2014 Tax Return Documents (SAMUELSON
Transcription
2014 Tax Return Documents (SAMUELSON
Form (99) 1040 U.S. Individual Income Tax Return 2014 Department of the Treasury - Internal Revenue Service For the year Jan. 1-Dec. 31, 2014, or other tax year beginning Your first name and initial OMB No. 1545-0074 , 2014, ending IRS Use Only-Do not write or staple in this space. See separate instructions. , 20 Your social security number Last name MICHAEL SAMUELSON If a joint return, spouse's first name and initial 400-00-6004 Spouse's social security number Last name ELIZABETH SAMUELSON 400-00-2073 Home address (number and street). If you have a P.O. box, see instructions Apt. no. Make sure the SSN(s) above and on line 6c are correct. 219 PASADENA AVE City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Sacramento CA Foreign country name Presidential Election Campaign 95841 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 Single X 3 Exemptions 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. .......... } . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . b X X c Dependents: 6a Yourself. If someone can claim you as a dependent, do not check box 6a Spouse (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 . . . . . . . . . . . . . . . . . . . . . 9b Qualified dividends 1,800 . . . . . . . . . . . . . 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 ......................... . . . . . 15a b Taxable amount . . . . . IRA distributions . . 16a b Taxable amount . . . . . Pensions and annuities .. Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . . . . . . . . . . . . . . . . . . . . .. Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Unemployment compensation . . . . . . . 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 . . ......... 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 82,500 1,417 2,500 13 14 15b 16b 17 18 19 20b 21 22 86,417 36 8,050 78,367 23 24 25 26 8,050 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 (2014) Form 1040 (2014) MICHAEL Tax and Credits Standard Deduction for People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. All others: Single or Married filing separately, $6,200 Married filing jointly or Qualifying widow(er), $12,400 Head of household, $9,100 38 39a b a Form(s) 8814 46 39b b Form 4972 c 12,400 65,967 7,900 58,067 7,534 40 41 42 43 44 45 46 47 7,534 1,660 5,874 61 . . . . . . . . . . . . . . . . . . . . 55 56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . . 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 . . . . . . . 61 Health care: individual responsibility (see instructions) Full-year coverage 62 Taxes from: a 47 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) 145 62 72 ..................... Federal income tax withheld from Forms W-2 and 1099 . . . . 64 11,850 65 2014 estimated tax payments and amount applied from 2013 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 b d Add lines 56 through 62. This is your total tax Routing number Account number 2439 b Reserved c 73 Reserved d . ... 77 Amount of line 75 you want applied to your 2015 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 6,019 11,850 5,831 5,831 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)? Yes. Complete below. 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 06004 02073 Date Firm's name Firm's address No Identity Protection PIN (see inst.) Spouse's occupation 01-01-2015CLERK Date RICK K Print/Type preparer's name X 01-01-2015COMPUTER PROGRAMMER Spouse's signature. If a joint return, both must sign. Preparer's signature EEA 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 . . . . . . . . . . . 50 Education credits from Form 8863, line 19 1,660 . . . 51 Retirement savings contributions credit. Attach Form 8880 Child tax credit. Attach Schedule 8812, if required . . . . . . . 52 . . . . . . . . . 53 Residential energy credit. Attach Form 5695 71 Paid Preparer Use Only ... Alternative minimum tax (see instructions). Attach Form 6251 70 Joint return? See instructions. Keep a copy for your records. If your spouse itemizes on a separate return or you were a dual-status alien, check here 45 69 Sign Here boxes } Total checked Tax (see instructions). Check if any from: 68 Amount You Owe Third Party Designee Blind. 44 42 65 Direct deposit? See instructions. Blind. 43 41 63 Refund You were born before January 2, 1950, Spouse was born before January 2, 1950, Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line 40 from line 38 b If you have a qualifying child, attach Schedule EIC. { 400-00-6004 Page 2 38 78,367 ........................ ... ................................ Exemptions. If line 38 is $152,525 or less, multiply $3,950 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 60 a Payments Check if: 57 Other Taxes & ELIZABETH SAMUELSON Amount from line 37 (adjusted gross income) 12-18-2014 RICK K Drake Software 235 East Palmer Street Franklin, NC 28734 Check if self-employed Firm's EIN Phone no. PTIN P12354678 11-1222333 828-524-8020 Form 1040 (2014) Interest and Ordinary Dividends SCHEDULE B OMB No. 1545-0074 2014 (Form 1040A or 1040) 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. MICHAEL & ELIZABETH SAMUELSON 1 Amount this interest first. Also, show that buyer's social security number and address ILLS FARGO BANK ILLS FARGO BANK KATTYBANK TT AND B BANK WAKO BANK WAKO BANK INTEREST SUBTOTAL 1,417 ............................... Add the amounts on line 1 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. 