DEpattm~rt~oftfieTreas~Ry—tiaTemePFievenue6kuice E.. {99x ' . 1 ~'oN13 ryo_ 15*35-0d74 ~~ ~ o~~ IJ.S:: lndiir~d'ua~~ t~~oirr~~'~ax: ~et~rr~ C .~~~ ._. .— F6r.theyaac;,lan,f-Rec:3i,~(1i6;orother ta+cyear:hegicining>~ Last name Your first name and initial 2016:ending::. Sanders Bernard ~astnatne i#.a,joL~t.retttc~,..spouse's.fr~sY.mmear~d~ir~ilia}~. na: ~'~~.sure:tha&SM1f(sf;abr~a~ arsd ar~'lin~-8aars3ecizreot. ~~I~li1~:a~. '~'#~tCiS Gheck:anfY9ne "4 ~D Head:of household 4with:qualifying persoa).,;~c-e ir~structioos:j if 'the•gnaliiying person.is~~chiid but notyflur dependertt,~errterthis 1 `~ ~Rgle Q . ~C 'A4~ffISd'fjIlR~.j0ltltly~.(BYB~ ff^.GNtI~;DfI@ hBCI•IIIGp[l7E~ ;3. QBJIar~iedfiiingsepara#e#~!,.~rrter:s~ouse'si~~~J~abova arit! #ull•nam~~liere. ►. ~Q~~ E'xemptiorrs', Check•here if you,~orgowsAQuseit fling lointty, want 33to go to mis Tund. checking 'Foreign postai code a box below will not change your tax or refund. ~ You r]Spouse Foreign province/state/county Foreign country name 6a ,cniid'sname.riar~:.► 5 [] Dualifying vutdorai(erj with dependent cf~ild~ ~ Y~Lr's~Jf' (f someaFle.can claim you xs~a deperrde~rt;. do~not check box-Ha:. 14 ' ~C '` C:in..cc c Dependents: (1) First name. last name i2) Dependents social security :lumber (4) ✓ ff child under age 17 q ualdyfng for child tax credft (see instruc8ons) (3) DependenPs relationship to you If mure:than four depeeidentsssee . ~ on'6a•anil.6tr Mo. of children on 6c who: • lived with you • did not live with youdue:ta.div~rce or separation. (seeinsevcbon~ Ce}~,aerttisan.6c ❑_., D ~: ~~check here -►[]_ •~IICt'~~l'!~ :Attach~orr~(sy W12 here. A3so '.tt •a ` acPi^ F^oJr►ris ~. V '~~:~1'41 1089-R.if ta~c: etia&~vuithheid.. ~lairrie~rl ~) -d ,Total numbec~if,e~r~pfar~s 7 Wages, salaries,tips, etc. A'Etacti~Forrri~s)~)~Y~2 8a Taxabis interest. Attach Schedule B if required b ~ Tax-exempt interest. Do not include on line 8a :9a '~Q, Atld-nurtibers~on '. ~ .~ I Imas_aboge ► ~ `~ _ E `~ ~ 8b ~rdinarydinridends: P,ttach~5chedule B if>r~quired b "Quaf~ad<~lividends ~UhCfL~YG .. 2• 337,~i~~~. 139. E ;fib J~ SY•SxTI~Y+'~~t~:~1I11yt'llS~~'~Y;t1~1L.~'Cd'h!'YU4M M~~ifiY~~~101~n '.. :. .. ~. .. . " ~-~~ ~1 1 .. .. .. ,. .. .. .. .. .. 1t Rlirrr~itiy.r iv~d:. .._ ._ ... _ .. .. ._ 1 12: Businessincome~or. possj_ Jktta~h 5'ch~iule~C or C=FZ~'. i3 Capital gain or (toss). Attach Scf~edufe D if required. If not required, check here ► Q~ ` 1 1 14 Other gains or (losses). Attach Form 4797. b Taxable amount 9 15a i5a IRA distributions b.:T~bla;amounY. 1~ ' ifi~ • Pensions~~nd n • annuities-• 16a_ 1 17• Rental°real es~;,rbkaltie~;,,.partnerships;~SGnrparatiorrs;:trvsks~etc:.Attaeh~S'chedul~;E: '1 t8' F'arm•ifr~roi~ee:i~r'(~s;~:~tttav4~r~S~fte~lule-~'.: .. ... _ ... ._ .. ,. .. .. .. .. .. .. _ _ -~1 Unempfoyment~comperisation `49 .:51, ]::45:. J b T.ascable:aruourrt _2i ':!XDa' "`~ocial.secur~ tieneiit5 L2D~ ~ 2 21 ' Other income. List type and amount Z Combine the amounts in the far right column for lines 7 through 21. This.is your total income ► 22 1,073.333. 23 Educator expenses certain.bmsin~,s;expenses-off:resy~isfis, ~erfArming:a~tists,end Gross ~°'~4 fee-basis goxemmertt officlals~Aitach`Fprrn.~P1D&•.or:~:1D6-~Z l~tCci~e. r,-arrr;~a~39 ~ .;25 a~coiirit~cYe~uc;~on:-Rsttac'r, '~5. t'~eahYr; savn;gs .. .. 26" 26~ ~vloving. e~peFlse~=~tttach~Fcirm 3903 ~ . 2e' , ~edue2~6le~peitofself-eraipla}i~entta~.,Atxa~Schedufe:SE . 27~ TO~..7~Q:.'7:: ;~ 28 28 Self-employed SEP, SIMPLE, and qualified plans 29 29 Self-employed health insurance deduction _ 30 . ,. 30 Penalty on early wRhdrawal of savings . 31.a '31a~ Atirriara~vpaid b:•Recipien~~•S5N h .. _ _ _ _ .. 32 _ _-- 32' IFT,4:cleductian _ .. . _- --_ -_fig• _ .33 ..Student taan ihierest.deLlu~iipn . _ . , X34 Tuitionin~ome) _ Q ~linct: , Jaewary~ 2;1952, 'Cu~l.kioxes' ~': ~~' ~=Vau::+uer.~~bnrn.~trefaie Tex andr Z ,gip '4 if: ~ ~ Spouse was bom before January 2, 1952, [~ Blind. ~ cheoked ► 39a Credi#s °~~M b if Yourspouse ftemizes on a sePante return or You were adual-status alien, check here► 39b❑ ~ z~;a:~~, 4i3-:.: ~:_____ .._~~,~ ~t 4Ff,. lt~mi~ed~de,.du~tions-(iramSchedctfeAr.ar~yzxsrstarrctard.dedzrctran~(see:t~,margir7j:. ,. Standard'. O.eiiuction>: 4't. I~t1.24r>T..3;T. 4~1 .. . . Su#tractline~~t(3fr~cn.line,38. for.—„ ul6piy$4Q50hy,-thenumtrer•ar~~lin~.6ii.Othenvise5aainstractians~ 4 2 ~-• acemptiQris,ff1~ne:38:is~~155,fi5Uorfess, ; ro r,Pe~sle;eaho:.:4~.. E n[~erfc araY :~3 `faxabie incorr~2. ~ylitraci line-~2:fiiorm line 47 if Tin~~;is mite than•li~e~li;;:enter-~Ul.,'D2~,137. 4Ti bOx•An Ifne ... .. .. .39a;ar_39b:nr.. `~'4.' `Talc%.see ~ instructEonS:;Gh~ck ~) ( 8B14 b[]F.tsrm-~72 : ~ 3~1:;.2:2;5,. • c~ ff~~' . 'fram:=:a [~ Ft~rm,$) ~ vvho:Ea~r.be ~~_ -~-0~i , ~lai~ecf as a . -~45 9Atl:~aiTativs`,midi#~i~xan:3~r~(5~e~rts3 t~liatss~:'f~tttaeh-Ftirtn:&2~~ .'.dependent, ~ • ~cess advance Premium tax credit rePaY"~ent. Attach Form'8962 46 see instructions. 351,225. ► Q7 47 Add lines 44,45, and 46 •All others: ;~9i3ach•~F~rm_11•~1'6~fxequir€~d . _ ~ . . ={#8_: j ~~: <~18 . ~r~r~n~axser #9 '+ %~ ~tfarr~ed'~fiihn5 ~,,9. ~aedit•farchikl:~ad dependent.ca+~sxper~,ses.:At#ach-Forrn:24~4~ ~~~,~s s~pacakelK ~,~ .. .. -• 1.9 _ .. i0 Farm S`863, line from cr~c#ts 6 ~ fdu~ai~nn tss.~.~ ' ~6,3oDReiSrerrientsasnngs•Ccininbutioii~c~ditaitacfi Form 8880 51 Mamedfiling 'S'( jo7ntlygr, 52'.: u Q~.yi~~~ ~hiid troecredit. ,~tacfi Schedule~881~~ if requirced • 52 cvidow(er~, . 53" ~, 1.2'0>: FtttaE4i dorm 56~5~ Re~ide»ti~N~ne►'gy Cr~dti#~: 5~f' $iz,soo 54 `~'` Other credfts from Forrn: a ❑ 3800 b ❑ 8801 c ❑ ~ Head of . household, ~r 6,120. credits your total 55 are through 5A. These Add lines 48 $9,300 .. _. .,: ~ . .. .. e~: ' 55: 3:45,_ LtY,fi~:. <:: rte:. ~utiYrae~,Jin~ 55~f~rt1 fine;~'.:Attach~Farrri.~32Hrf-r~equireri ~Ts~C~S _ _ 6Ua ;~BDa HA[~setmld;employrraenris~esfmm~'ScM~dute H `~ `~ "'~iist=time~ome~yer credit repayment.•Attac#f~Foriti ~t35'if regdired 61 0. 61 Neagh care: individual responsibility(see instructions) Full-year coverage QX _ 62 62 TaxEs from: a QX Form 8959 b ~ Forrn 8960 c ❑Instructions; enter code{s) 5 8 5 0. :37:2.,3~bs8.:. ,► ~ 63 ` 69 .:Raid li~aes°56rthrough 62:Tfiis.is;.. Rur.tatalta~c ., .;64 .5'1.r S'0.~. ~ Federal insomeitaic~r.