The following additional information is available for the Dr. Ivan and Irene Incisor family from Chapters 1-4.

Ivan and Irene paid the following in 2012 (all by check or can otherwise be substantiated):

Contributions to Perpetual Perpetuity Catholic Church..............................$ 400

Tuition to Perpetual Perpetuity Catholic School for Ira..............................6,000

Clothes to Salvation Army (10 bags in good condition) ...............................350

Contributions to George Kerry's Congressional campaign.............................250

Psychotherapy for Irene...................................................................2,000

Eyeglasses for Ira.............................................................................375

Prescription medication and drugs.......................................................1,800

Credit card interest..........................................................................1,345

Interest on Ivan's dental school loans....................................................3,000

Investment interest on stock margin account..............................................325

Auto loan interest (auto was paid for by a home equity loan on residence)..........900

Auto insurance..............................................................................1,600

Dave Deduction, CPA, for preparation of last year's tax return.......................700

Safe-deposit box for storage of stocks and tax data....................................100

Contribution to an educational savings account for Ira..............................1,000

Home mortgage interest..................................................................10,875

Home property taxes.........................................................................3,100

State sales taxes.................................................................................5,000

Unreimbursed business expense (seminar on tooth polishing)..........................700

In June, Ivan purchased a new professional HDV camcorder for $7,000. While the Incisors were on vacation in August, someone broke into their residence and stole the camcorder. Ivan's homeowners' insurance did not reimburse him for any part of the loss since he declined the special premium add-on for high value items required by his policy. Note that the ''Saver's Credit'' discussed in Chapter 4, also known as the ''Surprise Credit,'' may apply.

Required: Combine this new information about the Incisor family with the information from Chapters 1-4 and complete a revised 2012 tax return for Ivan and Irene. Be sure to save your data input files since this case will be expanded with more tax information in later chapters.

Transcribed Image Text:

