IMG_20150629_0001

2& L5-2A16 V 1- S taffi q{ a rd V e ri fi * : ati o n Wo rks he e tDeperudent

Your 2015-20.16 Free Application lbr Fedeial Studen'r Arcl (l'Ai::,A) i,,,rrs seleeleri ll;,i a review process called Verificatlon TheFederal Regulatory law state.q that belbre au,arding FeCcral Studeni .t.i,.i. rvc ma\' :rsk you to conlirnt the intbrmation you and

Music Ftnancial Aid Ol ce. If you have questions al-roL( reijilci!i.liJli, tll.asc sg11!lict the Easttnan School o1'Music Financial Aid

delay'ed.

t A.(i I \t,{\*

Ilome -dddress (include apt no )

A. Dependent Student's Infoffnation&eiu\- 9eit\,.\0410Last Name l'r,st NanilrrfS( Boutnt'j

_skec.[

Financial Aid OfficePhone (585) 274-1070lrar (585) 232-8601i.r"irlirplqh:rii(ris.lli-igtltq.llgi-qd!1

'Lqri j7'>20\\\ iy i rM StLr.lcnt ll)-I5@l)at* ol'flirth

r,en{tl2etr ag b*y*i I, cclrnaii ,\.iriLcss(itjD 1x-Ltc$LAiiernate or Cell Phone Nurnbei

qAza1-lp Lr)ild

Home Phone Number (include area code)

B. Dependent Sttrdent's Family InformatiomNumtler of Household htlembers and Nalxx}:rer im CollegeList belorrz the people in the parents' househqld lncluctre:

, The student. The parents (including a stcpparent) cvcn if the s;iu'ciei'i1. ijr-.i:sli't livt ir'iiil fhc pitr-ents. Theparents'otherchilclreniftheparentsrviilprovi.i,,,rrore iharri.riril'ol'lheirsuppoliliornJulyl,20l5throughJune30-

2016, or if the otlier children would be requrred to pior'rrlc p;iieirtrl iti[i:; ttilttu'tr ii t]:ut r,vcre completing a ITAFSA for2015-2C16 inclurle chiidren rvho meet eitirer oith.csr,!Il.ri.iiirds er,,:n il-1iic ohiiciretl cio not iive with the parents.

pror,ide more than half o1'their suppo':t thrur,rgl, ilrne l'-1. ,lt)iir.l'or a1y, house hold rnernirer, exclutlimg y'our p*reutisi" r.,,i-.n

'viil bt t:nl ollr:rl qt-rSAfl-h.flflmS in a degree, diploma, orcertificateprogramatapostseconrlaryeciucationai insliiui:i:liiii',,t';'t-i:e1rrcr:t:"1,;l'i 1.20 l-5andJune30,20l6. Includethename o{'the college. lf urore space is neetlerl, attncli i} i1{ij.ii}r'rllc ptage lvith th* stuilent's name and [D number at the top.

Name Will be Enrolled atLeast Half Time

,fufi;E ,{ana$, ft.at;,;tkp,te), ,

Age

State

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Student's Name: SSN or ESM Student ID:C. Dependent Student's trncome to Be Verified

Student FederalTax Return FilersInstructions: Completethrssectioniftircstudent, lr-lc-tli]-i-u,irl lr]ga20l4lRsincometaxreturn Thebest.utaytoverifyincome is b.y using the IRS Datu Retrieva! Too! (f R,l Dtt'i) thut is pttrt of FAFSA on the lyeb. jn most cases no furtherdocumentation is needed to venfy 2014 li(S incortre tax retlrrn inlbrnration that uas trar.rsf'erred lnto the student"s FAFSAusing the IRS DRT if that inlorrnation wus not changed.In most cases, for electronic fllers, 20 i 4 IRS income tax r'0tufn infbr-mation for the IRS DRT is available rvlthin 3 weeksafter the 2014 electronic IRS income tax return has been accepted by the IRS Generally, for fllers of 2014 paper IRSincome tax returns, the 20l1lRS income tiix return inforr-nation is available fbr the IRS DRT within g weeks after the 2014paper IRS income tax returtr has been reccived bv tlre Ii{.1Important Notc: If tht student fi!*d, on will file, *n ar4encle d 20 t4 IRS incomc tax return, the student must contacta financial aid counselor treforc completing this srctiorr.

