Form
(99)
Department of the Treasury - Internal Revenue Service
1040 U.S. Individual Income Tax Return 2015
For the year Jan. 1-Dec. 31, 2015, or other tax year beginning
Your first name and initial
OMB No. 1545-0074
, 2015, ending
IRS Use Only-Do not write or staple in this space.
See separate instructions.
, 20
Your social security number
Last name
STRAW
BERRY
If a joint return, spouse's first name and initial
400-00-6004
Spouse's social security number
Last name
BLUE
BERRY
400-00-2073
Home address (number and street).
Apt. no.
Make sure the SSN(s) above
and on line 6c are correct.
1234 FRUIT LOOP
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
TOWSON
MD
Foreign country name
Presidential Election Campaign
21286
Foreign province/state/county
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
a box below will not change your tax or
refund.
Foreign postal code
You
Filing
Status
Check only one
box.
1
2
3
Exemptions
Single
X
4
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.
5
Qualifying widow(er) with dependent child
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above
and full name here.
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Spouse
b
X
X
c
Dependents:
6a
Yourself. If someone can claim you as a dependent, do not check box 6a
(1) First name
Last name
(3) Dependent's
relationship to you
(2) Dependent's
social security number
If more than four
Boxes checked
on 6a and 6b
No. of children
(4) Chk If child under on 6c who:
age 17 qualifying
lived with you
for child tax credit
(see instructions)
did not live with
you due to divorce
or separation
(see instructions)
dependents, see
check here
12
...............................
....................... 7
Wages, salaries, tips, etc. Attach Form(s) W-2
Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . 8a
Tax-exempt interest. Do not include on line 8a . . . . . . . 8b
. . . . . . . . . . . . . . . . . . . . . 9a
Ordinary dividends. Attach Schedule B if required
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. . . . . 9b
Qualified dividends
2,500
. . . . . . . . . . . . . 10
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . 12
13
Capital gain or (loss). Attach Schedule D if required. If not required, check here
14
Other gains or (losses). Attach Form 4797
d
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see instructions.
7
8a
b
9a
b
10
11
15a
16a
17
18
19
20a
Adjusted
Gross
Income
Total number of exemptions claimed
.........................
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.
IRA distributions
15a
b Taxable amount . . . . .
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.
16a
b Taxable amount . . . . .
Pensions and annuities
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Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
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Farm income or (loss). Attach Schedule F
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Unemployment compensation
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Social security benefits
20a
b Taxable amount
21
Other income
22
Combine the amounts in the far right column for lines 7 through 21. This is your total income
23
Reserved
24
Certain business expenses of reservists, performing artists, and
.........................
30
....
Health savings account deduction. Attach Form 8889 . . . .
Moving expenses. Attach Form 3903 . . . . . . . . . . . .
Deductible part of self-employment tax. Attach Schedule SE .
Self-employed SEP, SIMPLE, and qualified plans . . . . . .
.........
Self-employed health insurance deduction
.
.
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Penalty on early withdrawal of savings
31a
Alimony paid b Recipient's SSN
32
IRA deduction
fee-basis government officials. Attach Form 2106 or 2106-EZ
25
26
27
28
29
33
34
35
36
37
....
Add numbers
on lines
above
2
85,500
2,209
2,500
13
14
15b
16b
17
18
19
20b
21
22
90,209
36
6,200
84,009
23
24
25
26
6,200
27
28
29
30
31a
. . . . . . . . . . . . . . . . . . . . . . . 32
Student loan interest deduction . . . . . . . . . . . . . . . 33
Reserved . . . . . . . . . . . . . . . . . . . . . . . . . 34
Domestic production activities deduction. Attach Form 8903 . 35
Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . . .
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
EEA
2
Dependents on 6c
not entered above
instructions and
Income
Spouse
37
Form 1040 (2015)
Form 1040 (2015) STRAW
Tax and
Credits
38
39a
All others:
Single or
Married filing
separately,
$6,300
Married filing
jointly or
Qualifying
widow(er),
$12,600
Head of
household,
$9,250
46
Form(s) 8814
b
Form 4972 c
12,600
71,409
8,000
63,409
8,216
40
41
42
43
44
45
46
8,216
1,340
6,876
61
. . . . . . . . . . . . . . . . . . . . 55
Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . .
