arm 1 04 US. Individual Income Tax Return For thoyoar Jan 1-Doc you u. EXTENSION TO 10 1931612016 OMB No. 1545 con RS Use Only ?Donot write . 2016 ending or staple in this space. See separate Your social acuity nwnber Your first name and initial 1 Last name CHRI STOPHER . ENNEDY Ila joint return. spouse's ?rst name and initial Last name SHEILA BERNER ENNEDY Home address inumber and street]. It have a PD. poi see instructions. city. town a: post oft-co. state. and ZIP code. it you have it terelon address. also complete spaces below item's social scanty nurnba Make one the above lid on line 6c are correct Presidential Election Check has it you or your spouse ti ti mg jointly went to go to this fund a box below Foreign country name Foreign province/state/county or tel code dim? I You 11?11 Spouse Filing Status 1 USingle 4 [3 Head oi househOIIWali ng person). It the qualifying 2 Married tiling iointly (even it only one had income) person is a child but it yo nt. enter this child's 3 I: Married filing separately. Enter spouse's SSN above name here. Check only one box. and lull name here. i 5 widowier) with depe Exemptions 6: Yourselt. If someone can claim you as a dependent. do not check box Ba 2 Spouse ?ugly?: cm i: Dependents: (2)09mndont's coma underage? mum .21.. (??rst name Last name 9? relation: 9 to nutmegdivorce a ?lat-m (m Instructions) It more than tour dependents. see Dependents on 6: instructions and check here Add nunbers it Total number oi exemptions claimed . . .. .. :3er 2 Income 7 Wages. salaries, tips, etc. Attach Form(s) W-2 7 8a Taxable interest. Attach Schedule ii tequrred Attach Form (5) Tax-exempt interest. Do not include on line w_2 here. Also 9: Ordinary dividends. Attach Schedule it requ red attach Forms 1: Qualified dividends 1 9b 1 22.7 . 9 3 6 . STMT 3 13929331123: 10 Taxable reiunds, credits, or ottsets at state and local income taxes 3 STMT 5 10 . WIS withheld. 11 Alimony received 12 Business income or (loss). Attach Schedule or C-Capital gain or (loss). Attach Schedule it required. It not required. check here W-2. 14 Other gains or (losses). Attach Form 4797 14 see instructions. 153 IRA distributions 15a Taxable amount 15b 18a Pensions and annuities 1811 Taxable amount 16b 17 Rental real estate, royalties. partnerships. corporations. trusts. etc. Attach Schedule Farm income or (loss). Attach Schedule 18 19 Unemployment compensation 19 20a Social security benefits 20: I i Taxable amount 20b 21 Other income. List type and amount SEE STATEMENT 2 21 2 8 . 22 Combine the amounts in the far right column tor lines 7 through 21. This is vour total income Educator expenses 23 Adjusted 24 24 Gross 25 Health savings account deduction. Attach Form 8889 25 Income 26 Moving expenses Attach Form 3903 28 27 Deductible part 01 sell-employment lax. Attach Schedule Sell-employed SE P. SIMPLE. and quali?ed plans Sell-employed health insurance deduction 29 247 . 5 3 30 Penalty on early withdrawal of savings 30 31a Alimony paid I: Recipient's 5 31a 32 IRA deduction 32 33 Student loan interest deduction 33 34 Tuition and tees. Attach Form 8917 34 35 Domestic production activities deduction. Attach Form 8903 35 8 7 8 . 36 Add lines 23 through oaooca 11.30.11: 37 Subtract line 361romline 22. This is your adiusted gross income LHA For Disclosure. Privacy Act. and Paperwork Reduction Act Notice. see separate instructions. Fam1040i20?di Farrow-1012010) CHRISTOPHER . 3HE I LA BERNER Psa- 2 Tax and 38 Amount from line 37 (adjusted gross incomeCredits 393 Check You were born before January 2. 1952. Blind. Total boxes 33:; . it: Spouse was born before January 2, 1952. Blind. checked 5 39a 315cm 11:01: 11 your spouse itemtzes on a separate return or you were a dual-slalus alien, check here 5 39b on line or 40 Itemized deductions (lrom Schedule A) or your standard deduction (see left margin39b Ol'who canr? $553-$333 41 Subtract the 40 from instructions. 42 Exemptions. ll line 38 is $155,650 or less, multiply 54,050 by the number on line 6d. Otherwise, see inst. 42 0 . 43 Taxable income. Subtract line 42 trom line 41. him 42 is more than line 41, enter Tax. Check it any irom: ai:] Form(s) 8814 pm Form 4972 44 53 753_. 45 Alternative minimum tax. Attach Form 5251 Liam" 46 Excess advance premium tax credit repayment. Attach Form 8962 48 Mmieduinc 47 Add lines 44Foreign tax credit. Attach Form 1116 it required 48 5 5 7 8 . 