Department of the Treaury-Intemal Revenue Service U.S. Individual Income Tax Return OMB No. 1 545-0074| RS Use Orly-Do net nmtecr stapla İthia apaca. For the year Jan.1-Doc. 31, 2011, arother tax yoar beginning 2011, anding frst name and initial Your social security nurmber joint retum Make sure the S5N) abow and on line Bc are comect r pest offca, state, and P code IH you have a foreign address,aso complate spacea below isee instructiens). s here ityou, or your spouse iH ng oinly, want $3 to go to this fund.Checking Foreign province/county Foreign posla bax below vil not change your t counry ㎎me a 1 Single 口Married filing jointly (even if only one had income 4 Head of household (with qualifying persont. (See instructions) If ha qualiftying parson is a child but not your depandant,entor this 2 Check anly one 3 Married ling separately. Enter spouse's SSN above and full name here. 5 Qualtying widow(or) with dependent chid Yourself. If someone can clam you as a dependent, do not check box 8a Exemptions (€) reationship uquatying for child tax credit v'けchild under age l c Dependents: First name 3) Dependents Last marme If more than four dependents, see nstructions and check here d Total number of exemptions claimed 7 Wage8, salaries, tips, elc. Attach Formia) W-2 8a Taxable interest. Atach Schedule B if required Income b Tax-exempt interest. Do not include on line 8a Attach Form's W-2 here. Also attach Forms W-2G and 9a Ordinary dividands. Attach Schedulo B if requirnd b 10 Qualified dividands Taxable refunds, credits, or offsets of state and local income taxes was withheld.Alimony received 2 Business income or (ossi Attach Schedule C or C-EZ 13 Capital gain or (loss). Attach Schedule D if required. If not required, check her13 14 Other gains or (osses). Attach Form 4797. 15a 12 If you did not get a W-2, see instructions. IRA distributions 15a 15b 16a Pensions and annuities 16a 17 Rental real estate, royalties, partnerships, S corporations, trusts, elc. Atlach Schedule E 17 18 Farm income or (0oss). Attach Schedule F Enclose, but do not attach, anyUnemployment compensation payment. please use Form 1040-V. 19 20a 21 22 Also, Social security benerts 20a b Taxable amount Other income. List type and amount Contre the amounts in the far nit curm for lines 7 through 21. This is our total income 7 8a Wage8, salaries, tips, elc. Attach Formia) W-2 Taxable interest. Atach Schedule B if required Income Attach Form's W-2 here. Also b Tax-exempt interest. Do not include on line 8a 9a Ordinary dividands. Attach Schedulo B if requirnd b Qualified dividands 10 Taxable refunds, credits, or offsets of state and local income taxes W-2G and 1009-R iftax was withheld.Alimony received 2 Business income or (ossi Attach Schedule C or C-EZ 13 Capital gain or (loss). Attach Schedule D if required. If not required, check her13 14 Other gains or (osses). Attach Form 4797 If you did not see instructions. 15a IRA distributions b Taxable amount 15b 16a Pensions and annuities 16a 17 Rental real estate, royalties, partnerships, S corporations, trusts, elc. Atlach Schedule E 17 18 Farm income or (0oss). Attach Schedule F not attach, any 9 Unemployment 20a Social security benerts 20a 21 Other income. List type and amount 22 Combine the amounts in thefar 23 Educator cocpenses 24 Certain business expenees of reeervists, performing artists, and b Taxable amount Form 1040-V. right column for lines7 21. This is your total income Gross Income fee-basis govemment officils. Attach Form 2108 ar 2108-EZ 25 Healith savings account daduction. Attach Form 8889 27 28 29 30 31a 32 33 34 35 36 37 Deduebble part of selt-emplayment tax. Attach Schedie SE27 Self-employed SEP, SIMPLE, and qualified plans Self-employed health insurance deduction Penalty on earty withdrawal of savings Allmony paid b Recpient's SSN IRA deduction Student loan interest deduction Tuition and fees. Attach Form 8917 Domestic production activiies deduction. Attach Form 8903 35 Add lines 23 through 35 Subtract line 38 from line 22. This is your adjusted 37 For Disclosure, Privagy Act, and Paperwork Reduction Act Notice, see separate instructions Can No, 113208 Form 1040 2011) Form 1040 (2011) Tax and Credits Page 2 38 Amount from line 37 (adjusted gross income) 39a kYou were bon bofore January 2, 1947, Blind. Total boues Spouse was bom before January 2,1947, Blind. checked 39a b Ifyour spouse ilemizes on a separate retum or you were a dual-status aien, checke390 0 Iternized deductions (from Schedule