56
Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . 57
a
Unreported social security and Medicare tax from Form:
4137 b
8919 . . . . 58
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . 59
Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . 60a
. . . . . . . . . . . . 60b
First-time homebuyer credit repayment. Attach Form 5405 if required
Health care: individual responsibility (see instructions) Full-year coverage
X . . . . . . . 61
62
Taxes from: a
48
49
50
51
52
53
54
Other credits from Form: a
55
3800
b
54
c
8801
Add lines 48 through 54. These are your total credits
56
58
59
Form 8959
b
Form 8960 c
Instructions; enter code(s)
62
72
.....................
Federal income tax withheld from Forms W-2 and 1099 . . . . 64
12,700
65
2015 estimated tax payments and amount applied from 2014 return . . .
Earned income credit (EIC) . . . . . . . . . . . . . . . . . 66a
Nontaxable combat pay election . . . 66b
. . . . . . . 67
Additional child tax credit. Attach Schedule 8812
American opportunity credit from Form 8863, line 8 . . . . . . 68
Net premium tax credit. Attach Form 8962 . . . . . . . . . . . 69
Amount paid with request for extension to file . . . . . . . . . 70
Excess social security and tier 1 RRTA tax withheld . . . . . . 71
Credit for federal tax on fuels. Attach Form 4136 . . . . . . . 72
73
Credits from Form: a
74
Add lines 64, 65, 66a, and 67 through 73. These are your total payments
.......
74
75
If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid
75
76a
Amount of line 75 you want refunded to you. If Form 8888 is attached, check here
76a
64
66a
b
67
Add lines 56 through 62. This is your total tax
b
Routing number
d
Account number
2439 b
8885
Reserved c
73
d
.
...
77
Amount of line 75 you want applied to your 2016 estimated tax
78
Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions
Estimated tax penalty (see instructions)
79
79
63
6,876
12,700
5,824
5,824
Savings
X X X X X X X X X c Type: Checking
X X X X X X X X X X X X X X X X X
77
78
...........
Do you want to allow another person to discuss this return with the IRS (see instructions)?
X
Yes. Complete below.
No
Designee's
Phone
Personal identification
name
no.
number (PIN)
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.
Your signature
Date
Your occupation
Daytime phone number
Preparer One
06004
Spouse's signature. If a joint return, both must sign.
02073
828-524-8020
1 2 3 4 5
01-01-2016VP OF OPERATIONS
Date
828-524-8020
Identity Protection PIN (see inst.)
Spouse's occupation
01-01-2016EVENT PLANNER
Preparer's signature
EEA
39b
47
47
71
Paid
Preparer
Use Only
39a
...............
Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . .
Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign tax credit. Attach Form 1116 if required . . . . . . . . 48
. . . 49
Credit for child and dependent care expenses. Attach Form 2441
Education credits from Form 8863, line 19 . . . . . . . . . . . 50
1,340
Retirement savings contributions credit. Attach Form 8880 . . . 51
Child tax credit. Attach Schedule 8812, if required . . . . . . . 52
. . . . . . . . . 53
Residential energy credit. Attach Form 5695
70
Joint return? See
instructions.
Keep a copy for
your records.
...
Alternative minimum tax (see instructions). Attach Form 6251
69
Sign
Here
If your spouse itemizes on a separate return or you were a dual-status alien, check here
45
68
Amount
You Owe
Third Party
Designee
boxes
} Total
checked
Tax (see instructions). Check if any from: a
65
Direct deposit?
See
instructions.
Blind.
44
42
63
Refund
Blind.
43
41
b
If you have a
qualifying
child, attach
Schedule EIC.
You were born before January 2, 1951,
Spouse was born before January 2, 1951,
Itemized deductions (from Schedule A) or your standard deduction (see left margin)
Subtract line 40 from line 38
60 a
Payments
{
400-00-6004 Page 2
38
84,009
........................
...
................................
Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions . .
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . . .
40
57
Other
Taxes
Check
if:
b
Standard
Deduction
for People who
check any
box on line
39a or 39b or
who can be
claimed as a
dependent,
see
instructions.
