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F
o
r
m

(99)

Department of the Treasury—Internal Revenue Service

1040 U.S. Individual Income Tax Return 2011

For the year Jan. 1–Dec. 31, 2011, or other tax year beginning

Your first name and initial

OMB No. 1545-0074

, 2011, ending

IRS Use Only—Do not write or staple in this space.

See separate instructions.
Your social security number

,20

Last name

Jeff

J

Bell

If a joint return, spouse's first name and initial

Ivy

N

111-11-1111

Last name

Spouse's social security number

Bell

123-45-6781
Apt. no.

Home address (number and street). If you have a P.O. box, see instructions.

Make sure the SSN(s) above
and on line 6c are correct.

4326 Orange Blossom Trail
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).

Dallas

TX

Foreign country name

Filing Status

Foreign province/country

Single

1

X

2
3

Exemptions

6a
b
c

X
X

4

Head of household (with qualifying person). (See instr.) If the
qualifying person is a child but not your dependent, enter this
child's name here.

5

Qualifying widow(er) with dependent child

Yourself. If someone can claim you as a dependent, do not check box 6a

Boxes checked
on 6a and 6b

. . . . . . .

Tyler

Last name

Bell

social security number

relationship to you




lived with you
did not live with
you due to divorce
or separation
(see instructions)

(see instructions)

123-45-6788 Son

X

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.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.

Adjusted
Gross
Income

KIA

1

Dependents on 6c
not entered above
Add numbers on
lines above

d Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Income

2

No. of children
on 6c who:

Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(4) V if child under age 17
(2) Dependent's
(3) Dependent's
Dependents:
qualifying for child tax credit

(1) First name

If more than four
dependents, see
instructions and
check here

Foreign postal code

Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above
and full name here.

Check only one
box.

Presidential Election Campaign
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
You
Spouse

75080

Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . .
Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . .
Tax-exempt interest. Do not include on line 8a . . . . . . . . . . . . . .
8b
Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . .
Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9b
10
Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . .
11
Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . .
13
Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . . . . . . . . . . .
14
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . .
15a IRA distributions . . . . . . . . . . . . . . 15a
b Taxable amount
16a Pensions and annuities . . . . . . . . . . . 16a
b Taxable amount
17
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . .
18
Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . .
19
Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20a
20a Social security benefits
b Taxable amount . . . . .
7
8a
b
9a
b

. . .
. . .

0
. . .
. . .
. . .
.
.
.
.
.
.
.

.
.
.
.
.
.
.

.
.
.
.
.
.
.

Other income. List type and amount _ _ _ _ _ _ _ _ _ _ _ _GAMBLING
_____________________
Combine the amounts in the far right column for lines 7 through 21. This is your total income
0
Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24
25
26
27
28
29
30
31a
32

Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ . .
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 . . . . . . . . . . . . . .
Alimony paid b Recipient's SSN
IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . .

33
34

Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . .
Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . .

35

Domestic production activities deduction. Attach Form 8903

.
.
.
.
.
.
.

.
.
.
.
.
.
.

.
.
.
.
.
.
.

.
.
.
.
.
.
.

. . . . .

. . . . . . .

24
25
26
27
28
29
30
31a
32
33
34
35

7
8a

100,000
15,000

9a

0

10
11
12
13
14
15b
16b
17
18
19
20b
21
22

0

0
. . .

21
22
23

.
.
.
.
.
.
.

3

53,619
-3,000
0
0
6,000
0

4,200
175,819

0
0
0
3,788
0
0
0
0

0

36
Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . . . . . . .
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

36
37

3,788
172,031
Form 1040 (2011)

Jeff

Form 1040 (2011)

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,
$5,800
Married filing
jointly or
Qualifying
widow(er),
$11,600
Head of
household,
$8,500

Other
Taxes

Payments
If you have a
qualifying
child, attach
Schedule EIC.

38
39a
b

J Bell

111-11-1111

Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Blind.
You were born before January 2, 1947,
Check
Total boxes
0
checked
39a
if:
Spouse was born before January 2, 1947,
Blind.
. . . . . .

40

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41

Itemized deductions (from Schedule A) or your standard deduction (see left margin)

42

Exemptions. Multiply $3,700 by the number on line 6d

43
44

Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-

Subtract line 40 from line 38

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .

Form(s) 8814 b

Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . . . . . . . . . . . . . . .

47

Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . . 47

48

Credit for child and dependent care expenses. Attach Form 2441

. . . .

49

Education credits from Form 8863, line 23

50

Retirement savings contributions credit. Attach Form 8880 . . . . . . .

. . . . . . . . . . . . . . .

48
49
50

0

51

Child tax credit (see instructions)

52

Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . .

51
52

53

Other credits from Form: a

53

54
55

Add lines 47 through 53. These are your total credits . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . . . . . . . . . . . . . . .

3800

. . . . . . . . . . . . . . . . . . . .
b

c

8801

56

Self-employment tax. Attach Schedule SE

57

Unreported social security and Medicare tax from Form:

57

58
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . .
59 a Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . .
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . . . . . . .

58
59a

b

. . . . . . . . . . . . . . . . . . . . . . . . . .

61
62
63

Add lines 55 through 60. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . .
25,000
62
Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . .
9,000
63
2011 estimated tax payments and amount applied from 2010 return . .

66
67

68

Amount paid with request for extension to file . . . . . . . . . . . . . .

68

69

Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . .

69

70
71

Credit for federal tax on fuels. Attach Form 4136
Credits from Form:

70

72

a
2439 b
8839 c
8801 d
8885
71
Add lines 62, 63, 64a, and 65 through 71. These are your total payments . . . . . . . . . . .

Refund

73

If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid

Direct deposit?
See
instructions.

74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here . . . .
b Routing number XXXXXXXXX
c Type:
Checking
Savings
d Account number XXXXXXXXXXXXXXXXX
75
76

61

36,317

72
73

34,000

64a

64a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . .
64b
b Nontaxable combat pay election . . . . .
American opportunity credit from Form 8863, line 14 . . . . . . . . . . .
First-time homebuyer credit from Form 5405, line 10 . . . . . . . . . .

KIA

60

Other taxes Enter code(s) from instructions

66
67

Paid
Preparer
Use Only

59b

60

65

Joint return? See
instructions.
Keep a copy for
your records.

55
56

8919 . . . . . . . .

4137

0
29,731
6,586
0
0
0
0

54

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a

29,731
0
29,731

0

. . . . . . . . . . . . . .

Sign
Here

43

46

0
0

Additional child tax credit. Attach Form 8812

Third Party
Designee

42

44
45

962 election

Form 4972 c

65

Amount
You Owe

12,140
159,891
11,100
148,791

Tax (see instructions). Check if any from:
a

45
46

39b

If your spouse itemizes on a separate return, or you were a dual-status alien, check here

40
41

Page 2
172,031

38

. . . . . . . . . . . .

0
0

0

. . .

74a

Amount of line 73 you want applied to your 2012 estimated tax
75
Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions

2,317

76

0

77
Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . . .
77
Do you want to allow another person to discuss this return with the IRS (see instructions)?

Yes. Complete below

Designee's
name

Personal indentification
number (PIN)

Phone
no.

X

No

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

Regional Manager
Spouse's signature. If a joint return, both must sign.

Date

Spouse's occupation

Self-employed CPA
Print/Type preparer's name

Preparer's signature

Date

Firm's name

Firm's EIN

Firm's address

Phone no.

214-456-7891
If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)

Check
if
self-employed

PTIN

Form 1040 (2011)

SCHEDULE A
(Form 1040)

OMB No. 1545-0074

Itemized Deductions
Attach to Form 1040.

Department of the Treasury
(99)
Internal Revenue Service

2011

Attachment
Sequence No.

See Instructions for Schedule A (Form 1040).

Jeff
Medical
and
Dental
Expenses
Taxes You
Paid

J Bell
1
2
3
4
5

111-11-1111

Caution. Do not include expenses reimbursed or paid by others.
10,600
Medical and dental expenses (see instructions) . . . . . . . . . .
1
172,031
Enter amount from Form 1040, line 38 . . . 2
12,902
Multiply line 2 by 7.5% (.075) . . . . . . . . . . . . . . . . . . . 3
Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . .
State and local (check only one box):
a.
Income taxes, or
1,440
5
. . . . . . . . . . . . . . . . . . .
b. X General sales taxes
5,000
Real estate taxes (see instructions) . . . . . . . . . . . . . . . . 6

6
7 Personal property taxes . . . . . . . . . . . . . . . . . . . . . .
8 Other taxes. List type and amount
_______________
___________________________________

Note.
Your mortgage
interest
deduction may
be limited (see
instructions).

Gifts to
Charity
If you made a
gift and got a
benefit for it,
see instructions.

9 Add lines 5 through 8
10 Home mortgage interest and points reported to you on Form 1098 . . . . . . . . . . .
11 Home mortgage interest not reported to you on Form 1098. If paid
to the person from whom you bought the home, see instructions
and show that person's name, identifying no., and address
___________________________________
___________________________________
___________________________________
12 Points not reported to you on Form 1098. See instructions for
special rules . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Mortgage insurance premiums (see instructions) . . . . . . . . .
14 Investment interest. Attach Form 4952 if required. (See instructions)
15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . . .
16 Gifts by cash or check. If you made any gift of $250 or more,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Other than by cash or check. If any gift of $250 or more, see
instructions. You must attach Form 8283 if over $500 . . . . . . .
18 Carryover from prior year . . . . . . . . . . . . . . . . . . . . . .
19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . . .

10

4,000

11

0

12

0
0

13

14
. . . . . . . . . . .
16

500

17

0
0

18
. . . . . . . . . . .

Casualty and
Theft Losses 20
Job Expenses 21
and Certain
Miscellaneous
Deductions

Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . . . . . .
Unreimbursed employee expenses—job travel, union dues,
job education, etc. Attach Form 2106 or 2106-EZ if required.
(See instructions.) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
___________________________________
0
21
___________________________________
22
22 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . .
23 Other expenses—investment, safe deposit box, etc. List type
and amount
_________________________
0
23
___________________________________
0
24 Add lines 21 through 23 . . . . . . . . . . . . . . . . . . . . . . 24
172,031
25 Enter amount from Form 1040, line 38 . . . 25
3,441
26 Multiply line 25 by 2% (.02) . . . . . . . . . . . . . . . . . . . . . 26
27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . . . . . .
Other
28 Other—from list in the instructions. List type and amount
_______________
Miscellaneous
_______________________________________________

Deductions
Total
Itemized
Deductions
KIA

Gambling Losses

1,200

29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount
on Form 1040, line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30 If you elect to itemize deductions even though they are less than your standard
deduction, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see Form 1040 instructions.

4

0

9

6,440

15

4,000

19

500

20

0

27

0

28

1,200

29

12,140

0

7

0
8
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest
You Paid

07

Your social security number

Name(s) shown on Form 1040

Schedule A (Form 1040) 2011

SCHEDULE B

Attach to Form 1040A or 1040.

Department of the Treasury
(99)
Internal Revenue Service

Part I
Interest

Bell

Part II

Amount

15,000

Ford Motor Company

1

Add the amounts on line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Excludable interest on series EE and I U.S. savings bonds issued after 1989.
Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form
1040, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note: If line 4 is over $1,500, you must complete Part III.

2
3

5

08

111-11-1111

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
this interest first. Also, show that buyer's social security number and address

(See instructions for
Schedule B, and the
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.

Attachment
Sequence No.

Your social security number

J
1

2011

See Instructions.

Name(s) shown on return

Jeff

OMB No. 1545-0074

Interest and Ordinary Dividends

(Form 1040A or 1040)

List name of payer

2

15,000

3
4

15,000
Amount

______________________________________________

Ordinary
Dividends
(See the instructions
for Schedule B, and the
instructions for
Form 1040A, or
Form 1040,
line 9a.)

5
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.

Add the amounts on line 5. Enter the total here and on Form 1040A, or Form
1040, line 9a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note. If line 6 is over $1,500, you must complete Part III.
6

6

0

You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a
Yes No
foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
7a At any time during 2011, did you have a financial interest in or signature authority over a financial
Part III
account (such as a bank account, securities account, or brokerage account) located in a foreign
X
Foreign
country? See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," are you required to file Form TD F 90-22.1 to report that financial interest or signature
Accounts
authority? See Form TD F 90-22.1 and its instructions for filing requirements and exceptions to
X
requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and Trusts b Ifthose
you are required to file Form TD F 90-22.1, enter the name of the foreign country where the
(See
financial account is located
___________________________________________
instructions.)
8
During 2011, did you receive a distribution from, or were you the grantor of, or transferor to, a
X
foreign trust? If "Yes," you may have to file Form 3520. See instructions. . . . . . . . . . . . . . . . . . . . .
KIA
For Paperwork Reduction Act Notice, see your tax return instructions.
Schedule B (Form 1040A or 1040) 2011

Profit or Loss From Business

SCHEDULE C
(Form 1040)

OMB No. 1545-0074

Department of the Treasury
(99)
Internal Revenue Service

Attachment
Sequence No.

Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form 1065.

Ivy

123-45-6781

N Bell

B Enter code from instructions

Principal business or profession, including product or service (see instructions)

541310

Consulting
C

Business name. If no separate business name, leave blank.

E

Business address (including suite or room no.)
City, town or post office, state, and ZIP code

X

Cash

D Employer ID number (EIN), (see instr.)

_ _ _ _4326
_ _ _ _ Orange
_ _ _ _ _ _ _Blossom
_ _ _ _ _ _ _Trail
____________________________

Dallas

Accrual

TX

75080

F

Accounting method:

G
H

Did you "materially participate" in the operation of this business during 2011? If "No," see instructions for limit on losses . . .
If you started or acquired this business during 2011, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1)

(2)

Other (specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

(3)

X

I

Did you make any payments in 2011 that would require you to file Form(s) 1099? (see instructions)

. . . . . . . . . . . . .

Yes

If "Yes," did you or will you file all required Forms 1099? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

. . . . . . . . . .

b Gross receipts or sales not entered on line 1a (see instructions)

. . . . . . . .

1a
1b

1d

2

Returns and allowances plus any other adjustments (see instructions) . . . . . . . . . . . . . . . . . . . . .

2

3

Subtract line 2 from line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4
5
6
7

Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . . . . .
Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3
4

9

Expenses.

No

69,000
0
69,000
0
69,000
0
69,000

5
6
7

Enter expenses for business use of your home only on line 30.

Advertising . . . . . . . . . .
Car and truck expenses (see
instructions) . . . . . . . . . .

8
9

10

Commissions and fees

. . . .

10

11

Contract labor (see instructions)

11

12

Depletion

12

13

Depreciation and section 179
expense deduction (not
included in Part III) (see
instructions) . . . . . . . . .

. . . . . . . . . . .

13

14

Employee benefit programs
(other than on line 19) . . . . .

14

15

Insurance (other than health) .

15

16

Interest:

Office expense (see instructions) . . .

18

19

Pension and profit-sharing plans

19

20

Rent or lease (see instructions):

18

2,631

0

. . .

a Vehicles, machinery, & equipment . .

20a

b Other business property

20b

. . . . . . .

21

Repairs and maintenance . . . . . . .

21

22

Supplies (not included in Part III) . . .

22

23

Taxes and licenses . . . . . . . . . .

23

24

Travel, meals, and entertainment:
a Travel . . . . . . . . . . . . . . . . .

24a

b Deductible meals and
entertainment (see instructions)

24b

. . .

25

Utilities

. . . . . . . . . . . . . . . .

26

Wages (less employment credits)

0

6,000
1,000

0

25

. .

26

Other expenses (from line 48) . . . . .

27a

b Reserved for future use . . . . . . .

27b

Mortgage (paid to banks, etc.)

16a

Other . . . . . . . . . . . . .

16b

17

Legal and professional services

17

28

Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . . . . . . .

28

29

Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29

30

Expenses for business use of your home. Attach Form 8829. Do not report such expenses elsewhere

30

15,381
53,619
0

31

53,619

a
b

No

0
69,000

c Income reported to you on Form W-2 if the "Statutory Employee" box on
0
1c
that form was checked. Caution. See instr. before completing this line . . . . .
d Total gross receipts. Add lines 1a through 1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

X

Income

1a Merchant card and third party payments. For 2011, enter -0-

Part II

No

Yes

J

Part I

09

Social security number (SSN)

Name of proprietor

A

2011

(Sole Proprietorship)
For information on Schedule C and its instructions, go to www.irs.gov/schedulec

27a

4,000

Net profit or (loss). Subtract line 30 from line 29.
If a profit, enter on both Form 1040, line 12 (or Form 1040NR, line 13) and on Schedule SE, line 2.
If you entered an amount on line 1c, see instr. Estates and trusts, enter on Form 1041, line 3.
If a loss, you must go to line 32.
32
If you have a loss, check the box that describes your investment in this activity (see instructions).
If you checked 32a, enter the loss on both Form 1040, line 12, (or Form 1040NR, line 13) and
on Schedule SE, line 2. If you entered an amount on line 1c, see the instructions for line 31.
Estates and trusts, enter on Form 1041, line 3.
If you checked 32b, you must attach Form 6198. Your loss may be limited.
KIA
For Paperwork Reduction Act Notice, see your tax return instructions.

. . . .

1,750

31

32a
32b

X

All investment is at risk.
Some investment is not
at risk.

Schedule C (Form 1040) 2011

Ivy
N Bell
Cost of Goods Sold (see instructions)

123-45-6781

Schedule C (Form 1040) 2011

Part III
33

Method(s) used to
value closing inventory:

34

Was there any change in determining quantities, costs, or valuations between opening and closing inventory?
If "Yes," attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a

Cost

b

Lower of cost or market

c

2

Other (attach explanation)

35

Inventory at beginning of year. If different from last year's closing inventory, attach explanation . . . . . .

35

36

Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . . . . . . . . . . . .

36

37

Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . . . . . . . . . . .

37

38

Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

38

39

Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39

40

Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

40

41

Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41

42

Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . . . . .

42

Part IV

Page

Yes

No

0

0

Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9
and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must
file Form 4562.
_ _ _ _06/07/11
__________

43

When did you place your vehicle in service for business purposes? (month, day, year)

44

Of the total number of miles you drove your vehicle during 2011, enter the number of miles you used your vehicle for:
a Business _ _ _ _ _ _ _4,940
_ _ _ _ _ _ b Commuting (see instructions) _ _ _ _ _ _ _ _ _ _ _ _ _0_ _ _ _ _ c Other _ _ _ _ _ _ _9,060
___________

45

Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . . . . . . . . . . .

46

Do you (or your spouse) have another vehicle available for personal use?

47a

Do you have evidence to support your deduction?

b

X

Yes
Yes

. . . . . . . . . . . . . . . . . . . . .

No

X

No

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X

Yes

No

If "Yes," is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X

Yes

No

Part V

Other Expenses. List below business expenses not included on lines 8–26 or line 30.

_ _ _ _Prof.
_ _ _ _ _ journal
_ _ _ _ _ _ _ subscrip.
______________________________________________

1,500

_ _ _ _Prof.
_ _ _ _ _ org.
_ _ _ _ _dues
________________________________________________

250

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

48
KIA

Total other expenses. Enter here and on line 27a

. . . . . . . . . . . . . . . . . . . . . . . . . . .

48

1,750
Schedule C (Form 1040) 2011

SCHEDULE D
(Form 1040)
Department of the Treasury
Internal Revenue Service

OMB No. 1545-0074

Capital Gains and Losses
(99)

Attachment
Sequence No. 12
Your social security number

Name(s) shown on return

Jeff
Part I

2011

Attach to Form 1040 or Form 1040NR.
See instructions for Schedule D (Form 1040).
Use Form 8949 to list your transactions for lines 1, 2, 3, 8, 9, and 10.

J Bell

111-11-1111

Short-Term Capital Gains and Losses—Assets Held One Year or Less

Complete Form 8949 before completing line 1, 2, or 3.
This form may be easier to complete if you round off cents to
whole dollars.

(e) Sales price from
Form(s) 8949, line 2,
column (e)

(f) Cost or other basis
from Form(s) 8949,
line 2, column (f)

(g) Adjustments to
gain or loss from
Form(s) 8949,
line 2, column (g)

(h) Gain or (loss)
Combine columns (e),
(f), and (g)

1

Short-term totals from all Forms 8949 with box A
checked in Part I . . . . . . . . . . . . . . . . . . .

0 (

0)

0

0

2

Short-term totals from all Forms 8949 with box B
checked in Part I . . . . . . . . . . . . . . . . . . .

0 (

0)

0

0

3

Short-term totals from all Forms 8949 with box C
checked in Part I . . . . . . . . . . . . . . . . . . .

0 (

0)

0

0

4
5

Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . .
Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss
Carryover Worksheet in the instructions.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

0

6
7

Net short-term capital gain or (loss). Combine lines 1 through 6 in column (h). If you have any
long-term capital gains or losses, go to Part II below. Otherwise, go to Part III on next page . . . . . .

Part II

5
6

(

0)
0

7

Long-Term Capital Gains and Losses—Assets Held More Than One Year

Complete Form 8949 before completing line 8, 9, or 10.
This form may be easier to complete if you round off cents to
whole dollars.

(e) Sales price from
Form(s) 8949, line 4,
column (e)

(f) Cost or other basis
from Form(s) 8949,
line 4, column (f)

(g) Adjustments to
gain or loss from
Form(s) 8949,
line 4, column (g)

(h) Gain or (loss)
Combine columns (e),
(f), and (g)

8

Long-term totals from all Forms 8949 with box A
checked in Part II . . . . . . . . . . . . . . . . . . .

0 (

0)

0

0

9

Long-term totals from all Forms 8949 with box B
checked in Part II . . . . . . . . . . . . . . . . . . .

0 (

0)

0

0

10

Long-term totals from all Forms 8949 with box C
checked in Part II . . . . . . . . . . . . . . . . . . .

0 (

110,000 )

0

-110,000

11

Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) .
from Forms 4684, 6781, and 8824
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

66,660

12

Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1

12

13

Capital gain distributions. See the instructions

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

14

Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss
Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14

15
KIA

Net long-term capital gain or (loss). Combine lines 8 through 14 in column (h). Then go to Part III on
page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions.

15

0
(

0)
-43,340

Schedule D (Form 1040) 2011

Schedule D (Form 1040) 2011

Part III
16

Jeff

J Bell

111-11-1111

Page

2

Summary

Combine lines 7 and 15 and enter the result

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16

-43,340

If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line
14. Then go to line 17 below.
If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete
line 22.
If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form
1040NR, line 14. Then go to line 22.
17

Are lines 15 and 16 both gains?
Yes. Go to line 18.
No. Skip lines 18 through 21, and go to line 22.

18

Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions . . . . . .

18

19

Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19

20

Are lines 18 and 19 both zero or blank?
Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete
the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040,
line 44 (or in the instructions for Form 1040NR, line 42). Do not complete lines 21 and 22
below.
No. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete the
Schedule D Tax Worksheet in the instructions. Do not complete lines 21 and 22 below.

21

If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:
The loss on line 16 or
($3,000), or if married filing separately, ($1,500)

. . . . . . . . . . . . . . . . . . . . . . . . . . .

21 (

3,000 )

Note. When figuring which amount is smaller, treat both amounts as positive numbers.
22

Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?
Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete
the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040,
line 44 (or in the instructions for Form 1040NR, line 42).

X No. Complete the rest of Form 1040 and Form 1040NR.
KIA

Schedule D (Form 1040) 2011

Form

Sales and Other Dispositions of Capital Assets

8949

Department of the Treasury
Internal Revenue Service

See instructions for Schedule D (Form 1040).
For more information about Form 8949, see www.irs.gov/form8949
Attach to Schedule D to list your transactions for lines 1, 2, 3, 8, 9, and 10.

(99)

Name(s) shown on return

Jeff

J

Part I

Bell

OMB No. 1545-0074

2011

Attachment
Sequence No.
Social security number

12A

111-11-1111

Short-Term Capital Gains and Losses—Assets Held One Year or Less

Note. You must check one of the boxes below. Complete a separate Form 8949, page 1, for each box that is checked.
*Caution. Do not complete column (b) or (g) until you have read the instructions for those columns (see the instructions for Schedule
D (Form 1040)). Columns (b) and (g) do not apply for most transactions and should generally be left blank.
(A) Short-term transactions reported on
(B) Short-term transactions reported on Form
(C) Short-term transactions for which you
Form 1099-B with basis reported to the IRS

1

(a)
Description of property
(Example: 100 sh. XYZ Co.)

1099-B but basis not reported to the IRS
(b)
Code, if any,
for column (g)*

(c)
Date acquired
(Mo., day, yr.)

(d)
Date sold
(Mo., day, yr.)

2

Totals. Add the amounts in columns (e) and (f). Also, combine the
amounts in column (g). Enter here and include on Schedule D, line 1 (if
box A above is checked), line 2 (if box B above is checked), or line 3 (if
box C above is checked) . . . . . . . . . . . . . . . . . . . . . . .

KIA

For Paperwork Reduction Act Notice, see your tax return instructions.

cannot check box A or B
(e)
Sales price
(see instructions)

(f)
Cost or other basis
(see instructions)

(g)
Adjustments to
gain or loss, if any*

2
Form 8949 (2011)

Form 8949 (2011)

Attachment Sequence No.

Name(s) shown on return. Do not enter name and social security number if shown on other side.

Jeff
Part II

J

12A

Page 2

Your social security number

Bell

111-11-1111

Long-Term Capital Gains and Losses—Assets Held More Than One Year

Note. You must check one of the boxes below. Complete a separate Form 8949, page 2, for each box that is checked.
*Caution. Do not complete column (b) or (g) until you have read the instructions for those columns (see the instructions for Schedule
D (Form 1040)). Columns (b) and (g) do not apply for most transactions and should generally be left blank.
(A) Long-term transactions reported on
(B) Long-term transactions reported on Form
X (C) Long-term transactions for which
Form 1099-B with basis reported to the IRS
(a)
Description of property
(Example: 100 sh. XYZ Co.)

3

Groupon

4

1099-B but basis not reported to the IRS

(b)
Code, if any,
for column (g)*

(c)
Date acquired
(Mo., day, yr.)

(d)
Date sold
(Mo., day, yr.)

08/05/10 WORTHLES

Totals. Add the amounts in columns (e) and (f). Also, combine the
amounts in column (g). Enter here and include on Schedule D, line 8 (if
box A above is checked), line 9 (if box B above is checked), or line 10
(if box C above is checked) . . . . . . . . . . . . . . . . . . . . . .

4

you cannot check box A or B

(e)
Sales price
(see instructions)

(f)
Cost or other basis
(see instructions)

WORTHLESS

110,000

0

110,000

(g)
Adjustments to
gain or loss, if any*

0

0
Form 8949 (2011)

SCHEDULE E
(Form 1040)

OMB No. 1545-0074

Supplemental Income and Loss

2011

(From rental real estate, royalties, partnerships,
S corporations, estates, trusts, REMICs, etc.)

Department of the Treasury
Internal Revenue Service (99)

Attach to Form 1040, 1040NR, or Form 1041.

Attachment
Sequence No.

See separate instructions.

Name(s) shown on return

Jeff

J Bell

111-11-1111
Yes X

A Did you make any payments in 2011 that would require you to file Form(s) 1099 (see instructions)
B If "Yes," did you or will you file all required Forms 1099?

Part I

13

Your social security number

Yes

No
No

Income or Loss From Rental Real Estate and Royalties

Note. If you are in the business of renting personal property, use
Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.

Caution. For each rental property listed on line 1, check the box in the last column only if you owned that property as a member of a
qualified joint venture (QJV) reporting income not subject to self-employment tax.
Type–from list
Fair Rental Personal
1 Physical address of each property–street, city, state, zip
2 For each rental real
QJV
below

A
B

Orange Blossom Tra Dallas TX 75062

estate property listed,
report the number of
days rented at fair rental
value and days with
personal use. See
instructions.

1

C

Days

Use Days

365

A
B
C

0

Type of Property:
1 Single Family Residence
2 Multi-Family Residence

3 Vacation/Short-Term Rental
4 Commercial

5 Land
6 Royalties

7 Self-Rental
8 Other (describe)

Income:

Properties
A

3a Merchant card and third-party payments. For 2011, enter -0- .
b Payments not reported to you on line 3a . . . . . . . . . . . .

3a
3b

0
24,000

Total not including amounts on line 3a that are not
income (see instructions) . . . . . . . . . . . . . . . . . . .

4

24,000

4

B

C

Expenses:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . .
Auto and travel (see instructions) . . . . . . . . . . . . . . .
Cleaning and maintenance . . . . . . . . . . . . . . . . . . .
Commissions . . . . . . . . . . . . . . . . . . . . . . . . . .
Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Legal and other professional fees . . . . . . . . . . . . . . .
Management fees . . . . . . . . . . . . . . . . . . . . . . .
Mortgage interest paid to banks, etc. (see instructions) . . . .
Other interest . . . . . . . . . . . . . . . . . . . . . . . . . .
Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation expense or depletion . . . . . . . . . . . . . . .
Depreciation
Other (list)
__
_ _ _ _ _ _ _ _ _ _Expense
_____________
Total expenses. Add lines 5 and 19 . . . . . . . . . . . . . .

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

0
0
3,000
0
0
0
0
14,000
0
0
0
4,000
0
0
7,000
28,000

0

0

21

Subtract line 20 from line 4. If result is a (loss), see
instructions to find out if you must file Form 6198 . . . . . . .

21

-4,000

0

0

22
23a
b
c
d
e
f
g
24
25
26

KIA

Deductible rental real estate loss after limitation, if any,
0) (
) (
22 (
on Form 8582 (see instructions) . . . . . . . . . . . . . . .
0
Total of all amounts reported on line 3a for all rental properties
. . . . . . . . . 23a
0
Total of all amounts reported on line 3a for all royalty properties
. . . . . . . . . 23b
24,000
Total of all amounts reported on line 4 for all rental properties . . . . . . . . . . . 23c
0
Total of all amounts reported on line 4 for all royalty properties . . . . . . . . . . 23d
14,000
Total of all amounts reported on line 12 for all properties . . . . . . . . . . . . . 23e
0
Total of all amounts reported on line 18 for all properties . . . . . . . . . . . . . 23f
28,000
Total of all amounts reported on line 20 for all properties . . . . . . . . . . . . . 23g
Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . . . . . . .
24
Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here. 25 (
Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here.
If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this amount on Form 1040, line
17, or Form 1040NR, line 18. Otherwise, include this amount in the total on line 41 on page 2
26
For Paperwork Reduction Act Notice, see your tax return instructions.

)

0
0)
0

Schedule E (Form 1040) 2011

Attachment Sequence No. 13
Page 2
Your Social security number

Schedule E (Form 1040) 2011
Name(s) shown on return. Do not enter name and social security number if shown on page 1.

Jeff

J Bell

111-11-1111

Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.

Part II
27

Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which
any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See instructions.

Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year
unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed
partnership expenses? If you answered “Yes,” see instructions before completing this section.

28

(b) Enter P for
partnership; S
for S corporation

(a) Name

K&R partnership

A
B
C
D

(c) Check if
foreign
partnership

P

A
B
C
D
29a
b
30
31
32

(d) Employer
identification
number

No

(e) Check if
any amount is
not at risk

11-1111111

Passive Income and Loss
(f) Passive loss allowed
(attach Form 8582 if required)

X

Yes

Nonpassive Income and Loss

(g) Passive income
from Schedule K-1

(h) Nonpassive loss
from Schedule K-1

(i) Section 179 expense
deduction from Form 4562

(j) Nonpassive income
from Schedule K-1

6,000

0
Totals
0
0
0
Totals
Add columns (g) and (j) of line 29a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add columns (f), (h), and (i) of line 29b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the
result here and include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . . . . .

Part III

6,000
30
31

(

6,000
0 )
6,000

32

Income or Loss From Estates and Trusts
(b) Employer
identification number

(a) Name

33
A
B

Passive Income and Loss
(c) Passive deduction or loss allowed
(attach Form 8582 if required)

Nonpassive Income and Loss

(d) Passive income
from Schedule K-1

(e) Deduction or loss
from Schedule K-1

(f) Other income from
Schedule K-1

A
B

34a
b
35
36
37

0
Totals
0
0
Totals
Add columns (d) and (f) of line 34a
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and
include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV

(b) Employer identification
number

(c) Excess inclusion from
Schedules Q, line 2c
(see instructions)

39

0
0

40
41

0
6,000

Summary

40
41
42

Net farm rental income or (loss) from Form 4835. Also, complete line 42 below
Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code
U; and Schedule K-1 (Form 1041), line 14, code F (see instructions) . . . .