,\l:! the box that applics:W ln'.stirclent h4!-q$d the IR.S DIt'l rtr I]AFSA on ther Web to transfbr 2014 IRS income tax return inlbrmation into the' ,t studenl's I'AFSAI The student haurglJgl-uEd the III S DR]- in ]",qi- S A c,il the Web, but wr ll use the tool to transfbr 2014 iRS income tax

return information into the student.s t'AirSA onee the 2Ci,1 Ilds tax return has been filed. The Eastman Schorl of MusicFinancial Aicl Office cannot pt'ocee(l vlith lhe t'eriJic*tion pror:ess tmtil the IRS' information has been transferrei inrothe FAFSA.

El 'rne student is ltnable or chooses r]qlto use the II{S Lllll' in ITAFSA on the Web, and instead will provide the EastmanSchool of Music Financial Aid oifice a 20i4 IRS'Fax Rrturn t'ranscript.To obtain a 2014 IRS Truu Return'l'runscrfiit, go to ytvty,-!8Slgpv and click on the "Get Transcript of your TaxRecords"linkorcalll-800-908-9946 A,{akesurelurequestilte"lRST'oxReturn'li.anscript"aruJnotthe,,tRSTaxAccount Transcrtpt."-{,)9e 7,o1xy 5551, dat

Student's Name: SSN ar HSM Student ID:D. Parent's Income Infcrmation to Be Verifi*d

Parent Federa! Tax Return Filers -'l'he instruriic;ns brxow apply r* rach parent inrluded in the household inSection B' Notify tlre Eastman Financial r\itl Office if thr panenii lilcd nepa*"to IRS income tax returns for2014 orhad a changc in marital status after the end of the Ztit4 lax ycar om Drcrm5er 31,2014.

Instructions: Complete this section tllhc parents lilqc!-q,r.r'ril ii1.9a2()i4litll incorne rax return The best.tvay to vertfyincome is hy tr,sing the lRS Data Relriet,al Tot;l ([tt,\ D{77'i thct is 1:ttrt q't;.,i1--.SA on the Llreb.trn most cases, fbr electronic frlers, 20 l4 IRS incorne tax rellrin infoilnation lirr the IRS DRT rs available within 3 weeksa{terthe20l4electroniclRsincoittetaxreturnha:;beenacceptecl by,theII{S Cerierail'r,, lbrlllersof 20 l4paperIRSincoite e 1ax returns. the 2014lRS income tax reiu:-n inibrrnalrOn is avaii;LtiiC f.\r the III-S nif'f ivithin g weeks aiier the20lr4 paper IRS inconre tar return has been recerved b1, the iRtlImportant Note: If the parents filed, or will file, an i-mgl]dgd 2i!1,f lIlS irrcome tax rcturn, the parents mustcontact a financial aid counsetror before cornplctiug tlris secfiu*.

Check the bor that applies:f} 'fire parents hayg-gseil the IRS DRT rn FAITSA on tire Web lo translcr:ti)14 IRS incrrme tax return iniormation into the

student's FAF'SA.

f] Tireparentshaye-qalyslusedthelRSDRl inirAFs.q.nihoweir.br-it r,r'iil uselherool totransl.er20l4lRSincomeraxreturn information inl.o the parent's ITAFSA once i,h* 20 i ,:i IRS tax re{Lrrrr l.ras bce n filed. 't'he Eastnrun School of futusicliinancial AitlOffice cannot complete the t,et.ificLtriot? ll.t.o.,t,r,; until tl.tt !RS infcrmution has been transferred into theFAF-SA.

H"t'l',e parerts are unable el_clLqore l19t jo use thr: lF.S I.;R I in f AFljA erii lhe \,Vcb and insteacl will provicie the EastmanSchool olMusic Irinancia] Ai,j OI'llce a2Al4 iR.S Tar f,{eiurrr ?'ransrrilit(s).7'o obtain a 201 4 IRS Ta:c Return Trtnscript, go io )!)!\v ll:!:\]gpt uilci click on the " Get -l'ranscript of your TaxRecot'ds" littk or call l-8{}0-908-9946. A.folie sure to rtqlri,st tie " ttll' 'l-r;x lleturn Trartscript" antl nit the ..IRS TaxAccowntT-ranscript " Use the SSI'| anddote a.j'hirtlt cirhe

.first;tersor ii.ster! on the 20t4 IRS income taxretunt, andthe qddress onJile with the IRS (normalll; tlti.s v'il! bt: rhc tifulriss usetl t:rt the 2Al l IRS income tax rettffn). lt takes upto lhree v'eeksfor !RS income tax in;forntation lo he at,uilultle.[t;r elecrt^ottic.filers anil up to eight weeksJ:or paperJilers.

