Deramont ot essay — ions Renmie Serco (99) rom 1040 _ U.S. Individual Income Tax Return [2014 Jor re a Fach yar ln Doe, 0, oar tx yar Bing ag See separate instructions, or en 3 AT Taam Your sec eer rer JOE_HARDWORKER }o00-00-0001 i BeThen poses We EST Ta Spowne's socal ear ner HARRIET HARDWORKER (000-00-1000 Feats Gre anda) yao ve FO DS ACO Tae Wake sure te SND ewe MATE! SE ‘and on line 6e are correct. SMITHTOWN, WY Presidential Election Campaign i ios PT you iseowse 4 = oad of hosehoU th aualfing person) ee Filing Status 1 [Sinai 4 iiticions) ihe sual parson a chk 2 [RY Mia ing jt it ry oad inca) but rot your dependent, enertis aide Ciechod 3 [fries ing ss. esas’ SM abv & ab fame hee one box, ame hee. > 5 [1] Qualitying wicow(er with dependent chia Exemptions 6a [X! Yourself. if someone can claim you as a dependent, do mot check box 6a aera 2 FE spouse a @ooperians |S oependants « Dependents Berroa | Oesterem | day ‘uber ‘oyu (Fist name Last name If more than four dependents, see instructions an exes ase" Tol aurber of erenplons dammed sa -[d 7 Wages, salaries, tps, et, Alach Form(s) W2 7 50,000. Income Ba Taxable interest. Attach Schedule B if required. Bal b Taxcexempt ntrest. Do molinclade on tine 8 a Ataen forme) 98 Ordinary dividends, lta Schedule B if equed sal Heels baum cen ai = soe Taxable refunds. credits. or offsets of state and local income taxes. Hasasswihitia. 11 Alimony received. 1 12 Busines income or Gas). tach Schedule Cor C-EZ 7% Myon 13. aaa anor ee At Se ec -oO 3 Beiter, Other gan or Cosss) tach Fou 8797 iz 15a RA dstibutons 18a b Taxable amount 150 16a Pensions and annuities... [Wea b Tavable amount 168 17" Renal eal esate, soyates, prineisipsS corporation, wuss, ec. Altach Schedule [7 18 Farm income or (loss), Attach Schedule F, 18 19 Unemployment compensation. 49 2a scl ety ns 20 Taxable amount 208 21 Ober — 22 conti aa ts i it en ins 2 30,000. 23” Educator expences Adjusted (24 Certain business expenses of reservsts, performing arists, and fee-bases Gross. government officials, Attach Form 2105 or 2105-E2 24 Income 28 Health savings account deduction. Attach Form 8889. 25 25 Mowng expences. Altach Form 3903 26 27 este pra 8 erg, Ath Svea SE 7 28 Sol-emplayed SEP, SIMPLE, and qulfed plans FA 29. Sel-employed eat insurance deduction 23 30 Penal oneal withdrawal of savings. 30 31a Kiron god basipats 8M aia 32) IRA dedation, z 33. Student oan tees deacon = 34 Tuton and fos. Allah Form 897 z 35. Dimste pen scutes Gz. 3 236 ies 3 toh 6 36 0. 37 Subtract line 36 trom line 22. This is your adjusted gross income. +[37 30,000. BAR For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions FORT laemve Form TOAO (2074)Form 1040 (2014) __JOE AND HARRIET HARDWORKER. 00-00-0001 Page 2 BE ui Wf 37 Gated ese = 30,00. Tax and 39a Check [| |Youwere born before January 2, 1950. Bind] total boxes Credits if |Spouse was born before January 2. 1950, []Blind._\ehecked = 39a Standard bia se anon nap wi owe Gash ol, dete. > 96 Betton Zo” acts cn Se aa sd action rk mr). 0 12,400, [for — 41 Subtract line 40 from line 38. Oil 77,600. People who | 42, wma tn 5:57 ih 30 ee cine Oo, esceea te | 43 Hetmome sags ioet feminos 7 77 Meron Wess Po 4300. sectcmgnas | 43 nan ome a 9 8 69,700 eer who can | ag Tax coe ins). Check if any from a [ frome) sata eens tae Fox 372 a 9.551. Se | a5, alternative minimum tx (see rstucons) Atzzn Form 62 € atvoters: | 46 Excore advance promi tx creat iepoment:Alach Fem 8862 = [Single or 47 Acd lines 44, 45 and 46 > [ar 9,551 sexs 49 Guat edd rd ce ones ih Fm 2 s Moved sing | 30 Eeucton creas fom Fm BS, ine 12 0 faiier "| 51. Retwement soins cntibuons crest. Atach Form 6880. [31 usttere | 52. chi tox cleat. Auch Swat S812. requeed 2 F285” |S. esdental eneray cess Ach Form 5098 a Heesot,, | onerestontuma[]30 & [Jam © [] Pa i 55 Add ines 48 thought, These ae you tll ea ss 56_Subct ine 3 fom in 47. in 5516 more han tne 47 ener [ie 355L, Other 57” Soret Aa Sale SE 7 Faxes 58 Unertel