42

43

Reconciliation for real estate professionals. If you were a real estate
professional (see instructions), enter the net income or (loss) you reported
anywhere on Form 1040 or Form 1040NR from all rental real estate activities
in which you materially participated under the passive activity loss rules . .

43

KIA

0
(e) Income from
Schedules Q, line 3b

0

Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below

Part V

0
0 )

(

37

(d) Taxable income (net loss)
from Schedules Q, line 1b

0
39

35
36

Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder
(a) Name

38

0

. . . . . . . . .

Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17, or Form 1040NR, line 18 .

0
Schedule E (Form 1040) 2011

SCHEDULE SE
(Form 1040)

OMB No. 1545-0074

Department of the Treasury
Internal Revenue Service (99)

Attach to Form 1040 or Form 1040NR.

Attachment
Sequence No.

See separate instructions.

Name of person with self-employment income (as shown on Form 1040)

Ivy

2011

Self-Employment Tax
Social security number of person
with self-employment income

N Bell

17

123-45-6781

Before you begin: To determine if you must file Schedule SE, see the instructions.

May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.
Did you receive wages or tips in 2011?
No

Yes

Are you a minister, member of a religious order, or Christian
Science practitioner who received IRS approval not to be taxed
on earnings from these sources, but you owe self-employment
tax on other earnings?

Was the total of your wages and tips subject to social security
or railroad retirement (tier 1) tax plus your net earnings from
self-employment more than $106,800?

Yes

No

Yes

No

Are you using one of the optional methods to figure your net
earnings (see instructions)?

Did you receive tips subject to social security or Medicare tax
that you did not report to your employer?

Yes

Yes

No

No
Did you receive church employee income (see instructions)
reported on Form W-2 of $108.28 or more?

Yes

No

Did you report any wages on Form 8919, Uncollected Social
Security and Medicare Tax on Wages?

Yes

No

You may use Short Schedule SE below

You must use Long Schedule SE on page 2

Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.
1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form

1065), box 14, code A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Y . .

2

0

1a
1b

(

0)

Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
Ministers and members of religious orders, see instructions for types of income to report on this
line. See instructions for other income to report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

53,619

3

Combine lines 1a, 1b, and 2.

3

53,619

4

Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
not file this schedule unless you have an amount on line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

49,517

5

6,586

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
see instructions.
5

Self-employment tax. If the amount on line 4 is:

• $106,800 or less, multiply line 4 by 13.3% (.133). Enter the result here and on Form 1040, line 56,
or Form 1040NR, line 54.
• More than $106,800, multiply line 4 by 2.9% (.029). Then, add $11,107.20 to the result.
Enter the total here and on Form 1040, line 56, or Form 1040NR, line 54. . . . . . . . . . . . .
6

KIA

Deduction for employer-equivalent portion of self-employment tax.
If the amount on line 5 is:
• $14,204.40 or less, multiply line 5 by 57.51% (.5751)
• More than $14,204.40, multiply line 5 by 50% (.50) and add $1,067
to the result.
Enter the result here and on Form 1040, line 27, or Form
1040NR, line 27
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions.

6

3,788
Schedule SE (Form 1040) 2011

Form

6252

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0228

Installment Sale Income
Attach to your tax return.
Use a separate form for each sale or other disposition of
property on the installment method.

Name(s) shown on return

2011

Attachment
Sequence No.
Identifying number

79

Jeff

J Bell
111-11-1111
Citrus
COunty
1 Description of property
-------------------------------------------------------------------------------------------------------------------------------------6/6/1990
9/2/2011
2a Date acquired (mm/dd/yyyy)
______________________
b Date sold (mm/dd/yyyy)
________________
3 Was the property sold to a related party (see instructions) after May 14, 1980? If "No," skip line 4 . . . . . .
X No
Yes
Was the property you sold to a related party a marketable security? If "Yes," complete Part III. If "No,"
complete Part III for the year of sale and the 2 years after the year of sale . . . . . . . . . . . . . . . . . .

4

Part I

7
8
9
10
11
12
13
14
15
16
17
18

Part II

20
21
22
23
24
25
26

Part III

5

300,000

13
14

200,000
100,000

0
100,000
0
300,000
Installment Sale Income. Complete this part for the year of sale and any year you receive a payment or have
certain debts you must treat as a payment on installment obligations.

Gross profit percentage (expressed as a decimal amount). Divide line 16 by line 18. For years after
the year of sale, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If this is the year of sale, enter the amount from line 17. Otherwise, enter -0- . . . . . . . . . . . . .
Payments received during year (see instructions). Do not include interest, whether stated or unstated
Add lines 20 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payments received in prior years (see instructions). Do not include
0
23
interest, whether stated or unstated
. . . . . . . . . . . . . . . . . . . .
Installment sale income. Multiply line 22 by line 19 . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the part of line 24 that is ordinary income under the recapture rules (see instructions) . . . . .
Subtract line 25 from line 24. Enter here and on Schedule D or Form 4797 (see instructions) . . . . .

19

No

Gross Profit and Contract Price. Complete this part for the year of sale only.

Selling price including mortgages and other debts. Do not include interest whether stated or unstated
Mortgages, debts, and other liabilities the buyer assumed or took the
0
6
property subject to (see instructions) . . . . . . . . . . . . . . . . . . . .
300,000
7
Subtract line 6 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . .
200,000
8
Cost or other basis of property sold . . . . . . . . . . . . . . . . . . . . .
9
Depreciation allowed or allowable . . . . . . . . . . . . . . . . . . . . . .
200,000
10
Adjusted basis. Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . .
11
Commissions and other expenses of sale . . . . . . . . . . . . . . . . . .
12
Income recapture from Form 4797, Part III (see instructions) . . . . . . . .
Add lines 10, 11, and 12
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 13 from line 5. If zero or less, do not complete the rest of this form (see instructions) . .
If the property described on line 1 above was your main home, enter the amount of your excluded
gain (see instructions). Otherwise, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gross profit. Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 13 from line 6. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . .
Contract price. Add line 7 and line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5
6

Yes

15
16
17
18

19
20
21
22

0.3333
0
200,000
200,000

24

66,660
0
66,660

25
26

Related Party Installment Sale Income. Do not complete if you received the final payment this tax year.

Name, address, and taxpayer identifying number of related party -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------X No
Yes
Did the related party resell or dispose of the property ("second disposition") during this tax year? . . . . . .

27
28
29

If the answer to question 28 is "Yes," complete lines 30 through 37 below unless one of the following conditions is met. Check the box that applies.

a
b
c
d
e
30
31
32
33
34
35
36
37
KIA

The second disposition was more than 2 years after the first disposition (other than dispositions of
marketable securities). If this box is checked, enter the date of disposition (mm/dd/yyyy) . . . . . .
The first disposition was a sale or exchange of stock to the issuing corporation.
The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition.
The second disposition occurred after the death of the original seller or buyer.
It can be established to the satisfaction of the IRS that tax avoidance was not a principal purpose for either of the
dispositions. If this box is checked, attach an explanation (see instructions).
Selling price of property sold by related party (see instructions) . . . . . . . . . . . . . . . . . . . . 30
Enter contract price from line 18 for year of first sale . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Enter the smaller of line 30 or line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Total payments received by the end of your 2011 tax year (see instructions) . . . . . . . . . . . . . . 33
Subtract line 33 from line 32. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Multiply line 34 by the gross profit percentage on line 19 for year of first sale . . . . . . . . . . . . . 35
Enter the part of line 35 that is ordinary income under the recapture rules (see instructions) . . . . . 36
Subtract line 36 from line 35. Enter here and on Schedule D or Form 4797 (see instructions) . . . . . 37
For Paperwork Reduction Act Notice, see page 4.

Form

0
0
0
0
0
0
0

6252 (2011)

Form

8582

OMB No. 1545-1008

Passive Activity Loss Limitations

2011

See separate instructions.

Department of the Treasury
Internal Revenue Service (99)

Attachment
Sequence No.
Identifying number

Attach to Form 1040 or Form 1041.

Name(s) shown on return

Jeff
Part I

J Bell
2011 Passive Activity Loss

88

111-11-1111

Caution: Complete Worksheets 1, 2 and 3 before completing Part I.
Rental Real Estate Activities With Active Participation (For the definition of active participation see
Special Allowance for Rental Real Estate Activities in the instructions.)
1a Activities with net income (enter the amount from Worksheet 1,
column (a))
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
b Activities with net loss (enter the amount from Worksheet 1, column
(b)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b
c Prior years unallowed losses (enter the amount from Worksheet 1,
column (c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c
d Combine lines 1a, 1b, and 1c . . . . . . . . . . . . . . . . . . . . . . . .
Commercial Revitalization Deductions From Rental Real Estate Activities
2a
2a Commercial revitalization deductions from Worksheet 2, column (a)
b Prior year unallowed commercial revitalization deductions from
Worksheet 2, column (b) . . . . . . . . . . . . . . . . . . . . . . . 2b

0
(

4,000 )

(

0 )

. . . . . . . . . . .
(

)

(

)

c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
All Other Passive Activities
3a Activities with net income (enter the amount from Worksheet 3,
column (a)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3a

0

b Activities with net loss (enter the amount from Worksheet 3, column
(b)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3b (

0 )

c Prior years unallowed losses (enter the amount from Worksheet 3,
column (c))
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3c (

0 )

d Combine lines 3a, 3b, and 3c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Combine lines 1d, 2c, and 3d. If this line is zero or more, stop here and include this form with
your return; all losses are allowed, including any prior year unallowed losses entered on line 1c,
2b, or 3c. Report the losses on the forms and schedules normally used . . . . . . . . . . . . .
If line 4 is a loss and:

-4,000

1d

2c (

0)

3d

0

4

-4,000

Line 1d is a loss, go to Part II.
Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III.
Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15.

Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete
Part II or Part III. Instead, go to line 15.

Part II
5
6
7

8
9
10

Note: Enter all numbers in Part II as positive amounts. See instructions for an example.
Enter the smaller of the loss on line 1d or the loss on line 4 . . . . . . . . . . . . . . . . . . .
150,000
6
Enter $150,000. If married filing separately, see instructions . . . .
175,819
Enter modified adjusted gross income, but not less than zero (see instructions) 7
Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9,
enter -0- on line 10. Otherwise, go to line 8.
0
8
Subtract line 7 from line 6 . . . . . . . . . . . . . . . . . . . . . .
Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see instructions .
Enter the smaller of line 5 or line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 2c is a loss, go to Part III. Otherwise, go to line 15.

Part III
11
12
13
14

KIA

5

4,000

9
10

0
0

Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities

Note: Enter all numbers in Part III as positive amounts. See the example for Part II in the instructions.
Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11
Enter the loss from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Reduce line 12 by the amount on line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13 . . . . . . . . . . 14

Part IV
15
16

Special Allowance for Rental Real Estate Activities With Active Participation

Total Losses Allowed

Add the income, if any, on lines 1a and 3a and enter the total . . . . . . . . . . . . . . . . . . .
Total losses allowed from all passive activities for 2011. Add lines 10, 14, and 15. See
instructions to find out how to report the losses on your tax return . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see instructions.

15

0

16

0
Form

8582 (2011)

Jeff
J Bell
111-11-1111
Caution: The worksheets must be filed with your tax return. Keep a copy for your records.
Worksheet 1—For Form 8582, Lines 1a, 1b, and 1c (See instructions.)

Page 2

Form 8582 (2011)

Current year

Prior years

Overall gain or loss

Name of activity
(a) Net income
(line 1a)

(b) Net loss
(line 1b)

(c) Unallowed
loss (line 1c)

(d) Gain

Orange Blossom Tra D

0

4,000

0

Total. Enter on Form 8582, lines 1a, 1b,
and 1c . . . . . . . . . . . . . . . . .

0

4,000

0

(e) Loss

0

4,000

Worksheet 2—For Form 8582, Lines 2a and 2b (See instructions.)
Name of activity

(a) Current year
deductions (line 2a)

(b) Prior year
unallowed deductions (line 2b)

Total. Enter on Form 8582, lines 2a
and 2b . . . . . . . . . . . . . . .

0

0
Worksheet 3—For Form 8582, Lines 3a, 3b, and 3c (See instructions.)
Current year

(c) Overall Loss

Prior years

Overall gain or loss

Name of activity
(a) Net income
(line 3a)

(b) Net loss
(line 3b)

(c) Unallowed
loss (line 3c)

(d) Gain

(e) Loss

Total. Enter on Form 8582, lines 3a, 3b,
and 3c . . . . . . . . . . . . . . . .

Worksheet 4—Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.)
Name of activity

Form or schedule
and line number
to be reported on
(see instructions)

(a) Loss

(b) Ratio

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c) Special
allowance

(d) Subtract
column (c) from
column (a)

1.00

Worksheet 5—Allocation of Unallowed Losses (See instructions.)
Name of activity

Orange Blossom Tra D

Total
KIA

Form or schedule
and line number
to be reported on
(see instructions)

Sch E, line 22A

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(a) Loss

(b) Ratio

4,000

1.0000

4,000

1.00

(c) Unallowed loss

4,000

4,000
Form 8582 (2011)

Jeff
J Bell
Worksheet 6—Allowed Losses (See instructions.)

111-11-1111

Form 8582 (2011)

Name of activity

Orange Blossom Tra D

Total

Form or schedule
and line number to
be reported on (see
instructions)

(a) Loss

(b) Unallowed loss

Page 3

(c) Allowed loss

Sch E, line 22A

4,000

4,000

0

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,000

4,000

0

Worksheet 7—Activities With Losses Reported on Two or More Forms or Schedules (See instructions.)
Name of activity:

(a)

(b)

(c) Ratio

(d) Unallowed
loss

(e) Allowed loss

Form or schedule and line number
to be reported on (see
instructions): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1a Net loss plus prior year unallowed
loss from form or schedule . . .
b Net income from form or
schedule . . . . . . . . . . . . .
c Subtract line 1b from line 1a. If zero or less, enter -0Form or schedule and line number
to be reported on (see
instructions): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1a Net loss plus prior year unallowed
loss from form or schedule . . .
b Net income from form or
schedule . . . . . . . . . . . . .
c Subtract line 1b from line 1a. If zero or less, enter -0Form or schedule and line number
to be reported on (see
instructions): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1a Net loss plus prior year unallowed
loss from form or schedule . . .
b Net income from form or
schedule . . . . . . . . . . . . .
c Subtract line 1b from line 1a. If zero or less, enter -0Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
KIA

1.00
Form 8582 (2011)

Form

OMB No. 1545-1190

Like-Kind Exchanges

8824

2011

(and section 1043 conflict-of-interest sales)

Name(s) shown on tax return

Attachment
Sequence No. 109
Identifying number

Jeff

111-11-1111

Department of the Treasury
Internal Revenue Service

Part I

Attach to your tax return.

J Bell
Information on the Like-Kind Exchange

Note: If the property described on line 1 or line 2 is real or personal property located outside the United States, indicate the country.
1 Description of like-kind property given up:
Levy
_ _ _ _ County
________________________________________________________________
Land
____________________________________________________________________
2 Description of like-kind property received:
Dixie
_ _ _ _ _ County
_______________________________________________________________
Land
____________________________________________________________________
06/06/90
3
3 Date like-kind property given up was originally acquired (month, day, year) . . . . . . . . . . . . . .
. . . . . . . . . . . . .

4

02/10/11

5 Date like-kind property you received was identified by written notice to another party (month,
day, year). See instructions for 45-day written notice requirement . . . . . . . . . . . . . . . . . . .

5

02/10/11

6 Date you actually received the like-kind property from other party (month, day, year). See instructions

6

02/10/11

4 Date you actually transferred your property to other party (month, day, year)

7 Was the exchange of the property given up or received made with a related party, either directly or indirectly
(such as through an intermediary)? See instructions. If “Yes,” complete Part II. If “No,” go to Part III . . . . . .

Part II

X No

Related Party Exchange Information

Name of related party

8

Yes

Relationship to you

Related party's identifying number

Address (no., street, and apt., room, or suite no., city or town, state, and ZIP code)

9 During this tax year (and before the date that is 2 years after the last transfer of property that was part of
the exchange), did the related party sell or dispose of any part of the like-kind property received from you
(or an intermediary) in the exchange or transfer property into the exchange, directly or indirectly (such as
through an intermediary), that became your replacement property?
. . . . . . . . . . . . . . . . . . . . . . .

