Prepared for 2017 TAX RETURN FILING INSTRUCTIONS U.S. INDIVIDUAL INCOME TAX RETURN FOR THE YEAR ENDING DECEMBERCLAIRE C. MCCASKILL 1941 SPRING HOUSE DRIVE ST. LOUIS, MO 63122 Prepared by Amount of tax Total tax 46 _0 7 5 Less: payments and credits 5 5 4 1 2 Plus: interest and penalties 0 OVERPAYMENT 9 3 3 7 Miscellaneous Donations 0 Overpayment Credited to your estimated tax Flefunded to you 9 3 3 7 Make check NOT APPLICABLE payable to Mail tax return and check (if applicable) to THIS RETURN HAS QUALIFIED FOR ELECTRONIC FILING AND THE PRACTITIONER PIN PROGRAM HAS BEEN ELECTED. AFTER REVIEWING THE RETURN, PLEASE SIGN AND RETURN FORM 8879 TO OUR OFFICE. WE WILL THEN TRANSMIT YOUR RETURN ELECTRONICALLY TO THE IRS. Return must be mailed on or before Special Instructions NOT APPLICABLE DO NOT MAIL THE PAPER COPY OF THE RETURN TO THE IRS. IF AFTER THREE WEEKS YOU HAVE NOT RECEIVED YOUR REFUND, YOU MAY CONTACT THE IRS AT 1-800-829?4477. 700081 04-01-17 THIS IS NOT A FILEABLE COPY 8879 IRS e-file Signature Authorization Form Department of the Treasury Return completed Form 8879 to your ERO. (Do not send to IRS.) 20 1 7 Internal Revenue Service Go to for the latest information. Submission Identification Number (SID) Taxpayer's name Social securi number CLAIRE c. MCCASKILL Spouse's name Spouse's social security number 1 1 I I I Part I Tax Return Information ?ax Year Ending December 31, 2017 (Whole dollars only) 1 Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040Ez, line 4; Form 1040NR, line 37Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ. line 12; Form 1040NR, line 61Federal income tax withheld from Forms W2 and 1099 (Form 1040. line 64; Form 1040A, line 40; 62aRefund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 133; Form 1040-88, Part I, line 13a; Form1040NR,line73a) . . 4 9,337. Amount you owe (Form 1040. line 78; Form 1040A, line 50: Form 1 040EZ. line 14; Form 1040NR. line 5 5 Part 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 ol my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 3t. 2013?. and to the best of my knowledge and ballet. It is true. correct. and accurately lists all amounts and sources at income I received during the tax year. 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 to send my return to the IRS and to receive from the tits [at an acknowledgement of receipl or reason for rejection oi the transmission. [it] the reason for any delay to processing the return or relund, and the date at any relund. It applicable, I authorize the LLB. Treasury and its designated Financial Agent to initiate an Alli-I electronic lunds Withdrawal {direct debit} entry to the ?nancial institution account indicated in the tax preparation soltware tor payment oi my federal taxes owed on this return andror a payment at estimated tax, and the linancial Institution to debit the entry to this account. This authorization is to remain in full force and eflect until I notily the 0.8. Treasury Financial Agent to terminate the authorization. To revolts (cancel) a payment. I must contact the 0.8. Treasury Financial Agent at 1-885-353-4531 Payment cancellation requests must be received no later than 2 business days prior to the payment {settlement} date. I also authorise the linancial Institutions involved in the processing of the electronic payment oi taxes to receive con?dential information necessary to answer inquiries and resolve issues related to the payment. I luttlrei acknowledge that the personal identi?cation number tPIlil} below is my signature for my electronic income tax return and. it applicable, my Electronic Funds Withdrawal Consent. Taxpayer?s PIN: check one box only authorize to enter or generate my PIN ERO firm name Enter five digitsI but as my signature on my tax year 2017 electronically filed income tax return. don?t enter all zeros i:i I will enter my PIN as my signature on my tax year 2017 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 below. Yoursignatureb THIS IS NOT A FILEABLE COPY Date} 04/05/2018 Spouse's PIN: check one box only Ci I authorize to enter or generate my PIN ERO firm name Enter five digits. but as my signature on my tax year 2017 electronically filed income tax return. don?t enter alt zeros i:i I will enter my PIN as my signature on my tax year 2017 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 below. Spouse's signature II- Date It- Practitioner PIN Method Returns Only - continue below Part??t Certification and Authentication - Practitioner PIN Method Only EFINIPIN. Enter your six-digit EFIN followed by your five-digit self?selected PIN. Don?t enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the tax year 201? electronically filed income tax return for the taxpayeds) indicated abowe. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345. Handbook for Authorized IFIS e?file Providers of Individual Income Tax Returns. signature Date It 719995 11-10.17 ERO Must Retain This Form - See Instructions Don?t Submit This Form to the IRS Unless Requested To Do So LHA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8879 (2017) 1 THIS IS NOT A FILEABLE COPY State-Only e-file Signature Authorization 8879-8 0 Do not send to the Taxing Authority. This is not a tax return. 20 1 7 Keep this form for your records. Submission Identification Number (SID) Taxpayer's name Social security number CLAIRE . MCCASKILL Spouse's name Spouse's social security number _Part I Electronically Filed States MO Part II I Taxpayer Declaration and Signature Authorization [Be sure you get and keep a copy of your return) Under penalties of perinty, I declare that I have examined a copy at my electronic income tax return and accompanying schedules and statements for the tax year ending December 31, Edit, and to the best of my knowledge and belief, it is true, correct. and complete. I consent to allow my intermediate service proyider. transmitter, or electronic return originator to send my return to the taxing authority and to receive irom the taxing authority ta] an acknowledgement of receipt or reason for reiection ot the transmission, {It} the reason tor any delay in processing the return or rate no. and let the date at any refund. If applicable. authorize the taxing authority and its designated Financial Agent to initiate an electronic funds withdrawal {direct debit] entry to the financial institution account indicated in the tax preparation soltware tor payment at nry Federal taxes cured on this return andror a payment of estimated tax, and the lrnancial institution to debit the entry to this account. I further understand that this I also authorize the tlnanciat institutions inyolyed in the processing of the electronic payment ot taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. llurther acknowledge that the personal identi?cation number (Pitt) below is my Signature for my electronic income tart return and. it applicable, my Electronic Funds Withdrawal Consent. Taxpayer?s PIN: check one box only tauthorize to enter or generate I ?rm name Enter five numbers, but as my signature on my tax year 201 electronically filed income tax return. do not enter all zeros I will enter my PIN as my signature on my tax year 2017 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 must complete Part below. Yoursignature} THIS IS NOT A FILEABLE COPY Date} 04/06/2018 Spouse?s PIN: check one box only I authorize to enter or generate my PIN ERO firm name Enter five numbers. but as my signature on my tax year 2017' electronically filed income tax return. do not enter all zeros I will enter my PIN as my signature on my tax year 2017 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 below. Spouse's signature Date Practitioner PIN Method Returns Only - continue below [Part Certification and Authentication - Practitioner PIN Method Only eno?s Enter your six-digit EFIN followed by your five-digit self-selected PIN. do not enter all zeros I certify that the aboye numeric entry is my PIN, which is my signature for the tax year 201 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. 719871 04?01?17 ERO Must Retain This Form Do Not Submit This Form to the Tax Authority 2 Tax Year 2017 e-file Jurat/Disclosure for Form 1040, 1040A, 1040EZ, or 1040NR using Practitioner PIN method (with or without Electronic Funds Withdrawal) ERO Declaration I declare that the information contained in this electronic tax return is the information furnished to me by the taxpayer. If the taxpayer furnished me a completed tax return, I declare that the information contained in this electronic tax return is identical to that contained in the return provided by the taxpayer. If the furnished return was signed by a paid preparer, I declare I have entered the paid preparer's identifying information in the appropriate portion of this electronic return. If I am the paid preparer, under the penalties of perjury I declare that have examined this electronic return, and to the best of my knowledge and belief, it is true, correct, and complete. This declaration is based on all information of which I have any knowledge. ERO Signature I am signing this Tax Return by entering my PIN below. ERO's PIN (enter EFIN plus 5 self?selected numerfcs) Taxpayer Declarations Perjury Statement 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 accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge. Consent to Disclosure I consent to allow my Intermediate Service Provider, transmitter, or Electronic Return Originator (ERO) to send my return/form to IRS and to receive the following information from IRS: a) an acknowledgment of receipt or reason for rejection of transmission; b) the reason for any delay in processing or refund; and, c) the date of any refund. am signing this Tax Return and Electronic Funds Withdrawal Consent, if applicable, by entering my Self-Select PIN below. Taxpayer's PIN: - Date 04062018 Spouse?s PIN: 719936 04-01-17 1040 U.S. Individual Income Tax Returnm) 2017 OMB No 1545.0074 IRS Use Only - Do not write or staple in this space For the year Jan 1-Dec ?31. 2017. or other tax year beginning . 2017. ending 368 separate lY?Ul' name and Last name Your social security number CLAIRE . MCCASKILL ii a Film return, first name and Last name Spouse's social security number Home address {number and street). If you have at RU. aox. see instructions. Apt. no. A Make sure the SSMS) above 1 9 4 1 SPRING HOUSE DRIVE and on line 6c are correct City. town or post of?ce. state. and ZIP code if you have a foreign address. also complete spaces below Pm?'dm'ml Human Comm" Chilacl-t mire if you, wager.? spouse in inll . wont to to ST LOUI MO 6 3 1 2 2 line fans Cris-citing a Muggelow Foreign country name Foreign province/state/county Foreign postal code ?Change Wm" You l:l Spouse Filing Status 1 l_l Single 2 El Married filing jointly (even if only one had income) 4 Head of household (with qualifying person). If the qualifying person is a child but not your dependent, enter this child's Check only 3 Married filing separately. Enter spouse's SSN above name here. one box. andfull name here. A SHEPARD 5 l:l Qualifying widowter] (see instructions) . 6a LELI Yourself. If someone can claim you as a dependent, do notcheck box 6a mam?? 1 Exemptions . IJl__?i Spouse . . No ofchildren Dependents: (2)Dependent's social ifilgng?g?: ?titt'is?'ii Triaviawivciih you (1) First name Last name security number you weigh-Euler tit-Id ??igul?ttcli??m?g If more than four dependents, see Dependents on 6c instructions and ?mad ab?V? check here El Add numbers it Total number of exemptions claimed . . . . .. . . 333953> 1 Income 7 Wages, salaries, tips, etc. Attach Form(Taxable interest. Attach ScheduleBif required . 8a 23 . Tax-exempt interest. Do not include on line 8a . I 8b I wgc?tg?m 9a Ordinary dividends. Attach Schedule if required . attach Forms Qualified dividends .. lglildtax 10 Taxable refunds, credits, or offsets of state and local income taxes 10 waswithheld. 11 Alimonyreceived .. Business income or (loss). Attach Schedule Capitalgain or(loss). Attach Schedule if requrred lfnot requrred check here D- l:l 13 geta W-2, 14 Other gains or (losses). Attach Form 4797 I I I . I 14 see instructions. 15a IRA distributions I I I I I II 15a bTaxable amount I 15b 16a Pensions and annuities I II 16a l'l Taxable amount .. 16b 8 5 5 2 . 17 Rental real estate, royalties, partnerships, corporations, trusts, etc. Attach Schedule Farm income or (loss). Attach Schedule 18 19 Unemploymentcompensation II 19 20a Socialsecurity benefits 203 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 EGUCHIOF EXPENSES . 23 Adjusted 24 performing artists. and fee- -basi-s government 24 Gross 25 Health savings account deduction. Attach Form 8889 I 25 Income 26 Moving expenses. Attach Form 3903 Deductible part of self~employment tax. Attach Schedule Self-employed SEP, SIMPLE, and qualified plans Self-employed health insurance deduction 29 30 Penalty on early withdrawal of savings 31a Alimony paid 1) Recipient's SSN 313 32 IRA deduction .. .. I 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 I 36 710001 02 22 18 37 Subtract line 36 from line 22. This' is your adjusted gross income LHA For Disclosure, Privacy Act, and Papenrvork Reduction Act Notice, see separate instructions. Form 1040 (2017) Form 104012017) CLAIRE . MCCASKILL Page 2 Tax and 38 Amount from line 37 (adjusted gross incomeCredits 398 Check You were born before January 2, 1953, :1 Blind. Total boxes Egg; if: :1 Spouse was born before January 2, 1953, :1 Blind. checked 39a If your spouse itemizes on a separate return or you were a dual-status alien, check here 39b LKJ animus sea or 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin895 11er can? 32:33:11er 41 Subtract line 40 from line instructions 42 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see inst. 42 0 . 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 4 1, enter -Tax.Check ifany from: al:l Form(s) 8814 bl:l Form 4972 c[:J 44 4 5 '764 . 45 Alternative minimum tax. Attach Form 8251 45 5 3 ?7 . 46 Excess advance premium tax credit repayment. Attach Form 8962 . 