+ithheid:fir+~xn F...arms:Z!a! 2,:s~d ;1IX99 Paymen#s ~;~a If yotl Have°a~ 66a- Earned income 66a cr~dit'~ElC). ,A ~ g ~, uali elation ~ 66b ; ,~~ ~:r~'r z ~;~a<~.~,.:.. t bat b ~ Nortta~table PaX childattach: ScCiedui`e EiC. ~y RiiYiPh'orraCchilfl`taz ctecJfti ~ttCacft Se~iedirl~ 88t2 - ~'T 68 ,4merican opportunity credit from Form 8863, line 8 68 69 Net premium tax credit. Attach Form 8962. 69 _ 70:. 2:3:5::,;Q:QQ~:.. 7l7.. Amr~unt'paici~..~uith requesifarext~nsion:tQ:fil~ 7`t sssociabsecurit~and.tier.1~RF~TlX~ta~ewithheld 7`I E .- - - :7~` 72 ~ ~~rlit•far~federal::Ya~cann fueJ~:Attach Farm 4y 36 73 ~::Eredi4sfrom-Form: a Q~439~b ~`fieser~ed c ~~8$85 adD ~'3 ~ s '-74 ,',Acid lines-84,~i5;'~8a,:..anc~:67.thro~h::~3,These'.are;yAur_to3al:payments ~ie'hJllf~ ' 75 '"ff'tine i4 is more than line'63, subtract Tiny 58 hom line 74. This is the amount you overpaid ►❑ 76a Amount of line 75 you want refundQcl to you. If Form 8888 is attached, check here ►oi'ype: ❑Checking ❑Savings ~ X~ X I X(X i X X X~ X X Direct deposit? ~ b Routing number `.See. ► ~,:d ~aourtt:numkper ~ ~X ~ X ~ :.X'• '~K ~ ~C 3~ X..X..~ instruotior,~. _: ,. . .,,. .'2>4 r 13;'.x... 7T _f~rrtounttsf line'T3: ou want applied to your 2017 estimated~#ax ► X77 #cosri lava 63: For-detaits,os~ hour to. pay, see~instrucf4ans .► At4tnluit •Aanr.~t ows:`8iabtcact li~z 74 you 'Z8 7g; 1~dU dVlt~e 79' E9tinisted tai'"1~8!I~"~.5e~instrt~otiot~9}' ~ ~`~~S '" s<~F._~' 74 75 76a »~ ~vw ~396,,:.5D.7. ~ ~ r g 34 0. '~~ I:x 'x 1~ ~ X 'X €~ ~' r . 78,f: ~~1 •F z~- • a n ~' a-; Via..,e~ , z ~~ ,~.s"~ ~a~ydw:wanttcT~~lld~nt~ariatherpei~ii~to'•diSCtiss~this,'refum_Nrith:.the:lFi~{§ee,insYruetic~ns).?.' ❑ Yes,•Complete~treiavms Q Wa. Yhl'd P~l'Ly': Phone' PersonatidehtifioaYron De`slgnee's~ Designee no._ ► number (PIN) name ► ~gn Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge end belief; they are true, correct, and accurately list all amounts and sources of incomeI received during the iex year. ~ederavon pf preparer (otherthan taxpayer] Is based on all information of which preparer has any Imowledge. MeC~ bate::: ~*aur4ecupation. }~auesigri~tur~: . Daytimes hor~e~umhar.. Jgintreium2'See;+: G(~sl'L~IiIIiGIIt S.E?'~V_~ZCGs-;. insiruetionsri: _. I~te sue'ss,~r~2urP. !t_a.1ar~t.rstwn~.boH►m~egtsign. ' ' Spot+se's:occupatiorr •N'the, se,~tya;an~aa~ay~r~tecuonacs:e~,y~.~r P1Ny~nte~it.., ,cat ~~z„y,.,_,~.,,~~~~ yourracroriis ~~?.8~1~ Preparer Use On(y Pri~it~1"pBpt~parss~ssnatY~e ~+ms's name ► Firm's address ► 3,ranvrrsr~tsulfurmlD4p _ ~i~e~tarer.~signa#ure I~ Self —Pre ared - ~~f~ok ❑ if Sei~-emPioyea PTIN Firms Eit~ Phone no. t~:m~nmwikyi~~ ~orin'yQ~ {ZD1fi) SCHEDULE.A.: dorm ~~o~. DepartinenfoftF~e Treasury Internal Revenue Service(99) Names) shown on Form 1040 ar~e:~vo::.15a~ aa~a It~~iz~d Deductions lrsfor ~~'''~' ~' itiig.aftoi~_Sr.~dWe_A.and.its.sepa~ate insiructians is ataa~aw.irs.govCsch.edulea. ►Attach to Form 1040. Seguece No. 07 Your social secu " number B:~rfiard~.; & 1a~i~:. fT ~~n~e~s: 11Ae~diEat ~aiP~d Dental -~~s Taxes You P~i~1 ~;y ~ Caution.,C~o:,rrcrt include expenses:reimbursed orpaid by-others 1 fiA:edical and tldrital.eitperrs~s:('see~ instru~tib~isJ ~~nt~r:artr~ucrt fr~m~~rm 1D~ Ime.~B 2. .. ...-1 ~~D6~, 6.2:5 y~ pytultipfy Im~:~`by 'tD=4/o`~0.'1;0). Sut if either ~ou~oryour~spause=yeas ~,~,; t~~~o►era,~a~r~~;~a~s~;a~i~~ty:H~~.~y~:~s~~t~o~j~~~t~a ~ . 4 Sub#ract line 3 from line 1. if line 3 is more than line 1, enter -0- . 5 State and local (check only one bob: .. _. `v _ ._ .. .. :a '~"1ncorrt~~taxes,:~or b ~;~enerak-salest~es . ~. 6 6 fleal.'estate.ta~ces~(see instructions. 7' 'T P~rsarial prop~rt~cta~ces: _ acrd arriaur~t- ► S.. other t~ces_ List '' .2~; Q:4fi':.. ~`~ '; A 1 .:'~ `~;~ ~~.;:~~7 ~ --------------------- ,~ g;= (nt~t'est You Paid. Nate:: ~fou~:sn~rtgags irtter~st eleduetion::may ~i~R++i~ts~ instructions). ~ 0 ~;:'2.•~. Z.3b... ~; ~; ' ~-6 ~ 27~ ''zx~^y ~~t ~t.,-. r = 9 AcJd lines 5 throw h 8. . . . . . . . . . . . . . . . . . . . . . 21 418. 10 Home mortgage interest and points reported to you on Form 1088 10 nof.reparfed"~o ynu on Farm ~i~Q9S.. If paid` a ~; n r~r H2ime. mnrfgageantecest tci~th~~persorr frnr~e'uu~rom you: bought the-horrte~see~instructions ~~ anzisMow~that. p• ersan's name rdentifY.in9 nes.; and address;► ~ ~;.~: .`..; __ .._.____. ~~ ___ 12 Points not reRorted to You on Form 1098. See instructions for 12 special rules . 13 13 Mort9a9e insurance premiums Csee instructions) . 'F%4 InvQsttnent interest:Pdtach Form=4J52 if required. ($.ee in5truetions,) ` ~. 4 ~''` . 9~ 2 9, 011. ~` "`; z r~.-..} ""=~s i'''~~: 14 ~ -'~1,~41~8.. 15 i~. '~1dd.lines '1:D:thrgt~ h 1~# as~y.-gift o#.$25C1 t~ mEu~e~s x ~ $. ~C~a~ks t.4 #,~►• '~;~,#4~bya sas~r.4s ck~cls.;S# yc~s..sna~ 10'--~:G.~O'~.. .. ?6' se's ari~..gi#t ~f $25fl more;,,see; pr checl~. If by cash oK G?tiier• than !f you matl~a: 1:7' i7 instructions. You must attach Form $283 if over $500. gift and got a benefit for it, 18 ~$ Carryover from prior year see instructions. 19 Add lines 16 throw h 18 ~~ 10, 600 . 19 Casualty::and. ~Q' . 'T{~eftLosses~.,_.2D ~:Gasual. . ~~~.r. .theftlass ~s :R~ttael~..Farm;:4.68?~:- 5ee~instructions `.:.: ... ._ . .. .. ... ... .. ;,1ab~xi ~~ 'f Unreimtauts~d ~mptoye~,:axp~rrses~--Jnb 3r-av~t, anr~n .dui, ~nd.Cerk~in fob Ed~ration> etc. ~cF~ Form 2`1O~.or..~1ti6~~ rf required _~:~; 1•:~1~45,. 1, nlliscellanienus ~See;~nstr~ctiot~s.).:► ~mp1o~_~s ;business =~x~~nses ~ ,21 2~. 900. ~UeduCti0lts 22 `Tax preparation fees etc. List type 7deposit box, sa#e expenses—investmen#, 23 Othar ,..~-,~~ ~._ and amount ► ---_---------------------------------------------_._~._ "' 23 .. . -_ ____ _________. 24 '. 2„~D~5;. `2~ =Add links>2't through`2~3 . e 3.:, bfi2~ 62fi: ~ °~a~: ~s cnt~r t ~~inri~t:#r~i~narm 5fl40;~ime>3a• '~5. ~ Z 1,.2':53 _ .. 28, . 26 (dlultiplyfine~~5 bye 2°/6'~ (0:02j~ ' . 27 ,;~/,, Subtractline~2~•from-line.24...if~lirie~~26 is r~io~e~tharr line•24;.et~ter -0'= amount ► instructions. List type and Other 28 CJther—from list in --------------------------------------- ~~~. Miscellaneous Deductions 28 1040;~.tirte~~8~.oue~'$t~5;f~50.?._ 29. Is.Faim ~"atal CI' Na~1~`t~ur'dQducticFn is~na#.(irr~~ted~Rcid.the~maunts in the farright.ct~lumn It~iizet[ 29 38,; 48.9.. U ~ fpr.:trnes~4::itirc3tr~ti~:~;Rtsa,.,~rrt~rtt~is:attioirritpn ~'ciim~lQ4.L~, tins~4Q De~ucti~ns ~ ~ ' ~~-1~'es.''