Form
(99)
1040 U.S. Individual Income Tax Return 2014
Department of the Treasury - Internal Revenue Service
For the year Jan. 1-Dec. 31, 2014, or other tax year beginning
Your first name and initial
OMB No. 1545-0074
, 2014, ending
IRS Use Only-Do not write or staple in this space.
See separate instructions.
, 20
Your social security number
Last name
MICHAEL
SAMUELSON
If a joint return, spouse's first name and initial
400-00-6004
Spouse's social security number
Last name
ELIZABETH
SAMUELSON
400-00-2073
Home address (number and street). If you have a P.O. box, see instructions
Apt. no.
Make sure the SSN(s) above
and on line 6c are correct.
219 PASADENA AVE
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Sacramento
CA
Foreign country name
Presidential Election Campaign
95841
Foreign province/state/county
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.
Foreign postal code
You
Filing
Status
Check only one
box.
1
2
Single
X
3
Exemptions
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
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above
and full name here.
.......... }
. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .
b
X
X
c
Dependents:
6a
Yourself. If someone can claim you as a dependent, do not check box 6a
Spouse
(1) First name
Last name
(3) Dependent's
relationship to you
(2) Dependent's
social security number
If more than four
Boxes checked
on 6a and 6b
No. of children
(4) Chk If child under on 6c who:
age 17 qualifying
lived with you
for child tax credit
(see instructions)
did not live with
you due to divorce
or separation
(see instructions)
dependents, see
check here
12
...............................
....................... 7
Wages, salaries, tips, etc. Attach Form(s) W-2
Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . 8a
Tax-exempt interest. Do not include on line 8a . . . . . . . 8b
. . . . . . . . . . . . . . . . . . . . . 9a
Ordinary dividends. Attach Schedule B if required
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . 9b
Qualified dividends
1,800
. . . . . . . . . . . . . 10
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
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
14
Other gains or (losses). Attach Form 4797
d
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
8a
b
9a
b
10
11
15a
16a
17
18
19
20a
Adjusted
Gross
Income
Total number of exemptions claimed
.........................
.
.
.
.
.
15a
b Taxable amount . . . . .
IRA distributions
.
.
16a
b Taxable amount . . . . .
Pensions and annuities
..
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
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..
Farm income or (loss). Attach Schedule F
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.
..
Unemployment compensation
.
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.
.
.
.
Social security benefits
20a
b Taxable amount
21
Other income
22
Combine the amounts in the far right column for lines 7 through 21. This is your total income
23
Reserved
24
Certain business expenses of reservists, performing artists, and
.........................
30
....
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
31a
Alimony paid b Recipient's SSN
32
IRA deduction
fee-basis government officials. Attach Form 2106 or 2106-EZ
25
26
27
28
29
33
34
35
36
37
....
Add numbers
on lines
above
2
82,500
1,417
2,500
13
14
15b
16b
17
18
19
20b
21
22
86,417
36
8,050
78,367
23
24
25
26
8,050
27
28
29
30
31a
. . . . . . . . . . . . . . . . . . . . . . . 32
Student loan interest deduction . . . . . . . . . . . . . . . 33
Reserved . . . . . . . . . . . . . . . . . . . . . . . . . 34
Domestic production activities deduction. Attach Form 8903 . 35
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.
EEA
2
Dependents on 6c
not entered above
instructions and
Income
Spouse
37
Form 1040 (2014)
Form 1040 (2014) MICHAEL
Tax and
Credits
Standard
Deduction
for People who
check any
box on line
39a or 39b or
who can be
claimed as a
dependent,
see
instructions.
All others:
Single or
Married filing
separately,
$6,200
Married filing
jointly or
Qualifying
widow(er),
$12,400
Head of
household,
$9,100
38
39a
b
a
Form(s) 8814
46
39b
b
Form 4972
c
12,400
65,967
7,900
58,067
7,534
40
41
42
43
44
45
46
47
7,534
1,660
5,874
61
. . . . . . . . . . . . . . . . . . . . 55
56
Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . .
Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . 57
a
Unreported social security and Medicare tax from Form:
4137 b
8919 . . . . 58
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . 59
Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . 60a
. . . . . . . . . . . . 60b
First-time homebuyer credit repayment. Attach Form 5405 if required
. . . . . . . 61
Health care: individual responsibility (see instructions) Full-year coverage
62
Taxes from: a
47
48
49
50
51
52
53
54
Other credits from Form: a
55
3800
b
54
c
8801
Add lines 48 through 54. These are your total credits
56
58
59
Form 8959
b
Form 8960 c
Instructions; enter code(s)
145
62
72
.....................
Federal income tax withheld from Forms W-2 and 1099 . . . . 64
11,850
65
2014 estimated tax payments and amount applied from 2013 return . . .
Earned income credit (EIC) . . . . . . . . . . . . . . . . . 66a
Nontaxable combat pay election . . . 66b
. . . . . . . 67
Additional child tax credit. Attach Schedule 8812
American opportunity credit from Form 8863, line 8 . . . . . . 68
Net premium tax credit. Attach Form 8962 . . . . . . . . . . . 69
Amount paid with request for extension to file . . . . . . . . . 70
Excess social security and tier 1 RRTA tax withheld . . . . . . 71
Credit for federal tax on fuels. Attach Form 4136 . . . . . . . 72
73
Credits from Form: a
74
Add lines 64, 65, 66a, and 67 through 73. These are your total payments
.......
74
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
64
66a
b
67
b
d
Add lines 56 through 62. This is your total tax
Routing number
Account number
2439 b
Reserved c
73
Reserved d
.
...
77
Amount of line 75 you want applied to your 2015 estimated tax
78
Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions
Estimated tax penalty (see instructions)
79
79
63
6,019
11,850
5,831
5,831
Savings
X X X X X X X X X c Type: Checking
X X X X X X X X X X X X X X X X X
77
78
...........
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete below.
Designee's
Phone
Personal identification
name
no.
number (PIN)
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
06004
02073
Date
Firm's name
Firm's address
No
Identity Protection PIN (see inst.)