46 Married ?ling 47 Add lines 44$3853th 48 Foreign tax credit. Attach Form 1116 if required 48 Eimfgr?'ing 49 Credit for child and dependent care expenses. Attach Form 2441 49 Qualifying 50 Education credits from Form 8863, line 19 50 51 Retirement savings contributions credit. Attach Form 8880 51 3:336:13?. 52 Child tax credit. Attach Schedule 8812, if required 52 $9.350 53 Residential energy credits. Attach Form 5695 53 54 Othercredits from Form: a. 3800 8801 54 904 . 55 Add lines 48 through 54. These are your total credits 55 9 04 . 56 Subtract line 55 from line 47. if line 55 is more than line 47, enter -Self-employment tax. Attach Schedule SE 57 Other 58 Unreported social security and Medicare tax from Form: a :1 4137 8919 58 Taxes 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59 60a Household employment taxes from Schedule 608 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 0 El Inst; enter code(s) STATEMENT 46,075. Payments 64 Federal income tax withheld from Forms W-2 and 1099 84 5 5 4 2 . STATEMENT 5 65 2017 estimated tax payments and amount applied from 2016 return 65 :jsz?fyri?g? it Earned income credit(EiC) 66a child, attach Nontaxable combat pay election 66b I . 67 Additional child tax credit. Attach Schedule 8812 57 68 American opportunity credit from Form 8863, line 8 68 89 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 Creditforfederal tax on fuels. Attach Form 4136 .. .. 72 73 Credits from Form: a 2439 E8885 73 74 Add lines 64, 65, 66a,and 67 through 73. These are your total payments . .. . .. . P- 74 55 412 - Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid . 75 9 3 3 '7 . 76a Amount of line 75 you want refunded to you. if Form 8888 is attached, check here 76a 9 3 3 '7 . ggeectdeposn? b? b33115? Type: I: Checking Savings (1:311:51ng 77 Amount of line 75 you want applied to your 2018 estimated tax 77 Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions 78 You Owe 79 Estimated tax penalty {see instructions} I 75 I Third Do you want to allow another person to discuss this return with the IRS (see instructions}? LZSJ Yes. Complete below. lilo identification ?9.51 Hall's Phone DeSIgnee ?a number 1le1 Sign Ideciale 1hat have examined this return and accent pliitlnu ash statements. and to the best 111 Illv kl'ltjl'rl?d?i. and select, ihcyare iruamrleci, and 3131:8141.in I151 .111 summit. and sources of income I received during the tax year culmination of principal miner I?lldn Latpajeli is basal: on all inferntaIi-in Here Your nlgnalura Date Your occupation Daytime phone number Joint return? See instructions UNI TED STATES SENATOR K999 3 COPY Spouse?s Signalura If a 1mm return, both must sign Date Spouse's occupation if the IRS sent you an Identity for your Protection PIN, records enter it here Print/Type preparer's name Preparer's signature Date Check I if Paid self-employed Preparer Use only Firm's name 710002 02?22?18 Firm's address Firm?s EIN Phone no SCHEDULE A (Fornt1040) Department of the Treasury Internal Revenue Service Nam-3(5) shown on Form 1040 CLAIRE C. MCCASKILL Itemized Deductions OMB No 1545?0074 Go to for instructions and the latest information. Attach to Form 1040. (99) Attachment Sequence No 07 Von-r also: nl securlly number Medical Caution: Do not include expenses reimbursed or paid by others and 1 Medical and dental expenses (see instructions) II II 1 Dental 2 Enter amount from Form 1040, line 38 I 2 Expenses 3 Multiplyline2by75% (0. 075)" ., II I 3 4 Subtract i'rne 3 from linet. If line 3' 15 more than line1, enter 0? 4 Taxes You 5 State and local (check only one box): Paid a lil Incometaxes, or SEESTATEMENT7 5 14 .426. El General sales taxes 6 Fiealestatetaxes (see instructions) 6 7 Personal propertytaxes . 7 8 Other taxes. List type and amount a .. . .. I9 14.426- Interest 10 Home mortgage interest and points reported to you on Form 1098 I .. 10 You Paid 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 '3 name, identifying no. and address Nam mgrrergcortgage 12 Points not reported to you on Form 1098 See instructions for special rules 12 deduction may 13 Mortgage Insurance premiums (see instructionslimited (see 14 Investment interest. Attach Form 4952 If requrred See Instructrons II t4 Instructrons). 15 Addiinestothroughm . l1 15 Gifts to 16 Gifts by cash or check. If you made any gift of $250? or more, see instructions I 16 7 3? 2 0- Charity 1? Other than by cash or check. If any gift of $250 or more, see instructions. STMT 8 "you madea You mustattach Form8283ifover$500 17 and got a . benefitforit, 18 Carryoverfrom prloryear .. .. . 18 see instructions. 19 Add lines 16 through 18 19 78,200. Casualty and 20 Casualty or theft loss(es) other than net qualrfred disaster iosses. Attach Form 4684 and" Theft Losses enter the amount from I_ine 18 of that form. See instructions 20 Job Expenses 21 Unreimbursed employee expenses- job travel union dues, job education, etc. and Certain Attach Form 2106 or 2106-EZ if required. See instructions. Mlscellaneous Deductions 21 22 Tax preparation fees 22 23 Other expenses investment, safe deposit box, etc. List type and amount 23 24 Addline321through23II I 24 25 Enteramountfrom Form 1040, line 38 .. II 26 Multiplyline25 by2% (0.02) .. I II 26 27 Subtract line 261mm line 24. If line 26' re more than line 24 enter -0m 27 Other 28 Other - from list' In instructions. List type and amount Miscellaneous Deductrons 28 29 Is Form 1040, line 38, over $156,900? No. Your deduction is not limited. Add the amounts in the far right column Total for lines 4 through 28. Also, enter this amount on Form 1040. line 40. SITMTI .Itemized Yes. Your deduction may be limited. See the Itemized Deductrons DedUCtions Worksheet in the instructions to figure the amount to enter. 30 If you elect to itemize deductions even though they are less than your standard deduction, check here LHA 719501 02?22-13 For Paperwork Reduction Act Notice, see the Instructions for Form 1040. Schedule A (Form 1040) 2017 5 SCHEDULE - - - (Form mm or 1040, Interest and Ordinary DIVIdends 2017 rm Attach to Form 1040A or 1040. Attachment I Go to for instructions and the latest information. Sequence No 08 Wan You' social ma?a CLAIRE . MCCASKILL Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the Amount er est property as a personal residence, see the instructions and list this interest first. Also, show that buyer's social security number and address RBC 3 7 7 5 2 . UMB BANK 8 . FROM K-l CHEF AMYB LLC 3 . 1 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 onthat 2 Addtheamountson line1 .. .. .. . .. . . . .. 2 23 . orm. 3 Excludable interest on series EE and US. savings bonds issued after 1989. Attach Form 8815 .. . .. . .. . .. . .. . .. 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a 4 2 3 . Note: If line 4 is over $1,500, yOu must complete Part Amount Part II 5 List name of payer . RBC Ordinary Dividends Note: If you 5 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. 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040. line Note: If line 6 is over $1,500; you must complete Part1?. Part You must complete this part if you had over $1,500 of taxable interest or ordinary dividends; (D) had a foreign Yes No account; or to) received a distribution from, or were a grantcr of. or a transferor to. a foreign trust. Foreign 7a At any time during 2017, did you have a financial interest in or signature authority over a financial account (such Accounts as a bank account, securities account, or brokerage account) located in a foreign country? See instructions .. arid If "Yes," are you required to file Form 114, Report of Foreign Bank and Financial Accounts to report that financial interest or signature authority? See Form 114 and its instructions for filing requirements and exceptions to thoserequirements . .. .. If you are required to file Form 114, enter the name of the foreign country where the financial account is located . I 8 During 2017, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? 121501 1o-25-1r If ?Yes," you may have to file Form 3520. See instructions LHA For Paperwork Reduction Act Notice, see your tax return instructions. 6 Schedule (Form 1040A or 1040) 2017 Interest and Dividend Summary Name: CLAIRE . MCCASKILL I Interest on Tax-Exempt Private Activity Original Issue Ordinary Qualified Capital Gain Federal Income State Tax Foreign ayer nterest Savings Bonds Interest Interest Discount (OID) Dividends Dividends Distributions Tax Withheld Withheld Tax Paid REC 3 7 7 5 2 - REC 3775 975. 951. UME BANK 18 . FROM 1 CHEF AMYB LLC 3 . TOTALS 23. 975. 951. 730191 04?01?17 6 . SCHEDULE Capital Gains and Losses OMB No 1545-0074 (Form 1040) Attach to Form 1040 or Form 1040MB. 20 1 7 Department of the Treasury Go to for instructions and the latest information. Attach '"tema' Revam?e (99? Use Form 8949 to list your transactions for lines 1b. 2, 3, Eb. Q, and 10. Semi: No 12 Name(s) shown on return Your social security number CLAIRE C. MCCASKILL Short-Term Capital Gains and Losses - Assets Held One Year or Less See instructions for how to figure the amounts to (9) [hi Gain or (loss) enter on the lines below. Adjustments Subtract column Proceeds Cost to gain or loss from from column and This form may be easier to complete if you round off (sales price) (or other basis) Form(s) 8949, Part I, combine the result cents to whole dollars line 2, column (9) with column (9) 1a Totals for all short-term transactions reported on Form 1099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions) However, if you choose to report all these transactions on Form 8949, leave this line blank andgotollne 1b 1b Totals for all transactions reported on Form(s) 8949 with Box A checked . . 2 Totals for all transactions reported on Form(s) 8949 with Box checked 3 Totals for all transactions reported on Form(s 8949 with Ben . .. 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 4 5 Net short-term gain or (loss) from partnerships, corporations, estates, and trusts from Schedule(Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss CarryoverWorksheetinthe instructions .. . .. .. .. . . . . .. . ., 6 7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column If you have any long-term capital gains or losses cc- to Partli below. Otherwise go to Part on page2 7 - Long- -Term Capital Gains and Losses- Assets Held More Than One Year See instructions for how to figure the amounts to (9) Gain or ?055} enter on the lines belowi Adjustments subtract (E) Proceeds Cost to gain or loss from from column and This form may be easier to complete round Off (sales price) (or other basis) Form(s) 8949, Part II, combine the result cents to whole dollars. line 2, column (9) with column 83 Totals for all long-term transactions reported on Form 1099-8 for which basis was reported to the IRS and for which you have no adjustments (see instructions) However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 8b 8b Totals for all transactions reported on mForrn(s) 12.582- 12.582. 0- 9 Totals for all transactions reported on Form(s) 8949 with Box checked. 10 Totals for all transactions reported on Form(s) 8949 with Box checked 11 Gain from Form 4797, Part long -term gain from Forms 2439 and 6252; and long- -term gain or (loss) from Forms 4684. 6781Net long-term gain or (loss) from partnerships, corporations, estates, and trusts from Schedule(s) K-1 12 13 Capital gain distributions .. . . 13 14 Long- -term capital loss carryover Enter the amount, if any, from line t3 of your capitat Loss carryover Worksheet In the Instructions .. .. 14 15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column Then go to on page?! .. . 15 0 - LHA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule (Form 1040) 2017 720511 11?02-17 .7 ScheduleD(Form1040)2017 CLAIRE C. MCCASKILL Summary 16 17 18 19 21 Combine lines 7 and 15 and enter the result I If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 17 below. If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22. 0 If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form line 14. Then go to line 22. Are lines 15 and 16 both gains? 1: Yes. Go to line 18. No. Skip lines 18 through 21, and go to line 22. If you are required to complete the 28% Rate Gain Worksheet(see instructions), enter the amount, if any, from line 7 of that worksheet If you are required to complete the Unrecaptured Section 1250 Gain Worksheet (see instructions), enter the amount, if any, from line 18 of that worksheet Are lines 18 and 19 both zero or blank? Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42). Don?t complete lines 21 and 22 below. No. Complete the Schedule Tax Worksheet in the instructions. Don?t complete lines 21 and 22 below. If line 16 is a loss, enter here and on Form 1040, line 13, or Form line 14, the smaller of: 0 The loss on line 16 or 1' or if married filing separately, ($1,500) Note: When figuring which amount is smaller, treat both amounts as positive numbers. Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b? Yes. Complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44 (or in the instructions for Form 1040NR, line 42). No. Complete the rest of Form 1040 or Form 1040NR720512 11-02-17 Schedule (Form 1040) 2017 Form 8949 (2017) Attachment Sequence No. 12A Page 2 Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on page 1 Social security number or taxpayer identification no. CLAIRE . MCCASKILL Befona you check Box D. E. orF baiow, see whether you received any Form(s) 1099?3 or suoETrTufe statiementj?s} from your bro er. cu statement will have the same information as Form 1099-8. Either show whether your basis (usually your cost} was reported to the by your broker and ma even teit you which box to check. -P3rt Long-Term. Transactions involving capital assets you held more than 1 year are long term. For short-term transactions. see page 1. Note: You may aggregate all long-term transactions reported on Form(s) 1099B showing basis was reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D. Iine 8a; you aren?t required to report these transactions on Form 8949 (see instructions). You must check Box D. E. or below. Check only one box. If more than one box applies for your long-term transactions. complete a separate Form 3949. page 2. for each applicable box If ou have more long-term transactions than will fit on this page for one or more of the boxes. complete as many forms with the same box checked as you need (D) Long-term transactions reported on Form(s) 1099-8 showing basis was reported to the IRS (see Note above) (E) Long-term transactions reported on Form(s) 1099-B showing basis wasn?t reported to the IRS Lon -term tranSactions not to on Form 10998 #333 If ou entgy?n agilounotr Description of property Date acquired Date sold or Proceeds Cost or other in enter a code in Gain . Exam Ie:100 Co. Mo..da . . d' (sa'es Price) basiSyr) (M13921: Note belowand column [1 einstruutiuns fromcolumn(d)& see Cofumn in combine the result the instructions Code(s) gimount Of with column I EAF ET I EMERGING ETF 2 Totals. Add the amounts in columns and negative amounts). Enter each total here and include on your Schedule D, line 8b (if Box above is checked), line 9 (if Box aboveischeo orline'lO BoxFaboveis 12.582. 