2016 Tax Return Project-Please Help

lebhdsdajt

sample_solution.zip

Home >Business & Finance homework help >Accounting homework help >2016 Tax Return Project-Please Help

Sample Solution/Question.docx

1040 Project Instructions

ACCT 538

Fall 2015

Based on the information provided, you are to complete the 2014 Form 1040 and any supporting schedules/forms for Magdalena Schmitz. You do not need to prepare a state tax return. You should complete this tax return by hand using the forms available from the IRS website, www.irs.gov. You can use Adobe (or similar program) to type your responses on the forms. You may not use tax return preparation software to assist in preparing the forms. You may find the form instructions helpful in completing this assignment. Please provide a list of assumptions you make, if any. I will grade your return subject to any reasonable assumptions listed. You do not need to calculate AMT.

You are to work on this assignment individually. Working on this assignment or discussing it with others is not permitted. Any collaboration will be considered a violation of the Academic Honesty Policy, which will result in a grade of zero on this assignment and reporting of the violation to the Dean’s office.

Your assignment is due no later than 11:59 p.m. on November 8th. Please include your name in the paid preparer’s box on page 2 of the 1040. You do not need to include a cover page.

Instructions:

Please complete the 2014 federal income tax return for Magdalena Schmitz. Ignore the requirement to attach the form(s) W-2 to the front page of the Form 1040. If required information is missing, use reasonable assumptions to fill in the gaps.

Magdalena Schmitz has undergone some major changes in her life recently. In 2012, at the age of 46, her husband, Roger, passed away. Magdalena has not remarried as of the end of 2014. Magdalena currently lives in Bedford, Pennsylvania. She was living in Pittsburgh when her husband passed away but she moved back to her childhood home so she could get help from her family raising her children. Magdalena was employed in Pittsburgh early in the year but left that job and relocated 100 miles away to pursue a new life and start her new job. Magdalena has three children (ages as of the end of the year): Alyssa (23), Tyler (16), and Connor (11). Magdalena would like to determine her federal income tax under the filing status that is most advantageous for her.

Magdalena reported the following information:

· Magdalena’s social security number is 294-83-2845

· Alyssa’s social security number is 824-84-8456

· Tyler’s social security number is 824-34-9584

· Connor’s social security number is 824-56-2984

· Magdalena’s mailing address is 623 S. Liberty Road Bedford, Pennsylvania 15522

Alyssa is unmarried and a full-time graduate student at Pennsylvania State University (PSU) (EIN 33-9876543). PSU’s address is 1250 Happy Valley, State College, PA 16801. She received her bachelor’s degree the year her father passed away. This year represents her fifth year of full-time higher education schooling. Alyssa works part-time in State College to help with some of her living expenses. Alyssa earned $2,300 in gross income during the year and had her income tax return prepared on campus by Volunteer Income Tax Assistance (VITA) volunteers. Magdalena provided support for Alyssa including paying for rent, books, tuition, food, clothes, medicine, and other support items. In total, Magdalena provided $12,700 of support for the year. PSU provided Alyssa with a Form 1098-T at year end.

Alyssa’s higher education expenses for her university studies were as follows:

Tuition $6,500

Books $2,000

In order to permit Magdalena to maintain a full-time job, she sends Connor to a day care program after school five days a week. During the year, Magdalena paid the day care operator $4,250 for Connor’s care.

The day care details are as follows:

Horizon Day Care

452 S. Patriot Road

Bedford, PA 15522

EIN-43-6598324

Magdalena incurred the following moving-related expenses during the year:

Household items $3,200

Meals in transit 150

House hunting trip 1,350

In addition she drove her car the 100 miles to Bedford as part of the move. Her previous workplace was located 10 miles from the previous home she was renting and her new job is exactly 100 miles away from her prior residence.

Magdalena’s W-2s for the year reported the following:

Employer	Gross Wages	Federal Income Tax Withholding	State Income Tax Withholding
Juniata Development Corporation	$48,535	$900	$700
Pittsburgh Real Estate	$2,450	$200	$125

Magdalena’s employers withheld all applicable and appropriate payroll taxes. The entire Schmitz family was covered by minimum essential health insurance during each month in 2014. The insurance was provided by Magdalena’s employers.

On January 1, 2013 (prior year), Magdalena started a photography business in which she takes bridal and wedding photographs. She does not do any of the professional printing. However, she provides all of the original negatives to her clients on a password-protected web site as part of her service. This unique service along with her skill and reputation has allowed her to earn additional money on the weekends, primarily in the summer, to help support her daughter in college. Magdalena rents all of the camera equipment from a friend and does not currently own any equipment herself. The photography business uses the cash method of accounting. The business did not have any obligation to file a Form 1099 to any payee during the year. Magdalena reported the following revenue and expenses for her business for the year:

Gross Revenue $6,500

Photographic supplies $ 430

Camera rental $1,050

Web site hosting fee $ 200

Magdalena also received the following during the year:

Life Insurance Payment-Mutual Life (Mother’s passing) $150,000

Cash gift from her father $ 5,000

Interest income-First Bank of Bedford $ 310

Interest income-General Electric Bond $ 3,200

Interest income-Bedford School District Municipal Bond $ 2,500

Interest income-Johnstown Rural Improvement District Bond $ 1,300

PA state income tax refund* $ 325

*Refund was from state tax she paid last year. Magdalena deducted all of her state taxes as itemized deductions, and received full tax benefit for the deductions, on her prior year federal tax return.

Magdalena did not own, control or manage any foreign bank accounts nor was she a grantor or beneficiary of a foreign trust during the tax year.

Magdalena paid or incurred the following expenses during the year:

Dentist (unreimbursed by insurance) $1,500

Doctors (unreimbursed by insurance) $ 475

Prescriptions (unreimbursed by insurance) $ 255

Real property taxes on residence $ 950

Vehicle registration fee based upon age of vehicle $ 175

Mortgage interest on principal residence (Form 1098 received) $6,845

Contribution to the American Lung Association $ 600

Contribution to the Habitat for Humanity $1,000

Contribution to Methodist Church of PA $3,000

Contribution to Penn State University $ 400

Magdalena wants to contribute to the Presidential Election Campaign. She would like to receive a refund (if any) of any tax she may have overpaid for the year. Her preferred method of receiving the refund is by check.

Sample Solution/Solution.zip

PPSub050516_462184_1/f1040.pdf

Fo rm 1040 Department of the Treasury—Internal Revenue Service (99)

U.S. Individual Income Tax Return 2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions. Your first name and initial Last name Your social security number

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

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

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

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

Foreign country name Foreign province/state/county Foreign postal code

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

Filing Status

Check only one box.

1 Single

2 Married filing jointly (even if only one had income)

3 Married filing separately. Enter spouse’s SSN above and full name here. ▶

4 Head of household (with qualifying person). (See instructions.) If

the qualifying person is a child but not your dependent, enter this

child’s name here. ▶

5 Qualifying widow(er) with dependent child

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

b Spouse . . . . . . . . . . . . . . . . . . . . . . . . }

c Dependents: (1) First name Last name

(2) Dependent’s social security number

(3) Dependent’s relationship to you

(4) ✓ if child under age 17 qualifying for child tax credit

(see instructions)

If more than four dependents, see instructions and check here ▶

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

Boxes checked on 6a and 6b No. of children on 6c who: • lived with you • did not live with you due to divorce or separation (see instructions)

Dependents on 6c not entered above

Add numbers on lines above ▶

Income

Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld.

If you did not get a W-2, see instructions.

7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7

8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a

b Tax-exempt interest. Do not include on line 8a . . . 8b

9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a

b Qualified dividends . . . . . . . . . . . 9b

10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10

11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11

12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12

13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶ 13

14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14

15 a IRA distributions . 15a b Taxable amount . . . 15b

16 a Pensions and annuities 16a b Taxable amount . . . 16b

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17

18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18

19 Unemployment compensation . . . . . . . . . . . . . . . . . 19

20 a Social security benefits 20a b Taxable amount . . . 20b

21 Other income. List type and amount 21 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income ▶ 22

Adjusted Gross Income

23 Educator expenses . . . . . . . . . . . 23

24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 24

25 Health savings account deduction. Attach Form 8889 . 25

26 Moving expenses. Attach Form 3903 . . . . . . 26

27 Deductible part of self-employment tax. Attach Schedule SE . 27

28 Self-employed SEP, SIMPLE, and qualified plans . . 28

29 Self-employed health insurance deduction . . . . 29

30 Penalty on early withdrawal of savings . . . . . . 30

31 a Alimony paid b Recipient’s SSN ▶ 31a

32 IRA deduction . . . . . . . . . . . . . 32

33 Student loan interest deduction . . . . . . . . 33

34 Tuition and fees. Attach Form 8917 . . . . . . . 34

35 Domestic production activities deduction. Attach Form 8903 35

36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . ▶ 37

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2015)

Form 1040 (2015) Page 2

Tax and Credits

38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38

39a Check if:

{ You were born before January 2, 1951, Blind.

Spouse was born before January 2, 1951, Blind. } Total boxes

checked ▶ 39a

b If your spouse itemizes on a separate return or you were a dual-status alien, check here ▶ 39b

Standard Deduction for— • People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. • All others: Single or Married filing separately, $6,300 Married filing jointly or Qualifying widow(er), $12,600 Head of household, $9,250

40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40

41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41

42 Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions 42

43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43

44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44

45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45

46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46

47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . ▶ 47

48 Foreign tax credit. Attach Form 1116 if required . . . . 48

49 Credit for child and dependent care expenses. Attach Form 2441 49

50 Education credits from Form 8863, line 19 . . . . . 50

51 Retirement savings contributions credit. Attach Form 8880 51

52 Child tax credit. Attach Schedule 8812, if required . . . 52

53 Residential energy credits. Attach Form 5695 . . . . 53

54 Other credits from Form: a 3800 b 8801 c 54

55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55

56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . ▶ 56

Other Taxes

57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57

58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58

59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59

60 a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a

b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b

61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61

62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62

63 Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . ▶ 63

Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64

65 2015 estimated tax payments and amount applied from 2014 return 65 If you have a qualifying child, attach Schedule EIC.

66a Earned income credit (EIC) . . . . . . . . . . 66a

b Nontaxable combat pay election 66b

67 Additional child tax credit. Attach Schedule 8812 . . . . . 67

68 American opportunity credit from Form 8863, line 8 . . . 68

69 Net premium tax credit. Attach Form 8962 . . . . . . 69

70 Amount paid with request for extension to file . . . . . 70

71 Excess social security and tier 1 RRTA tax withheld . . . . 71 72 Credit for federal tax on fuels. Attach Form 4136 . . . . 72

73 Credits from Form: a 2439 b Reserved c 8885 d 73

74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . ▶ 74

Refund

Direct deposit? See instructions.

75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75

76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . ▶ 76a ▶

▶

b Routing number ▶ c Type: Checking Savings

d Account number

77 Amount of line 75 you want applied to your 2016 estimated tax ▶ 77 Amount You Owe

78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions ▶ 78 79 Estimated tax penalty (see instructions) . . . . . . . 79

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No Designee’s name ▶

Phone no. ▶

Personal identification number (PIN) ▶

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

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

Spouse’s signature. If a joint return, both must sign. Date

▲

Spouse’s occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.)

Paid Preparer Use Only

Print/Type preparer’s name Preparer’s signature Date Check if self-employed

PTIN

Firm’s name ▶

Firm’s address ▶

Firm's EIN ▶

Phone no.

www.irs.gov/form1040 Form 1040 (2015)

Version B, Cycle 5

Internal Use Only

DRAFT AS OF

December 23, 2015

Version B, Cycle 5

Internal Use Only

DRAFT AS OF

December 23, 2015

2015 Form 1040

SE:W:CAR:MP

U.S. Individual Income Tax Return

Form

1040

Department of the Treasury—Internal Revenue Service

(99)

U.S. Individual Income Tax Return

2015

2015. Catalog Number 11320B.

OMB No. 1545-0074

O M B Number 1545-0074. For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

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

See separate instructions.

▲

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

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.

Filing Status

Check only one box.

Single

Married filing jointly (even if only one had income)

Married filing separately. Enter spouse’s SSN above and full name here. ▶

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

Qualifying widow(er) with dependent child

Exemptions

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

Spouse

}

Dependents:

(1) First name Last name

(2) Dependent’s

social security number

(3) Dependent’s relationship to you

(4) ✓ if child under age 17 qualifying for child tax credit

(see instructions)

(4) Check if child under age 17 qualifying for child tax credit (see instructions).

If more than four dependents, see instructions and check here ▶

Total number of exemptions claimed

Boxes checked on 6a and 6b

No. of children on 6c who:

• lived with you

• did not live with you due to divorce or separation

(see instructions)

Dependents on 6c not entered above

Add numbers on lines above ▶

Income

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.