A) or your standard deduction (sea left margin) People who check any box orar% 4 Subtract line 40 from line 38 | 42 Exemptions. Multiply $3.700 by the number on linc6d 39a or 396or 43 Taxable income. Subtract line 42 from line 41, it line 42 ls more than line 41, enter-0- who can be claimed as a 44ax (see instructionst Check if any fromFormis) 8814 b Form 4972962 electin44 45 Alternative minimum tax (see instructions). Altach Form 6251 47 Foreign tax credit. Attach Form 1116 If required 49 Education credits from Form 8883, line 23 51 Child tax credit (oee instructions) nstructionsdd ines 44 and 45 All others: 46 hing 48 Credit for child and dependent care expenees. Aitach Form 2441 48 Married filing 50 Retirement savings contributions credit. Attach Forn 8880 5 52 $11,600 Haad of Residential energy credits. Attach Form 5635 8801 53 Other credits from Fom a 3800 b c O500Icld.5 Add inee 47 through 53. Theee are your total credits 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter- Other Taxes Selfemployment tax. Attach Schedule SE 57 Unreported social security and Medicare tax from Form: a4137 b8919 58 Additional tax on IRAs, other qualified rebirement plans, etc. Attach Form 5329 if required 59a Houschold employment taxes from Schedule H 59 b First-time homebuyer credit repayment. Attach Form 5405 if required 60 Other taxes. Enter code(s from instructions 61 Add ines 55 62 63 2011 estimated tax payments and amount applied from 2010 return 63 84a Earned income credit (Eic) 0. This is your total tax 61 Payments If you have a child, attach Federal income tax withheld from Forms W-2 and 1099 b Nble combat pay election 64b Schedule EIC 65 Additional child tax credit. Altach Form 8812 68 American opportunity credit from Form 8383, line 14 First-time homebuyer credit from Form 5405, line 10 68 Amount paid with request for extension to file 69 Excess social security and tier 1 RRTA tax withheld 70 Credia for federal tax on fuels. Attach Form 4138 71 Credits from Fom a 2439 b[] 8839 c[Де801 d 8885 L 71 72 Add Ines 62, 63, 64a, and 86 through 71. These are your total payments 72 72 Add Ines 62, 63, 64a, and 86 through 71. These are your total payments 72 Refund 73 ne 72 is more than line 61, subtract line 61 from line T2. This is the amount you overpaid 73 74a Amount of line 73 you want refunded to you. If Fom 8888 is attached, check here 74 Drect depositb Routing number Check Savings d Account number 5 Amount of line 73 you want to your 2012 estimated tax 76 Amount you owe. Subtract line 72 frorn line 61. For details on how to pay, see instructions76 75 You Owe77 Estimated tax Third Party Designee Deigee's Do you want to alow another person to discuss this retum with the IRS (see instructions)? Yes. Complete below. No Personal identification gn Under penalties of pejury, declare that I have eamined this retun and apcompanying schedues and statements, and to the best my knowledge and belilef they 8 e true. carret omplete. Declaraton od preparer Kirer than t8xpayer)鴪based on all romition cf ㎡.㎝ preparer has amy knowledge. Here Joint setue? See Keep a copy for Your signature Date Your oocupation Daytime phone number Spouse's signature. If a joint return, both must sign Date f the IPS sent you an identity Paotection PN enterit our oDnda Print/Type pmparer's name Proparar's signature Date Paid Preparer Use Only Check L EIN Firns address Form 1040 (2011 SCHEDULE A (Form 1040) Department of the Treasury Itemized Deductions OMB No. 1545-0074 2011 ce No. 07 Attach to Form 1040 See Instructions for Schedule A (Form 1040). Your social security number Medical and Dental Expenses Caution. Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses (see instructions) 2 Enter amount from Form 1040, line 38 2 4 Subtract line 3 from line 1- lf line 3 is more than line 1, enter-0- Taxes You Paid 5 State and local (check only one boxj: a b Income taxes, or General sales taxes 7 Personal property taxes 8 Other taxes. List type and amount 9 Add ines 5 Interest 10 Home mortgage interest and points reported to you on Form 1098 10 You Paid Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions our mortgage and show that deduction may be limited (see 12 Points not reported to you on Form 1098. See instructions for person's name, identitying no., and address 13 Mortgage insurance premiums (see instructions 14 Investment interest. Attach Form 4952 if required. (See instructions) 14 15 Add ines 10 16 Gifts by cash or check. If you made any gift of $250 or more 13 15 Gifts to Charity If you made a 17 Other than by cash or check. If any gift of $250 or more, see gift and got a benefit for it, 18 Caryover from prior year. see instructions. 