Depar~nentof~theTceasury—Intemal.Revenue.Service (99). ; ~~ O40 U.~. ~IHf3l~lldll~~ ~11C01'~~ ~aX ~@t11f~1 For the year Jan.1-0ec.31,2017,or other tax year beginning Last name Yourfirst name and initial Sanders ' Bernard If a joint return, spouse's first name and initial Jane 0 , 7 /~~ p p ~,O ~ ` OMB No. 1545-007A `IRS Use Only—Do not write or staple in thls space. Se9 separate instlUCtions. ,2D77, ending ,20 Your social security number Spouse's social security number Last name Sanders ~ Home address(number and street). If you have a P.O. taox, see instructions. Apt, no. City,town or post vffi~;state,and ~IPvod2. Hyou haven #oraign address,also camptete spaces betow•(see instructiorrs). Foreign province/state county Foreign country name Filing Status Check only one box. .Exemptions PresitlentiafElectioA~Cimpaign Cheek here8 you,or yourspoU58 H filing ~mty;warit$3togotothlslund,Checldng Foreignpostaicode b a box below will not change yourla+c or refund. ❑you ~Spcuse 4 L,J Head of household (with qual(fying person). (See instructions.) 1 ❑Single If the qualifying person is a child but not your dependent, enter th(s 2 ~ Married filing jointly (even if only one had income) child's narrie here. ► 3 ❑ `Married filing separately. Enter spouse's SSN above 5 n Qualitying widower) (see instructions) and full name here.► 6a. ~ Yourself. If someone can claim youas a dependent,do not.check box 6a.. on.6~•and 6b 2' w IY —f e.. .~~., C Dependetlts: last name (Yj Flrst name i .Make sure the SSN(s)above andon,line 6c are correct., (2) Dependent's sodas security number (3) QependenYs relationship to you No. of cfiildren on 6c v+ho: _ •lived with you •did not lied with you due M d(vorce orseparatlon (see instructions) Dependents on 6c not entered above ,_ (4) ✓ if child under age 17 9ual~ng for child ta~c credft (see insWctions) ' ❑ If more than four dependents, see instructions and check here ► ❑ Add numbers on ' t ~~ Imes above t' d. TotaCnurraber of exemptions:claimed ~ncvme Attach Forms) W-2 here. Also attach Forms W-2G and 1099-R 'rf tex w.as withheld. r 'UVag~s;'salaries,tlPs~ ~tc,`Attanh Farms}.W'=2 ' 8a Taxable_ interest. Attach Schedule B if required b lax-e~mpt interest. Do not taclude on line Sa 9a ordinary dividends. Attach Schedule B if required Sb .. 7 139,~9~ . Sa 183. ~; 9a 9b ~~ ,. Qualified dividends 10 Taxable refunds, credits,or offsets of state and local income taxes 11 Alimony receNed 12 Business income or (loss). Attach Schedule C or GEZ Capital gain or. Qoss):Attach Schedule D if required. If not requited; check here ► ❑: 13 lTyou did not t4 Other gains or (tosses). Attach Form 4797. get a W-2, 156 b Taxable amount 15a iRA distributions see instructions. 16b b Taxable amount Pensions and annuities 16a 17 Rental real estate, royalties, partnersh(ps,5 corporations, trusts, etc. Attach Schedule E 18 Farm income or (loss). Attach Schedule F . 19 Unemployment compensation 52,044. ~ b Taxable amount 20b Social security benefits ~ 20a ( 21.. . Other income. List i~pe and.amount ----------------------------------------------------------•~ Combine the amounts in the~far righ4~column for lines through 21. This isgourtotal income'► 23 _-'~'` Educator expenses Adjusted Certain business expenses of reservists, performing artists, and GYdSS fee-basis government officials. Attach Farm 2106 or 2706-EZ 24 ~l'1CQitl@ ~, 25 Health savings account deduction. Attach Form 8889 .. 25 2S 26 `_ Moving expenses. Attach Form 39 3 Deductible part ofset(-employment tax. Attach Schedule 5E 27 27 18 9 6 6 ~* 28 Self-employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurance deduction 29 Penalty on early wiYtidrawat of savings . ~' 30 36 ~ ~31a Alimony paid b Recipients SSN ► 31a ~$~ ^ 32 IRA deduction . ~s ` 32 33 Student loan interest deduction . 33 ~'~~YA -~.;, v~::~ i ~¢.`~~'i 34 Tuition and fees. Attach Form 8917 34 3S Domestic Production activities deduction. Attach Form 8903 35 ' ~`='4z"~ 3S _ Add lines 23 through 35 .. 36 Subtract Ifne•36from line 22. This is your_adjusted_gross Income 37 ► 37. For disclosure, Privacy Act, and Paperwork Reduction. Act.Plotioe, see separate instructions, gpp r~v.ovmwM~ua~yaPsp b 10 11 12 13 Y4 15a 16a 17 18 19 20a 21: 22 23 24 9 6'1., 784 . 5 13 8 . 4 4 2 3 7. 1, 1~ 0,'891. 18 ,9 6 6 . ], 13~.925 _ . dorm h ~4.~ (2017 Page Z F~nr, ~nan r~mT 1,Z31,975. 38 Amount from line 37(adjusted gross income) ❑ Slind. 1 Total boxes ' "•N ' Check ~ ~ You were born before January 2, 1953, Tax and 2 ~ ' ❑ Blind. 1 checked ► 39a ~ Spouse was born before January 2,1953, ff: Credits • ~ ~` b If your spouse itemizes on a separate return or you were adual-status alien, check here► 39b~ ~ 40 margin) deduction (see teft standard A) or your Schedule (from 40 Itemized deductions Standard from line 38 4i 40 ~ ° ~O~ 41 line Subhact for— 42 Exemptions. If tine 38 is $156,900 or less, multiply $4,050 by the number on Hne 6d. Otherwise, see inshuctions •People who 42 check.any. ,~_ .~azable income. Subtract line42'frohi line 4l, !i line 42'is morE~tlSan line 4l, enter -0= 43' ~ box on (ine 44 398~or99b~sr. ',44 'Tax (see ihsfrtictwns). check if:arayfirom: a:.0 Farin(s)=881A b. Q'Form 49' 2. c ❑ who can be 45 Alternative minimum tax (see instructions). Attach Form 6257 claimed as a 45 dependent, ~ A6 Form 8962 ~ Attach ayment. credit re tax remium advance cess see p p instructions. ► 47 47 Add lines 44,45, and 46 . •All others: A8 =_ -. c Foreign tax credit. Attach Form 1ii6 if required . `~ Single or 49 f ` ~~~ 2441 Attach Form expenses. dependent care Credit for child and Marcied filing 49 50 line 19 Form 8863, cred(ts from Education ~ $6p350te~Y~ 51 wRetirement savings contributions credit. Attach Form 8880 Marrietl filing 51 yotsit4y a -~~~ 52 required. Attach.Schedule 8812, if credit. 52. .Child.tax quai~fying. 53 ~~~dential energy credits. Attach Form 5695 ~~ $12,700 54 = "~ Other credits from Form: a ❑ 3800 b Q 8801 c ❑ ~4 Head of household, 55 ~r total credits These are your Add lines 48 through 54. $9,350 > 56 ~ Subtract 1(ne 55 from line ~7. If line 55 is more than line 47, enter -0b7 .. Seif-employment tax. Attach Schedule SE 57 38 39a o~t£r Takes ~ b Q 8919 Unreported social security and Medicare tax from Form: _ a ❑ 4137 tax on IRAs, other qualffled retirement plans, etc. Attach Form 5329 if required Additfonai ~ _ _ .. SQa ~ Household employment•faxes from-Schedule N. ., _ b ~frst-time homebuyer eredit repayment. 3~ttach Form`5405 if required Health care: Individual responsibility (see instructions) full-year coverage ~ 61 Taxes from: a ~Form•8959 b ~ Form 8960 c• Q Instructions; enter codes) 62 63 73 74 ' ~5 R.e.~Wtld. 76a Directdeposft? ~ b See ► d instructions. TT AmOtutt 78 You OWe 79 Add lines 56 throw h 62. This is our total tax Federal income tax wfthheld from Forms W-2 and 1099 2017 estimated tax payments and amount applied from 2016 return Earned income credit(EIG) 66b Nontaxable combat pay election Additional child tax credit. Attach Schedule 8812 American opporfunify credit from Form 8863, fine 8 Net premium tax credft. Attach Form 8962. Amount paid with request for extension to file Excess social security and tier 1 RRTA tax withheld Credit for #ederal tax on fuels. Attach Form 4136 64 65 66a ~ 67 68 69 70 71 72 242,231. 689 ~ ~9~ ~ 8'89'., b94.~. <~297,~~ 0.. 1,506. 299,056. 299,056. 37,931. 56 56 Payments ~ 65 if you have a 66a qual(fying b child, attach Schedule EIC: 67 68 69 70 71 72 . 59 6Da,. 60b ' 61 62 I 63 28,233. ~~4= 149,139. T~~" ~ 0. 6 B95. 343',882. ~'~ ~~ ,~z~ ~ ,,~x~ $ ~~~~ AT ~~ ~>-* -' 'e 170,000 erg= ~, ' ~'W ~~; 73 ~-A;;~, Credits from Form: a Q 2439 b Q Aese~ved c Q 8885 d ❑ ~ 74 Add lines 6A,65, 66a, and 67 through 73. These are your total payments 75 !.f_tin..e~74:.is~mnre•thagJine63, subtract:lipe63~fC.om.line_74,'f~tis is the amount you ovgrpaid. ~~ ❑ 76a AmounY~Af`tine ~5:you-want refunded to,you, if Form 8888"is~attacMed,=.check~here -' ►cType; ~ Checking ❑.Savings Routing number f~ A Account number ~ ~ ~ ~ ~ ~ ~ ~ ~ "s~ Amount of line 75. ou want a plied to our 2018 estimated tax1 77 Amount you Dive. Subtract line 74 from line 63. For details on how to pay, see instructions I 7g 79 ~'~ ~~~' Estimated tax penalty (see instructions) 34 7,372. 3. 49.0. 