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

Ordinary dividends. Attach Schedule B if required

Qualified dividends

Taxable refunds, credits, or offsets of state and local income taxes

Alimony received

Business income or (loss). Attach Schedule C or C-EZ

Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶

Other gains or (losses). Attach Form 4797

IRA distributions

15a

b Taxable amount

15b

Pensions and annuities

16a

b Taxable amount

16b

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

Farm income or (loss). Attach Schedule F

Unemployment compensation

Social security benefits

20a

b Taxable amount

20b

Other income. List type and amount

Combine the amounts in the far right column for lines 7 through 21. This is your total income ▶

Adjusted Gross Income

Educator expenses

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 ▶

31a

IRA deduction

Student loan interest deduction

Tuition and fees. Attach Form 8917

Domestic production activities deduction. Attach Form 8903

Add lines 23 through 35

Subtract line 36 from line 22. This is your adjusted gross income ▶

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11320B

Form 1040 (2015)

Page 2

Tax and Credits

Amount from line 37 (adjusted gross income)

Check if:

{

}

Total boxes checked ▶

39a

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

Standard Deduction for—

• People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions.

• All others:

Single or Married filing separately, $6,300

Married filing jointly or Qualifying widow(er), $12,600

Head of household, $9,250

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

Subtract line 40 from line 38

Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions

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

Tax (see instructions). Check if any from:

Alternative minimum tax (see instructions). Attach Form 6251

Excess advance premium tax credit repayment. Attach Form 8962

Add lines 44, 45, and 46 ▶

Foreign tax credit. Attach Form 1116 if required

Credit for child and dependent care expenses. Attach Form 2441

Education credits from Form 8863, line 19

Retirement savings contributions credit. Attach Form 8880

Child tax credit. Attach Schedule 8812, if required

Residential energy credits. Attach Form 5695

Other credits from Form:

Add lines 48 through 54. These are your total credits

Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- ▶

Other Taxes

Self-employment tax. Attach Schedule SE

Unreported social security and Medicare tax from Form:

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

Household employment taxes from Schedule H

60a

First-time homebuyer credit repayment. Attach Form 5405 if required

60b

Health care: individual responsibility (see instructions)

Taxes from:

enter code(s)

Add lines 56 through 62. This is your total tax ▶

Payments

Federal income tax withheld from Forms W-2 and 1099

2015 estimated tax payments and amount applied from 2014 return

If you have a qualifying child, attach Schedule EIC.

Earned income credit (EIC)

66a

Nontaxable combat pay election

66b

Additional child tax credit. Attach Schedule 8812 .

American opportunity credit from Form 8863, line 8

Net premium tax credit. Attach Form 8962

Amount paid with request for extension to file

Excess social security and tier 1 RRTA tax withheld

Credit for federal tax on fuels. Attach Form 4136

Credits from Form:

Add lines 64, 65, 66a, and 67 through 73. These are your total payments ▶

Refund

Direct deposit? See instructions.

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid

Amount of line 75 you want refunded to you. If Form 8888 is attached, check here ▶

76a

▶

Routing number

▶ c Type:

Account number

Amount of line 75 you want applied to your 2016 estimated tax ▶

Amount You Owe

Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions ▶

Estimated tax penalty (see instructions)

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)?

Designee’sname ▶

Phoneno. ▶

Personal identificationnumber (PIN) ▶

Sign Here

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

Your signature

Date

Spouse’s signature. If a joint return, both must sign.

Date

▲

If the IRS sent you an Identity Protection PIN, enter it

here (see inst.)

Paid Preparer Use Only

Preparer’s signature

Date

Check if

self-employed

www.irs.gov/form1040

Form 1040 (2015)

f1_01: Jan 1
f1_02: Dec 31
f1_03: 15
f1_04: Magdalena
f1_05: Schmitz
f1_06: 294832845
f1_07:
f1_08:
f1_09:
f1-10: 623 S Liberty Road Bedford,
f1-11:
f1-12: Pennsylvania 15522
f1_13:
f1_14:
f1_15:
c1_01: 1
c1_02:
c1_03: S
f1-16:
f1_17:
c1_04: 1
c1_05:
f1_18: Alyssa Schmitz
f1_19: 824848456
f1_20:
c1_06:
f1_21: Tyler Schmitz
f1_22: 824349584
f1_23:
c1_07:
f1_24: Connor Schmitz
f1_25: 824562984
f1_26:
c1_08:
f1_27:
f1_28:
f1_29:
c1_09:
c1_10:
f1_30: 1
f1_31: 3
f1_32:
f1_33:
f1_34: 4
f1_35: 50885
f1_36: 00
f1_37: 7310
f1_38: 00
f1_39:
f1_40:
f1_41:
f1_42:
f1_43:
f1_44:
f1_45: 325
f1_46: 00
f1_47:
f1_48:
f1_49: 4820
f1_50: 00
c1_11:
f1-_51:
f1_52:
f1_53:
f1_54:
f1_55:
f1_56:
f1_57:
f1_58:
f1_59:
f1_60:
f1_61:
f1_62:
f1_63:
f1_64:
f1_65:
f1_66:
f1_67:
f1_68:
f1_69:
f1_70:
f1_71:
f1_72:
f1_73:
f1_74:
f1_75:
f1_76: 63340
f1_77: 00
f1_78:
f1_79:
f1_80:
f1_81:
f1_82:
f1_83:
f1_84: 4573
f1_85: 00
f1_86: 341
f1_87: 00
f1_88:
f1_89:
f1_90:
f1_91:
f1_92:
f1_93:
f1_94:
f1_95:
f1_96:
f1_97:
f1_98:
f1_99:
f1_100:
f1_101: 4000
f1_102: 00
f1_103:
f1_104:
f1_105: 8914
f1_106: 00
f1_107: 54426
f1_108: 00
f2_01: 54426
f2_02: 00
c2_01:
c2_02:
c2_03:
c2_04:
f2-03:
c2_05:
f2_04: 15495
f2_05: 00
f2_06: 38931
f2_07: 00
f2_08: 16000
f2_09: 00
f2_10: 22931
f2_11: 00
c2_06:
c2_07:
c2_08:
f2_12:
f2_13: 2978
f2_14: 00
f2_15:
f2_16:
f2_17:
f2_18:
f2_19: 2978
f2_20: 00
f2_21:
f2_22:
f2_23: 600
f2_24: 00
f2_25: 1700
f2_26: 00
f2_27:
f2_28:
f2_29:
F2_30:
f2_31:
f2_32:
c2_09:
c2_10:
c2_11:
f2_33:
f2_34:
f2_35:
f2_36: 2300
f2_37: 00
f2_38: 678
f2_39: 00
f2_40: 681
f2_41: 00
c2_12:
c2_13:
f2_42:
f2_43:
f2_44:
f2_45:
f2_46:
f2_47:
f2_48:
f2_49:
c2_14:
f2_50:
f2_51:
c2_15:
c2_16:
c2_17:
f2_52:
f2_53:
f2_54:
f2_55: 1359
f2_56: 00
f2_57: 2900
f2_58: 00
f2_59:
f2_60:
f2_61:
f2_62:
f2_63:
f2_64:
f2_65:
f2_66:
f2_67:
f2_68:
f2_69:
f2_70:
f2_71:
f2_72:
f2_73:
f2_74:
f2_75:
f2_76:
c2_18:
c2_19:
c2_20:
c2_21:
f2_77:
f2_78:
f2_79:
f2_80: 2900
f2_81: 00
f2_82: 1541
f2_83: 00
c2_22:
f2_84:
f2_85:
c2_23:
f2_88:
f2_89:
f2_90:
f2_91:
f2_92:
f2_93:
c2_24:
f2_94:
f2_95:
f2_96:
f2_97:
f2_98:
f2_99:
f2_100:
f2_101:
c2_25:
f2_102:
f2_103:
f2_104:
f2_105:
f2_106:

PPSub050516_462184_1/f1040sa.pdf

SCHEDULE A (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Itemized Deductions ▶ Information about Schedule A and its separate instructions is at www.irs.gov/schedulea.

▶ Attach to Form 1040.

OMB No. 1545-0074

2015 Attachment Sequence No. 07

Name(s) shown on 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) . . . . . 1 2 Enter amount from Form 1040, line 38 2 3 Multiply line 2 by 10% (.10). But if either you or your spouse was

born before January 2, 1951, multiply line 2 by 7.5% (.075) instead 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . 4

Taxes You Paid

5 State and local (check only one box): a Income taxes, or b General sales taxes } . . . . . . . . . . . 5

6 Real estate taxes (see instructions) . . . . . . . . . 6 7 Personal property taxes . . . . . . . . . . . . . 7 8 Other taxes. List type and amount ▶

8 9 Add lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . 9

Interest You Paid

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

10 Home mortgage interest and points reported to you on Form 1098 10 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 ▶

11 12

Points not reported to you on Form 1098. See instructions for special rules . . . . . . . . . . . . . . . . . 12

13 Mortgage insurance premiums (see instructions) . . . . . 13 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . 15

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

Gifts by cash or check. If you made any gift of $250 or more, see instructions . . . . . . . . . . . . . . . . 16

Other than by cash or check. If any gift of $250 or more, see instructions. You must attach Form 8283 if over $500 . . . 17

18 Carryover from prior year . . . . . . . . . . . . 18 19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . 19

Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . 20 Job Expenses and Certain Miscellaneous Deductions

Unreimbursed employee expenses—job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) ▶ 21

22 Tax preparation fees . . . . . . . . . . . . . 22 23

Other expenses—investment, safe deposit box, etc. List type and amount ▶

23 24 Add lines 21 through 23 . . . . . . . . . . . . 24 25 Enter amount from Form 1040, line 38 25 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- . . . . . . 27

Other Miscellaneous Deductions

28 Other—from list in instructions. List type and amount ▶

28 Total Itemized Deductions

Is Form 1040, line 38, over $154,950?

29 No. Your deduction is not limited. Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40. } . . Yes. Your deduction may be limited. See the Itemized Deductions Worksheet in the instructions to figure the amount to enter.

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. Cat. No. 17145C Schedule A (Form 1040) 2015

Version B, Cycle 8

IINTERNAL USE ONLY

DRAFT AS OF

December 23, 2015

2015 Form 1040 (Schedule A)

SE:W:CAR:MP

Itemized Deductions

SCHEDULE A (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Itemized Deductions

▶ Information about Schedule A and its separate instructions is at www.irs.gov/schedulea.

▶ Attach to Form 1040.

OMB No. 1545-0074

2015

2015. Catalog Number 17145C.

Attachment

Sequence No. 07

Attachment Sequence Number 07. For Paperwork Reduction Act Notice, see Form 1040 instructions.

Medical and Dental Expenses

Caution: Do not include expenses reimbursed or paid by others.

Medical and dental expenses (see instructions)

Enter amount from Form 1040, line 38

Multiply line 2 by 10% (.10). But if either you or your spouse was born before January 2, 1951, multiply line 2 by 7.5% (.075) instead

Subtract line 3 from line 1. If line 3 is more than line 1, enter -0-

Taxes YouPaid

State and local (check only one box):

}

Real estate taxes (see instructions)

Personal property taxes

Add lines 5 through 8

InterestYou Paid

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

Home mortgage interest and points reported to you on Form 1098

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 ▶

Points not reported to you on Form 1098. See instructions for special rules

Mortgage insurance premiums (see instructions)

Investment interest. Attach Form 4952 if required. (See instructions.)

Add lines 10 through 14

Gifts toCharity

If you made agift and got abenefit for it,see instructions.

Gifts by cash or check. If you made any gift of $250 or more, see instructions

Other than by cash or check. If any gift of $250 or more, see instructions. You must attach Form 8283 if over $500

Carryover from prior year

Add lines 16 through 18

Casualty and Theft Losses

Casualty or theft loss(es). Attach Form 4684. (See instructions.)

Job Expensesand Certain Miscellaneous Deductions

Unreimbursed employee expenses—job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) ▶

Tax preparation fees

Other expenses—investment, safe deposit box, etc. List type and amount ▶

Add lines 21 through 23

Enter amount from Form 1040, line 38

Multiply line 25 by 2% (.02)

Subtract line 26 from line 24. If line 26 is more than line 24, enter -0-

Other Miscellaneous Deductions

Total Itemized Deductions

Is Form 1040, line 38, over $154,950?

No. Your deduction is not limited. Add the amounts in the far right column

for lines 4 through 28. Also, enter this amount on Form 1040, line 40.

}

Yes. Your deduction may be limited. See the Itemized Deductions

Worksheet in the instructions to figure the amount to enter.

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.

Cat. No. 17145C

Schedule A (Form 1040) 2015

Magdalena Schmitz

294-83-2845

f1_1:
f1_2:
f1_3: 2230
f1_4: 00
f1_5: 54426
f1_6: 00
f1_7: 5442
f1_8: 60
f1_9: 0
f1_10: 00
c1_1: 1
f1_11: 2525
f1_12: 00
f1_13: 950
f1_14: 00
f1_15: 175
f1_16: 00
f1_17:
f1_18:
f1_19:
f1_20:
f1_21: 3650
f1_22: 00
f1_23: 6845
f1_24: 00
f1_25:
f1_26:
f1_27:
f1_28:
f1_29:
f1_30:
f1_31:
f1_32:
f1_33:
f1_34:
f1_35: 6845
f1_36: 00
f1_37: 5000
f1_38: 00
f1_39:
f1_40:
f1_41:
f1_42:
f1_43: 5000
f1_44: 00
f1_45:
f1_46:
f1_47:
f1_48:
f1_49:
f1_50:
f1_51:
f1_52:
f1_53:
f1_54:
f1_55:
f1_56:
f1_57:
f1_58:
f1_59:
f1_60:
f1_61:
f1_62:
f1_63:
f1_64:
f1_65:
f1_66:
f1_67:
f1_68:
f1_69: 15495
f1_70: 00
c1_2: No
c1_3:

PPSub050516_462184_1/f1040sb.pdf

SCHEDULE B (Form 1040A or 1040)

Department of the Treasury Internal Revenue Service (99)

Interest and Ordinary Dividends ▶ Attach to Form 1040A or 1040.

