COVER PAGE

Filing Checklist for 2013 Tax Return Filed On Standard Forms

Prepared on: 10/23/2014 04:26:38 am
Return: C:\Users\Computer\Documents\HRBlock\ROBERTA SANTOS 2013 Tax Return.T13
To file your 2013 tax return, simply follow these instructions:
Step 1. Sign and date the return
If your return is signed by a representative for you, you must have a power of attorney attached that specifically authorizes the representative to
sign your return. To do this, you can use Form 2848, Power of Attorney and Declaration of Representative.
Step 2. Assemble the return
These forms should be assembled behind Form 1040 --U.S. Individual Income Tax Return
- Schedule A
- Schedule B
- Schedule D
- - Form 8949
- Schedule E
- Form 8582 - Page 1
- - Form 8582 Page 2 (Regular Tax)
- Form 1040-V
Staple these documents to the front of the first page of the return:
Form W-2: Wage and Tax Statement
1st (ADVERTISING INC)
Step 3. Pay the balance due on your taxes
Make your check or money order for $459 payable to "United States Treasury." Don't send cash.
Write the following on your check or money order:
- "2013 Form 1040"
- Your name and address
- Your daytime phone number
- Your Social Security Number
On the right side of the check or money order write the dollar amount of the payment, like this: $459.00.
Don't staple or otherwise attach the payment to the return. Instead, just place it loose in the envelope with the return.
Step 4. Mail the return
Mail the return to this address:


Internal Revenue Service
P.O. Box 802501
Cincinnati, OH 45280-2501
We recommend that you use one of these IRS-approved methods to send your return. Retain the proof of mailing to avoid a late filing penalty:
- U.S. Postal Service certified mail.
- DHL Same Day Service.
- FedEx Priority Overnight, Standard Overnight, 2Day, International Priority, or International First.
- United Parcel Service Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day Air A.M., Worldwide Express Plus, or Worldwide Express.
Step 5. Keep a copy
Print a second copy of the return for your records. We recommend that you also print and retain these supporting forms, which don't need to be
sent to the IRS:
- - Background Worksheet
- - Dependents Worksheet
- - Child Tax Credit Worksheet
- - Last Year's Data Worksheet
- - Form 1099-INT/OID
- - Form 1099-DIV
- - Home Mortgage Interest Worksheet
- - Charitable Worksheet
- - State and Local Income Tax
- - Capital Gains and Losses Worksheet
- - K-1 Partnership/S Corporation
2013 return information - Keep this for your records
Here is some additional information about your 2013 return. Keep this information with your records.
You will need your 2013 AGI to electronically sign your return next year.
Quick Summary
Income $111,100
Adjustments - $0
Adjusted gross income $111,100
Deductions - $22,200
Exemption(s) - $11,700
Taxable income $77,200
Tax withheld or paid already $12,800
Actual tax due - $13,259
Refund applied to next year - $0
You Owe $459
* Your long-term capital gains and
qualifying dividends are taxed at a
lower rate than your other income.
As a result, your total federal tax is
less than the tax shown on the IRS's
Tax Table.
(2) Dependent's
social security number
Head of household (with qualifying person). (See instr.) If the
qualifying person is a child but not your dependent, enter this
child's name here.
b Tax-exempt interest. Do not include on line 8a . . . . . . . . . . . . . .
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31a Alimony paid b Recipient's SSN
26
30
31a
32
34
35
37
15a b Taxable amount . . .
16b
16a b Taxable amount . . .
17
18
19
20b 20a
21
22
23
8b
9a 9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . .
10
11
12
13
14
15b
14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you did not
get a W-2,
see instructions.
7
8a 8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . . . .
Boxes checked
on 6a and 6b
No. of children
on 6c who:
Single
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above
and full name here.
Qualifying widow(er) with dependent child
If more than four
dependents, see
instructions and
check here
6a
b
c
Yourself. If someone can claim you as a dependent, do not check box 6a . . . . . . .
