Using the information provided in the chapter background and gathered from the exercise on CS2-15,

Complete the following:

a. Perform a risk assessment of BUS?s growth-related change initiatives, including the name change

to BUG. Use the results of that risk assessment to prioritize those initiatives that are candidates

for internal audit projects.

b. Based on the prioritized risk assessment, determine the highest risk initiatives for which

the internal audit function should perform an internal audit engagements. Give the reasons

for your determination of highest risk.

c. Discuss the level of involvement the internal audit function will have in

the engagement selected in b. above. Consider:

1. Customer expectations.

2. Frequency and format of customer communications.

3. Internal audit resources available.

4. Type and amount of testing to be performed.

d. Develop a summary work program for the highest prioritized initiative

chosen for an engagement in b. above

FRANSISCO & EVA MARTINEZ 46 MILANO STREET RALEIGH, NC 27513 2015 INCOME TAX RETURN PRACTICE LAB 15 PRACTICE LAB WAY WASHINGTON DC 20005 (202) 202-2022 [ [FRANSISCO E MARTINEZ & [EVA S MARTINEZ Preparer No.: 995 [46 MILANO STREET Client No. : XXX-XX-6789 [RALEIGH NC 27513 Invoice Date: 04/13/2017 [(123) 456-7890 [ INVOICE [ [ [ Description Amount [ [ [ [ [ [ [ [ [ [PREPARATION OF 2015 FEDERAL/STATE FORMS & WORKSHEETS: [ [ [ [ [ [FORM 1040 [ [ [SCHEDULE A (ITEMIZED DEDUCTIONS) [ [ [SCHEDULE A CONTRIBUTION WORKSHEET [ [ [SCHEDULE C (BUSINESS PROFIT/LOSS) [ [ [SCHEDULE D (CAPITAL GAINS & LOSS) [ [ [FORM 8949 (SALES OF CAPITAL ASSETS) (2) [ [ [CAPITAL GAIN TAX WORKSHEET [ [ [SCHEDULE E (SUPPLEMENTAL INCOME) [ [ [SCHEDULE SE (SELF-EMPLOYMENT TAX) [ [ [FORM W-2 (WAGES AND TAX) [ [ [FORM W-2G (GAMBLING WINNINGS) [ [ [FORM 4562 (DEPRECIATION) [ [ [FORM 6251 (ALTERNATIVE MINIMUM TAX) [ [ [FORM 8283 (NON CASH CONTRIBUTIONS) [ [ [FORM 8879 (E-FILE SIGNATURE AUTHORIZATION) [ [ [FORM 8453 (E-FILE DECLARATION) [ [ [FORM 8582 (PASSIVE ACTIVITY LOSS) [ [ [FORM 8960 (NET INVESTMENT INCOME TAX) [ [ [DEPRECIATION WORKSHEET [ [ [FORM 1040 X [ [ [NC STATE RESIDENT RETURN [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ Total Invoice [ [ $0.00 [ [ [ [ [ [ Amount Paid [ [ $0.00 [ [ [ [ [ [ Balance Due [ [ $0.00 Form 1040X (Rev. January 2016) Department of the TreasuryInternal Revenue Service Amended U.S. Individual Income Tax Return a OMB No. 1545-0074 Information about Form 1040X and its separate instructions is at www.irs.gov/form1040x. X 2015 This return is for calendar year Other year. Enter one: calendar year 2014 2013 2012 or fiscal year (month and year ended): Your first name and initial Your social security number Last name FRANSISCO E MARTINEZ If a joint return, spouse's first name and initial 123-45-6789 Spouse's social security number Last name EVA S MARTINEZ 123-45-6782 Current home address (number and street). If you have a P.O. box, see instructions. Apt. no. Your phone number 46 MILANO STREET 123-456-7890 City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). RALEIGH, NC 27513 Foreign country name Foreign postal code Foreign province/state/county Amended return filing status. You must check one box even if you are not changing Full-year coverage. your filing status. Caution: In general, you cannot change your filing status from joint to If all members of your household have fullseparate returns after the due date. year minimal essential health care coverage, Head of household (If the qualifying person is a child but not check "Yes." Otherwise, check "No." Single your dependent, see instructions.) (See instructions.) X Married filing jointly Married filing separately X Yes Qualifying widow(er) Use Part III on the back to explain any changes Income and Deductions 1 2 3 4 5 No A. Original amount B. Net change or as previously amount of increase adjusted or (decrease) (see instructions) explain in Part III Adjusted gross income. If net operating loss (NOL) carryback is included, check here . . . . . . . . . . . . . . . a Itemized deductions or standard deduction . . . . . . . . . Subtract line 2 from line 1 . . . . . . . . . . . . . . . Exemptions. If changing, complete Part I on page 2 and enter the amount from line 29 . . . . . . . . . . . . . . . . . Taxable income. Subtract line 4 from line 3 . . . . . . . . . . C. Correct amount 1 2 3 253048 56497 196551 253048 56497 196551 4 5 20000 176551 20000 176551 QDCGTW 6 37848 37848 Credits. If general business credit carryback is included, check here . . . . . . . . . . . . . . . . . . . . . a Subtract line 7 from line 6. If the result is zero or less, enter -0- . . . Health care: individual responsibility (see instructions) . . . . . . Other taxes . . . . . . . . . . . . . . . . . . . . Total tax. Add lines 8, 9, and 10 . . . . . . . . . . . . . 7 8 9 10 11 37848 37848 10573 48421 10573 48421 12 40000 40000 13 14 28000 28000 Tax Liability 6 7 8 9 10 11 Tax. Enter method(s) used to figure tax (see instructions): Payments 12 13 14 15 Federal income tax withheld and excess social security and tier 1 RRTA tax withheld (If changing, see instructions.) . . . . . . . . . Estimated tax payments, including amount applied from prior year's return . . . . . . . . . . . . . . . . . . . . . . Earned income credit (EIC) . . . . . . . . . . . . . . . Refundable credits from: Schedule 8812 Form(s) 4136 2439 8801 other (specify): 16 17 8863 8885 8962 or 15 Total amount paid with request for extension of time to file, tax paid with original return, and additional tax paid after return was filed . . . . . . . . . . . . . . . . . . . . . . . . Total payments. Add lines 12 through 16 . . . . . . . . . . . . . . . . . . . . 16 17 68000 Refund or Amount You Owe 18 19 20 21 22 23 Overpayment, if any, as shown on original return or as previously adjusted by the IRS . . . . . . Subtract line 18 from line 17 (If less than zero, see instructions.) . . . . . . . . . . . . . Amount you owe. If line 11, column C, is more than line 19, enter the difference . . . . . . . . If line 11, column C, is less than line 19, enter the difference. This is the amount overpaid on this return Amount of line 21 you want refunded to you . . . . . . . . . . . . . . . . . . . Amount of line 21 you want applied to your (enter year): estimated tax . 23 18 19 20 21 22 68000 19579 19579 Complete and sign this form on Page 2. For Paperwork Reduction Act Notice, see instructions. QNA Form 1040X (Rev. 1-2016) MARTINEZ 123-45-6789 Page 2 Form 1040X (Rev. 1-2016) Part I Exemptions Complete this part only if you are increasing or decreasing the number of exemptions (personal and dependents) claimed on line 6d of the return you are amending. A. Original number of exemptions or amount reported or as previously adjusted See Form 1040 or Form 1040A instructions and Form 1040X instructions. 