4 ................................... ................................... 3 1,417 4 Amount Note. If line 4 is over $1,500, you must complete Part III. 5 List name of payer DOMINION RESOURCES INFIDELITY INVESTMENT COMPANY 300 2,200 (See instructions for Form 1040A, or Form 1040, line 9a.) Part III Foreign Accounts and Trusts 1,417 2 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a Note. If you received a Form 1099-DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. 259 99 35 194 410 420 1 2 Attach Form 8815 Part II Ordinary Dividends 400-00-6004 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 (See instructions for Form 1040A, or Form 1040, line 8a.) 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. 08 Your social security number Name(s) shown on return Part I Interest Attachment Sequence No. 5 DIVIDEND SUBTOTAL 6 2,500 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a ................................... 6 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. 7a 2,500 Yes No At any time during 2014, 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 instructions.) ......................................... X If "Yes," are you required to file FinCEN Form 114, Report of Foreign Bank and Financial 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 2014, 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) 2014 Form 3903 Moving Expenses OMB No. 1545-0074 170 Your social security number Name(s) shown on return MICHAEL & ELIZABETH SAMUELSON 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 7,250 2 800 .............................................. 3 8,050 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 2014 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 2014, the standard mileage rate for using your vehicle to move to a new home is 23.5 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 8,050 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. 2,350 miles 2. Number of miles from your old home to your old workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 5 miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 2,345 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 (2014) Form Education Credits (American Opportunity and Lifetime Learning Credits) 8863 Department of the Treasury Internal Revenue Service (99) Attachment Sequence No. Information about Form 8863 and its separate instructions is at www.irs.gov/form8863. 50 Your social security number MICHAEL & ELIZABETH SAMUELSON 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 2014 Attach to Form 1040 or Form 1040A. Name(s) shown on return Part I OMB No. 1545-0074 ........................ ........ 2 180,000 3 78,367 4 101,633 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 ...................... . . . . . . . . . . . . . . ...................... Enter the smaller of line 10 or $10,000 . . . . . . . . . . . . . . . . . . ...................... Multiply line 11 by 20% (.20) 13 Enter: $128,000 if married filing jointly; $64,000 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 ........................ 13 128,000 14 78,367 15 49,633 16 20,000 10 11 12 8,300 8,300 1,660 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 1,660 1,660 Form 8863 (2014) Form 8863 (2014) Page 2 Your social security number Name(s) shown on return MICHAEL & ELIZABETH SAMUELSON 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) ELIZABETH SAMUELSON 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 NURSING (1) (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. 99 EAST PALMER STREET Sacramento, CA 95841 (2) Did the student receive Form 1098-T from this institution for 2014? (3) Yes X No Yes X No (2) Did the student receive Form 1098-T from this institution for 2014? Did the student receive Form 1098-T from this institution for 2013 with Box No Yes No (3) Did the student receive Form 1098-T from this institution for 2013 with Box 2 filled in and Box 7 checked? If you checked "No" in both (2) and (3), skip (4). (4) Yes 2 filled in and Box 7 checked? If you checked "No" in both (2) and (3), skip (4). (4) If you checked "Yes" in (2) or (3), enter the institution's If you checked "Yes" in (2) or (3), enter the institution's federal identification number (from Form 1098-T). 23 Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2014? federal identification number (from Form 1098-T). 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 2014 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 2014? Yes - Stop! Go to line 31 for this No - Go to line 26. student. 26 Was the student convicted, before the end of 2014, of a Yes - Stop! felony for possession or distribution of a controlled Go to line 31 for this substance? student. TIP No - Complete lines 27 through 30 for this student. You cannot take the American opportunity credit and 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Subtract $2,000 from line 27. If zero or less, enter -0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 8,300 Form 8863 (2014) Form IRS e-file Signature Authorization 8879 Department of the Treasury Internal Revenue Service Submission Identification Number (SID) Social security number MICHAEL SAMUELSON 400-00-6004 Spouse's social security number Spouse's name ELIZABETH SAMUELSON 1 2 3 4 5 2014 00-777777-060045 Taxpayer's name Part I OMB No. 1545-0074 Do not send to the IRS. This is not a tax return. Keep this form for your records. Information about Form 8879 and its instructions is at www.irs.gov/form8879. 