19 Add ines 16 see instructions... instructions. You must attach Form 8283 if over $500 17 18 19 alty and Theft Losses 20 or theft loss(es). Attach Form 4684 . (See instructions. 20 Job Expenses 21 Unreimbursed employee expenses-job trave, union dues and Certain Miscellaneous See instructions.) Deductions 22 Tax preparation fees... job education, etc. Attach Form 2106 or 2106-EZ if required. 21 23 Other expenses-investment, safe deposit box, etc. List type and amount 23 23 24 24 Add lines 21 through 23 25 Enter amount from Form 1040, line 38 25 26 Multiply line 25 by 2% (02) 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter-0- 28 Other-from list in instructions. List type and amount 26 27 Other Miscellaneous Deductions Total Itemized Deductions 30 If you elect to itemize deductions even though they are less than your standard 28 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40 29 deduction, check here For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 17145C Schedule A (Form 1040) 2011 SCHEDULE B (Form 1040A or 1040 Department of the Tresaury OMB No. 1545-0074 Interest and Ordinary Dividends Attach to Form 1040A or 1040. Pinformation about Schedule B Form 1040A or 1040 and its instructions is at www.in gov/rom1040 2012 No. 08 inte al Re e ue e wo·gg Names) shown on return Your sooial security numbor Part l 1 List name of payer. If any interest is from a seller-financed mortgage and the Amount buyer used the property as a personal residence, see instructions on back and list this interest first. Also, show that buyer's social security number and address Interest See instructions on back and the instructions for Form 1040A, or Form 1040 ine 8a.) Note. If you received a Form 1099-INT, Form 1099-OID, or substitute statement from a brokerage firm, ist the firm's name as the payer and enter the total interest shown on that fomm 2 Add the amounts on line 1 3 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 Part III. Amount Part II 5 List name of payer Note. If line 4 is over $1,500, you must Part III. Part II Ordinary Dividends 5 List name of payer See instructions on back and the Form 1040A, or Form 1040 ine 9a.) Note. If you 1099-DV or substitute statement from a brokerage firm, ist the firm's name as the payer and enter the ordinary dividends shown on that form. 6 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 You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account: or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust Yes No 7a At any time during 2012, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign Part III Foreign Accounts and Trusts If "Yes," are you required to file Form TD F 90-22.1 to report that financial interest or signature authority? See Form TD F 90-22.1 and its instructions for filing requirements and exceptions to those requirements If you are required to file Form TD F 90-22.1, enter the name of the foreign country where the financial account is located During 2012, did you receive a distribution from, or were you the grantor of, or transferor to, a b 8 u may have to file Form 3520. See instructions on back For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Fom 1040A or 10401 2012 U.S. Individual Income Tax Return For the year Jan 1-Dic 31, 3011, orother tax pear beginning 2011, endng Your social security number a jont retum social security number Make sare the SSNa) above own or post office, state. ryo.have ธ address, also complete spoces below see Presidential Bectien Campoign you ar your spong country name want 83 togo to this fund Checing Forsign postal code Married Sling jointly (even Ionly one hed incomel Head of household with qualtying parsonl. Ree intructionsf the qualitying parson a a child but net your dependant, anter this Check only one 3 Maried ling separately, Enber spouse's SSN above and full name here. Qualifying widowlerj with dependent chid Yourself. If sameone can claim you as a dapendent, do not check box Ea No. af children lved with a Dependents: Dependent If more than four check here d Total number of exemptions claimed 7 Wages, salaries tips, elc. Attach Foms) W-2 88 Taxable intenest. Atach Schedule 8 if required b Tax-exempt inbarest. Do not include an ine 8a Attach Form(s) a Ordinary dividonds. Attach Schedule B if nequired 2 here. Also