~"our°deduction rr~ay~be~limitect:~5ee~the Itemi~etl Deductions 'V~toi~ sf~eet Sri~tlie P~tstn;rctior~s to figues~khe;~rv~~unt t~~tst~r.. ~,, ~? 30 If you elect to itemize deductions even though they are, less than 'your star~dard ~ ❑ ~ 4° y ~ _. ~~ deduc#ion, check here A~vmn~v~mwi~.c~.~ ScheduleA(Form i040)2o1s ForPapenvork Reduction Act Notice,see-Form y040 instructions. BAA ~2. Z r. ~ ~ ~'x'~~k~ f ~ :w s~~~aWt.~ ~- Lc~~~ From ~us6rtess P~r~fi~ o~r~(Sole•~roprietoxship}..: ( ~OCC~t1 1fl4d) ~'~$'~'~,~, ~~~:, ~~~./ ~''~'~~ Irdciina#ifin.a6out&:cfied~le C:and its separa4e instructions.is_at.wa~iinrirs:g!ovlsctiedulec. ` Attachment Department ofihe Trnasury Internal Revenue Service(99) ►AitaCh to Form 1040,1040NR, or 1041; partnerships generally must file Form 1065. Sequence No. 09 SocEai secu ' number SSN) Name of proprietor ,He?~TTa~.c~3., S~~tT.ders. B Entercnde.from•instructions , A Prinei~al business.or prafession,.including product.or service..(.seeiinstructions)'., 'C ,:Basinass.r~ame. ff rw`separafe busin~ss=nam~, leaoe titanic. ...E _~usir~ess'addre`fis'tr~cladirigs~iie,or'.Kooix~•r~ajl-~ D'Empfoyer kt3~numher. (EIDt~?.(see instr.) Ci ,town or ost office, state, and ZIP code (3) ❑Other (specify} ► (2) ❑Accrual (1) ~f Cash Accounting method: Did:Y4u °r~ater~ally participate" in`the>.operation of:thisbusiness durirrg:~01.6? if `NQ,'';~:~'instructions #or limit-ori losses . ".Q Yes ► .~ 'If%~:ousta~'t~3-~raoquiFed t~tis.ka+~sin~ss:d~~ing:20'16,.check here j ~ 1099'? ~see instructions Q°V'es did •you make any. pa. Yments in 20°16 that would require:yQu to -file Forms .. CIV'es" _.. If.;"Y~s,"_tlid'~. U orwill :_ ..fle-re uired•F'o"rm5=t[I~9?:' -- .. ... .. ..: ,.. _ ., ~. . ... F :~ M J ------- '[]ido Q No ~].No Income Gross receipis~or sales. See.instrucYons for line 7 and check the box if this income was reported to you on .► ❑ 1 Form W-2 and the "Statutory employee" box on that form was checked 2 2 Returns and allowances 3'•.. _ _ 3'•:' :Sutitr`ac5t:lirte:.~•from-lineal _ 4 • _ lin~4?.~~4 ~stiofgns~dsssflid~(from, ~ _ _ _ _ .. _ _.. .. _ .. 5. 5. Cu'oss:prnfit_.Sub~act.Jine°4 from line 3 .. - - - - - - S •& 'Ottierincoine,•inclwding~federaland_siate gasoline~r•fiuel ta~c:credit;or ce~nd"jsee instruotion5) 7 .. 1 ' `7 ,Gross`income,.:;A~d lines~;and'6 :_ .. .. .. _.. _,. ~ .. _ i 8 8 Advertising . Car and truck expenses(see .9 instructiarss). .., ' _ "lad... 10 . ^GommissiRns~and:fees 4:~.. ' 4.1; Gcu~tsa~i.4abas;4~:evastsuotk;ris~f ' 12' 12" Depletion 13_ Oepreaiation~and'_secti~n"179 9 ~ ~~~~~'in~~~~` ~°~~ Part' lllj (see included instructions). 14 Employee benefit programs (ather.'diari:oT~ line>1S). ; ., i5`, . insurance~jath~than heafth~. . .'~6• ;~RrElPS~: 13 t4-. 7~ -"'~~.cn~. sue::~,:.., 18 Office expense(see instructions) Pension and profit-sharing plans 19 20 ,Rent--or lease.{s..ee instructiorFs); ~ ~~ . V~hiclss,~mac:hinery,:ttnd~.q~ipment b: Okkier~kxssinessf~oP~~`J. _ 21' Re}iairs and mairrtenance:. 22:: Suppliesr(~ot included in:!'art IIO'. 23 Taxes and licenses . 24 Travel, meals, and entertainment: a Travel . , .. b.~ Deductibles:meats and. entertainment(see~,instiuetions): r` te ~~f1lfl'f8S ~ ,=~ ~ ~'1Nages(less>employrrrerrt-cr~diis). :a 'Nloi~#gaye~(peid:ta'henks;~etc) -f6a .. _ y.6b :•.27a ~7ther=e>cpense~~(f~om.line 48). _ b ~Dfher i7 Legal and professional services b Reserved forfuture use 17 28 Total expenses before expenses for business use of home. Add lines 8 through ~7a ► 29 Tentative profit or poss). Subtract line 28 from line 7 . :~0 ~sp~r[s~s #or busies u5e~:trf:~nur hpm~. Dn. nat:t~port t}a~se~xper~ses-~el~wh~ce: ~lttaeh Form.682~J unless using .the.simplified rtiefhod'~see instructions), Si+r~p1iSied +~ie94ro~ ii4ers on4q> enter the;total square.#oatagc~ o#; (a) your Name: and ¢i)~tiie part ofyour hofne riled for b~sirress: . Us~th~-5impiified (iAetliod U+YorksMeet in the~instr'uctiams:tafigur~Uie;amount;to~enCeFor~-1ine~=30' .. ~ 31 Net profit or poss). Subtract line 30 from line 29. • If a profd, enter on both Form 1040, line 12 (or Form 1040P1R, line 13) and on Schedule SE, line 2. Qf you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, lime 3. ~. . ~• J~a Ioss~,giii~;masY ga>tn liri~ 3~' 1• 32` lf~~uu.havealoss;,che~kth~box;thatdese~ihes;•yourinv~stmentinthis.actiuity,(sa.~:instructians~:. . • ~If-:y~u~h~ck~d.32a,_enter.the.lpss.,on:b~tii'.F~rm SQ4Q, line'12ii(o~-~01'm 1'04UI+IR.~ li►ie 13).~ncl on~ Schedule S~; line 2.,jli,you checked the box'on line 1,, •see`the line 37 instruction: Estates:and tt~s3~,;-enter:ori~Drm'lt~4y, lure:~. • If you checked 32b, you must attach Form 6198, Your foss may be limited. For Paperwork Reduction Act Rlotice,. see the separate instructions. BA/~ REY0fR9ll InluA.cg.cfp.sp ~ ~6 Li6.`~. . .15:6. `'156 18 19 ~~ ~"`?w`%f'; •~20a 20b.<...,..-:._....,_._:.. 21 22 23 ~ -J-~~-< 24a _ , 2dti• :~J~ ' 76 ~ .27;a 27b 28 29 ' 15 6 . . 3Q' 31 15 6 . ~ ~~a O'~All in~restment is:at:rtsk. 32b L]'~Dme irises#rn~rrtis rrot ~~~~k' Schedule G (Form 1040) 2016 Page 2 Sche3ule~(Form:.1040)2016' Cost of Goods Sold {see instructions). 33 3Et • ~5 3S 37 ' 38 Methods) used to c ❑Other (attach explanation) b ❑ Lower of cost or market a ❑ Cost value closing inventory: Was:there~arryeha~gein:deterr~'ii~ir~g~gr~anEi4ies;:cost,-.oruaf~atiata~befweengpening;anzE-e~osinginvenfory•7! . [] Y'es .. . .. If;,~Yes;,`:attach;explanation Inveirtory of beginning of~year. (f diffeieriffrom:lastyear'-s:~losing inveirtory, attach explana#io~ _ _. ❑ No- ~5 36 :A~hases}sss~cos3x3f~iterr+s-uvi4ficlravvriftar~ersorial~se 37 Cast of labor. Do not include any amounts paid to yourself. _ `Materialsartri.suppties 38 39 Offier cas#s. 39 9fl ~dt3 lines 35t}irougfi 3~' . 40 41 Inventory at end of year .' 41 42`• Cyst ctf'gao'ds~sold: Sui~iract line 41 frorrr line>.40'.. Enterthe:result here acrd orriirre.4 :, - 42. -, ~ . ~'" lnfarmation on Your Vehicle. Complete this part only if' you are claiming car or truck expenses on.line 9" and~are nit required to file Farm'4`~62 for this business.~~ee the instructions for line 1'3 to find out if you must ~fiie-Fnrm'~4562. . 43 When did you place yourvehicle.in service for business purposes?(month, day, year) •~4 ~ffhe:'total nurYiber of niiles,you droveyour vefiicle during`20'IQ, errterttre number of mi[es.