400-00-2073 Tax Return Information - Tax Year Ending December 31, 2014 (Whole Dollars Only) ............ . . . . . . . ............ Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12) Federal income tax withheld (Form 1040, line 64; Form 1040A, line 40; Form 1040EZ, line 7) . . . . . . . . . . .. Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a) . . . . . . . . . . . . . .. Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14) Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4) Part II 1 2 3 4 78,367 6,019 11,850 5,831 5 Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return) Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31, 2014, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidenital information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent. Taxpayer's PIN: check one box only X I authorize Drake Software to enter or generate my PIN ERO firm name 06004 Enter five digits, but do as my signature on my tax year 2014 electronically filed income tax return. not enter all zeros I will enter my PIN as my signature on my tax year 2014 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Your signature Date Spouse's PIN: check one box only X I authorize Drake Software to enter or generate my PIN ERO firm name as my signature on my tax year 2014 electronically filed income tax return. 02073 Enter five digits, but do not enter all zeros I will enter my PIN as my signature on my tax year 2014 electronically filed income tax return. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. Spouse's signature Date Practitioner PIN Method Returns Only - continue below Part III Certification and Authentication - Practitioner PIN Method Only ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 777777-12345 Do not enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the tax year 2014 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Publication 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. ERO's signature RICK K Date 12-18-2014 ERO Must Retain This Form - See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So For Paperwork Reduction Act Notice, see your tax return instructions. EEA Form 8879 (2014) Department of the Treasury - Internal Revenue Service 9325 Form (Rev. January 2014) Acknowledgement and General Information for Taxpayers Who File Returns Electronically Thank you for participating in IRS e-file. Taxpayer name MICHAEL & ELIZABETH SAMUELSON Taxpayer address (optional) 219 PASADENA AVE Sacramento, CA 95841 1. X 2014 Your federal income tax return for 2. Your return was accepted on FRESNO Drake Software was filed electronically with the Submission Processing Center. The electronic filing services were provided by . using a Personal Identification Number (PIN) as your electronic signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN for you. The Submission ID assigned to your return is 3. Your return was accepted on . . Allow 4 to 6 weeks for the processing of your return. The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a child's name and social security number mismatch. 4. Your electronic funds withdrawal payment was accepted. 5. Your electronic funds withdrawal payment was not accepted. You must pay the balance due by the prescribed due date. Refer to the "If You Owe Tax" section. 6. Your Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, was accepted on is . The Submission ID assigned to your extension . PLEASE DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS. IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN. If You Need to Make a Change to Your Return If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S. Individual Income Tax Return, to the IRS Submission Processing Center that processes paper returns for your area. The address is available at www.irs.gov, or you can call the IRS toll-free at 1-800-829-1040. If You Need to Ask About Your Refund The IRS notifies your Electronic Return Originator (ERO) when your return is accepted, usually within 48 hours. If your return was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks since the IRS accepted your return and you have not received your refund, go to www.irs.gov and click on "Where's My Refund?" to view your refund status. Exception: If box 3 above is checked, please allow 4 to 6 weeks for processing of your return. A notice will be sent to you advising of changes to your return. Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the first social security number shown on your return, your filing status, and the exact amount of the refund you expect. TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive it by then, or if TeleTax does not give your refund information, call the Refund Hotline at 1-800-829-1954. EEA Form 9325 (Rev. 1-2014) The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fiscal Service offsets refunds through the Treasury Offset Program to cover past due child support, federal agency non-tax debts such as student loans and state income tax obligations. Fiscal Service sends you an offset notice if it applies your refund or part of your refund to non-tax debts. If you have questions about the offset, contact the agency identified in the notice. You may also call the Treasury Offset Program Call Center at 1-800-304-3107, if you have additional questions. If You Owe Tax If your return has a balance due, you must pay the amount you owe by the prescribed due date. If you paid