3,4;9:0. i ix. :~, ~-~ ~; ~: Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? ❑Yes.Complete below. QX No Phone Designee's Personal ident'rfication Designee no. E► number (PIfV) name ► Undec penalties of perjuryt; I declaretliat I have examined thisretum and accompanyingschedules and statements, andto•thetiest of my knowledge arrd~bellef, iheysare:We, coneety and ~~4~. n accurately Ils[ aq amounts and'sources of income treceived during the lax year. Declaratlon of pieparer (other than taxpayer is based on alF fn{omiaUon bt wMcii prepa~eY tins any Knowledge: H@r@ Your signature Date Your occupation Da me hone number ,lointretum7Se8 ~ Goverrunent Service instructions. Spouse's signature. If a joint reium, both must sign. Keep a copy For Date Spouse's occupation If the IRS sent you an Identity Protection PAN, enter it yourrecorcls. Writer horn lcaw loci l Print/7ype preparer's name I Preparer's signature Date ~~IC~ , Check ❑ if self-employed Preparer Else OnFy . - F~,'sname ►.. • Se1,f~P,~epared- Go to www.irsgov/Fomi1Q40 for lastructians and the latest information. AEVQYIti1A InWi~cNsp . FO(ITI~0~(201: SCHEDULE A (FOI'm 1040) Itemized Deductions oMB No. 15A5-0074 ►Go to w~vvcirs.govlScheduJeA for instructions and the latest information. Attach to Form 1040. Caution: if you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 28. ~O17 Attachment Se uence No. 07 Department of the Treasury Inteinal Revenue Service (s9) Names) shown on Form 1040 Bernard & Jane 0 Sanders Caution: Do not include expenses reimbursed or paid by others. Medical 1 2 ,700. 1 Medical and dental expenses (see instructions) and 1,131, 925 . 2 Enter amount from Form 1040, line 38 2 Dental 84 ,894 . 3 3 Multiply line 2 by 7.5% (0.075). Expenses 4 Subtract line 3 from line 1. If line 3 is more than line 1; enter -0- . 5 State and local (check only one box): Taxes You 5 a ~] Income taxes, or 189, 530. Paid b ❑General sales taxes } 26,792. 6 6 Real estate taxes(see instructions) 7 7 Personal property taxes 8 Other taxes. List type and amount ~► ---------------------------------8 9 Add lines 5 throu h 8 . 14 153. 10 Home mortgage interest and points reported to you on Form 1098 10 Interest 11 Home mortgage interest not reported,to you on Form 1098. If paid You Paid - .. to the person from whom you bought the home, see instructions Note: and show that person's name, identifying no., and address ► Your mortgage ______-----------------------------------• interest ,:-_ . . deduction may ________________________________ be-limited (see 12 Points not reported to you on Form 1098. See instructions for instructions). 12 Special rules . 13 .. ,.. ... 13 Mortgage insurance premiums (see instructions) . 14 ,.. . .. . 14 Investment intermit. Attach' Form 4952 if required. See instructions -15 Add lines 10 throe h 14 Gifits to 16 Gifts 6y cash or check. If you made any gift of $250 or more, 36,300. 16 see instructions. Charity if you made~a 17 Other than by cash or check. If any gift of $250 or more, see 17 gift and got a instructions. You must attach Form 8283 if over $500. benefit for it, 18 18 Carryover from prior year see instructions. 19 Add lines 16 throe h 18 Casualty and 20 Casualty or theft los$(es) other than net qualified disaster losses. Attach Form 4684 and T~teft Lasses enter the amount from line 18 of that form. See instructions Job'~xpenses 21 Unreimbursed employee expenses —job travel, union dues, and.Certain job education, etc. Attach Form 21Q6 or 2106-EZ if required. 16, 046. Miscellaneous See instructions, ► Employee__business__expenses___ 21 Deductions ~ f~ preparation fees 22 220. • '' 23 Other expenses—investment, safe deposit box, etc. List type and amount ► 23 24 16 266. 24 Add lines 21 through 23 1 131 925 . 25 Enter amount from Form 1040, line 38 25 22, 639 . 26 .~ 26 Multiply line 25 by 2% (0.02) 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0Outer 28 Other—from list in instructions. t.ist type and amount ► Miscellaneous Deductions ~ 29 Is Form 1040, line 38, over $156,900? TQtal~.' Iterrtiaed ❑ No. Your deduction is not limited. Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, Line 40. L'~eduCtions ~ Yes. Your deduction may be limited. See the Itemized 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 ► ❑ R~vavlznsimw.c~.crp.s~ gqp For Paperwork Reduction Act Notice,see the Instructions for Form iQ40. ber '0. 4 ~ 9 216, 322 . 15 14,153. 19 36, 300. 20 27 0. Zg 29 242,231. Schedule a(Form 1040)2017 SCHECIULE B (Form 1040A or 1040) Interest and Ordina ►Attach to Form 1040A or 1040. Department oFtheTreasury ►Go to ►Kww.irs.gov/Schedu/eB for instructions and the latest iMormation. Intemat Revenue Service(99) Names) shown on return Bernard & Jane O Sanders Part I 1 List name of payer. If any interest is from aseller-financer! mortgage and the buyer used the property as a personal residence, see the instructions and list this interest interest first. Also, shove that buyer's social security number and address ► US Senate Federal Credit Union (See instructions --------------------------------------------------------------------------------------------------------------US Senate Federa; Cxedit Union andthe instructions for --------------------------------------------------------------------------------------------------------------Form 1040A, or Form 1040, --------------------------------------------------------------------------------------------------------------line 8a.) Note: If.Yo~ received a Form 108-INT, Form 1099-OID~ or substitute statementfrom a brokerage firm, listthe firm's name asthe payer and enter the total (merest shown on that form. Part II r mary Dividends OMB No. 1545-0074 Dividends ~O Attachment Sequence No. ~ Yoursocial securi number amount 79.68 103.64 --------------------------------------------------------------------------------------------------------------- ~ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------~ ' ----------------------------------------2 Add the amounts on line 1 3 F.~ccludable interest on series EE and I U.S. savings bonds issued after 1589. Attach Form 8815. 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line Sa . . . . . . . . . . . . . . . . . . . . . . ► Note: If line 4 is over $1,500, ou must corn fete Part III. 5 . List name of payer ► ---------------------------------- 2 183.32 3 4 183.32 Amaunt --------------------------------------------------------------------------------------------------------------------------------------------------------- (Seeinstructions anii the ~ instructionsfor Form 1040A~ or Form 1040. line 9a.) ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------`---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Note: If you feceived aForm. 1089-DIV or substitute statemertt .from a brokerage firm, list the firm's name asthe payerand enter the ordinary dividendsshown on that form. --------------------------------------------------------------------------------------------------------------- 5 ------------------------------------------------------------------------------------------------------------------------~---------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=---------------------6 Add the amounts on line 5. Enter the total here and ,on Form 1040A, or Form ► 6 1040, line 9a Note: If line 6 is over $1,b00, ou must corn lete Part.11l. ~,~ ~o You must complete tills part if you {a) had over $1,500 of taxable interest or ordinary dividends; (b) had a Part 111 foreign account; or (e) received a distribution from; or were a grantor of, or a transferor to, a foreign trust. ---7a At any time during 2017, did you have a financial interest in or signature authority over a financial F01'@I~E1 account (such as a bank account, securities account, or brokerage account) located in a foreign ACGOU(1'~.S country? See instructions and. Trusts if "Yes," are you required to file FinCEN Form 114, Report of Foreign Bank and Financial (FEAR), to report that financial interest or signature authority? See FinCEN Form 114 accounts (See instructions.) and its instructions for filing requirements and exceptions to those requirements . b If you are required to file FinCEN Form 114, enter the name of thte foreign country where the financial account is located ► 8 During 2017, did you receive a distribution from, or were you the grantor of, or transferor to, a ~ ~ X foreign trust? !f "Yes," you may have to fi(e Form 3520. Sew instructions . or 1040) 2017 Schedula e (Form y040A For Paperwork Reduction Act Notice, see your tax return instructions. BAA • AEy~~ryq~~~ IMsittg.dp.sP SCHEDULE G (Fo1'm f04D}' Department of Me Treasury Intemai Revenue Service (99) Name of proprieYar Done No.15a~-ooza CrjO ~ ~j ~TO~ti'~ Uf" ~.OSS ~t'Oi'i'l. ~Ct5di1@SS (Sots ProprietorsfiipJ ~~ ~ ►Go to tiv►v~virs.govlScheduleC for instructions and the latest information. Attachment ►Attach to Form 1040,1040NR, or 1041; partnerships ger►eraily must file Form iQ65. Sequence No. 09 Social sacurityt number (SSI~ Bernard Sanders B Enter code tram instructions ► 7 1 1 5 1 0 D SmpkytlriD rteimnsr(EINJ (ses7n~fr.) Principal business or profession, fnciuding product or service (see instructions) Baok Author Business name. If nd separate basiness name, loave blank. A • C' _ Business address (including suite or room no.) ► --------------------------------------------------------City town or post office state, and ZIP code (3) ❑Other (specify) ► (2) ❑Accrual (1) Q Cash Accounting method: Q Y~ ❑ N~ Did you "materially participate" in the operation of this business during 2017? If "No," see instructions for limit on losses ► ❑ If you started or acquired this business during 2017, check here ❑ Yes ~ No D(d you make any payments in 2017 that would require you to file Form(s)1099? (sea instructions) Yes ~]No ~ . . . . . . . . . . . . . . . . . . . Jf "Yes," did ou or will ou filer wired Forms 10997 E F G H 1 J income. 1 2 3 4 5 6 7 Gross receipts or sales. See instructions for -line 1 and check the box if this income was reported to you on .► ❑ Form W-2 and the "Statutory employee" box on that form was checked . allowances Returns and .Subtract line 2 from line 7 ~. Cost of goods sold (from line 42) Gross profit. Subtract Tine 4 from line 3 Other income,including federal and state gasoline or fuel tax credit or refund (see instructions) d Grossincame: ~tdd'lines S a»d 6 •., 1 2 3 4 5 6 7 855,631. 855,631. 855,63.1. 85'5,63.~. Ean~nses::Frrtpr_exnPns~s f~r~us~n~ss.use nf.vour h~m~e nnty nn Iine3D. 18 8 Offioe expense(see instructions) 18 Advertising . 19 Pension and profit-sharing plans 18 Caz and truck expenses (ses 20 Rertt or lease(see Instructions): 9 instructions}. 10 10 a Vehicles, machinery, and equipment 20a Commissions and fees b Other business property 11 20b Contract labor(see instructions) 11 12 Depletion 12 21 21 Repairs and maintenance.. 13 Depreciation and section 179 25. 22 Supplies (not included in Part 114) 22 . expense daduetbn '(slot 2 3 Taxes.and licenses . . . . ~ 3 ; . . .. 2 included irn Part Ilij (see ?ft 13 Travel, meals, and entertainment: ~ a4~.''~~ instructions), a Travel . 24a 14 Employee benefit programs (other than on line 19). 14 b Deductible meals and 15 Insurance (other than health) 15 entertainment(see instructions) 24b 122. i6 Interest: r~ r'? 25 Utilities 25 ~_:._ a Mortgage (paid to banks, etc.) iSa 26 Wages (less employment credits). 26 b Other 27a Other expenses(from line 48). 16b 27a -~-~.~a,,.- ~ uu a,.m a ' f~ t_egatancf.prafessionatseNices iT b. .Resenred.forfufureuse .278. -,. > : ~,.~..r-~._A,-;:~,:,..r;,,~.:E<. 2H Total expenses b~fore:expensas for business use of hotrte.'Add GnesB through'2~a 1.4'x., .'► ;28' 29 Tentative profit or Qoss). Subtract line 28 from line 7 . _. 855 , 4 84 . 29 30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions). Simplified rnethod filers only: enter the-total square footage of; {a) your home: and (b) the part of your home used for business: .Use the Simplified Mathod Worksheet in the instructions to figure the amount to enter on line 30 30 31 Net profit or Qoss), Subtract line 30 from line 29. • If a profit,.enter. on-both. Farm 1040, line 12.(or Formi040NR, line 13~ and on. Schedule SE, line 2. (Cf you cf~ecked'the box on me i, see insfrucfions). Estates anti frusfs; enter on Form 1'04"1; line 3. ~ 3t $5 5 , 4 84. 8 9 • It a Ions, you filust go to line 32. S2 1 If you have a loss, check the box that describes your investment in this activity (see instructions). • If you checked 32a, enter the loss on both Form 1040, line 12, (or Form 1040NR, line 13) and on Schedule SE, line 2. Qf you checked the box on line 1, see the line 37 instructions). Estates and trusts, enter on Form 1041, line 3, • If you checked 32b, you must attach Form 6198. Your loss may be limfted. Ear Pap~rsnrark Reductiorr.Act Notiee;see_`"` ..2?b ., ~~: '> 28 TS~taPexpens~s `LiEfore e~tpsnses fior b~sin:ess use of home, P.dd lines'8 through 2~a _ m 28 29 Tentative profit or (loss): Subtract line 28 from line 7 . 10 6,2 5 0 . 29 ~ F~cpenses for business use of your home. do not report these expenses elsewhere. Attach Form. 8829 unless us(ng the simplified method (see instructions}. Simplified method filers only: enter the total square footage of: (a) your home: and (b) the part of your home used for business: .Use the Simplified Method Worksheet in the instructions to figure the amount to enter on Ilne 30 30 31 Net profit or poss). Subtract line 30 from line 29. • If a.profd~ enter on.both.Form.1040,line 12.(or. Form 10~i0NRr line 13j and on.5chedule SE. line 2. (tf you cf~ecked t}iebox on fine i, see insfrucfionsj. Estates andtrusts; enter on Form 1ft4t, Goe 3. ~ 37 7: d 6,250. • ~r a joss, you must go to une :~z. ~ 32. If you have a loss, check the box that describes your investment in this activity (see instructions). • if you.checked 32a, enter the loss on both Porn 1040, line 12, (or Form 9040iJR, line 13) and 32a Q Ail investment is at risk. on Schedule SE;line 2. (If you checked the box on line 7, see the line 31 instructions). Estates and 3~ Q Some investrnent is not Vusts, enter on Form 1041, line 3. at risk. • If you checked 32b, you must attach Form' 6198. Your loss may be limited. Fac~Pa~.ie~i~enrk•.R~ctc[ction~Aet[+take; sQe~the~~separakeiasiruo~ons: t~v:una~~7~uicrerpsa~ ,B;QR`. Sch.~dufe,CjFot+ntQ9Q)2Q17 E .Page2 ScheduVe C(Form 1040]2017 Cost of ~oocfs ~ofcf {see 'instructions) 33 ~ 34 Methods) used to c ❑Other(attach explanatidn) b ❑Lower of cost or market a ❑ Cost value closing inventory: Was there any change in determining quantities, costs, or valuations between opening and closing inventory) [] Yes If "Yes," attach explanation '•-3:~" - 3~ lirventayat be~fnning otyear. If~drTfereniPram lastyear°sclosing inventory; attach•explanation 36 Purchases less cost of items withdrawn for personal use 37 Cost of labor. Qo not include any amounts paid to yourself . 38 Materials and supplies 38 S9 Other costs. 39 40 Add lines 35 through 39 40 41 Inventory at end of year 42 Cost of goods sold. Subtract line 41 from line Q0. Enter the result here and on Ifne 4. [] No T_ 36 37 .. 41 .. 42 Information on Your Wehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13to find out if you must file:.Eczrctt.45.6?. 43 When did you place your vehicle in service for business purposes?(month, day, year) ► ________ ------ ______ -------- 44 Of the total number of miles you drove your vehicle during 2017, enter the number of miles you used your vehicle for: a Business c Other ~ Yes ~ Mo Do you,(oryour spouse} have anothex vehicle available for personal use?. ~, Yes ~, No Do you have evidence to support your deduction? ~ Xes ~ Na 45 Was your vehicle avaiiabfe for personal use during off-duly hours? 46 47a b _ b Commuting (see instructions) ". If "Yes," is the evidence written? Oti~r Expenses. List below business expenses not included on {fines 8-26 or line 30. Yes • ❑ Mo _ __ _ -- ----------------------------------------------------------------------------------------------------------------------------- A8 Total other eupenses. Enter here and on Tine 27a qg i a~un,~xnr rgum.,,~ 0 - scf e~+~Js~a(Fame In40),2d~7 $~..~~D~~~ ~'.. (FOt'm iO4~) Department of the Treasury intemai Revenue SerAce (ss) Name of proprietor Jane O Sanders ~ ~C Principal business or profession, including product or service (see instruct(ons) VEDA Commissioner 8us+ness name. If~rto separate business name, IBav2 b13t1R. E Business address (including suite or room no.) ► A OMB.No,154.5-OOZd nn O ~ '"1 « ~ Attachment Sequence No. 09 (SSt~ ~~~i~t,0~ ~~'~~'~~ im r a~~e$$ (Sofa Proprietorship) ►Go to wwsv.irs.gov/ScheduleC for instructions and the latest information. ►Attach to Form 1040,1Q40NR, or 1041; partnerships generally must file dorm 1065. B Emercadetroen instructlons ► 5 A 1 6 0 0 D EmployerlD number(EtNJ(seainstr.