Spouse's occupation
01-01-2015CLERK
Date
RICK K
Print/Type preparer's name
X
01-01-2015COMPUTER PROGRAMMER
Spouse's signature. If a joint return, both must sign.
Preparer's signature
EEA
39a
...............
Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . .
Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign tax credit. Attach Form 1116 if required . . . . . . . . 48
. . . 49
Credit for child and dependent care expenses. Attach Form 2441
.
.
.
.
.
.
.
.
. . . 50
Education credits from Form 8863, line 19
1,660
.
. . 51
Retirement savings contributions credit. Attach Form 8880
Child tax credit. Attach Schedule 8812, if required . . . . . . . 52
. . . . . . . . . 53
Residential energy credit. Attach Form 5695
71
Paid
Preparer
Use Only
...
Alternative minimum tax (see instructions). Attach Form 6251
70
Joint return? See
instructions.
Keep a copy for
your records.
If your spouse itemizes on a separate return or you were a dual-status alien, check here
45
69
Sign
Here
boxes
} Total
checked
Tax (see instructions). Check if any from:
68
Amount
You Owe
Third Party
Designee
Blind.
44
42
65
Direct deposit?
See
instructions.
Blind.
43
41
63
Refund
You were born before January 2, 1950,
Spouse was born before January 2, 1950,
Itemized deductions (from Schedule A) or your standard deduction (see left margin)
Subtract line 40 from line 38
b
If you have a
qualifying
child, attach
Schedule EIC.
{
400-00-6004 Page 2
38
78,367
........................
...
................................
Exemptions. If line 38 is $152,525 or less, multiply $3,950 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- . . . .
40
60 a
Payments
Check
if:
57
Other
Taxes
& ELIZABETH SAMUELSON
Amount from line 37 (adjusted gross income)
12-18-2014
RICK K
Drake Software
235 East Palmer Street
Franklin, NC 28734
Check
if
self-employed
Firm's EIN
Phone no.
PTIN
P12354678
11-1222333
828-524-8020
Form 1040 (2014)
Interest and Ordinary Dividends
SCHEDULE B
OMB No. 1545-0074
2014
(Form 1040A or 1040)
Attach to Form 1040A or 1040.
Department of the Treasury
Internal Revenue Service
(99)
Information about Schedule B and its instructions is at www.irs.gov/scheduleb.
MICHAEL & ELIZABETH SAMUELSON
1
Amount
this interest first. Also, show that buyer's social security number and address
ILLS FARGO BANK
ILLS FARGO BANK
KATTYBANK
TT AND B BANK
WAKO BANK
WAKO BANK
INTEREST SUBTOTAL
1,417
...............................
Add the amounts on line 1
3
Excludable interest on series EE and I U.S. savings bonds issued after 1989.
4
...................................
...................................
3
1,417
4
Amount
Note. If line 4 is over $1,500, you must complete Part III.
5
List name of payer
DOMINION RESOURCES
INFIDELITY INVESTMENT COMPANY
300
2,200
(See instructions
for Form 1040A,
or Form 1040,
line 9a.)
Part III
Foreign
Accounts
and Trusts
1,417
2
Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form
1040, line 8a
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.
259
99
35
194
410
420
1
2
Attach Form 8815
Part II
Ordinary
Dividends
400-00-6004
List name of payer. If any interest is from a seller-financed mortgage and the
buyer used the property as a personal residence, see instructions and list
(See 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.
08
Your social security number
Name(s) shown on return
Part I
Interest
Attachment
Sequence No.
5
DIVIDEND SUBTOTAL
6
2,500
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.
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.
7a
2,500
Yes
No
At any time during 2014, 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
(See
instructions.)
.........................................
X
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
..............
X
If you are required to file FinCEN Form 114, enter the name of the foreign country where the
financial account is located
8
During 2014, 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
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
..................
X
Schedule B (Form 1040A or 1040) 2014
Form
3903
Moving Expenses
OMB No. 1545-0074
170
Your social security number
Name(s) shown on return
MICHAEL & ELIZABETH SAMUELSON
Before you begin:
400-00-6004
See the Distance Test and Time Test in the instructions to find out if you can deduct your moving
expenses.
See Members of the Armed Forces in the instructions, if applicable.
......
Transportation and storage of household goods and personal effects (see instructions)
Travel (including lodging) from your old home to your new home (see instructions). Do not
.........................................
include the cost of meals
1
7,250
2
800
..............................................
3
8,050
3
Add lines 1 and 2
4
Enter the total amount your employer paid you for the expenses listed on lines 1 and 2 that is
not included in box 1 of your Form W-2 (wages). This amount should be shown in box 12 of your
.......................................
Form W-2 with code P
5
Attachment
Sequence No.
Attach to Form 1040 or Form 1040NR.
Internal Revenue Service (99)
1
2
2014
Information about Form 3903 and its instructions is available at www.irs.gov/form3903.
Department of the Treasury
...
4
Is line 3 more than line 4?
No. You cannot deduct your moving expenses. If line 3 is less than line 4, subtract line 3
from line 4 and include the result on Form 1040, line 7, or Form 1040NR, line 8.
X Yes. Subtract line 4 from line 3. Enter the result here and on Form 1040, line 26, or Form
1040NR, line 26. This is your moving expense deduction
General Instructions
Future Developments
For the latest information about developments
related to Form 3903 and its instructions, such as
legislation enacted after they were published, go
to www.irs.gov/form3903.
What's New
For 2014, the standard mileage rate for
using your vehicle to move to a new home
is 23.5 cents a mile.
..................
Moving Expenses You Can
Deduct
You can deduct the reasonable expenses
of moving your household goods and
personal effects and of traveling from your
old home to your new home. Reasonable
expenses can include the cost of lodging
(but not meals) while traveling to your new
home. You cannot deduct the cost of
sightseeing trips.
Purpose of Form
Use Form 3903 to figure your moving
expense deduction for a move related to
the start of work at a new principal place
of work (workplace). If the new workplace
is outside the United States or its
possessions, you must be a U.S. citizen or
resident alien to deduct your expenses.