}rou used your-veliicte for: , ~ Business ---------------------------- b Commuting'(see instructions) c Y7ther .. 45 . INas your vehicle available-for personal.use during.off-duty hours?. G6 Do you (or your spouse) have another vehicle available for personal use?. 4T.a. []ay~ou.have:evidence,w:suppatyaurdeduction7. b .~ . _ If "Yes," is the evidence written? ~ Yes [] No` [] Yes ~ No [~`~~~ Quo` ~ Yes ~ Nb "Other Expenses.:~L'ist below business expenses not included.on lines 8=26.or Iine.30. 48 Total other expenses. Enter here and on line 27a eevoia~tn imu~i.a~.c~sp Schedule C(Form 1040)2016 5eheduleSE(Foma 7040)2076• Narneof person with seif-employment income(as:shown on Form 1040or•Forrn 1040NR) Hernard ~ S-ande~rs~ ' Attachment Sequenee No, 17 Page 2 ~ Social.security number Of person ~.— with sell-ernployment.incoms;► Section B—La Scheduie SE Self-Employment Tax Note. ~f.youF orrty; i~o(t~ subject ter sell err~pbyrrtent talc is ch~rch:'ernR#vYee irtctsm~~ see i~str~trort~: Rlso see'ir~Y~~tr~teEintts f€~r the' definition of church. employee°incam~:. A' lf~you area minister, member- of a~religious-order; or Christian Science practitioner and you filed Form 43'67, but you ► ❑ had-$40D or:.rnore~f°.atTier.netsarnings:from:seff.:.employrrFent, check here-anr~~ontinue-with.€?~rt I 1a Net~arm•profiit or(Iossj~fram Schedule F, lire 34,:and farm partnerships;~~cheduie K1 _(Form 10~~), is t~ox 1~4;eode~~A.-~~fvte.Skip liter 1a:and 1 b if~~ou iase the farm~optional. method see ir~str~tc#ions) b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve 1b t 1 Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z 2 T9et.~profrt vr'(iossjfrom Schredule.C,tine.31;~~dnedu9e'G~EZ,°4in~ 3;.~cttedu9e ~K=1 ~~vrrn '~•465j, box 'I~i,,code ~A"{other than farming);-and Schedale fC-1 :(Form 1b65-B), bnx'9, cods: J1. Minisfers and'rriembers of~'religious orders, see instructions #or types of income to report ~on this:lin~, Sc~ instructions for other incom:e to report. Note. Skip this line. if.you.use.th~ nonfarm •. - - - - - - - - - - - - 2• apticrnal riiethnd (see instructionsj.• 799 ,.5~35 ~9 9~; 53 ~. _ 3~: 3: C~i~kiitte~ litters ~ a'; i.k~; attd,2.. 7 3 8 , 3 71. _ 4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 4a Note. If line 4a is less than $400 due to Conservation Reserve Program payments on line 1 b,see instructions. 4irb. 1~ you eie€~.€frre..or b~~ of-f#~ie-aptional:rs~ethodsy:emterthe.totaf o~lir~es.15. and 'k7 Mere. ._ _ c~ Gombine:lines.~a.and.~h•_ Ifiless.than ~40(7;.stap;:y~~ do:not a~e.self-employment tax. 7'38, 37~. . Exception. If less than $400 and you had ahuroh employee income, enter°-0- and continue ► 4c` -5a' 'Enter your-church~employee-income~from Form W-2. See 5a instructions for:;definition ~f church einplu~ee income a5b' .b dt~lwt~iplydine~~-a';hey"~:~S~fi~.(G3~3~)..~Je~s•#J~an°~~T)D;-~rater -0•~ . 738, 371. 6 6 Add lines 4c antl 5b 7 Maximum amount of combined wages and self-employment earnings subject to serial security 1~~,50D L1.0 _ _ _ _ ~ . ta~c.or..the 6.2%"portion-of-#tie 7:659~o railroad ~e~icemsrtt Mier 19 #ax for2Q'~•6 .. ~Sa 'Total :social •security-vueges ~ar~d~-tips (total 9f.•bcjxes 3 an+d :7: on Form(s~ W-2~ and.raiiroad retirement (tier 1) compensation. ~~« ,wA~ 118 ; S 00 8a If $118,500 or~rno~e, skip`lines 8b through 10, and go to line 1'1 z b Unreporf d tips subject tv social security tax (from Farm 413?; Iirie 10) 8b' 8~ ~~y c 'Vkl~ges sub}~Ct to sociai~§ecuri~y tax ~~o~rt• Form 89'49; line"VO}" d Add lines 8a, 8ti, and 8c 8d 9 Subtract line 8d from line 7. If zero or less, enter -0- here and en line 10 and go to line 11 . ► 9 i0" is . ' Mu~ipiy-tt~a smaller af~li'rie ~'or t~ne'9'tiy T2:4'90 (0:°f24j . 2;L~~.4:13':. _ .. ii~ Multipiyline;6;by.~.J~%o-.(~.07~9j. _ ., .. 1.1 21, 413 . 12 ~ Self-employment tax.. P;tld lines 10 and 11. Enter here and on Form 1040, line 57, or Farm 1040NR, line 55 12 13 Deduction for one-half of self=employmerrt tax. `~ ~ ~''~~ '' f =a '~';, .~ ' Muftipiy line 1'~ by:~Q% (0:5i7~.'~~nte'rthe result here and.on -~ '93 ~~ '~'~ ,'7 n7 . ~. 'dorm 4 ,~fit~e" ~5~;OP ~QCH9 ~d4QN#3;•line:27 . Optional Methads'To Figure Net Earnings (see instructions) Farm Optional Method. You may use this method only if (a) your gross farm income' was not more ~ j , than ~7,~6Q, or (b) your net farrri proflts2 were I~ss than X5.;457. .5,04:D ...O.D 't4 :fVla~cimurr~.ir~cor~e for.aptior~al methods _ _ _ Wf4 .. 15 Enter the.smalter of: two-thirds (2%a) of gross farm income' (not 4ess than zero) ar $5,040. Also include this arrtount. on line 4b above . 15 Nonfarm Optional IVo~eth`od: You. may use this method only if (a) your net nonfarm profits3 were less than $5,457 ,' arid' also less than 72.189% of your gross nonfarm income,° and (ti) you tiad ne# comings from sef~employment of at least $400 in 2 of the prior 3 years. Caution. You may use this method no more than five times. 16 Subtract line'15 from line 14 _ 16 17: Erlterthrs.smaller nf`..tviia-thirds (2/a) of'gmss.nonfarm incdmea (Rotiess:tharr:zero):o.r the amount crn iine•16: Also inelude~thisamount on fine-4b~above : 17 ~ From Sch. F, line 9, and Sch. K-i (Form 1065), box 14, code B. 3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form '1065), box 14, code A; -and Sch: K-7 (Form 1065-8), bax~9, code J1. 2 From Sch: F, line 34;`and Scfi. K-1. (Form 1065), brnc 14, code A—minus tFre ° From.Sch: C, line 7; Sch. GEZ, line 1; $ch. K-1 .(Form 1065), box 14, code .amount.yDu would have entered 9n line.ib had you not used the optional G; and Sch. K-1 (Form'1065-B), boz 9; code J2. method, flEV01rz5n71mu~cy.dpsp SchedUle.SE jEOttn 1040} 2016 SCHEDULE C~~ (Form 1040) {5~ote~Pixiprietarship}. ii ~ ~ `~`~~ 1-#nfomiatioriabnutfictieclble.C"and::its:sepaTa~e insiiuctions:is:at:wr~stsvifs.g+ov/si>(i~etlul AtCacfiment ►dttach rto dorm 1040,.1040NR, or 1041; partnerships generelly must tiie Form iQ65. Sequence No. 09 Social secu ' number SSN) Department of the Treasury Internal Revenue Seroica (99) Name of proprietor Hei'2~ca1E4 ~~Frcte~s: Principal.business~orprofession,,.including p.roductorseruic~,(~ee:;instructions), A~. ~ Rec~rcIiri '.Artist 6 • Brininess narrie:•If no •separate business name, leave~blank. Be~irard :5an~l~eis F ~G H 'I J' _ i 2 34. 