& BLUE BERRY
Amount from line 37 (adjusted gross income)
Preparer One
Preparer One
The Tax Firm
Firm's name
1040 Prep Lane
Firm's address
Franklin, NC 28734
Date
11-24-2015
Check
if
self-employed
PTIN
P01111111
Print/Type preparer's name
Firm's EIN
Phone no.
828-524-8020
Form 1040 (2015)
Interest and Ordinary Dividends
SCHEDULE B
OMB No. 1545-0074
(Form 1040A or 1040)
2015
Attach to Form 1040A or 1040.
Department of the Treasury
Internal Revenue Service
(99)
Information about Schedule B and its instructions is at www.irs.gov/scheduleb.
STRAW & BLUE BERRY
1
400-00-6004
Amount
List name of payer. If any interest is from a seller-financed mortgage and the
buyer used the property as a personal residence, see instructions and list
Interest
this interest first. Also, show that buyer's social security number and address
(See instructions
for Form 1040A,
or Form 1040,
line 8a.)
AVOCADO BANK
KIWI BANK
MELON SAVINGS
ORANGE BANK AND TRUST
PLANTAIN BANK
Note: If you
received a Form
1099-INT, Form
1099-OID, or
substitute
statement from
a brokerage firm,
list the firm's
name as the
payer and enter
the total interest
shown on that
form.
INTEREST SUBTOTAL
...............................
Add the amounts on line 1
3
Excludable interest on series EE and I U.S. savings bonds issued after 1989.
4
1
158
225
1,407
92
327
2
2,209
2,209
2
Attach Form 8815
...................................
3
Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form
1040, line 8a
...................................
Part II
5
2,209
4
Note: If line 4 is over $1,500, you must complete Part III.
Amount
List name of payer
MANGO HOLDINGS
PINEAPPLE INVESTMENTS
Ordinary
Dividends
300
2,200
(See instructions
for Form 1040A,
or Form 1040,
line 9a.)
5
Note: If you
received a Form
1099-DIV or
substitute
DIVIDEND SUBTOTAL
2,500
statement from
a brokerage firm,
list the firm's
name as the
payer and enter
the ordinary
Add the amounts on line 5. Enter the total here and on Form 1040A, or Form
6
dividends shown
1040, line 9a
6
on that form.
Note: If line 6 is over $1,500, you must complete Part III.
You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a
foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
...................................
Part III
Foreign
Accounts
and Trusts
08
Your social security number
Name(s) shown on return
Part I
Attachment
Sequence No.
7a
2,500
Yes
No
At any time during 2015, did you have a financial interest in or signature authority over a financial
account (such as a bank account, securities account, or brokerage account) located in a foreign
country? See instructions
.........................................
(See
If "Yes," are you required to file FinCEN Form 114, Report of Foreign Bank and Financial
instructions.)
Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114
and its instructions for filing requirements and exceptions to those requirements
b
X
..............
If you are required to file FinCEN Form 114, enter the name of the foreign country where the
financial account is located
8
During 2015, did you receive a distribution from, or were you the grantor of, or transferor to, a
foreign trust? If "Yes," you may have to file Form 3520. See instructions
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
..................
X
Schedule B (Form 1040A or 1040) 2015
Form
Education Credits
(American Opportunity and Lifetime Learning Credits)
8863
Department of the Treasury
Internal Revenue Service
(99)
50
Your social security number
400-00-6004
Complete a separate Part III on page 2 for each student for whom you are claiming either credit
before you complete Parts I and II.
CAUTION
Refundable American Opportunity Credit
1
After completing Part III for each student, enter the total of all amounts from all Parts III, line 30
2
Enter: $180,000 if married filing jointly; $90,000 if single, head of
household, or qualifying widow(er)
3
Attachment
Sequence No.
Information about Form 8863 and its separate instructions is at www.irs.gov/form8863.
STRAW & BLUE BERRY
Part I
2015
Attach to Form 1040 or Form 1040A.
Name(s) shown on return
!
OMB No. 1545-0074
........................
........
2
180,000
3
84,009
4
95,991
5
20,000
1
Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you
are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from
Puerto Rico, see Pub. 970 for the amount to enter
4
Subtract line 3 from line 2. If zero or less, stop; you cannot take any
education credit
5
.................................
Enter: $20,000 if married filing jointly; $10,000 if single, head of household,
or qualifying widow(er)
6
................
..............................