12.582. 0. Note: If you checked Box above but the basis reported to the IRS was incorrect, enter in column (9) the basis as reported to the IRS, and enter an adjustment in column (9) to correct the basis. See Column (9) in the separate instructions for how to figure the amount of the adjustment. 723012 11-02-17 Form 8949 (2017) 9 Qualified Dividends and Capital Gain Tax Worksheet - Line 44 Keep for Your Records Name(s) shown on return Your SSN CLAIRE C. MCCASKILL Before you begin: 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 don?t have to file Schedule 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. However, if you are filing Form 2555 or 2555-E2 (relating to foreign earned income), enter the amount from linesofthe Foreign Earned Income Tax Worksheet Enter the amount from Form 1040, line 913Are you filing Schedule Yes. Enter the smaller of line 15 or 16 of Schedule If either line 15 or 16 is blank or a loss, enter No. Enter the amount from Form 1040, ins13 4. Add lines2and 3 4. 951 - 5. If filing Form 4952 (used to figure investment interest expense deduction), enter any amount from line 49 of that form. Otherwise, enter -0- .. 5. 0 - 6. Subtract ine5from line 4. lfzero or less, enter-Subtractline6from line 1. lfzero or less, enter -Enter: 3 37,950 it single or married filing separately, $75,900 if married filing jointly or qualifying widow(er50,800 it head of household. 9. Enterthesmallerofline1orline8 .. . 9. 37. 950- 10. EnterthesmalleroflineTorline9 11. Subtract line 10from Iine9. This amount is taxed at0% 11. . 12. Enterthe smallerof line1 or ine6 II II 12. 951 - 13. Entertheamountfromline11 14. Subtractline13fromline12 I 14. 951- 15. Enter: 418,400 if single. $235,350 if married filing separately, 15. 235 35 0 . 470,700 if married filing jointly or qualifying widow(er), 444,550 if head of household. 16. Enterthesmallerofline1 or ine15 II 16. 175 . 746 - 17. Add lines7and11 II 17. 175 795 . 18. Subtract line17 from line 16. lfzero ortess, enter-O- I I 13. 951 . 19. Enterthe smallerofline14or line 20. Multiplylineia .. .. 20. 143- 21. Add Iinesiiand19 . .. 21. 951- 22. Subtractline21 from line12 22. 0. 23. Multiply line 22 by20% (0.20) .. .. 23. 0 - 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 to figure the tax. If the amount on line 7 is $100,000 or more, use the Tax Computation Worksheet 25. Add Iines2o,23.and 26. Figure the tax on the amount on line 1. If the amount on line1 is less than $100,000, use the Tax Table to figure the tax. If the amount on line1 is $100,000 or more. use the Tax Computation Worksheet all taxable income. Enter the smaller of line 25 or 26. Also include this amount on Form 1040, line 44. If you are filing Form 2555 or 2555-EZ, don't enter this amount on Form 1040, line 44. Instead, enter it on line4ofthe Foreign Earned Income Tax Worksheet *lf you are ?ling Form 2555 or 2555-EZ, see the footnote in the Foreign Earned Income Tax Worksheet before completing this line. 710451 01?17?18 SCHEDULE Supplemental Income and Loss (Form 1040) (From rental real estate, royalties, partnerships, corporations, estates, trusts, REMICs, etc.) Attach to Form 1040. 1040NR, or Form 1041. '?ieina' Revenue SW06 (99) DI- Go to for instructions and the latest information. Department of the Treasury OMB No. 1545-0074 2017 Attachment Sequence No 13 Name(s) shown on return CLAIRE C. MCCASKILL Your social security number I Part Income or Loss From Rental Real Estate and Royalties Note: If you are in the business of renting personal property, use Schedule or C-EZ [see instructions). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40. A Did you make any payments in 2017 that would require you to file Formls) 1099? (see instructions"Yes." did you or will you tile required Forms 1099? 1a address of each property (street, city. state. ZIP codeType of Property 2 For each rental real estate property listed Fair Rental Personal QJV loo below) so A only if you meet the requirements to file as A i_.i a qualified joint venture. See instructions. 3 Type of Property: 1 Single Family Residence 3 Vacation/Short-Term Rental 5 Land 7 Self-Rental 2 Multi-Family Residence 4 Commercial 6 Royalties Other (describe) Income: I Properties: A 3 Rentsreceived .. 3 4 Royalties received 4 Expenses: 5 AdvertisingI 5 6 Auto and travel (see instructionsCleaning and maintenance .. 7 8 Commissions 8 9 Insurance Legaland other professional fees . .. 10 11 Management fees Mortgage interest paid to banhs, etc. (see Instructions) I I 12 13 Other Interest 13 14 Repairs .. .. . 14 15 Supplies .. .W . .. 15 16 Taxes .. .. .. . . .. . 16 17 Utilities . .. 17 18 Depreciation expense or depletion I II 18 19 Other (list) 19 20 Total expenses. Add lines 5 through 19 II 20 21 Subtract line 20 from line 3 (rents) and/or 4 (royalties) lf result 15 a (loss), see instructions to find out if you must file Form 6198 21 22 Deductible rental real estate loss after limitation, if any, on Form 8582 (see instructions) .. . 22 )l 1 23a Total ofall amounts reported on line3forall rental properties 23a Total of all amounts reported on line 4 for all royalty properties 23b Total of all amounts reported on line 12 for all properties 23c cl Total of all amounts reported on line 18 for all properties 23d Total of all amounts reported on line 20 for all properties 23a 24 Income. Add positive amounts shown on line 21 Do not include any losses I .. 24 25 Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here I I II 25 26 Total rental real estate and royalty' Income or (loss). Combine lines 24 and 25. Enter the result here. If Parts II, IV, and line 40 on page 2 do not apply to you, also enter this amount on Form 1040. line 17, or Form 1040NR, line 18. Otherwise, include this amount in the total on line 41 on page 2 II . 26 0 . LHA For Paperwork Reduction Act Notice, see the separate instructions. V2149?l 10-20-17 10 Schedule (Form 1040) 2017 Schedule (Form 1040) 2017 lqama?r SIEWH Cl? ?Hun-l 50 6411'? Elna SDCFEI: annuity 115101.?? On page 1 CLAIRE C. MCCASKILL Caution: The IRS compares amounts reported on your tax return with amounts shown on Schedulels) K-1. Part II Income or L055 From Partnerships and Corporations Note: If you report a loss from an at-risk activity for which any amount is not at risk, you must check column on line 28 and attach Form 6198. See instructions. Attachment Sequence No 13 Page 2 Your social security number 27 Are you reporting any loss not allowed in a prior year due to the at-risk, excess farm loss, or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? 1:1 Yes $1 No If you answered ?Yes," see instructions before completing this section. {hit-ms- Pig (9) Check (It) Employer Check if 28 (a)Name identification number 31,3253; '3 A CHEF AMYB LLC Passive Income and Loss Nonpassive Income and Loss Passive loss allowed (9) Passive income Nonpassive loss (1) Section 179 expense Nonpassive income (attach Form 8582 if required) from Schedule K-1 from Schedule K-t deduction from Form 4532 from Schedule K29a Totals . 5,577. Totals. .. 30 Add columns (9) and (j of line 29a 30 5 .- 577 . 31 Add columns andI (i of line 29b . . 31 32 Total partnership and corporation income or (loss). Combine lines 30 and 31. Enter the result here and include In the total on line_ 41 below 32 5 5 7 '7 . Part Income or Lose From Estates and Trusts 33 Name A 3 Passive Income and Loss Nonpassive Income and Loss Passive deduction or loss allowed Passive income Deduction or loss (1) Other income from (attach Form 8582 if required) from Schedule K-1 from Schedule K-1 Schedule K-1 A 34a Totals Totals 35 Add columns and of line 34a 35 36 Add columns(c )and(e )ofline34b 36 I i 37 Total estate and trust' income or (loss). Combine lines 35 and 36. Enter the result here and include In the total on line 41 below 37 Part Income or Loss From Real Estate Mortgage Investment Conduits Ftesi dual Holder (G) from d) Taxable Income (net It: In ome from 33 Name iden1i21c?1110pr10r?fmber oss)fror?ngc1hbedules 0 Settieldufes 0, line 3b 39 Combine columns and only. Enter the result here and include in the total on line 41 below 39 Part Summary 40 Net farm rental income or(loss) from Form 4835. Also, complete line 42 below . 40 41 Total income or (loss). Combine lines 25, 32. 37. 39. and 40 Enter the result here and on Form 1040, line it, or Form 1041mm, irna Reconciliation of farming and fishing income. Enter your gross farming and fishing income reported on Form 4835, line 7; Schedule (Form 1065), box 14, code Schedule K-1 (Form 11208), box 17, code and Schedule (Form 1041), box 14, code (see instructions) 42 I 43 Reconciliation for real estate professionals. If you were a rest estate professional (see instructions). enter the net Income or (lose) you reported anywhere on Form 1040 or Form 1040NFI from all rental real estate activities in which you materially participated under the peeswe loss rules 43 I 721501 10?20-17 11 Schedule (Form 1040) 2017 2017 Income from CHEF AMYB LLC I.D. NUMBER: TYPE: PARTNERSHIP ACTIVITY INFORMATION: CHEF AMYB LLC OTHER PASSIVE ACTIVITY ORDINARY INCOME (LOSS) 5,755. SECTION 179 AND CARRYOVER -l78. TOTAL PASSIVE ACTIVITY INCOME (LOSS) 5,577. TAX PREFERENCE ITEMS: DEPRECIATION ADJUSTMENT OTHER K-l INFORMATION: INTEREST INCOME 3. CREDITS 562. INVESTMENT INCOME 3. 562. NONDEDUCTIBLE EXPENSES 728021 04-01-17 12 Form 3800 General Business Credit Go to for instructions and the latest information. You must attach all pages of Form 3800, pages 1, 2, and 3, to your tax return. OMB No 1545?0895 2017 Attachment Sequence No 22 Mamas] shown on return CLAIRE C. MCCASKILL Part I Current Year Credit for Credits Not Allowed Against Tentative Minimum Tax (See instructions and complete Partls) before Parts I and II) number General business credit from line 2 of all Parts with box A checked Passive activity credits from line2 of all Parts with box checked Enter the applicable passive activity credits allowed for 2017. See instructions I Carryforward of general business credit to 2017. Enter the amount from line 2 of Part with box checked. See instructions for statement to attach 01 Carryback of general business credit from 2018. Enter the amount from line 2 of Part with box checked 6 Addlines13?4and5 .. . Part II Allowable Credit 7 Regular tax before credits: 0 Individuals. Enter the sum of the amounts from Form 1040 lines the amounts from Form lines 42 and 44 II I *0 Corporations. Enter the amount from Form 1120, Schedule Part I line 2 or ?the" 45,764. applicable line of your returnI 0 Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule Gm lines 1a and 1b; or the amount from the applicable line of your return II II I I 8 Alternative minimum tax: 0 Individuals Enter the amount from Form 6251 line 35 II II Corporations Enter the amount from Form 4626. line 14 I II 537. ll Estates and trusts. Enter the amount from Schedule I (Form 1041) line 56 9 Add lines 7 and 8 46,301. 103 Foreign tax credit .. . 103 Certain allowable credits (see InstructIons10b Add lines 103 and 10b 10c 11 Net income tax. Subtract line 10c from line 9. If zero, skip lines 12 through 15 and enter -0- on line 16 11 46.301. 12 Net regular tax. Subtract line 100 from line 7. If zero or less, enter -Enter 25% (0.25) of the excess, if any, of line 12 over $25,000 (see instructionsTentative minimum tax: 0 Individuals. Enter the amount from Form 6251, line 33 .. 0 Corporations. Enter the amount from Form 4626, line Estates and trusts. Enter the amount from Schedule (Form 1041). line 54 15 Enter the greater of line 13 or line 14 15 46.301. 16 Subtract ine15from ine11. Ifzero or less, enter-O- 16 0. 17 Enter the smaller of line 6 or line 16 17 0. corporations: See the line 17 instructions if there has been an ownership change, acquisition, or reorganization. LHA For Paperwork Reduction Act Notice, see separate instructions. 714401 01-18-18 13 Form 3800 (2017) Form 3800 [2017} Part Allowable Credit (Continued) Note: If you are not required to report any amounts on lines 22 or 24 below, skip lines 18 through 25 and enter -0- on line 26. Page 2 18 Multiply line 14 by 75% (0.75). See instructions .. I II II 18 19 Enterthe greaterofline130rline18 I II I 19 20 Subtract line 19 from line 11. If zero or less. enter -0- 20 21 Subtract line 17 from line 20. If zero or less, enter -0- 21 2 Combine the amounts from line 3 of all Parts with box A. C, or checked .. I 22 23 Passive activity credit from line301 all Parts with box checked Enter the applicable passive activity credit allowed for 2017. See instructions Addlines22and24 25 26 Empowerment zone and renewal community employment credit allowed. Enter the 26 0. 27 Subtract line 13 from line 11 . If zero or less, enter -Add lines 17 and 26 28 Subtract line 28 from line 27. lfzero orless, enter II 37 985 - Enter the general business credit from line50f all Parts with box Achecked II II II II 31 Reserved 31 32 Passive activity credits from line 5 of all Parts with box checked 32 I 5 6 2 . Enter the applicable passive activity credits allowed for 2017. See instructions . . 