}` 1 :I ~ I :I C(ty, town or post office, state, and ZIP code (2) ❑Accrual (3) Q Other (specify) ► ___ _ _______ Accounting method: (1) Q Cash Q Yes ~ No Did you "materfal{y participate" in the operation of this business during 2017? If "No," see instructions for limit on losses ► ❑ if you started or acquired this business during 2017, check here ❑Yes ~ No Did you make any payments in 2017 that would require you to file Form(s)1099?(see inshuctions) ~ Yes [~ Plo . . . . . . . . . . . . . . . . . . . Jf "Yes," did, ou or will you fife required Forrns 1099? InGom~ F G H J 1 2 3 4 5 6 ~ Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on .► ❑ Form W-2 and the "Statutory employee" box on that form was checked . Returns and allowances Subtract line 2 from line 1 Cost of goods sold (from Ilne 42) _Gross profit. Subtract line 4 from line 3 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) ► Gross incorrte. Add lines 5and 5 . Exnenses_~Enter-e~~enses~r business use~Af:unur hom~x~nfv on Iine.3D. 50. 1 2 3 4 5 6 T Advertising . 18 Office expense (see instructions) S 18 19 Pension and profit-sharing plans 19 9 ~ Car and truck expenses (see 20 9 Rent or lease (see instructions): Instructions}. a Vehicles, machinery, and equipment 20a 10 10 Commissions and fees 11 b Other business property GonUact labor (see instNctions) 11 20b 12 Depletion 21 12 Repairs and maintenance 21 13 Depreciation and section 179 22 Supplies (not included in Part III) 22 expense deduction (not 23 Taxes.and licenses . 23.. included fns Part 111} (see 13 24 Travel, meals, and entertainment: instructions}. a Travel . 14 Employee benefit programs 2~ta (other than on line 19) . 14 b Deductible meals and 15 Insurance (other than health) 15 entertainment (see instructions) 24b -,y~.~. 16 interest: 25 Utilities 25 a Mortgage (paid to banks, etc.) 16a 26 Wages (less employment credits) . 26 b Other . 16b 27a tither expenses (from line 48) . 27a f~ Legal andprofessionalservicas. ?fi b. .Resenredforfufureuse 2Tb '28 Total~expens~s before~expenses for business.userof home.~~dd Iines~~ ihrough'~7a . ~i ' `.28 29 Tentative profit or poss). Subtract line 28 from line 7 . 29 ~ 6cpenses for business use of your home. Do not report these .expenses elsewhere. Attach Form 8829 unless using the simplified method (see instructions). Simplified method filers only: enter the total square footage of: (a) your~home: and (b) the part of your home used for business: .Use the Simplified Method Worksheet in the instructions to figure the amount to enter on tine 30 30 31 Net profit or posse. Subtract line 30 from line 29. • If a profit,. enter. on.both.Form 1040,1ine.12.(or Form 10d0IdR, line 131 and on Schedule SP, line 2 (Ifyou cfiecked the box on line 1~, see instn~ctjbns). Estates and trusts, enter on Form 1049, line 3. 39 • It a loss, you must go to line 32. . ~ 32 If you have a loss, check the box that describes your investment in this activity (see instructions). 50. 50. 5'Q. 8 • If you checked 32a, enter the loss on both Form 14AD, line 12, (or Form 1040PdR, line 13) and on Schedule SE, line 2. pf you checked the box .on line 1, see the line 31 instructions). Estates and trusts, enter on Form 1041, Tine 3. • If you checked 32b, you must attach Form 6198. Your loss may be limited. Foe Pa{~.enr[srrk B~ductiorr.Act Nairce, seethe-separate instructions; :_ 8AR aEu~~nsn~mw:~rr~sn _. ' ~ ~ k:= 5 0. 5 0. ~a ~ Ail investment is at risk, 32p [f Some investment Is not at risk. Sch~dute G (Eorm:t04S~ ZOiT Rage 2 Schedule G(Form 7040 2017 Cost of Goods Sotd (see ~nsrtructions) 33 34 Methods) used to c ❑Other (attach explanation) b ❑Lower of cost or market a ❑ Cost value closing inventory: closing inventory? valuations opening and between Was there any change in determining quantities, costs, or ❑Yes .. If"Yes," attach explanation 35 lnvenfory a~ beginning otyear. ff drfferent from 7asf year's-cfosfng Fnvenfory, aifacfi explanaCorr 36 Purchases less cost of items withdrawn for personal use 37 Cost of labor. Do not include any amounts paid to yourself. 36 Materials and supplies 39 Other vests. 40 Add lines 35 through 3S 41 Inventory at end of year 42 Cost of goods sold. Sub4ract line 41 from Ilne 40. Enter the result here and on line 4. ❑ No . _ .. . 4u - 4't 42 information on Your Vehicle. Complete this part only if you are claiming car or truck ex~nses on line 9 and are not required to file Form 4562 for this.business. See the instructions,for llne 13 to find ou# if you must fike Eorrri 45.62. 43 When did you place your vehicle in service for business purposes?(month, day, year} 44 Of the total number of miles you droue your vehicle during 2017, enter the number of miles you used your vehicle for: a b Commuting (see instructions) Business --------------------------- --------------------- c Other ----❑ NO 45 Was your vehicle available for personal use during off-duty hours? ❑ Y~ 4& Do you(or. your.spouse}.have another vehicle available for, personal. use?.. Q Yes' [] No 47a Do you have evidence to support your deduction? ~ Yes. ~ No [] Yes. []No b If "Yes," is the evidence written? O#her Expenses. List below business expenses not included on lines 826 or line 30. 48 Total other expenses. Enter here and on line 27a e 48 R:v.ttn51u4?r~cpucsn SchedWe.C.([osm_iQ4l~20'17 SCHEDULE SE (Form 1040) oMa No.15a5-oo7a $elf E117~~19y117~n'~ .i.a?( - ~0,1 Attachment Sequence No. 17 R Go #o.wwr~ir~yovlScheduleSE for.instretctio~s and:the iatest:iAfortnatio~t. ►A#tach to Form 104U or Form iQ40idR. Departinent ofth'e Tieasury s internal Revenue Service (99) Name of person with seH-employmerrt income (as shown on Form 1040 or Form 1040NR) — J~ne~ O ~aF3dEs~'s- Social security number of person v~afk~.seFi.-emptokme►~t.inceme.► Before you begin; To determine if you must #ile Schedule SE, see the instructions. Ma}~ t Use Short Sch~duEe SE or 11~ust 1 Use Long Sch~duie SE? Nate:'Use tYiis ilotrichart otily~if you musf`file Schedule SE:if unsure, see'Vliho Musf F'i!e Schedule ~ in'fhe instructions. Did you receive wages or tips in 2017? .No .. Xas ~..~_„~~ Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? Was the total of your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from self-employment more than $127,200? Yes Fdo fi4D Did you receive •tips su6ject`fo sociar seearit'y ar Medioare fax that you didn't repoR to your employe~'1 Are. you using. one of the.optionai meitiods to figure your..net yam;, earnings (see instructions)? No Did you receive church employee income (see instructions) reported on Form 1N-2 of $10828 or more? No Did you report any wages on Form 8919, Uncollected Social _security and Medicare.Tax on Wages? Yes No You may use Shock Sbheilaie SE below You must use Long'Scheilule SE on page'2 Section A —Short Schedule SE. Caution; Read above to see if you can use Short Schedule SE. 1a~ Net farm profit or (foss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), box' 1'4; Cody A . b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z 'fa` 1b ( Net profit or ({oss)~from Schedule~G, line 31 ~ Schedule GEZ, line 3; Schedule K-1 (Form •1065); bax 14, code A (other than farming); and Schedule K-1 (Form 1065-Bj, box 9, code J1. Ministers and members of religious orders, see instructions for types of income to report on ~. 2 this line. See instructions for• other income to report . 3 3 Combine lines 1a, 1b, and 2 4 1Vlultiply line~3 by~92.35% (0.9235). ifless fhan $40D, you don't owe self-amploymenf tax; don't .► 4 file this schedule unless you have an amount on line 1b . Reserve Program payments on line 7 b, Note: if line 4 is less than $400 due to Conservation :see.ins~ructions. 5 Self-employment tax. If the amount on line 4 is: . • $127,2Q0 or less, mu{tipfy line 4 by 15.3% (x.153}. Enter the result here and on Form 1040, fine 57, or Form •f04UNR, line 55 • More than $.127,200, multiply, line 4 by 2.9% (0,029),.. Then,. add $15,772,80 to the result.. 5 Enter the total here and on Form 1040, line 57, or Form 1~40NR, line 55. 6 Deduction for one-half of self-employment tax. ~. . Multiply. line 5. by 50% (0.50 . Enter. the result here and on Form. ~ g 1040; line•27, 'or Form~1~~0IdR; tine•27~ . .. 