24 25 26 27 28 29 30 Yourself and spouse. Caution: If someone can claim you as a dependent, you cannot claim an exemption for yourself . . . . . Your dependent children who lived with you . . . . . . . . . Your dependent children who did not live with you due to divorce or separation Other dependents . . . . . . . . . . . . . . . . . . Total number of exemptions. Add lines 24 through 27 . . . . . . C. Correct number or amount B. Net change 24 25 26 27 28 Multiply the number of exemptions claimed on line 28 by the exemption amount shown in the instructions for line 29 for the year you are amending. Enter the result here and on line 4 on page 1 of this form . . 29 List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see instructions. (a) First name Part II (b) Dependent's social security number Last name (c) Dependent's relationship to you (d) Check box if qualifying child for child tax credit (see instructions) Presidential Election Campaign Fund Checking below will not increase your tax or reduce your refund. Check here if you did not previously want $3 to go to the fund, but now do. Check here if this is a joint return and your spouse did not previously want $3 to go to the fund, but now does. Part III Explanation of changes. In the space provided below, tell us why you are filing Form 1040X. a Attach any supporting documents and new or changed forms and schedules. Sign Here Remember to keep a copy of this form for your records. Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information about which the preparer has any knowledge. F F Your signature Date Spouse's signature. If a joint return, both must sign. Date Firm's name (or yours if self-employed) Date Paid Preparer Use Only F PRACTICE LAB Preparer's signature IRS Print/type preparer's name S12345678 PTIN For forms and publications, visit IRS.gov. QNA 15 PRACTICE LAB WAY WASHINGTON DC 20005 Firm's address and ZIP code Check if self-employed (202)202-2022 Phone number EIN Form 1040X (Rev. 1-2016) TAX YEAR: 2015 CLIENT SPOUSE : : 123-45-6789 123-45-6782 PROCESS DATE: 04/13/2017 FRANSISCO E MARTINEZ EVA S MARTINEZ ADDRESS : 46 MILANO STREET : RALEIGH NC 27513 BIRTH DATE BIRTH DATE : 07/01/1967 : 06/27/1968 PREPARER : 995 Phone #1: (123) 456-7890 PREPARER FEE: Phone #2: (123) 456-7987 ELECTRONIC : Phone #3: TOTAL FEES : STATUS : 2 FED TYPE: Electronic Mail ST TYPE : Regular Tax E-MAIL : NONE@TAXSLAYERPRO.COM ________________________________________________________________________________ DEPENDENT NAME _____________________________________________________________________________ BIRTH DATE SSN RELATIONSHIP MONTHS DIEGO MARTINEZ 04/09/1992 123-45-6786 SON 12 VICTORIA MARTINEZ 12/06/1999 123-45-6783 DAUGHTER 12 THOMAS MARTINEZ 07/29/2000 123-45-6781 SON 12 ________________________________________________________________________________ LISTING OF FORMS FOR THIS RETURN ________________________________ FORM 1040 FORM W-2 FORM W-2G SCHEDULE A (ITEMIZED DEDUCTIONS) FORM 8283 (NON CASH CONTRIBUTION) SCHEDULE C (BUSINESS INCOME) SCHEDULE D (CAPITAL GAINS/LOSSES) SCHEDULE E (SUPPLEMENTAL INCOME/LOSS) SCHEDULE SE (SELF EMPLOYMENT TAX) FORM 4562 (DEPRECIATION) FORM 6251 (ALTERNATIVE MINIMUM TAX) FORM 8582 (PASSIVE ACTIVITY LOSS LIMITATIONS) FORM 8949 (SALES AND OTHER DISPOSITIONS OF CAPITAL ASSETS) FORM 8960 (NET INVESTMENT INCOME TAX) FORM 1040X (AMENDED RETURN) DEPRECIATION WORKSHEET NC STATE RESIDENT RETURN ________________________________________________________________________________ * QUICK SUMMARY * __________________________________________________________________________ SUMMARY FEDERAL NC RESIDENT FILING STATUS 2 2 TOTAL INCOME 258327 0 TOTAL ADJUSTMENTS 5279 0 ADJUSTED GROSS INCOME 253048 0 DEDUCTIONS 56497 0 EXEMPTIONS 20000 0 TAXABLE INCOME 176551 213692 TAX 37848 12287 CREDITS 0 0 PAYMENTS 68000 13941 OTHER TAXES 10573 0 EARNED INCOME CREDIT 0 0 REFUND 19579 1654 AMOUNT DUE 0 0 CLIENT : FRANSISCO MARTINEZ SPOUSE : EVA MARTINEZ 123-45-6789 123-45-6782 PREPARER : 995 DATE : 04/13/2017 ________________________________________________________________________________ LISTING OF FORMS FOR THIS RETURN ________________________________ * W-2 INCOME FORMS SUMMARY * ________________________________________________________________________________ 1. ____________________________________________________________________________ T/S EMPLOYER WAGES FED WITH FICA MED TAX STATE WITH ST S AVIS 180000 40000 7254 2610 9941 NC TOTALS...... 180000 40000 7254 2610 9941 * W-2G INCOME FORMS SUMMARY * ________________________________________________________________________________ 1. ______________________________________________________________________ [T/S] PAYER GROSS WINNING FED WITH STATE WITH ST T CASINO 3200 0 0 TOTALS...... 3200 0 0 W-2 Form 2015 Wage and Tax Statement a Employee's social security number 123-45-6782 b Employer identification number (EIN) Department of the TreasuryInternal Revenue Service This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it. 1 Wages, tips, other compensation 2 Federal income tax withheld OMB No. 1545-0008 12-3456789 180000 c Employer's name, address, and ZIP code 3 Social security wages AVIS 12345 WAY ST CARY NC 27513 5 Medicare wages and tips 40000 4 Social security tax withheld 117000 7254 6 Medicare tax withheld 180000 2610 7 Social security tips 8 Allocated tips 9 d Control number e Employee's first name and initial Last name EVA S 10 Dependent care benefits Suff. 11 Nonqualified plans 12a See instructions for box 12 C o d e MARTINEZ 13 Statutory employee Retirement plan Third-party sick pay 14 Other 46 MILANO STREET RALEIGH NC 27513 OTHER C 500 12b C o d e D 30000 12c 14000 C o d e 12d C o d e f Employee's address and ZIP code 15 State NC Employer's state ID number 16 State wages, tips, etc. 12345673256 180000 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 9941 ----------------------------------------------------------------------------b Employer identification number (EIN) This information is being furnished to the Internal Revenue Service. If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this income is taxable and you fail to report it. 1 Wages, tips, other compensation 2 Federal income tax withheld c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld 5 Medicare wages and tips 6 Medicare tax withheld 7 Social security tips 8 Allocated tips a Employee's social security number OMB No. 1545-0008 9 d Control number e Employee's first name and initial Last name 10 Dependent care benefits Suff. 11 Nonqualified plans 13 Statutory employee Retirement plan 12a See instructions for box 12 C o d e Third-party sick pay 14 Other 12b C o d e 12c C o d e 12d C o d e f Employee's address and ZIP code 15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name 8879 Form IRS e-file Signature Authorization OMB No. 1545-0074 2015 a Do not send to the IRS. This is not a tax return. a Keep this form for your records. a Information about Form 8879 and its instructions is at www.irs.gov/form8879. Department of the Treasury Internal Revenue Service F Submission Identification Number (SID) Taxpayer's name Social security number FRANSISCO E MARTINEZ 123-45-6789 Spouse's social security number Spouse's name EVA S MARTINEZ Part I 1 2 3 4 5 123-45-6782 Tax Return InformationTax Year Ending December 31, 2015 (Whole Dollars Only) Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4) . . . . . Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12) . . . . . . . . . Federal income tax withheld (Form 1040, line 64; Form 1040A, line 40; Form 1040EZ, line 7) . . . Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a) Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14) . . . . . . . Part II 253048 48421 40000 19579 1 2 3 4 5 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 of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31, 2015, and to the best of my knowledge and belief, it is true, correct, and complete. 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 (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent. Taxpayer's PIN: check one box only X I authorize PRACTICE LAB to enter or generate my PIN ERO firm name 1 6 7 8 9 Enter five digits, but do not enter all zeros as my signature on my tax year 2015 electronically filed income tax return. I will enter my PIN as my signature on my tax year 2015 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 III below. Your signature a Date a Spouse's PIN: check one box only X I authorize PRACTICE LAB 04/13/2017 to enter or generate my PIN ERO firm name 1 6 7 8 2 Enter five digits, but do not enter all zeros as my signature on my tax year 2015 electronically filed income tax return. I will enter my PIN as my signature on my tax year 2015 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 III below. Spouse's signature a Date a 04/13/2017 Practitioner PIN Method Returns Onlycontinue below Part III Certification and AuthenticationPractitioner PIN Method Only ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 3 6 9 2 5 8 1 9 2 5 8 Do not enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the tax year 2015 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. ERO's signature a IRS Date a 04/13/2017 ERO Must Retain This Form See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So For Paperwork Reduction Act Notice, see your tax return instructions. QNA Form 8879 (2015) Form 8453 Department of the Treasury Internal Revenue Service Please print or type. P R I N T U.S. Individual Income Tax Transmittal for an IRS e-file Return OMB No. 1545-0074 For the year January 1-December 31, 2015 a See instructions on back. a Information about Form 8453 and its instructions is available at www.irs.gov/form8453. 2015 Your first name and initial Last name FRANSISCO E MARTINEZ If a joint return, spouse's first name and initial Last name EVA S MARTINEZ Your social security number 123-45-6789 Spouse's social security number 123-45-6782 Home address (number and street). If you have a P.O. box, see instructions. C L E A R L Y Apt. no. 46 MILANO STREET City, town or post office, state, and ZIP code (If a foreign address, also complete spaces below.) RALEIGH, NC c Important! You must enter your SSN(s) above. c 27513 Foreign country name Foreign province/state/county Foreign postal code FILE THIS FORM ONLY IF YOU ARE ATTACHING ONE OR MORE OF THE FOLLOWING FORMS OR SUPPORTING DOCUMENTS. Check the applicable box(es) to identify the attachments. Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes (or equivalent contemporaneous written acknowledgement) Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to sign the return) Form 3115, Application for Change in Accounting Method Form 3468 - attach a copy of the first page of NPS Form 10-168, Historic Preservation Certification Application (Part 2 Description of Rehabilitation), with an indication that it was received by the Department of the Interior or the State Historic Preservation Officer, together with proof that the building is a certified historic structure (or that such status has been requested) Form 4136 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provider identifying the product as renewable diesel and, if applicable, a statement from the reseller Form 5713, International Boycott Report X Form 8283, Noncash Charitable Contributions, Section A (if any statement or qualified appraisal is required), or Section B, Donated Property, and any related attachments (including any qualified appraisal or partnership Form 8283) Form 8332, Release/Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a divorce decree or separation agreement, that went into effect after 1984 and before 2009) (see instructions) Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities Form 8864 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provider identifying the product as renewable diesel and, if applicable, a statement from the reseller Form 8885, Health Coverage Tax Credit, and all required attachments Form 8949, Sales and Other Dispositions of Capital Assets (or a statement with the same information), if you elect not to report your transactions electronically on Form 8949 DO NOT SIGN THIS FORM. For Paperwork Reduction Act Notice, see your tax return instructions. QNA Form 8453 (2015) Form 1040 (99) Department of the TreasuryInternal Revenue Service 2015 U.S. Individual Income Tax Return OMB No. 1545-0074 , 2015, ending IRS Use OnlyDo not write or staple in this space. See separate instructions. For the year Jan. 1-Dec. 31, 2015, or other tax year beginning Your first name and initial Last name , 20 Your social security number FRANSISCO E MARTINEZ 123-45-6789 If a joint return, spouse's first name and initial Last name Spouse's social security number EVA S MARTINEZ 123-45-6782 Apt. no. Home address (number and street). If you have a P.O. box, see instructions. c 46 MILANO STREET City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking Foreign postal code a box below will not change your tax or refund. You Spouse RALEIGH, NC 27513 Foreign country name Filing Status Check only one box. Exemptions Foreign province/state/county 1 x 2 3 Single Married filing jointly (even if only one had income) b c X X Spouse . Dependents: . . . If you did not get a W-2, see instructions. Adjusted Gross Income . Last name . . . . . . child's name here. a 5 Qualifying widow(er) with dependent child . THOMAS MARTINEZ Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . } (4) \u0014 if child under age 17 qualifying for child tax credit (see instructions) (3) Dependent's relationship to you 123-45-6786 123-45-6783 123-45-6781 VICTORIA MARTINEZ SON X X DAUGHTER SON Dependents on 6c not entered above . . . . . . . . . . . . . FB . . . . . . 