▶ Information about Schedule B and its instructions is at www.irs.gov/scheduleb.

OMB No. 1545-0074

2015 Attachment Sequence No. 08

Name(s) shown on return Your social security number

Part I

Interest

(See instructions on back 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.

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 on back and list this interest first. Also, show that buyer’s social security number and address ▶

Amount

2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . 2 3

Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . 3

Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a . . . . . . . . . . . . . . . . . . . . . . ▶ 4

Note: If line 4 is over $1,500, you must complete Part III. Amount

Part II

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

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.

5 List name of payer ▶

Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a . . . . . . . . . . . . . . . . . . . . . . ▶ 6

Note: If line 6 is over $1,500, you must complete Part III.

Part III Foreign Accounts and Trusts (See instructions on back.)

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 2015, 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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements . . . . . .

b If you are required to file FinCEN Form 114, enter the name of the foreign country where the financial account is located ▶

8 During 2015, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If “Yes,” you may have to file Form 3520. See instructions on back . . . . . .

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Form 1040A or 1040) 2015

Schedule B (Form 1040A or 1040) 2015 Page 2

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future Developments For the latest information about developments related to Schedule B (Form 1040A or 1040) and its instructions, such as legislation enacted after they were published, go to www.irs.gov/scheduleb.

Purpose of Form Use Schedule B if any of the following applies.

• You had over $1,500 of taxable interest or ordinary dividends.

• You received interest from a seller-financed mortgage and the buyer used the property as a personal residence.

• You have accrued interest from a bond.

• You are reporting original issue discount (OID) in an amount less than the amount shown on Form 1099-OID.

• You are reducing your interest income on a bond by the amount of amortizable bond premium.

• You are claiming the exclusion of interest from series EE or I U.S. savings bonds issued after 1989.

• You received interest or ordinary dividends as a nominee.

• You had a financial interest in, or signature authority over, a financial account in a foreign country or you received a distribution from, or were a grantor of, or transferor to, a foreign trust. Part III of the schedule has questions about foreign accounts and trusts.

Specific Instructions

TIP You can list more than one payer on each entry space for lines 1 and 5, but be sure to clearly show the amount paid next to the payer's name. Add the separate amounts paid by the payers

listed on an entry space and enter the total in the “Amount” column. If you still need more space, attach separate statements that are the same size as the printed schedule. Use the same format as lines 1 and 5, but show your totals on Schedule B. Be sure to put your name and social security number (SSN) on the statements and attach them at the end of your return.

Part I. Interest Line 1. Report on line 1 all of your taxable interest. Taxable interest generally should be shown on your Forms 1099-INT, Forms 1099-OID, or substitute statements. Include interest from series EE, H, HH, and I U.S. savings bonds. Also include any accrued market discount that is includible in income. List each payer’s name and show the amount. Do not report on this line any tax-exempt interest from box 8 or box 9 of Form 1099-INT. Instead, report the amount from box 8 on line 8b of Form 1040A or 1040. If an amount is shown in box 9 of Form 1099-INT, you generally must report it on line 12 of Form 6251. See the Instructions for Form 6251 for more details. For more information on market discount and other investment income see Pub. 550.

Seller-financed mortgages. If you sold your home or other property and the buyer used the property as a personal residence, list first any interest the buyer paid you on a mortgage or other form of seller financing. Be sure to show the buyer’s name, address, and SSN. You must also let the buyer know your SSN. If you do not show the buyer’s name, address, and SSN, or let the buyer know your SSN, you may have to pay a $50 penalty.

Nominees. If you received a Form 1099-INT that includes interest you received as a nominee (that is, in your name, but the interest actually belongs to someone else), report the total on line 1. Do this even if you later distributed some or all of this income to others. Under your last entry on line 1, put a subtotal of all interest listed on line 1. Below this subtotal, enter "Nominee Distribution" and show the total interest you received as a nominee. Subtract this amount from the subtotal and enter the result on line 2.

TIP If you received interest as a nominee, you must give the actual owner a Form 1099-INT unless the owner is your spouse. You must also file a Form 1096 and a Form 1099-INT with the IRS. For

more details, see the General Instructions for Certain Information Returns and the Instructions for Forms 1099-INT and 1099-OID.

Accrued interest. When you buy bonds between interest payment dates and pay accrued interest to the seller, this interest is taxable to the seller. If you received a Form 1099 for interest as a purchaser of a bond with accrued interest, follow the rules earlier under Nominees to see how to report the accrued interest. But identify the amount to be subtracted as “Accrued Interest.”

Original issue discount (OID). If you are reporting OID in an amount less than the amount shown on Form 1099-OID, follow the rules earlier under Nominees to see how to report the OID. But identify the amount to be subtracted as “OID Adjustment.”

Amortizable bond premium. If you are reducing your interest income on a bond by the amount of amortizable bond premium, follow the rules earlier under Nominees to see how to report the interest. But identify the amount to be subtracted as “ABP Adjustment.”

Line 3. If, during 2015, you cashed series EE or I U.S. savings bonds issued after 1989 and you paid qualified higher education expenses for yourself, your spouse, or your dependents, you may be able to exclude part or all of the interest on those bonds. See Form 8815 for details.

Part II. Ordinary Dividends

TIP You may have to file Form 5471 if, in 2015, you were an officer or director of a foreign corporation. You may also have to file Form 5471 if, in 2015, you owned 10% or more of the total

(a) value of a foreign corporation’s stock, or (b) combined voting power of all classes of a foreign corporation’s stock with voting rights. For details, see Form 5471 and its instructions.

Line 5. Report on line 5 all of your ordinary dividends. This amount should be shown in box 1a of your Forms 1099-DIV or substitute statements. List each payer’s name and show the amount.

Nominees. If you received a Form 1099-DIV that includes ordinary dividends you received as a nominee (that is, in your name, but the ordinary dividends actually belong to someone else), report the total on line 5. Do this even if you later distributed some or all of this income to others. Under your last entry on line 5, put a subtotal of all ordinary dividends listed on line 5. Below this subtotal, enter “Nominee Distribution” and show the total ordinary dividends you received as a nominee. Subtract this amount from the subtotal and enter the result on line 6.

TIP If you received dividends as a nominee, you must give the actual owner a Form 1099-DIV unless the owner is your spouse. You must also file a Form 1096 and a Form 1099-DIV with the IRS. For more

details, see the General Instructions for Certain Information Returns and the Instructions for Form 1099-DIV.

Part III. Foreign Accounts and Trusts

TIP Regardless of whether you are required to file FinCEN Form 114 (FBAR), you may be required to file Form 8938, Statement of Specified Foreign Financial Assets, with your income tax

return. Failure to file Form 8938 may result in penalties and extension of the statute of limitations. See www.irs.gov/form8938 for more information.

Line 7a–Question 1. Check the “Yes” box if at any time during 2015 you had a financial interest in or signature authority over a financial account located in a foreign country. See the definitions that follow. Check the “Yes” box even if you are not required to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Financial account. A financial account includes, but is not limited to, a securities, brokerage, savings, demand, checking, deposit, time deposit, or other account maintained with a financial institution (or other person performing the services of a financial institution). A financial account also includes a commodity futures or options account, an insurance policy with a cash value (such as a whole life insurance policy), an annuity policy with a cash value, and shares in a mutual fund or similar pooled fund (that is, a fund that is available to the general public with a regular net asset value determination and regular redemptions).

Financial account located in a foreign country. A financial account is located in a foreign country if the account is physically located outside of the United States. For example, an account maintained with a branch of a United States bank that is physically located outside of the United States is a foreign financial account. An account maintained with a branch of a foreign bank that is physically located in the United States is not a foreign financial account.

Signature authority. Signature authority is the authority of an individual (alone or in conjunction with another individual) to control the disposition of assets held in a foreign financial account by direct communication (whether in writing or otherwise) to the bank or other financial institution that maintains the financial account. See the FinCEN Form 114 instructions for exceptions. Do not consider the exceptions relating to signature authority in answering Question 1 on line 7a.

Other definitions. For definitions of “financial interest,” “United States,” and other relevant terms, see the instructions for FinCEN Form 114.

Line 7a–Question 2. See FinCEN Form 114 and its instructions to determine whether you must file the form. Check the “Yes” box if you are required to file the form; check the “No” box if you are not required to file the form.

If you checked the “Yes” box to Question 2 on line 7a, FinCEN Form 114 must be electronically filed with the Financial Crimes Enforcement Network (FinCEN) at the following website: http://bsaefiling. fincen.treas.gov/main.html. Do not attach FinCEN Form 114 to your tax return. To be considered timely, FinCEN Form 114 must be received by June 30, 2016.

▲! CAUTION

If you are required to file FinCEN Form 114 but do not properly do so, you may have to pay a civil penalty up to $10,000. A person who willfully fails to report an account or provide account

identifying information may be subject to a civil penalty equal to the greater of $100,000 or 50 percent of the balance in the account at the time of the violation. Willful violations may also be subject to criminal penalties.

Line 7b. If you are required to file FinCEN Form 114, enter the name of the foreign country or countries in the space provided on line 7b. Attach a separate statement if you need more space.

Line 8. If you received a distribution from a foreign trust, you must provide additional information. For this purpose, a loan of cash or marketable securities generally is considered to be a distribution. See Form 3520 for details.

If you were the grantor of, or transferor to, a foreign trust that existed during 2015, you may have to file Form 3520.

Do not attach Form 3520 to Form 1040. Instead, file it at the address shown in its instructions.

If you were treated as the owner of a foreign trust under the grantor trust rules, you are also responsible for ensuring that the foreign trust files Form 3520-A. Form 3520-A is due on March 15, 2016, for a calendar year trust. See the instructions for Form 3520-A for more details.

Version A, Cycle 11

INTERNAL USE ONLY DRAFT AS OF September 21, 2015

SCHEDULE B

(Form 1040A or 1040)

Department of the Treasury Internal Revenue Service (99)

Interest and Ordinary Dividends

▶ Attach to Form 1040A or 1040.

▶ Information about Schedule B and its instructions is at www.irs.gov/scheduleb.

Attach to Form 1040A or 1040. Information about Schedule B and its instructions is at ww.irs.gov/scheduleb.

OMB No. 1545-0074

2015

2015. Catalog Number 17146N.

Attachment

Sequence No. 08

Attachment Sequence Number 08. For Paperwork Reduction Act Notice, see your tax return instructions.

Part I

Interest

(See instructions on back 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 froma brokerage firm, list the firm’s name as thepayer and enter the total interest shown on that form.

Amount

Add the amounts on line 1

Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815

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.

Amount

Part II

Ordinary Dividends

(See instructions on back and theinstructions for Form 1040A, orForm 1040,

line 9a.)

Note: If youreceived a Form1099-DIV orsubstitutestatement froma brokerage firm,list the firm’sname as thepayer and enterthe ordinarydividends shownon 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.

Part III Foreign Accounts and Trusts (Seeinstructions on back.)

Yes

At any time during 2015, 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 you are required to file FinCEN Form 114, enter the name of the foreign country where the financial account is located ▶

During 2015, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If “Yes,” you may have to file Form 3520. See instructions on back

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

Cat. No. 17146N

Schedule B (Form 1040A or 1040) 2015

Page 2

General Instructions

Section references are to the Internal Revenue Code unless otherwise noted.

Future Developments

For the latest information about developments related to Schedule B (Form 1040A or 1040) and its instructions, such as legislation enacted after they were published, go to www.irs.gov/scheduleb.

Purpose of Form

Use Schedule B if any of the following applies.

• You had over $1,500 of taxable interest or ordinary dividends.

• You received interest from a seller-financed mortgage and the buyer used the property as a personal residence.

• You have accrued interest from a bond.

• You are reporting original issue discount (OID) in an amount less than the amount shown on Form 1099-OID.

• You are reducing your interest income on a bond by the amount of amortizable bond premium.

• You are claiming the exclusion of interest from series EE or I U.S. savings bonds issued after 1989.

• You received interest or ordinary dividends as a nominee.

Specific Instructions

TIP

You can list more than one payer on each entry space for lines 1 and 5, but be sure to clearly show the amount paid next to the payer's name. Add the separate amounts paid by the payers

Part I. Interest

Line 1. Report on line 1 all of your taxable interest. Taxable interest generally should be shown on your Forms 1099-INT, Forms 1099-OID, or substitute statements. Include interest from series EE, H, HH, and I U.S. savings bonds. Also include any accrued market discount that is includible in income. List each payer’s name and show the amount. Do not report on this line any tax-exempt interest from box 8 or box 9 of Form 1099-INT. Instead, report the amount from box 8 on line 8b of Form 1040A or 1040. If an amount is shown in box 9 of Form 1099-INT, you generally must report it on line 12 of Form 6251. See the Instructions for Form 6251 for more details. For more information on market discount and other investment income see Pub. 550.

TIP

If you received interest as a nominee, you must give the actual owner a Form 1099-INT unless the owner is your spouse. You must also file a Form 1096 and a Form 1099-INT with the IRS. For

more details, see the General Instructions for Certain Information Returns and the Instructions for Forms 1099-INT and 1099-OID.