2:333,? 49 Credit tor ch'ld and dependent care expenses. Attach Form 2441 49 Qualifying 50 Education credits lrom Form 8863. line 19 50 3m? 51 Retirement savings contributons credit. Attach Form 8880 51 Id. 52 Child tax credit Attach Schedule 8812. lrequ red 52 $9,300 53 Residential energy credits. Attach Form 5695 53 54 Other credits lrom Form: 3 3800 i: 8801 54 2 . 55 Add lines 48 through 54. These are your total credits Subtract line 551rornlne47.ttline 55 is more than line 47, enter -Self-employment tax. Attach Schedule SE 57 2?2.1 7 2 5 . Other 58 Unreported social security and Medicare tax from Form: a 4137 I: 8919 58 Taxes 59 Additional tax on IRAs. other method retirement plans, etc. Attach Form 5329 it required 59 60:: Household employment taxes lrom Schedule 503 It First-time homebuyer credit repayment. Attach FUND 5405 it required 60b 61 Health care: Individual responsibl ity (see instructions) Full-year coverage [El 61 62 Taxes irom: a [it Form 3959 [Xi Form 8960 I: inst.; enter code(s) STATEMENT Add lines 56 through 62. This is your total tax Payments 64 Federal income tax withheld lrom Forms W-2 and 1099 64 85 2016 estimated tax payments and amount applied lrom 2015 return STATEMENT 1 2 a it Earned income credit (EIC) . 66: ount?yrno child.a.ttad1 Nontaxable combat pay election 66b I 57 Additional child tax credit. Attach Schedule 3312 or 68 American opportunity credit from Form 8863. line 68 69 Net premium tax credit. Attach Form 8962 69 70 Amount paid with request tor extension to tile Excess social security and tier 1 RRTA lax withheld 71 72 Credit for lederal tax on luets. Attach Form 4136 . 72 73 Credits lrom Form: a [32439 nestntic D8985 73 74 Add lines 64. 65. 66a, and 67 might 73. These are your total payments Refund 75 11 line 74 is more than line 63. subtract line 63 from line 74. This is the amount you overpaid 76: Amount at line 75 ou want relunded to you. It Form 8868 is attached, check here 75; get? deposit? milil Type. Chatting Settings ll mil: 77 Amount of line 75 you want applied toyotrr 2017 estimated tax Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay. see instructions 78 You Owe 79 Estimate?x penalty (see instructions) 79 Third Party Do you want to allow another rson to discuss this return with the IRS (see instructions Poo Clue - Designate on Personal dent rtcauon Desrgnee "m . . number re: Si 11 Under enaltiesol perm. I declare that I lave crammed this return and accompanying scheduies and statements. and to the best at my muledpemd belief they are true correct and accu Ilstalamoontsald sources lrecelved dump ttietuyeal De?ation olpreparutotbeitllan anal tnloimaiuil 01 which prewer has anylnonledpe Here ?Wu" Coke Your occupation Daytime phone number Joint return? . ll: QUHYEHQDTIVE Keep a copy Spouse's sag-lattice. Ila [we 3: . a Spoun'! occupation line RS sent you an derilrty tor your Protect on record; INANCIAL enter it here I Print/Typo preparer?: nor-no Chock :1 Paid all amp oyod 610002 ti-ao-io Fit PreparelcpA? m's nudes: Flm?a EIN Lung :19. Illinois Department of Revenue 2016 Form lL-1040 Individual Income Tax Return or for fiscal year ending ill-19,7" ,9 a Over 80% of lame yer: ?le eiectronlcaliy. it is easy and you will get your refund faster. Visit Step 1: Personal Information fro! cut. may, thus We. CHRISTOPHER G. KENNEDY SHEILA BERNER KENNEDY Filing status (see instructions) or head of household Married tiling jomtly Ci Married ?tinq separately Widowed Step 2: 1 Federal adjusted gross income from your federal Form 1040. Line 37; 1040A. Line 21; or (Whole dollars only) Income 104052. Line4. 1 1,242,805 .00 2 Federally tax-exempt interest and dividend income from your lederal Form 1040 or 1040A, Line 86; or federal Form 104052. 2 2 160 .00 3 Other addit:ons. Attach Schedule Total Income. Add Lines 1 through .00 Step 33 5 Social Security bene?ts and certain retirement plan income 1 Base received it included in Line 1 Attach Page 1 of federal return 5 .00 Income 6 Ililno 3 Income Tax overpayment included in federal Form 1040, Line 10. 6 .00 7 Other subtractions Attach Schedule Check it Line 7 includes any amount from Schedule 1299-0. 8 Add Lines 5. 