment
Sequence No.
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
166
Caution:
To take the making work pay credit, you must include your social security number (if filing a joint return, the number of either you or
your spouse) on your tax return. A social security number does not include an identification number issued by the IRS. Only the
Social Security Administration issues social security numbers.
Caution:
You cannot take the making work pay credit if you can be claimed as someone else’s dependent or if you are a nonresident alien.
Important: Check the ’No’ box on line 1a and see the instructions if:
(a) You have a net loss from a business,
(b) You received a taxable scholarship or fellowship grant not reported on a Form W-2,
(c) Your wages include pay for work performed while an inmate in a penal institution,
(d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental
section 457 plan, or
(e) You are filing Form 2555 or 2555-EZ.
1 a Do you (and your spouse if filing jointly) have 2010 wages of more than $6,451 ($12,903 if married filing jointly)?
X Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.
No. Enter your earned income (see instructions)
1a
b Nontaxable combat pay included on line 1a
(see instructions)
2 Multiply line 1a by 6.2% (.062)
1b
2
3
Enter $400 ($800 if married filing jointly)
3
4
Enter the smaller of line 2 or line 3 (unless you checked ’Yes’ on line 1a)
5
Enter the amount from Form 1040, line 38*, or Form 1040A, line 22
5
32,083.
6
Enter $75,000 ($150,000 if married filing jointly)
6
150,000.
7
Is the amount on line 5 more than the amount on line 6?
X No. Skip line 8. Enter the amount from line 4 on line 9 below.
Yes. Subtract line 6 from line 5
7
4
800.
8
Multiply line 7 by 2% (.02)
8
9
Subtract line 8 from line 4. If zero or less, enter -0-
9
800.
10
0.
11
800.
10
Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You may have
received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received
social security benefits, supplemental security income, railroad retirement benefits, or veterans disability
compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions).
X
No. Enter -0- on line 10 and go to line 11.
Yes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010.
Do not enter more than $250 ($500 if married filing jointly)
11
Making work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on
Form 1040, line 63; or Form 1040A, line 40
*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
Schedule M (Form 1040A or 1040) 2010
FDIA8501
09/20/10
Form 1040
Line 10
State and Local Income Tax Refund Worksheet
2010
State and local taxes paid in 2009 or prior years and refunded in 2010
Keep for your records
Name(s) Shown on Return
Social Security Number
Jeremy J & Nancy S Koss
387-82-7371
Part I
1
2
3
4
State and Local Income Tax Refunds from 2009 Tax Returns
(a)
State
or
Local
Code
(b)
Refund
Amount
(c)
Estimated
Tax Paid
After
12/31/2009
(d)
Extension
Payments
(e)
Total
Payments
and
Withholding
WI
1,591.
1,591.
Totals
1,591.
1,591.
(f)
Refund
Allocated to
Column (c)
Total state and local refunds. Total line 1 column (b).
Refund allocated to tax paid after 12/31/2009. Total line 1 columns (f) and (g).
(Include net tax paid after 12/31/2009 on Schedule A, line 5.)
Net refund. Line 2 less line 3.
Part II
(g)
Refund
Allocated to
Column (d)
1,591.
1,591.
Recovery Amount
The recovery amount is the amount of the state and local income tax deducted in 2009 refunded in 2010.
5
Total state and local income tax deduction from line 5 of your 2009 Schedule A
1,591.
6
Recovery amount. Lesser of line 4 or line 5.
1,591.
Part III
Recovery Exclusion
The recovery exclusion is the part of the recovery amount which did not reduce tax in 2009.
7
Recovery exclusion from standard deduction and/or sales tax deduction:
a Allowable itemized deductions, from 2009 Schedule A, line 29
b Allowable itemized deductions, refigured by excluding recovery amount:
(1) Refigured state and local tax deduction:
(a) Refigured state income tax deduction
0.
(b) Sales tax deduction
(c) Refigured deduction. Larger of (a) or (b)
0.
(2) Refigured total itemized deductions before limitation
21,910.
(3) Refigured reduction for limitation on itemized deductions
0.
(4) Refigured allowable itemized deductions. Line 7b(2) less line 7b(3)
c 2009 standard deduction based on 2009 filing status, exemptions and deductions
d Larger of lines 7b(4) or 7c
e Subtract line 7d from line 7a
f Subtract line 7e from line 6
8
Recovery exclusion from negative taxable income. If 2009 taxable income
was negative, enter here as a positive number, else enter zero.
9
Recovery exclusion from alternative minimum tax. If no alternative minimum
tax (AMT) in 2009 enter zero. If did pay AMT in 2009, enter amount from line 22
10
Recovery exclusion from unused tax credits. If no unused credits in 2009,
enter zero. If there were unused credits in 2009, enter amount from line 33.
11
Total recovery exclusion. Add lines 7f, 8, 9, and 10.
Part IV
23,501.
21,910.
12,400.
21,910.
1,591.
0.
11,038.
0.
0.
11,038.
Taxable Refund
The recovery amount less the recovery exclusion is a taxable refund.
12
Taxable refund from 2009. Line 6 less line 11.
13
Total taxable refunds from 2008 or prior tax returns. Total line 34 column (d).
14
Total taxable refunds. Add lines 12 and 13. Enter here and on Form 1040, line 10
0.
0.
File by Mail Instructions for your 2010 Wisconsin Tax Return
Important: Your taxes are not finished until all required steps are completed.
(If you prefer, you can still e-file. Go to the end of these instructions for
more information.)
Jeremy J & Nancy S Koss
2251 N 66TH ST
WAUWATOSA, WI 53213-2037
|
Balance
| Your Wisconsin state tax return (Form 1) shows you are due a refund
Due/
| of $1,957.00. Your refund check should be mailed in one to two weeks
Refund
| (this is only an estimate).
______________________________________________________________________________________
|
|
| Your tax return - The official return for mailing is included in
| this printout. Remember to sign and date the return.
|
| Enclose readable copies of your withholding statements (Forms W-2,
| W-2G, 1099-G, 1099-R, and 1099-MISC).
|
| Mail your return and attachments to:
| Wisconsin Department of Revenue
| P.O. Box 59
| Madison, WI 53785-0001
|
| Deadline: Postmarked by April 18, 2011
|
| Don’t forget correct postage on the envelope.
______________________________________________________________________________________
|
|
What You
| Keep these instructions and a copy of your return for your records.
Need to
| If you did not print one before closing TurboTax, go back to the
Keep
| program and select Print & File tab, then select the Print for Your
| Records category.
______________________________________________________________________________________
|
|
2010
| Taxable Income
$
14,486.00
Wisconsin
| Total Tax
$
0.00
Tax
| Total Payments/Credits
$
1,957.00
Return
| Amount to be Refunded
$
1,957.00
Summary
|
______________________________________________________________________________________
|
|
Special
| Your printed state tax forms may have special formatting on them,
Formatting
| such as bar codes or other symbols. This is to enable fast
| processing. Don’t worry, these forms have been approved by your
| taxing authority and are acceptable for printing and mailing.
______________________________________________________________________________________
|
|
Changed
| You can still file electronically. Just go back to TurboTax, select
Your Mind
| the Print & File tab, then select the E-file category. We’ll walk
About
| you through the process. Once you file, we will let you know if your
e-filing?
| return is accepted (or rejected) by the state taxing agency.
______________________________________________________________________________________
|
What You
Need to
Mail
Page 1 of 1
1
D
O
Wisconsin
income tax
Complete
form using
BLACK INK
2010
For the year Jan. 1 - Dec. 31, 2010,
or other tax year
beginning
, 2010
N
ending
O
T Your social security number
,
.
Spouse’s social security number
387827371
S
T
A Your legal last name
P
L
E
If a joint return, spouse’s legal last name
391665488
Legal first name
KOSS
M.I.
JEREMY
J
Spouse’s legal first name
KOSS
M.I.
NANCY
S
Home address (number and street). If you have a PO Box, see instructions.
Apt. no.
WAUWATOSA
Filing status Check
State
ZIP code
WI
bbelow
53213-2037
I
N
S
T
R
U
C
T
I
O
N
S
X
R
E
T
B U
E R
F N
O
R
E
Legal
last name
If married, fill in spouse’s
SSN above and full name here
County of A
MILWAUKEE
32083 .00
.00
.00
45453 .00
State and municipal interest (see instructions)
2
3
Capital gain/loss addition (see instructions)
Fill in code number and amount, see instructions.