Part II. Ordinary Dividends

TIP

You may have to file Form 5471 if, in 2015, you were an officer or director of a foreign corporation. You may also have to file Form 5471 if, in 2015, you owned 10% or more of the total

(a) value of a foreign corporation’s stock, or (b) combined voting power of all classes of a foreign corporation’s stock with voting rights. For details, see Form 5471 and its instructions.

Line 5. Report on line 5 all of your ordinary dividends. This amount should be shown in box 1a of your Forms 1099-DIV or substitute statements. List each payer’s name and show the amount.

TIP

If you received dividends as a nominee, you must give the actual owner a Form 1099-DIV unless the owner is your spouse. You must also file a Form 1096 and a Form 1099-DIV with the IRS. For more

details, see the General Instructions for Certain Information Returns and the Instructions for Form 1099-DIV.

Part III. Foreign Accounts and Trusts

TIP

Regardless of whether you are required to file FinCEN Form 114 (FBAR), you may be required to file Form 8938, Statement of Specified Foreign Financial Assets, with your income tax

return. Failure to file Form 8938 may result in penalties and extension of the statute of limitations. See www.irs.gov/form8938 for more information.

Other definitions. For definitions of “financial interest,” “United States,” and other relevant terms, see the instructions for FinCEN Form 114.

If you checked the “Yes” box to Question 2 on line 7a, FinCEN Form 114 must be electronically filed with the Financial Crimes Enforcement Network (FinCEN) at the following website: http://bsaefiling.fincen.treas.gov/main.html. Do not attach FinCEN Form 114 to your tax return. To be considered timely, FinCEN Form 114 must be received by June 30, 2016.

▲

CAUTION

If you are required to file FinCEN Form 114 but do not properly do so, you may have to pay a civil penalty up to $10,000. A person who willfully fails to report an account or provide account

Line 7b. If you are required to file FinCEN Form 114, enter the name of the foreign country or countries in the space provided on line 7b. Attach a separate statement if you need more space.

If you were the grantor of, or transferor to, a foreign trust that existed during 2015, you may have to file Form 3520.

Do not attach Form 3520 to Form 1040. Instead, file it at the address shown in its instructions.

8.2.1.3144.1.471865.466429

Interest and Ordinary Dividends

SE:W:CAR:MP

2015 Form 1040A or 1040 (Schedule B)

Magdalena Schmitz

294-83-2845

en_US

f1_1:
f1_2:
f1-3: Interest Income-First Bank of Bedford
f1-4: 310
f1-5: 00
f1-6: Interest Income-General Electric Bond
f1-7: 3200
f1-8: 00
f1-9: Interest Income-Bedford School District Municipal Bond
f1-10: 2500
f1-11: 00
f1-12: Interest Income-Johnstown Rural Improvement District Bond
f1-13: 1300
f1-14: 00
f1-15:
f1-16:
f1-17:
f1-18:
f1-19:
f1-20:
f1-21:
f1-22:
f1-23:
f1-24:
f1-25:
f1-26:
f1-27:
f1-28:
f1-29:
f1-30:
f1-31:
f1-32:
f1-33:
f1-34:
f1-35:
f1-36:
f1-37:
f1-38:
f1-39:
f1-40:
f1-41:
f1-42:
f1-43:
f1-44:
f1-45: 7310
f1-46: 00
f1-47: 0
f1-48: 00
f1-49: 7310
f1-50: 00
f1_51:
f1_52:
f1_53:
f1_54:
f1_55:
f1_56:
f1-57:
f1-58:
f1-59:
f1-60:
f1-61:
f1-62:
f1-63:
f1-64:
f1-65:
f1-66:
f1-67:
f1-68:
f1-69:
f1-70:
f1-71:
f1-72:
f1-73:
f1-74:
f1-75:
f1-76:
f1-77:
f1-78:
f1-79:
f1-80:
f1-81:
f1-82:
f1-83:
f1-84:
f1-85:
f1-86:
f1-87:
f1-88:
f1-89:
f1-90:
f1-91:
f1-92:
f1-93:
f1-94:
f1-95:
f1-99:
f1-100:
f1-101:
f1-96:
f1-97:
c1_1:
c1_2:
f1-98:
c1_3:
ViewerLocale:

PPSub050516_462184_1/f1040sc.pdf

SCHEDULE C (Form 1040) 2015

Profit or Loss From Business (Sole Proprietorship)

Department of the Treasury Internal Revenue Service (99)

▶ Information about Schedule C and its separate instructions is at www.irs.gov/schedulec. ▶ Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form 1065.

OMB No. 1545-0074

Attachment Sequence No. 09

Name of proprietor Social security number (SSN)

A Principal business or profession, including product or service (see instructions) B Enter code from instructions

▶

C Business name. If no separate business name, leave blank. D Employer ID number (EIN), (see instr.)

E Business address (including suite or room no.) ▶

City, town or post office, state, and ZIP code

F Accounting method: (1) Cash (2) Accrual (3) Other (specify) ▶

G Did you “materially participate” in the operation of this business during 2015? If “No,” see instructions for limit on losses . Yes No

H If you started or acquired this business during 2015, check here . . . . . . . . . . . . . . . . . ▶

I Did you make any payments in 2015 that would require you to file Form(s) 1099? (see instructions) . . . . . . . . Yes No

J If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . . . . . . . . Yes No

Part I Income 1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on

Form W-2 and the “Statutory employee” box on that form was checked . . . . . . . . . ▶ 1

2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . . . . 4

5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5

6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6

7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . ▶ 7 Part II Expenses. Enter expenses for business use of your home only on line 30.

8 Advertising . . . . . 8

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

Employee benefit programs (other than on line 19) . . 14

15 Insurance (other than health) 15

16 Interest:

a Mortgage (paid to banks, etc.) 16a

b Other . . . . . . 16b 17 Legal and professional services 17

18 Office expense (see instructions) 18

19 Pension and profit-sharing plans . 19

20 Rent or lease (see instructions):

a Vehicles, machinery, and 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

Deductible meals and entertainment (see instructions) . 24b

25 Utilities . . . . . . . . 25

26 Wages (less employment credits) . 26

27 a Other expenses (from line 48) . . 27a

b Reserved for future use . . . 27b

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. Do not report these expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions). Simplified method filers only: enter the total square footage of: (a) your home:

and (b) the part of your home used for business: . Use the Simplified

Method Worksheet in the instructions to figure the amount to enter on line 30 . . . . . . . . . 30

31 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 checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3.

• If a loss, you must go to line 32. } 31

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 checked the box on line 1, see the line 31 instructions). Estates and trusts, enter on Form 1041, line 3. • If you checked 32b, you must attach Form 6198. Your loss may be limited.

} 32a All investment is at risk.

32b Some investment is not at risk.

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11334P Schedule C (Form 1040) 2015

Schedule C (Form 1040) 2015 Page 2 Part III Cost of Goods Sold (see instructions)

Method(s) used to value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)

Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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 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.

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 2015, enter the number of miles you used your vehicle for:

a Business b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

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

48 Total other expenses. Enter here and on line 27a . . . . . . . . . . . . . . . . 48

Schedule C (Form 1040) 2015

Version A, Cycle 5

INTERAL USE ONLY DRAFT AS OF September 8, 2015

2015 Form 1040 (Schedule C)

SE:W:CAR:MP

Profit or Loss From Business

SCHEDULE C (Form 1040)

2015

2015. Catalog Number 11334P.

Profit or Loss From Business

(Sole Proprietorship)

Department of the Treasury Internal Revenue Service (99)

▶ Information about Schedule C and its separate instructions is at www.irs.gov/schedulec.

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

OMB No. 1545-0074

Attachment

Sequence No. 09

Attachment Sequence Number 09. For Paperwork Reduction Act Notice, see the separate instructions.

B Enter code from instructions

Accounting method:

(1)

(2)

(3)

Did you “materially participate” in the operation of this business during 2015? If “No,” see instructions for limit on losses

If you started or acquired this business during 2015, check here ▶

Did you make any payments in 2015 that would require you to file Form(s) 1099? (see instructions)

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

Part I

Income

Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on Form W-2 and the “Statutory employee” box on that form was checked ▶

Returns and allowances

Subtract line 2 from line 1

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 ▶

Part II

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

Advertising

Car and truck expenses (see instructions)

Commissions and fees

Contract labor (see instructions)

Depletion

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

Employee benefit programs (other than on line 19)

Insurance (other than health)

Interest:

Mortgage (paid to banks, etc.)

16a

Other

16b

Legal and professional services

Office expense (see instructions)

Pension and profit-sharing plans

Rent or lease (see instructions):

Vehicles, machinery, and equipment

20a

Other business property

20b

Repairs and maintenance

Supplies (not included in Part III)

Taxes and licenses

Travel, meals, and entertainment:

Travel

24a

Deductible meals and

entertainment (see instructions)

24b

Utilities

Wages (less employment credits)

Other expenses (from line 48)

27a

Reserved for future use

27b

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

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

Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions).

. Use the Simplified

Method Worksheet in the instructions to figure the amount to enter on line 30

Net profit or (loss). Subtract line 30 from line 29.

• If a loss, you must go to line 32.

}

If you have a loss, check the box that describes your investment in this activity (see instructions).

• If you checked 32b, you must attach Form 6198. Your loss may be limited.

}

32a

32b

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11334P

Schedule C (Form 1040) 2015

Page 2

Part III

Cost of Goods Sold (see instructions)

Method(s) used to

value closing inventory:

Was there any change in determining quantities, costs, or valuations between opening and closing inventory?

If “Yes,” attach explanation

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

Purchases less cost of items withdrawn for personal use

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

Materials and supplies

Other costs

Add lines 35 through 39

Inventory at end of year

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

Part IV

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.

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

Of the total number of miles you drove your vehicle during 2015, enter the number of miles you used your vehicle for:

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

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

Do you have evidence to support your deduction?

If “Yes,” is the evidence written?

Part V

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

Total other expenses. Enter here and on line 27a

Schedule C (Form 1040) 2015

f1_001: Magdalena Schmitz
f1_002: 294-83-2845
f1_003: Photography Business
f1_004:
f1_005:
f1_006:
f1_007:
f1_008:
c1_01: Off
f1_009:
c1_02:
c1_03: 0
c1_04:
c1_05:
c1_06:
f1_010: 6500
f1_011: 00
f1_012:
f1_013:
f1_014:
f1_015:
f1_016:
f1_017:
f1_018:
f1_019:
f1_020:
f1_021:
f1_022: 6500
f1_023: 00
f1_024:
f1_025:
f1_026:
f1_027:
f1_028:
f1_029:
f1_030:
f1_031:
f1_032:
f1_033:
f1_034:
f1_035:
f1_036:
f1_037:
f1_038:
f1_039:
f1_040:
f1_041:
f1_042:
f1_043:
f1_044:
f1_045:
f1_046:
f1_047:
f1_048:
f1_049:
f1_050:
f1_051:
f1_052: 1250
f1_053: 00
f1_054:
f1_055:
f1_056: 430
f1_057: 00
f1_058:
f1_059:
f1_060:
f1_061:
f1_062:
f1_063:
f1_064:
f1_065:
f1_066:
f1_067:
f1_068:
f1_069:
f1_070:
f1_071:
f1_072: 1680
f1_073: 00
f1_074: 4820
f1_075: 00
f1_076:
f1_077:
f1_078: 0
f1_079: 00
f1_080: 4820
f1_081: 00
c1_07: 0
c2_01:
c2_02:
c2_03:
c2_04:
f2_001:
f2_002:
f2_003:
f2_004:
f2_005:
f2_006:
f2_007:
f2_008:
f2_009:
f2_010:
f2_011:
f2_012:
f2_013:
f2_014:
f2_015:
f2_016:
f2_017:
f2_018:
f2_019:
f2_020:
f2_021:
f2_022:
c2_05:
c2_06:
c2_07:
c2_08:
f2_023:
f2_024:
f2_025:
f2_026:
f2_027:
f2_028:
f2_029:
f2_030:
f2_031:
f2_032:
f2_033:
f2_034:
f2_035:
f2_036:
f2_037:
f2_038:
f2_039:
f2_040:
f2_041:
f2_042:
f2_043:
f2_044:
f2_045:
f2_046:
f2_047:
f2_048:
f2_049:
f2_050:
f2_051:

PPSub050516_462184_1/f1040sse.pdf

SCHEDULE SE (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Self-Employment Tax ▶ Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.

▶ Attach to Form 1040 or Form 1040NR.

OMB No. 1545-0074

2015 Attachment Sequence No. 17

Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person with self-employment income ▶

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 2015?

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?

Yes ▶

No ▼

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

Yes ▶

No ▼

Did you receive church employee income (see instructions) reported on Form W-2 of $108.28 or more?

Yes ▶

No ▼

You may use Short Schedule SE below

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 $118,500?