7, 5'10. ...: ) 2 For Paperwork Reduction Act No4ice, see your tax re4urn instructions, gqq Rev.t uw~v mm~i.cy.crp.s~ T 0 6 , 3 0 0. 106, 300. 9 8 , L 6 8. `~~ ~ . ._ 15 , d2 0. ~` ~' ~ .. ~.. Schedule SE (Form 1040) 2017 Schedule SE {Form 1040)2017 ~ Name of person with self-employment income(as shown on Form 1040 or Form 1040NR) Bernard- Sanders_ Page 2 Attachment Sequence No. 17 Social security number of person with self-empioymen4 income Section B—Lo Schedule SE Self-Employment Tax Note:!f your only irrcorne subject to set#-ernpto~ment tax is churctremptoyee irrcorne;see-instr~ot~ons: Alsase~ instruetion~for the definition of church employee~incame, A tf you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you ~ ❑ had $400 or more of o#her net earnings from self-employment, check here and continue with Part I 1a Net farm profit ar(loss)from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form~1065), box 14; code=A. Nate: Skip lines 1a.and 1 b if you use the farm optional metha~3 {see instructions) 1a b If you received social security retiremer~ or disability benefits, enter fhe amount of Conservation Reserve Program payments included on Schedule F, Une 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z 1 b ( 2 Net~-~rrofit of floss)from 5ci~~d~ale:C, line 3i;Schedule G-~Z,1ine 3; Schedute K-~ {Form i065~, box t4, code A (other than farming); and Schedule K-1 (Foram 1065-8), box 9, erode J1. Ministers and members of religious orders, see instructions for types of income to report on this line. See instructions for other income to report. Note: Skip this line if you use the nonfarm 2 optional method {see instructions). .. .. .. .. .. .. .. .. .. .. .. 3. .. .. ., .. and. 2.. 7b; 3. :Gombir're lines i.a. 4a If line 3 is more than zero, multiply tine 3 by 32,35% (0.9235). Otherwise, enter amount from line 3 4a Note: If line 4a is less than $400 due to Conservation Reserve Program payments online 1 b, see instructions. -4ts b !f you elect oFle or bath of the optio~tak metkxods, e~fer ~he~totai of lies 1~5 and 17 here c Combine-lines 4a and 4b. If 4ess than $400, stop; you don't owe self-employment tax: 4c F~cception: If less than $400 and you had church employee income,enter -0- and continue ► n~~~, ; 5a Enter your church employee income from Form W-2. See 5a instructions for definition of church employee income . -.5n~ b ~~~,tr+ay~~,e ~~:~~~2.3~°~0 (0:~2~). ~.less'#t»n $7DO,:e~ter -a 6 6 Add lines 4c and 5b self-employment security earnings subject to social 7 Maximum amount of combined wages and '~ tax or the 6.2°~6~~portion of the 7:85% raitroad retirement(tier 1j tax for 20'17. 8a Total social security wages and tips (total of boxes 3 and 7 on Forms) VU-2) and railroad retirement (tier 1) compensation. 8a 161, 549 if $127,200 or more, skip lines 8b through.l0, and go to line 11 b Unreported tips subject to social security tax (from Form 4737, line 1Q) 8b 8~~ ,; , ~~ e Vltages subject tt social security tax (from Form 8319,line 10j 8d d Add lines 8a, Sb, and 8c go line 11 . ~ inter and on line 10 and to 9 -0here line zero or less, 7. If 9 Subtract line 8d from t'tY " i6 Multiply fh~ smaller of line 6~or ~'n~*~3'by'~2:~°io (~.'f24) . i1 11 Multiply line'6 by 2.9% (0.029) 12 Self-employment tax. Add lines 10 and 11. Enter here and on dorm 1040, line 57, or Form 1040NR, line 55 12 i3 Deduofion for ane-hall of self=employment tax. Multiply line i2 by 50% (0.50). Enter the result here and on 11,•4 ~ ~ • 13 Form 1{}~8, dine 2'~, or ~ar~n 1iI4t1Af~;~ine'27 . • O tional Mefhads To Figure Idet Earnings see instructions) Farm Optional Method. You may use this method only if (a) your gross farm income' wasn't more ~; ttian~$~;800, or~(b) your net farm`profiits2 were`4ess~Yiian $x;63'1. 14 1.4 Maximum income for optional methods Also income' (not less than zero) or $5,200. ~5 Enfier the smaller of: two-thirds (2!s) of gross farm 15 . . include this amount on line 4b above . Nonfarm Optional Method. You may use #his method only if (a) your net nonfarm profits3 were less than $5,631 and`afso less than 72:189% ofyour gross nonfarm mcom2;° and'(ti)°qou had het earnings from self-employment ' r of at least $400 in 2 of the prior 3 years. Caution: You may use this method no more than five times. ` yfi-3 16 Subtract Iine 15 from line 14 . 17. Enfertlie.smaller of:.twa-thirds:(~~a) ofgross.nonfarm income4 (not less:than.zero)o.r.the 17 amount on line 16. Also include this amount on line 4b above . ' ) ~ ~ 855,484. 855,4.8:4... 740,Q39. 7 9 0 , 0 3 9 .. fl. 790, 039 . 127,200 00 Z 2 , 97.1. 2 2 , 911. ~~ 5,200 00 ~ 3 From Sch. C, line 31; Sch. C-~, line 3; Sch. K-1 (Form 1065), box 14, code ~ From Sch. F, line 9, and Sch. K-1 (Form y065~, box 74, code B. A; and Sch. K-1 (Form 1065-B), box 9, code J7. 2 From Sch. F, line 34, and Sch. K-1 (Form 7065), box 14, code A—minus the amount you would have entered.on line 1b hadyouu not.usedthe optional "From Sch. C, line 7;.Sch. C-EZ, line 1; Sch. K-1 (Form 1065),.box 14,.code C; and Sch. K-1 orm 1065-8 ,'box 9, code J2. method. AEV11fiS1171nIue.cg.cipsp SChedUle SE {Folio 1040) 2017 Form 6Z~1 Alternative ~fiinir~um 1°ax~Ind1VI~U~IS OMB No.1545-0074 ~ j Oj~j ►:Go: to ww~a.irs:gnvlForm&25•i for instructions and the>latest°information. ~epartinent bf Uie Treasury ~ ►,attach to Foe'm 1040 or Form 1040tdR. Internal Revenue Service (99) Names) shown on Form 1040 or Forrn 1040NR Berrfard &- Jane O SaMc~ers ~ ~ SequenceNo. 32 ber Alternative MinimumTax~ble.fncome (See instructions for how to complete each line.) 1 If filing Schedule A (Form 7040), enter the amount from Form 1040, line 41, and go to line 2. Otherwise, enter the amount from Form 1040, line 38, and go to line 7. (If less than zero, enter as a negative amount.) 2 Reserved for future use _ J. 3 TaxestromSahedule~`(Farrn 7fl4flj, line9 4 Enter the home mortgage interact adjustment, if any, from line 6 of the worksheet in the instructions for this line 5 Miscellaneous deductions from Schedule A (Form 1040), sine 27. 6 ~t~'Form 1040,`Arte 38 ~.is.$'l56,900~or`less, enter• -0=. Otherwise, see'~ins"iructlons . 7 Tax refund from Form 1040, Iine 10 or fine 21 8 Investment interest expense (difference between regular tax and AMl'~. 9 Depletion•(clifference between ~reguiar tax and AN1'~ 10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount 11 Alternative tax net operafiitg foss deduction . 12 Interest from specified private activify bonds exempt from the regular tax 13 14~ 15 16 17 18 19 20 21 22 23 2A 25 26 27 28 Qualified small business stock, see instructions . Exercise of incentiva.stock options (excess. of AMY income over regular tax income) . . Estates and trusts (amount from Schedule K-1 (Form 7041), box 12, code A) Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6) Disposition of property (difference between AMT and regular tax gain or loss) Depreciation on asse#s placed in service af#er 1986 (difference betwesn regular tax and AMl) ". Passive actidities (difference between P;i~IT and regular tax income or loss) Loss limitations (difference between AMT and regular tax income or loss) . Circulation costs (difference betwesn regular tax and AM'n .. Long-term contracts;(difference between P,MT.and regular tax income) Mining costs (difference between regular tax and AM'n Research and experimsnta4 costs (difference between regular tax and AMA Income from certain installment sales before January 1, 1987 Intangible drilling costs preference . Other adjustments, including income-based related adjustments Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line 28 is more than $249,450, see instructions. . . A(ternatiue Ntinimuri°i Tax (AtVI'1`) 29 Exemption. (If you were underage 24 at the end; of 2017, see instructions.) IF your filing status is ... ANP~ line 28 is not over ... THEN enter on line 29 ... Single or head of household $120,700. $54,300 Married filing jointly or qualifying widower) 160,900. 84,500. 80,450. Married filing separately. 42,250 If line 28 is over the amount shown above for your filing status, see instructions. 