Other additions
Fill in total other additions on line 4.
3
.00
.00
.00
.00
.00
4
.00
5
32083 .00
5
Add the amounts in the right column for lines 1 through 4
6
State tax refund (Form 1040, line 10)
6
7
United States government interest
7
8
Unemployment compensation (see instructions)
8
10 Capital gain/loss subtraction (see instructions)
Fill in code number and amount, see instructions.
11 Other subtractions
Fill in total other subtractions on line 11.
0 .00
.00
.00
.00
3 .00
9
10
.00
.00
.00
.00
.00
11
.00
12
Add lines 6 through 11
12
13
Subtract line 12 from line 5. This is your Wisconsin income
13
Intuit I-010i
6244
1
2
P
A
Y
M
E
N
T
Town
Special
conditions
Federal adjusted gross income (see instructions)
9 Social security adjustment (see instructions)
C
L H
I E
P R
E
U
Form W-2 wages included in line 1
4
P
A
P
E
R
WAUWATOSA
School district number
see instructions
Also, check here if married
1
Village
M.I.
Legal
first name
Head of household (see instructions).
City
A
Married filing joint return
Married filing separate return.
Fill in spouse’s SSN above and full
name here
A
S
S
E
M
B
L
I
N
G
X
City,
village,
or town
Single
S
E
E
Designating an amount will not change your tax or refund.
Tax district
Check below then fill in either the name of city,
village, or town and the county in which you
lived at the end of 2010.
2251 N 66TH ST
City or post office
Campaign fund If you want $3 to go to the State Election
Campaign Fund and the Democracy Trust Fund,
check here.
You
Your spouse
3 .00
32080 .00
WIIA0112
11/16/10
Form 1 (2010)
Name
JEREMY J & NANCY S KOSS
14
Wisconsin income from line 13
15
Standard deduction. See table in instructions, OR
SSN
387827371
15
32080 .00
14094 .00
16
17986 .00
14
F
Page 2 of 4
If someone else can claim you (or your spouse) as a dependent, see instructions and check here
16
Subtract line 15 from line 14. If line 15 is larger than line 14, fill in 0
17
Exemptions (Caution: see instructions)
a Fill in exemptions from your federal return
b Check if 65 or older
You +
5 x $700
17 a
x $250
17 b
Spouse =
3500 .00
.00
c Add lines 17a and 17b
18
Subtract line 17c from line 16. If line 17c is larger than line 16, fill in 0. This is taxable income
18
19
Tax (see instructions)
19
20
21
Itemized deduction credit. Enclose Schedule 1, page 4
Armed forces member credit (must be stationed outside U. S.
See instructions)
School property tax credit
22
a
Rent paid in 2010
' heat included
Rent paid in 2010
' heat not included
b Property taxes paid on home in 2010
23
20
0 .00
21
.00
.00
.00
Find credit
from table in
instructions
22 a
.00
5327 .00
Find credit
from table in
instructions
22 b
300 .00
.00
Historic rehabilitation credits
23
If line 14 is less than $10,000 ($19,000 if
married filing joint), see instructions
24
Working families tax credit
25
Certain nonrefundable credits from line 5 of Schedule CR
26
Add credits on lines 20 through 25
26
27
Subtract line 26 from line 19. If line 26 is larger than line 19, fill in 0
27
28
Alternative minimum tax. Enclose Schedule MT
28
29
Add lines 27 and 28
29
30
Married couple credit.
Enclose Schedule 2, page 4
30
480 .00
31
Other credits from Schedule CR, line 18
31
.00
32
Net income tax paid to another state.
Enclose Schedule OS
32
.00
24
25
0 .00
.00
33
Add lines 30, 31, and 32
33
34
Subtract line 33 from line 29. If line 33 is larger than line 29, fill in 0. This is your net tax
34
35
Recycling surcharge. Enclose Schedule RS
35
36
Sales and use tax due on out-of-state purchases (see instructions)
36
37
Advance earned income credit (see instructions)
37
38
b Packers football stadium
c Breast cancer research
d Veterans trust fund
e Multiple sclerosis
.00
.00
.00
.00
.00
480 .00
0 .00
.00
.00
.00
.00
.00
.00
.00
f Firefighters memorial
g Prostate cancer research
h Military family relief
i Second Harvest
Total (add lines a through i)
Penalties on IRAs, retirement plans, MSAs, etc.
(see instructions)
.00 x .33 =
38 j
39
40
Credit repayments and other penalties (see instructions)
40
41
Add lines 34 through 37, and 38j through 40
41
Intuit
300 .00
381 .00
.00
381 .00
Donation (decreases refund or increases amount owed)
a Endangered resources
39
3500 .00
14486 .00
681 .00
17 c
WIIA0112
11/16/10
.00
.00
.00
0 .00
Form 1 (2010)
Page 3 of 4
Name(s) shown on Form 1
Your social security number
JEREMY J & NANCY S KOSS
387827371
42
Amount from line 41
43
Wisconsin tax withheld. Enclose withholding statements
43
1696 .00
44
2010 estimated tax payments and amount
applied from 2009 return
44
.00
45
261 .00
45
46
3
Earned income credit. Number of qualifying children
Federal
credit
608 .00 x
Farmland preservation credit.
0 .00
42
43 % =
a Schedule FC, line 18
46 a
.00
b Schedule FC-A, line 13
46 b
.00
47
Repayment credit (see instructions)
47
.00
48
Homestead credit. Enclose Schedule H or H-EZ
48
.00
49
Eligible veterans and surviving spouses property tax credit
49
.00
50
Other credits from Schedule CR, line 27. Enclose Schedule CR
50
.00
51
Add lines 43 through 50
51
1957 .00
52
If line 51 is larger than line 42, subtract line 42 from line 51.
This is the AMOUNT YOU OVERPAID
52
1957 .00
53
Amount of line 52 you want REFUNDED TO YOU
53
1957 .00
54
Amount of line 52 you want
APPLIED TO YOUR 2011 ESTIMATED TAX
55
56
0 .00
54
If line 51 is smaller than line 42, subtract line 51 from line 42. This is the
AMOUNT YOU OWE. Paper clip payment to front of return
Underpayment interest. Fill in exception code ' See
Schedule U. Also include on line 55 (see instructions)
Third
Party
Designee
.00
56
Do you want to allow another person to discuss this return with the department (see instr)?
Designee’s
name
D
Phone
no.
D
.00
55
Personal
identification
number (PIN)
Yes
Complete the following.
X
No
D
Paper clip copies of your federal income tax return and schedules to this return.
Assemble your return (pages 1 through 4) and withholding statements in the order listed in the instructions.
Sign here
B
Under penalties of law, I declare that this return and all attachments are true, correct, and complete to the best of my knowledge and belief.
Your signature
Spouse’s signature (if filing jointly, BOTH must sign)
Date
Daytime phone
Intuit I-010ai
Mail your return to:
If tax due
If refund or no tax due
If homestead credit claimed
Wisconsin Department of Revenue
PO Box 268, Madison, WI 53790-0001
PO Box 59, Madison, WI 53785-0001
PO Box 34, Madison, WI 53786-0001
For Department
Use Only
C
Do Not Submit
Photocopies
WIIA0103
11/19/10
Form 1 (2010)
Name
JEREMY J & NANCY S KOSS
387827371
SSN
Page 4 of 4
Schedule 1 ' Itemized Deduction Credit (see instructions)
1
Medical and dental expenses from line 4, federal Schedule A. See instructions for exceptions
1
1560 .00
2
Interest paid from line 15, federal Schedule A. Do not include interest paid to purchase a second home
located outside Wisconsin or a residence which is a boat. Also, do not include interest paid to purchase or
hold U.S. government securities
2
10281 .00
3
Gifts to charity from line 19, federal Schedule A. See instructions for exceptions
3
500 .00
4
Casualty losses from line 20, federal Schedule A, only if the loss is directly related to a
federally-declared disaster
4
.00
5
Add lines 1 through 4
5
12341 .00
6
Fill in your standard deduction from line 15 on page 2 of Form 1
6
14094 .00
7
Subtract line 6 from line 5. If line 6 is more than line 5, fill in 0
7
0 .00
8
Rate of credit is .05 (5%)
8
X .05
9
Multiply line 7 by line 8. Fill in here and on line 20 on page 2 of Form 1
9
0 .00
G
You must submit this page with Form 1 if you claim either of these credits
H
Schedule 2 ' Married Couple Credit When Both Spouses Are Employed (see instructions)
When completing this schedule, be sure to fill in your income in column (A) and your spouse’s income in column (B)
(A) YOURSELF
1
(B) SPOUSE
Taxable wages, salaries, tips, and other employee compensation.