Yes

No

10 During this tax year (and before the date that is 2 years after the last transfer of property that was part of
the exchange), did you sell or dispose of any part of the like-kind property you received? . . . . . . . . . . . .

Yes

No

If both lines 9 and 10 are “No” and this is the year of the exchange, go to Part III. If both lines 9 and 10 are “No” and this is not
the year of the exchange, stop here. If either line 9 or line 10 is “Yes,” complete Part III and report on this year’s tax return the
deferred gain or (loss) from line 24 unless one of the exceptions on line 11 applies.
11 If one of the exceptions below applies to the disposition, check the applicable box:
a

The disposition was after the death of either of the related parties.

b

The disposition was an involuntary conversion, and the threat of conversion occurred after the exchange.

c

You can establish to the satisfaction of the IRS that neither the exchange nor the disposition had tax avoidance as one of
its principal purposes. If this box is checked, attach an explanation (see instructions).

KIA

For Paperwork Reduction Act Notice, see the instructions.

Form

8824 (2011)

Page 2

Form 8824 (2011)
Name(s) shown on tax return. Do not enter name and social security number if shown on page 1.

Jeff
Part III

Your social security number

J Bell

111-11-1111
Realized Gain or (Loss), Recognized Gain, and Basis of Like-Kind Property Received

Caution: If you transferred and received (a) more than one group of like-kind properties or (b) cash or other (not like-kind) property,
see Reporting of multi-asset exchanges in the instructions.

Note: Complete lines 12 through 14 only if you gave up property that was not like-kind. Otherwise, go to line 15.
12
13
14

15
16
17
18
19
20
21
22
23
24
25

Fair market value (FMV) of other property given up . . . . . . . . . . . .
12
13
Adjusted basis of other property given up . . . . . . . . . . . . . . . . .
Gain or (loss) recognized on other property given up. Subtract line 13 from line 12. Report the
gain or (loss) in the same manner as if the exchange had been a sale . . . . . . . . . . . . . . .
Caution: If the property given up was used previously or partly as a home, see Property used as
home in the instructions.
Cash received, FMV of other property received, plus net liabilities assumed by other party,
reduced (but not below zero) by any exchange expenses you incurred (see instructions) . . . . .
FMV of like-kind property you received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add lines 15 and 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adjusted basis of like-kind property you gave up, net amounts paid to other party, plus any
exchange expenses not used on line 15 (see instructions) . . . . . . . . . . . . . . . . . . . . .
Realized gain or (loss). Subtract line 18 from line 17 . . . . . . . . . . . . . . . . . . . . . . .
Enter the smaller of line 15 or line 19, but not less than zero . . . . . . . . . . . . . . . . . . . .
Ordinary income under recapture rules. Enter here and on Form 4797, line 16 (see instructions) .
Subtract line 21 from line 20. If zero or less, enter -0-. If more than zero, enter here and on
Schedule D or Form 4797, unless the installment method applies (see instructions) . . . . . . . .
Recognized gain. Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deferred gain or (loss). Subtract line 23 from line 19. If a related party exchange, see instructions
Basis of like-kind property received. Subtract line 15 from the sum of lines 18 and 23 . . . . .

Part IV

.

14

0

.
.
.

15
16
17

25,000
175,000
200,000

.
.
.
.

18
19
20

200,000
0
0
0

.
.
.
.

22

21

23
24
25

0
0
0
175,000

Deferral of Gain From Section 1043 Conflict-of-Interest Sales

Note: This part is to be used only by officers or employees of the executive branch of the Federal Government or judicial
officers of the Federal Government (including certain spouses, minor or dependent children, and trustees as described in
section 1043) for reporting nonrecognition of gain under section 1043 on the sale of property to comply with the
conflict-of-interest requirements. This part can be used only if the cost of the replacement property is more than the basis of
the divested property.

27

Enter the number from the upper right corner of your certificate of divestiture. (Do not attach a
copy of your certificate. Keep the certificate with your records.) . . . . . . . . . . . . . . . .
Description of divested property
-------------------------------------------------------------------

28

--------------------------------------------------------------------------------------------Description of replacement property
----------------------------------------------------------------

26

--------------------------------------------------------------------------------------------29

Date divested property was sold (month, day, year) . . . . . . . . . . . . . . . . . . . . . . . . . .

30

Sales price of divested property (see instructions)

31

Basis of divested property

32

Realized gain. Subtract line 31 from line 30

33

Cost of replacement property purchased within 60 days after date
of sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

34

Subtract line 33 from line 30. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . .

35
36

Ordinary income under recapture rules. Enter here and on Form 4797, line 10 (see instructions) . .
Subtract line 35 from line 34. If zero or less, enter -0-. If more than zero, enter here and on
Schedule D or Form 4797 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

37
38
KIA

. . . . . . . . . . . . .

30

. . . . . . . . . . . . . . . . . . . . . . . . .

31

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29

32

0

34

0

33

35
36

0

Deferred gain. Subtract the sum of lines 35 and 36 from line 32 . . . . . . . . . . . . . . . . . . .

37

0

Basis of replacement property. Subtract line 37 from line 33

38

0

. . . . . . . . . . . . . . . . . . . .

Form

8824 (2011)

2011

Department of the Treasury
Internal Revenue Service

Form 1040- V

Detach Here and Mail With Your Payment and Return

Department of the Treasury
Internal Revenue Service

2011

Use this voucher when making a payment with Form 1040.
Do not staple this voucher or your payment to Form 1040.
Make your check or money order payable to the "United States Treasury."
Write your social security number (SSN) on your check or money order.

111-11-1111

123-45-6781

Jeff
J Bell
Ivy
N Bell
4326 Orange Blossom Trail
Dallas

KIA

Form

1040-V (2011)

Form 1040-V Payment Voucher
Amount you are paying
by check or money order

KIA 1017

TX 75080

111111111 DJ BELL 30 0 201112 610

Dollars

2,317

SUPPORTING FORMS

RE: 2011 Tax Returns
PREPARED FOR: Jeff Bell

SSN: 111-11-1111

PRINTED ON: December 02, 2013
PREPARED USING: H&R Block 2011 [7102]

SUPPORTING FORMS WHICH CAN BE SUBMITTED TO THE IRS
SUPPORTING FORMS IN YOUR RETURN
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

-

Background Worksheet - Background Information Worksheet
Dependents Worksheet - Worksheet for Dependents
Child Tax Credit Worksheet - Child Tax Credit Worksheet
Form 1099-INT/OID - Interest Income Worksheet
Home Mortgage Interest Worksheet - Home Mortgage Interest Worksheet
Charitable Worksheet - Charitable Donations Worksheet
Vehicle Worksheet - Vehicle Expense Worksheet
Capital Gains and Losses Worksheet - Capital Gains and Losses
Rentals & Royalties - Rentals and Royalties Worksheet
K-1 Partnership/S Corporation - K-1 (Partnership/S Corporation) Worksheet

**************** DO NOT MAIL THIS PAGE ****************

BACKGROUND

BACKGROUND INFORMATION WORKSHEET

1. YOUR NAME, ADDRESS AND TELEPHONE NUMBER
Your name (first, MI, last, Jr/III) . . . . . . . . . . . . . .Jeff
Spouse's name (first,MI,last,Jr/III) . . . . . . . . . . . .Ivy

2011

J Bell
N Bell

C/O information, if necessary . . . . . . . . . . . . . . .
Foreign address (not APO/FPO)
Your street and apartment # (if any) . . . . . . . . . . 4326 Orange Blossom Trail
Your city, state, and ZIP code . . . . . . . . . . . . . . .Dallas
, TX 75080
Foreign country . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign province/county . . . . . . . . . . . . . . . . . . .
Foreign postal code . . . . . . . . . . . . . . . . . . . . . . .
Your telephone number (daytime) . . . . . . . . . . . .214-456-7891
I live outside the U.S. and Puerto Rico and my main place of work is
outside the U.S. and Puerto Rico, or I'm in military or naval service
outside the U.S. and Puerto Rico.
Check here if you received a letter from the IRS with an
identity protection personal identification number (IP PIN).
IP PIN's are uncommon. They are sent to certain taxpayers
taxpayers who have had a problem with identity theft.
6-digit IP PIN . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. GENERAL INFORMATION
Yours
Your spouse's
123-45-6781
Social Security number . . . . . . . . . .111-11-1111
03/20/1969
Date of birth (MM/DD/YYYY) . . . . . 07/01/1968
"X" if legally blind . . . . . . . . . . . . . . .
Enter "X" if disabled . . . . . . . . . . . . .
Self-employed CPA
Occupation . . . . . . . . . . . . . . . . . . .Regional Manager
"X" if you want $3 to go to
Pres. Elec. Campaign Fund . . . . . . .
Primary taxpayer
Spouse
g. If this return is for a
deceased person, enter
the date of death . . . . . . . . . . . . . .
h. Full-time student (see help
panel for details)
3. FILING STATUS
a. Choose your filing status below:
Single
Married filing joint return
Married filing separate return
Head of household
Qualifying widow(er)
b. If you are married filing separately, check the applicable box.
I want to itemize my deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I want to use the standard deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Check the box if you are married filing separately AND you and your
spouse lived apart throughout 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. If filing status is head of household, and qualifying person is a child
but not your dependent, enter the child's name . . . . . . . . . . . .
and SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Click here to clear or make a new selection . . . . . . . . . . . . . . .
e. If qualifying widow(er), enter the year your spouse died . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Dual-Status Alien: Enter "X" if you or your spouse is a dual-status alien
AND you are NOT entering on this tax return your combined worldwide
income. If you enter "X," your standard deduction is zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a.
b.
c.
d.
e.
f.

AND you are NOT entering on this tax return your combined worldwide
income. If you enter "X," your standard deduction is zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BACKGROUND (CONT'D) PAGE 2
2011
Jeff
J Bell
SSN: 111-11-1111
4. EXEMPTIONS FOR YOU AND YOUR SPOUSE
a. Place an "X" here if anyone else (a parent, e.g.) can claim you as a
dependent on his or her tax return. (Joint filers enter "X" only if
someone else can claim you, AND your tax before withholding is zero.) . . . . . . . . . . . . . . . . . .
b. Enter "Y" if you are entitled to an exemption for yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y
c. If married, place an "X" here if anyone else (a parent, e.g.) can
claim your spouse as an exemption on his or her tax return. (Joint
filers enter "X" only if someone else can claim your spouse, AND your
tax before withholding is zero.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Enter "X" if you are entitled to an exemption for your spouse . . . . . . . . . . . . . . . . . . . . . . . . . .
Your Exemption for Alternative Minimum Tax
YES NO
e. You had at least one parent living on the last day of 2011 . . . . . . . . . . . . . . . . . . . . .
If you answered yes to the previous question and you were ages 18-23
on the last day of 2011, answer the next question.
f. Your earned income was less than half of your support in 2011 . . . . . . . . . . . . . . . . .
5. TAXES PAID/WITHHELD
a. Estimated taxes paid (do not include 2010 refund applied):
Date
Amount
9,000

9,000
Total estimated tax payments . . . . . . . . . . . .
Amount
paid
with
Form
4868
(for
October
returns)
.
.
.......................
b.
c. Withholding on Form 1099-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Withholding on Form 1099-PATR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. PAYING YOUR TAXES BY CREDIT CARD
a. Confirmation number, if taxes are being paid by credit card.
b. Amount charged to credit card (not including convenience
fee), if taxes are being paid by credit card . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. REFUND INFORMATION
Direct Deposit
Would you like to speed your refund by having the IRS deposit it directly
into your account at a bank or other financial institution in the
United States? If so, fill in the following regarding the
account and place an X here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1a. Routing Transit Number ("RTN") . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Depositor Account Number ("DAN") . . . . . . . . . . . . . . . . . . . . . . . .
Note: Here is a sample of the numbers you might find at the bottom
of a check, with "RTN," "DAN," and check number identified.
RTN:
DAN:
Check number:
123404567
123-4567
0101
c. Type of account:
Checking
Savings
d. Amount to be deposited in first account . . . . . . . . . . . . . . . . . . . . .
2a. Routing Transit Number ("RTN") . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Depositor Account Number ("DAN") . . . . . . . . . . . . . . . . . . . . . . . .
c. Type of account:
Checking
Savings
d. Amount to be deposited in second account . . . . . . . . . . . . . . . . . .
3a. Routing Transit Number ("RTN") . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Depositor Account Number ("DAN") . . . . . . . . . . . . . . . . . . . . . . . .
c. Type of account:
Checking
Savings
d. Amount to be deposited in third account . . . . . . . . . . . . . . . . . . . .
Applying Refund to Your 2012 Estimated Tax

0

If you are due a refund this year, do you want to apply any of it to 2012
estimated tax? If so, please enter the amount here

estimated tax? If so, please enter the amount here
BACKGROUND (CONT'D) PAGE 3
Jeff
J Bell
8. THIRD PARTY DESIGNEE

SSN:

2011
111-11-1111

Do you want to allow another person to discuss this return with
the IRS?
Yes
No
If Yes, complete the following information:
Designee's name:
Designee's phone number:
Designee's personal
identification number (PIN):
9. RETURN ASSISTANCE
How was this return prepared:
By yourself.
With help of an IRS-sponsored program (if so, enter one of the
following: TC, TCE, TC-X, TCE-X, VITA, VITA-T, Self-Help,
IRS-Prepared, IRS-Reviewed, Outreach):
.
10. STATE TAX RETURNS
Enter information below about any 2011 state tax returns you're filing.
For each state, select the residency status that applies for 2011.
Name of state(s)
Your residency status
Spouse's residency status

DEPENDENTS
Jeff

WORKSHEET FOR DEPENDENTS
J Bell

2011
SSN:111-11-1111

SECTION I BASIC INFORMATION
Tell us about the person you want to claim as a dependent:
First Name
MI Last Name
Soc. Sec. No.
Tyler
Bell
123-45-6788
Relationship
Son

Date of Birth
06/30/1997

Type of Dependent
Child Lived with You
Time Lived With You
Lived With All Year or Born

Person's age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
DOB string . . . . . . . .June 30, 1997
Person is fosterchild placed with you by court order/placement agency . . . . . . . . . . . . . . . . . . . .
Yes No
Was this person a US citizen/resident alien of the US in 2011? . . . . . . . . . . . . . . . . . . . . . .
If no, was this person a resident of Canada or Mexico in 2011? . . . . . . . . . . . . . . . . . . . . . .
Is this person your adopted child who lived with you all year? . . . . . . . . . . . . . . . . . . . . . . . .
SECTION II QUICK ENTRY
If you're not sure this person qualifies, check NO and go to Section III.
Yes
Are you sure this person qualifies as your dependent in 2011 . . . . . . . . . . . . . . . . . . . . . . .
IF YOU ANSWERED YES - STOP!
You do not need to complete the rest of this worksheet.
We will prevent you from checking this box if you have not completed
all the information in Section I, or if we've determined (based upon
that information) this person cannot be your dependent.

No

SECTION III DEPENDENT QUALIFICATION TESTS
Do not complete this Section unless you answered NO in Section II.
PART A ALL DEPENDENTS
Yes
1. Will the person named in Section I file a joint return in 2011? . . . . . . . . . . . . . . . . . . . . .
* If NO, go to line 3.
* If YES, go to line 2.