If you qualify to deduct expenses for
more than one move, use a separate Form
3903 for each move.
For more details, see Pub. 521, Moving
Expenses.
Who Can Deduct Moving
Expenses
If you move to a new home because of a
new principal workplace, you may be able
to deduct your moving expenses whether
you are self-employed or an employee. But
you must meet both the distance and time tests
that follow. Also, your move must be closely
related both in time and place to the start of
work at your new job location. For more details,
see Pub. 521.
TIP
8,050
5
Members of the Armed Forces
may not have to meet the distance
and time tests. See Members of the
Armed Forces later in the instructions.
Distance Test
Your new principal workplace must be at
least 50 miles farther from your old home
than your old workplace was. For example,
if your old workplace was 3 miles from
your old home, your new workplace must
be at least 53 miles from that home. If you
did not have an old workplace, your new
workplace must be at least 50 miles from
your old home. The distance between the
two points is the shortest of the more
commonly traveled routes between them.
TIP
Distance Test Worksheet
To see if you meet the
distance test, you can
use the worksheet
below.
Keep a Copy for Your Records
1. Number of miles from your old home to your new workplace
. . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2,350
miles
2. Number of miles from your old home to your old workplace
. . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
5
miles
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 2,345
miles
3. Subtract line 2 from line 1. If zero or less, enter -0Is line 3 at least 50 miles?
X
Yes. You meet this test.
No. You do not meet this test. You cannot deduct your moving expenses. Do not complete Form 3903.
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
Form 3903 (2014)
Form
Education Credits
(American Opportunity and Lifetime Learning Credits)
8863
Department of the Treasury
Internal Revenue Service
(99)
Attachment
Sequence No.
Information about Form 8863 and its separate instructions is at www.irs.gov/form8863.
50
Your social security number
MICHAEL & ELIZABETH SAMUELSON
400-00-6004
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.
CAUTION!
Refundable American Opportunity Credit
1
After completing Part III for each student, enter the total of all amounts from all Parts III, line 30
2
Enter: $180,000 if married filing jointly; $90,000 if single, head of
household, or qualifying widow(er)
3
2014
Attach to Form 1040 or Form 1040A.
Name(s) shown on return
Part I
OMB No. 1545-0074
........................
........
2
180,000
3
78,367
4
101,633
5
20,000
1
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
4
Subtract line 3 from line 2. If zero or less, stop; you cannot take any
education credit
5
.................................
Enter: $20,000 if married filing jointly; $10,000 if single, head of household,
or qualifying widow(er)
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)
...................................
7
6
1.000
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
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
Part II
9
10
............
...................
8
.......
9
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
12
......................
.
.
.
.
.
.
.
.
.
.
.
.
.
.
......................
Enter the smaller of line 10 or $10,000
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
......................
Multiply line 11 by 20% (.20)
13
Enter: $128,000 if married filing jointly; $64,000 if single, head of
zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19
11
household, or qualifying widow(er)
14
7
........................
13
128,000
14
78,367
15
49,633
16
20,000
10
11
12
8,300
8,300
1,660
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
15
Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0on line 18, and go to line 19
16
...........................
Enter: $20,000 if married filing jointly; $10,000 if single, head of household,
or qualifying widow(er)
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
18
.................................................
Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) . . . . .
19
Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see
places)
instructions) here and on Form 1040, line 50, or Form 1040A, line 33
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
.....................
17
18
19
1.000
1,660
1,660
Form 8863 (2014)
Form 8863 (2014)
Page 2
Your social security number
Name(s) shown on return
MICHAEL & ELIZABETH SAMUELSON
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.
CAUTION!
Part III
400-00-6004
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)
ELIZABETH SAMUELSON
400-00-2073
22 Educational institution information (see instructions)
a. Name of first educational institution
b. Name of second educational institution (if any)
UNIVERSITY OF NURSING
(1)
(1) Address. Number and street (or P.O. box). City, town or post
office, state, and ZIP code. If a foreign address, see instructions.
Address. Number and street (or P.O. box). City, town or post
office, state, and ZIP code. If a foreign address, see instructions.
99 EAST PALMER STREET
Sacramento, CA 95841
(2)
Did the student receive Form 1098-T
from this institution for 2014?
(3)
Yes
X
No
Yes
X
No
(2) Did the student receive Form 1098-T
from this institution for 2014?
Did the student receive Form 1098-T
from this institution for 2013 with Box
No
Yes
No
(3) Did the student receive Form 1098-T
from this institution for 2013 with Box
2 filled in and Box 7 checked?
If you checked "No" in both (2) and (3), skip (4).
(4)
Yes
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
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 2014?
federal identification number (from Form 1098-T).
X
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 2014
at an eligible educational institution in a program leading towards
Yes - Go to line 25.
No - Stop! Go to line 31
a postsecondary degree, certificate, or other recognized
for this student.
postsecondary educational credential? (see instructions)
25 Did the student complete the first 4 years of post-secondary
education before 2014?
Yes - Stop!
Go to line 31 for this
No - Go to line 26.
student.
26 Was the student convicted, before the end of 2014, of a
Yes - Stop!
felony for possession or distribution of a controlled
Go to line 31 for this
substance?
student.
TIP
No - Complete lines 27
through 30 for this student.
You cannot take the American opportunity credit and 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
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . . . . . . 28
Subtract $2,000 from line 27. If zero or less, enter -0.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . . . . . . 29
Multiply line 28 by 25% (.25)
27 Adjusted qualified education expenses (see instructions). Do not enter more than $4,000
28
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
EEA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
8,300
Form 8863 (2014)
Form
IRS e-file Signature Authorization
8879
Department of the Treasury
Internal Revenue Service
Submission Identification Number (SID)
Social security number
MICHAEL SAMUELSON
400-00-6004
Spouse's social security number
Spouse's name
ELIZABETH SAMUELSON
1
2
3
4
5
2014
00-777777-060045
Taxpayer's name
Part I
OMB No. 1545-0074
Do not send to the IRS. This is not a tax return.
Keep this form for your records.