Yes ▶

No ▼

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

Yes ▶

No ▼

No ◀

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

Yes ▶

▶ 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 . . . . . . . . . . . . . . . . . . . . . . . . 1a

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 Z 1b ( )

2 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

3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . 3 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 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: • $118,500 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57, or Form 1040NR, line 55 • More than $118,500, multiply line 4 by 2.9% (.029). Then, add $14,694 to the result. Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . . 5

6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.50). Enter the result here and on Form 1040, line 27, or Form 1040NR, line 27 . . . . . . . . 6

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11358Z Schedule SE (Form 1040) 2015

Schedule SE (Form 1040) 2015 Attachment Sequence No. 17 Page 2 Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person

with self-employment income ▶

Section B—Long Schedule SE Part I Self-Employment Tax

Note. If your only income subject to self-employment tax is church employee income, see instructions. Also see instructions for the definition of church employee income.

A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had $400 or more of other net earnings from self-employment, check here and continue with Part I . . . . . . ▶

1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A. Note. Skip lines 1a and 1b if you use the farm optional method (see instructions) 1a

3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . 3 4 a If line 3 is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter amount from line 3 4a

Note. If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions. b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here . . 4b c Combine lines 4a and 4b. If less than $400, stop; you do not owe self-employment tax.

Exception. If less than $400 and you had church employee income, enter -0- and continue ▶ 4c 5 a Enter your church employee income from Form W-2. See

instructions for definition of church employee income . . . 5a b Multiply line 5a by 92.35% (.9235). If less than $100, enter -0- . . . . . . . . . . 5b

6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Maximum amount of combined wages and self-employment earnings subject to social security

tax or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2015 . . . . . . 7

8 a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2) and railroad retirement (tier 1) compensation. If $118,500 or more, skip lines 8b through 10, and go to line 11 8a

b Unreported tips subject to social security tax (from Form 4137, line 10) 8b c Wages subject to social security tax (from Form 8919, line 10) 8c d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . 8d

9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . ▶ 9 10 Multiply the smaller of line 6 or line 9 by 12.4% (.124) . . . . . . . . . . . . . 10 11 Multiply line 6 by 2.9% (.029) . . . . . . . . . . . . . . . . . . . . . 11 12 Self-employment tax. Add lines 10 and 11. Enter here and on Form 1040, line 57, or Form 1040NR, line 55 12 13 Deduction for one-half of self-employment tax.

Multiply line 12 by 50% (.50). Enter the result here and on Form 1040, line 27, or Form 1040NR, line 27 . . . . . . . . 13

Part II Optional Methods To Figure Net Earnings (see instructions) Farm Optional Method. You may use this method only if (a) your gross farm income1

was not more than $7,320, or (b) your net farm profits2

were less than $5,284. 14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . 14 15 Enter the smaller of: two-thirds (2/3) of gross farm income1 (not less than zero) or $4,880. Also

include this amount on line 4b above . . . . . . . . . . . . . . . . . . . 15 Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3

were less than $5,284 and also less than 72.189% of your gross nonfarm income,4

and (b) you had net earnings from self-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

Enter the smaller of: two-thirds (2/3) of gross nonfarm income4

(not less than zero) or the amount on line 16. Also include this amount on line 4b above . . . . . . . . . . . 17

1 From Sch. F, line 9, and Sch. K-1 (Form 1065), box 14, code B. 2 From Sch. F, line 34, and Sch. K-1 (Form 1065), box 14, code A—minus the

amount you would have entered on line 1b had you not used the optional method.

3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), box 14, code A; and Sch. K-1 (Form 1065-B), box 9, code J1.

4 From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch. K-1 (Form 1065-B), box 9, code J2.

Schedule SE (Form 1040) 2015

Version A Cycle 3

INTERNAL USE ONLY

DRAFT AS OF

August 26, 2015

2015 Schedule SE (Form 1040)

SE:W:CAR:MP

Self-Employment Tax

SCHEDULE SE (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Self-Employment Tax

▶ Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.

▶ Attach to Form 1040 or Form 1040NR.

OMB No. 1545-0074

O M B Number 1545-0074.

2015

2015. Catalog Number 11358Z.

Attachment

Sequence No. 17

Attachment Sequence Number 17. For Paperwork Reduction Act Notice, see your tax return instructions.

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 2015? If "No," go to the next question.

Did you receive wages or tips in 2015?

Yes

Did you receive wages or tips in 2015? If "Yes," go to the next question.

▼

Are you a minister, member of a religious order, or Christian Science practitioner who received I R S approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? If "No," go to the next question. If "Yes," You must use Long Schedule S E on page 2.

Yes

▶

▼

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

Are you using one of the optional methods to figure your net earnings (see instructions)? If "No," go to the next question. If "Yes," you must use Long Schedule S E on page 2.

Yes

▶

▼

Did you receive church employee income (see instructions) reported on Form W-2 of $108.28 or more?

Did you receive church employee income (see instructions) reported on Form W-2 of $108.28 or more? If "No," you may use Short Schedule S E below. If "Yes," you must use Long Schedule S E on page 2.

Yes

▶

▼

You may use Short Schedule SE below

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 $118,500?

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 $117,000? If "No," go to the next question. If "Yes," you must use Long Schedule S E on page 2.

Yes

▶

▼

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

Did you receive tips subject to social security or Medicare tax that you did not report to your employer? If "No," go to the next question. If "Yes," you must use Long Schedule S E on page 2.

Yes

▶

▼

◀

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

Did you report any wages on Form 8919, Uncollected Social Security and Medicare Tax on Wages? If "Yes," you must use Long Schedule S E on page 2. If "No," go the question "Are you a minister, member of a religious order, or Christian Science practitioner who received I R S approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings?"

Yes

▶

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.

Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A

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 Z

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

Combine lines 1a, 1b, and 2

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 ▶

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

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

• $118,500 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57, or Form 1040NR, line 55

• More than $118,500, multiply line 4 by 2.9% (.029). Then, add $14,694 to the result.

Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55

Deduction for one-half of self-employment tax.

Multiply line 5 by 50% (.50). 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.

Cat. No. 11358Z

Schedule SE (Form 1040) 2015

Attachment Sequence No. 17

Page 2

Section B—Long Schedule SE

Part I

Self-Employment Tax

Note. If your only income subject to self-employment tax is church employee income, see instructions. Also see instructions for the definition of church employee income.

If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had $400 or more of other net earnings from self-employment, check here and continue with Part I ▶

Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A. Note. Skip lines 1a and 1b if you use the farm optional method (see instructions)

Combine lines 1a, 1b, and 2

If line 3 is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter amount from line 3

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

If you elect one or both of the optional methods, enter the total of lines 15 and 17 here

Combine lines 4a and 4b. If less than $400, stop; you do not owe self-employment tax. Exception. If less than $400 and you had church employee income, enter -0- and continue ▶

Enter your church employee income from Form W-2. See

instructions for definition of church employee income

Multiply line 5a by 92.35% (.9235). If less than $100, enter -0-

Add lines 4c and 5b

Maximum amount of combined wages and self-employment earnings subject to social security tax or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2015

Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2) and railroad retirement (tier 1) compensation.

If $118,500 or more, skip lines 8b through 10, and go to line 11

Unreported tips subject to social security tax (from Form 4137, line 10)

Wages subject to social security tax (from Form 8919, line 10)

Add lines 8a, 8b, and 8c

Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 ▶

Multiply the smaller of line 6 or line 9 by 12.4% (.124)

Multiply line 6 by 2.9% (.029)

Self-employment tax. Add lines 10 and 11. Enter here and on Form 1040, line 57, or Form 1040NR, line 55

Deduction for one-half of self-employment tax.

Multiply line 12 by 50% (.50). Enter the result here and on Form 1040, line 27, or Form 1040NR, line 27

Part II

Optional Methods To Figure Net Earnings (see instructions)

Farm Optional Method. You may use this method only if (a) your gross farm income1 was not more than $7,320, or (b) your net farm profits2 were less than $5,284.

Maximum income for optional methods

Enter the smaller of: two-thirds (2/3) of gross farm income1 (not less than zero) or $4,880. Also include this amount on line 4b above

Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3 were less than $5,284 and also less than 72.189% of your gross nonfarm income,4 and (b) you had net earnings from self-employment of at least $400 in 2 of the prior 3 years. Caution. You may use this method no more than five times.

Subtract line 15 from line 14

Enter the smaller of: two-thirds (2/3) of gross nonfarm income4 (not less than zero) or the amount on line 16. Also include this amount on line 4b above

1 From Sch. F, line 9, and Sch. K-1 (Form 1065), box 14, code B.

2 From Sch. F, line 34, and Sch. K-1 (Form 1065), box 14, code A—minus the amount you would have entered on line 1b had you not used the optional method.

3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), box 14, code A; and Sch. K-1 (Form 1065-B), box 9, code J1.

4 From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch. K-1 (Form 1065-B), box 9, code J2.

Schedule SE (Form 1040) 2015

f1_1: Magdalena Schmitz
f1_2: 294-83-2845
f1_3:
f1_4:
f1_5:
f1_6:
f1_7: 4820
f1_8: 00
f1_9: 4820
f1_10: 00
f1_11: 4451
f1_12: 00
f1_13: 681
f1_14: 00
f1_15: 341
f1_16: 00
f2_1:
f2_2:
c2_1: Off
f2_3:
f2_4:
f2_5:
f2_6:
f2_7:
f2_8:
f2_9:
f2_10:
f2_11:
f2_12:
f2_13:
f2_14:
f2_15:
f2_16:
f2_17:
f2_18:
f2_19:
f2_20:
f2_21:
f2_22:
f2_23: 118,500
f2_24: 00
f2_25:
f2_26:
f2_27:
f2_28:
f2_29:
f2_30:
f2_31:
f2_32:
f2_33:
f2_34:
f2_35:
f2_36:
f2_37:
f2_38:
f2_39:
f2_40:
f2_41:
f2_42:
f2_43: 4,880
f2_44: 00
f2_45:
f2_46:
f2_47:
f2_48:
f2_49:
f2_50:

PPSub050516_462184_1/f2441.pdf

Form 2441 Department of the Treasury Internal Revenue Service (99)

Child and Dependent Care Expenses ▶ Attach to Form 1040, Form 1040A, or Form 1040NR.

▶ Information about Form 2441 and its separate instructions is at www.irs.gov/form2441.

1040A . . . . . . . . . . 1040

2441

◀ . . . . . . . . . .

1040NR

OMB No. 1545-0074

2015 Attachment Sequence No. 21

Name(s) shown on return Your social security number

Part I Persons or Organizations Who Provided the Care—You must complete this part. (If you have more than two care providers, see the instructions.)

1 (a) Care provider’s name

(b) Address (number, street, apt. no., city, state, and ZIP code)

(d) Amount paid (see instructions)

Did you receive dependent care benefits?

No ▶ Complete only Part II below. Yes ▶ Complete Part III on the back next.

Caution. If the care was provided in your home, you may owe employment taxes. If you do, you cannot file Form 1040A. For details, see the instructions for Form 1040, line 60a, or Form 1040NR, line 59a.

Part II Credit for Child and Dependent Care Expenses 2 Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.

(a) Qualifying person’s name

First Last

(b) Qualifying person’s social security number

person listed in column (a)

Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Enter your earned income. See instructions . . . . . . . . . . . . . . . 4 5 If married filing jointly, enter your spouse’s earned income (if you or your spouse was a

student or was disabled, see the instructions); all others, enter the amount from line 4 . 5 6 Enter the smallest of line 3, 4, or 5 . . . . . . . . . . . . . . . . . . 6 7 Enter the amount from Form 1040, line 38; Form

1040A, line 22; or Form 1040NR, line 37 . . . . . 7 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7

If line 7 is:

Over But not over

Decimal amount is

$0—15,000 .35

15,000—17,000 .34

17,000—19,000 .33

19,000—21,000 .32

21,000—23,000 .31

23,000—25,000 .30

25,000—27,000 .29

27,000—29,000 .28

If line 7 is:

Over But not over

Decimal amount is

$29,000—31,000 .27

31,000—33,000 .26

33,000—35,000 .25

35,000—37,000 .24

37,000—39,000 .23

39,000—41,000 .22

41,000—43,000 .21

43,000—No limit .20

8 X .

9 Multiply line 6 by the decimal amount on line 8. If you paid 2014 expenses in 2015, see the instructions . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions. . . . . . . 10

11 Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 49; Form 1040A, line 31; or Form 1040NR, line 47 . . . . 11

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11862M Form 2441 (2015)

Form 2441 (2015) Page 2 Part III Dependent Care Benefits 12

Enter the total amount of dependent care benefits you received in 2015. Amounts you received as an employee should be shown in box 10 of your Form(s) W-2. Do not include amounts reported as wages in box 1 of Form(s) W-2. If you were self-employed or a partner, include amounts you received under a dependent care assistance program from your sole proprietorship or partnership . . . . . . . . . . . . . . . . . . 12

13 Enter the amount, if any, you carried over from 2014 and used in 2015 during the grace period. See instructions . . . . . . . . . . . . . . . . . . . . . . . 13

14 Enter the amount, if any, you forfeited or carried forward to 2016. See instructions . . . 14 ( ) 15 Combine lines 12 through 14. See instructions . . . . . . . . . . . . . . . 15 16 Enter the total amount of qualified expenses incurred

in 2015 for the care of the qualifying person(s) . . . 16 17 Enter the smaller of line 15 or 16 . . . . . . . . 17 18 Enter your earned income. See instructions . . . . 18 19 Enter the amount shown below that applies

to you.

• If married filing jointly, enter your spouse’s earned income (if you or your spouse was a student or was disabled, see the instructions for line 5).

• If married filing separately, see instructions.

