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Please complete the following forms: Form 1 0 4 0 Schedule 1 Schedule A Schedule B Bob ( age 4 3 ) and Melissa Grant
Please complete the
following forms:
Form
Schedule
Schedule A
Schedule B
Bob age and Melissa Grant age are married and live in Lexington, Kentucky. The Grants have two children Jared, age and Alese, age The Grants would like to file a joint tax return for the year.
Bobs Social Security number is
Melissas Social Security number is
Jareds Social Security number is
Aleses Social Security number is
The Grants mailing address is Hickory Road, Lexington, Kentucky
Jared and Alese are tax dependents for federal tax purposes
Bob Grants Forms W provided the following wages and withholding for the year:
Employer
Gross Wages
Federal Income Tax Withholding
State Income Tax Withholding
National Storage
$
$
$
Lexington Little League
$
Melissa Grants Form W provided the following wages and withholding for the year:
Employer
Gross Wages
Federal Income Tax Withholding
State Income Tax Withholding
Jensen Photography
$
$
$
All applicable and appropriate payroll taxes were withheld by the Grants respective employers. All the Grant family was covered by minimum essential health insurance during each month in The insurance was provided by Bobs primary employer, National Storage.
The Grants also received the following during the year:
Interest income from First Kentucky Bank $
Interest income from City of Lexington, KY Bond $
Interest income from US Treasury Bond $
Interest income from Nevada State School Board Bond $
Ordinary dividends from ABC S&P Index Fund $
Qualified dividends from ABC S&P Index Fund $
Gambling winnings $
Gambling losses on separate trips and engagements $
Workers compensation payments to Bob $
Disability payments received by Bob on account of injury $
National Storage paid of the premiums on the policy and included the premium payments in Bobs taxable wages
Melissa received the following payments as a result of a lawsuit she filed for damages sustained in a car accident:
Medical Expenses for physical injuries $
Emotional Distress from having been physically injured $
Punitive Damages $
Total $
The Grants did not own, control or manage any foreign bank accounts nor were they a grantor or beneficiary of a foreign trust during the tax year.
The Grants paid or incurred the following expenses during the year:
DentistOrthodontist unreimbursed by insurance $
Doctor fees unreimbursed by insurance $
Prescriptions unreimbursed by insurance $
KY state tax payment made on for tax return liability $
KY state income taxes withheld during $
Real property taxes on residence $
Vehicle registration fee based upon age of vehicle $
Mortgage interest on principal residence $
Interest paid on borrowed money to purchase the City of
Lexington, KY municipal bonds $
Interest paid on borrowed money to purchase
US Treasury bonds $
Contribution to the Red Cross $
Contribution to Senator Rick Hartleys Reelection Campaign $
Contribution to First Baptist Church of Kentucky $
Fee paid to Jones & Company, CPAs for tax preparation $
In addition, Bob drove miles commuting to work and Melissa drove miles commuting to work. The Grants have represented to you that they maintained careful logs to support their respective mileage.
The Grants drove miles in total to receive medical treatment at a hospital in April.
The Grants both want to contribute to the Presidential Election Campaign Fund. The Grants would like to receive a refund if any of any tax they may have overpaid for the year. Their
preferred method of receiving the refund is by check.
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