7 . 8b . . . . . . . . . 8a . . . . . . . 9a 10 11 Qualified dividends . . . . . . . . . . . 9b Taxable refunds, credits, or offsets of state and local income taxes Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 12 13 14 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . Capital gain or (loss). Attach Schedule D if required. If not required, check here a Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 12 13 14 15a 16a 17 IRA distributions . 15a b Taxable amount . . . Pensions and annuities 16a b Taxable amount . . . Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 15b 16b 17 18 19 20a Farm income or (loss). Attach Schedule F . Unemployment compensation . . . . Social security benefits 20a 18 19 20b 21 22 Other income. List type and amount GAMBLING WINNINGS Combine the amounts in the far right column for lines 7 through 21. This is your total income 23 Educator expenses 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 25 Health savings account deduction. Attach Form 8889 . 24 25 26 27 28 Moving expenses. Attach Form 3903 . . . . . . Deductible part of self-employment tax. Attach Schedule SE . Self-employed SEP, SIMPLE, and qualified plans . . 26 27 28 29 30 31a Self-employed health insurance deduction Penalty on early withdrawal of savings . . . . . . . . . . 32 33 34 Alimony paid b Recipient's SSN a IRA deduction . . . . . . . Student loan interest deduction . . Tuition and fees. Attach Form 8917 . 29 30 31a . . . . . . . . . . . . 32 33 34 35 36 37 Domestic production activities deduction. Attach Form 8903 35 Add lines 23 through 35 . . . . . . . . . . . . . Subtract line 36 from line 22. This is your adjusted gross income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . 8a b 9a Taxable interest. Attach Schedule B if required . Tax-exempt interest. Do not include on line 8a . Ordinary dividends. Attach Schedule B if required . . . . . . . b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Taxable amount . . . Boxes checked on 6a and 6b No. of children on 6c who: lived with you did not live with you due to divorce or separation (see instructions) . d Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. the qualifying person is a child but not your dependent, enter this (2) Dependent's social security number DIEGO MARTINEZ Income Head of household (with qualifying person). (See instructions.) If Yourself. If someone can claim you as a dependent, do not check box 6a . (1) First name If more than four dependents, see instructions and check here a 4 Married filing separately. Enter spouse's SSN above and full name here. a 6a Make sure the SSN(s) above and on line 6c are correct. . . . . . . . . a . 2 3 0 0 Add numbers on lines above a 5 180000 74727 400 21 22 3200 258327 36 37 5279 253048 23 5279 . . For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. !"# . . . . . . . . . a Form 1040 (2015) MARTINEZ 123-45-6789 Page 2 Form 1040 (2015) 38 Amount from line 37 (adjusted gross income) Tax and Credits 39a Check if: Standard Deduction for People who check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. All others: Single or Married filing separately, $6,300 Married filing jointly or Qualifying widow(er), $12,600 Head of household, $9,250 Payments If you have a qualifying child, attach Schedule EIC. Blind. Blind. . } . . . . . . 44 45 46 47 48 49 50 51 52 53 54 55 58 59 60a Alternative minimum tax (see instructions). Attach Form 6251 . Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . 48 . . . . . . Residential energy credits. Attach Form 5695 . . . . 53 3800 b 8801 c Other credits from Form: a 54 Add lines 48 through 54. These are your total credits . . . . . Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . . . . . . . . Self-employment tax. Attach Schedule SE . . . . . . . 8919 . . Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . . . . . . . . . . . . . . . Unreported social security and Medicare tax from Form: a . Household employment taxes from Schedule H . . . . . . . 4137 . . 62 63 Taxes from: a Form 8959 b X Form 8960 c Add lines 56 through 62. This is your total tax . . . . a Nontaxable combat pay election 66b Additional child tax credit. Attach Schedule 8812 . . . . 67 68 69 70 American opportunity credit from Form 8863, line 8 . Net premium tax credit. Attach Form 8962 . . . . Amount paid with request for extension to file . . . . . . . . . 68 69 70 71 72 Excess social security and tier 1 RRTA tax withheld . . . . b . . . . . . 71 72 Credits from Form: a 2439 b Reserved c 8885 d 73 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . Credit for federal tax on fuels. Attach Form 4136 . . . . 56497 196551 20000 176551 36434 1414 43 44 45 46 47 37848 . . . . 55 a . . . . 37848 10558 56 57 58 59 60a 60b X . . . . . Instructions; enter code(s) a . . . . . . . . . . . 64 Federal income tax withheld from Forms W-2 and 1099 . . 40000 2015 estimated tax payments and amount applied from 2014 return 65 28000 Earned income credit (EIC) . . . . . . . . . . 66a 67 75 76a . . Full-year coverage . 40 41 42 52 First-time homebuyer credit repayment. Attach Form 5405 if required Health care: individual responsibility (see instructions) 253048 49 50 51 Credit for child and dependent care expenses. Attach Form 2441 Education credits from Form 8863, line 19 . . . . . Retirement savings contributions credit. Attach Form 8880 Child tax credit. Attach Schedule 8812, if required . . . b 61 64 65 66a b . . . . Add lines 44, 45, and 46 . . . . . . . Foreign tax credit. Attach Form 1116 if required . 38 Total boxes checked a 39a Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . Form 4972 c Tax (see instructions). Check if any from: a Form(s) 8814 b a If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 61 62 15 48421 63 74 75 Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . a 76a Routing number Savings X X X X X X X X X a c Type: Checking Account number X X X X X X X X X X X X X X X X X Amount of line 75 you want applied to your 2016 estimated tax a 77 77 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78 79 Estimated tax penalty (see instructions) . . . . . . . 