• All others, enter the amount from line 18.

} . . . 19

20 Enter the smallest of line 17, 18, or 19 . . . . . . 20 21

Enter $5,000 ($2,500 if married filing separately and you were required to enter your spouse’s earned income on line 19) . . . . . . . . . . . . . 21

22 Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers go to line 25.)

No. Enter -0-. Yes. Enter the amount here . . . . . . . . . . . . . . . . . . . . 22

23 Subtract line 22 from line 15 . . . . . . . . . 23 24 Deductible benefits. Enter the smallest of line 20, 21, or 22. Also, include this amount on

the appropriate line(s) of your return. See instructions . . . . . . . . . . . . . 24 25

Excluded benefits. Form 1040 and 1040NR filers: If you checked “No” on line 22, enter the smaller of line 20 or 21. Otherwise, subtract line 24 from the smaller of line 20 or line 21. If zero or less, enter -0-. Form 1040A filers: Enter the smaller of line 20 or line 21 . . 25

Taxable benefits. Form 1040 and 1040NR filers: Subtract line 25 from line 23. If zero or less, enter -0-. Also, include this amount on Form 1040, line 7, or Form 1040NR, line 8. On the dotted line next to Form 1040, line 7, or Form 1040NR, line 8, enter “DCB.” Form 1040A filers: Subtract line 25 from line 15. Also, include this amount on Form 1040A, line 7. In the space to the left of line 7, enter “DCB” . . . . . . . . . . . . . . 26

To claim the child and dependent care credit, complete lines 27 through 31 below.

27 Enter $3,000 ($6,000 if two or more qualifying persons) . . . . . . . . . . . . 27 28 Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount

from line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 29

Subtract line 28 from line 27. If zero or less, stop. You cannot take the credit. Exception. If you paid 2014 expenses in 2015, see the instructions for line 9 . . . . . 29

30 Complete line 2 on the front of this form. Do not include in column (c) any benefits shown on line 28 above. Then, add the amounts in column (c) and enter the total here. . . . . 30

31 Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on the front of this form and complete lines 4 through 11 . . . . . . . . . . . . . . . . . . . . 31

Form 2441 (2015)

Version A, Cycle 3

INTERNAL USE ONLY DRAFT AS OF October 21, 2015

2015 Form 2441

SE:W:CAR:MP

Child and Dependent Care Expenses

Form 2441

Department of the Treasury Internal Revenue Service (99)

Child and Dependent Care Expenses

▶ Attach to Form 1040, Form 1040A, or Form 1040NR.

▶ Information about Form 2441 and its separate instructions is at www.irs.gov/form2441.

1040A

. . . . . . . . . .

1040

2441

◀

. . . . . . . . . .

1040NR

OMB No. 1545-0074

2015

2015. Catalog Number 11862M.

Attachment

Sequence No. 21

Attachment Sequence Number 21. For Paperwork Reduction Act Notice, see your tax return instructions.

Part I

Persons or Organizations Who Provided the Care—You must complete this part.

(If you have more than two care providers, see the instructions.)

(a) Care provider’s

name

(b) Address

(number, street, apt. no., city, state, and ZIP code)

(d) Amount paid

(see instructions)

Did you receive

dependent care benefits?

▶

Complete only Part II below.

Yes

▶

Complete Part III on the back next.

Part II

Credit for Child and Dependent Care Expenses

Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.

(a) Qualifying person’s name

First

(a) Qualifying person's name: First.

Last

(a) Qualifying person's name: Last.

(b) Qualifying person’s social security number

incurred and paid in 2015 for the person listed in column (a)

Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 31

Enter your earned income. See instructions

If married filing jointly, enter your spouse’s earned income (if you or your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4

Enter the smallest of line 3, 4, or 5

Enter the amount from Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 37

Enter on line 8 the decimal amount shown below that applies to the amount on line 7

If line 7 is:

Over

If line 7 is: Over.

But not over

Decimal amount is

$0—

15,000

.35

15,000—

17,000

.34

17,000—

19,000

.33

19,000—

21,000

.32

21,000—

23,000

.31

23,000—

25,000

.30

25,000—

27,000

.29

27,000—

29,000

.28

If line 7 is:

Over

If line 7 is: Over.

But not over

Decimal amount is

$29,000—

31,000

.27

31,000—

33,000

.26

33,000—

35,000

.25

35,000—

37,000

.24

37,000—

39,000

.23

39,000—

41,000

.22

41,000—

43,000

.21

43,000—

No limit

.20

X .

Multiply line 6 by the decimal amount on line 8. If you paid 2014 expenses in 2015, see the instructions

Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions

Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 49; Form 1040A, line 31; or Form 1040NR, line 47

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

Cat. No. 11862M

Form 2441 (2015)

Page 2

Part III

Dependent Care Benefits

Enter the amount, if any, you carried over from 2014 and used in 2015 during the grace period. See instructions

Enter the amount, if any, you forfeited or carried forward to 2016. See instructions

Combine lines 12 through 14. See instructions

Enter the total amount of qualified expenses incurred in 2015 for the care of the qualifying person(s)

Enter the smaller of line 15 or 16

Enter your earned income. See instructions

Enter the amount shown below that applies

to you.

• If married filing jointly, enter your spouse’s earned income (if you or your spouse was a student or was disabled, see the instructions for line 5).

• If married filing separately, see instructions.

• All others, enter the amount from line 18.

}

Enter the smallest of line 17, 18, or 19

Enter $5,000 ($2,500 if married filing separately and you were required to enter your spouse’s earned income on line 19)

Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers go to line 25.)

Subtract line 22 from line 15

Deductible benefits. Enter the smallest of line 20, 21, or 22. Also, include this amount on the appropriate line(s) of your return. See instructions .

Taxable benefits. Form 1040 and 1040NR filers: Subtract line 25 from line 23. If zero or less, enter -0-. Also, include this amount on Form 1040, line 7, or Form 1040NR, line 8. On the dotted line next to Form 1040, line 7, or Form 1040NR, line 8, enter “DCB.”Form 1040A filers: Subtract line 25 from line 15. Also, include this amount on Form 1040A, line 7. In the space to the left of line 7, enter “DCB” .

To claim the child and dependent care credit, complete lines 27 through 31 below.

Enter $3,000 ($6,000 if two or more qualifying persons) .

Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount from line 25 .

Subtract line 28 from line 27. If zero or less, stop. You cannot take the credit.Exception. If you paid 2014 expenses in 2015, see the instructions for line 9 .

Complete line 2 on the front of this form. Do not include in column (c) any benefits shown on line 28 above. Then, add the amounts in column (c) and enter the total here .

Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on the front of this form and complete lines 4 through 11 .

Form 2441 (2015)

f1_01_0_: Magdalena Schmitz
f1_02_0_: 294-83-2845
f1_05_0_: Horizon Day Care
f1_06_0_: 452 S. Patriot Road
f1_07_0_: Bedford, PA 15522
f1_08_0_: 43-6598324
f1_09_0_: 4250
f1_10_0_: 00
f1_11_0_:
f1_12_0_:
f1_13_0_:
f1_14_0_:
f1_15_0_:
f1_16_0_:
f1_17_0_: Connor
f1_18_0_: Schmitz
f1_19_0_: 824-56-2984
f1_22_0_: 4250
f1_23_0_: 00
f1_24_0_:
f1_25_0_:
f1_26_0_:
f1_29_0_:
f1_30_0_:
f1_31_0_: 3000
f1_32_0_: 00
f1_33_0_: 63340
f1_34_0_: 00
f1_35_0_: 63340
f1_36_0_: 00
f1_37_0_: 3000
f1_38_0_: 00
f1_39_0_: 54426
f1_40_0_: 00
f1_42_0_: 20
f1_43_0_: 600
f1_44_0_: 00
f1_45_0_:
f1_46_0_:
f1_51_0_: 600
f1_52_0_: 00
f2_01_0_:
f2_02_0_:
f2_03_0_:
f2_04_0_:
f2_05_0_:
f2_06_0_:
f2_43_0_:
f2_44_0_:
f2_07_0_:
f2_08_0_:
f2_09_0_:
f2_10_0_:
f2_11_0_:
f2_12_0_:
f2_13_0_:
f2_14_0_:
f2_15_0_:
f2_16_0_:
f2_21_0_:
f2_22_0_:
f2_45_0_:
f2_17_0_:
f2_18_0_:
f2_19_0_:
f2_20_0_:
f2_23_0_:
f2_24_0_:
f2_27_0_:
f2_28_0_:
f2_29_0_:
f2_30_0_:
f2_33_0_:
f2_34_0_:
f2_35_0_:
f2_36_0_:
f2_37_0_:
f2_38_0_:
f2_39_0_:
f2_40_0_:
f2_41_0_:
f2_42_0_:

PPSub050516_462184_1/f8863.pdf

Form 8863 Department of the Treasury Internal Revenue Service (99)

Education Credits (American Opportunity and Lifetime Learning Credits)

▶ Attach to Form 1040 or Form 1040A. ▶ Information about Form 8863 and its separate instructions is at www.irs.gov/form8863.

OMB No. 1545-0074

2015 Attachment Sequence No. 50

Name(s) shown on return Your social security number

▲! CAUTION

Complete a separate Part III on page 2 for each student for whom you are claiming either credit before you complete Parts I and II.

Part I Refundable American Opportunity Credit 1 After completing Part III for each student, enter the total of all amounts from all Parts III, line 30 . 1 2 Enter: $180,000 if married filing jointly; $90,000 if single, head of

household, or qualifying widow(er) . . . . . . . . . . . . . 2

3 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter . . . . . . . . 3

4 Subtract line 3 from line 2. If zero or less, stop; you cannot take any education credit . . . . . . . . . . . . . . . . . . . 4

5 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) . . . . . . . . . . . . . . . . . 5

6 If line 4 is: • Equal to or more than line 5, enter 1.000 on line 6 . . . . . . . . . . . . • Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to

at least three places) . . . . . . . . . . . . . . . . . . . . . } . . . . 6 .

7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the conditions described in the instructions, you cannot take the refundable American opportunity credit; skip line 8, enter the amount from line 7 on line 9, and check this box . . . . ▶ 7

8 Refundable American opportunity credit. Multiply line 7 by 40% (.40). Enter the amount here and on Form 1040, line 68, or Form 1040A, line 44. Then go to line 9 below. . . . . . . . . . 8

Part II Nonrefundable Education Credits 9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions) 9

10 After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19 . . . . . . . . . . 10

11 Enter the smaller of line 10 or $10,000 . . . . . . . . . . . . . . . . . . . . 11 12 Multiply line 11 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . 12 13 Enter: $130,000 if married filing jointly; $65,000 if single, head of

household, or qualifying widow(er) . . . . . . . . . . . . . 13

14 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter . . . . . . . . 14

15 Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on line 18, and go to line 19 . . . . . . . . . . . . . . . 15

16 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) . . . . . . . . . . . . . . . . . 16

17 If line 15 is: • Equal to or more than line 16, enter 1.000 on line 17 and go to line 18 • Less than line 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at least three

places) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . 18 Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) ▶ 18 19 Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see

instructions) here and on Form 1040, line 50, or Form 1040A, line 33 . . . . . . . . . . 19 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 25379M Form 8863 (2015)

Form 8863 (2015) Page 2 Name(s) shown on return Your social security number

▲! CAUTION

Complete Part III for each student for whom you are claiming either the American opportunity credit or lifetime learning credit. Use additional copies of page 2 as needed for each student.

Part III Student and Educational Institution Information See instructions.

20 Student name (as shown on page 1 of your tax return) 21 Student social security number (as shown on page 1 of your tax return)

22 Educational institution information (see instructions) a. Name of first educational institution

(1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions.

(2) Did the student receive Form 1098-T from this institution for 2015?

Yes No

(3) Did the student receive Form 1098-T from this institution for 2014 with Box 2 filled in and Box 7 checked?

Yes No

If you checked “No” in both (2) and (3), skip (4). (4) If you checked “Yes” in (2) or (3), enter the institution's

federal identification number (from Form 1098-T). –

b. Name of second educational institution (if any)

(1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions.

(2) Did the student receive Form 1098-T from this institution for 2015?

Yes No

(3) Did the student receive Form 1098-T from this institution for 2014 with Box 2 filled in and Box 7 checked?

Yes No

If you checked “No” in both (2) and (3), skip (4). (4) If you checked “Yes” in (2) or (3), enter the institution's

federal identification number (from Form 1098-T). –

23 Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2015?

Yes — Stop! Go to line 31 for this student. No — Go to line 24.

24 Was the student enrolled at least half-time for at least one academic period that began or is treated as having begun in 2015 at an eligible educational institution in a program leading towards a postsecondary degree, certificate, or other recognized postsecondary educational credential? (see instructions)

Yes — Go to line 25. No — Stop! Go to line 31 for this student.

25 Did the student complete the first 4 years of postsecondary education before 2015 (see instructions)?

Yes — Stop! Go to line 31 for this student.

No — Go to line 26.

26 Was the student convicted, before the end of 2015, of a felony for possession or distribution of a controlled substance?

Yes — Stop! Go to line 31 for this student.

No — Complete lines 27 through 30 for this student.

▲! CAUTION

You cannot take the American opportunity credit and the lifetime learning credit for the same student in the same year. If you complete lines 27 through 30 for this student, do not complete line 31.