sry an eden am om # [Jas CJ = 59a on A, er ued tere pe Rah om 58 ear = SOatowstclderpyient ones tom Schodlo ea time homebijer eet Fepeyment:Atoch Form S88 vege a 61 Heath ce ings respoemy Gee tions) Fulyeareoverge et 2 Tonstom # | [tameee BL] fmsen [| ntsc cox) @ 3 Alton 62 Ts wyatt [es 3551 Payments Gt Federal core tax wield fon Foms W2 and 1089 [SL Tyga wes —|_65_ eis pyr ot anced ton en ati, OSS Eamedincome cea ey wot ea Jae atlach (te noaatle conta py etn... > [66] [Eat ee ea i ian eae o 6% Ameren opportunity ee tom Fem 888, ne 8 a 69 Net rem tax ce. Alach Farm 982 @ 17 Amount pt wih requ fo evlensen to ie 0 2. Excess socal security and er 1 PRT tax wil a 72 Cre rfc axon tl: Ach gpm #16 a 73. Crests om Frm a [es been’ ef acre! a] 3 7A Als 6, 2.71, The ayo alps = 74 0 Refund ‘75 if lime 74 is more than line 63, subtract line 63 fromm line 74. This is the amount you overpaid, 7 ba Amount of ne 98 you want selunded ta you IiForm BE58gatace, chock hore * [Tea > Breutng number me type: []oheching [] Semmes Seeinstochons, Account number. ‘77 hevount of ine 75 you want applied to your 2075 estimated tax ~T7 | Amount "78 Amount you owe. Subtract live 74 from line 63. For detals on how 10 pay, se mstructions. * [8 9,722. You Owe 79 stmatedtoecenaly Gee nststons) in| a. “Third Party os oon ale re pro is en wih Pe RS tit ves. complete veiw. ] No Designee” ees vcere wes stem Sign Under penalties of peypay. | declare at | have examined ths retun and accompanying schedules ated to the best of my knowledge and Saha. LABORER es ae [accion Bite enter SAN se HOMEMAKER Fens Paid SELF SELF sir cmwlaped Preparer Use only — : Form 1040 2074)Depart ote Teasiry~ ama Reni Sere (28) rom 1040 _U.S. Individual Income Tax Return [201 4 7 Far tayex Jan) Der 3,200, oor tx yar Dogma PA, edi See separate wnstustons: Teor bata od Ta our seca secry mer BOB_BORNINTHERTGHTWOMB loo0-00-0001 MARRY BORNINTHERTCHTWOMB. 10-00-1000 Fore aS Grad ae, M0 ave a PO, Se ATE Timms) A Male sure tha SSN) above MAIN ST ‘ang on ine 6c are coiect iy om OR HR. HBF EP FRI TB ET, TS SC NT AT Presidential Election Campaign SMITHTOWN, NY nae ee ou, or our zou You [Spouse Filing Status [)Snv 4 Uvraiictones te quaisiny parsons chia 2 FR) ame rg cern ty ne tine) butt you? dependent, enriches coocteost 3 [june ira septa, terse’ SW ate & mame here ‘one bor. romehere = 5 _L) auaitying wiscw(er with dependent child Exemptions 6a [X] Yourself. f someone can claim you as a dependent, do not check box 6a eae 2 spouse ee @Sependents | @yDepensenrs | Te nen «Dependents: DesPsccsny | eRersap” | katy eee uber a a Ay First name Lastname TCE net scat. T I more than four dependents, see instructions ‘and check here... >| Total number of exoriptions dammed 7. Wages, salaries. tps, etc. Attach Form(s) 2 7 Income a tana ces, Atach Schedule 8 reqored ra) bTaxcexempt interest. Do nat include on ine 83 80 ‘ntaenFomisy 98 Ordinary dividends, Attach Schedule B if required 22 70,000. eee Ae Quoted cers ; | 10,000.,7" tach Forms axable refunds, etek, or offsets of state and local income axes, Tieaciuibieig, 11 Alimony received. 1 12 Business income or (loss). Attach Schedule G of CEZ 12 Mymaeet 13. captal ain oss). At eh Ded rte ech - 13 20,000. Seintiustins, 14. Other gains or (losses). Attach Form 4757, 1a Ba RA distributions 15] b Taxable amount 158] Y6aPensions anc annutes..... [lea b Taxable amount 168] 7 Rental eal estate, royalties, parinershis, 5 corporaons, wuss, ete tach Sehedule E [7 18 Farm income or (oss). Allach Schedule F. 18 419. Unemployment compensation 19 20, Sonal eu bres 204] |b Taxable amount 208] 2 Obw cone a -- _ fa 22 contin tw aneriia pt enina fr ne 7 ough 71,1 yo tal neome ofa 30,000 23 Educator expenses. 