Do NOT include deferred compensation, interest, dividends, pensions,
unemployment compensation, or other unearned income
1
29224 .00
16229 .00
Net profit or (loss) from self-employment from federal Schedules C,
C-EZ, and F (Form 1040), Schedule K-1 (Form 1065), and any other
taxable self-employment or earned income
2
0 .00
0 .00
3
Combine lines 1 and 2. This is earned income
3
29224 .00
16229 .00
4
Add amounts from your federal Form 1040, lines 24, 28, and 32, plus
repayment of supplemental unemployment benefits, and contributions to
secs. 403(b) and 501(c)(18) pension plans included in line 36, and any
Wisconsin disability income exclusion. Fill in the total of these adjustments
that apply to your or your spouse’s income
4
.00
.00
Subtract line 4 from line 3. This is qualified earned income. If less than
zero, fill in 0
5
29224 .00
16229 .00
2
5
6
Compare the amounts in columns (A) and (B) of line 5. Fill in the smaller amount here.
If more than $16,000, fill in $16,000
6
16000 .00
7
Rate of credit is .03 (3%)
7
X .03
8
Multiply line 6 by line 7. Fill in here and on line 30 on page 2 of Form 1
8
480 .00
WIIA0104 11/19/10
Do not fill in
more than $480.
Intuit
2010
SCHEDULE
CAPITAL GAINS AND LOSSES
a Enclose with your Wisconsin income tax return a
Name(s) shown on Form 1 or Form 1NPR
Your social security number
Jeremy J & Nancy S Koss
Part I
Short-Term Capital Gains and Losses ' Assets Held One Year or Less
(a) Description of property
(Example, 100 shares XYZ Co)
(b) Date acquired
(c) Date sold
(mo, day, yr)
(mo, day, yr)
(d) Sales price
(e) Cost or
387-82-7371
(f) LOSS
If (e) is more than (d),
subtract (d) from (e)
other basis
WD
Wisconsin Department of Revenue
(g) GAIN
If (d) is more than (e),
subtract (e) from (d)
1
2
3
4
5
6
7
Short-term gain from Form 6252, and short-term gain or loss from
Forms 4684, 6781, and 8824
2
Net short-term gain or loss from partnerships, S corporations, estates, and trusts
from Schedule(s) K-1
Adjustment from Wisconsin Schedule T (see Basis Difference in instructions)
Short-term capital loss carryover from 2009 Wisconsin Schedule WD, line 32
Add lines 1 through 5, in columns (f) and (g)
Net short-term capital gain or (loss). Combine columns (f) and (g) of line 6
3
4
5
6
Part II
7
Long-Term Capital Gains and Losses ' Assets Held More Than One Year
8
9
10
11
12
13
14
15
Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term
gain or loss from Forms 4684, 6781, and 8824
Net long-term gain or loss from partnerships, S corporations, estates, and trusts
from Schedule(s) K-1
Capital gain distributions
Adjustment from Wisconsin Schedule T (see Basis Difference in instructions)
Long-term capital loss carryover from 2009 Wisconsin Schedule WD, line 37
Add lines 8 through 13, in columns (f) and (g)
Net long-term capital gain or (loss). Combine columns (f) and (g) of line 14
10
11
12
13
14
10.
15
10.
10.
NOW GO TO PAGE 2 R
I-070
Intuit
9
WIIA1112
07/02/10
Schedule WD 2010
Page 2
Name(s) shown on Form 1 or Form 1NPR (Do not fill in name and social security number if shown on page 1.)
Your social security number
Jeremy J & Nancy S Koss
Part III
Summary of Parts I and II (see instructions)
387-82-7371
16
Combine lines 7 and 15, and fill in the net gain or (loss) here (if line 16 is a loss, go to line 26)
17
If line 16 shows a gain, fill in the smaller of line 15 or line 16.
Fill in -0- if there is a loss or no entry on line 15
17
Fill in 30% of line 17
18
Portion of the amount on line 14, column (g) that is
attributable to gain on the sale of farm assets. If zero, skip
lines 20-23 and fill in the amount from line 18 on line 24
19
Amount from line 14, column (g)
20
Divide line 19 by line 20.
Carry the decimal to 4 places
21
Multiply line 17 by the decimal amount on line 21
22
Fill in 30% of line 22
23
Add lines 18 and 23
Subtract line 24 from line 16
If line 16 shows a loss, fill in the smaller of
a The loss on line 16,
b $500, or
c Wisconsin ordinary income (see instructions)
18
19
20
21
22
23
24
25
26
16
10.
10.
3.
24
25
3.
7.
26
Note: When figuring whether 26a, 26b, or 26c is smaller, treat all numbers as if they are positive.
If filing Form 1, complete Part IV. If filing Form 1NPR, fill in amount from line 25 or 26, on line 7, column B of Form 1NPR
Part IV
27
Computation of Wisconsin Adjustment to Income
(Do not complete this part if you are filing on Form 1NPR.)
Adjustment (see instructions for Part IV)
a Fill in gain from federal Form 1040, line 13 (if a loss, fill in -0-)
b Fill in gain from Wisconsin Schedule WD, line 25 (if blank, fill in -0-)
27 a
27 b
10.
7.
c If line 27b is more than line 27a, subtract line 27a from line 27b.
Fill in result here and on line 3 of Form 1
27 c
d If line 27b is less than line 27a, subtract line 27b from line 27a.
Fill in result here and on line 10 of Form 1
27 d
e Fill in loss from federal Form 1040, line 13 as a positive amount
(if a gain, fill in -0-)
27 e
0.
f Fill in loss from Wisconsin Schedule WD, line 26 as a positive amount
(if blank, fill in -0-)
27 f
0.
g If line 27f is more than line 27e, subtract line 27e from line 27f. Fill in result here and on line 10 of
Form 1 as a positive amount (if you also have an amount on line 27d, add the amounts on lines 27d
and 27g, and fill in only the total on line 10 of Form 1)
27 g
h If line 27f is less than line 27e, subtract line 27f from line 27e. Fill in result here and on line 3 of
Form 1 as a positive amount (if you also have an amount on line 27c, add the amounts on lines 27c
and 27h, and fill in only the total on line 3 of Form 1)
27 h
Part V
Computation of Capital Loss Carryovers from 2010 to 2011 (Complete this part if the loss on line 16 is more than
the loss on line 26.)
Short-Term Capital Loss Carryover
28 Fill in loss shown on line 7 as a positive amount. If none, fill in -0- and skip lines 29 through 32
29 Fill in gain shown on line 15. If that line is blank or shows a loss, fill in -030 Subtract line 29 from line 28
31 Fill in the smaller of line 26 or line 30, treating both as positive amounts
32 Subtract line 31 from line 30. This is your short-term capital loss carryover from 2010 to 2011
28
29
30
31
32
Long-Term Capital Loss Carryover
33 Fill in loss from line 15 as a positive amount. If none, fill in -0- and skip lines 34 through 37
34 Fill in gain shown on line 7. If that line is blank or shows a loss, fill in -035 Subtract line 34 from line 33
33
34
35
36
37
Intuit
Subtract line 31 from line 26, treating both as positive amounts. (Note: If you skipped lines 29
through 32, fill in amount from line 26 as a positive amount.)
Subtract line 36 from line 35. This is your long-term capital loss carryover from 2010 to 2011
WIIA1112
07/02/10
36
37
3.
2010 Wisconsin Form EIC-A
Earned Income Credit
Information for up to three qualifying children
Instructions
Complete the information for each qualifying child for the Wisconsin Earned Income Credit. If you have more than three qualifying children, you
only have to list three to get the maximum credit.