No

2. Does this person satisfy the exception to the dependent
joint return test? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
See the FAQ to the right to learn about the exception to joint return test.
* If YES, go to Part B, line 3.
* If NO STOP. You cannot claim this person as your dependent.
PART B DETERMINE WHETHER PERSON IS YOUR QUALIFYING CHILD
3. If this person is your child, are any of these statements true? . . . . . . . . . . . . . . . . . . . . .
* You are divorced or legally separated under a decree of divorce
or separate maintenance from the child's other parent.
* You are separated under a written separation agreement from the
child's other parent.
* You lived apart during the last 6 months of the calendar year.
Answer NO if this person is not your child.
* If NO, go to line 4.
* If YES, complete the MINI-WORKSHEET FOR LINE 3.
Yes
4. Did this person live in your home for more than half the year? . . . . . . . . . . . . . . . . . . . .
If YES, go to line 5.
If NO:
* If you also answered NO to line 3 go to Part C. You cannot
claim this person as your Qualifying Child, but you may be
able to claim this person as your Qualifying Relative.
* If you answered YES to line 3 and YES to line h or line j
of the MINI-WORKSHEET FOR LINE 3 go to line 5.
* If you answered YES to line 3 and you did NOT check line h or
line j of the MINI-WORKSHEET FOR LINE 3, go to Part C. You cannot
claim this person as your Qualifying Child, but you may
be able to claim this person as your Qualifying Relative.
5. Is this person's relationship valid for a Qualifying Child? . . . . . . . . . . . . . . . . . . . . . . . . .
We calculate this answer based upon the relationship selected in Section I.
Check this box if this person is your fosterchild, placed in your care
by an authorized placement agency or by judgment, decree, or other

No

valid court order.
* If YES go to line 6.
* If NO go to PART C. You cannot claim this person as your
Qualifying Child, but you may be able to claim this person as your
Qualifying Relative.
6. Was this person under age 19 at the end of the year? . . . . . . . . . . . . . . . . . . . . . . . . . .
We calculate this based on this person's date of birth in Section I.
* If YES, skip lines 7-9 and go to line 10.
* If NO, go to line 7.
7. Was this person a student in 2011? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* If NO, go to line 9.
* If YES, go to line 8.
8. Was this person under age 24 at the end of the year? . . . . . . . . . . . . . . . . . . . . . . . . . .
We calculate this based on this person's date of birth in Section I.
* If YES, skip line 9 and go to line 10.
* If NO, go to line 9.
9. Was this person permanently and totaly disabled?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* If YES, go to line 11.
* If NO go to line 10.
10. Is this person younger than taxpayer (or spouse if MFJ)?. . . . . . . . . . . . . . . . . . . . . . .
* If YES, go to line 11.
* If NO go to PART C. You cannot claim this person as your
Qualifying Child, but you may be able to claim this person as your
Qualifying Relative.
11. Did this person provide over half his/her own support in 2011? . . . . . . . . . . . . . . . . . .
* If NO, read the caution below and go to line 12.
* If YES, STOP. You cannot claim this person as your dependent.
12. Do you want to claim this person as your dependent? . . . . . . . . . . . . . . . . . . . . . . . . .
If you do not have the better claim to the dependent exemption, you
should only answer YES to line 12 if you know the other taxpayer will
not claim this person as a dependent.
PART C DETERMINE WHETHER PERSON IS YOUR QUALIFYING RELATIVE
Complete this Part only if this person is not a Qualifying Child and
we directed you to complete this Part in Part B.
Yes
13. Although not your Qualifying Child, is this person a Qualifying
Child for somebody else? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
See the FAQ to the right to see who can be a Qualifying Child.
* If NO, go to line 14.
* If YES STOP. You cannot claim this person as your dependent.
14. Is this person's relationship valid for a Qualifying Relative? . . . . . . . . . . . . . . . . . . . . . .
See the FAQ to the right to see who can be a Qualifying Relative.
* If YES, go to line 15.
* If NO STOP. You cannot claim this person as your dependent.
15. Did this person have more than $3,700 of gross income in 2011? . . . . . . . . . . . . . . . . .
See the FAQ to the right to learn what is considered gross income.
* If NO, go to line 16.
* If YES STOP. You cannot claim this person as your dependent.
16. Did you (and your spouse if married filing jointly) provide more
than half the support for this person during 2011? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TIP! Answer YES if a multiple support agreement lets you claim this person.
Note: We calculate line 16 if you completed the MINI-WORKSHEET FOR LINE 5.
See the FAQ to the right to learn what is considered support.
* If YES, this person is your Qualifying Relative and we'll make
this person your dependent.
* If NO, this person is not your Qualifying Relative or your dependent.

No

CHILD TAX CR WKS
Jeff

CHILD TAX CREDIT WORKSHEET
Form 1040 line 51 and 1040A line 33

J Bell

2011
SSN:

111-11-1111

To calculate your Child Tax Credit, we complete Parts I and II of the Child Tax
Credit Worksheet below. However, if any one of the following bullet-points apply
we complete the Publication 972 Worksheet and not the Child Tax Credit Worksheet.
You are claiming any of the following credits:
1. Mortgage Interest Credit (Form 8396)
2. D.C. First-time Homebuyer Credit (Form 8859)
3. Residential energy efficient property credit (Form 5695, Part II)
You excluded income from Puerto Rico or American Samoa (Form 4563).
You are filing Form 2555 or Form 2555-EZ.
CHILD TAX CREDIT WORKSHEET
PART I

1.
2.
3.

4.

5.
6.

The child tax credit is based on the number of qualifying children who
lived with you during 2011. We automatically calculate the number of your
qualifying children based upon information on the Dependent Worksheet.
1 X $1,000
Number of qualifying children
Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Adjusted gross income (Form 1040, ln 38, Form 1040A, ln 22) . . . . . . . . . . . . . . . . 2
Amount corresponding to your filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Married filing jointly - $110,000
Single, head of household, or qualifying widow(er) - $75,000
Married filing separately - $55,000
Is amount on line 2 more than amount on line 3?
No - Leave line 4 blank and enter zero on line 5.
Yes - Ln 2-ln 3 increased to next multiple of $1,000 . . . . . . . . . . . . . . . . . . . 4
Line 4 times 5% (.05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Is amount on line 1 more than amount on line 5?
No - STOP! You cannot take the child tax credit on Form 1040,
line 51, or Form 1040A, line 33. You also cannot take the
additional child tax credit on Form 1040, line 65 or Form
1040A, line 42. Complete the rest of your Form 1040 or 1040A.
Yes - Ln 1 - ln 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

PART II
7. Regular tax (1040 ln 46; 1040A ln 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
8. Add the following amounts from:
Form 1040:
Form 1040A:
0
Line 47
Line 48
Line 29
+
Line 49
Line 31
+
0
Line 50
Line 32
+
Form 5695, Line 14
+
Form 8834, Line 23
+
Form 8910, Line 22
+
Form 8936, Line 15
+
Schedule R, Line 22
+
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
9. Are the amounts on lines 7 and 8 the same?
Yes - STOP! You can't take the child tax credit because
there's no tax to reduce. You may qualify for
the additional child tax credit.
No - Subtract line 8 from 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
10. Is the amount on line 6 greater than the amount on line 9?
Yes - Enter the amount from line 9. You may qualify for
the additional child tax credit.
No - Enter the amount from line 6.
This is your Child Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
PUBLICATION 972 WORKSHEET
X $1,000
1. Number of qualifying children
Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. Adjusted gross income (Form 1040, ln 38, Form 1040A, ln 22) . . . . . . . . . . . . . . . . 2
3. Modifications to adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

1,000
172,031
110,000

63,000
3,150

5. Amount corresponding to your filing status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Married filing jointly - $110,000
Single, head of household, or qualifying widow(er) - $75,000
Married filing separately - $55,000
6. Is amount on line 4 more than amount on line 5?
No - Leave line 6 blank. Enter -0- on line 7.
Yes - Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
If the result is not a multiple of $1,000, increase it
to the next multiple of $1,000. For example, increase $425
to $1,000, increase $1,025 to $2,000, etc.
7. Line 6 times 5% (.05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
8. Is amount on line 1 more than amount on line 7?
No - STOP! You cannot take the child tax credit on Form 1040,
line 51, or Form 1040A, line 33. You also cannot take the
additional child tax credit on Form 1040, line 65 or Form
1040A, line 39. Complete the rest of your Form 1040 or 1040A.
Yes - Ln 1 - ln 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
9. Regular tax (1040 ln 46; 1040A ln 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
10. Add the following amounts from:
Form 1040:
Form 1040A:
Line 47
Line 48
Line 29
+
Line 49
Line 31
+
Line 50
Line 32
+
Form 5695, Line 14
+
Form 8834, Line 23
+
Form 8910, Line 22
+
Form 8936, Line 15
+
Schedule R,Line 22
+
TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
11. Are you claiming any of the following credits?
Mortgage interest credit, Form 8396
Residential energy efficient property credit, Form 5695, Part II
District of Columbia first-time homebuyer credit, Form 8859
No. Enter the amount from line 10.
YES. Complete the Line 11 Worksheet (below) to figure the
amount to enter here.
Amount from line 10 or line 15 of the Line 11 Worksheet . . . . . . . . . . . . . . . . . . . 11
12. Subtract line 11 from line 9 (not less than -0-) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13. Is the amount on line 8 more than the amount on line 12?
No. Enter the amount from line 8.
Yes. Enter the amount from the line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
LINE 11 WORKSHEET PUBLICATION 972
See IRS Publication 972
1. Amount from line 8 of the Publication 972 Worksheet . . . . . . . . . . . . . . . . . . . . . . . 1
2. Taxable earned income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
3. Is the amount on line 2 > $3,000?
No. Leave line 3 blank, enter -0- on line 4,
and go to line 5.
YES. Subtract $3,000 from the amount on line 2.
Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4. Multiply the amount on line 3 by 15% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5. Is the amount on line 1 of the Publication 972
Worksheet $3,000 or more?
No. If line 4 is:
Zero, enter the amount from line 1 on line 12 of this
worksheet. Do not complete the rest of this worksheet. Instead,
go back to the Publication 972 Worksheet and enter the amount
from line 10 on line 11 and complete lines 12 & 13.
If line 4 is not zero leave ln. 6 through 9 blank, enter -0- on
line 10, and go to line 11.
YES. If line 4 is equal to or > line 1, leave lines
6 through 9 blank, enter -0- on line 10, and go
to line 11. Otherwise, go to line 6.
6. Social Security, Medicare, Tier 1 taxes:

7.

8.
9.
10.
11.
12.

13.

14.
15.

ii. If you (and/or your spouse if married and filing a
joint return) were a railroad employee, enter
the amount of Tier 1 tax withheld from your pay
(from W-2, box 14). Employee representatives enter
50% of your total Tier 1 tax and Tier 1 Medicare
tax you paid for 2011 . . . . . . . . . . . . . . . . . . . .
Total Social Security/Medicare/Tier 1 tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Self-employment tax adjustment (1040 line 27), Social
Security tax on unreported tip income (1040 line 57)
and uncollected Social Security and Medicare or RRTA
taxes shown in box 12 of your Form(s) W-2 with codes
A, B, M and N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
EIC plus excess FICA & RRTA tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Line 8 minus line 9 (not less than -0-) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Enter the larger of 4 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Is line 11 more than line 1?
No. Subract ln. 11 from ln. 1 and enter the result.
Yes. Enter -0-.
Enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Enter the total of the amounts from Form 8396, line 9, and
Form 5695, line 31, and
Form 8859, line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Enter the amount from line 10 of the Pub. 972 Worksheet . . . . . . . . . . . . . . . . . .14
Add lines 13 and 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

FORM 1040 AND 1040A EARNED INCOME WORKSHEET
See IRS Publication 972
1a. Amount from Form 1040 or 1040A, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1a
b. Nontaxable combat pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1b
Next, if you are filing Schedule C, C-EZ, F, or SE, or you received
a Sch. K-1 (Form 1065/1065-B), go to ln. 2a. Otherwise, skip lines 2a
through 2e and go to line 3.
If you are filing Form 1040A, skip lines 2-3 and go to line 4a.
Note:
2a. Enter any statutory employee income reported on line 1
Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b. Enter any net profit or (loss) from Schedule C, line 31;
Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14 code A
(other than farming); Schedule K-1 (Form 1065-B) box 9 code J1*.
Reduce any Schedule K-1 amounts as described in the
instructions for completing Schedule SE in the Partner's
Instructions for Schedule K-1. Do not include any statutory
employee income or any other amounts exempt from self-employment
tax. Options and commodities dealers must add any gain or subtract
any loss (in the normal course of dealing in or trading
section 1256 contracts) from section 1256 contracts or
related property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2b
c. Enter any net farm profit or (loss) from Schedule F,
line 36, and from farm partnerships, Schedule K-1 (Form
1065), box 14, code A.* Reduce this amount by any
Schedule K-1 amounts as described in the instructions for
completing Schedule SE in the Partner's Instructions for
Schedule K-1. Do not include on this line any
0
amounts exempt from self-employment tax . . . . . . . . . . . . . . . . . . . 2c
d. If you used the farm optional method to figure net
earnings from self-employment, enter the amount from
Sch. SE, Section B, line 15. Otherwise, skip this line
and enter on ln. 2e the amt. from ln. 2c . . . . . . . . . . . . . . . . . . . . . .2d
e. If line 2c is a profit, enter the smaller of line 2c or
2d. If line 2c is a (loss), enter the (loss) from
line 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e
3. Add lines 1a, 1b, 2a, 2b, & 2e. If zero or less, stop.
Do not complete the rest of this worksheet. Enter -0- on line 2
of the Line 11 Worksheet or line 4a of Form 8812 . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4. Enter any amount included on line 1a that is:
a. A scholarship or fellowship grant not reported on

0
0

0

0

0

0

0
Form W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4a
b. For work done as an inmate in a penal institution (Enter
"PRI" and this amount on the dotted line next to line 7
of Form 1040 or Form 1040A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b
c. A pension or annuity from a nonqualified deferred
compensation plan or a nongovernmental section 457 plan
(enter "DFC" and this amount on the dotted line next to
line 7 of Form 1040 or Form 1040A). This amount may be
shown in box 11 of your Form W-2. If you received such
an amount but box 11 is blank, contact your employer for
0
the amount received as a pension/annuity . . . . . . . . . . . . . . . . . . . .4c
If you are filing Form 1040A, skip lines 5 - 6
Note:
and go to line 7.
5a. Enter any amount included on line 3 that is also
included on Form 2555, line 43, or Form 2555-EZ, line 18
Do not include any amount that is also included on line
4a, 4b, or 4c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5a
b. Enter the amount, if any, from Form 2555, line 44, that
is also deducted on Form 1040 line 27, Sch. C, C-EZ,
or F, or included on Sch. E in partnership net income
or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5b
0
c. Subtract 5b from 5a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5c
0
6. Enter the amount from Form 1040, line 27 . . . . . . . . . . . . . . . . . . . . .6
7. Form 1040 filers add lines 4a-4c, 5c, and 6.
Form 1040A filers add lines 4a-4c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
8. Form 1040 filers subtract line 7 from line 3.
Form 1040A filers add 1a + 1b less line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
We enter line 8 on line 2 of the Line 11 Worksheet
Note:
or line 4a of Form 8812.
If you have Sch. K-1 amounts and you are not required to
file Sch. SE, complete the appropriate line(s) of Sched. SE
Section A. Put your name and Social Security number on
Schedule SE and attach it to your return.
This is your Child Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
We enter this amount on Form 1040, line 51, or Form 1040A, line 33.

0
0

FORM 1099-INT/OID
INTEREST INCOME WORKSHEET
2011
Is this interest for:
You
Your spouse
Both of you
Ford Motor Company
Interest paid by:
FORM 1099-INT
15,000
$
Box 1 - Interest income:
$
Box 2 - Early withdrawal penalty:
Box 3 - Interest on U.S. Savings Bonds and
Treasury obligations:
$
Box 3 includes Series EE or I Savings Bond interest . . . . . . . . . . . . . . . . . . . . .
$
Box 4 - Federal income tax withheld:
$
Box 5 - Investment expenses:
$
Box 6 - Foreign tax paid:
Box 7 - Foreign country or U.S. possession:
$
Box 8 - Tax-exempt interest:
$
Box 9 - Specified private activity bond interest:
$
Box 10 - Tax-exempt bond CUSIP no.:
FORM 1099-OID
$
Box 1 - Original issue discount for 2011:
$
Box 2 - Other periodic interest:
$
Box 3 - Early withdrawal penalty:
$
Box 4 - Federal income tax withheld:
$
Box 6 - Original issue discount on U.S. Treasury obligations:
$
Box 7 - Investment expenses:
SELLER-FINANCED MORTGAGE INTEREST
Buyer's name . . . . . . . . . . . . . . . . . . . . . . . . .
Buyer's Social Security number . . . . . . . . . . .
Buyer's address . . . . . . . . . . . . . . . . . . . . . . . .
Interest received in 2011 . . . . . . . . . . . . . . . . .
ADJUSTMENTS
Nominee interest
OID adjustment
Accrued interest adjustment required
Amortizable bond premium
U.S. Savings Bond adjustment (not the same as Form 8815 adj.)
Other adjustment (frozen deposit, etc.)
Amount of adjustment:

HOME MORTGAGE INTEREST WORKSHEET
2011
Jeff
J Bell
SSN: 111-11-1111
Is this Worksheet for . . . . . . . . . . .
Yourself
Your spouse
Both of you
Was this mortgage secured by your main or second home? . . . . . . . . . . . . . . . Yes
No
Description of Property . . . . . . . . . . . . . . . . . . . . . .
Name of lender/bank/co-op . . . . . . . . . . . . . . . . . . . . .
Did you receive a Form 1098 for this mortgage? . . . . . . . . . . . . . . . . . . . . . . . . Yes
Did you pay this interest to a financial institution? . . . . . . . . . . . . . . . . . . . . . . . .Yes
A.
1.
2.