b Qualified dividends 10 Taxable refunds, credits, or offsets of stabe and local ncome taxos 1 Alimony received 2 Business income or (loes). Altach Schedule C or C-EZ 13 Capital gain or 0ossl. Attach Scheue D if required. If not required, check here ם 14 Other gains or (osaas) Attach Fam 479 15a IRA distributions 16a Persions and anues 16a 17 Rental real estae, royaities, partnershipe, S corporations, trusts, etc. Attach Schedule E 18 Fam income orss Attach Schedule F attach Forma 2G and 1009-R if tax 12 13 If you did not 9t a W-2, see instructions b Taxable amount b Taxable amount 15a 17 Enclase, but do not attach, any Unemployment compensation payment. Also,20 Social security banalts 20a b Taxable amount ploase use Form 1040-V. 21 Other income. List type ard amount 22 Conbine he amounts in the far right column for lines 7 23 Educator expenses 24 Cortain business expensas of resarvists, parfoming artists, and 21. This b your total inoome fee-basis govemment officials. Atfach Form 2106 or 2108-EZ 24 25 Health savinga account dฉdiction. Attach Form 8889 26 Moving expenses. Attach Form 3903 27 Deductible part of et-employment tax Attach Schedule SE 28 Sel-employed SEP,SMPLE, and qualified plans 29 Sel-employed health insurance deduction 30 Penalty on eary withdrawal of savings 27 7 Wages, salaries tips, elc. Attach Foms) W-2 88 Taxable intenest. Atach Schedule 8 if required b Tax-exempt inbarest. Do not include an ine 8a Attach Form(s) 2 here. Also a Ordinary dividonds. Attach Schedule B if nequired b Qualified dividends 10 Taxable refunds, credits, or offsets of stabe and local ncome taxos 1 Alimony received 2 Business income or (loes). Altach Schedule C or C-EZ 13 Capital gain or 0ossl. Attach Scheue D if required. If not required, check here 14 Other gains or (osaas) Attach Fam 479 12 13 ם b Taxable amount b Taxable amount see instructions 15a IRA 16a Persions and anues 16a 17 Rental real estae, royaities, partnershipe, S corporations, trusts, etc. Attach Schedule E 18 Fam nome or 0058A Attach Scheie F 17 but do18 Fam not attach, ay unemployment compensation payment. Also,20 Social security banalts 20a ploase use b Taxable amount Form 1040-V. 21 Other income. List type and amount 22 Conbine he amounts in the far right column for lines 7 23 Educator expenses 24 Cortain business expensas of resarvists, parfoming artists, and 21. This b your total inoome fee-basis govemment officials. Atfach Form 2106 or 2108-EZ 24 25 Health savinga account dฉdiction. Attach Form 8889 26 Moving expenses. Attach Form 3903 27 Deductible part of et-employment tax Attach Schedule SE 27 28 Sel-employed SEP,SMPLE, and qualified plans 29 Sel-employed health insurance deduction 30 Penalty on eary withdrawal of savings 31a Ainony paid b Recipient's S5N 32 IRA deduction 33 Sbudent loan interest deduction 34 Tution and fees. Attach Form 8917 5 Domestic producion activities deduction. Altach Form 8903 35 38 Add lines 23 through 35 37 Subtract ine 36 from ine 22. This is your ad usted 31a Cat. Mo11220 Fnm 1040 p Form 1040 3o1 Page 2 38 Amount from ine 37 (adjusted gross income) 39a CheckYou were bom before January 2, 1947, Blind. Total bowes Tax and 1 Spouse was bom beforeJanuary 2, 1947, Blind,Jchecked 39a your spouse ileries on a separate return or you were a dual-status alien, check here to ized deductions Orom Schedule or your standard deduction Isee let margin 390 Ь 40 People who Subtract Iine 40 from Iine 38 box on ineExemptions. Multiply $3,700 by the number on line Bd 3a or30r Taxable income. Subtract line 42 fram ine 41, If ine 42 is more than line 41, enter -o- Tax (se instructions), Check if an aFom) 8814 b Form 4972 92 eletion 45 Alternative minimum tax (vee instructiona), Altach Fom 6251 Add ines 44 and 45 All others ried tiing3 Crecit for child and dependent care expenses. Atach Form 2441 48 3800E Married firgRetirement savings contriburtions crecit. Attach Form 888050 Foneign tax cradit. Attach Form 1118 if required Education oredits from Form 8863, ine 23 51 Child tax credit (see instructions 52 Residential energy credits. Attach Form 5695 Haad of . . I 53 Oher credits from Font a 3800 il B801 ell-. 