If the parents lile separafe 20I4 IRS incorne tilx re{urns.2014 lRii-i'ax I{rturn Transcripts must be providedfor br;th.lK check here rra 2014 iR.s rax R.eturn Transcripr(s) is pri:vicled.n Check here if a 20 l4 iRS I'ax Return T'ransoripiis) rvjll be pior,ii.lr:d laicr Vcrification cannot be completecl until theIRS far Rcturn T'ranscript(s) has been submjllcd tti tnc llilsiliili:r Sr:irool of Music Iiinancial Aid Otfiie.

Parent NonTax Filers - These instructions apply to ear[r parr:nt inclurir,,l in the househok.l in Section B.Cornplete this se ction if the parent(s) u'rll not lile ai:.j qg,liilrrltrg]ryrl trl f rl,- :r ,lu 1l iile t,me tax return rvith the IRSCheck the box that applies:

fl Neither parent was ernployctl and hacl no incomr eanrr-t! liopr rvori< i5 :fj i.ifJ One or both parents were employed in 20l4 ancl have lrsteii beior,i,rlic rranies of'a.ll t:mployers, the amount earne6 1]om

eachemployerin20ll.andwhetheranlRSW-2or1099 lorrnisattar:hed Pror,,iCecopicsofall 20l4IRSW-2and/orl099fbrmsissuedtoilrcparents. Llstevrrr-ycrnployerr:r,cnrfiitectrlii(iveididnotprovrdeaplR.SW-2fbrmor1099lbrm Frovide a signcd statemcnt erplarning thc iearlorr ii'unabie ro rrl:iain an lliS W*2 or 1099 fbrm for income earnedfrom employ'er' If more space is needed, attach a separale page rvith the student's name and ID number at the top.

Amount EarnedEmployer's Nante IRS W-2 or 1099Attached?

Jr:.:::::ir;;iali:i:itri I 1 b 2 " ij{}{). $i}, {qxeaiple) f,gs.{exanipl

Student's Name: SSN or ESM Student ID:

E. Supplemental Nutrition Assistance Program (SNAP) BenefitsfI ttre parents cer1i1)'that.

--

a membcr o1'the parents' household (listed in Section B) receivedbenefits l'rom the Suppiententai Nutrition Ass;istance Frogram or SNAP ({brrnerly known as the Food Stamp Program)sometimeduring20l3or20l4. Sl.lAPma.r, lteknorvnb5ranothernarneinsomestates. Forassistanceindeterminingthename used in a state. please cali l-ti(10-4FED-:\lii ( I -8A+43-3243) ,{ copy of the benefits staternent must beincluded with this workshcet.

F. Child Support Paid[- Oneoftheparents,inciirdedinthehor-rseirold(lisler.lrn-{tctionB),orthestr-rdentpaidchrldsupportin2014 Listbelorv

the names of tlre persorrs rlho paid the child suilpot-t. rhe narnes of the persons to whom the child support was paid, thenames o1'1he children I'br whom thc r:hild sr-ippoi-t rvas paid. and the total annual amount of child support that was paid in2014 for each child I1'asked b.1 the Eastmau School o1'N,fusic Financial Aid Offrce, documentation of the payment ofchild support may need to be provided. If rnore space is needed, attach a separate page that includes the student'snarne and ID nurnbrr at the top.

Narne of Person Wlro PaiclClrild Support

Nanie ui- Petson 1o Whorn ChildSuppcrr.t *'as Paiil

.r "n-.7 Cfl, t,i fu-r li t u,Support Was Paid

WARNING: lf you purposely glve false or misleadinginformation on this worksheet, you may be fined, besentenced to jail, or both.

G.

W;;ii,\*;n;i:i#i;l;i;il

Certification and Signature s

Each person signing tl-ris wclrksheot cerlrircs that all oi t.ltt:intormation rcporled cln it is completc a;rl ,-:orrcct.'Ihe student and one parcnt whose infor;rra,iiorr rvas repor{edon the FAFSA must sign and dare.