Information about Form 8879 and its instructions is at www.irs.gov/form8879.
400-00-2073
Tax Return Information - Tax Year Ending December 31, 2014
(Whole Dollars Only)
............
.
.
.
.
.
.
.
............
Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12)
Federal income tax withheld (Form 1040, line 64; Form 1040A, line 40; Form 1040EZ, line 7) . . . . . . . . . .
..
Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a)
.
.
.
.
.
.
.
.
.
.
.
.
.
..
Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14)
Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4)
Part II
1
2
3
4
78,367
6,019
11,850
5,831
5
Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements
for the tax year ending December 31, 2014, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts
in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return
originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the
reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S Treasury and its designated Financial
Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment
of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to
remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S.
Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement)
date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidenital information necessary to
answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my
electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent.
Taxpayer's PIN: check one box only
X
I authorize
Drake Software
to enter or generate my PIN
ERO firm name
06004
Enter five digits, but do
as my signature on my tax year 2014 electronically filed income tax return.
not enter all zeros
I will enter my PIN as my signature on my tax year 2014 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Your signature
Date
Spouse's PIN: check one box only
X
I authorize
Drake Software
to enter or generate my PIN
ERO firm name
as my signature on my tax year 2014 electronically filed income tax return.
02073
Enter five digits, but do
not enter all zeros
I will enter my PIN as my signature on my tax year 2014 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Spouse's signature
Date
Practitioner PIN Method Returns Only - continue below
Part III
Certification and Authentication - Practitioner PIN Method Only
ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
777777-12345
Do not enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2014 electronically filed income tax return for
the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN
method and Publication 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO's signature
RICK K
Date
12-18-2014
ERO Must Retain This Form - See Instructions
Do Not Submit This Form to the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see your tax return instructions.
EEA
Form 8879 (2014)
Department of the Treasury - Internal Revenue Service
9325
Form
(Rev. January 2014)
Acknowledgement and General Information for
Taxpayers Who File Returns Electronically
Thank you for participating in IRS e-file.
Taxpayer name
MICHAEL & ELIZABETH SAMUELSON
Taxpayer address (optional)
219 PASADENA AVE
Sacramento, CA 95841
1.
X
2014
Your federal income tax return for
2.
Your return was accepted on
FRESNO
Drake Software
was filed electronically with the
Submission Processing Center. The electronic filing services were provided by
.
using a Personal Identification Number (PIN) as your electronic
signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN
for you. The Submission ID assigned to your return is
3.
Your return was accepted on
.
. Allow 4 to 6 weeks for the processing of your return.
The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a
child's name and social security number mismatch.
4.
Your electronic funds withdrawal payment was accepted.
5.
Your electronic funds withdrawal payment was not accepted. You must pay the balance due by the prescribed
due date. Refer to the "If You Owe Tax" section.
6.
Your Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, was
accepted on
is
. The Submission ID assigned to your extension
.
PLEASE DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS.
IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN.
If You Need to Make a Change to Your Return
If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S.
Individual Income Tax Return, to the IRS Submission Processing Center that processes paper returns for your area. The
address is available at www.irs.gov, or you can call the IRS toll-free at 1-800-829-1040.
If You Need to Ask About Your Refund
The IRS notifies your Electronic Return Originator (ERO) when your return is accepted, usually within 48 hours. If your
return was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks
since the IRS accepted your return and you have not received your refund, go to www.irs.gov and click on "Where's My
Refund?" to view your refund status. Exception: If box 3 above is checked, please allow 4 to 6 weeks for processing of your
return. A notice will be sent to you advising of changes to your return.
Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the
first social security number shown on your return, your filing status, and the exact amount of the refund you expect.
TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of
the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive it by then, or if
TeleTax does not give your refund information, call the Refund Hotline at 1-800-829-1954.
EEA
Form 9325 (Rev. 1-2014)
The IRS uses refunds to cover overdue taxes and notifies you when this occurs. The Fiscal Service offsets refunds
through the Treasury Offset Program to cover past due child support, federal agency non-tax debts such as student loans
and state income tax obligations. Fiscal Service sends you an offset notice if it applies your refund or part of your refund
to non-tax debts. If you have questions about the offset, contact the agency identified in the notice. You may also call the
Treasury Offset Program Call Center at 1-800-304-3107, if you have additional questions.
If You Owe Tax
If your return has a balance due, you must pay the amount you owe by the prescribed due date. If you paid by electronic
funds withdrawal (direct debit) or by credit card, no voucher is needed. The credit card service providers will charge a
convenience fee based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted
may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option
to either continue or end the transaction. For information on paying your taxes electronically, including by credit or debit
card, go to www.irs.gov/e-pay.
If you are not paying electronically you may use Form 1040-V, Payment Voucher, which you can obtain from your
Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a
notice that requests full payment of the tax due, plus penalties and interest. If you can not pay the amount in full, complete
Form 9465, Installment Agreement Request, which you may file electronically. To apply for an installment agreement
online, go to www.irs.gov. You may also order Form 9465 by calling 1-800-TAX-FORM (1-800-829-3676). If approved, the
IRS charges a user fee to set up an installment agreement.
If You Need to Inquire About Your Electronic Funds Withdrawal Payment
You may call 1-888-353-4537 to inquire about the status of your electronic funds withdrawal payment. If there is a change
to the bank account information included on your return, you should call this number to cancel a scheduled payment. You
should have available the social security number of the first person listed on the tax return, the payment amount, and the
bank account number. Cancellation requests must be received no later than 11:59 p.m. E.T. two business days prior to
the scheduled payment date.
Tax Refund Related Financial Products
Financial institutions offer a variety of financial products to taxpayers based on their refunds. Contracts for financial
products are between you and the financial institution. The IRS is not associated with the contract. If you have questions
about tax refund related products, contact your Electronic Return Originator or the lender.