American Opportunity Credit 27 Adjusted qualified education expenses (see instructions). Do not enter more than $4,000 . . . . 27 28 Subtract $2,000 from line 27. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 28 29 Multiply line 28 by 25% (.25) . . . . . . . . . . . . . . . . . . . . . . . . . 29 30 If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and

enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30, on Part I, line 1 . 30 Lifetime Learning Credit

31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts III, line 31, on Part II, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . 31

Form 8863 (2015)

Version A, Cycle 4

INTERNAL USE ONLY

DRAFT AS OF

November 5, 2015

Form 8863

Department of the Treasury

Internal Revenue Service (99)

Education Credits

(American Opportunity and Lifetime Learning Credits)

▶ Attach to Form 1040 or Form 1040A.

▶ Information about Form 8863 and its separate instructions is at www.irs.gov/form8863.

OMB No. 1545-0074

2015

2015. Catalog Number 25379M.

Attachment

Sequence No. 50

Attachment Sequence Number 50. For Paperwork Reduction Act Notice, see your tax return instructions.

Your social security number

▲

CAUTION

Complete a separate Part III on page 2 for each student for whom you are claiming either credit before you complete Parts I and II.

Part I

Refundable American Opportunity Credit

After completing Part III for each student, enter the total of all amounts from all Parts III, line 30

Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er)

Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter

Subtract line 3 from line 2. If zero or less, stop; you cannot take any education credit

Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er)

If line 4 is:

• Equal to or more than line 5, enter 1.000 on line 6

• Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places)

}

Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet

the conditions described in the instructions, you cannot take the refundable American opportunity

credit; skip line 8, enter the amount from line 7 on line 9, and check this box ▶

Refundable American opportunity credit. Multiply line 7 by 40% (.40). Enter the amount here and on Form 1040, line 68, or Form 1040A, line 44. Then go to line 9 below

Part II

Nonrefundable Education Credits

Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions)

After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19

Enter the smaller of line 10 or $10,000

Multiply line 11 by 20% (.20)

Enter: $130,000 if married filing jointly; $65,000 if single, head of household, or qualifying widow(er)

Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter

Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on line 18, and go to line 19

Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er)

If line 15 is:

• Equal to or more than line 16, enter 1.000 on line 17 and go to line 18

• Less than line 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at least three places)

Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) ▶

Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 50, or Form 1040A, line 33

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

Cat. No. 25379M

Form 8863 (2015)

Page 2

Your social security number

▲

CAUTION

Complete Part III for each student for whom you are claiming either the American

opportunity credit or lifetime learning credit. Use additional copies of page 2 as needed for each student.

Part III

Student and Educational Institution Information See instructions.

Student social security number (as shown on page 1 of your tax return)

Educational institution information (see instructions)

(2) Did the student receive Form 1098-T from this institution for 2015?

(3) Did the student receive Form 1098-T from this institution for 2014 with Box 2 filled in and Box 7 checked?

If you checked “No” in both (2) and (3), skip (4).

(4)

If you checked “Yes” in (2) or (3), enter the institution's federal identification number (from Form 1098-T).

–

(2) Did the student receive Form 1098-T from this institution for 2015?

(3) Did the student receive Form 1098-T from this institution for 2014 with Box 2 filled in and Box 7 checked?

If you checked “No” in both (2) and (3), skip (4).

(4)

If you checked “Yes” in (2) or (3), enter the institution's federal identification number (from Form 1098-T).

–

Has the Hope Scholarship Credit or American opportunity credit been claimed for this student for any 4 tax years before 2015?

Was the student enrolled at least half-time for at least one academic period that began or is treated as having begun in 2015 at an eligible educational institution in a program leading towards a postsecondary degree, certificate, or other recognized postsecondary educational credential? (see instructions)

Did the student complete the first 4 years of postsecondary education before 2015 (see instructions)?

Was the student convicted, before the end of 2015, of a felony for possession or distribution of a controlled substance?

▲

CAUTION

You cannot take the American opportunity credit and the lifetime learning credit for the same student in the same year. If you complete lines 27 through 30 for this student, do not complete line 31.

American Opportunity Credit

Adjusted qualified education expenses (see instructions). Do not enter more than $4,000

Subtract $2,000 from line 27. If zero or less, enter -0-

Multiply line 28 by 25% (.25)

If line 28 is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and enter the result. Skip line 31. Include the total of all amounts from all Parts III, line 30, on Part I, line 1

Lifetime Learning Credit

Adjusted qualified education expenses (see instructions). Include the total of all amounts from all Parts III, line 31, on Part II, line 10

Form 8863 (2015)

2015 Form 8863

SE:W:CAR:MP

Education Credits (American Opportunity and Lifetime Learning Credits)

NameShown: Magdalena Schmitz
First3_SS: 294
Middle2_SS: 83
Last4_SS: 2845
f1_001:
f1_002:
f1_003:
f1_004:
f1_005:
f1_006:
f1_007:
f1_008:
f1_009:
f1_010:
f1_011:
f1_012:
c1_01_0_:
f1_013:
f1_014:
f1_015:
f1_016:
f1_017:
f1_018:
f1_019: 8500
f1_020: 00
f1_022: 8500
f1_023: 00
f1_024: 1700
f1_025: 00
f1_026: 65000
f1_027: 00
f1_028: 54426
f1_029: 00
f1_030: 10574
f1_031: 00
f1_032: 10000
f1_033: 00
f1_034: 1
f1_035: 000
f1_036: 1700
f1_037: 00
f1_038: 1700
f1_039: 00
StudentName: Alyssa Schmitz
First3_SSpg2: 824
Middle2_SSpg2: 84
Last4_SSpg2: 8456
aName: Pennsylvania State University (PSU)
aAddress: 1250 Happy Valley, State College, PA 16801
c2_01_0_: Yes
c2_03_0_: Yes
f2_300: 3
f2_301: 3
f2_302: 9
f2_303: 8
f2_304: 7
f2_305: 6
f2_306: 5
f2_307: 4
f2_308: 3
bName:
bAddress:
c2_02_0_:
c2_04_0_:
f2_309:
f2_310:
f2_311:
f2_312:
f2_313:
f2_314:
f2_315:
f2_316:
f2_317:
c2_05_0_: No
c2_06_0_: No
c2_07_0_: 0
c2_08_0_: 0
f2_167_0_:
f2_168_0_:
f2_169_0_:
f2_170_0_:
f2_200_0: 8500

PPSub050516_462184_1/f8917.pdf

Form 8917 Department of the Treasury Internal Revenue Service

Tuition and Fees Deduction ▶ Attach to Form 1040 or Form 1040A.

▶ Information about Form 8917 and its instructions is at www.irs.gov/form8917.

OMB No. 1545-0074

2015 Attachment Sequence No. 60

Name(s) shown on return Your social security number

▲! CAUTION

You cannot take both an education credit from Form 8863 and the tuition and fees deduction from this form for the same student for the same tax year.

Before you begin: ✔ To see if you qualify for this deduction, see Who Can Take the Deduction in the instructions below.

✔ If you file Form 1040, figure any write-in adjustments to be entered on the dotted line next to Form 1040, line 36. See the 2015 Form 1040 instructions for line 36.

1 (a) Student’s name (as shown on page 1 of your tax return)

First name Last name

(b) Student’s social security number (as shown on page

1 of your tax return)

2 Add the amounts on line 1, column (c), and enter the total . . . . . . . . . . . . . 2

3 Enter the amount from Form 1040, line 22, or Form 1040A, line 15 3

4 Enter the total from either:

• Form 1040, lines 23 through 33, plus any write-in adjustments entered on the dotted line next to Form 1040, line 36, or

• Form 1040A, lines 16 through 18. . . . . . . . . . . 4

5 Subtract line 4 from line 3.* If the result is more than $80,000 ($160,000 if married filing jointly), stop; you cannot take the deduction for tuition and fees . . . . . . . . . . . . . 5

*If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Effect of the Amount of Your Income on the Amount of Your Deduction in Pub. 970, chapter 6, to figure the amount to enter on line 5.

6 Tuition and fees deduction. Is the amount on line 5 more than $65,000 ($130,000 if married filing jointly)?

Yes. Enter the smaller of line 2, or $2,000.

No. Enter the smaller of line 2, or $4,000.

Also enter this amount on Form 1040, line 34, or Form 1040A, line 19.

} . . . . . . . . . . . . . . 6

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37728P Form 8917 (2015)

Form 8917 (2015) Page 2

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future Developments For the latest information about developments related to Form 8917 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/form8917.

Purpose of Form Use Form 8917 to figure and take the deduction for tuition and fees expenses paid in 2015.

This deduction is based on adjusted qualified education expenses paid to an eligible educational institution (postsecondary). See Qualified Education Expenses, later, for more information.

TIP You may be able to take the American opportunity credit or lifetime learning credit for your education expenses instead of the tuition and fees deduction. See Form

8863, Education Credits, and Pub. 970, Tax Benefits for Education, for more information about these credits.

Who Can Take the Deduction You may be able to take the deduction if you, your spouse, or a dependent you claim on your tax return was a student enrolled at or attending an eligible educational institution. The deduction is based on the amount of qualified education expenses you paid for the student in 2015 for academic periods beginning in 2015 or beginning in the first 3 months of 2016.

Generally, in order to claim the deduction for education expenses for a dependent, you must have paid the expenses in 2015 and must claim an exemption for the student as a dependent on your 2015 tax return (line 6c of Form 1040 or 1040A). For additional information, see chapter 6 of Pub. 970.

You cannot claim the tuition and fees deduction if any of the following apply. • Your filing status is married filing separately. • Another person can claim an exemption for you as a dependent on his or her tax return. You cannot take the deduction even if the other person does not actually claim that exemption. • Your modified adjusted gross income (MAGI), as figured on line 5, is more than $80,000 ($160,000 if filing a joint return). • You were a nonresident alien for any part of the year and did not elect to be treated as a resident alien for tax purposes. More information on nonresident aliens can be found in Pub. 519, U.S. Tax Guide for Aliens.

You cannot claim a tuition and fees deduction for any student if you or anyone else claims an American opportunity or lifetime learning credit (Form 8863) in 2015 with respect to expenses of the student for whom the qualified education expenses were paid. However, a state tax credit will not disqualify you from claiming a tuition and fees deduction.

Qualified Education Expenses Generally, qualified education expenses are amounts paid in 2015 for tuition and fees required for the student’s enrollment or attendance at an eligible educational institution. Required fees include amounts for books, supplies, and equipment used in a course of study if required to be paid to the institution as a condition of enrollment or attendance. It does not matter whether the expenses were paid in cash, by check, by credit or debit card, or with borrowed funds.

Qualified education expenses include nonacademic fees, such as student activity fees, athletic fees, or other expenses unrelated to the academic course of instruction, only if the fee must be paid to the institution as a condition of enrollment or attendance. However, fees for personal expenses (described below) are never qualified education expenses.

Qualified education expenses do not include amounts paid for: • Personal expenses. This means room and board, insurance, medical expenses (including student health fees), transportation, and other similar personal, living, or family expenses. • Any course or other education involving sports, games, or hobbies, or any noncredit course, unless such course or other education is part of the student's degree program or helps the student acquire or improve job skills.

Qualified education expenses do not include any expenses for which you take any other deduction, such as on Schedule A (Form 1040) or Schedule C (Form 1040).

You may receive Form 1098-T, Tuition Statement, from the institution reporting either payments received in 2015 (box 1) or amounts billed in 2015 (box 2). However, the amount in box 1 or 2 of Form 1098-T may be different from the amount you paid (or are treated as having paid). In completing Form 8917, use only the amounts you actually paid (plus any amounts you are treated as having paid) in 2015 (reduced, as necessary, as described in Adjusted Qualified Education Expenses, later). See chapter 6 of Pub. 970 for more information on Form 1098-T.

Qualified education expenses paid directly to the institution by someone other than you or the student are treated as paid to the student and then paid by the student to the institution.

Academic Period An academic period is any quarter, semester, trimester, or any other period of study as reasonably determined by an eligible educational institution. If an eligible educational institution uses credit hours or clock hours and does not have academic terms, each payment period may be treated as an academic period.

Prepaid Expenses Qualified education expenses paid in 2015 for an academic period that begins in the first 3 months of 2016 can be used in figuring the tuition and fees deduction for 2015 only. See Academic Period, earlier. For example, if you pay $2,000 in December 2015 for qualified tuition for the 2016 winter quarter that begins in January 2016, you can use that $2,000 in figuring the tuition and fees deduction for 2015 only (if you meet all the other requirements).

▲! CAUTION

You cannot use any amount you paid in 2014 or 2016 to figure the qualified education expenses you use to figure your 2015 tuition and fees deduction.

Adjusted Qualified Education Expenses For each student, reduce the qualified education expenses paid by or on behalf of that student under the following rules. The result is the amount of adjusted qualified education expenses for each student. Tax-free educational assistance. For tax-free educational assistance received in 2015, reduce the qualified educational expenses for each academic period by the amount of tax-free educational assistance allocable to that academic period. See Academic Period, earlier.

Form 8917 (2015) Page 3

Tax-free educational assistance includes: 1. The tax-free part of any scholarship or fellowship grant

(including Pell grants), 2. The tax-free part of any employer-provided educational

assistance, 3. Veterans' educational assistance, and 4. Any other educational assistance that is excludable from

gross income (tax free), other than as a gift, bequest, devise, or inheritance.