by electronic funds withdrawal (direct debit) or by credit card, no voucher is needed. The credit card service providers will charge a convenience fee based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option to either continue or end the transaction. For information on paying your taxes electronically, including by credit or debit card, go to www.irs.gov/e-pay. If you are not paying electronically you may use Form 1040-V, Payment Voucher, which you can obtain from your Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a notice that requests full payment of the tax due, plus penalties and interest. If you can not pay the amount in full, complete Form 9465, Installment Agreement Request, which you may file electronically. To apply for an installment agreement online, go to www.irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM (1-800-829-3676). If approved, the IRS charges a user fee to set up an installment agreement. If You Need to Inquire About Your Electronic Funds Withdrawal Payment You may call 1-888-353-4537 to inquire about the status of your electronic funds withdrawal payment. If there is a change to the bank account information included on your return, you should call this number to cancel a scheduled payment. You should have available the social security number of the first person listed on the tax return, the payment amount, and the bank account number. Cancellation requests must be received no later than 11:59 p.m. E.T. two business days prior to the scheduled payment date. Tax Refund Related Financial Products Financial institutions offer a variety of financial products to taxpayers based on their refunds. Contracts for financial products are between you and the financial institution. The IRS is not associated with the contract. If you have questions about tax refund related products, contact your Electronic Return Originator or the lender. Instructions for Electronic Return Originators Line 2 - PIN Presence Indicator - Check box 2 if the taxpayer entered a PIN or authorized the ERO to enter or generate the PIN for the taxpayer, and the Acknowledgement File PIN Presence Indicator is a "Practitioner PIN," "Self-Select PIN" or "Online Filer PIN." Form 8879, IRS e-file Signature Authorization, is required if the ERO enters or generates the PIN or if the Practitioner PIN method is used. Use Form 8453, U.S. Individual Income Tax Transmittal for an IRS e-file Return, to send required paper forms or supporting documentation listed next to the form check boxes (do not send Forms W-2, W-2G, or 1099R). Line 3 - Exception Processing - Check box 3 if the Acknowledgement File Acceptance Code equals "Exception." The acceptance code indicates that this return has been previously rejected and this subsequent submission still has invalid data. Line 4 - Payment Acknowledgement Literal - Check box 4 if the taxpayer requested to use electronic funds withdrawal to pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field equals "Payment Request Received." Line 5 - Payment Acknowledgement Literal - Check box 5 if the taxpayer requested to use electronic funds withdrawal to pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field does not equal "Payment Request Received." If box 5 is checked, inform the taxpayer that he/she must pay by check, money order, debit card, or credit card. Note: EROs can use the Acknowledgement File information, translated by the transmitter, to complete Form 9325. MICHAEL & ELIZABETH SAMUELSON EEA Form 9325 (Rev. 1-2014) Shared Responsibility Payment Worksheet 2014 Name as shown on return Social Security Number MICHAEL SAMUELSON 400-00-6004 If you or another member of your tax household had neither minimum essential coverage nor a coverage exemption for any month during 2014, use the Shared Responsibility Payment Worksheet, below, to figure your shared responsibility payment. You will enter the amount from line 14 of the worksheet on Form 1040, line 61; Form 1040A, line 38; or Form 1040EZ, line 11. Complete the monthly columns by placing "X's" in each month in which you or another member of your tax household had neither minimum essential coverage nor a coverage exemption. Name Jan Feb Mar Apr May Jun X X X X X X MICHAEL SAMUELS ELIZABETH SAMUE Jul Aug Sep Oct Nov Dec 1. Total number of X's in a month. If 5 or more, enter 5 ....... 0 0 0 2 2 2 0 0 0 0 0 0 0 0 0 2 2 2 0 0 0 0 0 0 2. Total number of X's in a month for individuals 18 or over* ........ 3. One-half the number of X's in a month for individuals under 18* ...... 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.0 2.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 190.0 190.0 190.0 0.0 0.0 0.0 0.0 0.0 0.0 4. Add lines 2 and 3 for each month ....... 5. Multiply line 4 by $95 for each month. If $285 or more, enter $285 ... ................................ 6 Enter your household income (see Household income) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78,367.00 . . . . . . . . . . . . . . . . . . . . . . . . . . 20,300.00 Enter your filing threshold (see Filing Thresholds For Most People) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58,067.00 Subtract line 8 from line 7 . . . . . . . . . . . . . . . . . . . . .......................... Multiply line 9 by 1% (.01) 580.67 6. Sum of the number of X's on line 1 above for the year 7. 8. 9. 10. 