Qualifying
Child
Information
Child 1
Child 2
Child 3
First
Last
First
Last
First
Last
1
Child’s name
Ethan
Koss
Owen
Koss
Samuel
Koss
2
Child’s
social security number
394-23-3867
394-23-3868
398-27-7637
X
X
X
3
4
Child’s
relationship to you
(check one)
6
Son or Daughter
Grandchild
Brother or Sister
Nephew or Niece
Foster Child
Son or Daughter
Grandchild
Brother or Sister
Nephew or Niece
Foster Child
Number of months child lived
with you in the United States
during 2010
NOTE: If the child lived with you
for more than half of 2010, but
less than 7 months, enter ’7’. If
the child was born or died in
2010, and your home was the
child’s for the entire time he or
she was alive during 2010,
enter ’12’
5
Son or Daughter
Grandchild
Brother or Sister
Nephew or Niece
Foster Child
Child’s
year of birth
12
12
12
2002
2002
2006
If the child was born
before 1992 '
a Was the child under age 24
at the end of 2010 and a full
time student?
Yes
No
Yes
No
Yes
No
b Was the child permanently
and totally disabled during
any part of 2010?
Yes
No
Yes
No
Yes
No
Intuit 1-012 (R 10-10)
WIIA2301
12/20/10
Form
Department of the Treasury
1040
Name,
Address,
and SSN
' Internal Revenue Service
U.S. Individual Income Tax Return
For the year Jan 1 - Dec 31, 2010, or other tax year beginning
Your first name
MI
Jeremy
If a joint return, spouse’s first name
See separate
instructions.
Nancy
2010
IRS Use Only ' Do not write or staple in this space.
(99)
, 2010, ending
, 20
OMB No. 1545-0074
Your social security number
Last name
J
Koss
MI
Last name
S
Koss
387-82-7371
Spouse’s social security number
391-66-5488
Home address (number and street). If you have a P.O. box, see instructions.
Make sure the SSN(s)
above and on line 6c
are correct.
Apartment no.
J
2251 N 66TH ST
City, town or post office. If you have a foreign address, see instructions.
Presidential
Election
Campaign
Filing Status
Check only
one box.
Exemptions
If more than four
dependents, see
instructions and
check here
WAUWATOSA
A
State
ZIP code
WI
53213-2037
Checking a box below will not
change your tax or refund.
Check here if you, or your spouse if filing jointly, want $3 to go to this fund?
1
2
3
X
6a
b
Single
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse’s SSN above & full
name here
4
5
You
Head of household (with qualifying person). (See
instructions.) If the qualifying person is a child
but not your dependent, enter this child’s
name here
Qualifying widow(er) with dependent child
X
X
Yourself. If someone can claim you as a dependent, do not check box 6a
Spouse
(2) Dependent’s
(3) Dependent’s
c Dependents:
social security
relationship
number
to you
(1) First name
Last name
Ethan J Koss
Owen J Koss
Samuel B Koss
Spouse
394-23-3867 Son
394-23-3868 Son
398-27-7637 Son
Boxes checked
on 6a and 6b
b
(4) if
child under
age 17
qualifying for
child tax cr
(see instrs)
X
X
X
No. of children
on 6c who:
? lived
with you
? did not
live with you
due to divorce
or separation
(see instrs)
Dependents
on 6c not
entered above
Add numbers
on lines
2
3
d Total number of exemptions claimed
above
5
7 Wages, salaries, tips, etc. Attach Form(s) W-2
7
45,453.
Income
8 a Taxable interest. Attach Schedule B if required
8a
43.
b Tax-exempt interest. Do not include on line 8a
8b
9 a Ordinary dividends. Attach Schedule B if required
9a
207.
Attach Form(s)
W-2 here. Also
b Qualified dividends
9b
203.
attach Forms
10 Taxable refunds, credits, or offsets of state and local income taxes
10
0.
W-2G and 1099-R
11 Alimony received
11
if tax was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ
12
If you did not
13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here
13
10.
get a W-2,
see instructions.
14 Other gains or (losses). Attach Form 4797
14
15 a IRA distributions
15 a
b Taxable amount
15 b
16 a Pensions and annuities
16 a
b Taxable amount
16 b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
17
-13,630.
18 Farm income or (loss). Attach Schedule F
18
Enclose, but do
not attach, any
19 Unemployment compensation
19
payment. Also,
20
a
Social
security
benefits
20
a
b
Taxable
amount
20 b
please use
Form 1040-V.
21 Other income
21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income
22
32,083.
23 Educator expenses
23
Adjusted
24 Certain business expenses of reservists, performing artists, and fee-basis
government officials. Attach Form 2106 or 2106-EZ
24
Gross
Income
25 Health savings account deduction. Attach Form 8889
25
26 Moving expenses. Attach Form 3903
26
27 One-half of self-employment tax. Attach Schedule SE
27
28 Self-employed SEP, SIMPLE, and qualified plans
28
29 Self-employed health insurance deduction
29
30 Penalty on early withdrawal of savings
30
31 a Alimony paid b Recipient’s SSN
31 a
32 IRA deduction
32
33 Student loan interest deduction
33
34 Tuition and fees. Attach Form 8917
34
35 Domestic production activities deduction. Attach Form 8903
35
36 Add lines 23 - 31a and 32 - 35
36
37 Subtract line 36 from line 22. This is your adjusted gross income
37
32,083.
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
FDIA0112 12/22/10
Form 1040 (2010)
Jeremy J & Nancy S Koss
Form 1040 (2010)
Tax and
Credits
Other
Taxes
Payments
If you have a
qualifying
child, attach
Schedule EIC.
Refund
Direct deposit?
See instructions.
Amount
You Owe
Third Party
Designee
Sign
Here
Joint return?
See instructions.
Keep a copy
for your records.
Blind. Total boxes
Blind. checked
39 a
b If your spouse itemizes on a separate return, or you were a dual-status alien, check here
39 b
40 Itemized deductions (from Schedule A) or your standard deduction (see instructions)
41 Subtract line 40 from line 38
42 Exemptions. Multiply $3,650 by the number on line 6d
43 Taxable income. Subtract line 42 from line 41.
If line 42 is more than line 41, enter -044 Tax (see instrs). Check if any tax is from:
a
Form(s) 8814
b
Form 4972
45 Alternative minimum tax (see instructions). Attach Form 6251
46 Add lines 44 and 45
47 Foreign tax credit. Attach Form 1116 if required
47
48 Credit for child and dependent care expenses. Attach Form 2441
48
49 Education credits from Form 8863, line 23
49
50 Retirement savings contributions credit. Attach Form 8880
50
51 Child tax credit (see instructions)
51
0.
52 Residential energy credits. Attach Form 5695
52
53 Other crs from Form: a
3800 b
8801 c
53
54 Add lines 47 through 53. These are your total credits
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -056 Self-employment tax. Attach Schedule SE
57 Unreported social security and Medicare tax from Form: a
4137 b
8919
58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
59 a
Form(s) W-2, box 9
b
Schedule H
c
Form 5405, line 16
60 Add lines 55-59. This is your total tax
61 Federal income tax withheld from Forms W-2 and 1099
61
62 2010 estimated tax payments and amount applied from 2009 return
62
63 Making work pay credit. Attach Schedule M
63
800.
64 a Earned income credit (EIC)
64 a
608.
b Nontaxable combat pay election
64 b
65 Additional child tax credit. Attach Form 8812
65
3,000.
66 American opportunity credit from Form 8863, line 14
66
67 First-time homebuyer credit from Form 5405, line 10
67
68 Amount paid with request for extension to file
68
69 Excess social security and tier 1 RRTA tax withheld
69
70 Credit for federal tax on fuels. Attach Form 4136
70
71 Credits from Form: a
2439 b
8839 c
8801 d
8885 71
72 Add lns 61-63, 64a, & 65-71. These are your total pmts
73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid
74 a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here
G b Routing number
XXXXXXXXX
G c Type:
Checking
G d Account number
XXXXXXXXXXXXXXXXX
75 Amount of line 73 you want applied to your 2011 estimated tax
75
76 Amount you owe. Subtract line 72 from line 60. For details on how to pay see instructions
77 Estimated tax penalty (see instructions)
77
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee’s
name
Phone
no.
G
Page 2
38
32,083.
40
41
42
20,695.
11,388.
18,250.
43
0.
44
45
46
0.
0.
0.
54
55
56
57
58
59
60
0.
0.
0.