33 9 0 4 - Carryforward of business credit to 2017. Enter the amount from line 5 of Part with box checked and line 6 of Part with box checked. See instructions for statement to attach Carryback of business credit from 2018. Enter the amount from line 5 of Part ill with box checked. See instructions 36 Add lines 30Enter the smaller of line 29 or line Credit allowed for the current year. Add lines 28 and 37. Report the amount from line 38 (if smaller than the sum of Part I, line 6, and Part II, lines 25 and 36, see instructions) as indicated below or on the applicable line of your return. 0 Individuals Form 1040, line 54. or Form 1040NR. line 51 II I II . Corporations. Form 1120, Schedule J. Part I, line 50 Estates and trusts. Form 10:11. Schedule (3. line 38 9 0 4 - Form 3800 (2017) 714402 01-18-18 14 Form 3800 (201?) Page 3 Namnisi shown on return IdaII'iIinng number CLAIRE . MCQASKILL Part General Business Credits or Eligible Small Business Credits{seeinsrructrons) Complete a separate Part ill for each box checked below (see instructions). A General Business Credit From a Non?Passive Activity El Reserved General Business Credit From 3 Passive Activity El Reserved General Business Credit Carryforwards El Eligible Small Business Credit Carryforwards General Business Credit Carrybacks El Reserved I if you are filing more than one Part ill with box A or checked. complete and attach first an additional Part combining amounts from all Parts ill with box AorB checked. Check here ifthis is theconsciidatsd Part . . P- la) Description oicredrt Note: On any IIne where the credit Is from more than one source, a separate Part Hi Is needed lfclaiming the?credit from a . for each pass-through entity. pass-through entIty, enter the EIN Enter the approprIate amount 1a investment (Form 3468, Part ii only) (attach Form 3468) .., I 1a Reserved 1b increasing research activities (Form 6765) 1c Low Income housrng (Form 8586 Part I only) 1d Disabled access (Form 8826) (see instructions for imitation)II II . 1e Renewable electricity, refined coal and Indian coal production (Form II 1f 9 indianempioyment(Form 8845) 19 Orphan drug(Form 8820).. . . . .. 1h i New markets (Form 8874) I .. II 1i Small employer pension plan startup costs (Form 8881) (see Instructrons for limitation) 1] Employer-provided child care facilities and services (Form 8882) (see instructions for ImItatIon) .. I 1k I Biodiesei and renewable diesel fuels (attach Form 8864) I I II I 1i Low sulfur diesel fuel production (Form 8896) 1m Distilled spirits (Form 8906) II II I 1n 0 Nonconventionalsourcefuel (carryforward only) 10 Energy efficient home (Form 8908) .. 1p Energy efficient appliance (carryforward only) 1q Alternative motorvehicle(Form Alternative fuel vehicle refueling property (Form 8911) I II II II 15 Enhanced orl recovery credIt (Form 8830) 1t Mine rescue team training (Form 8923) II II II 1u Agricultural chemicals security (carryforward only) .. 1v Employer differential wage payments (Form 8932) I I II II 1w Carbon dioxide sequestration (Form 8933) 1x Qualified plug-in electric drive motor vehicle (Form 8936) I I 1y Qualified plug-in electric vehicle (carryfonrvard only) II 1: aa Employee retention (Form 5884- A-) 1aa bb General credits from an electing large partnership (Schedule 1 (Form 1065- 1bb zz Other. Oil and gas production from marginal wells (Form 8904) and certain other credits (see instructione) 122 2 Add lines 1a through 1zz and enter here and on the applicable line of Part 2 0 - 3 Enter the amount from Form 8844 here and on the applicable line of Part li 3 4a investment (Form 3468, Part (attach Form 3468) 4a Work opportunity (Form 5334) 413 producer (Form 5473) 40 Low-income housing (Form 8586, Part ll) 4d Renewable electricity, refined coal, and Indian coal production (Form 8835) I .. 4e Employer social security and Medicare taxes paid on certain employee tips (Form 8846) . .. 562 - Qualifiedraiiroad track maintenance(Form I 49 Small employer health Insurance premiums (Form 8941) II 4h i Increasing research activities (Form 6765) 4i i Reserved 2 Other 42 5 Add lines 4a through 42 and enter here and on the applicable line of Part Add lines 2, 3, and 5 and enter here and entire applicable line of Part Ii 6 5 6 2 . 714403 01-18?18 1 5 Form 3800 i201?) Alternative Minimum Tax - Individuals 6251 2017 Go to for instructions and the latest information. Department of the Treasury Allachmont Internal Fievenue SerVIoe [99) P, Attach to Form 1040 Dr Form 1040NH. Sequence No 32 Name(s) shown on Form 1040 or Form 1040NFI Your social security number CLAIRE . MCCASKILL I Part I I Alternative Minimum Taxable Income 1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41 and go to line 2. Otherwise, enter the amount from Form 1040, line 38, and go to line 7. (If less than zero, enter as a negative amountReserved for future use .. . 2 3 Taxes from Schedule AIForm1040), IineQ 3 14 425 . 4 Enter the home mortgage interest adjustment if any from line of the worksheet in the instructions for this line 4 5 Miscellaneous deductions from ScheduleAtForm 1040) line 27_ .. 5 6 II Form 1040 line 38. is $155, 900 Or less, enter Otherwise. see instructions Tait refund from Form 1040, has 10m Itne21 7 8 Investment interest expense (difference between regular tax and AMT) 8 9 Depletion(difference betweenregulartaxandAMT)? 9 10 Net operating loss deduction frOm Form 1040 line 21. Enter as a positive amotint 1O 11 Alternative tax net operating loss deduction 11 12 Interest from speci?ed private activity bonds exempt from the regular tat-t 12 13 iQuali?ed small business stock. see instructions 13 14 Exercise of incentive stock options (excess of AMT Income over regular tax income)_ 14 15 Estates and meets (amount from Schedule K1 (Form 1041), box 12.code A) . 15 16 Electing large partnerships (amount from Schedule K-1 (Form 1065- box 6) 16 17 Disposition of property (dilference between AMT and regular tart gain or loss)_ 17 18 Depreciation on assets placed in servioe after 1985 (difference between regular tax and AMT) 18 19 Passive activities (difference between AMT and regular tax income or loss) 19 1 - 20 Loss limitations (difference between AMT and regular tax income or loss) 20 21 Circulation costs (difference between regulartax and AMT) 21 Long-term contracts (difference between AMT and regular tax income) 22 23 Mining costs (difference between regular tax and AMT) 23 24 Research and experimental costs (difference between regular tax and AMT) 24 25 Income from certain installment sales before January 1, 1987 25 26 Intangible drilling costs preference 26 27 Other adjustments, including incomebased related adjustments .. 27 28 Alternative minimum taxable' Income. Combine lines 1 through 27 (If married filing separately and line 28 Is more than $249 450 see instructionsPart II Alternative Minimum Tax (AMT) 29 Exemption. (If you were under age 24 at the end of 2017, see instructions.) lF your filing status AND line 28 is not THEN enter on line Single or head of household $120,700 $54,300 Married filing jointly or qualifying widow(er) 160, 900 . 84,500 Married filing separately .. 80, 450 42,250 STMT 1 29 15 388 . If line 28' Is over the amount shown above for your filing status see instructions. 30 Subtract line 29 from line 28. If more than zero, go to line 31 If zero or less. enter -0- here and on lines 31line you are filing Form 2555 or 2555-E2, see instructions for the amount to enter. 0 If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule (Form 1040) (as refigured for the AMT, if necessary), complete Part on page 2 and enter the-amount from line 64- hereAll others: If lIne 30 is $187,800 or less ($93,900 or less if marrIed ?ling separately), multiply lIne 30 by 26% (0.26). Otherwise, multiply line 30 by 28% (0.28) and subtract $3,756 ,878 if married filing separately) from the result. 32 Alternative minimum tax foreign tax credit (see instructions) 32 33 Tentative minimum tax. Subtract line 32 from line Add Form 1040, line 44 (minus any tax from Form 4972), and Form 1040, line 46 Subtract from the result any foreign tax credit from Form 1040, line 48 If you used to figure your tax on Form 1040, line 44, refigure that tax without using Schedule before completing this line (see instructionsAMT Subtract Line 34 rrom line as. If zero or less enter 0. Enter here and on Form mm line a 35 5 3 7 . 719431 01? 11-13 LHA For Papenrvork Reduction Act Notice, see your tax return instructions. Form 6251 (2017) 16 Form 5251 {2017) CLAIRE . MCCASKILL Part Tax Computation Using Maximum Capital Gains Rates Complete Part only if you are required to do so by line 31 or by the Foreign Earned Income Tax Worksheet in the instructions. 36 37 41 42 33386 3 51 8485128 Enter the amount from Form 6251, line 30. If you are filing Form 2555 or 2555-E2, enter the amount from line3ofthe worksheet in the instructions for line Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 13 of the Schedule Tax Worksheet in the instructions for Schedule (Form 1040), whichever applies (as refigured for the AMT, if necessary) (see instructions). If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter I I Enter the amount from Schedule (Form 1040), line 19 (as refigured for the AMT, if necessary) (see instructions). If you are filing Form 2555 or 2555-E2, see instructions for the amount to enter . you did not complete a Schedule Tax Worksheet for the regular tax or the AMT, enter the amount from line 37. Otherwise, add lines 37 and 38, and enter the smaller of that result or the amount from line 10 of the Schedule Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555 or see instructions for the amount to enter I I I I Enterthe smaller of ine36 or Iine39 . Subtract line 40 from line 36 If line 41 is $187,800 or less ($93,900 or less if married filing separately), multiply line 41 by 26% (0.26). Otherwise. multiply line 41 by 28% (0.28) and subtract $3,756 ($1,878 if married filing separately) from the Enter: $37,950 if single or married filing separately, or 0 $50,800 if head of household. Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 14 of the Schedule Tax Worksheet in the instructions for Schedule (Form 1040), whichever applies (as figured for the regular tax). if you did not complete either worksheet for the regular tax, enter the amount from Form 1040, line 43; if zero or less, enter -0-. If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter Subtract line 44 from line 43. If zero or less, enter -0- Enter the smaller of line 36 orline 37 .. II II Enter the smaller of line 45 or line 46. This amount is taxed at 0% I Subtract line 47 from line 46 Enter: 0 $418,400 if single 0 $235,350 if married filing separately 0 $470,700 if married filing jointly or qualifying widow(er) 0 $444,550 if head of household Entertheamountfromline45 . .. . .. . . . Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 19 of the Schedule Tax Worksheet, whichever applies (as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter the amount from Form 1040, line 43; if zero or less, enter -0-. If you are filing Form 2555 or Form 2555-E2, see instructions for the amount to enter I II Add line50 and ine51 .. Subtract line 52 from Iine49. lfzero or less, enter -0- .. I Enterthe smaller of line 48 or line Add lines lines 56 and 36 are the same, skip lines 57 through 61 and go to line 62. Otherwise, go to line 57. Subtract line 56from line 46 .. .. .. . Multiply line 57 by 20% (0.20) .. 0 $75,900 if married filing jointly or qualifying widow(er), If line 38 is zero or blank, skip lines 59 through 61 and go to line 62. Otherwise, go to line 59. Add lines 41, 56, and 57 Subtract line 59 from line 36 Multiply line 60 by 25% (025) Add lines 42line 36 is $187,800 or less ($93,900 or less if married filing separately), multiply line 36 by 26% (0 .26). Otherwise, multiply line 36 by 28% (0.28) and subtract $3,756 ($1,878 if married filing separately) from the result Enter the smaller of line 62 or line 63 here and on line 31 . if you are filing Form 2555 or 2555-E2, do not enter this amount on line 31. Instead, enter it on line 4 of the worksheet in the instructions for line 31 35 172,509. 37 951. 38 39 951. 40 951. 41 171,558. 42 45,158. 43 37,950. 44 175,795. 45 0. 46 951. 47 0- 43 951. 49 235,350. 50 0. 51 175,795. 52 175,795. 53 59,555. 54 951. 55 143. 56 95146.301. 46,425. 46, 301. 719591 01-11-18 17 Form 6251 (2017) ALTERNATIVE MINIMUM TAX RECONCILIATION REPORT Name(s) CLAIRE C. MCCASKILL Social Security Number TOTAL ADJ PREF Form . Adjustment Name Descr'pt'on Income Form 6251, Line 17 Form 6251, Line 18 Form 6251, Line 19 Form 6251, Line 20 Kl- CHEF AMYB LLC REGULAR INCOME 5,577. AMT ADJUSTMENTS l. l. AMT NET INCOME 5,578. 1. 719911 04-01-17 OMB No 1545-0074 Form 8959 AddItIonal Medicare Tax It If any line does not apply to you. leave it blank. See separate instructions. 20 17 Department of the Treasury Attach to Form 1040, 1040NR, 1040-PR, or 1040'88. Attachment 1 lmema' Revenue SW66 Go to for instructions and the latest information. sequence No 7 Name(s) shown on return Your social seeurit number CLAIRE c. MCCASKILL Part I Additional Medicare Tax on Medicare Wages 1 Medicare wages and tips from Form W-2, box 5. If you have more than one Form W-2, enter the total of the amounts from box5 1 174. 000- 2 Unreported tips from Form 4137, line6 . Wages from Form 8919. .. . .. 3 4 Add ines1 through3 Enter the following amount for your filing status Married filingjointly I I $250, 000 Married filing separately_ . . $125,000 Single Head of householdm or QualIfyIng widow(er) $200Subtract line5 from line 4 If zero or less enter Additional Medicare Tax on Medicare wages Multiply line 6 by 0. 9% (0. 009). Enter here and ?10 ?to Part 11.. 7 4 4 1 - Part II Additional Medicare Tax on Self-Employment Income 8 Self?employment income from Schedule SE (Form 1040), Section A, line 4, or Section B, line 6. if you had a loss, enter -0- (Form 1040-PR and Form 1040-SS filers, see instructionsEnter the following amount for your filing status: Married filing jointly . $250.000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 II .. II I 9 10 Enter the amount from line 4 10 11 Subtractline10from line9. lfzero orless, enter -0I 11 12 Subtractline11 fromlineB. lfzero orless, enter -OI 12 13 Additional Medicare Tax on self? employment Income. Multiply line 12 by 0. 