11. Is line 10 more than $285? X Yes. Multiply line 10 by the number of months for which line 1 is more than zero No. Enter the amount from line 14 of the Flat Dollar Amount Worksheet 12. Divide line 11 by 12.0 13. Multiply line 6 by $204 } ................ ................................................ ................................................ 1,742.01 145.17 1,224.00 14. Enter the smaller of line 12 or line 13 here and on Form 1040, line 61; Form 1040A, line 38; or Form 1040EZ, line 11. This is your shared responsibility payment ............................. Rounded amount will carry to main form 145.17 145 *For purposes of figuring the shared responsibility payment, an individual is considered under 18 for an entire month if he or she did not turn 18 before the first day of the month. An individual turns 18 on the anniversary of the day the individual was born. For example, someone born on March 1, 1999, is considered age 18 on March 1, 2017. WK_89651.LD EEA Flat Dollar Amount Worksheet and Household Income Worksheets for Form 8965 2014 (Keep for your records) Name as shown on return Social Security Number MICHAEL SAMUELSON 400-00-6004 Flat Dollar Amount Worksheet ! CAUTION Do not complete this worksheet unless the amount on line 10 of the Shared Responsibility Payment Worksheet is less than $285. For each month, is the amount on line 5 of the Shared Responsibility Payment Worksheet less than the amount on line 10 of the Shared Responsibility Payment Worksheet?* 1. ............................................ February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Add the amounts in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Enter the amount Enter the amount from line 10 from line 5 January 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Add the amounts on line 13 of both columns. Enter the result on line 11 of the Shared Responsibility Payment Worksheet .......................................... *If the amount on line 1 of the Shared Responsibility Payment Worksheet is -0- for any month, leave both columns of this worksheet blank for that month. Household Income Worksheet ... 1. 78,367 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Amount from Dependents' Combined Modified AGI Worksheet, line 5 . . . . . . . . . . . . . . . . . . . . . . . . 6. Household income. Add lines 1, 5, and 6. Enter here and on the Shared Responsibility Payment Worksheet, line 7 . . 7. 0 78,367 . . . . . . . . . . . . . . . . 8. .................... Household income for computing Coverage Exemption A. Add lines 7 and 8. 78,367 1. Enter your adjusted gross income (AGI) from Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 37 2. Enter any tax-exempt interest from Form 1040, line 8b; Form 1040A, line 8b; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . . . . . 3. Enter any amounts from Form 2555, lines 45 and 50, and Form 2555-EZ, line 18 Form 1040NR, line 9b 3. 4. 4. 5. Modified AGI. Add lines 2 through 4. 6. 7. 8. Premiums paid through a salary reduction arrangement 9. 9. Dependents' Combined Modified AGI Worksheet - Line 2b 1. Enter the AGI for your dependents from Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 3; and Form 1040NR, line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Enter any tax-exempt interest for your dependents from Form 1040, line 8b; Form 1040A, line 8b; Form 1040EZ, the amount written to the left of the line 2 entry space; and Form 1040NR, line 9b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Enter any amounts for your dependents from Form 2555, lines 45 and 50, and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4. Add lines 2 and 3 Add lines 1 and 4. Enter here and on Household Income Worksheet, line 6 . . . . . . . . . . . . . . . . . . . . . 5. Form 2555-EZ, line 18 4. 5. The FILING THRESHOLD for this return is WK_89652.LD EEA ................................... 20,300 2014 Credit Limit Worksheet Name SSN MICHAEL & ELIZABETH SAMUELSON 400-00-6004 . . . . . . 1. 7,534 . . . . . . . . 2. Foreign tax credit amount from Form 1040, line 48 or Form 1040NR line 46 . . . . . . . . . . . . . . . . .. . Subtract line 2 from line 1. Enter this amount on Form 2441, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Amount from Form 2441, line 11 . ................. Subtract line 4 from line 3. Enter this amount on Schedule R, line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Amount from Schedule R, line 22 . . . . . . . . . . . . . . . 7. Enter amount from Form 8863, line 18 1,660 Subtract line 6 from line 5 . . . . . . . . . . . . . . . . . . . . . 8. 7,534 1. Amount from Form 1040, line 47; Form 1040A, line 30; or Form 1040NR line 45 2. 3. 4. 5. 6. 7. 8. 3. 7,534 5. 7,534 9. Enter the smaller of line 7 or line 8. Nonrefundable lifetime . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Enter amount from Form 8863, line 9 . . . . . . . . . . . . . . . . 10. Subtract line 9 from line 8. . . . . . . . . . . . . . . . . . . . . . 11. learning credit 10. 11. 1,660 5,874 12. Enter the smaller of line 10 or line 11. Nonrefundable American . . . . . . . . . . . . . . . . . . . . . . . . .12. Add line 9 and line 12. Enter this amount on Form 8863, line 23 . . . . . . . . . . . . . . . . . . . . . . . 13. . . . . . . . . . . . . . . . . . . . . 14. Subtract line 13 from line 8. Enter this amount on Form 8880, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15. Amount from Form 8880, line 12 . . . . . . . . . . . . . . . . . . . . 16. Subtract line 15 from line 14. Enter this amount on Form 5695, line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17. Amount from Form 5695, line 14 . . . . . . . . . . . . . . . . . . . . 