MORTGAGE FOR WHICH YOU RECEIVED A FORM 1098
Mortgage interest received, from Form 1098, box 1 . . . . . . . . . . . . . . . . . . . . . . . . . .
Points paid on purchase of principal residence, from
Form 1098, box 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3a. Refund of overpaid interest, from Form 1098, box 3 . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Portion of line 3a that is taxable in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Deductible mortgage insurance premiums from Form 1098, box 4 that
were paid in connection with a loan to buy, build,
or substantially improve your main or second home . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Real estate tax paid in 2011, from Form 1098, box 5 . . . . . . . . . . . . . . . . . . . . . . . . .
6. Other amounts related to this mortgage
a. Additional deductible interest paid to this financial
institution and not shown on Form 1098. Attach statement . . . . . . . . . . . . . . . .
b. Additional deductible points paid to buy/improve main home
and not shown on Form 1098 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Other points which must be spread out over the
life of the mortgage (e.g., points for a 2nd home, points
for a refinancing -- see IRS Pub. 936 for details). Enter
the total amount of such points that you paid in 2011 or
before. We will calculate the portion that is deductible
in 2011. See Help panel if mortgage ended in 2011 . . . . . . . . . . . . . . . . . . . . .
d. Additional deductible qualified mortgage insurance premiums
paid during 2011 under a mortgage insurance contract issued after
December 31, 2006, in connection with a loan to
buy, build, or substantially improve main or second home and
not shown on Form 1098 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. MORTGAGE FOR WHICH YOU DID NOT RECEIVE A FORM 1098
1. Deductible mortgage interest not reported on Form 1098 . . . . . . . . . . . . . . . . . . . . . .
Did you buy your home from the recipient of the interest?
Yes
If "Yes," provide the following information about
the recipient:
2. Deductible points paid on loan used to buy, build, or improve
main home and not reported on Form 1098 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Other points which must be spread out over the life
of the mortgage (e.g., points for a 2nd home, points for a
refinancing -- see IRS Pub. 936 for details). Enter the
total amount of such points that you paid in 2011 or before.
We will calculate the portion that is deductible in 2011.
See Help panel if mortgage ended in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Taxable portion of any refund of overpaid interest . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Deductible qualified mortgage insurance premiums paid during 2011
under a mortgage insurance contract issued after December 31, 2006 in
connection with a loan to buy, build, or substantially improve
main or second home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C.
1.
2.

No
No
4,000

No

ADDITIONAL INFORMATION FOR AMORTIZABLE POINTS
Length of mortgage in years. Enter zero if mortgage paid off in 2011 . . . . . . . . . . . . . . . . . . .
Date loan was made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Date loan was made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MORTGAGE INTEREST WORKSHEET, p. 2
2011

Jeff
D.

J Bell

SSN:

111-11-1111

ALLOCATIONS
Destination
Form 8829

Rental Wkst
Schedule F

Copy #

Description

Pct of Property (by area)
Used In Activity
%
%
%
%
%
%
%

MORTGAGE INTEREST WORKSHEET, p. 3
Jeff

%
2011
SSN: 111-11-1111

J Bell
EXPLANATORY STATEMENT

CHARITABLE
Jeff
PART I
1a.

CHARITABLE DONATIONS WORKSHEET

2011

J Bell

SSN:111-11-1111

CASH OR MONEY DONATIONS (SCHEDULE A, LINE 16)
Name of Charity

Type

Amount

Salvation Army (Tampa Branch)

500

1b. Sum of entries from table above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(a)
Subject to
50% Limit
2.
3.

4.
5.

6.

From K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mileage for charitable purposes
a. From DeductionPro . . . . . . . . . . . . . . . . .
b. Other than from DeductionPro . . . . . . . .
c. Total miles . . . . . . . . . . . . . . . . . . . . . . . .
Line 3c * 14 cents per mile . . . . . . . . . . . . . . .
Parking fees, tolls, and other
out-of-pocket expenses for
charitable purposes
a. From DeductionPro . . . . . . . . . . . . . . . . .
b. Other than from DeductionPro . . . . . . . .
c. Total out-of-pocket expenses . . . . . . . . .

(b)
Subject to
30% Limit

500
(c)
Total

0

0

0

0
0

0
0

0

0

0

0

6

500

Total cash or money donations. Sum of 1b, 2(c), 4(c),
5(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PART II

1b

NONCASH OR ITEM DONATIONS (SCHEDULE A, LINE 17)

PART II

NONCASH OR ITEM DONATIONS (SCHEDULE A, LINE 17)

0
1a. Noncash or item donations: 50% limit . . . . . . . . . . . . . . . . . . . .
0
1b. Noncash or item donations: 30% limit . . . . . . . . . . . . . . . . . . . .
1c. Noncash or item donations: 30% limit,
0
capital gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d. Noncash or item donations: 20% limit,
0
capital gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Total noncash or item donations. Sum of lines 1a - 1d . . . . . . . . . . . . . . . . . . . . .
PART III

0

CARRYOVERS FROM PRIOR YEARS TO CURRENT YEAR (SCHEDULE A, LINE 18)

PART III

CARRYOVERS FROM PRIOR YEARS TO CURRENT YEAR (SCHEDULE A, LINE 18)

Carryover of charitable
donations from:
a. 2010 . . . . . . . . . . . . . . . . . . .
b. 2009 . . . . . . . . . . . . . . . . . . .
c. 2008 . . . . . . . . . . . . . . . . . . .
d. 2007 . . . . . . . . . . . . . . . . . . .
e. 2006 . . . . . . . . . . . . . . . . . . .
Totals . . . . . . . . . . . . . . . . . .
f.
PART IV

Regular
50%

LIMITS (SCHEDULE A, LINE 19)

Capital Gain
30%

30%

0

0

0

20%

0

PART IV

LIMITS (SCHEDULE A, LINE 19)

Current-year donations subject to 50% limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carryover donations subject to 50% limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Current-year donations subject to 30% limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carryover donations subject to 30% limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Current-year capital gain donations subject to 30% limit . . . . . . . . . . . . . . . . . . . .
Carryover capital gain donations subject to 30% limit . . . . . . . . . . . . . . . . . . . . . .
Current-year capital gain donations subject to 20% limit . . . . . . . . . . . . . . . . . . . .
Carryover capital gain donations subject to 20% limit . . . . . . . . . . . . . . . . . . . . . .
172,031
Adjusted gross income . . . . . . . . . . . . . . . . .
86,016
Your 50% limit. Line 9 * 0.5 . . . . . . . . . . . . .
500
Smaller of line 1 or line 10 . . . . . . . . . . . . . .
Line 1 minus line 11 . . . . . . . . . . . . . . . . . . .
85,516
Line 10 minus line 11 . . . . . . . . . . . . . . . . . .
0
Smaller of line 2 or line 13 . . . . . . . . . . . . . .
Line 2 minus line 14 . . . . . . . . . . . . . . . . . . .
85,516
Line 13 minus line 14 . . . . . . . . . . . . . . . . . .
500
Sum of lines 1, 2, 5, and 6 . . . . . . . . . . . . . .
51,609
Your 30% limit. Line 9 * 0.3 . . . . . . . . . . . . .
85,516
Line 10 minus line 17 . . . . . . . . . . . . . . . . . .
0
of
lines
3,
18,
or
19
.
.
.
.
.
.
.
.
.
.
.
.
Smallest
Line 3 minus line 20 . . . . . . . . . . . . . . . . . . .
85,516
Line 19 minus line 20 . . . . . . . . . . . . . . . . . .
51,609
Line 18 minus line 20 . . . . . . . . . . . . . . . . . .
0
Smallest of lines 4, 22, or 23 . . . . . . . . . . . .
Line 4 minus line 24 . . . . . . . . . . . . . . . . . . .
85,516
Line 16 - sum of lines 20 and 24 . . . . . . . . . .
0
Smallest of lines 5, 18, or 26 . . . . . . . . . . . .
Line 5 minus line 27 . . . . . . . . . . . . . . . . . . .
85,516
Line 26 minus line 27 . . . . . . . . . . . . . . . . . .
51,609
Line 18 minus line 27 . . . . . . . . . . . . . . . . . .
0
Smallest of lines 6, 29, or 30 . . . . . . . . . . . .
Line 6 minus line 31 . . . . . . . . . . . . . . . . . . .
85,516
Line 29 minus line 31 . . . . . . . . . . . . . . . . . .
51,609
Line 30 minus line 31 . . . . . . . . . . . . . . . . . .
51,609
Line 23 minus line 24 . . . . . . . . . . . . . . . . . .
34,406
Your 20% limit. Line 9 * 0.2 . . . . . . . . . . . . .
of
lines
7,
33,
34,
35,
Smallest
0
or 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Line 7 minus 37 . . . . . . . . . . . . . . . . . . . . . . .
38.
85,516
Line 33 minus line 37 . . . . . . . . . . . . . . . . . .
39.
51,609
Line 34 minus line 37 . . . . . . . . . . . . . . . . . .
40.
51,609
Line 35 minus line 37 . . . . . . . . . . . . . . . . . .
41.
34,406
Line 36 minus line 37 . . . . . . . . . . . . . . . . . .
42.
43.
Smallest of lines 8, 39, 40, 41,
0
or 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Line 8 minus line 43 . . . . . . . . . . . . . . . . . . .
44.
Summary of Deductions and Carryovers
500
45.
Total deduction this year . . . . . . . . . . . . . . .
46.
Total carryover to next year . . . . . . . . . . . . .
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.

PART V

CARRYOVERS TO FUTURE YEARS

500
0
0
0
0
0
0
0

0

0

0

0

0

0

0

0

0

Total carryover to next year
PART V

CARRYOVERS TO FUTURE YEARS

Carryover of charitable
donations from:
a. 2011 . . . . . . . . . . . . . . . . . . .
b. 2010 . . . . . . . . . . . . . . . . . . .
c. 2009 . . . . . . . . . . . . . . . . . . .
d. 2008 . . . . . . . . . . . . . . . . . . .
e. 2007 . . . . . . . . . . . . . . . . . . .
Totals . . . . . . . . . . . . . . . . . .
f.
PART VI

Regular
50%

30%
0

0

0

0

Capital Gain
30%
0

20%
0

0

0

SUMMARY OF AMOUNTS FOR SCHEDULE A

1.
2.
3.
4.

Cash or money donations (to Schedule A, line 16) . . . . . . . . . . . . . . . . . . . .
Noncash or item donations (to Schedule A, line 17) . . . . . . . . . . . . . . . . . . .
Carryovers from prior years (to Schedule A, line 18) . . . . . . . . . . . . . . . . . .
Deductible donations (to Schedule A, line 19) . . . . . . . . . . . . . . . . . . . . . . .

1
2
3
4

500
0
0
500

5.

Carryovers to future years (next year's Sch A, line 18) . . . . . . . . . . . . . . . . .

5

0

Jeff

CAR & TRUCK WORKSHEET - DEPRECIATION or STANDARD MILEAGE
2011
FOR VEHICLES YOU STARTED USING AFTER 1980
J Bell
SSN: 111-11-1111

PART 1. DESCRIPTION OF VEHICLE AND DESTINATION FORM - ALL VEHICLES
a. Briefly describe this vehicle (e.g., "Car, Taurus") . . . . . . . . . . . . . . . . Acura
b. Form to which we should carry information about
this vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
c. Which copy of that tax form
1
(1=1st copy; 2=2nd copy, etc.) . . . . . . . . . . . . . .
d. Activity name on that tax form . . . . . . . . . . . . . . . .
e. "X" if this is a vehicle you leased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e-1. If you leased this vehicle, "X" if you used
standard mileage in a previous tax year . . . . . . . . . . . . . . . . .
f. "X" if you're a rural mail carrier using your own car . . . . . . . . . . . . . . . . . . . .
g. Check here if you acquired this vehicle in a like-kind
exchange or involuntary conversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g-1 Check here if you are making an election under
Regulations section 1.168(i)-6(i) . . . . . . . . . . . . . . . . . . . . . . .
h. Check here if this is a new alternative motor vehicle . . . . . . . . . . . . . . . . . .
If you checked box h., enter the following information:
1. Selected alternative motor vehicles:
Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Other qualifying vehicles
Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Vehicle identification number . . . . . . . . . . . . . . . . . .
4. If Volkswagen or Audi entered in question 1
above, when did you purchase this vehicle?
Before July 1, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
July 1, 2010 - December 31, 2010 . . . . . . . . . . . . . . . . . . . . . . .
January 1, 2011 or later . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Maximum credit allowable . . . . . . . . . . . . . . . . . . . . .
6. Phaseout percentage . . . . . . . . . . . . . . . . . . . . . . . .
0
7. Credit allowable. Line 5 * line 6 . . . . . . . . . . . . . . . .
Note: Here is how to take the standard mileage deduction
for more than one car per business on Form 2106 or Form
2106-EZ. If you used two cars consecutively (one after the
other) or alternately (at different times), you should treat
them as one car on the Vehicle Worksheet, and combine the
miles traveled. You may ignore this note if you're using
actual expenses.
PART 2. FIGURING "BUSINESS PERCENT" - ALL VEHICLES
Preliminary Questions
a. Date car was placed in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/07/11
a-1 Check here if you converted this vehicle from
100% personal use to business/investment use
in 2011 and you don't have mileage records
for the personal use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Check here if you sold, gave away, or abandoned the car in 2011 . . . . . . . . . . . . . . . . .
If line b. is checked, enter month in which the sale, etc.
took place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b-1 Check here if you converted this vehicle from
business/investment use to 100% personal use
in 2011 and you don't have mileage records
for the personal use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ownership/Lease Questions
c. # months you owned/leased the car this year (from above) . . . . . . . . . . . . . . . . . . . . . 7
Note: We calculate line "c" based on the date placed
in service and month sold, abandoned, etc.
d. # months you used car at least partly for business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
e. # months of exclusively personal use (c-d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Mileage Questions
For the # months in use this year, that is, for

# Business/investment miles driven
2,470
before July 1, 2011 . . . . . . . . . . . . . . . . . . . . . . .
f-2. # Business/investment miles driven
2,470
after June 30, 2011 . . . . . . . . . . . . . . . . . . . . . . .
g. # Commuting miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9,060
h. # Other personal miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14,000
i. Total miles (f+g+h) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
j. Average daily round-trip commuting mileage . . . . . . . . . . . . . . . . . . .
35.29
k. Business/investment% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
l. If investment% > 0, check here if you also used
this vehicle more than 50% for business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f-1.

this vehicle more than 50% for business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PART 3. VEHICLE EXPENSES OTHER THAN DEPRECIATION - ALL VEHICLES
Note: Enter the full amount for the entire year in column "a" unless
otherwise noted. We'll figure the business portion automatically. If
you use the standard mileage method, you may not deduct any of these
expenses on the Vehicle Worksheet, except parking and tolls and, if you're
self-employed, personal property taxes and interest.
Expense Chart
a. Total Amt
b. Bus. %
c. Deductible Amt
(a*b)
a. Auto insurance . . . . . . . . . . . . . . . . .
b. Garage rent . . . . . . . . . . . . . . . . . . . .
c. Interest (only deductible if
Sched C, C-EZ or F vehicle) . . . . . . .
d. Gasoline . . . . . . . . . . . . . . . . . . . . . .
e. Registration, license . . . . . . . . . . . . .
f. Personal property taxes . . . . . . . . . .
g. Repairs . . . . . . . . . . . . . . . . . . . . . . .
h. Tires . . . . . . . . . . . . . . . . . . . . . . . . .
i. Oil . . . . . . . . . . . . . . . . . . . . . . . . . . .
j. Other expenses, e.g.,
temporary rentals . . . . . . . . . . . . . . .
0
k. Total expenses from column a . . . . . . .
Note: The amount from line k is carried to line 23 of Form 2106 if
you indicated that you're using that form.
l. Deductible amount (total of column c) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
m. Plus: Tolls, hourly parking
on business trips (local and out of town) . . . . . . . . . . . . . . . . . . . . . . . . . . .
n. TOTAL deductible amount (line l + line m) . . . . . . . . . . . . . . . . . . . . . . . . .
Special Section for Certain Self-Employed Taxpayers
Note: You may need to use this section if you're directing this Vehicle
Worksheet to a Schedule C AND you rented or leased the vehicle.
Otherwise, you may skip this section.
a. Business portion of vehicle rental or lease costs . . . . . . . . . . . . . .
b. Inclusion amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note: For any car first leased after 1986, there may be an
inclusion amount if the value of the vehicle when new was over
$12,800. For more information, see the IRS instructions for lines
20a and 20b of Schedule C and see IRS Publication 463.
c. Line a - line b (to Schedule C) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Special Section for Certain Employees
Note: You may need to use this section if you're directing this Vehicle
Worksheet to a Form 2106 AND you rented or leased the vehicle,
received the vehicle from your employer, or were a rural mail carrier.
Otherwise, you may skip this section.
Employees Who Rented or Leased Vehicle
a. Vehicle rental or lease costs . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Inclusion amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note: For any car first leased after 1986, there may be an
inclusion amount if the value of the vehicle when new was over
$12,800. For more information, see the IRS instructions for line
24b of Form 2106 and see IRS Publication 463.
Employees with Employer-Provided Vehicle
a. Value of employer-provided vehicle (if on
W-2 at 100% annual lease value) . . . . . . . . . . . . . . . . . . . . . . . .
Rural Mail Carriers
a. Equipment maintenance allowance . . . . . . . . . . . . . . . . . . . . . . .