9% (0. 009). Enter hereand gotoPartlli 13 Part Additional Medicare Tax? on Railroad Retirement Tax Act (RRTA) Compensation 14 Railroad retirement (RRTA) compensation and tips from F0rm(S) W2. box 14(See instructionS) 14 15 Enter the following amount for your filing status: Married filing jointly $250,000 Married filing separately $125,000 Single, Head of household, or Qualifying widow(er) $200,000 .. 15 16 Subtract IIne1Sfrom IIne14 lfzero or less enter --0 II II I 16 17 Additional Medicare Tax on railroad retirement (RRTA) compensation Multiply line 16 by 0.9% {0.009}. Enter hereand go to Part Part IV Total Additional Medicare Tax 18 Add lines 7, 13, and 17. Also include this amount on Form 1040, line 62, (Form 1040NR, 1040-PR, and 104088 filers. see instructionsiand go to PerthPart Withholding Reconciliation 19 Medicare tax withheld from Form W-2, box 6. If you have more than one Form W-2, box6 19 2 I 523 - 20 Entertheamountfromline1 II II I 20 21 Multiply line 20 by 1.45% (0.0145). This is your regular Medicare tax withholding on Medicare wages Subtract line 21 from line 19 If zero or less, enter --0. This' Is your Additional Medicare Tax withholding on Medicare wages .. 22 0 - 23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form box 14(see InstructionsTotal Additional Medicare Tax Withholdmg Add lines 22 and 23. Also include this amount with federal' Income tax withholding on Form 1040, line 64 (Form 1040NR, 1040-PR, and 1040- SSfilers, see instructions). .. .. . 24 723111 12-13-17 LHA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8959 (201 T) 19 Form 8960 Net Investment Income Tax Individuals, Estates, and Trusts Attach to your tax return. Department of the Treasury Internal Revenue Service (99) Go to for instructions and the latest information. OMB No 1545-2227 2017 Attachment Sequence No. 72 Name(s) shown on your tax return CLAIRE . MCCASKILL Part I Investment Income Section 6013(g) election (see instructions) Section 6013(h) election (see instructions) Regulations section 1 .1411-10Ig) election {see instructions} Your social security number or EIN 1 Taxable interest (see instructions975- 3 Annuities (see instructions) 3 4a Rental real estate. royalties partnerships ScorporatIons trusts etc (see InstructionS) . 4a 5 577 - Adjustment for net income or loss derived In the ordinary course ?of a non- -section 1411 trade or business (see instructions) .. I . 4b Combinelines4a and 4b . . 4c 5. 577- 5a Net gain or loss from disposition of property (see instructions) I I II 53 Net gain or loss from disposition of property that is not subject to net investment income tax (see instructionsAdjustment from disposition of partnership interest or corporation (see . .. 59 Combine lines 5a through 5c 5d 6 Adjustments to investment income for certain CFCs and PFICs (see InstructIons) 6 7 Other modifications to investment' Income (see instructions) 7 Totalinvestmentincome. Combine ines1 Part II Investment Expenses Allocable to Investment Income and ModIfIcatIons 9a Investment interest expenses (see instructionsState, local, and foreign income tax (see instructionsMiscellaneous investment expenses (see instructions9r: Add lines Additional modifications (see instructions) 10 11 Total deductions and modifications. Add lines Part Tax Computation 12 Net investment income. Subtract Part II, line 11 from Part I. line 8. Individuals complete lines 13? 17. Estates and trusts complete lines 18a-21. Ifzero orless, enter-Individuals: 13 Modified adjusted gross income (see instructionsThreshold based on filing status (see instructionsSubtract line14from line 13. Ifzeroor less, enter?O- I 15 141. 095- 16 Enterthesmaller ofIIne12 or IIne15 I 16 6 244 . 17 Net investment' Income tax for individuals Multiply line 1S by 3.8% (.038). Enter here and include on your tax return (see instructions) 17 2 3 7 - Estates and Trusts: 18a Net investment income(line12above)? I I 18a Deductions for distributions of net investment income and? deductions under section 642(c) (see instructions) I 18b Undistributed net investment income. Subtract line 18b from 18a (see instructions). Ifzero or less, enter -0- II II 18c 19a Adjusted gross income (see instructions) I . 193 Highest tax bracket for estates and trusts for the year (see instructiOIIS). 19b 0 Subtract line 19b from line 19a. If? zero or ?less enter -0 19c 20 Enter the smaller of IIne 18c or lIne 19c II II II 20 21 Net investment income tax for estates and trusts Multiply line 20 by 3.8% (.038).Enter here and include on your tax return (see instructions) .. 21 LHA For Paperwork Reduction Act Notice, see your tax return instructions. Form 8960 (2017) 723121 12-22-17 20 Lines 9 and 10 - Application of Itemized Deduction Limitations on Deductions Properly Allocable to Investment Income Worksheet Keep for Your Records Part I - Application of Section 67 to Deductions Properly Allocable to Investment Income 1. Enter the amount of Miscellaneous Itemized Deductions properly allocable to investment income before any itemized deduction limitations (Description and Form 8960 line number where they'll be reported): Description Li?e Amount (bi 3. Enter the amount of all Miscellaneous Itemized Deductions after the application of the section 67 limitation (Schedule A (Form 1040), 4. Enterthe lesserofthe total reported on ine20rline3 . 2. line1 2. line27) . 3- Part II - Application of Section 67 Limitation to Specific Deductions (3) IF line 3 is less than line 2, THEN divide line 3 by line 2 AND enter the amount in column (B). IF amounts reported on Part I, lines 2 and 4 are equal, THEN (Cl Multiply the individual amounts in column (A) by the amount in column (A) enter 1.00 in column Fieenter the amounts and descriptions from Part I, line 1. (B). Descrigtion Hie Amount (3) (bl TIP allowable after the application of the section 68 limitation. Ill or of this worksheet. Individuals - Use the amounts in column (C) on Part ill. line 1, to determine the amount of these deductions that are Estates or trusts Enter the amounts in column (C) in the appropriate location on lines 9 and 10. Don't complete Parts 723251 01?10-18 20.1 Lines 9 and 10 - Application of Itemized Deduction Limitations on Deductions Properly Allocable to Investment Income Worksheet - con?nued Part - Application of Section 68 to deductions properly allocable to investment income (Individuals Only) Keep for Your Records 1. Enter the amount of Miscellaneous Itemized Deductions properly allocable to investment income from column (C) of Part II: Description [Jig Amount {hi 2. Enter the amount of state, local, and foreign income taxes that are properly allocable to investment income .. .. . 2. 3 3 1 - 3. Enter the amounts of other Itemized Deductions subject to the section 68 limitation and properly allocable to investment income before any itemized deduction limitations (Description and Form 8960 line number where they'll be reported): Description Amount lb) 4. Enter the total deductions properly allocable to investment income subject to the section 68 limitation. Enter thesumoflines 1throughs . . .. .. . . .. .. . 4. 331 - 5. Enter the amount of total itemized deductions reported on Form 1040 Enter all other itemized deductions allowed but not subject to the section 68 deduction limitation: Investment Interest Expense Casualty Losses (other than losses described in section 165(c)(1)) (0) Medical Expenses Gambling Losses Totalofline56(a)through6(d) Be. 7- Subtractlinesefromlines .. 7. 89.350- 8. Enterthelesserofline70rline4 . . 8. 331. TIP This is the amount of itemized deductions that are property aiiocabie to investment income after the application of the sections 67 and 68 deduction limitations. Use Part of this worksheet to reconcile this amount to the individual deduction amounts reported on Form 8960, lines 9 and 10. Part IV - Reconciliation of Schedule A Deductions to Form 8960, lines 9 and 10 (Individuals Only) (BI IF Part line 8 is less than Part line 4, THEN divide line 8 by (C) line 4 AND enter the Multiply the individual amount in column (B). amounts in column IF the amounts (A) by the amount in reported on Part column (B). Enter lines 4 and 8 are these amounts in the (A) equal, THEN enter appropriate location Reenter the amounts and descriptions from Part lines 1 - 3. 1.00 in column (B). on lines 9 and 10. Miscellaneous Itemized Deductions properly allocable to investment income: Description Lne Amount 1. lb) 2. State, local,andforeign incometaxes 331- 1.0000 331 . Itemized Deductions Subject to Section 68 included on Line 3 of Part 3- 723252 01-10-18 20 . 2 8960 Net Investment Income Tax - Form Individuals, Estates, and Trusts 2017 MISSOURI Name(s) Your social securit number or EIN CLAIRE c. MCCASKILL Part I Investment Income I 1 Section 6013(9) election Regulations section 1 .1411~10Ig} election 1 Taxable interest (Form 1040, line 8a; or Form 1041, line 1) . 1 23 - 2 Ordinary dividends (Form1040 line9a; or Form1041, line 2a) 2 975 - 3 Annuities from nonqualified plans . .. . . . . 3 4a Rental real estate royalties partnerships Scorporations, trusts etc (Form1040 line17; or Form1041 line5Adjustment for net Income or loss derived In the ordinary course ?Combine lines Net gain or loss from disposition of property from Form 1040, combine lines 13 and 14; or from Form 1041, combine lines Net gain or loss from disposition of property that is not subject to net investment incometax II I I II II 5b Adjustment from disposition of partnership interest or corporation Combinelines5athrough50 Changes In Investment Incomeforcertain CFCs and PFICs 6 7 Other modifications to Investment Income Total Investmentincome CombIne 2. 3 413.536 and7 .. .. . . .. 8 6 575 - Part II State Income Tax Pro- ration for 2017 Income Tax Payments 9 Statetotalincome II I II I 9 255,096. 10 State Incometax payments for2017 I I II SEE STATEMENT __12 1o 13 254 . 11 2017 state income tax payments attributable to Investment income line 3 divided by line 9 times line 10 11 3 27 - Part State Income Tax Pro-ration for 2016 Estimate Payments Made in 2017 12 Stateestimate paymentsfor2016 .. .. II I I I 12 13 Percent ofstate' Income taxes attributableto Investmentincomefor2016 I 13 - 003435 14 2016 state estimate payments attributable to investment income. Line 12 times line 13 14 Part IV State Income Tax Pro-ration for Balance of Prior Years Tax Plus Extension Payments Paid in 2017 15 Balance of prior years tax plus extension payments paid' In 2017 15 1 i 172 16 Percent of state income taxes attributable to investment income for 2016 Balance oi prior years tax and extension payments attributable to investment income. Line 15 times line 16 17 4 . Part Reduction of State Tax Deduction 18 Reduction of statetax deduction 1B 19 Percent of state income taxes attributable to Investment Incomefor 2016 I 19 . 003485 20 Reduction of state tax deduction attributable to investment income. Line 18 times line 19 20 1 Part VI Total State Income Tax Payments Attributable to Investment Income 21 Combine lines 11, 131,17 and 20. Carry to Form 3960. LineQ Worksheet, Part lineForm 8960 (2017) 723161 04-01-17 20.3 Form 8582 Passive Activity Loss Limitations 1545-1008 I. See separate instructions. 20 17 Department ofthe Treasury Attach to Form 1040 or Form 1041. Attachment '"temal Emma same (99? Go to rm3582 for instructioris and the latest Information. Sequenca ?0 88 Name(s) shown on return Identifying number CLAIRE . MCCASKILL [Part I I 201? Passive Activity L055 Caution: Complete Worksheets 1. 2. and 3 before completing Part I. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities in the instructions.) 1a Activities with net income (enter the amount from Worksheet 1, column .. . .. . 13 Activities with net loss (enter the amount from Worksheet 1, column . . 1b PrIor years unallowed losses (enter the amount from Worksheet 1, column .. . . .. 1C 1 Combinelines 1a, 1b. and .. .. 1d Commercial Revitalization Deductions From Rental Real Estate Activities 2a Commercialrevitalization deductions from Worksheet 2,column(a) 2a i Prior year unallowed commercial revitalization deductions from Worksheet2, column .. 2b AddlinesZaand2b .. .. . . 2c All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column .. .. . 3a 5 577 - Activities with net loss (enter the amount from Worksheet 3, column . .. .. . ah i PrIor years unallowed losses (enter the amount from Worksheet3, column .. .. .. .. . . 3c Combinelines Combine lines 1d, 2c, and 3d. If this line Is zero or more, stop here and include this form with your return; all losses are allowed, including any prior year unallowed losses entered on line 10, 2b, or 30. Report the losses on the forms and schedules normally used 4 5 5'77 . If line 4 is a loss and: 0 Line 1d IS a loss, go to Part II. 0 Line 20' Is a loss (and line 1d' Is zero or more), skip Part II and go to Part II Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and ill and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part Instead, go to line 15 I Part?Tl Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part II as positive amounts. See instructions for an example. 5 . . 5 6 Enter $150 00.0 If married filing separately, see instructions I I II I 6 7 Enter modified adjusted gross income but not less than zero (see instructions) 7 Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter on line 10. Otherwise, go to line 8. 8 Subtractlinerromlines 8 9 Multiply line 8 by 50% (0.50). Do not enter more than $25,000. If married filing separately, see instructions 9 10 EnterthesmalleroflineSorline9 .. .. .. .. 10 if line 20 Is a loss. go to Part Otherwise, go to line 15. Part Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers In Part as positive amounts. See the example for Part II in the instructions. 