30 Subtract ling 29 from line 28. If more than zero,..go to line 31. If zero or,less, enter -0- here and Qn lines 31,.33, . . and •35,:and go to.line.34 _ 31 • If you are filing Form 2555 or 2555-F2, see instructions for the amount to enter. • 1i you reported capital ga9n d'sstribUtions direet{y on Form 1044, 4ine 13; you reported qualified d'+vfdends on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT, if necessary), complete Part III on the back and enter the amount from line 64 here. ~ A#1'others: If. line 30 is $1.$7,800 or less ($93,9 or less• Ef.macried flung separately), multiply line 30 by 26% (0.26). Otherwise, multiply line 30 by 28% (028) and subtract $3,756 ($1,878 if married filing separately) from the result. 32 Alternative minimum tax foreign tax credit (see instructions). 33 TerTCative~mirtimurt~ •tax. Sabtraet lin~32 from line 31 . . .. .. .. 34 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. (f you used Schedule J to figure your tax on Form 1040, fine 44, refigure that tax without using 6cheduie J before completing this line (see instructions) 35 AMT. Subtract line 34 from line 33. If zero or less, enter -0-..inter here and on Form 1040, line 45 . For Paperwork Reduction Act Notice, see your.t~c return instructions. BAA R~voz~ei,,ma~.~n.sP i 2 3 4 5 6 7 8 9 10 tr 12 889 , 694 . ~~___ _ ~~ ~~ „ ... '21'6 322. ( ( 4 2~; 544 . ~ ) { ~ 13 14` 15 16 17 18 i9 20 2i 22 23 24 25 ( 26 2T 0. ) 1, 0 81, 4 72 . 28 5: 29~ 30 ~ 1., .0.8.1.., 4 7:2 3~~~ 2 9 9,0 5 6 . '~' ~.32~ 33 Z'9 9 , 05 6 . . 34 35 2 9 7,5 5 0 . 1, 5 0 6 . corm 6251 ~aoi~ Page 2 Form 6251 (2017) Tax Computation Using FVlaximum.Capital Gains Rates ~ Complete Part Ill..only if you are requieed•to-daso byline 31 or by the Foreign Earned Income Tax Worksheet in-the.instructions. 38 Enter the amount from Form 6251, line 30. If you.are filing Form 2555 or 2555-EZ, enter the amount from 36 line 3 of the worksheet in the instructions for line 31 37 ~ Enfer the amountfrom line 6 of Elie Qualifiied Dividends and `Capital'Gain'Tax Worksheef ih the'insfnicfions for Form 1040, line 44, or•the amount from line 13 of the Schedule D Tax Worksheet in the instructions for Schedule D (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 38 Enter the amount from Schedule D (Form 1040), line 19 (as .refigured for the AMT, if necessary) (see insfruct~ons).Jf you are°filir~:Porm 2555 or 2555-.EZ, _see instructions-forlhe amountto•enter . 39 40 41 42 Q3 37 38 . If you did not complete a Schedule D 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 1U of the Sc~eduie'D Tax VVorksl~eeY :(as refigured for the AMT,ifi necessary). if you are`Yilii~g'fbrm 2555 or 2555~EZ, see instructions for the amount to enter Enter the smaller of line 36 or line 39 Subtract Iine.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 4~ by 28% {0.28)and'subtract $3,786($1,878 it married ii{ing separately)from the result Enter: • $75,900 (f married filing jointly or qualifying widow(er), •"$37,950' if'singfe or married' fi~ng: separafely, or • $50,800 if head of household. 39 40 4f 42 43 44 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 ] 4 of the Schedule D Tax VlForksheet in the instructions for Schedule D (Form 1040), whichever applies (as figured for the regular tax). ]f you did not compete either worksheet'for'the regular tax, enter "the amount firom Form 7040, line 43; ifi zero or1ess, enter -0~. if you .. 44 are filing Form 2555 or 2555-EZ, see instructions for the amount to enter . 45 Subtract line 44 from line 43. If zero or less, enter -045 ~6 "Enter fhe smaller.df~line 3.6 or line 37 ~. X16 47 47 Enter the smaller of line 45 or line 46. This amount is taxed at 0% -. 48 Subtract line 47 from ling 46 . 48 49 Enter: • $418,400 if single • $235,350 if married filing separately 49 • $470,700 if married filing jointly or qualifying widow(ar) • $444,550- if head of household 5b infer the arriounf:from firie.45. _ ~ :50 51 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~i9 of the Schedule D 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=EZ, see instructions for the amount to enter 52 Add line 50 and line 51 53 Subtract line 52 from line 49. If zero or less, enter -054 'Enter the.smallerof line 48 or line 53 .. 55 Multiply line 54 by 15% (0.15) ► 56 Adci tines 47 and 5~4 . .. If lines 56 and 38 are the same,'skip lines 57 through 61 and go to line 62.Otherwise, go to line 5T. 57. Subtract line 56 from line 46 . 58 Multiply line 57 by 20% (0.20) . ► If line 38 is zero or blank, skip lines 59 through 6i and go to line 62.Othenvise, go to line 59. 59 Add lines 41, 56, and 57 60 Subtract line 59 from line-36- .. ._ ... .. .~ .. ._ ._ ._ .. ... .. ... .. .. ... ... ... ... ... .. .. ._ . . 81 Multiply line 60 by 25% (0.25) . ► 62 Add lines 42, 55, 58, and 61 63 If line 36 is $187,800 or less ($93,900 or Gsss if married filing separately), multiply line 36 by 26% (0.26). Otherwise, multiply Tine 36 by 28% {0.28) and subtract $3,756 ($1,87$ if married filing separately) from the result 64 Enter the smaller of line 62 or line 83 here and on line 31. If you are filing Form 2555 or 2555-EZ, do not enter this amount on line 31. Instead, enter it on. line 4 of the worksheet in the instructions for line 31 i Si" 5~ 53 54 55 56 57' 58 59 . 60. 6i 62 63 64 NEYov2aliBmlutcg.dpsp Form ~~r Ji (201 oM8 No. 1545-0074 Addatimt~al i111edicare Tai Foy `~~~'~ Department of the Treasury Intema~ Revenue Service ►1f any line does not apply to you, leave it blank. See separate instructions. ►Attach to Form 1040,1040NR, 1040-PR, or 1040-SS. ►Go to www.irs,gov/Form8~59 for instructions and the Latest information. Names) shown on return Bernard & Jane.O Sanders Additional Medicare Tax on Medicare Wages 1 Medicare wages and tips from Form W-2, box 5, If you have mare than orre Form VYl=2; enter the ti~taF'of the amounts 2 3 4 5 6 ? 8 9 10 11 12 13 14 15 16 17 18 ' ~j ;O Attachment Sequence No. 71 Your social securi number ~;;'~„ '"x`'`~ 2 Unreported tips from Form 4137, line 6 3 s Wages from Form 8919, line 6 127,200. ~'.. '~~, 4 Addlineslthrough3 . Enter the following amount for your filing status: :o~, ,̀ . $250,000 -~~~'~r Married #fling jointly ~~ti_ *:p. i . $125,000 ~r.N Married filing separately. ._250,,000. Single,.Head.ofhousehold.,.or_f~ualifying.wl.dow(er).$200,000 .,5 .. '. 6: ~ Subtraet•line.5 from..line 4: If.zer~a or lessF enter..-0Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and 7 go to Part (I . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional Medicare lax on Self-Employment-Income ~~'~E Self-employment income from 6chedule SE (Form 7 D40), Section A, line 4, or Section B, line 6. if you had a Loss, enter y_ -~~- . 888 , 207. 8 -0- (Form 1Q40-PR and Form 1040-SS filers, see instructions.) ~ ~. ' Enter the following amount for your filing status: . $2~g0~0 M"G'= (vta~ried hlirag.~oiritly. ..~$1~S,bOD ~' Nlarriecifiiingsej~aratei~+ 250, 000. V`"J. ' . 9 Single, Head of household, or Qualifying widower) $200,000 10 127 ,2 00 . ~' Enter the amount from line 4 11 122, 800. Subtract line 10 from line 9. )f zero or less, enter -0- . ~. 12y Subtract line 11 from line 8. if zero or less, enter -0- . Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009). Enter . here and go to Part III . 13 Additional Medicare Tax on Railroad Retiremen# Tax Act (RRTA) Compensation RailroacJ retirement (RRTAj. compensation: and tips fror~i. 14 ~-r~;'; Forms) W;Z, box 14 (see instructions) Enter the following amount for your filing status: Married filing jointly. . $250,000 Married filing separately .. . . $125,000 Single, Head of household, or Qualifying widower) $200,000 15 r>' "' Subtract line 15 from line 14.'if zero or less, enter -0~~16 Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by tk:9%a (Q:QA93.:. Enfier here~and:9a.to; E?ark:l~! 17 Trjtai Aetditional Medicare lax Add lines 7, 13, and '17. Also include this amount on Form 1040, line~62, (Form 1040NR, 1040-PR', and 1040-SS filers; see instructions) and go to Part V 1g Withholding Reconciliation ~ 0. 765, 407 . 6, 889. ' 6, 889 . 19 Medicare tax withheld from Form W-2, box 6. If .you have more than one Form W-2, enter the total of the amounts from box 6 '. 2, 342 19 20 Enter the amount #rom line 7 '. 12 7 , 2 0 0 . 20 ;_,< 21 Multiply line. 20 bx 1.45.% (O.a1451. This. is your. r'egulaY Medicare tax witYifSof'ding on Nfedicare wages . 1, 844'. 