23 Adjusted 24 Cam bunt egense of eri, artrmig srt, ai les Gross severe ee, Rben For 2108 er 21052 za Income 25 Hoalth savings account deduction. Attach Form 8869 Ea 26 Mowing expenses. Attach Form 3603 26 27 desu par of set ample tach eee SE 2 28 Selt-amployed SEP, SIMPLE, and qualited plans 26 28. Settemployed heath insurance deduction 2 30 Penalty on ealy withdrawal of savings 30 31a Alrovy pad belek SSH... 31a] 32 IRA deduction 32 33. Student loan inerest deduction 33 34 Tution and fees, Attach Form 8917 34 35. Danese proton aches dein, Ate Farm BS5 3 36 ta es 23 tough 3, 36 o. 37 _Sultact ine 36 ftom ine 22. Ths your adjusted gross income. 37 30,000 ‘BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions, romavia wens Farm Toad (2014)Foum 1040 2012) _BOB_AND MARRY BORNTNTHERTGHTHOMB 00-00-0001 __Page2 3B Amount fom ine 37 (adusted gross iome) 3 30,000. Tax and 39a Check [ [You were born before January 2, 1950. tind. |_total bones Credits it |Spouse was born before January 2, 1950, []elind,_|ehecked © 39a aad bir sous entes na settee uae 9 saks eye es = 306 Deduction 20 anied dedetions (rom Ses A) or you standard deci ( et mo) 40 12,400. for “41 Subtract line 40 from line 38. 41 77,600. = Peo 442 xemptos ie 381 $12528 ess, mula $80 bythe random ne. Oras, sets [a 7,900. nck ay box | 43. Taabeineame uate om in eine 380 oF Tea ty nla sane. 48 69,700. em.er who can | 44 Tax (ee insts). Check if any from: a [roms sis (] Idependent, see Form 4972. a4 Oo. fnctactons. | 45_ Alternative minimum tax (ee instiuctions). Aden Form 6251 a5 0: feat oes: | a8. Excess advance premium tax credit repayment. Attach Form 8862 a8 single of 47 Add ines 44, 45 and 46. > bar a aredtiea | aa. vei ox ced. Atach Fer 1116 equred e $8200 49 Coot eh ard deze cae ents. tach Fe 281 29 area ting | 50 Education credits trom Form 8863, ine 19 50 pen 51 Retirement savings contributions creat, Attach Form 8880. [1 widowers 52 Child tax credit. attach Schedule 8812, f required 52 sido 53 Residential energy credits. Atach Form 8595 33 pee 54 other ers from Fo: a [J 3000 b LJeenr ¢ [] 54 55 Add lines 48 though 54. These are your tla credits 55 536 Sublract line 55 tom line 47. If ine 55 is mote than ine 47, enter. [56 0 ‘Other 7 Sehenplognet tw tach Sveue SE 37 Taxes ‘58 Unreported social scunty art Medicare tax from Feem: a [_]ais7 b [_] e519 38 59 fon fac on Rt, oti quid erent la, tach Fam 59 if eget 59 60a Household employment taxes from Schedule H 60a b First-time homebuyer credit repayment, Attach Form 5405 if required 600) 61 Health care: inva responstalty (see instuctions) Ful-year coverage [x] I 62 Tous ton: a |] Fond | ]FomeZ0 c [| istssens ects) @ 63 _ Add lines $6-62. This is your total tax, > [6s o Payments 64 Federal income tax withheld tom Forms W2 and 1088... [64 you ave 3165. if estrted npyments a amour pee em 2013 eta % cuatiying "66a Earned income credit (10) Nol esa ENS ete. iat combat ay eten” [660] 67 Adina eld tox ret. Attach Sehedale S512 o {68 American oppartuity ere rom Form 8853, line 8 e 68 Not premium tax crit. Attach Form 8862 a 70 Amount paid with request or extension to He 70 Ti Excess social secunty and tier 1 RRTA tox withheld 7 72 Cred for federal ax on tual. Attach Farm 436. 7 73 Crests fom Forme a|_Jatae b | JReseved cL] Resered o [_] 73 a_i 65, i, 809-7, Tea you ttl pms >| ° Refund "ne 7s se tan ine, sl ero ine8 Ths He noun eu oer. 75 ‘76a Amount of line 75 you want relunded to you. If Form 8888 is attached, check here. = [|| 76a » bRouting number [J] ctype: []checking — [] Savings: Buoct deposi? = a account umber ee MSUUCIONS, 77 anit ine 7S you wart pple to your AS eainted wx [77 | Brmount 78 Arun you ove, Sct ire 7 re ine For eae on ow py Se Roe 178 o You Owe 79 Estimated tax penalty (Gee instuctions) [79 | Third Party —_O2yor wart ato anne pronto seas ts tn wih Be RS (ee ons)? [i] Yes. Complete below. (Jno Designee pss » SELF SE" eass7eacu1 hasta + Sign ere Serene ra bs cy ona Sign siete Sree sora anarcaaatae, doin return? te osname Bee tehehons DIVIDEND COLLECTOR Keep a copy ST aE, BOT lame sures cmaren Irae aa pera re for your records. [PARTY GIVER ere qsee srs) Paid SELF |SELF seit-ernphted Preparer = — Use Only See - a Form 1040 2oIa)