11 Enter $25 000 reduced by the amount, if any, on line 10. If married filing separately, see instructions I 11 12 Enterthelossfromline4Reduce lIne12 by the amount Enter thesmallest of line 2c [treated as a positive amount}, line 11 or line 13Part IV Total Losses Allowed 15 Add the Income if any, on lInesia and 3a and enterthe total .. I .. I 15 16 Total losses allowed from all passive activities for 2017. Add lines 10 14, and 15. see InstructIons to find out howto report the losses on your tax return .. . .. .. 16 LHA 719751 10-13-17 For Paperwork Reduction Act Notice, see instructions. Form 8582 (2017) 20 . 4 Form 8582 (2017) CLAIRE . MCCASKILL Caution: The worksheets must be filed with your tax return. Keep a copy for your records. Worksheet 1 - For Form 8582, Lines 1a, 1b, and 1c (See instructions.) Current year Prior years Overall gain or loss Name of activity a Netincome Net loss (c)Unallowed . (line 1a) (line 1b) loss (line 1c) Gal" Loss Total. Enter on Form 8582, lines 1a. 1b, and 1c Worksheet 2 - For Form 3582, Lines 2a and 2b {See instructions.) . . Current year Prior year Name ?f act'my deductions (line 2a) unallowed deductions (line 2b) overa" '?ss Total. Enter on Form 8582, lines 2a and2b .. . .. Worksheet 3 - For Form 8582, Lines 3a, 3b, and 3c (See instructions.) Current year Prior years Overall gain or loss Name of activity (MN ll a et income et 055 na owe . (line 3a) (line 3b) loss (line 3c) Ga'" (9) L?ss SEE ATTACHED STATE NT FOR WOIRKSHEET 3 Total. Enter on Form 8582, lines 3a, 3b.and3c 5.577. Worksheet 4 - Use thisworksheet if an amount is shown on Form 8582, line 10 or 14 [See instructions.) Form or schedule Name of activit and line number Loss Ratio Special firi?iTSt to be reported on allowance from column (see instructions) Total . .. .. . .. Worksheet 5 - Allocation of Unallowed Losses (See instructions.) Form or schedule . . and line number Name of activrty to be reported on Loss Ratio Unallowed loss (see instructions) Total .. .. 719762 10-13-17 Form8582 (2017) 20 . 5 Form 8582-CR Passive Activity Credit Limitations (Rev. January 2012) See separate instructions. Attach to Form 1040 or 1041. OMB No 1545?1034 Attachment Sequence No 89 Name(s) shown on return C. MCCASKILL I Part I Passive Activity Credits identifying number Caution: if you have credits from a publicly traded partnership, see Publicly Traded Partnerships (PTPs) in the instructions. Credits From Rental Real Estate Activities With Active Participation (Other Than Rehabilitation Credits and Low-Income Housing Credits) (See Lines 1a through to in the instructions.) 1a Credits from Worksheet 1, column I ta Prior year unallowed credits from Worksheet 1, column 1b Add lines 1a and 1b 1c Rehabilitation Credits From Rental Real Estate Activities and Low-Income Housing Credits for Property Placed' In Service Before 1990 (or From Pass-Through Interests Acquired Before 1990) (See Lines 2a through 2c In the instructions.) 2a Credits from Worksheet2, column Prior year unallowed credits from Worksheet 2, column I I 2b 1: Add lines 2a and 2b 2c Low-Income Housing Credits for Property Placed' Ill Service After 1909 (See Lines 3a through Be In the instructions.) 3a Credits from Worksheet 3, column 3.3 Prior year unallowed credits from Worksheet3, column I 3b a Add lines 3a and so . 36 All Other Passive Activity Credits {See Lin es 411 through to in the Instructions-) 4a Credits from Worksheet 4, column Prior year unallowed credits from Worksheet 4, column Add lines Add lines 1cEnter the tax attributable to net passive income (see instructionsSubtract line 6 from line 5. lf line 6 15 more than or equal to line 5, enter and see instructions II 7 0 . Note: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part ll ill, orll/. Instead, go to line 37 Part II Special Allowance for Rental Real Estate Activities With Active Participation Note: Complete this part only if you have an amount on line to. Otherwise, go to Part ill. 8 Enterthe smaller of line 1c or line Enter$150, 000. If married filing separately, see instructions Enter modified adjusted gross income, but not less than zero (see instructions). If line 10 is equal to or more than line 9, skip lines 11 through 15 and enter-O- on line Subtract line 10 from line Multiply line 11 by 50% (.50). Do not enter more than $25,000. it married filing separately, see instructions 12 13a Enter the amount, if any, from line 10 of Form8582 I I II I I I 13a Enter the amount, if any, from line 14 of Form 8582 13b Add lines 13a and 13b Subtract line 13c from line Enter the tax attributable to the amount on line 14 (see instructions) 15 16 Enter the smaller of line at line 15 16 LHA For Paperwork Reduction Act Nottce see instructions 719771 04-01?17 21 Form 8582-CR (Rev. 01-2012) Form 8582- CR (Rev. 01- -2012) CLAIRE C. MCCASKILL [Part Acciuired Before 1990] Special Allowance for Rehabilitation Credits From Rental Real Estate Act Housing Credits for Preperty Placed' In Service Before 1990 (or From Pass- -Through Interests Note: Complete this part only if you have an amount on line 20. Othenvise. go to Part IV Ies an ow- ncome Enter the amount from line 7 Enter the amount from line 16 Subtract line 18 from line 17. If zero, enter -0- here and on lines 30 and 36, and then go to PartV I Enter the smaller of line 20 or line 19 I I I Enter $250, 000. If married filing separately, see instructions to find out if you can skip lines 21 through 26 Enter modified adjusted gross income, butnot less than zero. (See instructions for line 10.) If line 22 is equal to or more than line 21, skip lines 23 through 29 and enter -O- on line 30 Subtract line 22 from line 21 I I I II I Multiply line 23 by 50% (.50). Do not enter more than $25,000. If married filing separately, see instructions Enter the amount, it any, from line 10 of Form 8582 Enter the amount, if any, from line 14 of Form 8582 25b Add lines 25a and 25b Subtractline 25c from line Enter the tax attributable to the amount on line 26 (see instructions) Enter the amount, it any, from line 18 Subtract line 28 from line 27 Enter the smaller of line 20 or line 29 25c 27 28 29 30 30 Part Special Allowance forCLow Income Housing Credits for Property Placed' In Service After 1989 Note: Complete this part only If you have an amount on line 30 Otherwise, go to Part IK 8% 8?8?22 If you completed Part enterthe amount from line 19. Otherwise, subtract line 16 from line 7 II Enter the amount from line Subtract line 32 from line 31. If zero, enter -0- here and on line 36 Enter the smaller ofline 3c or line Tax attributable to the remaining special allowance (see instructions) Enter the smaller of line 34 or line 35 83 833833 Passive Activity Credit Allowed 37 Passive Activity Credit Allowed. Add lines 6, 16, 30, and 36. See instructions to find out how to report the allowed credit on yourtax return and how to allocate allowed and unallowed credits if you have more than one credit or credits from more than one activity. It you have any credits from a publicly traded partnership. see Publicly Traded in the instructions. 37 904. Election To Increase Basis of Credit Property 38 39 4O 41 It you disposed of your entire interest in a passive activity or former passive activity in a fully taxable transaction, and you elect to increase your basis in credit property used in that activity by the unallowed credit that reduced your basis in the property, check this box. See instructions II Name of passive activity disposed of Description of the credit property for which the election is being made Amount of unallowed credit that reduced your basis in the property 719772 04?0147 22 Form 8582-CR (Fiev 01?2012) ALTERNATIVE MINIMUM TAX Form 8582 Passive Activity Loss Limitations See separate instructions. 20 17 Department of the Treasury Attach to Form 1040 or Form 1041. Attachment 'mema' Revenue (99) P- Go to for instructions and the latest intorma_tion. Sequence N0 88 Name(s) shown on return Identifying number CLAIRE . MCCASKILL Part I 201 ?assive Activity LOSS Caution: Complete Worksheets 1, 2. and 3 before cumpleting Part l. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities in the instructions.) 1a Activities with net income (enter the amount from Worksheet 1. column .. . .. . .. . .. 13 Activities with net loss (enter the amount from Worksheet 1, column(b)) 1b 0 Prior years? unallowed losses (enter the amount from Worksheet 1 ,column(c)). .. 16 dCombinelines1a, 1b, and1c. 1d Commercial Revitalization Deductions From Rental Real Estate Activities 2a CommerCIal reVItaIIzatIon deductions from Worksheet 2,column 2a Prior year unallowed commercial revitalization deductions from Worksheet2, column(AdditnesEaand All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column(a)) .. .. 3a 5r578? Activities with net loss (enter the amount from Worksheet 3, column . .. .. . .. .. .. . .. .. 3b Prior years? unallowed losses (enter the amount from Worksheet 3, column .. .. 3C Combinelines 3aCombine lines 1d. 20, and 3d. If this line Is zero or more, stop here and include this form with your return; all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 30. Report the losses on the forms and schedules normally used .. . .. . 4 5 578 . If line 4 is a loss and: 0 Line 1d is a loss, go to Part II. 0 Line 20 is a loss (and line 1d is zero or more). skip Part ii and go to Part 0 Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts ii and Ill and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part Instead, go to line 15. Part II [Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part II as positive amounts. See instructions for an example. 5 Enterthesmalleroftheloss online1dorthelossonline4_. 5 6 Enter $150,000. If married filing separately, see instructions 6 7 Enter modified adjusted gross income but not less than zero (see instructions) 7 Note: If line 7' IS greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract 'ineTfrom "?95 . . . 8 9 Multiply line 8 by 50% (0.50).Do not enter more than $25,000. If married filing separately, see instructions 9 10 EnterthesmalleroflineSorlineQ .. 10 If line 2c is a loss. go to Part Otherwise, go to ine15. Part Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers in Part as positive amounts. See the example for Part II in the instructions. 11 Enter $25 000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11 12 Enterthelossfromline4Reduce km 12 by the amount on line10 .. 13 14 Enterthesmallestofline 2c(treated as apositive amountl. line 11 oriine 13 .. . 14 Part Total Losses Allowed 15 Add the' Income, If any, on lines 1a and 3a and enter the total .. 15 16 Total tosses allowed from all passwe activities for 2017. Add lInes1O 14, and 15. See InstructIons to find outhow to reportthe losses on your tax return 16 LHA 719761 10- 13? 17 For Paperwork Reduction Act Notice, see instructions. Form 8582 (2017) 22 . 1 ALTERNATIVE MINIMUM TAX Form8582(2017) CLAIRE C. MCCASKILL Caution: The worksheets must be filed with your tax return. Keep a copy for your records. Worksheet 1 - For Form 8582. Lines 13. 1b, and 16 (See instructions.) Current year Prior years Overall gain or loss Name of activity I I a et income Net 055 na lowe . (line 1a) (line 1b) loss (line 1c) Ga'? ??55 Total. Enter on Form 8582, lines 1a, 1b. and 1c h- Worksheet 2 - For Form 8582. Lines 2a and 2b (See instructions.) . . Current year Prior year Name Of deductions (line 2a) unallowed deductions (line 2b) Overall loss Total. Enter on Form 8582, lines 2a and2h . . .. . . Worksheet 3 - For Form 8582, Lines 3a, 3b, and 3c {See instructions.) Current year Prior years Overall gain or loss Name of activity tl ll a at income 055 na owe . . (line 3a) (line 3b) loss (line 3c) Ga'" L?ss SEE ATTACHED STATEMENT FOR WORKSHEET 3 Total. Enter on Form 8582, lines 3a, Worksheet 4 - Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.) Form or schedule . and line number Special Subtract Name of to be reported on Loss Ratio allowance column to) (see instructions) from column Total . Worksheet 5 instructions.) Form or schedule . . and line number . Name of activity to be reported on (a)Loss Ratio Unallowed loss (see instructions) Total .. . . . . 719762 10?13-17 Form 8582 (2017) 22.2 - - - - OMB 1545-0172 4562 DepreCIatIon and Amortization Form (Including Information on Listed Property) 20 17 Department of the Treasury Attach to your tax return' RY Attachment Internal Revenue Service (99) Go to wwarsgovIF??orm4562 for instructions and the latest information. Sequence No 179 Namets) shown on return Flu-amass or activity to which "us form relates IdontIl?ying number CLAIRE . MCCASKILL ALL BUSINESS ACTIVITIES I_F?art II Election To Expense Certain Property Under Section 179 Note: If you have any listed property. complete Part before you complete Part I. 1 Maximum amount (see InstructIons) .. . 1 510, 000. 2 Total cost of section 179 property placed in service (see InstructIons) 2 0 - 3 Thresholdcostofsection179 .. II 3 2. 030 I 000- 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- 4 0 . 5 Dollar limitation for tax year Subtract line 4 from line 1 If zero or less. enter If married llIIinIg separately. see instructions . . 5 2 5 5 6 Description of property ID) Cost (business use only) Elected cost TOTAL ALLOWABLE SECTIO 179 EXPENSE 178 . 7 Listed property Enterthe amountfromline 29 .. I 7 8 Total elected cost ofsection 179 property. Add amounts in column(c linesBand Tentative deduction. Enterthesmaller ofline?orlineSI I 9 17'3 . 10 Carryover of disallowed deduction from line 13 of your 2016 Form 4562 II II .. I 10 11 Business Income limitation Enter the smaller of business Income (not less than zero) or line5 Section 179 expense deduction. Add lines 9 and 10. but don't enter more than line Carryover of disallowed deduction to 2018. Add lineSQ and 10. less line 12 . 13 I Note: Don't use Part II or Part below for listed property Instead. use Part V. I Part II I Special Depreciation Allowance and Other Depreciation (Don?t include listed property.) 14 Special depreciation allowance for qualified property (other than listed property) placed in service during thetaxyear .. .. . . . . .. . .. 14 15 Property subjectto section 168(f)(1)electIon I 15 16 Otherdepreciationijincludinq . 16 I Part I MACRS Depreciation (Don?t include listed property.) (See Instructronsm) Section A 17 MACRS deductions for assets placed In service in tax years beginning before 2017 .. 