54 Add ines 47 through 53. These are your total credits 55 Subtract line 54 tro line 46.Iine 54 is more than ine 46, enter-D- Other Taxes Se-emplayment tax. Attach Schedule SE 57 Unreported social security and Medicare tax from Fam a4137 b 8919 5 Additioral tax on IRAs, other qualiřied retirerment plans, etc. Attach Form 5329 if nequired 59a Household employment taxes from Schedule H b First-time homebuyer credit repayment, Attach Fom 5405 if required 60 Other taxes. Enter code(8) fhom instructions 61 Add ines 55 2 Faderal income tax withheid from Forns W-2 and 1099 63 60. This is your total tax Payments 2011 estimated tax payments and amount applied from 2010 retum63 If you have a 6a Earned income credit (EC) qualfying ahild attachb b Nonfaocabile combet pay election 64b Schedule BC. 65 Additioral child tax credit. Attach Form 8812 American oppartunity credit from Farm 8883, ine 14 67 Frst-time homebuyer credit from Form 5405, ine 10 83 Amount paid with request lor extanaian to fila 69 Excess social security and Der 1 RATA tax withheld 70 Crodit for foderal tax on fuols. Ataoh Form 4136 71 0odistom Fom a 2439 b 8889 c 8801 d 8885171 72 Add Ines 62, 63, 64a and 65 through 71. These are your total payments 72 73 line 72 is more than line 61, subtract ine 61 from ine 72. This is the amount you overpaid 73 Refund Direct deposr?b nstructions.7 You Owe 77 Estimated tax Third Party Do you want to 74a Amount of line 73 you wat refunded to you. If Form 8888 is attached, check here74a Routing number d Account number Savings 5 Amount of ine 73 you want applied to your 2012 es 7 Amount you owe. Subtract line 72 from line 61.For details on how to pay, see instructions76 allow another person to discuss this return with the IRS (see instructione?Yes. Complete below. No Designee Degee's Parsonal identiñoation Under peralies of peeury, idolaset at i handumined飴return and accompanying schedules ard suononts, ard toth⑩ best of my kreeledge and bolt Here Your oocupation Dayame phone number etructions your records Paid Preparer Use Only epouse's signature. If a joint return, beth must sign Dale the IR3 sent you an idanity Prolactin Properor's signature set-employed firm's EN Form 104012011 Itemized Deductions SCHEDULE A Form 1040) Oeperment ofthe Treasury Names) shown on Fomn 1040 OMB No, 1545-0074 2011* Attach to Form 1040. See Instructions for Schedule A (Form 1040). eService (08 Your social security number Caution. Do nat include expenses 1 Medioal and dental expenses (see instructions 2 Enter amount from Form 1040, line 38 2 reimbursed or pald by others. Multiply line 2 by 7.5% (.075) 4 3 Expenses Subtract line 3 from line 1. If line 3 is more than line 1, enter-0- 5 Taxes You State and local (check only one box): a Income taxes, or b General sales taxes 6 Real estate taxes (see instructions) 7 Personal property taxes 8 Other taxes. List type and amount 9 Add lines 5 Interest 10 Home mortgage interest and pcints reported to you on Fom 1098 10 You Paid 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 mortgage deduction may be limited (see 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) 14 15 Add lines 10 16 13 15 Gifts to Gifts by cash or check. If you made any gift of $250 or more, see instructions 16 t you made a 17 Other than by cash or check. If any gift of $250 or more, see gift and gota benelt for L, 18 Carryover from prior year see irstructions 19 Add lines instructions. You must attach Form 8283 if over $500 17 18 19 Theft Losses 20 Attach Form 4684 Job Expenses 21 Unreimbursed employee expenses-job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-EZ if required. Miscellaneous See instructions.) Deductions 22 Tax proparation foos 23 Other safe deposit box, etc. List type and amount Deductions 22 Tax proparation foos 23 Other expenses-investment, safe deposit box, etc. List type and amount 23 24 Add lines 21 through 23 25 Enter amount from Form 1040, line 38 25 26 Multiply line 25 by 2% (.02) 27 Subtract ine 26 from line 24. If line 26 is more than line 24, enter-0- 24 27 Other Miscellaneous Deductions Total Itemized Deductions 30 If you elect to itemize deductions even though they are less than your standard 28 Other-from list in instructions. List type and amount 28 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount an Form 1040, line 40 29 deduction, check here For Paperwork Reduotion Agt Notice, see Form 1040 instructions Cat. No. 171450 Schedule A (Form 1040) 2011 SCHEDULE B Form 1040A or 1040) Daprtment of the Tr OMB No. 1545-004 Interest and Ordinary Dividends 2012 Attach to Form 1040A or 1040. Information about Schedule B Form 1040A or 10401 and its instructions is at www.irs.gov/form f040. rterT ฟ P erve Service Namelsl shown Your social security number Part l 1 List name of payer. If any interest is from a seller-tinanced