Instructions for Electronic Return Originators
Line 2 - PIN Presence Indicator - Check box 2 if the taxpayer entered a PIN or authorized the ERO to enter or generate
the PIN for the taxpayer, and the Acknowledgement File PIN Presence Indicator is a "Practitioner PIN," "Self-Select PIN"
or "Online Filer PIN." Form 8879, IRS e-file Signature Authorization, is required if the ERO enters or generates the PIN or
if the Practitioner PIN method is used. Use Form 8453, U.S. Individual Income Tax Transmittal for an IRS e-file
Return, to send required paper forms or supporting documentation listed next to the form check boxes (do not
send Forms W-2, W-2G, or 1099R).
Line 3 - Exception Processing - Check box 3 if the Acknowledgement File Acceptance Code equals "Exception." The
acceptance code indicates that this return has been previously rejected and this subsequent submission still has invalid
data.
Line 4 - Payment Acknowledgement Literal - Check box 4 if the taxpayer requested to use electronic funds withdrawal to
pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field equals "Payment Request
Received."
Line 5 - Payment Acknowledgement Literal - Check box 5 if the taxpayer requested to use electronic funds withdrawal to
pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field does not equal "Payment
Request Received." If box 5 is checked, inform the taxpayer that he/she must pay by check, money order, debit card, or
credit card.
Note: EROs can use the Acknowledgement File information, translated by the transmitter, to complete Form 9325.
MICHAEL & ELIZABETH SAMUELSON
EEA
Form 9325 (Rev. 1-2014)
Shared Responsibility Payment Worksheet
2014
Name as shown on return
Social Security Number
MICHAEL SAMUELSON
400-00-6004
If you or another member of your tax household had neither minimum essential coverage nor a coverage exemption for any month
during 2014, use the Shared Responsibility Payment Worksheet, below, to figure your shared responsibility payment. You will enter
the amount from line 14 of the worksheet on Form 1040, line 61; Form 1040A, line 38; or Form 1040EZ, line 11.
Complete the monthly columns by placing "X's" in each month in which you or another member of your tax household had neither
minimum essential coverage nor a coverage exemption.
Name
Jan
Feb
Mar
Apr
May
Jun
X
X
X
X
X
X
MICHAEL SAMUELS
ELIZABETH SAMUE
Jul
Aug
Sep
Oct
Nov
Dec
1. Total number of X's in a
month. If 5 or more,
enter 5
.......
0
0
0
2
2
2
0
0
0
0
0
0
0
0
0
2
2
2
0
0
0
0
0
0
2. Total number of X's in a
month for individuals 18 or
over*
........
3. One-half the number of X's
in a month for individuals
under 18*
......
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.0
2.0
2.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0 190.0 190.0 190.0
0.0
0.0
0.0
0.0
0.0
0.0
4. Add lines 2 and 3 for each
month
.......
5. Multiply line 4 by $95 for
each month. If $285 or
more, enter $285
...
................................
6
Enter your household income (see Household income) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
78,367.00
. . . . . . . . . . . . . . . . . . . . . . . . . . 20,300.00
Enter your filing threshold (see Filing Thresholds For Most People)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . . . . . . . . . . . . . . . . . . . . . 58,067.00
Subtract line 8 from line 7
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
..........................
Multiply line 9 by 1% (.01)
580.67
6. Sum of the number of X's on line 1 above for the year
7.
8.
9.
10.
11. Is line 10 more than $285?
X
Yes. Multiply line 10 by the number of months for which line 1 is more than zero
No. Enter the amount from line 14 of the Flat Dollar Amount Worksheet
12. Divide line 11 by 12.0
13. Multiply line 6 by $204
} ................
................................................
................................................
1,742.01
145.17
1,224.00
14. Enter the smaller of line 12 or line 13 here and on Form 1040, line 61; Form 1040A, line 38; or Form
1040EZ, line 11. This is your shared responsibility payment
.............................
Rounded amount will carry to main form
145.17
145
*For purposes of figuring the shared responsibility payment, an individual is considered under 18 for an entire month if he or she did not turn 18
before the first day of the month. An individual turns 18 on the anniversary of the day the individual was born. For example, someone born on
March 1, 1999, is considered age 18 on March 1, 2017.
WK_89651.LD
EEA
Flat Dollar Amount Worksheet and
Household Income Worksheets for Form 8965
2014
(Keep for your records)
Name as shown on return
Social Security Number
MICHAEL SAMUELSON
400-00-6004
Flat Dollar Amount Worksheet
!
CAUTION
Do not complete this worksheet unless the amount on line 10 of the Shared Responsibility Payment Worksheet is less
than $285.
For each month, is the amount on line 5 of the Shared Responsibility Payment Worksheet
less than the amount on line 10 of the Shared Responsibility Payment Worksheet?*
1.
............................................
February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add the amounts in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Enter the amount
Enter the amount
from line 10
from line 5
January
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14. Add the amounts on line 13 of both columns. Enter the result on line 11 of the Shared
Responsibility Payment Worksheet
..........................................
*If the amount on line 1 of the Shared Responsibility Payment Worksheet is -0- for any month, leave both columns of this worksheet blank for that
month.
Household Income Worksheet
...
1.
78,367
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
Amount from Dependents' Combined Modified AGI Worksheet, line 5 . . . . . . . . . . . . . . . . . . . . . . . . 6.
Household income. Add lines 1, 5, and 6. Enter here and on the Shared Responsibility Payment Worksheet, line 7 . . 7.
0
78,367
. . . . . . . . . . . . . . . . 8.
....................
Household income for computing Coverage Exemption A. Add lines 7 and 8.
78,367
1. Enter your adjusted gross income (AGI) from Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 37
2. Enter any tax-exempt interest from Form 1040, line 8b; Form 1040A, line 8b; or
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
. . . . . 3.
Enter any amounts from Form 2555, lines 45 and 50, and Form 2555-EZ, line 18
Form 1040NR, line 9b
3.
4.
4.
5. Modified AGI. Add lines 2 through 4.
6.
7.
8. Premiums paid through a salary reduction arrangement
9.
9.