Dependents:
(1) First name
Apt. no.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
Filing Status
Check only one
box.
1
2
3
4
5
1040 2013
Your first name and initial Last name
Your social security number
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.
F
o
r
m
28
IRS Use OnlyDo not write or staple in this space.
Form 1040 (2013)
16a Pensions and annuities . . . . . . . . . . .
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . . . . .
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19 Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20a Social security benefits
15a IRA distributions . . . . . . . . . . . . . .
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . . . . . . . . . . .
27 Deductible part of self-employment tax. Attach Schedule SE . . . . . . .
29 Self-employed health insurance deduction . . . . . . . . . . . . . . . . .
30 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . .
23 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26 Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . . .
28 Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . .
KIA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Adjusted
Gross
Income
Last name
(3) Dependent's
relationship to you
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dependents on 6c
not entered above
Add numbers on
lines above
Income
For the year Jan. 1Dec. 31, 2013, or other tax year beginning , 2013, ending ,20
Exemptions
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
b Taxable amount . . . . . . . .
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income
21 Other income. List type and amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . . . . . . .
Department of the TreasuryInternal Revenue Service (99)
lived with you
did not live with
you due to divorce
or separation
(see instructions)
Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make sure the SSN(s) above
and on line 6c are correct.
36
33 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . .
You Spouse
10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . . . . . . . . . . .
11 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . . . .
U.S. Individual Income Tax Return
32 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
34 Tuition and fees. Attach Form 8917.
27
b Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b
24
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 . . . . . . . . . . .
29
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
35 Domestic production activities deduction. Attach Form 8903 . . . . . . .
33
OMB No. 1545-0074
Foreign country name Foreign province/state/county Foreign postal code
See separate instructions.
V
(4) if child under age 17
qualifying for child tax credit
(see instructions)
ROBERTA SANTOS 123-45-6789
120 SANBORNE AVENUE
SPRINGFIELD IL 60781
X
X 1
JASON SANTOS 111-11-1111 Son
2
JUNE SANTOS 123-45-6788 Daughter
3
80,000
2,500
0
1,800
0
0
16,000
0
5,500
0
0
5,300
0
0
111,100
0
0
0
0
0
0
0
0
0
0
111,100
c 8885 b Reserved a 2439
51 Child tax credit. Attach Schedule 8812, if required . . . . . . . . . . .
48 Credit for child and dependent care expenses. Attach Form 2441 . . . .
c . . . .
If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
50 Retirement savings contributions credit. Attach Form 8880 . . . . . . .
40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . . . . .
61 Add lines 55 through 60. This is your total tax . . . . . . . . . . . . . . . . . . . . . . . . .
77
Date Your occupation
Date Spouse's occupation
Date
Check if
self-employed
Firm's EIN
Phone no.
66
68
72
73
75
62
64a
68 Amount paid with request for extension to file . . . . . . . . . . . . . .
65
53
56
57
58
59b
44
48
52
42 Exemptions. If line 38 is $150,000 or less, multiply $3,900 by the number on line 6d. Otherwise, see instructions .
41
Paid
Preparer
Use Only
38
Payments
Amount
You Owe
Tax and
Credits
40
d
You were born before January 2, 1949, Blind.
Spouse was born before January 2, 1949, Blind.
Your signature
Print/Type preparer's name
Firm's name
Firm's address
Spouse's signature. If a joint return, both must sign.
76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions
63 2013 estimated tax payments and amount applied from 2012 return . .
55
KIA
62 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . .
c Type: Checking Savings Direct deposit?
See
instructions.
Other
Taxes
Sign
Here
76
39a Check
if: 39a
41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
39b
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . . . . . . . . . . . . . . 43
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Form(s) 8814
42
b Form 4972 44 Tax (see instructions). Check if any from:
54
47
52 Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . .
c b 8801
54 Add lines 47 through 53. These are your total credits . . . . . . . . . . . . . . . . . . . . . . .
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . . . . . . . . . . . . . . .
71 Credits from Form:
57 Unreported social security and Medicare tax from Form:
59
58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . .
56 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here . . . .
b Routing number
d Account number
73 If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid . . .
72 Add lines 62, 63, 64a, and 65 through 71. These are your total payments . . . . . . . . . . .
75 Amount of line 73 you want applied to your 2014 estimated tax
77 Estimated tax penalty (see instructions) . . . . . . . . . . . . . . . . .
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.
Page 2 Form 1040 (2013)
45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . . . . . . . . . . . . . . .
46 Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Refund
51
47 Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . .
49
50
65 Additional child tax credit. Attach Schedule 8812 . . . . . . . . . . . .
Daytime phone number
Joint return? See
instructions.
Keep a copy for
your records.
Form 1040 (2013)
45
46
If you have a
qualifying
child, attach
Schedule EIC.
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee's
name
Phone
no.
Personal indentification
number (PIN)
Yes. Complete below No
PTIN
61
74a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here
53 Other credits from Form: a 3800
Total boxes
checked
b Nontaxable combat pay election . . . . . 64b
69
a 4137 b 8919 . . . . . . . .
49 Education credits from Form 8863, line 19 . . . . . . . . . . . . . . .
71
a Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . .
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . . . . . . .
66 American opportunity credit from Form 8863, line 8 . . . . . . . . . . .
67 67 Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
63
69 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . .
70 Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . . . . 70
Preparer's signature
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:
Married filing
jointly or
Qualifying
widow(er),
$12,200
Head of
household,
$8,950
Single or
Married filing
separately,
$6,100
59a
60 Taxes from: 60
64a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . .

a Form 8959 b Form 8960 c Instructions; enter code(s)
ROBERTA SANTOS 123-45-6789
111,100
0
22,200
88,900
11,700
77,200
13,259
0
13,259
0
0
0
0
13,259
0
0
0
0
0
0
13,259
9,000
3,800
0
0
12,800
XXXXXXXXX
XXXXXXXXXXXXXXXXX
459
0
X
ADVERTISING EXECUTIVE 303-222-2222
28 Otherfrom list in instructions. List type and amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
23 Other expensesinvestment, safe deposit box, etc. List type
and amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
13 Mortgage insurance premiums (see instructions)
Job Expenses
and Certain
Miscellaneous
Deductions
SCHEDULE A
(Form 1040)
Department of the Treasury
Internal Revenue Service
Attach to Form 1040.
Itemized Deductions
Information about Schedule A and its separate instructions is at www.irs.gov/schedulea.
OMB No. 1545-0074
2013
Attachment
Sequence No. 07
Your social security number
Name(s) shown on Form 1040
Medical
and
Dental
Expenses
Caution. Do not include expenses reimbursed or paid by others.
1 Medical and dental expenses (see instructions) . . . . . . . . . .
2 Enter amount from Form 1040, line 38 . . .
3 Multiply line 2 by 10% (.10). But if either you or your spouse was
born before January 2, 1949, multiply line 2 by 7.5% (.075) instead
4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . . . . . .
1
3
2
4
Taxes You
Paid
5 State and local (check only one box):
6 Real estate taxes (see instructions) . . . . . . . . . . . . . . . .
7 Personal property taxes . . . . . . . . . . . . . . . . . . . . . .
8 Other taxes. List type and amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
9 Add lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6
7
8
9
Interest
You Paid
10 Home mortgage interest and points reported to you on Form 1098 . . . . . . . . . . .
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
12 Points not reported to you on Form 1098. See instructions for
special rules . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Investment interest. Attach Form 4952 if required. (See instructions)
10
11
12
13
15
Gifts to
Charity
If you made a
gift and got a
benefit for it,
see instructions.
16 Gifts by cash or check. If you made any gift of $250 or more,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . .
17 Other than by cash or check. If any gift of $250 or more, see
instructions. You must attach Form 8283 if over $500 . . . . . . .