4,408.
4,408.
4,408.
72
73
74 a
Savings
76
X
Yes. Complete below.
Personal identification
number (PIN)
G
No
G
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
A
A
Your signature
Date
Your occupation
Daytime phone number
Dining Manager
Spouse’s signature. If a joint return, both must sign.
Date
Spouse’s occupation
Implementation Specialist
Print/Type preparer’s name
Paid
Preparer’s
Use Only
387-82-7371
38 Amount from line 37 (adjusted gross income)
39 a Check
You were born before January 2, 1946,
if:
Spouse was born before January 2, 1946,
Preparer’s signature
Date
Check
if
PTIN
self-employed
Firm’s name
Firm’s address
G
G
Self-Prepared
Firm’s EIN G
Phone no.
Form 1040 (2010)
FDIA0112
12/22/10
SCHEDULE A
OMB No. 1545-0074
Itemized Deductions
(Form 1040)
Department of the Treasury
Internal Revenue Service
2010
(99)
G Attach to Form 1040.
Attachment
Sequence No.
G See Instructions for Schedule A (Form 1040).
Name(s) shown on Form 1040
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
Medical
and
Dental
Expenses
Taxes You
Paid
Caution. Do not include expenses reimbursed or paid by others.
1 Medical and dental expenses (see instructions)
2 Enter amount from Form 1040, line 38
2
32,083.
3 Multiply line 2 by 7.5% (.075)
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -05 State and local (check only one box):
a X Income taxes, or
b
General sales taxes
6 Real estate taxes (see instructions)
7 New motor vehicle taxes from line 11 of the worksheet on page 2 (for certain
vehicles purchased in 2009). Skip this line if you checked box 5b
8 Other taxes. List type and amount G
1
3,966.
3
2,406.
5
1,696.
6
6,658.
07
4
1,560.
9
8,354.
15
10,281.
19
500.
7
8
Interest
You Paid
Note.
Your mortgage
interest
deduction may
be limited (see
instrs).
9
10
11
Add lines 5 through 8
Home mtg interest and points reported to you on Form 1098
Home mortgage interest not reported to you on Form 1098. If paid to the person
from whom you bought the home, see instructions and show that person’s name,
identifying number, and address G
12
13
14
Points not reported to you on Form 1098. See instrs for spcl rules
Mortgage insurance premiums (see instructions)
Investment interest. Attach Form 4952 if required.
(See instrs.)
Add lines 10 through 14
15
Gifts to
Charity
16
If you made
a gift and
got a benefit
for it, see
instructions.
17
18
19
Casualty and
Theft Losses
20
Job Expenses 21
and Certain
Miscellaneous
Deductions
Other
Miscellaneous
Deductions
Total
Itemized
Deductions
Gifts by cash or check. If you made any gift of $250 or
more, see instrs
Other than by cash or check. If any gift of $250 or
more, see instructions. You must attach Form 8283 if
over $500
Carryover from prior year
Add lines 16 through 18
10
10,281.
11
12
13
14
16
100.
17
18
400.
Casualty or theft loss(es). Attach Form 4684. (See instructions.)
Unreimbursed employee expenses ' job travel, union dues,
job education, etc. Attach Form 2106 or 2106-EZ if
required. (See instructions.) G
20
21
22
22
23
Tax preparation fees
Other expenses ' investment, safe deposit box, etc. List
type and amount G
24
25
26
27
28
Add lines 21 through 23
Enter amount from Form 1040, line 38
25
Multiply line 25 by 2% (.02)
Subtract line 26 from line 24. If line 26 is more than line 24, enter -0Other ' from list in instructions. List type and amount G
29
Add the amounts in the far right column for lines 4 through 28.
Also, enter this amount on Form 1040, line 40
30
If you elect to itemize deductions even though they are less than your standard
deduction, check here
23
24
26
27
28
BAA For Paperwork Reduction Act Notice, see Form 1040 instructions.
29
FDIA0301
12/21/10
20,695.
Schedule A (Form 1040) 2010
SCHEDULE D
OMB No. 1545-0074
Capital Gains and Losses
(Form 1040)
Department of the Treasury
Internal Revenue Service
(99)
2010
GAttach to Form 1040 or Form 1040NR. GSee Instructions for Schedule D (Form 1040).
G Use Schedule D-1 to list additional transactions for lines 1 and 8.
Attachment
Sequence No.
12
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
Part I
Short-Term Capital Gains and Losses ' Assets Held One Year or Less
(a) Description of
property (Example:
100 shares XYZ Co)
(b) Date acquired
(c) Date sold
(Mo, day, yr)
(Mo, day, yr)
(d) Sales price
(see instructions)
(e) Cost or other basis
(f) Gain or (loss)
Subtract (e) from (d)
(see instructions)
1
2
Enter your short-term totals, if any, from Schedule D-1, line 2
3
Total short-term sales price amounts. Add lines 1 and 2 in
column (d)
3
Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824
Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1
4
5
Short-term capital loss carryover. Enter the amount, if any, from line 10 of your Capital Loss Carryover
Worksheet in the instructions
7 Net short-term capital gain or (loss). Combine lines 1 through 6 in column (f)
6
7
4
5
2
6
Part II
Long-Term Capital Gains and Losses ' Assets Held More Than One Year
(a) Description of
property (Example:
100 shares XYZ Co)
(b) Date acquired
(c) Date sold
(Mo, day, yr)
(Mo, day, yr)
(d) Sales price
(see instructions)
(e) Cost or other basis
(see instructions)
(f) Gain or (loss)
Subtract (e) from (d)
8
9
Enter your long-term totals, if any, from Schedule D-1, line 9
9
10
Total long-term sales price amounts. Add lines 8 and 9 in
column (d)
10
11
12
Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from
Forms 4684, 6781, and 8824
Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1
11
12
13
Capital gain distributions. See instrs
13
14
Long-term capital loss carryover. Enter the amount, if any, from line 15 of your Capital Loss Carryover
Worksheet in the instructions
14
15 Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to Part III on
page 2
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA0612
12/22/10
10.
15
10.
Schedule D (Form 1040) 2010
Schedule D (Form 1040) 2010
Part III
16
387-82-7371
?
?
Page 2
Summary
Combine lines 7 and 15 and enter the result
?
17
Jeremy J & Nancy S Koss
16
10.
If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then
go to line 17 below.
If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.
If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form 1040NR,
line 14. Then to go line 22.
Are lines 15 and 16 both gains?
X
Yes. Go to line 18.
No. Skip lines 18 through 21, and go to line 22.
18
Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions
18
19
Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in
the instructions
19
20
2.
Are lines 18 and 19 both zero or blank?
Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the Qualified
Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the
Instructions for Form 1040NR, line 42). Do not complete lines 21 and 22 below.
X
21
No. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the Schedule
D Tax Worksheet in the instructions. Do not complete lines 21 and 22 below.
If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:
?
?
The loss on line 16 or
($3,000), or if married filing separately, ($1,500)
21
Note. When figuring which amount is smaller, treat both amounts as positive numbers.
22
Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?
Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the Qualified
Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the
Instructions for Form 1040NR, line 42).
No. Complete the rest of Form 1040 or Form 1040NR.
Schedule D (Form 1040) 2010
FDIA0612
12/22/10
SCHEDULE E
Supplemental Income and Loss
(Form 1040)
(From rental real estate, royalties, partnerships,
S corporations, estates, trusts, REMICs, etc)
G Attach to Form 1040, 1040NR, or Form 1041.
G See Instructions for Schedule E (Form 1040).
Department of the Treasury
Internal Revenue Service
(99)
OMB No. 1545-0074
2010
Attachment
Sequence No.
13
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
Part I
Income or Loss From Rental Real Estate and Royalties
387-82-7371
Note. If you are in the business of renting personal property, use
Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.
2 For each rental real estate
1 List the type and address of each rental real estate property:
Yes No
property listed on line 1, did you
A DUPLEX
or your family use it during the
2251A N 66TH ST
Wauwatosa, WI 53213
A
X
tax year for personal purposes
for more than the greater of:
B Multi-Family 29.00%
? 14 days, or
2060 S 82ND ST
West Allis, WI 53219
B
X
? 10% of the total days
C
rented at fair rental value?
(See instructions.)
C
Properties
Totals
Income:
A
B
C
(Add columns A, B, and C.)