24' = 22 Subtract line 21 from line 19. If zero or less, enter -0-. This is your Additional Medicare Tax e"~`n withholding on Medicare wages X22 23 Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box 14 (see instruct(ons) 2$ 24 Total Additional Medicare Tax withholding. Add lines 22 and 23. Also include this amount with federal income tax withholding on Form 1040, line 64 {Form 1040NR, 1040-PR, and 1Q441-SS fi}ers,. see.it~s~~r~~t ons~ _ ., 2¢~ For Paperwork Reduction Act Notice, see your tax return.instructions. nerozn~,eim,~~.~fl.~ BAA 498. X9.8. Fom, 8959 .(201 `~~a:•'~u~~~~r{'~ ~~'~~~j'8~.~i}~—. Fomt fi~~o• Department of the Treasury Intemai Revenue Service(99) Names)-shown on your tax return OMB-No. 7545-2227 ~tn~viduais, estates, and 'gust"s ~Att~ch to your tax return. > Qo to wsysvirs.gov/Farm8~0 for instructions and the latest intorrnation. Bernard & Jane O. Sanders Investment Income ❑ ~~tion 6013(8) election (see instructions) ❑ Section 6013(h)election (see instructions} Q~Re ulatidrtsseetion1:1411~1Q `~eleetion seainstructrons` .. .1 _"f-a~cabteirat~st•jst~e::urstru~tit~~s~ 2 Ordinary dividends(ses instructions) . .. 3 Annuities(sBe instructions) 4a Rental real estate, royalties, parEnerships, S corporations, trusts, 4a etc.(see instructions) b Adjustment for net income or toss derived in the ordinary course of 4b a non-section 1411 trade or business(see instructions). _. .. .. ... .. .. .. .. .. .. c ~nmbine.lines 4a.and 4b :. .. .. .. .. .. 5a:• 5a Net gain.ar loss from;dispositiara=.of property,(see instructior~.$), b, Net gain or loss from disposition of property That is not subject to _ 5b net investment income tax(see instructions) interest or corporation partnership 5 Adjustment disposition of c from 5c stock (see instructions) d' Combine lines 5a through 5c .. 6 Adjustments to investment income for certain CFCs and PFICs(see instructions) 7 Other modifications to investment income (see instructions) 8 'Co~ak~invesfrr~enf income:.Ccsm6ine rues 'f;Z; 3;4c 5ci~ 6; and ~'. Frrvestmer~f. _ enses:Allncaf~le:~o In~restme►rt IRcomeand'.Ntodifications 9a 9a Investment interest expenses (see instructions) 9b b State, local, and foreign income tax (see instructions) 3 8. 8c c Miscellaneous investment expenses (see instructions) d Add lines 9a, 9b, and 9c 10 Additional modrfications (see instructions) 11 Total deductions and modifications. Add lines 9d and 10 Tax Computation 12~`y Net investment income. Subtract Par#.11„line 1'4 from.Part.1, line 8: individuals• campiete lines.l3i7. Estates and trusts complete fines i8a-21. ff zero or Less, enter -0- . Individuals: ~ 13 Modified adjusted gross income (see instructions) 13 1,131, 925. 14 Threshold based on.ffling status (see instructions) 14 250 000. 15 Subtract line 14 from line 73. if zero or less, enter -015 881, 925. iS Enterthe smaller of line 12 or line 15 . 17 ~ Net' investment income tax for indiVid~tals. Multiply line 16 by 3.8% (.038). Enter here and mci~.nxryflur.~~reium`(see-ir cfrAris)~ . .. .. ... .. _ .. .- -. -• ._. .. . ... _. .. ~stet~sarrd'Crust~• 18a Net investment income {line~l2 above) 18a ' b Deductions for distributions of net investment income and deductions under section 642(c) (see instructions) 18b ~ Undistributed net investment income. Subtract line 18b from 18a (see instructions). If zero or less, enter -0.. 18c i9a Adjusted gross income (see instructions) 19a b Highest tax bracket for estates and trusts for the ,year ,(see ., instnactions) 19b c Subtract line 19b from line 19a. if zero or less, enter -019c 20 Enter the.smaller of line 18c or line 13c 21 Net Investment income tax for estates and trusts: Multiply Iine 20 by 3.6% (.038). Enter here and include on your tax return (see instructions) - --_ _For Pa}?erwork Reduction Act Notice,_see your tax return instructions, g~, ~vouianeim~ao9aa.sv ~~~ ~ ~ . Attachment S uence No. 72 ou soci se v umberor EIN '1 2 3 `"= x,~:= 1;83. ~~~ ~. a. F 4cy ~~ =~ri3 ¢a ~~F - ~.~ il 4b.:. ~5d 6 .7 6. I~83". :~,`,3:.' : ~~.,~~_;; 9d ~ 10 11 i2 z,-,,,~_,u. „~;~: ~::~: y h ~ :,a, ~: 16 .t7: 2 z~ ~_~: ~:...<` `2 'xs ' 'S~~ ,: ~:°'~-~"~ .F~ _ _. 38. ' 3 8. 145 . 145 . 6. `~: J ,yam 2p 21 ~ Form 8960 (207 ~j DMa:No~7 5a5-7 tio6 . Pas~i~e Activity Loss:limitatic~n~ Fob ~~~ ►See separate instructions. ►Attach to Form 1040 4r Form 1041. ►Go to tsnvw.its. ov/FormS582 for instructions and the latest information. ~~1~ Department of the Treasury Intemai Revenue Service (9s) Names) shown on return Bernard & Jane 0 Sanders Caution: Complete Worksheets 1, 2, and 3 before completing Part I. Rertta! Real Estate Acti'v'ities ~WitFi Active Participatibn (For tfie•definitibn of~actrve participatPbn, see ~5~cial=ANc~vaiara~~or- _ .. .-. acid 3c. . ;,k 111lorksh~ec~ 4—{:~se'~his wa~rksb~ee~ it'~an~moun~ ~s sY~awn'an'~brm 8~2, kne i~iY`aF ~4 f5ee is~s~ruc~~ons.) Form orschedule (~ Subtract (c) Special and Iine number (ay Loss column (c) from (b) Ratio Name of activity allowance to be reported on 'column (a) (ses instructions) ► Total . Worksheet 5—Allocation of Unallowed Losses (See instructions.) Form or schedule and 11ne number (a) Loss Name of activity to be repoited on ~(s~e instructinnsy Total ~' ~ 7.00 (b) Ratio (c} Unailovred loss 1.00 AEko7lt~te~'~'~rta~.a~e9r-. Fo[m8~2(20t7} bopartment a(tho 7roasury--internal Rovunuu Sarvico erg ~~ 9~e o ~r~~i~~i ~r~~ ~r~ ~m~ °fats ~~ ~° OM6 No.1545-007A b {~o tc~ www.lrs.govl~arm~O4DX Sor tnstruc4tons and ihcs 1~4es4lnfarmaiinn. (fiev. Jenupry 2b9~J) Q 2015 (~ 2Q18 [~ ?.p17 []2b1 B year calendar toy r~tun~ is This Qthor ysar. Entar one: calondar year or fiscal ear {month and year ended): Your first namo and in(tlai ~arnsrci if a Jofnt n~zum, spouse's tir&t name end lnkiai Sane Q Last namo Your soclnl aecurtiy num Sanders last namo Sanders Spau~e'e soda!agcuHty Gity, tovm or post oCtica, atato, end ZtP code, It you have a foreign address, n~a ~~ Your phone number Apt. no. Gurreni hmm~ ttddroea(numgor an8 atrpat), If you hgvo rx P.U. box,see Inatruc8ans. complate bpaces Uolow. Sae Instructions. Foraipn Foreign provinco/st»telcounry Foreign country Hama tai code (✓ Fuii-year haalth care coverage {or,for 6~mendad re#urn•f~ting s4~stus. You must chaok ana bax even if ypu aro not X018 amended returns onEy, exe~ptj. Sao inst. your fi{int~ status ohAnge can't you general, In Caution: status. filing your changing duo data. khe fi~om a joint return to soparate returns alter ❑ t~ualifytnc~ widow{er) C~ Marriad filing ~sparately [.]d' Marrie~3 filing jointly Q Singe fu1 Nc~ari ni hnusahntd (If thr~ nualifvinn rerson is a child bui not your der~endont. ses insfructions.l A. Original amount II. Ngt changa— ttmount of increase roportpd ar as previou5{y adJuated or (daoronse)-expiafn In Part UI (sao Inatructionsj Use Part III on the taac►~ to explain any changes .~_ __. _.. II1GpCY1~ c~iltl ~BCIUG~IC}►YS Adjusted gCoss inCbme, !~ a nsf operating foss (NOL) carryback is ~ Q 1 inclu~leci, check here 2 2 Itemized deductions ar standard deduction ~ 3 Subtract line 2 from line 1 4a Exemptions {amended returns for soars before 2pt8 only}, f4 charvc,~ing, ~a Complete Part t on pa~o 2 and tinter tha amount frgm ifno 2J , 4b b Qualified business Income deduction (20718 amended re4ums only) v Taxabia tnoame. 8ubfract Ilne 4a or 4b from line 3. if the rosult is zero 5 ~ __ or less, eni~r -0- a, corr~~z umaunt 1 __ ~"ax Liability 6 7 8 9 iQ 99 1'ax. ~ntar methods) used to figure ta>c (see instruotians); 6 .............—__..__............._.---__...,_.,........__.._..__.__----...._._....,..v...._... __ 7 Q hers chock ~ included, is credit carryback Credits, If a general business 8 Subtract line 7 from lino 6. tt the result is zero or less, enter -0~ ~ Fl~aith care: individual rasponsihility (see ins#ructions) ip Other4a>tes `fotai ta>c. ~1cld lines B, 9> and 7p __ ~1 ...._.. __.~.. .~... ~~y~►e~,cs Federal incnrr~e tax withhold and Qxcess social security arrd Fier 1 RRTA tax withheld, {## changing, see instructions.) h3 estimated ta~c payments, including amount appliod from prior year's return 14 Earnod incam~ oredk (GIC) ❑ Schadule 8812 Form{s) ❑ 24 9 15 Refundable arodits from: C~ 8902 or ❑ 8g$5 ~I88G3 4136 othar (~ (specify}:.___~................... 16 Total ampunt paid with request for ~xfension of tiir~e to file, tote paid e~✓ith tFuc paid after return was filed 17 Total a mints. Add lines '12 through 15, column C, ar7d sins 16 . '92 11 1~ '1Q 15 original ra4urn, artd additions! die#e nd os~ 6~maur~x Yt~u t~wcs 1~ 19 2p .9 ? 