18 Carryover from prior year . . . . . . . . . . . . . . . . . . . . . .
19 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
17
18
19
Casualty and
Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . . . . . . 20
21 Unreimbursed employee expensesjob travel, union dues,
job education, etc. Attach Form 2106 or 2106-EZ if required.
(See instructions.) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
22 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . .
24 Add lines 21 through 23 . . . . . . . . . . . . . . . . . . . . . .
25 Enter amount from Form 1040, line 38 . . .
26 Multiply line 25 by 2% (.02) . . . . . . . . . . . . . . . . . . . . .
27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . . . . . .
25
21
22
23
24
26
27
Other
Miscellaneous
Deductions 28
Total
Itemized
Deductions
29 Is Form 1040, line 38, over $150,000?
29
KIA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule A (Form 1040) 2013
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
30 If you elect to itemize deductions even though they are less than your standard
deduction, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14
(99)
a. Income taxes or
b. General sales taxes
. . . . . . . . . . . . . . . . . . .
Note.
Your mortgage
interest
deduction may
be limited (see
instructions).
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. . . . . . . .
Yes. Your deduction may be limited. See the Itemized Deductions
Worksheet in the instructions to figure the amount to enter.

ROBERTA SANTOS 123-45-6789
5,800
111,100
11,110
0
4,100
X
3,200
1,100
0
8,400
7,800
0
0
0
7,800
6,000
0
0
6,000
0
0
0
0
111,100
2,222
0
0
X
22,200
b If you are required to file FinCEN Form 114, enter the name of the foreign country where the
financial account is located _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form
1040, line 9a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part I
Interest
Note: If you
received a Form
1099-INT, Form
1099-OID, or
substitute
statement from
a brokerage firm,
list the firm's
name as the
payer and enter
the total interest
shown on that
form.
1 List name of payer. If any interest is from a seller-financed mortgage and the
buyer used the property as a personal residence, see instructions and list
this interest first. Also, show that buyer's social security number and address
Amount
Amount
2
3
4
5
1
Part II
Ordinary
Dividends
Note: If you
received a Form
1099-DIV or
substitute
statement from
a brokerage firm,
list the firm's
name as the
payer and enter
the ordinary
dividends shown
on that form.
Part III
Foreign
Accounts
and Trusts
7a At any time during 2013, did you have a financial interest in or signature authority over a financial
account (such as a bank account, securities account, or brokerage account) located in a foreign
country? See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
KIA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule B (Form 1040A or 1040) 2013
You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a
foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
5 List name of payer ______________________________________________
Note: If line 4 is over $1,500, you must complete Part III.
3 Excludable interest on series EE and I U.S. savings bonds issued after 1989.
Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form
1040, line 8a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 During 2013, did you receive a distribution from, or were you the grantor of, or transferor to, a
foreign trust? If "Yes," you may have to file Form 3520. See instructions. . . . . . . . . . . . . . . . . . . . .
6
(See instructions for
Schedule B, and the
instructions for
Form 1040A, or
Form 1040,
line 8a.)
(See the instructions
for Schedule B, and the
instructions for
Form 1040A, or
Form 1040,
line 9a.)
Note. If line 6 is over $1,500, you must complete Part III.
(See
instructions.)
SCHEDULE B
(Form 1040A or 1040)
Department of the Treasury
Internal Revenue Service
Attach to Form 1040A or 1040.
Interest and Ordinary Dividends
Information about Schedule B (1040A or 1040) and its instructions is a www.irs.gov/scheduleb.
OMB No. 1545-0074
2013
Attachment
Sequence No. 08 (99)
Name(s) shown on return Your social security number
If Yes, are you required to file FinCEN Form 114, Report of Foreign Bank and Financial
Accounts (FBAR), formerly TD F 90-22.1 to report that financial interest or signature authority?
See FinCEN Form 114 and its instructions for filing requirements and exceptions to those requirements . . .
ROBERTA SANTOS 123-45-6789
FIRST SAVINGS BANK
2,500
2,500
2,500
AMBER
1,800
1,800
X
X
X
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss
Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . .
Short-Term Capital Gains and LossesAssets Held One Year or Less
SCHEDULE D
(Form 1040)
Capital Gains and Losses
OMB No. 1545-0074
Attachment
Sequence No. 12
Department of the Treasury
Internal Revenue Service
Name(s) shown on return Your social security number
(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)
4
5
KIA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule D (Form 1040) 2013
2013
(d)
Proceeds
(sales price)
(e)
Cost
(or other basis)
Long-Term Capital Gains and LossesAssets Held More Than One Year
6
7
12
13
14
15
13 Capital gain distributions. See the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on
page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
9 Totals for all transactions reported on Form(s) 8949 with
Box E checked . . . . . . . . . . . . . . . . . . . .
7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any
long-term capital gains or losses, go to Part II below. Otherwise, go to Part III on the next page . . . .
6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss
Carryover Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part I
Part II
( )
Information about Schedule D and its separate instructions is at www.irs.gov/scheduled.
Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10.
12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1
5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Totals for all transactions reported on Form(s) 8949 with
Box F checked . . . . . . . . . . . . . . . . . . . .
Attach to Form 1040 or Form 1040NR.
( )
(99)
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 . . . . . . . . . . . . . . . . . . . .
8b Totals for all transactions reported on Form(s) 8949 with
Box D checked . . . . . . . . . . . . . . . . . . . .
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.
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
(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)
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.
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
ROBERTA SANTOS 123-45-6789
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0
0
0
0 0 0
0 0 0 0
0 0 0 0
13,500 8,000 0 5,500
0
0
0
5,500
The loss on line 16 or
($3,000), or if married filing separately, ($1,500)
17 Are lines 15 and 16 both gains?
Schedule D (Form 1040) 2013 Page 2
Summary
16
18
16 Combine lines 7 and 15 and enter the result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions . . . . . .
Part III
KIA
Schedule D (Form 1040) 2013
Yes. Go to line 18.
No. Skip lines 18 through 21, and go to line 22.
20 Are lines 18 and 19 both zero or blank?
21 If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:
19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.
Note. When figuring which amount is smaller, treat both amounts as positive numbers.
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.
( ) 21 . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 and Form 1040NR.
ROBERTA SANTOS 123-45-6789
5,500
X
0
0
X
Attachment Sequence No. 12A
Name(s) shown on return. (Name and SSN or taxpayer identification no. not required if shown on Page 1) Social security number or taxpayer identification number
Form 8949 (2013)
Long-Term. Transactions involving capital assets you held more than one year are long term. For short-term
transactions, see page 1.
Part II
Form 8949 (2013)
Page 2
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.
(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
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)
Description of property
(Example: 100 sh. XYZ Co.)
(b)
Date acquired
(Mo., day, yr.)
(c)
Date sold or
disposed
(Mo., day, yr.)
(d)
Proceeds
(sales price)
(see instructions)
(e)
Cost or other basis
See the Note below
and see Column (e)
in the separate
instructions
Adjustment, if any, to gain or loss.
If you enter an amount in column (g),
enter a code in column (f).
See the separate instructions.
(g)
Amount of
adjustment
(f)
Code(s) from
instructions
(h)
Gain or (loss).
Subtract column (e)
from column (d) and
combine the result
with column (g)
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.
Most brokers issue their own substitute statement instead of using Form 1099-B. They also may provide basis information (usually your cost) to you on
the statement even if it is not reported to the IRS. Before you check Box D, E, or F below, determine whether you received any statement(s) and, if so,
the transactions for which basis was reported to the IRS. Brokers are required to report basis to the IRS for most stock you bought in 2011 or later.
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 total directly on
Schedule D, line 8a; you are not required to report these transactions on Form 8949 (see instructions).
FALCON STOCK
ROBERTA SANTOS 123-45-6789
X
07/02/10 12/01/13 13,500 8,000 0 5,500
0
0
0
0
0
0
0
0
0
0
0
0
0
13,500 8,000 0 5,500
3 Rents received . . . . . . . . . . . . . . . . . . . . . . . . . .
For each rental real estate property listed
above, report the number of fair rental and
personal use days. Check the QJV box only if
you meet the requirements to file as a qualified
joint venture. See instructions.