3 Rents received
3
1,500.
3,460.
3
4,960.
4 Royalties received
4
4
Expenses:
5
6
7
8
9
10
11
Advertising
Auto and travel (see instructions)
Cleaning and maintenance
Commissions
Insurance
Legal and other professional fees
Management fees
5
6
7
8
9
10
11
12
Mortgage interest paid to banks, etc
(see instructions)
Other interest
Repairs
Supplies
Taxes
Utilities
Other (list)
12
13
14
15
16
17
13
14
15
16
17
18
300.
275.
88.
87.
188.
359.
3,427.
3,543.
2,000.
550.
1,332.
1,149.
116.
38.
1,525.
461.
19
9,221.
20
21
22
12
6,970.
6,217.
19
15,438.
1,873.
11,094.
1,279.
7,496.
20
3,152.
-9,594.
-4,036.
24
25
-13,630.
18
19
20
21
Add lines 5 through 18
Depreciation expense or depletion
(see instructions)
Total expenses. Add lines 19 and 20
22
Income or (loss) from rental real estate or
royalty properties. Subtract line 21 from line 3
(rents) or line 4 (royalties). If the result is a
(loss), see instructions to find out if you must
file Form 6198
23
Deductible rental real estate loss.
Caution. Your rental real estate loss on line 22
may be limited. See instructions to find out if you
must file Form 8582. Real estate professionals
must complete line 43 on page 2
23
-9,594.
-4,036.
Income. Add positive amounts shown on line 22. Do not include any losses
Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter total losses here
24
25
26
Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the
result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this
amount on Form 1040, line 17, or Form 1040NR, line 18. Otherwise, include this amount
in the total on line 41 on page 2
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIZ2301
06/25/10
26
-13,630.
Schedule E (Form 1040) 2010
Attachment Sequence No. 13
Schedule E (Form 1040) 2010
Page 2
Name(s) shown on return. Do not enter name and social security number if shown on Page 1.
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
Part II
Income or Loss From Partnerships and S Corporations
Note. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and
attach Form 6198. See instructions.
27
Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed
loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses?
Yes
X No
If you answered ’Yes,’ see instructions before completing this section.
(b) Enter P
Check if
(d) Employer
(e) Check if
for partnership; (c)foreign
(a) Name
identification
any amount
S for S
partnership
number
is not at risk
corporation
28
A
B
C
D
PTP-Ferrelgas Partners, L.P.
P
Passive Income and Loss
(f) Passive loss allowed
(attach Form 8582 if required)
A
B
C
D
29 a Totals
b Totals
30 Add columns (g) and (j) of line 29a
31 Add columns (f), (h), and (i) of line 29b
32
Nonpassive Income and Loss
(i) Section 179
(j) Nonpassive
expense deduction
income from
from Form 4562
Schedule K-1
(g) Passive income
from Schedule K-1
0.
43-1698480
(h) Nonpassive loss
from Schedule K-1
0.
0.
0.
Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and
include in the total on line 41 below
Part III
Nonpassive Income and Loss
(d) Passive income
from Schedule K-1
(e) Deduction or loss
from Schedule K-1
A
B
34 a Totals
b Totals
35 Add columns (d) and (f) of line 34a
36 Add columns (c) and (e) of line 34b
38
37
Income or Loss From Real Estate Mortgage Investment Conduits (REMICs) ' Residual Holder
(a) Name
(b) Employer
identification number
(c) Excess inclusion
from Schedules Q,
line 2c (see instructions)
(d) Taxable income
(net loss) from
Schedules Q, line 1b
Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below
Part V
(f) Other income
from Schedule K-1
35
36
Total estate and trust income or (loss). Combine lines 35 and 36. Enter the
result here and include in the total on line 41 below
Part IV
(e) Income from
Schedules Q, line 3b
39
Summary
40
Net farm rental income or (loss) from Form 4835. Also, complete line 42 below
41
Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on
Form 1040, line 17, or Form 1040NR, line 18
42
Reconciliation of farming and fishing income. Enter your gross farming
and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065),
box 14, code B; Schedule K-1 (Form 1120S), box 17, code U; and Schedule K-1
(Form 1041), line 14, code F (see instructions)
Reconciliation for real estate professionals. If you were a real estate
professional (see instructions), enter the net income or (loss) you reported
anywhere on Form 1040 or Form 1040NR from all rental real estate activities
in which you materially participated under the passive activity loss rules
BAA
0.
(b) Employer ID no.
Passive Income and Loss
43
32
(a) Name
(c) Passive deduction or loss allowed
(attach Form 8582 if required)
39
0.
0.
Income or Loss From Estates and Trusts
33
A
B
37
30
31
FDIZ2302
06/25/10
40
G
41
-13,630.
42
43
Schedule E (Form 1040) 2010
SCHEDULE EIC
Earned Income Credit
(Form 1040A or 1040)
Qualifying Child Information
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
2010
Complete and attach to Form 1040A or 1040
only if you have a qualifying child.
(99)
Attachment
Sequence No.
43
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
? See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and
Before you begin:
387-82-7371
64b, to make sure that (a) you can take the EIC and (b) you have a qualifying child.
? Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social
security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or
SSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-772-1213.
CAUTION!
? If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the
instructions for details.
? It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
Qualifying Child Information
1
2
3
Child’s name
If you have more than three qualifying
children, you only have to list three to get
the maximum credit
Child’s SSN
The child must have an SSN as defined in the
instructions for Form 1040A, lines 41a and
41b, or Form 1040, lines 64a and 64b, unless
the child was born and died in 2010. If your
child was born and died in 2010 and did not
have an SSN, enter ’Died’ on this line and
attach a copy of the child’s birth certificate,
death certificate, or hospital medical records.
Child’s year of birth
4 a Was the child under age 24 at the end of
2010, a student, and younger than you (or
your spouse, if filing jointly)?
b Was the child permanently and totally
disabled during any part of 2010?
Child 1
First name
Last name
Ethan
J Koss
394-23-3867
Year
2002
Owen
Last name
J Koss
394-23-3868
Year
2002
First name
Last name
Samuel B Koss
398-27-7637
Year
2006
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
Yes.
Go to line 5.
Yes.
Go to line 5.
Yes.
Go to line 5.
No.
Continue.
Yes.
No.
The child
is not a
qualifying child.
No.
Continue.
Yes.
Continue.
No.
The child
is not a
qualifying child.
No.
Continue.
Yes.
Continue.
No.
The child
is not a
qualifying child.
Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, foster child, etc)
6
First name
Child 3
If born after 1991 AND the child was
younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; go
to line 5.
Continue.
5
Child 2
Son
Son
Son
Number of months child lived with you in the
United States during 2010
? If the child lived with you for more than
half of 2010 but less than 7 months,
enter ’7’.
? If the child was born or died in 2010 and
your home was the child’s home for the
entire time he or she was alive during
2010, enter ’12’
12
months
Do not enter more than
12 months.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA7401
11/04/10
12
months
Do not enter more than
12 months.
12
months
Do not enter more than
12 months.
Schedule EIC (Form 1040A or 1040) 2010
Form
8812
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
Additional Child Tax Credit
(99)
2010
Complete and attach to Form 1040, Form 1040A, or Form 1040NR.
Name(s) shown on return
47
Your social security number
Jeremy J & Nancy S Koss
Part I
All Filers
1
Attachment
Sequence No.
387-82-7371
1040 filers:
Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040, line 51).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040A, line 33).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040NR, line 48).
1
3,000.
2
3
0.
3,000.
6
6,368.
If you used Pub 972, enter the amount from line 8 of the worksheet on page 4 of the publication.
2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48
3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit
4 a Earned income (see instructions)
4a
45,453.
b Nontaxable combat pay (see instructions)
4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
X Yes. Subtract $3,000 from the amount on line 4a. Enter the result
5
42,453.
6 Multiply the amount on line 5 by 15% (.15) and enter the result
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of
line 3 or line 6 on line 13.
X
Part II
Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13.
Otherwise, go to line 7.
Certain Filers Who Have Three or More Qualifying Children
7
Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6.
If married filing jointly, include your spouse’s amounts with yours. If you worked
for a railroad, see the instructions
8
1040 filers:
9
10
Enter the total of the amounts from Form 1040,
lines 27 and 57, plus any taxes that you identified using
code ’UT’ and entered on the dotted line next to line 60.