79 Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. 68000 19579 19579 b d No Personal identification a number (PIN) Phone no. a Designee's name a 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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date 04/13/17 Spouse's signature. If a joint return, both must sign. Date 04/13/17 Print/Type preparer's name Your occupation Daytime phone number ACCOUNTANT 123-456-7890 Spouse's occupation If the IRS sent you an Identity Protection PIN, enter it here (see inst.) PTIN Check if self-employed SALES EXECUTIVE Preparer's signature PRACTICE LAB Firm's address a 15 PRACTICE LAB WAY WASHINGTON DC 20005 Firm's name Date 04/13/2017 IRS www.irs.gov/form1040 QNA . 42 43 F Paid Preparer Use Only You were born before January 2, 1951, Spouse was born before January 2, 1951, . 39b Sign Here Joint return? See instructions. Keep a copy for your records. . . . a\u0001 Third Party Designee . Itemized deductions (from Schedule A) or your standard deduction (see left margin) Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . Direct deposit? See a instructions. Amount You Owe . 40 41 73 74 Refund . If your spouse itemizes on a separate return or you were a dual-status alien, check here a b 56 57 Other Taxes { . a S12345678 Firm's EIN Phone no. 202-202-2022 Form 1040 (2015) a SCHEDULE A (Form 1040) OMB No. 1545-0074 Itemized Deductions Department of the Treasury Internal Revenue Service (99) a Information about Schedule A and its separate instructions is at www.irs.gov/schedulea. a Attach to Form 1040. Name(s) shown on Form 1040 FRANSISCO & EVA MARTINEZ Medical and Dental Expenses Taxes You Paid 1 2 3 4 5 Interest You Paid Note: Your mortgage interest deduction may be limited (see instructions). 123-45-6789 Caution: Do not include expenses reimbursed or paid by others. Medical and dental expenses (see instructions) . . . . . 253048 Enter amount from Form 1040, line 38 2 Multiply line 2 by 10% (.10). But if either you or your spouse was born before January 2, 1951, multiply line 2 by 7.5% (.075) instead Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . State and local (check only one box): a X Income taxes, or . . . . . . . . . . . b General sales taxes Real estate taxes (see instructions) . . . . . . . . . Personal property taxes . . . . . . . . . . . . . Other taxes. List type and amount a } 6 7 8 2015 Attachment Sequence No. 07 Your social security number 4700 1 3 . 25305 . . . . . . 5 13941 6 7 4600 8 9 Add lines 5 through 8 . . . . . . . . . . . . . . . . 10 Home mortgage interest and points reported to you on Form 1098 10 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's name, identifying no., and address a 11 12 Points not reported to you on Form 1098. See instructions for special rules . . . . . . . . . . . . . . . . . 12 13 Mortgage insurance premiums (see instructions) . . . . . 13 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 15 Add lines 10 through 14 . . . . . . . . . . . . . . . Gifts to 16 Gifts by cash or check. If you made any gift of $250 or more, see instructions . . . . . . . . . . . . . . . . 16 Charity 17 Other than by cash or check. If any gift of $250 or more, see If you made a gift and got a instructions. You must attach Form 8283 if over $500 . . . 17 benefit for it, 18 Carryover from prior year . . . . . . . . . . . . 18 see instructions. 19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . 4 9 18541 15 8756 19 26000 8756 . . . . . . 10000 16000 . . . . . . Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . Job Expenses 21 Unreimbursed employee expensesjob travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-EZ if required. Miscellaneous 21 (See instructions.) a Deductions 22 Tax preparation fees . . . . . . . . . . . . . 22 20 23 Other expensesinvestment, safe deposit box, etc. List type and amount a Other Miscellaneous Deductions 24 25 26 27 28 23 Add lines 21 through 23 . . . . . . . . . . . . 24 Enter amount from Form 1040, line 38 25 Multiply line 25 by 2% (.02) . . . . . . . . . . . 26 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . Otherfrom list in instructions. List type and amount a GAMBLING LOSSES TO AMOUNT WON . . . . . 27 3200 29 Is Form 1040, line 38, over $154,950? Total Itemized 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. Deductions X Yes. Your deduction may be limited. See the Itemized Deductions } . . 28 3200 29 56497 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 . . . . . . . . . . . . . . . . . . . a For Paperwork Reduction Act Notice, see Form 1040 instructions. !"# Schedule A (Form 1040) 2015 Profit or Loss From Business SCHEDULE C (Form 1040) OMB No. 1545-0074 Name of proprietor Attachment Sequence No. 09 Social security number (SSN) FRANSISCO E MARTINEZ A 2015 (Sole Proprietorship) about Schedule C and its separate instructions is at www.irs.gov/schedulec. a Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form 1065. a Information Department of the Treasury Internal Revenue Service (99) 123-45-6789 B Enter code from instructions Principal business or profession, including product or service (see instructions) TAX PREPARATION a 5 4 1 2 1 3 D Employer ID number (EIN), (see instr.) C Business name. If no separate business name, leave blank. E Business address (including suite or room no.) F G H RALEIGH NC 27514 City, town or post office, state, and ZIP code (2) Accrual (3) Other (specify) a Accounting method: (1) X Cash Did you \"materially participate\" in the operation of this business during 2015? If \"No,\" see instructions for limit on losses If you started or acquired this business during 2015, check here . . . . . . . . . . . . . . . . . I J Did you make any payments in 2015 that would require you to file Form(s) 1099? (see instructions) . If "Yes," did you or will you file required Forms 1099? . . . . . . . . . . . . . . Part I a 65 OREO WAY . . . . . . . . . . . . . X Yes No a . . Yes Yes X No No Income 2 3 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 . . . . . . . . . a Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 4 5 6 Cost of goods sold (from line 42) . . . . . . . . . . . . . . . . . . . Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . . . . . . . 4 5 6 113500 7 Gross income. Add lines 5 and 6 . . . a 7 113500 4800 1 Part II Advertising . 9 Car and truck expenses (see instructions) . . . . . Commissions and fees . 11 12 13 . . . . Contract labor (see instructions) Depletion . . . . . Depreciation and section 179 expense deduction (not included in Part III) (see instructions) . . . . . 