Ken is 63 years old and unmarried. He retired at age 55 when he sold his business, Understock.com. Though Ken is retired, he is still very active. Ken reported the following financial information this year. Assume Ken files as a single taxpayer.

Ken won $1,200 in an illegal game of poker (the game was played in Utah, where gambling is illegal).

Ken sold 1,000 shares of stock for $32 a share. He inherited the stock two years ago. His tax basis (or investment) in the stock was $31 per share.

Ken received $25,000 from an annuity he purchased eight years ago. He purchased the annuity, to be paid annually for 20 years, for $210,000.

Ken received $13,000 in disability benefits for the year. He purchased the disability insurance policy last year.

Ken decided to go back to school to learn about European history. He received a $500 cash scholarship to attend. He used $300 to pay for his books and tuition, and he applied the rest toward his new car payment.

Kens son, Mike, instructed his employer to make half of his final paycheck of the year payable to Ken as a gift from Mike to Ken. Ken received the check on December 30 in the amount of $1,100.

Ken received a $610 refund of the $3,600 in state income taxes his employer withheld from his pay last year. Ken claimed $6,350 in itemized deductions last year (the standard deduction for a single filer was $6,300).

Ken received $30,000 of interest from corporate bonds and money market accounts.

Complete page 1 of Form 1040 for Ken.

Ken's address is 1001 N.W. 93 Street, Miami, FL 33168.

Ken's Social security number: 412-34-5670

1040 PG1

Form 1040	Department of the TreasuryInternal Revenue Service (99)				2016	OMB No. 1545-0074		IRS Use Only - Do not write in this space.
	U.S. Individual Income Tax Return
For the year Jan. 1Dec. 31, 2016, or other tax year beginning				, 2016, ending		, 20		See separate instructions.
Your first name and initial					Last name			Your social security number
Ken								412-34-5670
If a joint return, spouse's first name and initial					Last name			Spouse's social security number
Home address (number and street). If you have a P.O. box, see instructions.							Apt. no.	Make sure the SSN(s) above and on line 6c are correct.
1001 N.W. 93 Street, Miami, FL 33168.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below.								Presidential Election Campaign
								Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.
Foreign country name					Foreign province		Foreign postal code
								You	Spouse
Filing Status	1

Single

4

Head of household (with qualifying person). If the qualifying person is a child

Check only one box.

2

Married filing jointly (even if only one had income)

but not your dependent, enter this child's name here.

3

Married filing separately. Enter spouses

5

Qualifying widow(er) with dependent child

SSN above and full name here.

Exemptions

6a

Yourself. If someone can claim you as a dependent, do not check box 6a

Boxes checked on 6a and 6b

1

b

Spouse

No. of children on 6c who:

c

Dependents:

(2) Dependent's

(3) Dependent's

(4) X if child under

Lived with you

(1) First name

Last name

SSN

Relationship

age 17 qualifying

Did not live with you due to divorce

(xxx-xx-xxxx)

to you

for child tax credit.

or separation (see instruction)

If more than four dependents, see instructions and check here

Dependents on 6c not entered above

Add numbers on lines above

1

d

Total number of exemptions claimed

Income

7

7 Wages, salaries, tips, etc. Attach Form(s) W-2

7

8a

8a Taxable interest. Attach Schedule B if required

8a

Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld.

b

Tax-exempt interest. Do not include on line 8a

8b

9a

Ordinary dividends. Attach Schedule B if required

9a

b

Qualified Dividends

9b

10

Taxable refunds, credits, or offsets of state and local income taxes

10

11

Alimony received

11

12

Business income or (loss). Attach Schedule C or C-EZ

12

13

Capital gain or (loss). Attach Schedule D if required.

13

14

Other gains or (losses). Attach Form 4797

14

15a

IRA distributions

15a

b Taxable amount

15b

If you did not get a W-2, see instructions.

16a

Pensions and annuities

16a

b Taxable amount

16b

17

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E.

17

18

Farm income or (loss). Attach Schedule F

18

19

Unemployment compensation

19

20a

Social security benefits

20a

b 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

22

Adjusted

23

Educator expenses

23

Gross

24

Certain business expenses of reservists, performing artists, and

24

Income

fee-basis government officials. Attach Form 2106 or 2106-EZ

25

Health savings account deduction. Attach Form 8889

25

26

Moving expenses. Attach Form 3903

26

27

Deductible part of self-employment tax. Attach Schedule SE

27

28

Self-employed SEP, SIMPLE, and qualified plans

28

29

Self-employed health insurance deduction

29

30

Penalty on early withdrawal of savings

30

31a

Alimony paid

b Recipients SSN (xxx-xx-xxxx)

31a

32

IRA deduction

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

36

37

Subtract line 36 from line 22. This is your adjusted gross income . . . . .

37

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Form 1040 (2016)

UYA