17 I 13 If you are electing to group any assets placed In servme during the tax yew into one or more garter-'31 asset accounts check here El Section B- Assets Placed' In Service During 2017 Tax Year Using the General Depreciation System (to) Month and Basis for depreciation Classification of property year placed (businesst nvestment use Recovery (9) Convention Method (9) Depreciation deduction In serVIce only - see instructions) permd 19a Svyear property 5-year property 7-year preps-?y 10-year property 15-year property 20ryear property 9 25-year property 25 yrs. I I 27.5 yrs. MM ReeldentIal rental property 275 yrs. MM i Nonresidential real property 39 yrs. MM MM Section - Assets Placed in Service During 2017 Tax Year Using the Alternative Depreciation System 20a Class life 12-year 12 yrs. 40 year 40 yrs. MM I?rt I Summary {See instructions.) 21 Listed property. Enteramountfrom ine28 21 22 Total. Add amounts from line 12 lines 14 through 17, lines 19 and 20 in column and line 21 Enter here and on the appropriate lines of your return. Partnerships and corporations - see instr . 22 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs 23 716251 01-25-13 LHA For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2017) 23 CLAIRE . MCCASK ILL FORM 1040 PENSIONS AND ANNUITIES STATEMENT 1 MISSOURI JUDGES ALJ LEGISLATORS ELECTED OFFICIALS RET. SYSTEM AMOUNT RECEIVED THIS YEAR 40,031. NONTAXABLE AMOUNT CAPITAL GAIN DISTRIBUTION REPORTED ON SCH 40,031. CENTRAL TRUST COMPANY AMOUNT RECEIVED THIS YEAR 45,490. NONTAXABLE AMOUNT CAPITAL GAIN DISTRIBUTION REPORTED ON SCH 45,490. TOTAL INCLUDED IN FORM 1040, LINE 163 85,521. 24 1 CLAIRE . MCCASKILL FORM 1040 PERSONAL EXEMPTION WORKSHEET STATEMENT 2 1. IS THE AMOUNT ON FORM 1040, LINE 38, MORE THAN THE AMOUNT SHOWN ON LINE 4 BELOW FOR YOUR FILING NO. STOP. MULTIPLY $4,050 BY THE TOTAL NUMBER OF EXEMPTIONS CLAIMED ON FORM 1040, LINE 6D, AND ENTER THE RESULT ON LINE 42. YES. CONTINUE 2. MULTIPLY $4,050 BY THE TOTAL NUMBER OF EXEMPTIONS CLAIMED ON FORM 1040, LINE 6D 4,050. 3. ENTER THE AMOUNT FROM FORM 1040, LINE 38 266,096. 4. ENTER THE AMOUNT FOR YOUR FILING STATUS 156,900. SINGLE $261,500 MARRIED FILING JOINTLY OR $313,800 MARRIED FILING SEPARATELY $156,900 HEAD OF HOUSEHOLD $287,650 5. SUBTRACT LINE 4 FROM LINE 3. IF THE RESULT IS MORE THAN $122,500 ($61,250 IF MARRIED FILING SEPARATELY), STOP. ENTER -0- ON LINE 42 109,196. 6. DIVIDE LINE 5 BY $2,500 ($1,250 IF MARRIED FILING SEPARATELY). IF THE RESULT IS NOT A WHOLE NUMBER, INCREASE IT TO THE NEXT HIGHER WHOLE NUMBER (FOR EXAMPLE, INCREASE 0.0004 TO 1) 7. MULTIPLY LINE 6 BY 2% (.02) AND ENTER THE RESULT AS A DECIMAL 8. MULTIPLY LINE 2 BY LINE 7 9. SUBTRACT LINE 8 FROM LINE 2. TOTAL TO FORM 1040, LINE 42. FORM 1040 WAGES RECEIVED AND TAXES WITHHELD STATEMENT 3 FEDERAL STATE CITY AMOUNT TAX TAX SDI FICA MEDICARE NAME PAID WITHHELD WITHHELD TAX TAX TAX UNITED STATES SENATE DISBURSING OFFICE 174,000. 39,662. 8,454. 7,886. 2,523. TOTALS 174,000. 39,662. 8,454. 7,886. 2,523. 25 2, 3 CLAIRE C. MCCASKILL FORM 1040 QUALIFIED DIVIDENDS STATEMENT 4 ORDINARY QUALIFIED NAME OF PAYER DIVIDENDS DIVIDENDS RBC - 3775 975. 951. TOTAL INCLUDED IN FORM 1040, LINE 9B 951. FORM 1040 FEDERAL INCOME TAX WITHHELD STATEMENT 5 DESCRIPTION AMOUNT UNITED STATES SENATE DISBURSING OFFICE 39,662. MISSOURI JUDGES ALJ LEGISLATORS ELECTED OFFICIALS RET. SYS 11,208. CENTRAL TRUST COMPANY 4,542. TOTAL TO FORM 1040, LINE 64 55,412. FORM 1040 OTHER TAXES STATEMENT 6 DESCRIPTION AMOUNT FROM FORM 8959 441. FROM FORM 8960 237. TOTAL TO FORM 1040, LINE 62 678. SCHEDULE A STATE AND LOCAL INCOME TAXES STATEMENT 7 DESCRIPTION AMOUNT MISSOURI JUDGES ALJ LEGISLATORS ELECTED OFFICIALS RET. SYSTEM 2,400. CENTRAL TRUST COMPANY 2,400. UNITED STATES SENATE DISBURSING OFFICE 8,454. MISSOURI PRIOR YEAR BALANCE DUE AND EXTENSION PAYMENTS 1,172. TOTAL TO SCHEDULE A, LINE 5 14,426. 26 4, 5, 6, 7 CLAIRE C. MCCASKILL SCHEDULE A CASH CONTRIBUTIONS STATEMENT 8 AMOUNT AMOUNT AMOUNT DESCRIPTION 100% LIMIT 50% LIMIT 30% LIMIT ACCESS ACADEMICS 1,000. ALZHEIMERS FOUNDATION OF AMERICA 500. ARTHRITIS FOUNDATION 250. BACKSTOPPERS 5,000. CATHOLIC CHARITIES OF CENTRAL AND NORTHERN MO 500. COLLEGE BOUND 6,000. COLUMBIA PUBLIC SCHOOLS FOUNDATION 1,000. FISHER HOUSE FOUNDATION 6,000. FOLLY THEATER ENDOWMENT 1,000. FRANKFORT COMMUNITY HIGH SCHOOL ATHLETICS 1,000. HARRY TRUMAN SCHOLARSHIP FOUNDATION 5,000. GREATER GRACE CHURCH OF ST LOUIS 250. KC POLICE MEMORIAL FOUNDATION 5,000. METRO COMMUNITY COLLEGE FOUNDATION OF KC 1,000. MINERAL AREA COLLEGE 500. MO COALITION AGAINST DOMESTIC AND SEXUAL VIOLENCE 5,000. PHOENIX FAMILY 500. RAINBOW HOUSE 1,000. GREATER KC COMMUNITY FOUNDATION 1,000. SAFE HOUSE FOR WOMEN 2,500. SOME (so OTHER MIGHT EAT) 500. ST. RESEARCH HOSPITAL 2,000. UNITED AID FOUNDATION FOR ROMANIAN KIDS 250. UNIVERSITY OF MISSOURI 250. WASHINGTON UNIVERSITY PATNAIK SCHOLARSHIP 250. EMPLOYMENT NETWORK 500. FOUNDATION OF KC 2,500. STATE FAIR COMMUNITY COLLEGE 250. RISE COMMUNITY DEVELOPMENT 1,000. OZARKS FOOD HARVEST 7,500. THE FOOD BANK OF CENTRAL AND NE MISSOURI 3 500 . SOUTHERN BAPTIST CHURCH PRISON MINISTRY 500. ADHOC GROUP AGAINST CRIME 250. 27 8 u?r?m CLAIRE C. MCCASKILL UNIVERSITY OF KANSAS HEALTH SYSTEM JAMESON COMMUNITY BETTERMENT ASSOC LITTLE GUYS BASEBALL CLUB OF SPRINGFIELD MOUNT BEULAH MB CHURCH OF ST LOUIS LEAVENWORTH INTERFAITH COMMUNITY OF HOPE PINEY RIVER COVEY CHAPTER OF QUAIL FOREVER URI FOUNDATION NINE NETWORK HOUSTON EDUCATION FOUNDATION ONE AMERICA APPEAL FOR HURRICANE RELIEF GATEWAY CHAPTER OF PARALYZED VETERANS OF AMERICA MARK TWAIN HOME FOUNDATION MISSOURI STATE HIGHWAY PATROL BENEVOLENT FUND SURVIVING SPOUSE AND FAMILY ENDOWMENT FUND SUBTOTALS TOTAL TO SCHEDULE A, LINE 16 100. 250. 250. 250. 500. 500. 500. 600. 1,000. 1,000. 2,500. 2,500. 2,500. 2.500. 78,200. 28 78,200. 8 CLAIRE . MCCASKILL SCHEDULE A ITEMIZED DEDUCTIONS WORKSHEET STATEMENT 9 1. ENTER THE TOTAL OF THE AMOUNTS FROM SCHEDULE A, LINES 4, 9, 15, 19, 20, 27, AND 28. 92,626. 2. ENTER THE TOTAL OF THE AMOUNTS FROM SCHEDULE A, LINES 4, 14, AND 20, PLUS ANY GAMBLING AND CASUALTY OR THEFT LOSSES INCLUDED ON LINE 28 AND ANY QUALIFIED CONTRIBUTIONS INCLUDED ON LINE 16. 0. 3. IS THE AMOUNT ON LINE 2 LESS THAN THE AMOUNT ON LINE 1? IF NO, YOUR DEDUCTION IS NOT LIMITED. ENTER THE AMOUNT FROM LINE 1 ABOVE ON SCHEDULE A, LINE 29. IF YES, SUBTRACT LINE 2 FROM LINE 1. 92,626. 4. MULTIPLY LINE 3 BY 80% (.80). 74,101. 5. ENTER THE AMOUNT FROM FORM 1040, LINE 38. 266,096. 6. ENTER $313,800 IF MARRIED FILING JOINTLY OR QUALIFYING $287,650 IF HEAD OF $261,500 IF OR $156,900 IF MARRIED FILING SEPARATELY. 155,900. 7. IS THE AMOUNT ON LINE 6 LESS THAN THE AMOUNT ON LINE 5? IF NO, YOUR DEDUCTION IS NOT LIMITED. ENTER THE AMOUNT FROM LINE 1 ABOVE ON SCHEDULE A, LINE 29. IF YES, SUBTRACT LINE 6 FROM LINE 5. 109,196. 8. MULTIPLY LINE 7 BY 3% (.03). 3,276. 9. ENTER THE SMALLER OF LINE 4 OR LINE 8. 3,276. 10. TOTAL ITEMIZED DEDUCTIONS. SUBTRACT LINE 9 FROM LINE 1. ENTER THE RESULT HERE AND ON SCHEDULE A, LINE 29. 89,350. FORM 6251 PASSIVE ACTIVITIES STATEMENT 10 NET INCOME (LOSS) NAME OF ACTIVITY FORM AMT REGULAR ADJUSTMENT CHEF AMYB LLC SCH 5,578. 5,577. 1. TOTAL TO FORM 6251, LINE 19 1. 29 9, 10 CLAIRE . MCCASKILL FORM 6251 EXEMPTION WORKSHEET STATEMENT 11 1 ENTER: $54,300 IF SINGLE OR HEAD OF HOUSEHOLD: $84,500 IF MARRIED FILING JOINTLY OR QUALIFYING $42,250 IF MARRIED FILING SEPARATELY 42,250. 2 ENTER YOUR ALTERNATIVE MINIMUM TAXABLE INCOME (AMTI) FORM 6251, LINE 28 187,897. 3 ENTER: $120,700 IF SINGLE OR HEAD OF $160,900 IF MARRIED FILING JOINTLY OR QUALIFYING $80,450 IF MARRIED FILING SEPARATELY 80,450. 4 SUBTRACT LINE 3 FROM LINE 2. IF ZERO OR LESS ENTER 107,447. MULTIPLY LINE 4 BY 25% (.25) 26,862. (hU'l SUBTRACT LINE 5 FROM LINE 1. IF ZERO OR LESS, ENTER IF ANY OF THE THREE CONDITIONS UNDER CERTAIN CHILDREN UNDER AGE 24 APPLY TO YOU, COMPLETE LINES 7 THROUGH 10. OTHERWISE, STOP HERE AND ENTER THIS AMOUNT ON FORM 6251, LINE 29, AND GO TO FORM 6251, LINE 30 15,388. 7 MINIMUM EXEMPTION AMOUNT FOR CERTAIN CHILDREN UNDER AGE 24 8 ENTER YOUR EARNED INCOME, IF ANY 9 ADD LINES 7 AND 8 10 ENTER THE SMALLER OF LINE 6 OR LINE 9 HERE AND ON FORM 6251, LINE 29, AND GO TO FORM 6251, LINE 30 FORM 8960 STATE INCOME TAX PAYMENTS STATEMENT 12 MISSOURI DESCRIPTION AMOUNT UNITED STATES SENATE DISBURSING OFFICE 8,454. MISSOURI JUDGES ALJ LEGISLATORS ELECTED OFFICIALS RET. SYSTEM 2,400. CENTRAL TRUST COMPANY 2,400. TOTAL TO STATE FORM 8960, LINE 10 13,254. 30 11, 12 CLAIRE C. MCCASKILL FORM 8582 OTHER PASSIVE ACTIVITIES - WORKSHEET 3 STATEMENT 13 CURRENT YEAR PRIOR YEAR OVERALL GAIN OR LOSS UNALLOWED NAME OF ACTIVITY NET INCOME NET LOSS LOSS GAIN LOSS CHEF AMYB LLC 5,577. 0. 5,577. TOTALS 5,577. 0. 5,577. FORM 8582 SUMMARY OF PASSIVE ACTIVITIES STATEMENT 14 FORM OR PRIOR NET UNALLOWED ALLOWED A NAME SCHEDULE YEAR LOSS LOSS CHEF AMYB LLC SCH 5,577. 5,577. TOTALS 5,577. 5,577. PRIOR YEAR CARRYOVERS ALLOWED DUE TO CURRENT YEAR NET ACTIVITY INCOME TOTAL 31 13, 14 CLAIRE C. MCCASKILL FORM 8582-CR OTHER PASSIVE ACTIVITY CREDITS WORKSHEET 4 STATEMENT 15 NAME OF ACTIVITY CHEF AMYB LLC CHEF AMYB LLC TOTALS PRIOR YEAR FROM CURRENT UNALLOWED TOTAL FORM YEAR CREDITS CREDITS CREDITS 8846/3800, LINE 32 562. 562. CARRYOVER 342. 342. 562. 342. 904. 32 15 CLAIRE . MCCASKILL FORM 8582 ALTERNATIVE MINIMUM TAX STATEMENT 16 OTHER PASSIVE ACTIVITIES - WORKSHEET 3 CURRENT YEAR PRIOR YEAR OVERALL GAIN OR LOSS UNALLOWED NAME OF ACTIVITY NET INCOME NET LOSS LOSS GAIN LOSS CHEF AMYB LLC 5,578. 0. 5,578. TOTALS 5,578. 0. 5,578. FORM 8582AMT SUMMARY OF PASSIVE ACTIVITIES AMT STATEMENT 17 FORM OR PRIOR NET UNALLOWED ALLOWED A NAME SCHEDULE YEAR LOSS LOSS CHEF AMYB LLC SCH 5,578. 5,578. TOTALS 5,578. 5,578. PRIOR YEAR CARRYOVERS ALLOWED DUE TO CURRENT YEAR NET ACTIVITY INCOME TOTAL 33 16, 17 CLAIRE C. MCCASKILL FORM 4562 PART I - BUSINESS INCOME STATEMENT 18 INCOME TYPE WAGES TOTAL BUSINESS INCOME USED IN FORM 4562, LINE 11 34 AMOUNT 174,000. 174,000. 18 Prepared for Prepared by 2017 TAX RETURN FILING INSTRUCTIONS MISSOURI INCOME TAX RETURN FOR THE YEAR ENDING DEQEMBEB 3.1. 2017 CLAIRE C. MCCASKILL 1941 SPRING HOUSE DRIVE ST. LOUIS, MO 63122 Amount of tax Total tax 1 01.1.3 3 13,254 Plus: interest and penalties OVERPAYMENT 3 1 2 1 Miscellaneous Donations Overpayment Credited to your estimated tax 0 Refunded to you 3 2 1 Make Check NOT APPLICABLE payable to Mail tax return and check (if applicable) to Return must be mailed on or before Special Instructions THIS RETURN HAS QUALIFIED FOR ELECTRONIC FILING. AFTER YOU HAVE REVIEWED YOUR RETURN FOR COMPLETENESS AND ACCURACY, PLEASE SIGN, DATE AND RETURN FORM 8879-80 TO OUR OFFICE. WE WILL THEN SUBMIT YOUR ELECTRONIC RETURN TO THE MODOR. NOT APPLICABLE DO NOT MAIL THE PAPER COPY OF THE RETURN TO THE MODOR. IF AFTER THREE WEEKS YOU HAVE NOT RECEIVED YOUR REFUND, YOU MAY CONTACT THE MODOR AT 1-573-751?3505. 700081 04?01?17 Missouri Department of Revenue Form 2017 Individual Income MO-1040 Tax Return - Long Form For Calendar Year January 1 - December 31,2017 Print in BLACK ink only and DO NOT STAPLE. I: Select Here for Amended Return Select Here for Composite Return (For use by corporations or Partnerships) Vendor Code Department Use Only If filing a fiscal year return enter the beginning and ending dates here. l-J Fiscal Year Beginning Fiscal Year Ending Select the appropriate boxes that apply, as of December 31 2017. Age 62 through 64 Age 65 or Older Yourself Spouse I:l Yoursele? Spouse 100% Disabled Non-Obligated Spouse YourseifE' Spouse El YourselfD Spouse Blind Yourself : Spouse Deceased Deceased Social Security Number in 2017 Spouse's Social Security Number in 2017 First Name MI. Last Name Suffix a: CLAIRE IMCCASKILL Spouse's First Name M.l. Spouse's Last Name Suffix In Care Of Name (Attorney, Executor, Personal Representative, etc.) Present Address (Include Apartment Number or Rural Route) 1 94 1 SPRING HOUSE DRIVE a City, Town, or Post Office State ZIP Code "6 2 ST. LOUIS MO 53122 County of Residence ST LOUI COUNTY You may contribute to any one or all of the trust funds on Line 48. See pages 10-11 of the instructions for more trust fund information. - . Elderly Home Missouri Workers' Childhood Missouri Military General TVeterlansd Delivered Meals National Guard Memorial Lead Testing Family Relief Revenue piergangg?grd rus u? rus un Trust Fund Trust Fund Fund Fund Fund Fund GET 761001 03-07-18 M01 040 Page 1 Income 10. 11. Exemptions and Deductions 15. 16. 17. 12. 13. 14. Federal adjusted gross income from your 2017 federal return (see worksheet) Total additions (from Form MO-A. Part 1, Line 7) Total income-Add Lines1and2 .. . Total subtractions (from Form MO-A, Part 1, Line 17) Missouri adjusted gross income - Subtract Line 4 from Line 3 .. .. Total Missouri adjusted gross income - Add columns 5Y and 58 Income percentages - Divide columns 5Y and 58 by total on Line 6. (Must equal 100%) .00 .00 .00 .00 Pension, Social Security, Social Security Disability, and Military exemption (from Form MO-A, Part 3, Section E) Select your filing status box below. Enter the appropriate exemption amount on Line 9 I: A. Single - $2,100 (see Box before selecting.) El 3. c. D. Additional personal exemption (see instructions) Claimed as a Dependent on Another Person's Federal Tax Return - $0.00 Married Filing Combined (joint federal) - $4,200 Married Filing Separate - $2,100 Tax from federal return - Do not enter federal income tax Yourself (Y) Spouse (3) 266,096..1sL 2v .. 28 av 266,096.. as 4v I. [43 5v 266,096 53) a 266,096_. 100 78 9 2,100. I: E. Married Filing Separate (spouse NOT filing) - $4,200 El F. Head of G. Qualifying Widow(er) with Dependent Child - $3,500 Withhe d(seein8thCtionS) Other tax from federal return - Attach a copy of your federal return (pages1 and 2) Total tax from federal return - Add Lines 11 and 12 10' 5H 11 44,860 12 13 45,397 Federal tax deduction - Enter the amount from Line 13, not to exceed $5,000 for an individual filer or $10,000 for combined filers Missouri standard deduction or itemized deductions. 