14 Employee benefit programs (other than on line 19) . . Insurance (other than health) 15 16 a b 17 . . . . . . . . . . . . . . . . . 113500 2 3 113500 Expenses. Enter expenses for business use of your home only on line 30. 8 10 . 1 Interest: Mortgage (paid to banks, etc.) Other . . . . . . Legal and professional services 8 9 10 4313 Office expense (see instructions) 18 19 20 Pension and profit-sharing plans . Rent or lease (see instructions): Vehicles, machinery, and equipment 19 20a Other business property . . . Repairs and maintenance . . . Supplies (not included in Part III) . 20b 21 22 Taxes and licenses . . . . . Travel, meals, and entertainment: Travel . . . . . . . . . 23 600 24a 560 25 Deductible meals and entertainment (see instructions) . Utilities . . . . . . . . 24b 25 2200 2400 26 27a b Wages (less employment credits) . Other expenses (from line 48) . . Reserved for future use . . . 26 27a 27b 800 a 11 12 13 18 b 21 22 3300 23 24 a 14 15 b 1800 16a 16b 17 28 Total expenses before expenses for business use of home. Add lines 8 through 27a . . . . . . a 28 29 30 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . 29 . . . . . . . . . . . . Use the Simplified . . . . . . . Net profit or (loss). Subtract line 30 from line 29. If a profit, enter on both Form 1040, line 12 (or Form 1040NR, line 13) and on Schedule SE, line 2. (If you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3. If a loss, you must go to line 32. 32 38773 74727 Expenses 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: Method Worksheet in the instructions to figure the amount to enter on line 30 31 . 18000 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. (If you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter on Form 1041, line 3. If you checked 32b, you must attach Form 6198. Your loss may be limited. For Paperwork Reduction Act Notice, see the separate instructions. QNA Link ID - 4 } } 30 31 32a 32b 74727 All investment is at risk. Some investment is not at risk. Schedule C (Form 1040) 2015 FRANSISCO E MARTINEZ 123-45-6789 Page 2 Schedule C (Form 1040) 2015 Part III Cost of Goods Sold (see instructions) 33 Method(s) used to value closing inventory: 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If \"Yes,\" attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . X a Cost b Lower of cost or market c Other (attach explanation) 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation . . . 35 36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36 37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37 38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38 39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . 39 40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40 41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 . . . . . . 42 Part IV . . . Yes . No Information on Your Vehicle. 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 13 to find out if you must file Form 4562. 08 a / 01 /2012 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 2015, enter the number of miles you used your vehicle for: a X Business 7500 b Commuting (see instructions) 14000 c Other Yes No 45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . X 46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . X Yes No 47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . X Yes No If \"Yes,\" is the evidence written? . . . . . . . . . . . . . . . . . . . . X Yes No b Part V . . . . . . Other Expenses. List below business expenses not included on lines 8-26 or line 30. TOLLS & PARKING 48 QNA Total other expenses. Enter here and on line 27a . 800 . . . . . . . . . . . . . . . 48 800 Schedule C (Form 1040) 2015 SCHEDULE D (Form 1040) Department of the Treasury Internal Revenue Service (99) OMB No. 1545-0074 Capital Gains and Losses a Name(s) shown on return Attachment Sequence No. 12 Your social security number FRANSISCO & EVA MARTINEZ Part I 2015 a Attach to Form 1040 or Form 1040NR. Information about Schedule D and its separate instructions is at www.irs.gov/scheduled. a Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10. 123-45-6789 Short-Term Capital Gains and LossesAssets Held One Year or Less See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. (d) Proceeds (sales price) (e) Cost (or other basis) (g) Adjustments to gain or loss from Form(s) 8949, Part I, line 2, column (g) (h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 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 and go to line 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 B checked . . . . . . . . . . . . . 3 Totals for all transactions reported on Form(s) 8949 with Box C checked . . . . . . . . . . . . . 24000 24400 -400 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . 7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any longterm capital gains or losses, go to Part II below. Otherwise, go to Part III on the back . . . . . Part II 4 5 6 ( 7 ) -400 Long-Term Capital Gains and LossesAssets Held More Than One Year See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. (d) Proceeds (sales price) (e) Cost (or other basis) (g) (h) Gain or (loss) Adjustments Subtract column (e) to gain or loss from from column (d) and Form(s) 8949, Part II, combine the result with line 2, column (g) column (g) 8a Totals for all long-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 and go to line 8b . 8b Totals for all transactions reported on Form(s) 8949 with Box D checked . . . . . . . . . . . . . 9 Totals for all transactions reported on Form(s) 8949 with Box E checked . . . . . . . . . . . . . 10 Totals for all transactions reported on Form(s) 8949 with 48900 48100 Box F checked . . . . . . . . . . . . . . 11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . . . 11 12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 12 13 Capital gain distributions. See the instructions . . . . . . . . . . . . . . . . . . 14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . 15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 For Paperwork Reduction Act Notice, see your tax return instructions. QNA 800 14 ( 15 ) 800 Schedule D (Form 1040) 2015 MARTINEZ 123-45-6789 Page 2 Schedule D (Form 1040) 2015 Part III 16 Summary Combine lines 7 and 15 and enter the result . . . . . . . . . . . . . . . . . . 16 400 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. If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 22. 17 Are lines 15 and 16 both gains? X Yes. Go to line 18. No. Skip lines 18 through 21, and go to line 22. 18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions a 18 19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 19 20 . . Are lines 18 and 19 both zero or blank? X 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). Do not complete lines 21 and 22 below. No. Complete the Schedule D Tax Worksheet in the instructions. Do not complete lines 21 and 22 below. 