18. Subtract line 17 from line 16. Enter this amount on Form 8834, line 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19. Amount from Form 8834, line 23 . . . . . . . . . . . . . . . . . . . . 20. Subtract line 19 from line 18. Enter this amount on Form 8910, line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21. Amount from Form 8910, line 22 . . . . . . . . . . . . . . . . . . . . 22. Subtract line 21 from line 20. Enter this amount on Form 8936, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23. Amount from Form 8936, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . .24. Amount from Line 12 of WK_8812.PG2 . . . . . . . . . . . . . . . . 25. Subtract lines 23 and 24 from line 22. Enter this amount on Form 8396, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26. Amount from Form 8396, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27. Subtract line 26 from line 25 5,874 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28. Amount from Form 8839, line 14 . . . . . . 29. Enter the smaller of line 27 or line 28. Enter this amount on Form 8839, line 12 . . . . . . . . . . . . . . . . . . . . 30. Subtract line 29 from line 27. Enter this amount on Form 8859, line 8 Opportunity credit 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. CRED_LMT.LD 1,660 5,874 5,874 5,874 5,874 5,874 5,874 5,874 a b Safe, accurate, FAST! Use Employee's social security number 400-00-6004 OMB No. 1545-0008 1 Employer identification number (EIN) Wages, tips, other compensation 61-9514555 c 3 Social security wages 5 Medicare wages and tips 7 Social security tips MAYFLOWER TECHNOLOGIES e Employee's first name and initial MICHAEL 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 8,500 55,000 1522 CAPITAL BLVD Raleigh Control number Visit the IRS website at www.irs.gov/efile 55,000 Employer's name, address, and ZIP code d IRS e-file 3,410 55,000 NC 27604 9 Last name Suff. SAMUELSON 219 PASADENA AVE Sacramento 11 13 10 Statutory employee Dependent care benefits 12a See instructions for box 12 Nonqualified plans C o d e Retirement plan Third-party sick pay 12b C o d e 12c 14 Other CA 798 C o d e 95841 12d C o d e f Employee's address and ZIP code 15 State Form 16 State wages, tips, etc. Employer's state ID number 17 State income tax 18 Local wages, tips, etc. 2014 and Tax W-2 Wage Statement 19 Local income tax 20 Locality name Department of the Treasury-Internal Revenue Service Copy B - To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. EEA The information on the Form W-2 was used to prepare the taxpayer's 2014 Federal tax return by Drake Software a Employee's social security number Safe, accurate, Visit the IRS website at 400-00-6004 b 1 Employer identification number (EIN) Wages, tips, other compensation 95-9596543 c 3 Social security wages 5 Medicare wages and tips 7 Social security tips SMT SOLUTIONS INC e Employee's first name and initial MICHAEL 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 2,500 19,500 9150EMBERS BLVD Sacramento Control number www.irs.gov/efile 19,500 Employer's name, address, and ZIP code d IRS e-file FAST! Use OMB No. 1545-0008 1,209 19,500 CA 95841 9 Last name Suff. SAMUELSON 219 PASADENA AVE Sacramento 11 13 10 Statutory employee Retirement plan 95841 Dependent care benefits 12a See instructions for box 12 Nonqualified plans 14 Other CA 283 C o d e Third-party sick pay 12b C o d e 12c C o d e 12d C o d e f Employee's address and ZIP code 15 State Form Employer's state ID number 16 State wages, tips, etc. and Tax W-2 Wage Statement 17 State income tax 2014 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Department of the Treasury-Internal Revenue Service Copy B - To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. EEA The information on the Form W-2 was used to prepare the taxpayer's 2014 Federal tax return by Drake Software a b Safe, accurate, FAST! Use Employee's social security number 400-00-2073 OMB No. 1545-0008 1 Employer identification number (EIN) Wages, tips, other compensation 14-8871749 c 3 Social security wages 5 Medicare wages and tips 7 Social security tips CERTIFIED PEST CONTROL e Employee's first name and initial ELIZABETH 2 Federal income tax withheld 4 Social security tax withheld 6 Medicare tax withheld 8 Allocated tips 850 8,000 9100 MADISON AVE Sacramento Control number Visit the IRS website at www.irs.gov/efile 8,000 Employer's name, address, and ZIP code d IRS e-file 496 8,000 CA 95841 9 Last name Suff. SAMUELSON 219 PASADENA AVE Sacramento 11 13 10 Statutory employee Retirement plan 95841 Dependent care benefits 12a See instructions for box 12 Nonqualified plans 14 Other CA 116 C o d e Third-party sick pay 12b C o d e 12c C o d e 12d C o d e f Employee's address and ZIP code 15 State Form Employer's state ID number 16 State wages, tips, etc. and Tax W-2 Wage Statement 17 State income tax 2014 18 Local wages, tips, etc. 19 Local income tax 20 Locality name Department of the Treasury-Internal Revenue Service Copy B - To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Internal Revenue Service. EEA The information on the Form W-2 was used to prepare the taxpayer's 2014 Federal tax return by Drake Software Qualified Dividends and Capital Gain Tax Worksheet - Line 44 (Form 1040) Line 28 (Form 1040A) (Keep for Your Records) NAME SSN MICHAEL & ELIZABETH SAMUELSON Before you begin: 400-00-6004 See the instructions for line 44 to see if you can use this worksheet to figure your tax. Before completing this worksheet, complete Form 1040 through line 43. If you do not have to file Schedule D and you received capital gain distributions, be sure you checked the box on line 13 of Form 1040. 