6. and 7. This ts the total or your subtractionsIllinois base Income. Subtract Line a from Line Step 4: 10 a Number of exemptions from your federal return. $2.175 a 4 I 3 50 .00 Exemptions it someone can claim you as a dependent. see instructions. at $2.175 .00 3. Check if 65 or older: You Spouse $1.000 .00 Check if legally blind: I: You I: Spouse at $1 .000 .00 a Exemption allowance. Add Lines a through d. 10 4 3 5 0 .00 Step 5: 11 Residents: Net income. Subtract Line 10 from Line 9. Skip Line 12Nonresident: and part-year residents: Income Check the box that applies to you during 2016 Nonresident Part year resident. and enter the Illinois base income from Sch. NR. Attach Sch. NFI. 12 .00 Step 63 Fiscal ?lers see instructions before completing Step 6. Calendar-year lilers continue to Line 13. Tax 13 Residents: Multiply Line 11 by 3.75% (.0375). Cannot be less than zero. Nonresident: and part-year residents: Enter the tax from Schedule NRRecapture oi investment tax credits. Attach Schedule 4255. 14 .00 15 Income tax. Add Lines 13 and 14. Cannot be less than zero. 15 4 5 9 14 .00 Step 7: 16 Income tax paid to another state while an Illinois resident. 4 Staple your check and Tax After Attach Schedule an. 16 4 8 00 Non- 17 Preperty tax and K-12 education expense credit amount lrom refundable Schedule lCFt. Attach Schedule ICR. 17 3 2 8 5 .00 Credits 18 Credit amount from Schedule 1299-0. Attach Schedule 1299-0. 18 .00 19 Add Lines 16. 17. and 18. This is the total at your credits. Cannot exceed the tax amount on Line 15Tax after nonrefundable credits. Subtract Line 19 from Line 15at-loao pace 1 (9.07/17) This term is authorle as outlined under the Income Tax Act Disclosure of mx New, this I: required. Failure to provide Intonation could result in penalty 21 Tax alter nonrefundable credits from Page 1. Line 20. 21 42 3 8 1 .00 Step 8: 22 Household employment tax See instructions 22 .00 Other 23 Use tax on internet. mail order. or other out-of state purchases from Taxes UT kasheet or UT Table in the instructions Do not leave blank 23 7 4 6 .00 24 Compassionate Use ol Medical Cannabis Piol Program Act Surcharge 24 .00 25 Total Tax. Add Lines 21Step 91 26 Illinois Income Tax Withheld. Attach all W2 and 1099 forms. 25 .00 Payments 27 Estimated payments from Forms lL~lO40 ES and and including any overpayment applied lrom a prior year return.00 Refundable 28 Pass-through ang payments. Attach Schedule K-1 or K-l T. 28 .00 Credit 29 Earned Income Credit lrom Schedule ICH. Attach Schedule ICR. 29 .00 30 Total payments and refundable credit. Add Lines 26 through 29.00 Step 10: 31 Overpayment. ll Line 30 is greater than Line 25. subtract Line 25 from Line 30.00 "650" 32 Underpayment. If Line 25 is greater than Line 30. subtract Line 30 from Line 25. 32 .00 Step 11: 33 Late-payment penalty for underpayment of estimated tax 33 3 5 .00 Underpayment a Check if at least two?thirds of your federal gross income is from farming of Estimated Check if you or your spouse are 65 or older and permanently Tax Penalty living in a nursing home CI and Donations Check If your income was not received evenly during the year and you annualized your income on Form lL-2210. Attach Form Check if you were not required to file an Illinois Individual Income Tax return in the previous tax year. 34 Voluntary charitable donations. Attach Schedule G. 34 .00 35 Total penalty and donations. Add Lines Step 12: 36 It you have an overpayment on Line 31 and this amount is greater than Retund or Line 35, subtract Line 35 from Line 31. This is your remaining overpaymentAmount You 37 Amount from Line 36 you want refunded to you. Check one box on Line 38 See instructionschoose to receive my refund by direct deposit - Complete the information below it you check this box. Routing number Checking or Savings Account number Illinois Individual Income Tax refund debit card paper check 39 Amount to be applied to estimated tax. Subtract Line 37 lrom Line 36 See instructionsyou have an Underpayment on Line 32. add Lines 32 and 35 or It you have an overpayment on 31 and this amount is less than Line 35. subtract Line 31 from Une 35 Tris is the amount you owe. See instructions 40 .oo Step 13: Sign and Date Third Party Designee II no payment enclosed. mail to: I I1 payment enclosed, mail to: ILLINOIS DEPARTMENT OF REVENUE ILLINOIS DEPARTMENT OF REVENUE SPRINGFIELD IL 62719-0001 SPRINGFIELD IL 62726-0001 649002 08-22-17 ID: 28X page 2 (la-07117) DR AP DC a