21 If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of: The loss on line 16 or ($3,000), or if married filing separately, ($1,500) } . . . . . . . . . . . . . . . 21 ( ) Note: When figuring which amount is smaller, treat both amounts as positive numbers. 22 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 1040NR. QNA Schedule D (Form 1040) 2015 Form 8949 Department of the Treasury Internal Revenue Service Sales and Other Dispositions of Capital Assets a Information about Form 8949 and its separate instructions is at www.irs.gov/form8949. File with your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D. Name(s) shown on return OMB No. 1545-0074 2015 Attachment Sequence No. 12A Social security number or taxpayer identification number FRANSISCO & EVA MARTINEZ 123-45-6789 Before you check Box A, B, or C below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitute statement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by your broker and may even tell you which box to check. Part I Short-Term. Transactions involving capital assets you held 1 year or less are short term. For long-term transactions, see page 2. Note: You may aggregate all short-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D, line 1a; you aren't required to report these transactions on Form 8949 (see instructions). You must check Box A, B, or C below. Check only one box. If more than one box applies for your short-term transactions, complete a separate Form 8949, page 1, for each applicable box. If you have more short-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. x (A) Short-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above) (B) Short-term transactions reported on Form(s) 1099-B showing basis was not reported to the IRS (C) Short-term transactions not reported to you on Form 1099-B 1 (b) Date acquired (Mo., day, yr.) (c) Date sold or disposed of (Mo., day, yr.) STOCK 2 02/12/2015 09/13/2015 19500 15000 4500 STOCK 5 09/18/2015 11/26/2015 4500 9400 -4900 24000 24400 -400 (a) Description of property (Example: 100 sh. XYZ Co.) (d) Proceeds (sales price) (see instructions) Adjustment, if any, to gain or loss. If you enter an amount in column (g), (e) (h) enter a code in column (f). Cost or other basis. Gain or (loss). See the separate instructions. See the Note below Subtract column (e) and see Column (e) from column (d) and (f) (g) in the separate combine the result Code(s) from instructions with column (g) Amount of instructions adjustment 2 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 1b (if Box A above is checked), line 2 (if Box B above is checked), or line 3 (if Box C above is checked) a Note: If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. For Paperwork Reduction Act Notice, see your tax return instructions. QNA Form 8949 (2015) Attachment Sequence No. 12A Form 8949 (2015) Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on other side FRANSISCO & EVA MARTINEZ Page 2 Social security number or taxpayer identification number 123-45-6789 Before you check Box D, E, or F below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitute statement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by your broker and may even tell you which box to check. Part II 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) 1099-B showing basis was reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D, line 8a; you aren't required to report these transactions on Form 8949 (see instructions). You must check Box D, E, or F below. Check only one box. If more than one box applies for your long-term transactions, complete a separate Form 8949, page 2, for each applicable box. If you 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. x (D) Long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above) (E) Long-term transactions reported on Form(s) 1099-B showing basis was not reported to the IRS (F) Long-term transactions not reported to you on Form 1099-B 1 (b) Date acquired (Mo., day, yr.) (c) Date sold or disposed of (Mo., day, yr.) APPLE SHARES 01/01/2013 11/12/2015 14000 20250 -6250 STOCK 1 03/16/1996 07/22/2015 6500 7850 -1350 STOCK 3 06/25/2011 10/12/2015 15600 11750 3850 STOCK 4 07/19/2006 10/12/2015 12800 8250 4550 48900 48100 800 (a) Description of property (Example: 100 sh. XYZ Co.) (d) Proceeds (sales price) (see instructions) Adjustment, if any, to gain or loss. If you enter an amount in column (g), (e) (h) enter a code in column (f). Cost or other basis. Gain or (loss). See the separate instructions. See the Note below Subtract column (e) and see Column (e) from column (d) and (f) (g) in the separate combine the result Code(s) from instructions with column (g) Amount of instructions adjustment 2 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 8b (if Box D above is checked), line 9 (if Box E above is checked), or line 10 (if Box F above is checked) a Note: If you checked Box D above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. QNA Form 8949 (2015) SCHEDULE E (Form 1040) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Supplemental Income and Loss (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.) a a Information Attach to Form 1040, 1040NR, or Form 1041. about Schedule E and its separate instructions is at www.irs.gov/schedulee. FRANSISCO & EVA MARTINEZ Part I OMB No. 1545-0074 2015 Attachment Sequence No. 13 Your social security number 123-45-6789 Income or Loss From Rental Real Estate and Royalties Note: If you are in the business of renting personal property, use Schedule C 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 2015 that would require you to file Form(s) 1099? (see instructions) Yes X No B If \"Yes,\" did you or will you file required Forms 1099? Yes No 1a Physical address of each property (street, city, state, ZIP code) 1606 JACK NICKLAUS WAY AUGUSTA GA 309 6 A 0 B 0 C Fair Rental Personal Use 2 For each rental real estate property listed 1b Type of Property QJV above, report the number of fair rental and Days Days (from list below) personal use days. Check the QJV box A 1 160 30 A only if you meet the requirements to file as a qualified joint venture. See instructions. B B C C 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 8 Other (describe) Income: Properties: A B C 48000 3 Rents received . . . . . . . . . . . . . 3 4 Royalties received . . . . . . . . . . . . 4 Expenses: 5 Advertising . . . . . . . . . . . . . . 5 6 Auto and travel (see instructions) . . . . . . . 6 8800 7 Cleaning and maintenance . . . . . . . . . 