1. Enter the amount from Form 1040, line 43 (Form 1040A, line 27). However, if you are filing Form 2555 or 2555-EZ (relating to foreign earned income), enter the amount from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Enter the amount from Form 1040, line 9b (Form 1040A, line 9b)* . . . . . . . . . . . . . . . . . . . . . . . 2. line 3 of the Foreign Earned Income Tax Worksheet 2. 58,067 1,800 3. Are you filing Schedule D?* Yes. Enter the smaller of line 15 or 16 of Schedule D. If either ............. line 15 or line 16 is blank or a loss, enter -0- X No. 3. Enter the amount from Form 1040, line 13 (or Form 1040A, line 10) 4. Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 1,800 5. If filing Form 4952 (used to figure investment interest expense deduction), . . . . . . . . . . . . . . . . . . . . . . . 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. enter any amount from line 4g of that form. Otherwise, enter -06. Subtract line 5 from line 4. If zero or less, enter -07. Subtract line 6 from line 1. If zero or less, enter -0- 1,800 56,267 8. Enter: $36,900 if single or married filing separately, ...................... 8. 73,800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Enter the smaller of line 7 or line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10. Subtract line 10 from line 9. This amount is taxed at 0% . . . . . . . . . . . . . . . . . . . . . . . . . . . .11. Enter the smaller of line 1 or line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12. Enter the amount from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13. Subtract line 13 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14. 58,067 56,267 1,800 1,800 1,800 $73,800 if married filing jointly or qualifying widow(er), $49,400 if head of household. 9. Enter the smaller of line 1 or line 8 10. 11. 12. 13. 14. 15. Enter: $406,750 is single, $228,800 if married filing separately, . . . . . . . . . . . . . . . . . . . . . . 15. 450,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17. Add lines 7 and 11 Subtract line 17 from line 16. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18. Enter the smaller of line 14 or line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19. Multiply line 19 by 15% (.15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20. Add lines 11 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21. Subtract line 21 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22. Multiply line 22 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23. 58,067 58,067 $457,600 if married filing jointly or qualifying widow(er), $432,200 if head of household. 16. Enter the smaller of line 1 or line 15 17. 18. 19. 20. 21. 22. 23. 1,800 24. Figure the tax on the amount on line 7. If the amount on line 7 is less than $100,000, use the Tax Table . . . . . . 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25. to figure this tax. If the amount on line 7 is $100,000 or more, use the Tax Computation Worksheet 25. Add lines 20, 23 and 24 26. Figure the tax on the amount on line 1. If the amount on line 1 is less than $100,000, use the Tax Table to figure the tax. If the amount on line 1 is $100,000 or more, use the Tax Computation Worksheet . . . . . . 26. 7,534 7,534 7,804 27. Tax on all taxable income. Enter the smaller of line 25 or line 26. Also include this amount on Form 1040, line 44 (Form 1040A, line 28). If you are filing Form 2555 or 2555-EZ, do not enter this amount on Form 1040, line 44 (or Form 1040A, line 28). Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet . 27. *If you are filing Form 2555 or 2555-EZ, see the footnote in the Foreign Earned Income Tax Worksheet before completing this line. WK_CGTAX.LD EEA 7,534 Investment Income If You Are Filing Form 1040 FORM 1040 2014 Name as shown on return Your Social Security Number MICHAEL & ELIZABETH SAMUELSON 400-00-6004 Keep for Your Records Interest and Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. . . . . . . . . . . . . . . . 2. Enter any amount from Form 1040, line 8b, plus any amount on Form 8814, line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Enter any amount from Form 1040, line 9a 1. Enter any amount from Form 1040, line 8a 2. 3. 1,417 2,500 4. Enter the amount from Form 1040, line 21, that is from Form 8814 if you are filing that form to report your child's interest and dividend income on your return. (If your child received an Alaska Permanent Fund dividend, use Worksheet 2, on the next page, to figure the amount to enter on this line.) .......... 4. Capital Gain Net Income 5. Enter the amount from Form 1040, line 13. If the amount on that line is a loss, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 6. Enter any gain from Form 4797, Sales of Business Property, line 7. If the amount on that line is a loss, enter -0-. (But, if you completed lines 8 and 9 of Form 4797, enter the amount from line 9 instead.) . . . . . . . . . . . . . . . . 6. 7. Subtract line 6 of this worksheet from line 5 of this worksheet. (If the result is less than zero, enter -0-.