( ) ( ) ( )
Attach to Form 1040, 1040NR, or Form 1041.
Information about Schedule E and its separate instructions is at www.irs.gov/schedulee.
2013
SCHEDULE E
Department of the Treasury
Internal Revenue Service
Name(s) shown on return
Supplemental Income and Loss
Attachment
Sequence No.
OMB No. 1545-0074
13
Your social security number
1a Physical address of each property (street, city, state, ZIP code)
A
B
C
A
B
C
Income:
Expenses:
5 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . .
19 Other (list) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4
5
13
19
18
21
22
24
25
26
A B C
18 Depreciation expense or depletion . . . . . . . . . . . . . . .
20 Total expenses. Add lines 5 through 19 . . . . . . . . . . . .
21 Subtract line 20 from line 3 (rents) and/or 4 (royalties). If result is
a (loss), see instructions to find out if you must file Form 6198 . . . .
22 Deductible rental real estate loss after limitation, if any,
on Form 8582 (see instructions) . . . . . . . . . . . . . . .
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
KIA Schedule E (Form 1040) 2013
Part I 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.
6
7
8
9
10
12
11
14
15
16
17
17 Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16 Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Other interest . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Mortgage interest paid to banks, etc. (see instructions) . . . .
11 Management fees . . . . . . . . . . . . . . . . . . . . . . .
10 Legal and other professional fees . . . . . . . . . . . . . . .
9 Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Commissions . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Cleaning and maintenance . . . . . . . . . . . . . . . . . . .
6 Auto and travel (see instructions) . . . . . . . . . . . . . . .
24 Income. Add positive amounts shown on line 21. Do not include any losses . . . . . . . . . . . . .
25 Losses. Add royalty losses from line 21 and rental real estate losses from line 22. Enter total losses here.
4 Royalties received . . . . . . . . . . . . . . . . . . . . . . .
20
For Paperwork Reduction Act Notice, see the separate instructions.
(From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.)
(Form 1040)
(99)
Type of Property
(from list below)
Fair Rental
Days
Personal
Use Days
QJV
23a Total of all amounts reported on line 3 for all rental properties . . . . . . . . . . . 23a
23b
23c
23d
23e
b Total of all amounts reported on line 4 for all royalty properties . . . . . . . . . .
e Total of all amounts reported on line 20 for all properties . . . . . . . . . . . . .
c Total of all amounts reported on line 12 for all properties . . . . . . . . . . . . .
d Total of all amounts reported on line 18 for all properties . . . . . . . . . . . . .
3
Properties:
2
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)
( )
A
B
C
1b
A Did you make any payments in 2013 that would require you to file Form(s) 1099? (see instructions)
B If Yes, did you or will you file all required Forms 1099?
Yes
Yes
No
No
ROBERTA SANTOS 123-45-6789
0 0 0
0 0 0
0 0 0
0
0
0
0
0
0
0
0
( )
Name(s) shown on return. Do not enter name and social security number if shown on page 1.
(c) Check if
foreign
partnership
(d) Employer
identification
number
Nonpassive Income and Loss
(j) Nonpassive income
from Schedule K-1
30
Income or Loss From Estates and Trusts
(b) Employer
identification number
Nonpassive Income and Loss
(e) Deduction or loss
from Schedule K-1
(f) Other income from
Schedule K-1
35
39
40
Part V Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . . . .
42 Reconciliation of farming and fishing income. Enter your gross
farming and fishing income reported on Form 4835, line 7; Schedule K-1
(Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code
V; and Schedule K-1 (Form 1041), line 14, code F (see instructions) . . . . 42
(e) Income from
Schedules Q, line 3b
43
43 Reconciliation for real estate professionals. If you were a real estate
professional (see instructions), enter the net income or (loss) you reported
anywhere on Form 1040 or Form 1040NR from all rental real estate activities
in which you materially participated under the passive activity loss rules . .