Dependents' Combined Modified AGI Worksheet - Line 2b
1. Enter the AGI for your dependents from Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 3; and
Form 1040NR, line 37
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. Enter any tax-exempt interest for your dependents from Form 1040, line 8b; Form 1040A,
line 8b; Form 1040EZ, the amount written to the left of the line 2 entry space; and
Form 1040NR, line 9b
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Enter any amounts for your dependents from Form 2555, lines 45 and 50, and
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.
Add lines 2 and 3
Add lines 1 and 4. Enter here and on Household Income Worksheet, line 6 . . . . . . . . . . . . . . . . . . . . . 5.
Form 2555-EZ, line 18
4.
5.
The FILING THRESHOLD for this return is
WK_89652.LD
EEA
...................................
20,300
2014
Credit Limit Worksheet
Name
SSN
MICHAEL & ELIZABETH SAMUELSON
400-00-6004
. . . . . . 1.
7,534
.
.
. . . . . . 2.
Foreign tax credit amount from Form 1040, line 48 or Form 1040NR line 46
. . . . . . . . . . . . . . . . .. .
Subtract line 2 from line 1. Enter this amount on Form 2441, line 10
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . . 4.
Amount from Form 2441, line 11
.
.................
Subtract line 4 from line 3. Enter this amount on Schedule R, line 21
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . 6.
Amount from Schedule R, line 22
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
7.
Enter amount from Form 8863, line 18
1,660
Subtract line 6 from line 5 . . . . . . . . . . . . . . . . . . . . . 8.
7,534
1. Amount from Form 1040, line 47; Form 1040A, line 30; or Form 1040NR line 45
2.
3.
4.
5.
6.
7.
8.
3.
7,534
5.
7,534
9. Enter the smaller of line 7 or line 8. Nonrefundable lifetime
. . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
Enter amount from Form 8863, line 9 . . . . . . . . . . . . . . . . 10.
Subtract line 9 from line 8. . . . . . . . . . . . . . . . . . . . . . 11.
learning credit
10.
11.
1,660
5,874
12. Enter the smaller of line 10 or line 11. Nonrefundable American
. . . . . . . . . . . . . . . . . . . . . . . . .12.
Add line 9 and line 12. Enter this amount on Form 8863, line 23 . . . . . . . . . . . . . . . . . . . . . . . 13.
. . . . . . . . . . . . . . . . . . . . 14.
Subtract line 13 from line 8. Enter this amount on Form 8880, line 11
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . . . .15.
Amount from Form 8880, line 12
.
. . . . . . . . . . . . . . . . . . . 16.
Subtract line 15 from line 14. Enter this amount on Form 5695, line 13
.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
.
. . . . . . . .17.
Amount from Form 5695, line 14
.
.
. . . . . . . . . . . . . . . . . . 18.
Subtract line 17 from line 16. Enter this amount on Form 8834, line 22
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
. . . . . . .19.
Amount from Form 8834, line 23
.
.
.
. . . . . . . . . . . . . . . . . 20.
Subtract line 19 from line 18. Enter this amount on Form 8910, line 21
.
.
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.
.
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.
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.
.
. . . . . .21.
Amount from Form 8910, line 22
.
.
.
.
. . . . . . . . . . . . . . . . 22.
Subtract line 21 from line 20. Enter this amount on Form 8936, line 14
.
.
.
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.
.
.
.
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.
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. . . . .23.
Amount from Form 8936, line 15
.
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.
.
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.
.
.
.
.
.
.
.
.
.
. . . .24.
Amount from Line 12 of WK_8812.PG2
.
.
. . . . . . . . . . . . . . 25.
Subtract lines 23 and 24 from line 22. Enter this amount on Form 8396, line 8
.
.
.
.
.
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.
.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
.
. . .26.
Amount from Form 8396, line 10
.
.
.
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.
.
.
.
.
.
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.
.
.
.
.
.
.
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.
.
. . .27.
Subtract line 26 from line 25
5,874
.
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.
.
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.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. .28.
Amount from Form 8839, line 14
. . . . . . 29.
Enter the smaller of line 27 or line 28. Enter this amount on Form 8839, line 12
.
.
.
. . . . . . . . . . . . . . . . . 30.
Subtract line 29 from line 27. Enter this amount on Form 8859, line 8
Opportunity credit
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
CRED_LMT.LD
1,660
5,874
5,874
5,874
5,874
5,874
5,874
5,874
a
b
Safe, accurate,
FAST! Use
Employee's social security number
400-00-6004
OMB No. 1545-0008
1
Employer identification number (EIN)
Wages, tips, other compensation
61-9514555
c
3
Social security wages
5
Medicare wages and tips
7
Social security tips
MAYFLOWER TECHNOLOGIES
e
Employee's first name and initial
MICHAEL
2
Federal income tax withheld
4
Social security tax withheld
6
Medicare tax withheld
8
Allocated tips
8,500
55,000
1522 CAPITAL BLVD
Raleigh
Control number
Visit the IRS website at
www.irs.gov/efile
55,000
Employer's name, address, and ZIP code
d
IRS e-file
3,410
55,000
NC
27604
9
Last name
Suff.
SAMUELSON
219 PASADENA AVE
Sacramento
11
13
10
Statutory
employee
Dependent care benefits
12a See instructions for box 12
Nonqualified plans
C
o
d
e
Retirement
plan
Third-party
sick pay
12b
C
o
d
e
12c
14 Other
CA
798
C
o
d
e
95841
12d
C
o
d
e
f
Employee's address and ZIP code
15 State
Form
16 State wages, tips, etc.
Employer's state ID number
17
State income tax
18 Local wages, tips, etc.
2014
and Tax
W-2 Wage
Statement
19 Local income tax
20
Locality name
Department of the Treasury-Internal Revenue Service
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
EEA
The information on the Form W-2 was used to prepare the taxpayer's 2014 Federal tax return by Drake Software
a Employee's social security number
Safe, accurate,
Visit the IRS website at
400-00-6004
b
1
Employer identification number (EIN)
Wages, tips, other compensation
95-9596543
c
3
Social security wages
5
Medicare wages and tips
7
Social security tips
SMT SOLUTIONS INC
e
Employee's first name and initial
MICHAEL
2
Federal income tax withheld
4
Social security tax withheld
6
Medicare tax withheld
8
Allocated tips
2,500
19,500
9150EMBERS BLVD
Sacramento
Control number
www.irs.gov/efile
19,500
Employer's name, address, and ZIP code
d
IRS e-file
FAST! Use
OMB No. 1545-0008
1,209
19,500
CA
95841
9
Last name
Suff.