5 ' 6 ' 7 d~g`No::1545-0074 P~O'~j~ pP LOSS. ~!°Oi11. ~llSlil@SS B ~nter.code,frmrrinsa~uptions., ► 7" 1. . 1. 5 ~1 Q' D_.Empinyer:ID numher.(~IN~ (see instc:) , I ~ I ~ City, town or post office, state, and ZIP code (3) ❑Other(specify) ► (1} (~ Cash ~ (2) ❑Accrual Accounting method: -mod.you "materially parficipate" in the~operation of tl is-~,usiness clu~ing~20i6'~~If "~1o,"-see instn~e4ions'forlimit~on`losses . , _ _ _ _ _ ._ .. ., .. ~► If.~ou:startecl.oracquirsd:tt~is:business.cl~cit3g:20'4.6;checkhers Did you make any payments in 2016 thaf would require you to file Forms) 10'99? (see instructions If".~'es,"'clid you or wilt you file required Forms 1'0997 ~ Gross receipfs or sates. See insCructionsfor tine t"and check fhe box if fhis income was reported fo you on .► ❑ Form W-2 and the "Statutory employee" box on thatform was checked . -. Returns and allowances .. _ . .. .. Subtract~fine-2°from line.i Gostof:goods~sold{Erom•line42}:. .. .. _ ~. _ Cwoss profit Subtract line 4 from line 3 :.Other income, incfudigg~federal.artd-s#ate.gasoline.ar fiuel-ta~t aredit:z~r refund,jsee instructions).. ~ ► `Gross irtccme..`Attdiines.~'antl:6 sEic ~: -:,~.. .,~.. , 'j~ Xes ~~ t10 ❑ QYes (~ tJo ❑ Yes ❑ No 2 , 521. 1 2 3' 4.. 5 6 7 2r.5Z'1. 2~, 521 '2 , 5'21. s~s:~r~ter~xo~nses for~business use of vo~r-horne~or~n on~tirie"~Z3. 18 Office expense (see instructions) Advertising , 8 19 Pension and profit-sharing plans Car and truck expenses (see . ~ :20 Rent.ar ieasE (s~e,instructians~: '3 . instructions). ~ a Vehiel~;.:rri8cfiin~ry; ~ntl~et{uiprrjent • ~ =Gorrrm'issioFls;~nd €ees '10 1 b Other !ws'ssiess property 11 Contract.4abos' {see inst~ucttos~s) i1 21'' Re~airsar~d:maintenance: . _ 12 12 Depletion .. _ 13 f7epfeciatian -and section 179 22 Supplies-(not incir~ded in Part I41} .. expens~ deduetio~: (ii~f and licenses . _. taxes ~3 included in Part III) (see 13 24 Travel, meals, and entertainment instructions). a Travel : 14 Employee benefit programs 14 (atherthan~.on:•lihei~.:: ., b: . Deductible~meals~and errtertainrne[it (see insttuctibnsy' tS' ' [nsuranc~(ath'sr~titarr-health),= 16 y ~ .:. Interest: __ 2~ Utilities _ 7& 26 -~Lages~(lass:emp)s~yment:~retiits). :a Moatgage:~paidtnbanks,etc) 16a 2Fa ~Otherexpenses..{from line•46}.. -1B6 b. Other 17 Legat and professional services b Reserved for•future use 17 ► 28 Total expenses before expenses for business use of home. Add lines B through 27a 29 .. Tentative profft or (loss). Subtract line 28 from lime 7 . •~D E~pensas fflr bt~sir~ss ~:ese°•of:y~ur home. t~{not~cepart ttta5~~~?cp~ns~s~lsa~h~re.;Att~ch Form,8829 unless using th~sirriplified.msthod.-jsee instructionsj. Si~ip1sfiied srrethod fiSea's on4~; enter the tota4 st~~are footage. of:.(a} your home: .Use the Sii~pli~ied and (b) the part of yourhame used for business: Method Vi/orksheet in fhe instructions to figure the amount to enter.on (ine.3Q 31 Idet profit or (loss). Subtract line 30 from line 29. • If a profd, enter on both Form 1040, line 12 (or Form 1040NR, line 13) and on Schedule.SE, line 2. ~, Qf you checked the box on line 1, see instnictions). Estates and trusts, enter on Form 1041, line 3. ~: If a:I ;..Y~su~mus#; g9~ta•line~.32:.. 32 If'you hake a:loss;.eheel~- thy:box_that describes:.your investment in this activity: (sea instructioras~:. 8 9 • _ If.you. Checked 3.2a,.enter the loss on.both Form 1040, line 12s~(or Form-1040NR, linel3)°;arid on Schedule:'8E; 1'itte'2.;(li you checked the` boron lined., seethe line 31 instructions). Estates.and trlists,:enter.~n Form9D41.,.Giie.,3d If you checked 32b, you must attach Form 6198. Your loss may be limited. For Paperwork Reduction Act Notice;see the separate.instructions. RE'/01125ti71nlu~.o~.cip,sp BAA 18 19 F „~,M;,y ~2tla 20b 21 .22 23 ~~~~'a3x 24a - 2"#li` 25 26 27a 27b 28 . 29 2 , 5 21. 30:... .,. . . 31 - ___ ~_,_ ,_~ 2 521. 32a ~].AI4.in~sstment.isat risk. 32b 0 Some:irniestmerrt ~~not at risk. Schedule C (Form 1040) 2016 Schedule G(Form 104Dj.2016 Pagff.~ ' i asst-of Goods Sold (gee instructions) 33 34 :35 Methods) used to ' c ❑Other (attach explanation); b• ❑ Lower of cost or market a ❑ Cost value closing inventory: Wascftiereany.changes.in~deterrriining ~uanYities;.costs;.o,~.vat~a4i~sr~sbstvrreen opening a~fe~osirtg inventory. .. .. .. .. ❑ ~' If:"Y~„`attach explanation lnventory.atbeginning-~fyeaG.,lf-different#ruin"Last:years:elosingfrwer~Pory,.ai# _ .. 37 Cost of labor. Do not include any-amounts paid to yourself . _ .. ::38 ."~~rials:and:suppiies. :x.35,:._ ._..~,,,_,«,.,~..,,.,_~~_ 36 _ 36 ~.;P.irch~srs+less=cc~ht~uferns"w+ittiilrauv~:~fprpersiu~ial.cssse 37 :~acPianation _ ~ ~°: ... .. _ 38 39 Ofheroasis. 39 4fl Anti lines 3~ tfirougit'39' 4a 41 Inventory at end of year 49 42" C"ast;ofgoodssoad,~"ubtra~tline4'1 from Iine.4Q: Enter.the_result her~:and;an fine.4. 4~ lnforraation an Your Vehicle. Complete this part only if you are claiming car or truck• expenses on.line~9' and ~are~not°ret~uiredto file Form X562 forthrs busih~ss:See the:instructions~for lir~~ 1'3 to find rout if,you must . -file~rm=4562. 43 When did you place your vehicle in service for business purposes?(month, day, year) ► ____ _ ___ 'Of the total nutYiberof mifesyou~tiroveyour~vehicte during~201&;<~nterthe numberof milesyouu usetiyour-vehicteinr: a Business 45~ Vrlas your vetiicle:~vailable~foi' personal.use during ofFduty hours?' 46 Do you (or your spouse) haae another vehicle available for personal use?. _ 47a•. aa~au.hav~:evidence..fo.suppartyour.rfeductian?` b . Jf "Yes;" is,#he.evidence written? .. ., _ c "other b Commuting (see instructions .,. ._, _ .. .. : , ~ Y~+s Q Noc ~ Yes ~ No Q Yes ~`~RPo< ~ Yes Q Nq Other Expenses. ;List below business expenses not included on lines 8-26-or iine;30. Startup--hosts------- 48 . --.._.. ..................~------------------------------------------~ Total other expenses. Enter here and on fine 27a 4g BEvov2g171Nun.cy.cy.sp 2,000. 2, 0 00. Schedule C (Form iQ40) 2016 ~~~~_~~~..~: ~ '~'~~'~ fit° ~'^ #~f~'T 3a~~~as ~~~r '~9s'~'. 43i> w ::_.•::s ,,c- k ,r -:si w.e rr k x ~fP+:3~ t sr~s..;r:'t. '~',~zYs~ ~ i~`%~ ~~t ts~,tt ~"r~ s s _'''' ~.~ eS~ [ u~i~~~.~ ~~ 1~~ ~ .. ~'.~ ~~~ ~f~~ ~:.. o ~.E _. i.1L+ s:+zc f ~i. t',anc TCE3. Y; ~ ~n+=a<,~r~.},~.~ ;r~-nh _rc,__ Y. ~~t~~ 3r,~ F'^~~ ~' 3i i~£~~+~+' ~i,~1.. ,. ~ .::~, _ _...: ,N: ...