Casualties and Thefts Information about Form 4684 and its separate instructions is at www.irs.gov/form4684. Attach to your tax return. Use a separate Form 4684 for each casualty or theft. OMB No. 1545-0177 Form Department of the Treasury Internal Revenue Service Sequence No. 26 Name(s) shown on tax return SECTION A Personal Use Property (Use this section to report casualties and thefts of property not used in a trade or business or for income-producing purposes.) 1 Description of properties (show type, location, and date acquired for each property). Use a separate line for each property lost or damaged from th e same casualty or theft. Property A Property B Property C Property D Properties 2 Cost or other basis of each property......2 3 Insurance or other reimbursement (whether or not you Note: If line 2 is more than line 3, skip line 4. 4 Gain from casualty or theft. If line 3 is more than line 2, enter the difference here and skip lines 5 through 9 for that column. See instructions if line 3 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year . . 4 5 Fair market value before casualty or theft....5 6 Fair market value after casualty or theft... 6 8 Enter the smaller of line 2 or line 7......8 9 Subtract line 3 from line 8. If zero or less, enter -0-. 9 10 Casualty or theft loss. Add the amounts on line 9 in columns A throughD. . 10 11 Enter the smaller of line 10 or S100.......................11 Caution: Use only one Form 4684 for lines 13 through 18. 13 Add the amounts on line 12 of all Forms 4684 .....................13 14 Add the amounts on line 4 of all Forms 4684...... 15 If line 14 is more than line 13, enter the difference here and on Schedule D. Do not 14 complete the rest of this section (see instructions). If line 14 is less than line 13, enter -0- here and go to line 16. If line 14 is equal to line 13, enter-0- here. Do not complete the rest of this section. 15 16 If line 14 is less than line 13, enter the difference . ..16 17 Enter 10% of your adjusted gross income from Form 1040, line 38, or Form 1040NR, line 37, Estates and trusts, see 18 Subtract line 17 from line 16. If zero or less, enter -0-. Also enter the result on Schedule A (Form 1040), line 20, or Form 1040NR, Schedule A, line 6. Estates and trusts, enter the result on the "Other deductions" line of your tax return 18 For Paperwork Reduction Act Notice, see instructions. Cat. No. 129970 Form 4684 (2016)