SAMUELSON
219 PASADENA AVE
Sacramento
11
13
10
Statutory
employee
Retirement
plan
95841
Dependent care benefits
12a See instructions for box 12
Nonqualified plans
14 Other
CA
283
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f
Employee's address and ZIP code
15 State
Form
Employer's state ID number
16 State wages, tips, etc.
and Tax
W-2 Wage
Statement
17
State income tax
2014
18 Local wages, tips, etc.
19 Local income tax
20
Locality name
Department of the Treasury-Internal Revenue Service
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
EEA
The information on the Form W-2 was used to prepare the taxpayer's 2014 Federal tax return by Drake Software
a
b
Safe, accurate,
FAST! Use
Employee's social security number
400-00-2073
OMB No. 1545-0008
1
Employer identification number (EIN)
Wages, tips, other compensation
14-8871749
c
3
Social security wages
5
Medicare wages and tips
7
Social security tips
CERTIFIED PEST CONTROL
e
Employee's first name and initial
ELIZABETH
2
Federal income tax withheld
4
Social security tax withheld
6
Medicare tax withheld
8
Allocated tips
850
8,000
9100 MADISON AVE
Sacramento
Control number
Visit the IRS website at
www.irs.gov/efile
8,000
Employer's name, address, and ZIP code
d
IRS e-file
496
8,000
CA
95841
9
Last name
Suff.
SAMUELSON
219 PASADENA AVE
Sacramento
11
13
10
Statutory
employee
Retirement
plan
95841
Dependent care benefits
12a See instructions for box 12
Nonqualified plans
14 Other
CA
116
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f
Employee's address and ZIP code
15 State
Form
Employer's state ID number
16 State wages, tips, etc.
and Tax
W-2 Wage
Statement
17
State income tax
2014
18 Local wages, tips, etc.
19 Local income tax
20
Locality name
Department of the Treasury-Internal Revenue Service
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
EEA
The information on the Form W-2 was used to prepare the taxpayer's 2014 Federal tax return by Drake Software
Qualified Dividends and Capital Gain Tax Worksheet - Line 44 (Form 1040)
Line 28 (Form 1040A)
(Keep for Your Records)
NAME
SSN
MICHAEL & ELIZABETH SAMUELSON
Before you begin:
400-00-6004
See the instructions for line 44 to see if you can use this worksheet to figure your tax.
Before completing this worksheet, complete Form 1040 through line 43.
If you do not have to file Schedule D and you received capital gain distributions, be sure
you checked the box on line 13 of Form 1040.
1. Enter the amount from Form 1040, line 43 (Form 1040A, line 27). However, if you are filing Form
2555 or 2555-EZ (relating to foreign earned income), enter the amount from
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
Enter the amount from Form 1040, line 9b (Form 1040A, line 9b)* . . . . . . . . . . . . . . . . . . . . . . . 2.
line 3 of the Foreign Earned Income Tax Worksheet
2.
58,067
1,800
3. Are you filing Schedule D?*
Yes. Enter the smaller of line 15 or 16 of Schedule D. If either
.............
line 15 or line 16 is blank or a loss, enter -0-
X
No.
3.
Enter the amount from Form 1040, line 13 (or Form 1040A, line 10)
4. Add lines 2 and 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
1,800
5. If filing Form 4952 (used to figure investment interest expense deduction),
. . . . . . . . . . . . . . . . . . . . . . . 5.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
enter any amount from line 4g of that form. Otherwise, enter -06. Subtract line 5 from line 4. If zero or less, enter -07. Subtract line 6 from line 1. If zero or less, enter -0-
1,800
56,267
8. Enter:
$36,900 if single or married filing separately,
......................
8.
73,800
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
Enter the smaller of line 7 or line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10.
Subtract line 10 from line 9. This amount is taxed at 0% . . . . . . . . . . . . . . . . . . . . . . . . . . . .11.
Enter the smaller of line 1 or line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12.
Enter the amount from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13.
Subtract line 13 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14.
58,067
56,267
1,800
1,800
1,800
$73,800 if married filing jointly or qualifying widow(er),
$49,400 if head of household.
9. Enter the smaller of line 1 or line 8
10.
11.
12.
13.
14.
15. Enter:
$406,750 is single,
$228,800 if married filing separately,
. . . . . . . . . . . . . . . . . . . . . . 15.
450,000
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16.
.
.
.
.
.
.
.
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17.
Add lines 7 and 11
Subtract line 17 from line 16. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18.
Enter the smaller of line 14 or line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19.
Multiply line 19 by 15% (.15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20.
Add lines 11 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21.
Subtract line 21 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22.
Multiply line 22 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23.
58,067
58,067
$457,600 if married filing jointly or qualifying widow(er),
$432,200 if head of household.
16. Enter the smaller of line 1 or line 15
17.
18.
19.
20.
21.
22.
23.
1,800
24. Figure the tax on the amount on line 7. If the amount on line 7 is less than $100,000, use the Tax Table
. . . . . . 24.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25.
to figure this tax. If the amount on line 7 is $100,000 or more, use the Tax Computation Worksheet
25. Add lines 20, 23 and 24
26. Figure the tax on the amount on line 1. If the amount on line 1 is less than $100,000, use the Tax Table
to figure the tax. If the amount on line 1 is $100,000 or more, use the Tax Computation Worksheet
. . . . . . 26.
7,534
7,534
7,804
27. Tax on all taxable income. Enter the smaller of line 25 or line 26. Also include this amount on Form
1040, line 44 (Form 1040A, line 28). If you are filing Form 2555 or 2555-EZ, do not enter this amount on Form
1040, line 44 (or Form 1040A, line 28). Instead, enter it on line 4 of the Foreign Earned Income Tax Worksheet
. 27.