~,~..~:~: HE iww .w'!C~ i~at~.~aM ywa~~ 7 S ._ T _.....,. .:.... .:....... n t. ~~ .a.. ,.w ,r~::.j Iv_r t.'C 2t:~ .̀`t' it: t« .y ,,~ . ~~~i Additional INledicare 'f`az~on~ Medicare Vl/ages, ~n ''~' 1 Medicare wages and tips from Form VU-2`;' box 5. If you have ~.~-: ,n~ ~r~rore than orte Form W-2; $rater the total of tl~e'ar~o~r~ts '1 .. . . . .. ... .. ._ 'from box 5 ;,. ... 161., 0 3 3 . '°2 e ,:" ~ `2 ~1~nrieportetd tips'~ror~~~orrr+ ~'3~7,-~lirre Fi 3 3 Wages from.Form 8919, line 6 161, 033. r~~~= 4 _ 4 Add lines 1 through 3 ~, ~;Y~.~ ~`~j ~ ~~nger4'he'`foliowmg ~rnourft~orgour`ffling~ta3us: $~5D,DD%J ~ . .. ~ Married citing jointly_ $125,000 f~ ~rT~ Married filing separately 2 50 ,.0 0 0 . 5 ~ Single, Head of Frousehold arQualifying wiciow(er) $200,000 4 Y.6 6 Subtract line 5 from line 4. If zero ~r less; en~Cer~~O-~ 0.9% RAi.ittipCy i'me 6 by (0.009). Enter here and` 7 Additional fvTe~C~re Tex on Cvi'edioare wages. 7 ~ D o to Part it Additional Medicare Tax Qn Self-Employment [ncome „ ~{ g Self-employment income . frnm Schedcile~: SE (Form 1040)r ~ Secfion:~;. ling ~4,:or Sect[vn..B,' linff.6..lf'.you hid a. fosse grater ~ 5~<~,.~ 7 3 g,3 ~ 1, g -0- (Form 1040-PR"and ~orrn 104Q-SS'filers, see instructions.)' Enter the following amount for your filing status: .. . • '$250,000 .: 'Married filing jointly. i~iarriecl fii4ng separa~eiy ., $125,000, 250 , 000. 9 Single, Head of household, or Qualifying widower) $200,000 90 10' Enter the amount from, line 4 161, 0 3 3 . yt ' . ':Subtract line 1D frDm line', If,zero.or:less,:enter.=0- - - 1y... ~. .:~_._._ ..':8:8:,.:~~6.~,...,-. '12 •Subtract line 11 from I~ne 8. If.~aero ter less, enter -0- . 13 Additional Medicare'Tax pnself-employment income. Multiply line 12 by 0,9% (0.009). Enter here and go to Part III' . 9 15 r i~ 17 ~f'.L 18 T ~;a• :-~31 ~' ., . ~-•6.49 ,~4•Q4 . 12 . 5, 84'5". 13 Railroad retfremen~ (RR7A) compensation and tips from Forms) W-2, box 14. (see instructions) 14 Enter the following amount for your filing status: fUlarri~ci filing jointl~~. $2:5Q,.OQO. Marriedfiling,separateiy .... $125;000~ Singe; -Head of household, or Qualifying widow{erj $200,000 15 _ 1 Subtract line 15 from line 14. If zero or less, enter.-Q16 Additional MedicarQTax on railroacJ retirement (RRTA) compensation, Multiply line 16 by 0.9% (Q:009}. Enter here and go'to`Part 1V . ~ 17' Total Additional Medicare Tax --- __ Add lines 7, 13, and '17. Also include this amount on Form 1040, line 62, (Form 1040NR, 104f3}P~i;,and'1040-SS filers,.se~:instructioE2s):and:g4.to f?art:u . =-_— ,. ,. _ _ .. .. ~y8 __ iVfeciicar~ tax withhefc~ from farm W-2, box 8. ff you have more than one Form W-2, enter the total of the amounts from box 6 19 2, 335. 20 Enter the amount from 1in81 161, 0 3 3 . 20 21 Multiply line 20 by 1.45% (0:0145). This is your regular Medicare tax withholding on Medicare wages 21 2,3 3 5. 22: Subtract.lin~27 from lines l9~.lfize►fo,:ar:less;.enter-Q=..This:.i~~.your~Aclditigriat.Medicare Ta~c; withholding.on (`rtedicare.wages... _ _ ., 23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box 14 (see instructions) . 24 TotalAdditional Medicare 7ax:withhnldii~g.Adr1 Iines22:and.23..ALsn include#his amflunt with federal income tax withholding on Form 7 040, lime 64 (Form 1040NR, 1040-PR, and 1040-SS filers, see instructions) ., For f?aperwork Reduction Act Notir~; see your tau return instructions. BAA R~votr~it~ mro;r.cy.ct~.sP .5,..8:4:5,. I_. ~~ Q:.,. 23 Farm 8959 (2016) . Form • ~9~0 Net fnvestmemt Income Tax-I~'Idivid~als,,Estates; and 1'ru~#s .~~,~~y~~~~~ : Department of the Treasury tInformation about Form 89~ and its separate instructions is at w4vw.irs.govlfonn8960. Internal Revenue Service(99) Names)shown on your tax return OMB No. 15`45 X227' X01 Attachment Sequence No. 7`Z or EIN Ee~rnarel. &~ •~an~e FT ~arre~e tnvestment Income Section- 60t3(g)::e[.ectiarr:(see instructians~ Section 6013(hj election (see instructions) Regulations section 1.1411-i0(q) election {s~ .. .. .,. '1 ._ .. .. '1 Taxable intexest(see instructions} . .. •2 2 ~ndinary ~ividerids~(see`instruct+ar+s) '. 3 3 Annuities(ses instructions) corporations, trusts, ~ ~' 4a Rental real estate, royalties, partnerships; S ~a ~~c:jsee~instructivns) b Adjustment'#or:net.income•or loss•deriued..in the•ordinary,cqurse of 4b a non-section 1411 trade or business(see instructions). 4c 'c Combine lines 4a and 4b .' ~;~.v., 5a. ~' 5a het gain or loss from disposition 6f projserty(see instructions) re'n~'ay gs1': ~' b Nef gam or foss from disposr~ton of property that is not subject to 5b net investment income tax {see instructions) g ~ Adjustment from disposition of partnership interest or S corporation z~' 5c. ' ; .. stacl~ `(see instruetions~. .. .. .. , ASsI ... .. lir~es5a•through 5~ d Combine 6 6 Adjustments to investment income for certain CFCs and PFlCs (see instructions) ~. `7 ? Ofher modifications to investment income(see instructions) 8 ; 8 `"t'otal investment income. Combine lines 1,2; 3,~4c;5d,6, and 7.,_.,. _. ... . . ilv9en#=#ncom~ an~i"~ortifwca~ions . • :~~tves~~sent~EXptie e~s`#ifoca~e'to` 9a "= 9a Investment interest expenses(see instructions) 1. ~ ~~: 9b h State, local, and foreign income tax (see instructions) ~ 3c _ _ _. ~~,;'~ c fViisce(Ianeous investment-expenses ._(see instructions) 9d 9a, and .. d Add lines 9b, 9c "`i0 ' t0 Additional modifications(ses instructions} ii 11 •Total deductions anti modifications. Add lines 9d and 10 Tax:Gom ,utation ..:.. . . . ... . . i2 IVet investment income: Subtract Part"If, line 11 from Part I, line 8. Individuals complete lines 1312 7 7. Estates and trusts complete lines 18a-21. tf zero or less, enter -0- . Individuals: T F.Q6~2,;~~fi ~ `~ u~~""~ 13: 13' I~odi~ed',adjust~d gros~in~ome(see:instructions):: 250,.000-. 14 'Threshold based on filing status(ses instractionsp 14 15 812,b 26. i5 Stabtract line 14 from tine '!3. If zero or less,. enter -Q16 Enter the smaller of fine 12 or line 15 .' y16 17 'tJet investment. incorr~ t~ for individuals, Multiply line 1.6 by 3.8% (.038). _inter hero and include on your'tax r+etum (see instructions) 77 ~ ~"~°~-=z Esta#es arm Trusts: 18a Net investment income (line 12 above) 18a ts. Deductions for •distributEons .flf net investr►~ent incams .and _ 'f8b `' ~ ~ .