mortgage and the Amount buyer used the property as a personal residence, see instructions on back and list this interest first. Also, show that buyer's social security number and address Interest 3ee instructions instructions for Fom 1040A, or Fom 1040 line 88) Note. If you received a Form 099-INT, Fom 1099-OID, or a brokerage fim, ist the firm's 2 Add the amounts on line 1 the total intet 3 Excludable interest on serles EE and I U.S. savings bonds issued after 1989, shown on that onm. Attach Form 8815 Subtract line 3 from line 2. Enter the result here and on Form 10404, or Form 1040, line Ba Note. If ine 4 is over $1,500, you must e Part IIl Amount Part II 5 List name of payor Ordinary Dividends See Instruations on back and the Form 10404, or Form 1040 line 9a) Note. If you reooived a Form 1099-DW or subatitute statement from a brokerage firm. list the firm's payer and enter the orcdinary dvidends shown on that form. 6 Add the amounts on line 5. Enter the total here and on Form 1040A or Form 1040, line 9a It line 6 is over $1.500, you must complete Part I Note. Note. It line 6 is over $1.500, you must complete Part Il. You must complete this part if you (a) had over $1,500 of taxable interest or ardinary dividends; (b) had a foreign account: or (c) reccived a distribution from, or were a grantor of, or a transferor to, a foreign trast Yes No 7a At any time during 2012, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country? See instructions If Yes," are you required to file Fom TO F 90-22.1 to report that financial interest or signature Foreign and Trusts instructions on authority? See Form TO F 90-22.1 and its instructions for fiing requirements and exceptions to those requirements If you are required to file Form TD F 90-22.1, enter the name of the foreign country where the financial account is located b back 8 During 2012, did you receive a distribution from, or were you the grantor of, or transfeor to, a foreign trust? IN "Yes," you may have to fle Form 3520. See instructions on back For Paperwork Reduction Act Notice,s00 Yourtax retum instructions Cat. No. 17148N Schedule BForm 1040A or 1040) 23012 Casualties and Thefts OMB No, 1545-0177 om 4684 Department of the Treasury Inbernal Ravenue Senice Namel) shown on tax reburn Information about Form 4684 and its soparate instructions is at www.ins.gow/torm4684. Attach to your tax retum. Fonm 4684 for each Use a or theft SECTION A-Personal Use Property (Use this section to report casualties and thefts of property not used in a trade or business or for income- 1Description of properties (show type, location, and date acquired for each property). Use a separate line for each property lost or damaged from the same casualty or thet Property A Property B Property C Property D 2 Cost or other basis of each property 3 Insurance or other neimbursement (whether or not you filed a claim) (see instructions Note: M Nne 2 is more than ne 3, skip Nne 4 Gain from casualty or theft. If ine 3 is more than line 2, enter the diflerence here and skip lines 5 through 9 for that column. See instructions if line 3 includes insurance or other reimbursement you did not claim, or you recelved payment for your loss in a later tax year Fair market value before casualty or theft 6 Fair market value after casuality or theft Subtract line 8 from line 5 Enter the smaller of line 2 or line 7 8 9 Subtrect line 3 from ine 8. If zero or less, enter-0 10 Casualty or theft loes. Add the amounts on line 9 in columns A through D 11 Enter the smaller of line 10 or $100 12 Subtract line 11 fram line 10 Caution: Use andy ane Form 4584 for nes 13 through 18 13 Add the amounts on line 12 of all Forrms 4884 14 Add the amounts on line 4 of all Forms 4684 5If line 14 is more than line 13, enter the difference here and on Schedule D. Do not complete the rest of this section(see instructions). IH line 14 i less than ina 13, enter-0- here and go to line 16. If line 14 is equal to line 13, enter-0here. Do not complete the rest of this section lf lire 14 is less than line 13, ‘arter the diff rance Enter 1 0% of your adjusted gross income from Form 1040. ine 38, ar Form 1040NR. line 37, Estates and trusts, 999 16 17 18 Subtract line 17 fram line 16. If zaro or less, enter-0-, Also enter the result on Schedule A (Form 1040), line 20, or Form 104ONR, Schedule A, line 6. Estates and truals, enter the reault on the "Other deductions" line of your tax For Parerwerk Reductien Ast Notice s instrustions. No. 129070 pn12