*If you are filing Form 2555 or 2555-EZ, see the footnote in the Foreign Earned Income Tax Worksheet before completing this line.
WK_CGTAX.LD
EEA
7,534
Investment Income If You
Are Filing Form 1040
FORM 1040
2014
Name as shown on return
Your Social Security Number
MICHAEL & ELIZABETH SAMUELSON
400-00-6004
Keep for Your Records
Interest and Dividends
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
. . . . . . . . . . . . . . . 2.
Enter any amount from Form 1040, line 8b, plus any amount on Form 8814, line 1b
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
. . . . . . . . . . . . . . . 3.
Enter any amount from Form 1040, line 9a
1. Enter any amount from Form 1040, line 8a
2.
3.
1,417
2,500
4. Enter the amount from Form 1040, line 21, that is from Form 8814 if you are filing that form to report
your child's interest and dividend income on your return. (If your child received an Alaska Permanent
Fund dividend, use Worksheet 2, on the next page, to figure the amount to enter on this line.)
..........
4.
Capital Gain Net Income
5. Enter the amount from Form 1040, line 13. If the amount on that line is a
loss, enter -0-
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Enter any gain from Form 4797, Sales of Business Property, line 7. If the
amount on that line is a loss, enter -0-. (But, if you completed lines 8 and
9 of Form 4797, enter the amount from line 9 instead.)
. . . . . . . . . . . . . . . . 6.
7. Subtract line 6 of this worksheet from line 5 of this worksheet. (If the result is less than zero,
enter -0-.)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7.
Royalties and Rental Income from Personal Property
8. Enter any royalty income from Schedule E, line 4, plus any income from the
rental of personal property shown on Form 1040, line 21, minus any expenses
from Schedule E, line 20, related to royalty income, plus any expenses from
the rental of personal property deducted on Form 1040, line 36 of personal
property deducted on Form 1040, line 36 (If the result is less than zero, enter -0-.)
...............
8.
Passive Activities
9. Enter the total of any net income from passive activities (such as income
included on Schedule E, lines 26, 29a (col. (g)), 34a (col. (d)), or 40) and the
total of any losses from passive activities (included on Schedule E, lines
26, 29b (col. (f)), 34b (col. (c)), or 40). (See instructions below for line 9.)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
Adjustment from EIC screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10.
. . . . . . 11.
Add the amounts on lines 1, 2, 3, 4, 7, 8, 9 and 10. Enter the total. This is your Investment Income
(if zero or less, enter -0-.)
10.
11.
12. Is the amount on line 11 more than $3,300?
X
Yes. You cannot take the credit.
No. Go to Step 3 of the Form 1040 instructions for lines 64a and 64b to find out if you can take
the credit (unless you are using this publication to find out if you can take the credit; in that case, go
to Rule 7, next).
Instructions for line 9. In figuring the amount to enter on line 9, do not take into account any royalty income (or loss)
included on line 26 of Schedule E or any amount included in your earned income. To find out if the income on line 26 or line 40 of
Schedule E is from a passive activity, see the Schedule E instructions. If any of the rental real estate income (or loss) included on
Schedule E, line 26, is not from a passive activity, print "NPA" and the amount of that income (or loss) on the dotted line next to line 26.
WK_EIC4_.LD
EEA
0
3,917
W-2 Detail Listing
2014
Name(s) as shown on return
Social Security No.
MICHAEL & ELIZABETH SAMUELSON
400-00-6004
FEDERAL
T/S
Employer Name
Gross
W/H
STATE
State Code
Gross
W/H
T MAYFLOWER TECHNOLOGIES
55,000
8,500
T SMT SOLUTIONS INC
19,500
2,500
S CERTIFIED PEST CONTROL
8,000
850
_______________________________________________________________________
Taxpayer Totals
_______________________________________________________________________
74,500
11,000
Spouse Totals
_______________________________________________________________________
8,000
850
Totals
_______________________________________________________________________
82,500
11,850
Carryover Worksheet
List of items that will carryover to the 2015 tax return
2014
(Keep for your records)
Name(s) as shown on return
Your social security number
MICHAEL & ELIZABETH SAMUELSON
400-00-6004
Itemized Deductions
....................................
.
....................................
Contributions subject to 50% of AGI limitations
.................
Contributions subject to 30% of AGI limitations (50% capital gains appreciated property)
.
.
.
.
.
.
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.
.
.
.
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.
.................
Contributions subject to 30% of AGI limitations
.
................
Contributions subject to 20% of AGI limitations (30% capital gains appreciated property)
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
................
Taxable state and local refunds to Form 1040, line 10
.
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.
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.
...............
State/local taxes paid in 2015 to flow to the Schedule A
.
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...............
Preparer Fee to flow to the Schedule A
.
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..............
State donations and contributions carryover
.
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.
.
.
.
.
.
..............
State overpayment applied to next year
Carryover Amount
Contributions subject to 100% of AGI limitations
15
Expenses
...........................................
.................................
Disallowed investment interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section 179 expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......
Operating expenses, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use
.......
Excess depreciation, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use
Office in home operating expenses
Office in home excess casualty losses and depreciation
Losses
.................................................
Long-term capital loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net operating loss . . . . . . . . . . . . . . . . .
AMT . . . . . . . . . . . . . . . . .
.
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....................
Nonrecaptured net section 1231 losses
Short-term capital loss
Credits
.................................................
.....................
Credit for prior year minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign Tax credit . . . . . . . . . . . . . . . . . .
AMT . . . . . . . . . . . . . . . . .
District of Columbia first time home owner's credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........................................
Res. energy efficient property credit
Mortgage interest credit
General business credit (should be carried back before being carried forward)
Other
......................................
.
.
.
......................................
Federal tax liability for 2210 calculation
.
.
.....................................
State tax liability for state 2210 calculation
.
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.
. . . . . . . . . . . . Taxpayer
IRA basis
Spouse
Overpayment applied to next year's estimates
Passive Activity
At Risk Limitations
WK_CARRY.LD
6,019