7 8 Commissions. . . . . . . . . . . . . . 8 2500 9 Insurance . . . . . . . . . . . . . . . 9 10 Legal and other professional fees . . . . . . . 10 11 Management fees . . . . . . . . . . . . 11 14500 12 Mortgage interest paid to banks, etc. (see instructions) 12 13 Other interest. . . . . . . . . . . . . . 13 4800 14 Repairs. . . . . . . . . . . . . . . . 14 15 Supplies . . . . . . . . . . . . . . . 15 9800 16 Taxes . . . . . . . . . . . . . . . . 16 3000 17 Utilities . . . . . . . . . . . . . . . . 17 18180 18 Depreciation expense or depletion . . . . . . . 18 Other (list) a 19 19 61580 20 Total expenses. Add lines 5 through 19 . . . . . 20 Subtract line 20 from line 3 (rents) and/or 4 (royalties). If result is a (loss), see instructions to find out if you must -13580 file Form 6198 . . . . . . . . . . . . . 21 Deductible rental real estate loss after limitation, if any, 22 )( )( on Form 8582 (see instructions) . . . . . . . 22 ( 48000 23a Total of all amounts reported on line 3 for all rental properties . . . . 23a b Total of all amounts reported on line 4 for all royalty properties . . . . 23b 14500 c Total of all amounts reported on line 12 for all properties . . . . . . 23c 18180 d Total of all amounts reported on line 18 for all properties . . . . . . 23d 61580 e Total of all amounts reported on line 20 for all properties . . . . . . 23e 24 Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . 24 25 Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here 25 ( 21 26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here. If Parts II, III, 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 . . . . For Paperwork Reduction Act Notice, see the separate instructions. QNA ) ) 26 Schedule E (Form 1040) 2015 Attachment Sequence No. 17 Schedule SE (Form 1040) 2015 Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) FRANSISCO E MARTINEZ Page 2 Social security number of person with self-employment income a 123-45-6789 Section BLong Schedule SE Part I Self-Employment Tax Note. If your only income subject to self-employment tax is church employee income, see instructions. Also see instructions for the definition of church employee income. A If 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 other net earnings from self-employment, check here and continue with Part I . . . . . . a 1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), 1a box 14, code A. Note. Skip lines 1a and 1b if you use the farm optional method (see instructions) 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 1b ( 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code 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 optional method (see instructions) . . . . . . . . . . . . . . . . . . . . 3 4a Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . . If line 3 is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter amount from line 3 Note. If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see instructions. b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here . . c Combine lines 4a and 4b. If less than $400, stop; you do not owe self-employment tax. Exception. If less than $400 and you had church employee income, enter -0- and continue a 5a Enter your church employee income from Form W-2. See instructions for definition of church employee income . . . 5a b Multiply line 5a by 92.35% (.9235). If less than $100, enter -0- . . . . . . . . . . 6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . 7 Maximum amount of combined wages and self-employment earnings subject to social security tax or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2015 . . . . . . 2 3 4a ) 74727 74727 69010 4b 4c 69010 5b 6 69010 7 118,500 00 8a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2) and railroad retirement (tier 1) compensation. If $118,500 or more, skip lines 8b through 10, and go to line 11 8a b Unreported tips subject to social security tax (from Form 4137, line 10) 8b c Wages subject to social security tax (from Form 8919, line 10) 8c d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . 9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . a 10 Multiply the smaller of line 6 or line 9 by 12.4% (.124) . . . . . . . . . . . . . 11 Multiply line 6 by 2.9% (.029) . . . . . . . . . . . . . . . . . . . . . 12 Self-employment tax. Add lines 10 and 11. Enter here and on Form 1040, line 57, or Form 1040NR, line 55 13 Deduction for one-half of self-employment tax. Multiply line 12 by 50% (.50). Enter the result here and on Form 5279 13 1040, line 27, or Form 1040NR, line 27 . . . . . . . . Part II From Sch. F, line 9, and Sch. K-1 (Form 1065), box 14, code B. 2 From Sch. F, line 34, and Sch. K-1 (Form 1065), box 14, code Aminus the amount you would have entered on line 1b had you not used the optional method. QNA 118500 8557 2001 10558 Optional Methods To Figure Net Earnings (see instructions) Farm Optional Method. You may use this method only if (a) your gross farm income1 was not more than $7,320, or (b) your net farm profits2 were less than $5,284. 14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . 15 Enter the smaller of: two-thirds (2/3) of gross farm income1 (not less than zero) or $4,880. Also include this amount on line 4b above . . . . . . . . . . . . . . . . . . . Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3 were less than $5,284 and also less than 72.189% of your gross nonfarm income,4 and (b) you had net earnings from self-employment of at least $400 in 2 of the prior 3 years. Caution. You may use this method no more than five times. 16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . 17 Enter the smaller of: two-thirds (2/3) of gross nonfarm income4 (not less than zero) or the amount on line 16. Also include this amount on line 4b above . . . . . . . . . . . 1 8d 9 10 11 12 14 4,880 00 15 16 17 3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), box 14, code A; and Sch. K-1 (Form 1065-B), box 9, code J1. 4 From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch. K-1 (Form 1065-B), box 9, code J2. Schedule SE (Form 1040) 2015 Form 6251 Department of the Treasury Internal Revenue Service (99) Alternative Minimum TaxIndividuals a Information OMB No. 1545-0074 2015 about Form 6251 and its separate instructions is at www.irs.gov/form6251. a Attach to Form 1040 or Form 1040NR. Name(s) shown on Form 1040 or Form 1040NR Attachment Sequence No. 32 Your social security number FRANSISCO MARTINEZ & EVA MARTINEZ 123-45-6789 Part I Alternative Minimum Taxable Income (See instructions for how to complete each line.) 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

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