If line 4 is:
Equal to or more than line 5, enter 1.000 on line 6
.....................
......
Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to
at least three places)
...................................
7
6
1.000
Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet
the conditions described in the instructions, you cannot take the refundable American opportunity
credit; skip line 8, enter the amount from line 7 on line 9, and check this box
8
Refundable American opportunity credit. Multiply line 7 by 40% (.40). Enter the amount here and
on Form 1040, line 68, or Form 1040A, line 44. Then go to line 9 below
Part II
9
10
............
...................
8
.......
9
Nonrefundable Education Credits
Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions)
After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If
12
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Enter the smaller of line 10 or $10,000
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Multiply line 11 by 20% (.20)
13
Enter: $130,000 if married filing jointly; $65,000 if single, head of
zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19
11
household, or qualifying widow(er)
14
7
........................
13
130,000
14
84,009
15
45,991
16
20,000
10
11
12
6,700
6,700
1,340
Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you
are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from
Puerto Rico, see Pub. 970 for the amount to enter
15
Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0on line 18, and go to line 19
16
...........................
Enter: $20,000 if married filing jointly; $10,000 if single, head of household,
or qualifying widow(er)
17
................
.............................
If line 15 is:
Equal to or more than line 16, enter 1.000 on line 17 and go to line 18
Less than line 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at least three
18
.................................................
Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) . . . . .
19
Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see
places)
instructions) here and on Form 1040, line 50, or Form 1040A, line 33
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
.....................
17
18
19
1.000
1,340
1,340
Form 8863 (2015)
Form 8863 (2015)
Page 2
Your social security number
Name(s) shown on return
STRAW & BLUE BERRY
Complete Part III for each student for whom you are claiming either the American
opportunity credit or lifetime learning credit. Use additional copies of page 2 as needed for
each student.
!
CAUTION
Part III
400-00-6004
Student and Educational Institution Information
See instructions.
20 Student name (as shown on page 1 of your tax return)
21 Student social security number (as shown on page 1 of your tax return)
BLUE BERRY
400-00-2073
22 Educational institution information (see instructions)
a. Name of first educational institution
b. Name of second educational institution (if any)
UNIVERSITY OF COCONUT
(1)
Address. Number and street (or P.O. box). City, town or post
office, state, and ZIP code. If a foreign address, see instructions.
(1) Address. Number and street (or P.O. box). City, town or post
office, state, and ZIP code. If a foreign address, see instructions.
555 TROPICAL LANE
BALTIMORE, MD 21287
(2)
Did the student receive Form 1098-T
from this institution for 2015?
(3)
X
Yes
(2) Did the student receive Form 1098-T
No
from this institution for 2015?
Did the student receive Form 1098-T
from this institution for 2014 with Box
No
Yes
No
(3) Did the student receive Form 1098-T
Yes
X
No
from this institution for 2014 with Box 2
2 filled in and Box 7 checked?
If you checked "No" in both (2) and (3), skip (4).
(4)
Yes
filled in and Box 7 checked?
If you checked "No" in both (2) and (3), skip (4).
If you checked "Yes" in (2) or (3), enter the institution's
(4) If you checked "Yes" in (2) or (3), enter the institution's
federal identification number (from Form 1098-T).
federal identification number (from Form 1098-T).
40-9999999
23 Has the Hope Scholarship Credit or American opportunity credit
been claimed for this student for any 4 tax years before 2015?
X
Yes - Stop!
Go to line 31 for this student.
No - Go to line 24.
24 Was the student enrolled at least half-time for at least one
academic period that began or is treated as having begun in 2015
at an eligible educational institution in a program leading towards
Yes - Go to line 25.
No - Stop! Go to line 31
a postsecondary degree, certificate, or other recognized
for this student.
postsecondary educational credential? (see instructions)
25 Did the student complete the first 4 years of post-secondary
education before 2015?
Yes - Stop!
Go to line 31 for this
No - Go to line 26.
student.
26 Was the student convicted, before the end of 2015, of a
Yes - Stop!
felony for possession or distribution of a controlled
Go to line 31 for this
substance?
student.
!
CAUTION
No - Complete lines 27
through 30 for this student.
You cannot take the American opportunity credit and the lifetime learning credit for the same student in the same year. If
you complete lines 27 through 30 for this student, do not complete line 31.