TIP You may be able to increase the combined value of your tuition and fees deduction and certain educational assistance if the student includes some or all of the

educational assistance in income in the year it is received. For details, see Adjustments to Qualified Education Expenses, in chapter 6 of Pub. 970.

Generally, any scholarship or fellowship grant is treated as tax-free educational assistance. However, a scholarship or fellowship grant is not treated as tax-free educational assistance to the extent the student includes it in gross income (the student may or may not be required to file a tax return) for the year the scholarship or fellowship grant is received and either: • The scholarship or fellowship grant (or any part of it) must be applied (by its terms) to expenses (such as room and board) other than qualified education expenses as defined in Qualified education expenses in Pub. 970, chapter 1; or • The scholarship or fellowship grant (or any part of it) may be applied (by its terms) to expenses (such as room and board) other than qualified education expenses as defined in Qualified education expenses in Pub. 970, chapter 1. Tax-free educational assistance treated as a refund. Some tax-free educational assistance received after 2015 may be treated as a refund of qualified education expenses paid in 2015. This tax-free educational assistance is any tax-free educational assistance received by you or anyone else after 2015 for qualified education expenses paid on behalf of a student in 2015 (or attributable to enrollment at an eligible educational institution during 2015).

If this tax-free educational assistance is received after 2015 but before you file your 2015 income tax return, see Refunds received after 2015 but before your income tax return is filed, later. If this tax-free educational assistance is received after 2015 and after you file your 2015 income tax return, see Refunds received after 2015 and after your income tax return is filed, later. Refunds. A refund of qualified education expenses may reduce adjusted qualified education expenses for the tax year or may require you to include some or all of the refund in your gross income for the year the refund is received. See chapter 6 of Pub. 970 for more information. Some tax-free educational assistance received after 2015 may be treated as a refund. See Tax-free educational assistance treated as a refund, earlier.

Refunds received in 2015. For each student, figure the adjusted qualified education expenses for 2015 by adding all the qualified education expenses paid in 2015 and subtracting any refunds of those expenses received from the eligible educational institution during 2015.

Refunds received after 2015 but before your income tax return is filed. If anyone receives a refund after 2015 of qualified education expenses you paid on behalf of a student in 2015 and the refund is received before you file your 2015 income tax return, reduce the amount of qualified education expenses for 2015 by the amount of the refund.

Refunds received after 2015 and after your income tax return is filed. If anyone receives a refund after 2015 of qualified education expenses you paid on behalf of a student in 2015 and the refund is received after you file your 2015 income tax return, you may need to include some or all of the refund in your gross income for the year the refund is received. See chapter 6 of Pub. 970 for more information. Coordination with Coverdell education savings accounts and qualified tuition programs. Reduce your qualified education expenses by any qualified education expenses used to figure the exclusion from gross income of (a) interest received under an education savings bond program, or (b) any distribution from a Coverdell education savings account or qualified tuition program (QTP). For a QTP, this applies only to the amount of tax-free earnings that were distributed, not to the recovery of contributions to the program.

Eligible Educational Institution An eligible educational institution is generally any accredited public, nonprofit, or proprietary (private) college, university, vocational school, or other postsecondary institution. Also, the institution must be eligible to participate in a student aid program administered by the Department of Education. Virtually all accredited postsecondary institutions meet this definition.

An eligible educational institution also includes certain educational institutions located outside the United States that are eligible to participate in a student aid program administered by the Department of Education.

TIP The educational institution should be able to tell you if it is an eligible institution.

Additional Information See Pub. 970, chapter 6, for more information about the tuition and fees deduction.

Specific Instructions Line 1 Complete columns (a) through (c) on line 1 for each student for whom you elect to take the tuition and fees deduction. Note: If you have more than three students who qualify for the tuition and fees deduction, enter “See attached” next to line 1 and attach a statement with the required information for each additional student. Include the amounts from line 1, column (c), for all students in the total you enter on line 2.

Column (c) For each student, enter the amount of adjusted qualified education expenses. The expenses must have been paid for the student in 2015 for academic periods beginning after 2014 but before April 1, 2016.

Version A, Cycle 4

INTERNAL USE ONLY DRAFT AS OF December 30, 2015

Version A, Cycle 4

INTERNAL USE ONLY DRAFT AS OF December 30, 2015

Form 8917

Department of the Treasury Internal Revenue Service

Tuition and Fees Deduction

▶ Attach to Form 1040 or Form 1040A.▶ Information about Form 8917 and its instructions is at www.irs.gov/form8917.

OMB No. 1545-0074

2015

2013. Catalog Number 37728P.

Attachment

Sequence No. 60

Attachment Sequence Number 60. For Paperwork Reduction Act Notice, see your tax return instructions.

▲

CAUTION

You cannot take both an education credit from Form 8863 and the tuition and fees deduction from this form for thesame student for the same tax year.

Before you begin:

✔

To see if you qualify for this deduction, see Who Can Take the Deduction in the instructions below.

✔

If you file Form 1040, figure any write-in adjustments to be entered on the dotted line next to Form 1040, line 36. See the 2015 Form 1040 instructions for line 36.

(a) Student’s name (as shown on page 1 of your tax return)

First name Last name

(b) Student’s social security number (as shown on page1 of your tax return)

expenses (see instructions)

(a) Student’s name (as shown on page 1 of your tax return). First name and Last name.

(b) Student’s social security number (as shown on page 1 of your tax return).

Add the amounts on line 1, column (c), and enter the total

Enter the amount from Form 1040, line 22, or Form 1040A, line 15

Enter the total from either:

• Form 1040, lines 23 through 33, plus any write-in adjustments entered on the dotted line next to Form 1040, line 36, or

• Form 1040A, lines 16 through 18

Subtract line 4 from line 3.* If the result is more than $80,000 ($160,000 if married filing jointly), stop; you cannot take the deduction for tuition and fees

Tuition and fees deduction. Is the amount on line 5 more than $65,000 ($130,000 if married filing jointly)?

Enter the smaller of line 2, or $2,000.

Enter the smaller of line 2, or $4,000.

Also enter this amount on Form 1040, line 34, or Form 1040A, line 19.

}

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

Cat. No. 37728P

Form 8917 (2015)

Page 2

General Instructions

Section references are to the Internal Revenue Code unless otherwise noted.

Future Developments

For the latest information about developments related to Form 8917 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/form8917.

Purpose of Form

Use Form 8917 to figure and take the deduction for tuition and fees expenses paid in 2015.

This deduction is based on adjusted qualified education expenses paid to an eligible educational institution (postsecondary). See Qualified Education Expenses, later, for more information.

TIP

You may be able to take the American opportunity credit or lifetime learning credit for your education expenses instead of the tuition and fees deduction. See Form

8863, Education Credits, and Pub. 970, Tax Benefits for Education, for more information about these credits.

Who Can Take the Deduction

You may be able to take the deduction if you, your spouse, or a dependent you claim on your tax return was a student enrolled at or attending an eligible educational institution. The deduction is based on the amount of qualified education expenses you paid for the student in 2015 for academic periods beginning in 2015 or beginning in the first 3 months of 2016.

You cannot claim the tuition and fees deduction if any of the following apply.

• Your filing status is married filing separately.

• Another person can claim an exemption for you as a dependent on his or her tax return. You cannot take the deduction even if the other person does not actually claim that exemption.

• Your modified adjusted gross income (MAGI), as figured on line 5, is more than $80,000 ($160,000 if filing a joint return).

• You were a nonresident alien for any part of the year and did not elect to be treated as a resident alien for tax purposes. More information on nonresident aliens can be found in Pub. 519, U.S. Tax Guide for Aliens.

Qualified Education Expenses

Generally, qualified education expenses are amounts paid in 2015 for tuition and fees required for the student’s enrollment or attendance at an eligible educational institution. Required fees include amounts for books, supplies, and equipment used in a course of study if required to be paid to the institution as a condition of enrollment or attendance. It does not matter whether the expenses were paid in cash, by check, by credit or debit card, or with borrowed funds.

Qualified education expenses do not include amounts paid for:

• Personal expenses. This means room and board, insurance, medical expenses (including student health fees), transportation, and other similar personal, living, or family expenses.

• Any course or other education involving sports, games, or hobbies, or any noncredit course, unless such course or other education is part of the student's degree program or helps the student acquire or improve job skills.

Qualified education expenses do not include any expenses for which you take any other deduction, such as on Schedule A (Form 1040) or Schedule C (Form 1040).

Qualified education expenses paid directly to the institution by someone other than you or the student are treated as paid to the student and then paid by the student to the institution.

Academic Period

An academic period is any quarter, semester, trimester, or any other period of study as reasonably determined by an eligible educational institution. If an eligible educational institution uses credit hours or clock hours and does not have academic terms, each payment period may be treated as an academic period.

Prepaid Expenses

Qualified education expenses paid in 2015 for an academic period that begins in the first 3 months of 2016 can be used in figuring the tuition and fees deduction for 2015 only. See Academic Period, earlier. For example, if you pay $2,000 in December 2015 for qualified tuition for the 2016 winter quarter that begins in January 2016, you can use that $2,000 in figuring the tuition and fees deduction for 2015 only (if you meet all the other requirements).

▲

CAUTION

You cannot use any amount you paid in 2014 or 2016 to figure the qualified education expenses you use to figure your 2015 tuition and fees deduction.

Adjusted Qualified Education Expenses

For each student, reduce the qualified education expenses paid by or on behalf of that student under the following rules. The result is the amount of adjusted qualified education expenses for each student.

Tax-free educational assistance. For tax-free educational assistance received in 2015, reduce the qualified educational expenses for each academic period by the amount of tax-free educational assistance allocable to that academic period. See Academic Period, earlier.

Form 8917 (2015)

Page 3

Tax-free educational assistance includes:

1. The tax-free part of any scholarship or fellowship grant (including Pell grants),

2. The tax-free part of any employer-provided educational assistance,

3. Veterans' educational assistance, and

4. Any other educational assistance that is excludable from gross income (tax free), other than as a gift, bequest, devise, or inheritance.

TIP

You may be able to increase the combined value of your tuition and fees deduction and certain educational assistance if the student includes some or all of the

educational assistance in income in the year it is received. For details, see Adjustments to Qualified Education Expenses, in chapter 6 of Pub. 970.

• The scholarship or fellowship grant (or any part of it) must be applied (by its terms) to expenses (such as room and board) other than qualified education expenses as defined in Qualified education expenses in Pub. 970, chapter 1; or

• The scholarship or fellowship grant (or any part of it) may be applied (by its terms) to expenses (such as room and board) other than qualified education expenses as defined in Qualified education expenses in Pub. 970, chapter 1.

Tax-free educational assistance treated as a refund. Some tax-free educational assistance received after 2015 may be treated as a refund of qualified education expenses paid in 2015. This tax-free educational assistance is any tax-free educational assistance received by you or anyone else after 2015 for qualified education expenses paid on behalf of a student in 2015 (or attributable to enrollment at an eligible educational institution during 2015).

Refunds. A refund of qualified education expenses may reduce adjusted qualified education expenses for the tax year or may require you to include some or all of the refund in your gross income for the year the refund is received. See chapter 6 of Pub. 970 for more information. Some tax-free educational assistance received after 2015 may be treated as a refund. See Tax-free educational assistance treated as a refund, earlier.

Coordination with Coverdell education savings accounts and qualified tuition programs. Reduce your qualified education expenses by any qualified education expenses used to figure the exclusion from gross income of (a) interest received under an education savings bond program, or (b) any distribution from a Coverdell education savings account or qualified tuition program (QTP). For a QTP, this applies only to the amount of tax-free earnings that were distributed, not to the recovery of contributions to the program.

Eligible Educational Institution

An eligible educational institution is generally any accredited public, nonprofit, or proprietary (private) college, university, vocational school, or other postsecondary institution. Also, the institution must be eligible to participate in a student aid program administered by the Department of Education. Virtually all accredited postsecondary institutions meet this definition.

TIP

The educational institution should be able to tell you if it is an eligible institution.

Additional Information

See Pub. 970, chapter 6, for more information about the tuition and fees deduction.

Specific Instructions

Line 1

Complete columns (a) through (c) on line 1 for each student for whom you elect to take the tuition and fees deduction.

Note: If you have more than three students who qualify for the tuition and fees deduction, enter “See attached” next to line 1 and attach a statement with the required information for each additional student. Include the amounts from line 1, column (c), for all students in the total you enter on line 2.

Column (c)

For each student, enter the amount of adjusted qualified education expenses. The expenses must have been paid for the student in 2015 for academic periods beginning after 2014 but before April 1, 2016.

8.2.1.4029.1.523496.503679

2015 Form 8917

Tuition and Fees Deduction

SE:W:CAR:MP

f1_1: Magdalena Schmitz
f1_2: 294-83-2845
f1_3: Alyssa Schmitz
f1_4: 824-84-8546
f1_5: 8500
f1_6: 00
f1_7:
f1_8:
f1_9:
f1_10:
f1_11:
f1_12:
f1_13:
f1_14:
f1_15: 8500
f1_16: 00
f1_17: 63340
f1_18: 00
f1_19: 4914
f1_20: 00
f1_21: 58426
f1_22: 00
c1_01: No
f1_23: 4000
f1_24: 00