~terluctictns underse~tis~n..642.(c) ~s~e insiru~trons) • Undistributed net irrvestment income.:Subtract tine 18b fromi8a (see `. instructions). If zero or less, enter -018c '19a. ~ Adjusted gross income (see instructions] .' 99a ~~; .year b Highest tax bracket for estates and trusts for the (see tSb ~'~~~ instructions) =~<:;:.:;<~~_~. 19c c Subtractline 1,9b from line 19a. If zero or less, enter -0. .. . .. . . . .. 2U . 20~ En~er.the~srrjaller of lir~e~•.18c~~r line_19c . 2i Ne#_ investment income-taic..for estates: and..tcusts: Multiply- Iine..20 by 3.8°l0 (.o3.8). Enter here 2i and inelurle.on ourtax return see instructions Fop Papenaork Reduction Act Notice, see your tax return instructions. BA'A REV91125l171nluiLcg.clp.sp __ 139. 0. 139. 1. 1. 138. 138. 5. ' ..._.:... ~ .. _. .,. FOtTY1 H~O (2018) 8582 Form- OMB:No.1.ff45=1008 Passive Ac#ivity~Loss Limits#inns ►$84.ggparate inStrUCtionS. X016 ' ~' Aft~ch tolFiifm 1Q40-os. ~otm-iQ4'~. Department of Yiie Treasury ~ Imemal Revenue Service (99) ' ►information about Form 8582 and its instructions is available at Evwvii Attachment __ Iden ' 'n number Names) shown on return Segrrard- ~• Jane O~ Sa~rtc~Ex's,_ .., . .... 2Ut6 Passive Ac>tivity`Loss C~ution:.Comp/ete YVdrksheets.l 2; and`3'before completfngPFarfl: 5 z " ,~. Rental Real £state Activitiecs With'~4ctive Participation_(For the definition of•active participation, see z I` ~ , ~3 Special•Ailowance for~Rentaf~Real'Estate Activities in the instructions.) ~f ► -om'1r"Vorkshee~t =1, a amattr~t 'ia A~tidi~ies •vtrt#h met -incorrre (enter -#he is ' I column (a)) i` 3 b Activities with net loss (enter the amount from Worksheet 1, column i ~~ ..~ .. .. .. .. .. ~b " ( (t~ .. .. ... .. .. _. .. ... . . .. ... .. .. ~~ ~ `"'~ c Prior"years unailowed losses (enter the amount from Vlfgrkshee# 1, 1c ( .. column c :~. .~F ) ,~e~ ~ 1d d Cnrribine lines 1a, 1b; and• 7 c '~ ~ ~' Corriimerci~[ Revit~lix~tion Deduceions From.Rental Rea! Estate Activities col~imn ~florkshe~t 2, (a) . 2'~ E' ) frorrr ~° ~.~ r; 2a Eomrrrercial`revitai'rzation d~cluctions ~~"~-~~`~ 9 b Prior year unallowed commercial revitalization deductions from 2b ( ) {.r,~T~ ~__ _ , ~'~~ Worksheet 2, column (b) ~ cc ~~~ r c" -Adt2lines za anci'~Lt7 All Other Passive Activities v~~. , ~~ ~" .~ ~. 3a Activities with net income (enter the, amount from Worksheet 3, 2 ,~ 21. .~ ~~a 3a column (a}j ~, b Activities with net foss (enter the amount from Worksheet 3, column ~t~3). . its ~ ~ . ) >~~~~~. ; ~,~. ~ ~~~ ~ tt c Prior~years unallowerl losses (enter the amount from Worksheet 3, column (c)) 3c ( ) ~~,,~,~ ~ >: =". 2,521. d 'Combine-linEs'3a,`3b, anri'3c ..,.~ ~3xi... ,. 4 Combine lines 1d, 2c, and 3d, if this line is zero or more, stop here and include this form with your return; alt lasses are altawed, ir►c~uding any prior year u~allowed losses entered on line 1c, 2b', or 3c. Report the losses on the forms and schedules normally used 2', 52'1. 4 If line 4 is a loss and: •Line 1d is a loss, go to' Part fl. ~ Lme 2'c is a toss (and fine t'ci`i`s zero or more), skip Part f[ and~go to Part fiC: • Line 3d is a loss (and lines 7 d and 2c are zero or more), skip Parts fl and III and go to line 15. Caution: if your filing status is married filing separately and you /rued with your spouse of any time during the year, do not complete Part ll or. Part:llt>fnstead;_ go to tine 75. Special AI(owance_for Rental Real Estate Activities With Actiue Participation Note: Enter all numbers in Part ll as positive amounts. See instructions for an example. -5 Enter the smaller of the loss on line 1d or the loss on line 4 5 6 Enter $150,000, if married filing separately, see instructions 6 '~ ~ ~1~ 7 'Enter motli~ied adjusted gross.income, but not less than zero (sse instructions) t~~ j ~~ Y ~ Note: !f line 7 is greater than or equal to line 6, skip lines 8 and 9, x~ ;; ;:i enter -0- on Jine 'f 0. Otherwise, go io line 8. y _. 1 ~n 8 Subtract line 7 from line:6 I 8 V ~ =~~~~N `~' 9 Multiply line 8 by 50% :(0.5). Do not enter more than $25,000. If married filing separately, see instructions 9 i4 ~nt~ the scna44er of Sine 5 or iis►e 9 i0 0. If line 2c is a loss, .go to Pant Ilf. Otherwise, go to tine 15. Special Allowance for Commercial Revitalization Deductions from Rental Reaf Estate Activities Nafe: Enter atlnumbers in Part ItP as positive amounts. See the example for Part 1f in the instructions. 11 Enter $25,000 reduced by the amounf, if any, on line 1D. If married filing separately, see instructions 11 '12 Enter the loss from line 4 . 12 13. Reduce:line..12 b~ the.amount on. Iine.10 _ .:. . _ .. y3 1'4 Enter the smallest of line 2c (treated as a positive amount),, line 11, or line 7 3 .. ti4 Total Losses 15 Add the income, if any, on likes 1a and 3a and enter the total . 1.6 Tfltal lo~es..alRoaresi from ,all passive. activi#ies for•201.6. Add lines ~1.0, 14,. ,and 1:5. .See instructions to end out how to report the losses on your tax raturn For Papervrork Reduction Act Notice; see instructions. BpA BEVOth251t71mu0.cg.clp.sp Form Page 2 Fortii 8582'(2016). Caution: The worksheets must be filed with your. tax return. Keep a copy for your records. Worksl~e~t-1.--For Eocm8582,Lines 1a~ 1b;and i.c Ghee instructions:): Curren#year PVame of activity Prior years (~j.Neti~re;am~. . (#~~.Ne~-lass {line'1a) Overall gain or loss - (~~1~ra!lowed ~ `(line 1b) loss (tine fe) Total. En#er on Form X582, lines 1a, ib, `~; 1~f~r~~~~~ ~'~~ ' gig ~-' ~~" .•. ~. Ri#L7 .~C (e).Loss. {d).Gain ~ ` ~ 3 x Worksheet 2--For Forn~i`8582, Lines 2a and 2b (See instructions.) (aj'Current year deductions.(line-2a) Name of act4v'sty (b}Prior year unallowed deductions~(line:2b) ' ~ot~F: ~t~~on~~~rriir8582; Ifies 2ai.anc~-~ t ~ 2b~ (c)Overall loss ~::" ~` a~~~ ~r~' ~.~.. WorkShaet3-Por Form 8582, Lines 3a,3b, and 3c(See instructions.) Current year Name:~f.aativity Bernard Sanders Total. Enter on Form 8582f lines 3a7 3bf and'3'c ► taj`'i~iet i~r+~oi~ = (line 3a) Prior years ~p~Ydet'#oss (line 3b) 2,521. Overall gain or loss ~+c)~lin"a#lowe~tl loss pine 3c) 0. 2 52'1. Y~ ~~~4s'~»~= ~ _, ~~~~ ~St ~. .