American Opportunity Credit
. . . . . . . . . . . 27
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. . . . . . . . . . . 28
Subtract $2,000 from line 27. If zero or less, enter -0.
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. . . . . . . . . . . 29
Multiply line 28 by 25% (.25)
27 Adjusted qualified education expenses (see instructions). Do not enter more than $4,000
28
29
30 If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and
enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30 on Part I, line 1
.....
30
Lifetime Learning Credit
31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts
III, line 31, on Part II, line 10
EEA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
6,700
Form 8863 (2015)
Form
3903
Moving Expenses
OMB No. 1545-0074
170
Your social security number
Name(s) shown on return
STRAW & BLUE BERRY
Before you begin:
400-00-6004
See the Distance Test and Time Test in the instructions to find out if you can deduct your moving
expenses.
See Members of the Armed Forces in the instructions, if applicable.
......
Transportation and storage of household goods and personal effects (see instructions)
Travel (including lodging) from your old home to your new home (see instructions). Do not
.........................................
include the cost of meals
1
5,400
2
800
..............................................
3
6,200
3
Add lines 1 and 2
4
Enter the total amount your employer paid you for the expenses listed on lines 1 and 2 that is
not included in box 1 of your Form W-2 (wages). This amount should be shown in box 12 of your
.......................................
Form W-2 with code P
5
Attachment
Sequence No.
Attach to Form 1040 or Form 1040NR.
Internal Revenue Service (99)
1
2
2015
Information about Form 3903 and its instructions is available at www.irs.gov/form3903.
Department of the Treasury
...
4
Is line 3 more than line 4?
No. You cannot deduct your moving expenses. If line 3 is less than line 4, subtract line 3
from line 4 and include the result on Form 1040, line 7, or Form 1040NR, line 8.
X Yes. Subtract line 4 from line 3. Enter the result here and on Form 1040, line 26, or Form
1040NR, line 26. This is your moving expense deduction
General Instructions
Future Developments
For the latest information about developments
related to Form 3903 and its instructions, such as
legislation enacted after they were published, go
to www.irs.gov/form3903.
What's New
For 2015, the standard mileage rate for
using your vehicle to move to a new home
is 23 cents a mile.
..................
Moving Expenses You Can
Deduct
You can deduct the reasonable expenses
of moving your household goods and
personal effects and of traveling from your
old home to your new home. Reasonable
expenses can include the cost of lodging
(but not meals) while traveling to your new
home. You cannot deduct the cost of
sightseeing trips.
Purpose of Form
Use Form 3903 to figure your moving
expense deduction for a move related to
the start of work at a new principal place
of work (workplace). If the new workplace
is outside the United States or its
possessions, you must be a U.S. citizen or
resident alien to deduct your expenses.
If you qualify to deduct expenses for
more than one move, use a separate Form
3903 for each move.
For more details, see Pub. 521, Moving
Expenses.
Who Can Deduct Moving
Expenses
If you move to a new home because of a
new principal workplace, you may be able
to deduct your moving expenses whether
you are self-employed or an employee. But
you must meet both the distance and time tests
that follow. Also, your move must be closely
related both in time and place to the start of
work at your new job location. For more details,
see Pub. 521.
TIP
6,200
5
Members of the Armed Forces
may not have to meet the distance
and time tests. See Members of the
Armed Forces later in the instructions.
Distance Test
Your new principal workplace must be at
least 50 miles farther from your old home
than your old workplace was. For example,
if your old workplace was 3 miles from
your old home, your new workplace must
be at least 53 miles from that home. If you
did not have an old workplace, your new
workplace must be at least 50 miles from
your old home. The distance between the
two points is the shortest of the more
commonly traveled routes between them.
TIP
Distance Test Worksheet
To see if you meet the
distance test, you can
use the worksheet
below.
Keep a Copy for Your Records
1. Number of miles from your old home to your new workplace
. . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2,500
miles
2. Number of miles from your old home to your old workplace
. . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
10
miles
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 2,490
miles
3. Subtract line 2 from line 1. If zero or less, enter -0Is line 3 at least 50 miles?
X
Yes. You meet this test.
No. You do not meet this test. You cannot deduct your moving expenses. Do not complete Form 3903.
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
Form 3903 (2015)