22 23 .._ gverp~ymenf, if any, as show~~ on original return or as previously adjustocS by the IRS Subtract line 7 E3 from line '17. (If lass than zer~>, see instrucffons.) ~mcsunt yr~u awe. If line '1'1, column G, is mere 4han (ins 19, enter tho difference if line 71, column G, is ie~ than IinQ 7 5, enfier the difference. 'T'tiis is tl~e amount avarpaid nn this roYurn Amount of line 21 you want re~undad to you asCimatQd 4ax 23 Amoun4 of line 21~/au wani.a~~7ICsd 4a our_1mn2er ear: FOr PAj)BYWbp{S RftdUCilOtl ~QC~ PdOtICP~ 30~ IY131YUCtI011f3. .Cat. No. ~13fD1. 16 17 18 ~, ~9 ~0 21 ~ Y ;`` : `~:= ' ~` ~{ z '` c:ompteto mnd sign t~is corm on pogo z. Farm'~04~1~C(Rov. 1.2.O1J) Faye 2 Form 1 OAOX (F3~v: 1-201 ~J) ~_. _ __ _ ~ Exemptions and pependen#s what from changed has 2078 return) your exemptions (to dependents if amending Complete tf~is part only it any information relating to amending includo a change in the number of exemptions (of denendonts if you reported on Ehe return you are amending. "this would your ~01a return). A. Original number 29 blank. Fill in ail For 207F3 amended returns only, leave lines 24, 28, end c. corroct j of nxomptions or number 6, Net chanc~o amount reported other applicable Imes. C ~ amount or previousry as or before 2018, for years returns amended for or, 1040 ~orrn Note: See the adjusicd ns. instructio 1040X I=orm the also See the Firm 7040A instructions. claim you as a 24 Yourself and spouse; Caution: If someone can if emending your yourself, (ar n exemptio an claim can't depenclont, you 24 2018 return, leave line blank . ~~ ~ 25 you with lived ~n~ha children t Your dependen 2v 26 or separation di~~orce to 26 Yaur dependent children who didn't live with you due _ 27 Qther dependants 27 amending your 27. if through 2.~t lines Add ns. exemptio 28 Total number of ~~ 2018 return, leave line blank n the exemptio 28 by 29 Multiply the numbEr of exemptions claimed nn line year you are amount shgwn in the instructions for line 29 for the thus form, if amending. Enter the result here and on line 4a on page 1 of ~g amending your 201£3 return, leave line blank more than 4 descendents. see inst. and J here f If return. amended this on claimed List ALL denerdenis Ichildran and otherst 3o ~d) ✓if qualifies for {see instructions): Dependents(sea instructions): Credit tar other dependents ip (c) i'-ielationsh (b) Social security child tax credit (20tR nmentled realms only) t0 yoU LBSI nflme nuittber .. ~a~ f=irst name ~~ ❑ ~~ Presidential Election Campaign Fund [ Checking below ~von'i increase your tax or reduce your refund. the funrJ, but naw do, ~ Check here if you didn't previously want q13 to ga to not provi~usiy want ~3 to qo to the fund, but now does. ciid spouse your acid return a is ioint Cflecic 17ere if this below, tell us rvhy you are filing- dorm 1040X, provided Explanation of Ch~n~es. 1n the,space ~~ ~ forms and schedules. changed or new s anti document M~Attach any supporting 7(a) of Part iii of Schedule B. At no time during 2Q77 did taxpayers have a Taxpayers inaciverteritly checked file "yes" Uox on Line account located in a foreign co~mtry. A revised 5chodufe ~ is nRached. financial a over autlioricy tlaancial inlere;,t in or signature flemeniuer to yep a copy of this form for your rQcords. and that I have examined this amended return, including accgmpanying schedules Under penaltie of {~~rjury, 1 declare iha T! have filed an original return and true, correct, anel complete. Doclaratibn of preparo~ (other ihsan taxpayer) is st2tomenls,,;a 7d t~ file bast of my kn +le~c~e and belie(, this amended return is hased o~n,~#( into~tnaiion ahout i(~ich ~~prepurer hr> any knov+ledge ~.s j~ ,j~ / .~i. l(~I11ii2YF)~ ,r'~ '.._._..~..._ Government Service _. __._~ Y ur si~i ..—.3__.—.._.__.._~..~___.____ ~ I ~ ' • pousc's '~~xatwe. I( ~~' ins rot~rn, both must sign, ~.._ Darr. ate; Your occupation WYiter Spouse's occupation ;a*..:; >: \r,.> ~, :..:.:::.~....ia::........~.'.: ....:...:....:.:..:~.. c " .:.:::..::..::~:.. ::::::ia::e tip;\~:\>;:; ~R::. ..... .. .''.?is :\':: ~. :...v...w... : ';\::;~..:::::::.......::...::....:..:.:...:::...':*:'.:R3 i.. . .~`~ .~; :'w. ~~'h..... :,:.:..:.~::.~: :.:.:a:..,T,'...~T.::. ...\. "~ . ,.'\;3' 'ax ....::................ ... .... ............... ......~?::.: :'~:... ....:..:.a,::..:..':.:.:..:..:.a..:.:.:...:.i::.w:....::.:.:::..:..:.....:::.,...... ~. PI'If1111 ~)~:1 1)f .():ili'I~ti ilJl{Il; ...... a: \;::: ... .:'.a.::.. : ..::.q:..:.a3.::..a::3 ;>. '`..r ;;'~+.; ~...:: x;\'\k;~ _._....._r-~._.__._...._...._....__.................. PTf(J For terms and publications, vi,it w~a~in~.irs.c~ov. term 10~OX (Rev. t-2ot9) ~~'$~~~4r~~ ~~i~ xd~lA~~ ~~:~~~~~.~ ~ (Forrrt YQAOA pr 10A0) Faa~~b OMB No. f645-W7A two ~al~ ~ p+~~a~~ ~o ~oY111 ~OA4A Oi 90A0. ' the latost ErAormnttaai. ~ p¢fa wwta.frs.~ovtSch4dulo~ 4nr instructions and Depnrtrneni ui tho 7roasury Mtamul Ravenuo 5av;ce(99) Namo(s)shown an roturn AttuGtment 3squenco No, d8 Your social s4curity numbor Bernard & Jrsne C~ Sanders t~~t'~ 1 1 ~~~~'1"~~'~ (See instructions and the instructions (or Farm t0A0A. or Form 1040, ------•-U3 Senaee Federal Crc_dit Un3o~i.................w,._................_-........................»........._...~__.._._~.,......_.___....,_._.....---.._....._____.,,...,_._._.......... _~._.... _................................•_~.._..._.__...,,..».....»_....----...._....._....__..._.._,_---.._._ Na4e; If you rece(ved a Form 1093-INT, ~ottn 1099-0lD. or ....: ......__~......................,....._...____:.___..___..-----__._.___.._---__.____..__.______...._..----_._ .._.._. ---_. ___.... ........_..,.. ............____ ......_......»... ...............................~~._.....___._..... ._.__...._......_._...__..,......__....._........._.,.. ---~.........................................__..____.. statement from a brokerage rrm, list 4he flrm's name as tho payer and enter the total interest shown on that form. ............... ..___._».......~................................................................................ _. _.__---.---•--•----•..----__..._,.._....__.....................................»,.....__.__......._.__.......... .__.__.~_ —_..._.,..~.. .................. .................. ...................................................... .................................._.._.____........................,....._..._....__........_.__._.__._.___.----__ ..................................................:..................................................._,.__.__. Add the arrtounts on line 1 2 after 1989. 3 Excludable interest on series E~ and 1 U.S. sau~ngs bands issued Attach farm 8816. Form 4 Sub#ract line 3 .from line 2. inter the result here and on ~drm '(040A, or ~ IIne&a 1~40, t1a#~: if line 4 (s oveY $'1,500,. au must Corn carte Part ill. f~~a°~ $9 5 t~mount List name of payer. if any interest is from a sailer-f(nanced rnort~~ge and the buyer used the property as ~ personal residence, ses the instructions and list This interest first. Alsa, show that buyer's scrciai security nun7ber and adrJress► -------------- ---....---__ US Senate Federal Crc3dif Union . __---- 79 t03 i 983 2 3 ~1 ~g3 R~maun2 Liat name of payer b~ ~Yf~tt'Q~ti'~ ~tVit~~'%'6C~fi (See instrurtians and the Instructions for Form iQ40A, ar Form Yp40, fins 5a.) No4c~: Ii you received a Form 'IG9~J-DIV car subs9itufe statercient fram a brokerage firm, name as iho payer .and enter thaordinary divtdonHs ~shnwri on that form. __.»---._.._._. ..~...____.~..................................---_...,.__.____.....____~......._....__~_......---_ ,__._..... ---.~.__......___~.................................•----.....____~~_.~.._..____....~...,.......~....._ ...----».,......................•--_,_.~_..____.._.....___.-- qd~{~q~~ amounts on line 6. Enter the total here and an Form 1040F~> or Form ~ ~` 1p40, iSne 9a ...... IIf. late Part COtT1 t71USf OU , $1,500 aver is 6 line ~o#e: if dividend; (b) had a You must complete this part if you (a) had over ~1,50b of taxable intaresi pr ordinary j~~~ ~~~ fransferor to, a foroign trust, or a af, grantor were a or irom, dastributinn a ~~} receivAc! nr account; foreign authority over a financial 7a At any 4ime during 2077, did you have a finaiiolal interest fn or signature ~sJ~'~3~Y! located (n a foreign acoaunt) bro!