0 Single or Married Filing Separate- $6,350 '3 Head of Household - $9,350 0 Married Filing Combined or Qualifying Widow(er) - $12,700 If age 65 or older, blind, claimed as a dependent, see inst. If itemizing, see Form MOA, Part 2. Number of dependents (from Federal Form 1040 or 1040A, Line Go). Do not include yourself or spouse El Select box if claiming a stillborn child (see instructions). Number of dependents on Line 16 who are 65 years of age or older and do not receive Medicaid or state funding. Do not include yourself or spouse 761002 03-07-18 $1,200 14 5,000. 15 86,298, 16 MO-1040 Page 2 18. 19. Exemptions and Deductions (cont) 24. 25. 26. 27. 28. 29. 30. Tax 32. 33. 34. Payments and Credits 20. 21. 22. 23. 31. 35. 36. 37. 761003 03-07-18 Long-term care insurance deduction 18 Health care sharing ministry deduction 19 Military income deduction 20 Bring jobs home deduction 21 Transportation facilities deduction 22 I: A. Port Cargo Expansion I: B, International Trade Facility . - Cl 0. Qualified Trade Activities Total deductions - Add Lines 8, 9, 10, and 14 through o_o Subtotal - Subtract Line 23 from Line Multiply Line 24 by appropriate percentages on Linesrvandrs 25v 172,698?; 258 -E Enterprise zone or rural empowerment zone income modification 26Y l0__0 I 265 . 20 Taxable income-Subtract Line26 from Line25 27V 172, 698 278 .Q Tax(seetaxchartin the instructions) 28Y 10.1331; 288 .Q Resident credit Attach Form MO-CR and other states' income tax returnls) 29V 1; 298 .E Missouri income percentage - Enter 100% unless you are completing Form MO-NRI. Attach Form MO-NRI and a copy of your federal return if less than 100Balance - Subtract Line 29 from Line 28; OR multiply Line 28 by percentage on Line Other taxes Select box and attach federal form indicated. '3 Lump sum distribution (Form 4972) El Recapture of low income housing credit (Form 8611) 32?! .l 328 .. Subtotal - Add Lines MISSOURI tax withheld - Attach Forms W2 and 1099 Missouri estimated tax payments - Include overpayment from 2016 applied to 201 7 I16 .. Missouri tax payments for nanresident partners or corporation shareholders - Attach Forms MO-2NR and 37 .- MO-1 040 Page 3 Payments and Credits 42. 38. 39. 40. 41. Missouri tax payments for nonresident entertainers - Attach Form . Miscellaneous tax credits (from Form MO-TC, Line 13) - Attach Form . .. Property tax credit - Attach Form MO-PTS .. Total payments and credits - Add Lines 35 through 41 Skip Lines 43 through 45 if you are not ?ling an amended return. 43 44. Overpayment as shown (or adjusted) on original return Amended Return 46. 47. 48. Refund 49. . Amount paid on original return Indicate Reason for Amending Amount paid with Missouri extension oftime to file (form M0-60) Enter date of IRS report CI A. Federal audit Enter year of loss (YY) B. Net operating loss carryback Enter year of credit (YY) I: C. Investment tax credit carryback D. Correction other than A. B, or Amended return total payments and credits - Add Line 43 to Line 42 or subtract Line 44 from Line 42 If Line 42, or if amended return, Line 45, is larger than Line 34, enter the difference. Amount of OVERPAYMENT Amount of Line 46 to be applied to your 2018 estimated tax Enter date of federal amended return, if filedEnter the amount of your donation in the trust fund boxes below. See instructions for additional trust fund codes. Children's Veterans 483- Trust Fund - 48b- Trust Fund Missouri National Guard 48d' Trust Fund - 486. Memorial Fund - Missouri Military Family General 489' Relief Fund - 48h- Revenue Fund - Addllaonal Additional Fund Fund 48]. Code Amount . 48k. Total Donation - Add amounts from Boxes 48a through 48k and enter here Amount of Line 46 to be deposited into a Missouri 529 College Savings Plan (MOST) account. Enter amount from Line of Form 5632 761004 03-07?1 8 48c. 48f. 48L Elderly Home Delivered Meal Trust Fund Childhood Lead Testing Fund Organ Donor Program Fund Add-I lonal Fund Code E: Additional Fund Amount . 0?0 48 49 MO-104O Page 4 REFUND-Subtract Lines 47. 48. and 49 from Line46 and enter here 50 3 121' .. 50. If you would like your refund deposited directly into your checking or savings account, complete boxes a. b, and 0 below. 13. '2 a Routing 5 Number c. Checking El Savings b. Account Number 51. If Line 34 is larger than Line 42 or Line 45, enter the difference. Amount of UNDERPAYMENT (see the instructions for Line 5252. Underpayment of estimated tax penalty Attach Form M02210. Enter penalty amount here I II .. 52 .I El Select this box if you are a farmer exempt from the underpayment of estimated tax penalty. 53. AMOUNT DUE - Add Lines check. you authorize the Department of Revenue to process the check electronically. Any returned check may be presented again electronically Under penalties of perjury, declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief it is true. correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which he or she has any knowledge. As provided in Chapter 143, a penalty of up to $500 shall be imposed on an individual who files a frivolous return. I also declare under penalties of perjury that employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax exemption. credit, or abatement if I employ such aliens. Signature Date Spouse's Signature (If filing combined. BOTH must sign) Date 0 . I 5 E-mail Address Daytime Telephone .9 U) Preparer's Signature Date Preparer's FEIN, SSN, or Preparer?s Telephone Preparer's Address State ZIP Code I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer or any member of the preparer?s firm Yes El No Department Use Only DA Elmo EIDE (Revised 12-2017) Mail To: Balance Due: Refund or No Amount Due: Phone (Balance Due): (573) 751 -7200 Missouri Department of Revenue Missouri Department of Revenue Phone (Refund or No Amount Due): (573) 751?3505 PO Box 3370 PO. Box 3222 Fax: (573) 751-2195 Jefferson City, MO 65105-3370 Jefferson City, MO 65105-3222 E-mail: income@dor.mo.guv 1019 751005 03?07?18 040 Page 5 Form Missouri Department of Revenue MO- A 2017 Individual Income Tax Adjustments Department Use Only Attach to Form M01040. Attach your federal return. See information beginning on page 12 to assist you in completing this form. Social Security Number Spouse's Social Security Number 10. El Partnership El Fiduciary I: SCorporation El Railroad Retirement Benefits Military (nonresident) I: Combat Pay El Build America and Recovery Zone Bond Interest First Name MI. Last Name Suffix a CLAIRE I MCCASKILL Spouse's First Name MI. Spouse's Last Name Suffix Additions Yourself (Y) Spouse (8) 1. Interest on state and local obligations other than Missouri source I 1V -. 13 I 2. Partnership '1 Fiduciary Corporation Net Operating Loss (Carryback/Carryforward) I: Other (description) . El 28 .E 3. Nonqualified distribution received from a qualified 529 plan (higher education savings program) not used for qualified expenses 3Y . 38 I .E 4. Food Pantry contributions included on Federal ScheduleA . .. 4Y A El 481; 5. NonresidentPropertyTax Nonqualified distribution received from a qualified Achieving a Better 1: Life Experience Program (ABLE) not used for qualified expenses 6Y . 68 7. Total Additions - Add Lines 1 through 6. Enter here and on Form a M04040. Line Subtractions 8. Interest from exempt federal obligations included in federal adjusted gross income Attach a detailed list or all Federal Form(s) 1099 8Y 88 . 9. Any state income tax refund included in federal adjusted gross income Public-Private Transportation Act El Net Operating Loss Other (description) 1OY 11. Exempt contributions made to a qualified 529 plan (higher educatiOn savings program) 11Y 12. Qualified Health Insurance Premiums - Attach the Qualified Health Insurance Premiums Worksheet (Egrm $95) and supporting documentation 12Y 761011 12-14-17 For Privacy Notice, see instructions. 108 11S I I123l MO-A Page 1 13. Missouri depreciation adjustment (Section 143.121I .I14s I153 .I 163 .0 I: Sold or disposed property previously taken as addition modification 13v 3 14. Home Energy Audit Expenses- Attach the Home Energy Audit IE Expense . MY 8 15. Exempt contributions made to a qualified AchieVIng a Better Life 15?! It 16. Agriculture Disaster Relief 1 BY 17. Total Subtractions?- Add Lines 8 through 16. Enter here and on Form Line 4 L1 TY [173 .I Complete this section only if you itemize deductions on your federal return. Attach your Federal Form 1040 (pages 1 and 2) and Federal Schedule A. 1. Total federal itemized deductions from Federal Form 1040, Line 2017 Social security tax - (Yourself2017 Social security tax - (Spouse) 3 4. 2017 Railroad 41 5. 2017 Railroad retirementtax-Tierland Tierll(Spouse) . 5 .5 6 2017 Medicare tax-Yourself and Spouse (see instructions2017 Self-employment tax (see instructions) 7 E- 8- Total- Add Linesi throughY. 8 100 200?00 9. State and local income taxes from Federal ScheduleA Line5or see the worksheet below .. 9 10. Earningstaxes included in Line9 .I 11. Net state income taxes - Subtract Line 10 from Line 9 or enter Line 8 from worksheet below 12. Missouri Itemized Deductions - Subtract Line 11 from Line 8. Enter here and on Form M01040, Line Complete this worksheet only if your federal adjusted gross income from Federal Form 1040, Line 37 is more than $313,800 if married filing combined or qualifying widow(er), $287,650 if head of household, $261,500 if single or claimed as a dependent, or $156,900 if married filing 2 separate. Attach your Federal Itemized Deduction Worksheet (page 2 of Federal Schedule A instructions). I: an: 1. Enter amount from Federal itemized Deduction Worksheet, Line 3 (see Federal Schedule A instructions). If $0 or less, enter Enter amount from Federal Itemized Deduction Worksheet. Line9 (see Federal Schedule A instructionsState and local income taxes from Federal Form 1040, Schedule A, Line Earnings taxes included on Federal Form 1040, Schedule A, Line 5 4 0 .I 5. SubtractLine4fromLineS 5 14,426, 33 6. Divide Line 5 by Line 1 1 6 7, Multiply Line 2 by Line 6 [7 5 2 4 8. Subtract Line 7 from Line 5. Enter here and on Form MO-A, Part 2, Line Part 3 - Pension and Social Security/Social Security Disability/Military Exemption Public Pension Calculation - Pensions received from any federal, state, or local government. 1 Section A 10. 11. Missouri adjusted gross income from Form M01040, Line 6 . Taxable social security benefits from Federal Form 1040A, Line 14b or Federal Form 1040, Line 20b Subtract Line 2 from Line 1 Select the appropriate filing status and enter amount on Line 4. i Married Filing Combined (joint federal) - $100,000 0 Single, Head of Household, Married Filing Separate, and Qualifying Widow(er) - $85,000 Subtract Line 4 from Line 3 and enter on Line 5. If Line 4 is greater than Line 3, enter $0 Taxable pension for each spouse from public sources from Federal Form 1040A, Line 12b or 1040, Line 16b . . 6Y .. 68 Amount from Line 6 or $37,089 (maximum social security benefit), whicheveris less 7Y .. 78 If you received taxable social security, complete Form Lines 1 through 8 of Section C, and enter the amount(s) from Line(s) 6Y and 68. See instructions if Line 3 of Section is more than $0 I 8Y 88 I Subtract Line 8 from Line 7. If Line 8 is greater than Line 7, enter $0 9Y . 98 Add amounts on Lines and 9S 10 Total public pension, subtract Line 5 from Line 10. If Line 5 is greater than Line 10, enter $0 11 Private Pension Calculation - Annuities, pensions, IRAs, and 401(k) plans funded by a private source. 1. Section .01 761013 12-14-17 Missouri adjusted gross income from Form M01040. Line 6 Taxable social security benefits from Federal Form 1040A, Line 14b or Federal Form 1040, Line 20b Subtract Line 2 from Line 1 3 Select the appropriate filing status and enter the amount on Line 4. I Married Filing Combined (joint federal) - $32,000 0 Single, Head of Household and Qualifying Widow(er) - $25,000 Married Filing Separate- $16,000 4 Subtract Line 4 from Line 3. If Line 4 is greater than Line 3, enter $0 5 Taxable pension for each spouse from private sources from Federal Form 1040A, Lines 11b and 12b, or Federal Form 1040, Lines 15b and 16b 6V .- GS Amounts from Line 6Y and 68 or $6,000, whichever is less TY 78 Add Lines 7V and 78 8 Total private pension, subtract Line 5 from Line 8. if Line 5 is greater than Line 8, enter $0 9 MO-A Page 3 Social Security or Social Security Disability Calculation - To be eligible for social security deduction you must be 62 years of age by December 31 and have selected the 62 and older box on page 1 of Form MO-1040. Age limit does not apply to social security disability deduction. 1. Missouri adjusted gross income from Form M01040, Line 6 2. Select the appropriate filing status and enter the amount on Line 2. II Married Filing Combined (joint federal) - $100,000 0 Single, Head of Household, Married Filing Separate. and Qualifying Widow(er) - $85,000 (D ?l 3. Subtract Line 2 from Line1 and enter on Line 3. If Line 2 is greater than Line 1, enter $0 .3 4. Taxable social security benefits for each spouse from Federal Form 3; 1040A, Line14b or Federal Form1040. Line20b Taxable social security disability benefits for each spouse from Federal Form1040A, Line14b or1040, Line20b I 5Y i 58 .I 6. Amountfrom .. Add LinesSYand Total social security/social security disability. subtract Line 3 from Line 7. if Line 3 is greater than Line 7. enter $0 SJ -. Military Pension Calculation 1. Military retirement benefits included on Federal Form 1040A, Line 12b or Federal Form 1040, Line 16b .. I I 1 i .l 2. Taxable public pension from Federal Form 1040A, Line 12b or Federal Form 1040, Line 16b Divide Line1 by Line2(Floundto wholenumberMultiply Line 3 by Line 11 of Section A. If you are not claiming a public pension exemption, enter $0 .. 4 .- 5. Total militarypension,subtract Line4from Line1 Total Pension and Social Security/Social Security Disability/Military Exemption Add Line 11 [Section A), Line 9 {Section El], Line 8 {Section C). and Line 5 (Section D) from Form MOA. Enter total amount here and on Form M01040. Lrne 8 Section Attach to Form MO-1040. Attach your federal return. See information beginning on page 12 to assist you in completing this form. 761014 12-14-17 MO-A Page 4 (Revised 12-2017)