1040A filers: Enter -0-.
1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27
and 55, plus any taxes that you identified using code ’UT’
and entered on the dotted line next to line 59.
Add lines 7 and 8
Enter the total of the amounts from Form 1040, lines
64a and 69.
1040A filers: Enter the total of the amount from Form 1040A, line 41a,
plus any excess social security and tier 1 RRTA taxes
withheld that you entered to the left of line 44
(see instructions).
1040NR filers: Enter the amount from Form 1040NR, line 64.
7
8
9
1040 filers:
10
11
Subtract line 10 from line 9. If zero or less, enter -0-
11
12
Enter the larger of line 6 or line 11
12
Next, enter the smaller of line 3 or line 12 on line 13.
Part III
13
Additional Child Tax Credit
This is your additional child tax credit
13
3,000.
Enter this amount on
Form 1040, line 65,
Form 1040A, line 42, or
Form 1040NR, line 62.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
FDIA3001
07/08/10
Form 8812 (2010)
OMB No. 1545-0172
Form
4562
Department of the Treasury
Internal Revenue Service
Depreciation and Amortization
2010
(Including Information on Listed Property)
G See separate instructions.
(99)
Attachment
Sequence No.
G Attach to your tax return.
67
Name(s) shown on return
Identifying number
Jeremy J & Nancy S Koss
387-82-7371
Business or activity to which this form relates
Sch E DUPLEX
Part I
Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1
2
3
4
5
6
Maximum amount (see instructions)
Total cost of section 179 property placed in service (see instructions)
Threshold cost of section 179 property before reduction in limitation (see instructions)
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions
(a) Description of property
(b) Cost (business use only)
1
2
3
4
2,000,000.
5
(c) Elected cost
7 Listed property. Enter the amount from line 29
7
8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7
9 Tentative deduction. Enter the smaller of line 5 or line 8
10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs)
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
13 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12
13
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
Part II
500,000.
8
9
10
11
12
Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)
14
Special depreciation allowance for qualified property (other than listed property) placed in service during the
tax year (see instructions)
15 Property subject to section 168(f)(1) election
16 Other depreciation (including ACRS)
Part III MACRS Depreciation (Do not include listed property.) (See instructions)
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2010
18
14
15
16
17
If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here
Section B ' Assets Placed in Service During 2010 Tax Year Using the General Depreciation System
(c) Basis for depreciation
(a)
(b) Month and
(d)
(e)
(f)
Classification of property
year placed
in service
19 a 3-year property
b 5-year property
c 7-year property
d 10-year property
e 15-year property
f 20-year property
g 25-year property
h Residential rental
property
i Nonresidential real
property
(business/investment use
only ' see instructions)
Recovery period
25 yrs
27.5 yrs
27.5 yrs
39 yrs
Convention
Method
MM
MM
MM
MM
S/L
S/L
S/L
S/L
S/L
1,873.
(g) Depreciation
deduction
Section C ' Assets Placed in Service During 2010 Tax Year Using the Alternative Depreciation System
20 a Class life
b 12-year
c 40-year
Part IV
21
22
12 yrs
40 yrs
MM
S/L
S/L
S/L
Summary (See instructions.)
Listed property. Enter amount from line 28
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on
the appropriate lines of your return. Partnerships and S corporations ' see instructions
23 For assets shown above and placed in service during the current year, enter
the portion of the basis attributable to section 263A costs
23
BAA For Paperwork Reduction Act Notice, see separate instructions.
FDIZ0812 10/29/10
21
22
1,873.
Form 4562 (2010)
Jeremy J & Nancy S Koss
387-82-7371
Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment,
Form 4562 (2010)
Part V
Page 2
recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b,
columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section A ' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24 a Do you have evidence to support the business/investment use claimed?
Yes X No 24b If ’Yes,’ is the evidence written?
Yes
No
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Type of property (list
vehicles first)
25
26
Date placed
in service
Business/
investment
use
percentage
Basis for depreciation
(business/investment
use only)
Cost or
other basis
Recovery
period
Method/
Convention
Special depreciation allowance for qualified listed property placed in service during the tax year and
used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a qualified business use:
Depreciation
deduction
Elected
section 179
cost
25
27 Property used 50% or less in a qualified business use:
CHRYSLER TOWN AND COUNTRY 03/01/05
23.91
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
28
29 Add amounts in column (i), line 26. Enter here and on line 7, page 1
29
Section B ' Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other ’more than 5% owner,’ or related person. If you provided vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
30
31
Total business/investment miles driven
during the year (do not include
commuting miles)
Total commuting miles driven during the year
32
Total other personal (noncommuting)
miles driven
33
Total miles driven during the year. Add
lines 30 through 32
(a)
Vehicle 1
(c)
Vehicle 3
(d)
Vehicle 4
(e)
Vehicle 5
(f)
Vehicle 6
600
200
1,500
2,300
Yes
34
(b)
Vehicle 2
No
Yes
No
Yes
No
Yes
No
Yes
Was the vehicle available for personal use
during off-duty hours?
X
35
Was the vehicle used primarily by a more
than 5% owner or related person?
X
36
Is another vehicle available for
personal use?
X
Section C ' Questions for Employers Who Provide Vehicles for Use by Their Employees
No
Yes
No
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than
5% owners or related persons (see instructions).
Yes
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,
by your employees?
No
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners
39 Do you treat all use of vehicles by employees as personal use?
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
vehicles, and retain the information received?
41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)
Note: If your answer to 37, 38, 39, 40, or 41 is ’Yes,’ do not complete Section B for the covered vehicles.
Part VI
Amortization
(a)
(b)
(c)
(d)
(e)
(f)
Description of costs
Date amortization
begins
Amortizable
amount
Code
section
Amortization
period or
percentage
Amortization
for this year
42
Amortization of costs that begins during your 2010 tax year (see instructions):
43
44
Amortization of costs that began before your 2010 tax year
Total. Add amounts in column (f). See the instructions for where to report
FDIZ0812 10/29/10
43
44
Form 4562 (2010)
OMB No. 1545-0172
Form
4562
Department of the Treasury
Internal Revenue Service
Depreciation and Amortization
2010
(Including Information on Listed Property)
G See separate instructions.
(99)
Attachment
Sequence No.
G Attach to your tax return.
67
Name(s) shown on return
Identifying number
Jeremy J & Nancy S Koss
387-82-7371
Business or activity to which this form relates
Sch E Multi-Family
Part I
Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1
2
3
4
5
6
Maximum amount (see instructions)
Total cost of section 179 property placed in service (see instructions)
Threshold cost of section 179 property before reduction in limitation (see instructions)
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions
(a) Description of property
(b) Cost (business use only)
1
2
3
4
2,000,000.
5
(c) Elected cost
7 Listed property. Enter the amount from line 29
7
8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7
9 Tentative deduction. Enter the smaller of line 5 or line 8
10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs)
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
13 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12
13
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
Part II
500,000.
8
9
10
11
12
Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)
14
Special depreciation allowance for qualified property (other than listed property) placed in service during the
tax year (see instructions)
15 Property subject to section 168(f)(1) election
16 Other depreciation (including ACRS)
Part III MACRS Depreciation (Do not include listed property.) (See instructions)
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2010
18
14
15
16
17
If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here
Section B ' Assets Placed in Service During 2010 Tax Year Using the General Depreciation System
(c) Basis for depreciation
(a)
(b) Month and
(d)
(e)
(f)
Classification of property
year placed
in service
19 a 3-year property
b 5-year property
c 7-year property
d 10-year property
e 15-year property
f 20-year property
g 25-year property
h Residential rental
property
i Nonresidential real
property
(business/investment use
only ' see instructions)
Recovery period
25 yrs
27.5 yrs
27.5 yrs
39 yrs
Convention
Method
MM
MM
MM
MM
S/L
S/L
S/L
S/L
S/L
1,279.
(g) Depreciation
deduction
Section C ' Assets Placed in Service During 2010 Tax Year Using the Alternative Depreciation System
20 a Class life
b 12-year
c 40-year
Part IV
21
22
12 yrs
40 yrs
MM
S/L
S/L
S/L
Summary (See instructions.)