Schedule E (Form 1040) 2013 Attachment Sequence No. 13
Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)Residual Holder
Part II Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which
any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See instructions.
38
39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below
(a) Name
(b) Employer identification
number
33
A
B
A
B
(a) Name
Passive Income and Loss
(c) Passive deduction or loss allowed
(attach Form 8582 if required)
(d) Passive income
from Schedule K-1
34a Totals
37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and
include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
A
B
C
D
(a) Name
(b) Enter P for
partnership; S
for S corporation
Passive Income and Loss
(f) Passive loss allowed
(attach Form 8582 if required)
(g) Passive income
from Schedule K-1
(h) Nonpassive loss
from Schedule K-1
29a Totals
b Totals
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the
result here and include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . . . . .
(i) Section 179 expense
deduction from Form 4562
(c) Excess inclusion from
Schedules Q, line 2c
(see instructions)
(d) Taxable income (net loss)
from Schedules Q, line 1b
KIA
Your social security number
( ) 31
32
36
37
41
30 Add columns (g) and (j) of line 29a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31 Add columns (f), (h), and (i) of line 29b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17, or Form 1040NR, line 18 .
Part III
b Totals
A
B
C
D
Schedule E (Form 1040) 2013
Page 2
27 Are you reporting any loss not allowed in a prior year due to the at-risk, excess farm loss, or basis limitations, a prior year
unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed
Yes No
partnership expenses? If you answered Yes, see instructions before completing this section.
Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
(e) Check if
any amount is
not at risk
ROBERTA SANTOS 123-45-6789
X
ST PARTNERSHIP P 12-3456789
5,300
5,300 0
0 0 0
5,300
0
5,300
0 0
0 0
0
0
0
0 0 0
0
0
5,300
0

Information about Form 8582 and its instructions is available at www.irs.gov/form8582.
1a Activities with net income (enter the amount from Worksheet 1,
column (a)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d Combine lines 1a, 1b, and 1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Department of the Treasury
Internal Revenue Service (99)
Passive Activity Loss Limitations
Attach to Form 1040 or Form 1041.
See separate instructions.
OMB No. 1545-1008
2013
Attachment
Sequence No.
Name(s) shown on return Identifying number
Rental Real Estate Activities With Active Participation (For the definition of active participation, see
Special Allowance for Rental Real Estate Activities in the instructions.)
8582
Form
KIA For Paperwork Reduction Act Notice, see instructions. Form 8582 (2013)
All Other Passive Activities
1a
1b
1c
3a
3b
3c
4
5
6
7
8
15
16
6 Enter $150,000. If married filing separately, see instructions . . . .
7 Enter modified adjusted gross income, but not less than zero (see instructions)
8 Subtract line 7 from line 6 . . . . . . . . . . . . . . . . . . . . . .
9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see instructions .
4 Combine lines 1d, 2c, and 3d. If this line is zero or more, stop here and include this form with
your return; all losses are allowed, including any prior year unallowed losses entered on line 1c,
2b, or 3c. Report the losses on the forms and schedules normally used . . . . . . . . . . . . .
5 Enter the smaller of the loss on line 1d or the loss on line 4 . . . . . . . . . . . . . . . . . . .
15 Add the income, if any, on lines 1a and 3a and enter the total . . . . . . . . . . . . . . . . . . .
16 Total losses allowed from all passive activities for 2013. Add lines 10, 14, and 15. See
instructions to find out how to report the losses on your tax return . . . . . . . . . . . . . . . . .
1d
3d d Combine lines 3a, 3b, and 3c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10
10 Enter the smaller of line 5 or line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 2c is a loss, go to Part III. Otherwise, go to line 15.
(
(
)
)
(
(
)
)
b Activities with net loss (enter the amount from Worksheet 1, column
(b)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3a Activities with net income (enter the amount from Worksheet 3,
column (a)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Activities with net loss (enter the amount from Worksheet 3, column
(b)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Prior years unallowed losses (enter the amount from Worksheet 3,
column (c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part I 2013 Passive Activity Loss
Caution: Complete Worksheets 1, 2 and 3 before completing Part I.