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7. Royalties and Rental Income from Personal Property 8. Enter any royalty income from Schedule E, line 4, plus any income from the rental of personal property shown on Form 1040, line 21, minus any expenses from Schedule E, line 20, related to royalty income, plus any expenses from the rental of personal property deducted on Form 1040, line 36 of personal property deducted on Form 1040, line 36 (If the result is less than zero, enter -0-.) ............... 8. Passive Activities 9. Enter the total of any net income from passive activities (such as income included on Schedule E, lines 26, 29a (col. (g)), 34a (col. (d)), or 40) and the total of any losses from passive activities (included on Schedule E, lines 26, 29b (col. (f)), 34b (col. (c)), or 40). (See instructions below for line 9.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Adjustment from EIC screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10. . . . . . . 11. Add the amounts on lines 1, 2, 3, 4, 7, 8, 9 and 10. Enter the total. This is your Investment Income (if zero or less, enter -0-.) 10. 11. 12. Is the amount on line 11 more than $3,300? X Yes. You cannot take the credit. No. Go to Step 3 of the Form 1040 instructions for lines 64a and 64b to find out if you can take the credit (unless you are using this publication to find out if you can take the credit; in that case, go to Rule 7, next). Instructions for line 9. In figuring the amount to enter on line 9, do not take into account any royalty income (or loss) included on line 26 of Schedule E or any amount included in your earned income. To find out if the income on line 26 or line 40 of Schedule E is from a passive activity, see the Schedule E instructions. If any of the rental real estate income (or loss) included on Schedule E, line 26, is not from a passive activity, print "NPA" and the amount of that income (or loss) on the dotted line next to line 26. WK_EIC4_.LD EEA 0 3,917 W-2 Detail Listing 2014 Name(s) as shown on return Social Security No. MICHAEL & ELIZABETH SAMUELSON 400-00-6004 FEDERAL T/S Employer Name Gross W/H STATE State Code Gross W/H T MAYFLOWER TECHNOLOGIES 55,000 8,500 T SMT SOLUTIONS INC 19,500 2,500 S CERTIFIED PEST CONTROL 8,000 850 _______________________________________________________________________ Taxpayer Totals _______________________________________________________________________ 74,500 11,000 Spouse Totals _______________________________________________________________________ 8,000 850 Totals _______________________________________________________________________ 82,500 11,850 Carryover Worksheet List of items that will carryover to the 2015 tax return 2014 (Keep for your records) Name(s) as shown on return Your social security number MICHAEL & ELIZABETH SAMUELSON 400-00-6004 Itemized Deductions .................................... . .................................... Contributions subject to 50% of AGI limitations ................. Contributions subject to 30% of AGI limitations (50% capital gains appreciated property) . . . . . . . . . . . . . . . . . . . . ................. Contributions subject to 30% of AGI limitations . ................ Contributions subject to 20% of AGI limitations (30% capital gains appreciated property) . . . . . . . . . . . . . . . . . . ................ Taxable state and local refunds to Form 1040, line 10 . . . . . . . . . . . . . . . . . ............... State/local taxes paid in 2015 to flow to the Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . ............... Preparer Fee to flow to the Schedule A . . . . . . . . . . . . . . . . . . . . . . . . .............. State donations and contributions carryover . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. State overpayment applied to next year Carryover Amount Contributions subject to 100% of AGI limitations 15 Expenses ........................................... ................................. Disallowed investment interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section 179 expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... Operating expenses, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use ....... Excess depreciation, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use Office in home operating expenses Office in home excess casualty losses and depreciation Losses ................................................. Long-term capital loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net operating loss . . . . . . . . . . . . . . . . . AMT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... Nonrecaptured net section 1231 losses Short-term capital loss Credits ................................................. ..................... Credit for prior year minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Foreign Tax credit . . . . . . . . . . . . . . . . . . AMT . . . . . . . . . . . . . . . . . District of Columbia first time home owner's credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................................... Res. energy efficient property credit Mortgage interest credit General business credit (should be carried back before being carried forward) Other ...................................... . . . ...................................... Federal tax liability for 2210 calculation . . ..................................... State tax liability for state 2210 calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Taxpayer IRA basis Spouse Overpayment applied to next year's estimates Passive Activity At Risk Limitations WK_CARRY.LD 6,019