0

0

0

a. Equipment maintenance allowance . . . . . . . . . . . . . . . . . . . . . . .
PART 4. DEPRECIATION AND STANDARD MILEAGE - OWNED VEHICLES ONLY
a. Original cost (including sales tax & basis of trade-in) . . . . . . . . . . . . . . . . . . .
Note: See the help panel to the right if this vehicle is or was
eligible for the alternative motor vehicle credit.
b. If placed in service before this year, was the standard
mileage method used in the year the car was placed in
service? (If checked, skip to "Standard Mileage" questions.) . . . . . . . . . . . . . . . . . . . . . .
PART 5. QUESTIONS FOR DEPRECIATION - OWNED VEHICLES ONLY
Listed property and "SUV's"
a. Check here if this is a "passenger automobile" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if this is a truck or van placed in service
a-1.
after 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Check here if this is any other property used as a means of
transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you used this vehicle as an employee and you checked
b-1.
box a., a-1, or b. above, was your use of the
vehicle for your employer's convenience and
required as a condition of your employment? . . . . . . . . . . . .
Yes
No
c. Check here if this is NOT listed property (most people will
leave this box blank) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Check here if this is a "sport utility vehicle" under
section 179(b)(6) of the Internal Revenue Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bonus depreciation
e. Check here if this is property eligible for 100% bonus
depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if this is property eligible for 50% bonus depreciation
f.
under Section 168(k) of the Internal Revenue Code, as amended
by the Economic Stimulus Act of 2008 and the American Recovery
and Reinvestment Act of 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g. Check here if this is property eligible for 50% bonus depreciation
under Section 168(k) of the Internal Revenue Code, prior to amendment
by the Economic Stimulus Act of 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
h. Check here if this is property eligible for 30% bonus depreciation
under Section 168(k) of the Internal Revenue Code, prior to amendment
by the Economic Stimulus Act of 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if this is qualified New York Liberty
i.
Zone property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if this is qualified Gulf Opportunity Zone property . . . . . . . . . . . . . . . . . . . . . .
j.
k. Check here if this is qualified disaster assistance property . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if you checked box e., f., g., h., i., j., or k. above and
you are electing out of bonus depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
m. For vehicles placed in service before 2011, section 179 and bonus
depreciation amounts:
1) Section 179 amount (if any) from the year the vehicle was
0
first placed in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2) Bonus depreciation amount (if any) from the year the vehicle
0
was first placed in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Passenger Automobile Eligible For 100% Bonus Depreciation in Prior Year
For a "passenger automobile" (including a qualifying truck or van)
n.
placed in service before 2011, check here if the vehicle was eligible
for 100% bonus depreciation and you are not electing the safe harbor
method of accounting described in Revenue Procedure 2011-26 . . . . . . . . . . . . . . . . . . .
Note: If you check this box, you will not be allowed a
depreciation deduction for this vehicle in 2011.
o. For cars placed in service in 2011, section 179 and bonus
depreciation amounts:
1) Maximum section 179 amount, before taking into
500,000
account luxury limit and business percentage . . . . . . . . . . . . . . . . . . . . .
2) Maximum allowable section 179 amount, after taking into
account luxury limit and business percentage . . . . . . . . . . . . . . . . . . . . .
3) Section 179 deduction claimed this year . . . . . . . . . . . . . . . . . . . . . . . . .
4) Basis after Sec. 179: Original cost * business
percentage, minus Sec. 179 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5) Bonus depreciation: 100%/50%/30% of line 4 (but not more
than line 2 minus line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
p. Depreciable basis: Original cost * business percentage,
0
minus Sec. 179 and bonus depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
l.

0
minus Sec. 179 and bonus depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alternative Depreciation System (ADS)
q. Check here if you're required to use ADS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if you're using ADS, even though not required to . . . . . . . . . . . . . . . . . . . . . .
r.
s. If you checked box q. or r. and you used the car before 1987, enter the
number of years for depreciation (3, 5, or 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If the property is eligible, do you elect the (slower)
t.
150% declining balance method (usually leave blank) . . . . . . . . . . . . . . . . . . . . . . . . . . .
u. If the property is eligible, do you elect the (slower)
straight-line method (usually leave blank) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does the mid-quarter convention apply to this vehicle (we
v.
calculate this if the vehicle was placed in service this year) . . . . . . . . . . . . . . . . . . . . . . . N
w. Is this post-'88 property that is used in farming? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N
3,060
x. "Luxury car" limit on 2011 depreciation & Sec 179 . . . . . . . . . . . . . . . . . . . . .
1,080
"Luxury
car"
limit,
reduced
for
non-business
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
y.
Method
(200DB
=
200%
declining
balance;
150DB
=
150%
declining
z.
balance; SL = Straight line) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SL
Convention (HY=Half year; MQ=Mid-quarter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HY
aa.
bb. "Y" if depreciation is limited to the lesser of the
actual depreciation or the "luxury car" limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y
0
Amount of depreciation allowable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
cc.

0
Amount of depreciation allowable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
cc.
PART 6. QUESTIONS FOR STANDARD MILEAGE - OWNED OR LEASED VEHICLES
a. Enter an "X" if you're eligible for standard mileage for this vehicle.
To be eligible for standard mileage: (1) you can't use 5+ vehicles in
business or for investment at a time; (2) if you own the vehicle, you
must have used standard mileage for the car's first year; and (3) if
you lease the vehicle, you must have used standard mileage for the
entire lease period (with the exception of the period, if any,
before January 1, 1998) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Standard mileage method deduction: # cents per mile *
2,631
(number of business/investment miles) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
c. Plus: (Garage rent * bus %) + Business Tolls (above) . . . . . . . . . . . . . . . . . . . .
Note: If you are self-employed (i.e., you're directing this Vehicle
Worksheet to a Schedule C or Schedule F), then we also include on
line 6c (and ultimately on line 6d) the deductible amount of your
interest and taxes from the Expense Chart in Part 3.
2,631
d. TOTAL Standard Mileage (Std mileage amt + parking + tolls) . . . . . . . . . . . . . .
PART 7. FOR CARS PLACED IN SERVICE BEFORE THIS YEAR, WHERE STANDARD MILEAGE
WAS USED PREVIOUSLY: COMPARISON OF STANDARD MILEAGE TO STRAIGHT LINE
DEPRECIATION WITH EXPENSES - OWNED VEHICLES ONLY
a. Enter # years estimated useful life of car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
b. Enter estimated salvage value at end of useful life . . . . . . . . . . . . . . . . .
c. Straight line depreciation this year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. TOTAL straight line depreciation + expenses this year . . . . . . . . . . . . . .
e. TOTAL Standard Mileage (from above) . . . . . . . . . . . . . . . . . . . . . . . . . .
Straight line
Standard mileage
f. Larger of the two is . . . . . . . . . . . .
Straight line
Standard mileage
g. Your choice . . . . . . . . . . . . . . . . .
PART 8. FOR VEHICLES PLACED IN SERVICE THIS YEAR AND ELIGIBLE FOR STANDARD
MILEAGE: COMPARISON OF STANDARD MILEAGE TO ACTUAL EXPENSES,
INCLUDING REGULAR DEPRECIATION FOR OWNED VEHICLES OWNED OR LEASED VEHICLES
a. The totals allowable over the next . . . . . . . . . . 6 year(s), assuming the current
mileage, business percents, expenses, etc. will not change, are:
26,134 for Standard Mileage; with a
0 residual basis.
0 for Actual Expenses (MACRS); with a
0 residual basis.
Note: Ignore residual basis if this is a leased vehicle. A higher
residual basis is better. It means less taxable gain if you sell the car.
Or, it increases the amount you may depreciate on a new car if you trade
this car in.
Actual expenses;
Standard mileage.
b. Recommendation: We recommend . . . .
Actual expenses;
Standard mileage.
c. Your choice . . . . . . . . . . . . . . . . . . . . . . .
Note for Owners: If you choose actual expenses, you can't change your
choice in future years. If you choose standard mileage, you can switch
to actual expenses in future years but will no longer be entitled to use
accelerated depreciation. Also, your circumstances may change, and our
choice may turn out not to have been the best choice.
Note for Lessees: Whatever method you choose, you can't change your
choice in future years. Your circumstances may change, and our
choice may turn out not to have been the best choice.

choice may turn out not to have been the best choice.
PART 9. INFORMATION QUESTIONS FROM THE IRS - ALL VEHICLES
Y
a. Do you (or your spouse) have another vehicle
available for personal purposes (Y/N)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is personal use during off-duty hours permitted? . . . . . . . . . . . . . . . . . . . . . . .
c. Was the vehicle used primarily by a more than 5%
owner (of the business) or related person? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . . .
e. If yes, is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

N

PART 10. CALCULATION OF ALTERNATIVE MINIMUM TAX ADJUSTMENTS - OWNED VEHICLES
ONLY
a. AMT Method (150DB=150% declining balance; SL=Straight line) . . . . . . . . . . . . . . . . . . None
b. AMT Convention (HY=Half year; MQ=Mid-quarter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NA
c. Alt Min Tax Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
d. Alt Min Tax Adjustment (Reg Dep'n - Alt Min Tax Dep'n) . . . . . . . . . . . . . . . . . . . .
Note: If you designated this Vehicle Worksheet to carry to Form 2106,
Form 2106-EZ, or Schedule A, then the AMT adjustment on line 10d above does
not carry to Form 6251.
PART 11. SUMMARY - ALL VEHICLES
Depreciation allowable this year (from above) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Standard mileage allowable this year (from above) . . . . . . . . . . . . . . . . . . . . . . . .
Other deductible expenses (from above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alternative Minimum Tax adjustment this year (from above) . . . . . . . . . . . . . . . . . .
Alternative motor vehicle credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation chart for this vehicle. Note: If some use is "personal,"
then residual basis will be less than the sum of depreciation amounts.
This chart assumes a constant business use from year to year.
The chart does not reflect computations under the safe harbor method in
Revenue Procedure 2011-26.
Note: This chart is for illustration only and may not always
be accurate for your situation.
2011
2012
2013
2014
2015
2016
2017
2018
2019
Year
0
0
0
0
0
0
0
0
0
Dep'n
0
0
0
0
0
0
0
0
0
Basis
2021
2022
2023
2024
2025
2026
2027
2028
2029
Year
0
0
0
0
0
0
0
0
0
Dep'n
0
0
0
0
0
0
0
0
0
Basis
a.
b.
c.
d.
e.
f.

0
2,631
0
0
0

2020
0
0
2030
0
0

0
0
Basis
12. STATE DEPRECIATION
a.
b.
c.

d.

0

0

0

0

0

0

If bonus depreciation is being claimed on your federal return,
the amount of 2011 bonus depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If bonus depreciation was claimed in a prior year under
federal law, the amount of prior year bonus depreciation . . . . . . . . . . . . . . . . .
The amount of federal depreciation to which you would have
been entitled in 2011 for this asset without the federal
laws allowing bonus depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The difference between the amount of depreciation actually
being taken for this asset on your federal return and the
amount of depreciation to which you would have been entitled
without the federal laws allowing bonus depreciation . . . . . . . . . . . . . . . . . . . .

0

0

CAP GN/LOSS WKSHT
Jeff

CAPITAL GAINS AND LOSSES WORKSHEET

J Bell

2011
SSN:

111-11-1111

Groupon
Code: Z
1. Description:
08/05/2010 Date sold:
Date acquired:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
110,000
Cost/other basis (Form 1099-B, box 3 if applicable):
-110,000 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Yes
No. If Yes:
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Long-term
Type of gain/loss in box 8 is not correct:
Code:
2. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Yes
No
Basis shown and reported to IRS?
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
3. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Yes
No
Basis shown and reported to IRS?
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
4. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
5. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
6. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:

Code:

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Frm 1099-B or substitute broker's statement received?
Yes
No
Basis shown and reported to IRS?
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
7. Description:

Code:

Yes

No. If Yes:

Long-term

Type of gain/loss in box 8 is not correct:
Code:
7. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
8. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
9. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
10. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
Code:
11. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No
Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:
12. Description:
Date acquired:
Date sold:
(MM/DD/YYYY)
(MM/DD/YYYY)
Sales price:
Cost/other basis (Form 1099-B, box 3 if applicable):
0 Adjustments to gain/loss:
Gain/loss:
Frm 1099-B or substitute broker's statement received?
Basis shown and reported to IRS?
Yes
No

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Yes

No. If Yes:

Long-term

Code:

Yes

No. If Yes:

Correct basis (if amount in box 3 is not correct):
Type of gain/loss, if shown in box 8:
Short-term
Type of gain/loss in box 8 is not correct:

Long-term

RENTALS AND ROYALTIES
Jeff
J Bell
Check whose activity this is:
Taxpayer

RENTALS AND ROYALTIES WORKSHEET
SSN:
Spouse

2011
111-11-1111

Both

Did you make any payments in 2011 that would require you to
file Form(s) 1099 (see instructions)?
If "Yes," did you or will you file all required Forms 1099?

Yes
Yes

No
No

Check which kind of activity this is:
Rental
Royalty
1
Type of property:
If "Other", description:
I.
IDENTIFYING INFORMATION
1a. (Rentals only) Enter the following information about this property:
Street: Orange Blossom Tra City/town: Dallas
Percent ownership (if less than 100%):
Check here if the property was a dwelling:
Check here if the property was your main or second home:
Check here if the property was located in a foreign country
(see Help panel for details):
Check here if you owned the property as a member of a
qualified joint venture (QJV) reporting income not subject
to self-employment tax:
b. (Royalties only) Enter the name of this activity:
Name:

State: TX

ZIP:

75062
100.0%

II.
DAYS OF USE -- DWELLING
1a. Number of days rented at fair rental price (and not personal use) . . . . . . . . . . . . . . . . . . . . . . .365
b. Number of days offered for rent (and not rented, not personal use) . . . . . . . . . . . . . . . . . . . . .
0
c. Number of days of personal use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of days included on line c. for which you used
i.
property as main home if: (i) you rent or try to rent
property at fair rental price for 12 or more consecutive months
before or after using as main home; or (ii) you rent or
try to rent property at fair rental price for less than
12 consecutive months after using as main home, and period
ends because you sell or exchange property . . . . . . . . . . . . . . . . . . . . . . .
Number of days included on line c. for which you used
ii.
property for personal purposes while it was rented at
fair rental price . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of days included on line c. for which you rented
iii.
the property at less than fair rental price . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Total days owned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
e. Check here if the rental unit is a "residence" AND it was rented for
less than 15 days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Check here if the rental unit is a "residence" AND it was rented for
15 days or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g. If box 1f is checked, select an allocation method for itemizable expenses:
IRS Method
Tax Court method
h. Percentage for allocation of non-itemizable expenses related to
dwelling: (1a + 1b)/1d, but if 1c > 0, then
(1a + 1c.ii)/(1a + 1c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100.00%
i. Percentage for allocation of itemizable expenses: Same as line 1h,
but if Tax Court's allocation method chosen, then (1a + 1c.ii)/1d . . . . . . . . . . . . . . . . . . 100.00%
III.
DAYS OF USE -- NON-DWELLING
1a. Number of days rented . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Number of days offered for rent (and not rented, not personal use) . . . . . . . . . . . . . . . . . . . . .
c. Total days owned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Percentage for allocation of expenses related to non-dwelling:
(1a + 1b)/1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00 %
IV.
AT-RISK/PASSIVE ACTIVITY QUESTIONS
1.
2.
3.