Part II Special Allowance for Rental Real Estate Activities With Active Participation
Note: Enter all numbers in Part II as positive amounts. See instructions for an example.
Part IV Total Losses Allowed
88
Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9,
enter -0- on line 10. Otherwise, go to line 8.
Commercial Revitalization Deductions From Rental Real Estate Activities
2a Commercial revitalization deductions from Worksheet 2, column (a)
2a
Part III Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities
Note: Enter all numbers in Part III as positive amounts. See the example for Part II in the instructions.
11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions
12 Enter the loss from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Reduce line 12 by the amount on line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13 . . . . . . . . . .
Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete
Part II or Part III. Instead, go to line 15.
11
13
14
12
If line 4 is a loss and: Line 1d is a loss, go to Part II.
Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III.
Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15.
( )
c Prior years unallowed losses (enter the amount from Worksheet 1,
column (c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Prior year unallowed commercial revitalization deductions from
Worksheet 2, column (b) . . . . . . . . . . . . . . . . . . . . . . .
c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2b ( )
2c ( )
ROBERTA SANTOS 123-45-6789
0
0
0
0
0
5,300
0
0
5,300
5,300
Caution: The worksheets must be filed with your tax return. Keep a copy for your records.
Worksheet 1For Form 8582, Lines 1a, 1b, and 1c (See instructions.)
Name of activity
Current year Prior years Overall gain or loss
(a) Net income
(line 1a)
(b) Net loss
(line 1b)
(c) Unallowed
loss (line 1c)
(d) Gain (e) Loss
Total. Enter on Form 8582, lines 1a, 1b,
and 1c . . . . . . . . . . . . . . . . .
Worksheet 2For Form 8582, Lines 2a and 2b (See instructions.)
(a) Current year
deductions (line 2a)
(c) Overall Loss
Total. Enter on Form 8582, lines 2a
and 2b . . . . . . . . . . . . . . .
Worksheet 3For Form 8582, Lines 3a, 3b, and 3c (See instructions.)
Name of activity
Current year Prior years Overall gain or loss
(a) Net income
(line 3a)
(b) Net loss
(line 3b)
(c) Unallowed
loss (line 3c)
(d) Gain (e) Loss
Total. Enter on Form 8582, lines 3a, 3b,
and 3c . . . . . . . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of activity
Form or schedule
and line number
to be reported on
(see instructions)
(a) Loss (b) Ratio
(c) Special
allowance
(d) Subtract
column (c) from
column (a)
Worksheet 4Use this worksheet if an amount is shown on Form 8582, line 10 or 14 (See instructions.)
1.00
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of activity
Form or schedule
and line number
to be reported on
(see instructions)
(a) Loss (b) Ratio
Worksheet 5Allocation of Unallowed Losses (See instructions.)
1.00
(c) Unallowed loss
Form 8582 (2013)
Page 2 Form 8582 (2013)
Name of activity
KIA
(b) Prior year
unallowed deductions (line 2b)
ROBERTA SANTOS 123-45-6789
0
0
ST PARTNERSHIP 5,300 0 0 5,300 0
5,300 0 0
Detach Here and Mail With Your Payment and Return
Amount you are paying by check or money order.
Make your check or money order payable to
United States Treasury
Use this voucher when making a payment with Form 1040. Write your social security
number (SSN) on your check or money order.
Dollars
Department of the Treasury
Internal Revenue Service 2013 Form 1040- V
KIA 1017
Form 1040-V
Department of the Treasury
Internal Revenue Service (99)
Payment Voucher
2013
OMB No. 1545-0074
Do not staple or attach this voucher to your payment or return.
123456789 JP SANT 30 0 201312 610
123-45-6789
459
ROBERTA SANTOS
120 SANBORNE AVENUE
SPRINGFIELD IL 60781