~~~~L~~' 2 ,5 21. ~ (e) Lass (dl Gain 0. h ~ ~: .'S% g -~ y' ~ '~ WorKsheet 4—Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.) Name~of aativityr Form or schedule ancFline~number to bereported on (see instructions) (a) Loss. Total ~ Workshee# 5-A4toca#eort of Una4lawed Losses (See Instructions. Names°of activity Total Form or schedule anci line number try be reported on (see instructions). ~ (c)`Special allowance (b) Ratio- ~~~~~ column (c) from column;(a). 7.00 ~a) Loss @):~~o 1.00 AEVm@51171mui~cq.c~psp (c).Unallovued loss . Farm X582 (2016) , Residential Energy Credits r I OMB No. 1545-007'4 ► Information about Form 5695 and its separate instructions is at wurcyirssgovlform5695: ►Attach to Form 1040 or Form 1040NR. ~ ;, ~O Attachment Form'~695 Department of the Treasury " Internal Revenue Service Sequence No. 1~ Your social securi number Names) shown on return Bex~rraz~a:. & ~a-rye O. Sanc3e~s• Note: Ski lines 7 throu h 11 if ou onl have a credit caveyforward from 2015. 1 Qualified solar electric properly costs -. 1 2 Qualified solar water heating properly costs 2 3 'Qua?~ed•sma~l wind energy properrtyy~cos`~s . 4 Qualified geothermal heat pump property costs 4 5 Add lines 1 tfi"rough 4 5 .~ 19 , 9 0 0 . .'3 19 , 9 0 0. '. 6 6 Multiply line 5 by 30% (0.30) 7a Qualified fuel cell property. Was qualified fuel cell property installed on or in connection with your .. ► 7~ [Q Yes rrr'air~home tnca~ed~in~ifie~JnifedS#a4es? ~See~instnrefionsj~ property. ~' a credit~~for qualified fuel cell you canno#'take the brnt, checited "No" Caution:- If~you Skip lines 7b through 11: t b 'Print the complete address of the main home where you installed the fuel cell property. (! . t `iVumberand 8tree4 ~ `knit Flo. City, State, and ZIP code ;( ..~ $ Qualified fuel cell property cos#s 8 ,~ 9 Multiply line 8 by 30%0 (0.30) 9 a~ 10' Kilowatt capacity of property on Line 8 above.► 11 Enter the smaller of line 9 or line 10 11 'f2 Credit carryforward from 2015. Enter the amount, if any, from your 2015 Form 5695, line 16 't2 ' YO ~ N~ '•", 'j x $1,000 5 , 9 7 0. ~5; r 13 Add lines 6; 11, and 12 13 14 , Limitation 'based on tax liability. Enter the amount from the Residential Energy Efficient Property ~Crei~iiit'Lnriit'W'orks~eet'(seeinstructions) y4 15 Residential energy efficient property credit. Enter the smaller of line 13 or line 14. Also include this amount on Form 1040, line 53; or Form 1040NR, line 50 15 16 Gr•.edit -carryFor~ntard to -2.01,7. If line 1.5 is less than line 73, .subtract 1 line 15 from line~l3 ~. ~ 16 ( f For Paperwork 1'Reduction Act tso~ice, sea your tax return inshvcfions. epp e~vo~rzut7~mWtsy.cto.s~ 5, 970 . 351,075. 5 , 9 70 . Form 5695 (2016) Page 2 Form 5695(2016) . Nonbusiness Energy Properly Credit 17a Were the qualified energy efficiency improvements or residential ersergy property costs for your t 17a Q Yes ❑ No main home located in the United States?(seQ instructions), ~Ea~Ewn: i~ yo~:eFzeekecf,Vie.. "Na'.'• box> YoU,ca~o~ clai~x►..~k~e, nr~rab~si~ess es~er3Y. pxaperty cxedit ~ ~Do rtatcomplete f?art.tl.. b Print the complete address of the main home where you made the qualifying improvements. Cawtion: You carp anfy gave one main home at a time. ' Num6er and stFeet Unit No. j f City, State, and ZtP code . 4► 4.7~ ~~ Yes ~ ~Vo c Were ar~y of tivese ar~prov is re9at~d #fl She const~ction of t~is~ain home? Caution: ~If you checked the "Yes" box, you can only claim the nonbusiness energy property Y ~'~ j # credit for aualifying~improvements that were not related to the construction of the home. Do not i~clade expenses related to the construction• of yoar main home, even if the improvements were ~ ; ~ ~"'°' made after you moved. into thehome': Lirni~ation Vilorkskieet (gee-ins~ru~ioris} = ~#8~ . ~f~ k.~tetime {imi4~atiiorl: Erfterttie a~oact#~fso~tt~+eLifetime 19 Qualified energy efficiency improvements (original use must begin with you and the component must f reasonably be expected to last for at least 5 years; do not include tabor costs) (sew instructions). a a IrtseitaCtor~• i~r~ateriat or systern~ speci~icaf(y ancA prir~+~ri4y c3esignecl~ tc> remhea~h loss or gain o~ yg~ your homes-that meetsthe prescriptive criteria established bythe-2009 IECC : .. 19b b Exterior doors that meet or exceed the version 6.0 Energy Star program requirements c Metal or asphalt roof that meets or -exceeds •the Energy Star program requirements ••and has appropriate pigmented:coatings or'eooling granules .which are specifically and. primarily designed :tfl=reri~ce~~ae:heat gair~'t~f ~rour~l~a~~ -'i9o~ ~` ' d Exterior windows and s{ylights that meet or exceed the version 6A Energy Star program requirements 19d 19e e 7Vlascimum amount of cost on wliich~fhe crecl~t can`be~fgure~ . $2,000 ``~-H~g-" f, if ypu claimed window expenses on your Form 5695 .prior to 2016, ~` ~yi enter the amoun# from the Window Expense 'Worksheet {see instructions);.othsrwise enter'-0igf p, 19g g Subtract i ns i'9f from line t9e. If zero or less, enter -0- . 2, 40 0. , h Errter ttie smalCer of 1►ne t9d' or line i9g ~. 0. t9h 20 Add lines 19a, 19b, 19c, and 19h 20 0. 21 Multiply line 20 by 10% (0.10) 21 0. 22" . ResfderrtiaFenergy property costs (musf 6e pfaced~in service~by you;.includ~ labor costs for onsit~ - ' preparation, assembly, and original installation) {see instructions): a Energy-efficient building property. Do not enter more than $300. ~22a b Qualified natural gas, propane, or oil furnace or hot water boiler. Do not enter more than X150. 150 . 22b c Advanced main air circulating fan used in a natural gas, propane, or oi! furnace. Do not enter more #flan $50 ~~ 23 Add lines.22a through 22c 2,3 .. 150 . 24 Add lines 21 and 23 150 . 24 Z5 Maximum:credit amount (If you jointly.Dccupied the hom~,.seE instructions) . 25 500. 26 Enter the amount, if any,.from line 18 . 26 27 Subtract line 26 from line 25. if zero or less, stop; you cannot take the noabusiness energy property credit 27 500. 26 Enter the.smallar of lina24.or line27 .. .. :. .. .. .. .. .. .. .. .. . ~ ... ... .. .. .. 28~ 15,x.. 29 Limitation based on tax liability. Enter the amount from the Nonbusiness Energy Property Credit Limit Worksheet (see instructions} . 351,225. 29 30 Nat~dausiness ener~r., propertyr credit Enter the smaller of line 28 or line 29. Also include this .. amount on Form 1'0.40, line•5:3; or Form 1040NR; line•50 ~ .. .. .. . ,. .~ .. .. .. :. ... 15U. 30 AEVmr25ln lmuitcg.ctp.~ Form J~~J (2016)