Listed property. Enter amount from line 28
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on
the appropriate lines of your return. Partnerships and S corporations ' see instructions
23 For assets shown above and placed in service during the current year, enter
the portion of the basis attributable to section 263A costs
23
BAA For Paperwork Reduction Act Notice, see separate instructions.
FDIZ0812 10/29/10
21
22
1,279.
Form 4562 (2010)
Jeremy J & Nancy S Koss
387-82-7371
Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment,
Form 4562 (2010)
Part V
Page 2
recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b,
columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section A ' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24 a Do you have evidence to support the business/investment use claimed?
X Yes
No 24b If ’Yes,’ is the evidence written?
X Yes
No
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Type of property (list
vehicles first)
25
26
Date placed
in service
Business/
investment
use
percentage
Basis for depreciation
(business/investment
use only)
Cost or
other basis
Recovery
period
Method/
Convention
Special depreciation allowance for qualified listed property placed in service during the tax year and
used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a qualified business use:
Depreciation
deduction
Elected
section 179
cost
25
27 Property used 50% or less in a qualified business use:
2005 Chrysler Town and Country 03/01/04
2.77
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
28
29 Add amounts in column (i), line 26. Enter here and on line 7, page 1
29
Section B ' Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other ’more than 5% owner,’ or related person. If you provided vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
30
31
Total business/investment miles driven
during the year (do not include
commuting miles)
Total commuting miles driven during the year
32
Total other personal (noncommuting)
miles driven
33
Total miles driven during the year. Add
lines 30 through 32
(a)
Vehicle 1
(c)
Vehicle 3
(d)
Vehicle 4
(e)
Vehicle 5
(f)
Vehicle 6
175
6,150
6,325
Yes
34
(b)
Vehicle 2
No
Yes
No
Yes
No
Yes
No
Yes
Was the vehicle available for personal use
during off-duty hours?
X
35
Was the vehicle used primarily by a more
than 5% owner or related person?
X
36
Is another vehicle available for
personal use?
X
Section C ' Questions for Employers Who Provide Vehicles for Use by Their Employees
No
Yes
No
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than
5% owners or related persons (see instructions).
Yes
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,
by your employees?
No
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners
39 Do you treat all use of vehicles by employees as personal use?
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the
vehicles, and retain the information received?
41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)
Note: If your answer to 37, 38, 39, 40, or 41 is ’Yes,’ do not complete Section B for the covered vehicles.
Part VI
Amortization
(a)
(b)
(c)
(d)
(e)
(f)
Description of costs
Date amortization
begins
Amortizable
amount
Code
section
Amortization
period or
percentage
Amortization
for this year
42
Amortization of costs that begins during your 2010 tax year (see instructions):
43
44
Amortization of costs that began before your 2010 tax year
Total. Add amounts in column (f). See the instructions for where to report
FDIZ0812 10/29/10
43
44
Form 4562 (2010)
SCHEDULE M
OMB No. 1545-0074
Making Work Pay Credit
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service
(99)
G Attach to Form 1040A or 1040.
2010
G See separate instructions.
Attachment
Sequence No.
Name(s) shown on return
Your social security number
Jeremy J & Nancy S Koss
387-82-7371
166
Caution:
To take the making work pay credit, you must include your social security number (if filing a joint return, the number of either you or
your spouse) on your tax return. A social security number does not include an identification number issued by the IRS. Only the
Social Security Administration issues social security numbers.
Caution:
You cannot take the making work pay credit if you can be claimed as someone else’s dependent or if you are a nonresident alien.
Important: Check the ’No’ box on line 1a and see the instructions if:
(a) You have a net loss from a business,
(b) You received a taxable scholarship or fellowship grant not reported on a Form W-2,
(c) Your wages include pay for work performed while an inmate in a penal institution,
(d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental
section 457 plan, or
(e) You are filing Form 2555 or 2555-EZ.
1 a Do you (and your spouse if filing jointly) have 2010 wages of more than $6,451 ($12,903 if married filing jointly)?
X Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.
No. Enter your earned income (see instructions)
1a
b Nontaxable combat pay included on line 1a
(see instructions)
2 Multiply line 1a by 6.2% (.062)
1b
2
3
Enter $400 ($800 if married filing jointly)
3
4
Enter the smaller of line 2 or line 3 (unless you checked ’Yes’ on line 1a)
5
Enter the amount from Form 1040, line 38*, or Form 1040A, line 22
5
32,083.
6
Enter $75,000 ($150,000 if married filing jointly)
6
150,000.
7
Is the amount on line 5 more than the amount on line 6?
X No. Skip line 8. Enter the amount from line 4 on line 9 below.
Yes. Subtract line 6 from line 5
7
4
800.
8
Multiply line 7 by 2% (.02)
8
9
Subtract line 8 from line 4. If zero or less, enter -0-
9
800.
10
0.
11
800.
10
Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You may have
received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received
social security benefits, supplemental security income, railroad retirement benefits, or veterans disability
compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions).
X
No. Enter -0- on line 10 and go to line 11.
Yes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010.
Do not enter more than $250 ($500 if married filing jointly)
11
Making work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on
Form 1040, line 63; or Form 1040A, line 40
*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.
BAA For Paperwork Reduction Act Notice, see your tax return instructions.
Schedule M (Form 1040A or 1040) 2010
FDIA8501
09/20/10
Form 1040
Line 10
State and Local Income Tax Refund Worksheet
2010
State and local taxes paid in 2009 or prior years and refunded in 2010
Keep for your records
Name(s) Shown on Return
Social Security Number
Jeremy J & Nancy S Koss
387-82-7371
Part I
1
2
3
4
State and Local Income Tax Refunds from 2009 Tax Returns
(a)
State
or
Local
Code
(b)
Refund
Amount
(c)
Estimated
Tax Paid
After
12/31/2009
(d)
Extension
Payments
(e)
Total
Payments
and
Withholding
WI
1,591.
1,591.
Totals
1,591.
1,591.
(f)
Refund
Allocated to
Column (c)
Total state and local refunds. Total line 1 column (b).
Refund allocated to tax paid after 12/31/2009. Total line 1 columns (f) and (g).
(Include net tax paid after 12/31/2009 on Schedule A, line 5.)
Net refund. Line 2 less line 3.
Part II
(g)
Refund
Allocated to
Column (d)
1,591.
1,591.
Recovery Amount
The recovery amount is the amount of the state and local income tax deducted in 2009 refunded in 2010.
5
Total state and local income tax deduction from line 5 of your 2009 Schedule A
1,591.
6
Recovery amount. Lesser of line 4 or line 5.
1,591.
Part III
Recovery Exclusion
The recovery exclusion is the part of the recovery amount which did not reduce tax in 2009.
7
Recovery exclusion from standard deduction and/or sales tax deduction:
a Allowable itemized deductions, from 2009 Schedule A, line 29
b Allowable itemized deductions, refigured by excluding recovery amount:
(1) Refigured state and local tax deduction:
(a) Refigured state income tax deduction
0.
(b) Sales tax deduction
(c) Refigured deduction. Larger of (a) or (b)
0.
(2) Refigured total itemized deductions before limitation
21,910.
(3) Refigured reduction for limitation on itemized deductions
0.
(4) Refigured allowable itemized deductions. Line 7b(2) less line 7b(3)
c 2009 standard deduction based on 2009 filing status, exemptions and deductions
d Larger of lines 7b(4) or 7c
e Subtract line 7d from line 7a
f Subtract line 7e from line 6
8
Recovery exclusion from negative taxable income. If 2009 taxable income
was negative, enter here as a positive number, else enter zero.
9
Recovery exclusion from alternative minimum tax. If no alternative minimum
tax (AMT) in 2009 enter zero. If did pay AMT in 2009, enter amount from line 22
10
Recovery exclusion from unused tax credits. If no unused credits in 2009,
enter zero. If there were unused credits in 2009, enter amount from line 33.
11
Total recovery exclusion. Add lines 7f, 8, 9, and 10.
Part IV
23,501.
21,910.
12,400.
21,910.
1,591.
0.
11,038.
0.
0.
11,038.
Taxable Refund
The recovery amount less the recovery exclusion is a taxable refund.
12
Taxable refund from 2009. Line 6 less line 11.
13
Total taxable refunds from 2008 or prior tax returns. Total line 34 column (d).
14
Total taxable refunds. Add lines 12 and 13. Enter here and on Form 1040, line 10
0.
0.