Check here if you are subject to the at-risk rules and some of
your investment is NOT at risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount at risk at end of 2011 (or allowed loss from Form 6198): . . . . . . . . . . . . . . . .
Skip questions 3 - 7 if this is a royalty.
Check here if you were a "real estate professional" and materially
participated in this rental activity in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.
5.
6.
7.

Check here if you actively participated in this rental activity
in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prior year passive loss carryforward amount (or zero) . . . . . . . . . . . . . . . . . . . . . . . .
Check here if you totally disposed of this activity in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gain or loss on disposition of activity or activity property:
a. For purposes of regular tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. For purposes of Alternative Minimum Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. For purposes of Alternative Minimum Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
RENTALS/ROYALTIES
WORKSHEET FOR RENTALS AND ROYALTIES
2011
Jeff
J Bell
SSN: 111-11-1111
V.
1.

2.

3.
1.
2.

3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

13.
14.
15.
16.
17.
18.

Income/
Expense

INCOME

Rents/royalties received
(excluding merchant card
and third party payments)
a. From 1099-MISC, K-1 . . . . . . . . . .
b. Other rent/royalty income . . . . . . . .
Merchant card and third party
payments
a. Total . . . . . . . . . . . . . . . . . . . . . . . .
b. Portion of line a that is
not income (sales tax,
processing fees, tips,
"cash back" amounts from
merchant cards on 1099-K)
Total income . . . . . . . . . . . . . . . . . . . . .
VI.
EXPENSES
Advertising . . . . . . . . . . . . . . . . . . . . . .
Auto and travel . . . . . . . . . . . . . . . . . . .
a. Std mlg & vehicle exp . . . . . . . . . . .
b. Other auto and travel . . . . . . . . . . .
c. Total travel . . . . . . . . . . . . . . . . . . .
Cleaning and maintenance . . . . . . . . . .
Commissions . . . . . . . . . . . . . . . . . . . .
Depletion . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation . . . . . . . . . . . . . . . . . . . . .
FICA & employment taxes . . . . . . . . . .
Insurance . . . . . . . . . . . . . . . . . . . . . . .
Legal and professional fees . . . . . . . . .
Management fees . . . . . . . . . . . . . . . . .
Non-mortgage interest . . . . . . . . . . . . .
Mortgage interest and points . . . . . . . .
a. Mortgage interest paid to
banks and shown on Fm 1098 . . . .
b. Other mortgage interest . . . . . . . . .
c. Points paid to banks and
shown on Form 1098 . . . . . . . . . . .
d. Other points . . . . . . . . . . . . . . . . . .
Property taxes . . . . . . . . . . . . . . . . . . . .
Other taxes . . . . . . . . . . . . . . . . . . . . . .
Repairs . . . . . . . . . . . . . . . . . . . . . . . . .
Supplies for rental activity . . . . . . . . . . .
Utilities . . . . . . . . . . . . . . . . . . . . . . . . .
Other expenses related just
to rental activity . . . . . . . . . . . . . . . . . . .
Type
Depreciation Expense

Ownership
Portion

Rental
Portion

Amount
Allowed

24,000

24,000

24,000

24,000

24,000

0

0

0

0
3,000
0
0
0
0
0
0
0
0

0
3,000
0
0
0
0
0
0
0
0

0
3,000
0
0
0
0
0
0
0
0

14,000

14,000
0

14,000
0
0
0
4,000
0
0
0
0

0
0
3,000

0

14,000

4,000

4,000
0
0
0
0

0
0
4,000
0
0
0
0

7,000

7,000
0

7,000
0

7,000
0

0
0

0
0

0
0

19. Other expenses related to
operating or maintaining prop . . . . . . . .
Type

Totals (bef passive activity calc)
20. Adj. for part-rental prop . . . . . . . . . . . . .
-4,000
-4,000
-4,000
21. Net income or loss . . . . . . . . . . . . . . . .
22. Amount not deducted for rental activity this year.
Any remaining amounts on this line 22 may be deducted in
future years (if the activity is conducted "for profit") . . . . . . . . . . . . . . . . . . . . . . . . . . .
RENTALS/ROYALTIES

WORKSHEET FOR RENTALS AND ROYALTIES

-4,000

0
2011

RENTALS/ROYALTIES
Jeff
J Bell
VII.
(1)
Is this a
passive
activity?
Y
VIII.
(1)
Is this a
passive
activity?
Y

WORKSHEET FOR RENTALS AND ROYALTIES
SSN:

PASSIVE ACTIVITY COMPUTATION
(2)
(3)
(4)
Rental real
Activity's
Prior year
estate w/ active
net income
unallowed
participation?
or loss
loss (or 0)
Y

-4,000

(5)
This year
unallowed
loss.
4,000

2011
111-11-1111

(6)
Allowed income
or loss this
year.
0

ALTERNATIVE MINIMUM TAX (AMT) WORKSHEET FOR RENTAL ACTIVITIES
(2)
(3)
(4)
(5)
(6)
Rental real
Activity's
Prior year
This year
Allowed income
estate w/ active
net income
unallowed
unallowed or loss this
participation?
or loss
loss (or 0)
loss.
year.
Y

-4,000

4,000

0

SCHEDULE K-1
K-1 (PARTNERSHIP/S CORPORATION) WORKSHEET
(Partnership/S Corporation)
Jeff
J Bell
SSN:
Information About the Partnership/Corporation
1.
2.
3.
4.
5.
1.

2.
3.

11-1111111
Partnership/corporation employer id no:
KR partnership
Partnership/corporation name:
Type of entity (check one)
Partnership
S corporation
Check if foreign partnership:
Check if publicly traded partnership:
Information About the Partner/Shareholder
(Partners only) Type of partner:
General partner or LLC member-manager
Limited partner or other LLC member
Check if entire investment at risk:
Check if you are reporting (i) any loss not allowed in a prior year
due to the at-risk or basis limitations, or (ii) unreimbursed
partnership expenses:
Partner/Shareholder's Share of Current Year Income,
Deductions, Credits, and Other Items

1.(1)

Ordinary business income (loss):
X if non-passive
X if passive
Carryforward loss, box 1.
Carryforward loss, box 1-AMT
X if total disposition this year.
Gain/loss on disposition.
Gain/loss on disposition-AMT.

2.(2)

Net rental real estate income (loss):
X if passive (other than real estate
in which you actively participated)
X if real estate in which you
actively participated
X if non-passive (real estate
professional)
Carryforward loss, box 2.
Carryforward loss, box 2-AMT
X if total disposition this year.
Gain/loss on disposition.
Gain/loss on disposition-AMT.

3.(3)

Other net rental income (loss):
Carryforward loss, box 3.
Carryforward loss, box 3-AMT
X if total disposition this year.
Gain/loss on disposition.
Gain/loss on disposition-AMT.

4.

(P'ship only) Guaranteed payments:
Activity type:

5.(4)

Interest income:
If you'll be using a state edition of our program, enter
here the portion of box 5(4) that is from U.S. Treasury
obligations:

6a.(5a)

Ordinary dividends:
If you'll be using a state edition of our program, enter
here the portion of box 6a(5a) that is from U.S. Treasury
obligations:

6b.(5b)

Qualified dividends:

7.(6)

Royalties:
Copy number of Rentals & Royalties Wksht:
Be careful not to use a copy on which
you've entered data for another
rental or royalty activity.

6,000

2011
111-11-1111

8.(7)

Net short-term capital gain (loss):

9a.(8a)

Net long-term capital gain (loss):

9b.(8b)

Collectibles (28%) gain (loss):

9c.(8c)

Unrecaptured section 1250 gain:
From sale or exchange of
i.
partnership's or S corp's
business assets
From the sale or exchange of an
ii.
interest in a partnership
From an estate, trust, regulated
iii.
investment company (RIC), or
real estate investment trust
(REIT)

10.(9)

Net section 1231 gain (loss) allocable to:
Box 1 (ordinary income activ)
Box 2 (rental real estate activ)
Box 3 (other rental activity)

11.(10)

Other income (loss)

Additional information for box 11 (10):
Enter the following amounts, if any, included in box 11 (10),
code A.
REMIC taxable income (net loss)
REMIC excess inclusion
REMIC sec 212 expenses
Enter manually in the appropriate place in your return
any box 11 (10), code A items not reported above.
Enter information about box 11 (10), code C amounts
manually on Form 6781 as appropriate.
Enter the following amounts, if any, included in box 11,
code F (box 10, code E).
Also enter the activity type for the amount so that we know
to which activity to allocate the amount.
Recoveries of tax benefit items
Gambling winnings (if not
gambling business)
Gambling losses (if not
gambling business)
Sec 751(b) (receivables, inventory)
Specially allocated ord gain/loss
Net short-term capital gain/loss
Net long-term capital gain/loss
Total for year
28% rate gain/loss
Section 179 deduction allocable to:
Box 1 (ordinary income activity)
Box 2 (rental real estate activity)
Box 3 (other rental activity)
0
Total Section 179 deduction
Note: See the IRS instructions to Form 4562 and IRS Publication 946
for rules relating to the maximum section 179 deduction you can take.
You may need to adjust amounts in your return in certain situations.

12.(11)

13.(12)

Other deductions

Activity type:
Activity type:
Activity type:
Activity type:
Activity type:
Activity type:
Activity type:
Activity type:

Note: If you enter an amount in box 13 with code M (for a
partnership K-1), make sure to fill out the mini-worksheet for
Form 1040, Line 29, especially line e. This is necessary to ensure
that excess amounts carry to Schedule A.
Note: Special rules apply to food inventory contributions and
qualified conservation contributions. Adjust amounts in your return
as necessary.
Additional information for box 13 (12):
Enter the following amounts, if any, included in box 13 (12).
Other taxes
Other miscellaneous deductions
Payments to traditional IRA
Payments to Roth IRA
Payments to qualified plan
(e.g., Keogh plan):
Profit-sharing plan
Money purchase plan
Defined benefit plan
Payments to SEP plan
Payments to SIMPLE IRA plan
Penalty on early withdrawal
of savings
Check if part'ship/S corp
gave you Form 8283
14.

(Partnership only) Self-employment earnings (loss)

Note: If there is an amount shown in box 14 with code A, enter "1" if
the activity is a non-farm activity and "2" if it is
1
a farm activity: . . . . . . . . . . . . . . .
15.(13)

Credits

Additional information for box 15 (13):
Alternative motor vehicle credit
Note: If you have an amount shown in box 15(13) with code O and
are filing a traditional paper return, please write "From Schedule
K-1" in the margin on Form 1040.
16.(14)

Foreign transactions
Name of country/U.S. possession (code A):
Other information reported in box 16 (14):

Additional information for box 16 (14):
Gross income sourced at partner/
shareholder level
U.S. source
(i)
Foreign source
(ii)
Deductions allocated and apportioned
at partner/shareholder level
(1) Interest expense
U.S. source
(a)
Foreign source
(b)
(2) Other

17.(15)

Foreign source
(b)
Total foreign taxes
(1) Tax withheld at source on
dividends
(2) Taxes withheld at source on
rents/royalties
Amount on preceding line related
to non-passive rents/royalties
(3) Tax withheld at source on
interest
(4) Other foreign taxes paid or
accrued.
Alternative minimum tax (AMT) items

Additional information for box 17 (15):
Enter the following amounts, if any, included on box 17 (15)
or on an attached statement:
Accl. dep, leased prop, pre-87
Accl. dep, real prop, pre-87
OIL and GAS
(1) Gross income, oil and gas
(2) Deductions, oil and gas
(3) Excess intangible drilling
costs, oil and gas
(4) Excess depletion,oil & gas
GEOTHERMAL
(1) Gross income, geothermal
(2) Deductions, geothermal
(3) Excess intangible drilling
costs, geothermal
If you've entered an amount in box 17 and the underlying activity is
a passive activity, enter "1" if the activity is an ordinary trade or
business activity, "2" if it is a rental real estate activity, and
"3" if it is another kind of rental activity (leave the box blank if
the activity is not a passive activity) . . . . . . . . . . . . . . . .
18.

(Partnership only) Tax-exempt income and nondeductible expenses

Generally, increase the adjusted basis of your interest in the
partnership by any amount shown with box 18, code B.
Generally, decrease the adjusted basis of your interest in the
partnership by any amount shown with box 18, code C.
19.

(Partnership only) Distributions

16.

(S corporation only) Items affecting shareholder basis

Generally, increase the adjusted basis of your S corporation stock
by any amount shown with box 16, code B.
Generally, decrease the adjusted basis of your S corporation stock
by any amount shown with box 16, code C.
If distributions shown with box 16, code D, exceed the basis of your
stock, treat the excess as capital gain from the sale or exchange
of property and report it on the Capital Gains and Losses Worksheet.
20.(17)

Other information

20.(17)

K-1 WORKSHEET(Partnership/S Corp)

Page 2

K-1 WORKSHEET(Partnership/S Corp)
Page 2
Jeff
J Bell
SSN: 111-11-1111
PASSIVE ACTIVITY CALCULATIONS
(1)
(2)
(3)
(4)
(5)
(6)
Is this a
Rental real
Activity's
Prior year
This year
Allowed income
passive
estate w/ active
net income
unallowed
unallowed
or loss this
activity?
participation?
or loss
loss (or 0)
loss
year
N

N

6,000
0
0

0
0
0

6,000
0
0

ALLOCATIONS - Allocations of Passive Income and Loss Items to Tax Forms
(1)
(2)
(3)
(4)
Ordinary
Real
Other
Total,
K-1 Item
Income
Estate
Rental
(1)..(3),
Activity
Activity
Activity
for Scheds
a. Schedule E, from ln 1,2,3
0
0
0
(1) Passive (col's f and g) . . . . . . . . .
6,000
6,000
(2) Nonpassive (col's h & j) . . . . . . . .
0
0
0
0
b. Frm 4797 (Sec 1231),from 10 . . . . . .
c. Sched E (Sec 179), from 12
0
0
0
(1) Passive (col. f) . . . . . . . . . . . . . . .
0
0
Nonpassive
(col.
i)
.
.
.
.
.
.
.
.
.
.
.
.
(2)
0
d. Att Wks (Oth. Inc.) from 11 . . . . . . . .
0
e. Att Wks (Oth. Inc.) from 11 . . . . . . . .
0
f. Schedule A line 27, from 11 . . . . . . .
0
g. Form 4797 line 10, from 11 . . . . . . .
0
h. Form 4797 line 10, from 11 . . . . . . .
0
i. Schedule D line 5, from 11 . . . . . . . .
j. Schedule D line 12, from 11
0
(1) Total for year . . . . . . . . . . . . . . . .
0
(2) 28% rate gain/loss . . . . . . . . . . . .
6,000
0
0
6,000
Subtotal before dispositions . . . . . . . . .
k. Dispositions--MANUALLY enter
0
on Form 4797 or Schedule D . . . . . .
6,000
0
0
6,000
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ALTERNATIVE MINIMUM TAX (AMT) PASSIVE ACTIVITY CALCULATIONS
(1)
Is this a
passive
activity?
N

(2)
Rental real
estate w/ active
participation?
N

(3)
Activity's
net income
or loss
6,000
0
0

(4)
Prior year
unallowed
loss (or 0)

(5)
This year
unallowed
loss

(6)
Allowed income
or loss this
year
0
0
0

6,000
0
0

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