244377 ZOStudent"s ESM ID

-tl.L;LhL--DateDate

Submit this worksheet tu the Eastmsn School of Music Financiat Aid Office.26 Gibbs Street, Rochester, NY 14604ph 585.274.1070 fux 585.232.8601

. [email protected]

Amount c'l ChildSupport Paid in

2At4:fuIafu:Ja-fidl

: T.e.r.;.Ytrt J,g.qes ,,;,

Fom W-Z waeandrax 2014Copy C

- For EMPLOYEE'S RECORDS (see Notice toon back of CoPY B.)

d Control No

i Emploier's mmq addrqi-ls and ZP codeVALLEY CENTER*PAUMA UNTFIED28751 COLE GRAPE ROADVALLEY CENTER CA 92082

e Employee's name, atrd

BENJAMfN JAMES READ5888 BOUNTY STREETSAN DIEGO CA 92L20 ffiiirtemal Rcrcnue Scnice ll you arc

r""rr"a i" tt" a tax rct"um, a ncgligencc penehl or other sanct ion may beimn'os-.d on vou i[ this income i. ta\ahlc and you fail lo repon [.

rorm \f!/-! Wage and Tax Statement a E Ic_ory

9.:.F,:.r.:IrplL-oyjEls, TEcoRos (::e Ndrce b Emeloye on the back of copy B.) 2 FederatincometaiiiEEtEmproyets iIh-6JTJEGEEIFIiEABS ENTEBTAINMENT GROUP, LLC2600 W. OLIVE AVE. sTH FLOORBURBANK, CA 91505 S N4eaimrerege;;;G;

1o Dependenrcare bEilEtrrilproyee s name. address, and Zlp codeBENJAMIN "

" READ.

sAN DTEGO CA 92120_2919

See instructions foibiilT

16 Statewagei t,piE ta LomtwassJ6G

COPY B To Be Filed With Employee's FEDERAL Tax ReturnConhol numbert66279113

2 Federal income tax withheld551-4 r -5183

) Wages, tips, other compensation)265'/0.66

Enrployer's name, address and zipMccarthy Building Companies, Inc.1341 North Rock Hilf Roadst Louis MO 63124

securiry tax u,itlihcld3 Social security wagesI 1 7000.00

6 Medicare tax rvithheldr 835.27

Allocated tips 5 Medicare wages and tips)26510.66

Ernployee's ilrst narne and init Last Na)ne SuffixA11en P Read5BBB Bounty StSan Diego CA 92L20

Errployee's address and Zll' code

10 Dependent care be

13 statutory Emptoyee n I llro'ntt 2560.8rRclrrernent PLn B I v.J o..nr,t /r tJ 4l

L osnt lrrltr r^Third'prrry sick pry L_l I '

12a AA 12

I 8 Local q,ages, tips etc. I 9 Local incornc tax 20 Locality naneI 7 State incorne tax68I 3.30

Errployer's State lD numberi088 I 25,10000000

State wages, tips etc.126570.66

Form W-2 W and Tax Statement 2014 OMB No. 1515-0008 tnent of tlie Treas lnternal Revenue Service

0207 60

ffi fnternal Revenue Service

Adjustments to IncomeADJUSTED GR0SS INC0ME:....ADJUSTED GROSS INCOME PERDEPENDENT ON ANOTHER TP: . .FORM lO4()EZ DEDUCTION ANDTax and CreditsTAXABLE INC0ME!....TAXABLE INCOME PER COMPUTER:0ther Taxes

Unitcd $tntcs l)cpanment of th* TreasuryThis Product Contains Sensitive Taxpayen Data

Request Date: 05-I0-20I5Response Date: 06-10-2015Trackins Number t L00251469?64

Tax Return Transcript

r.* p""i33*.il1x;1"0;"11,;i: l,lizThe following items reflect the amount as shown on the retunn (pR), andthe amount as adjusted.(PC), if applicable. ihev do not-show

=rL="qu".rtactivity on the account.

SSN:SPOUSE SSN:

6q6-32-9075NAME(S) SHOWN 0N RETURN, BENJAMIN J READADDRESS: 5888 B0UNTY ST

sAN DIEGo, CA 92L20-2919-889FILING STATUS:FORM NUMBER:CYCLE POSTED:RECEIVED DATE:REMITTANCE:EXEMPTION NUMBER:PTIN:PREPARER EIN:Income

!49F!:_s4"l,4BIE9r IIf9, Erc:.... ...$6,087.00TAXABLE INTEREST INC0ME:.... .....$0.00TAX-EXEMPT INTEREST:... .....$0.00UNEHPL0YMENT C0MPENSATI0N:....

...$0.00

SingleI040EZ

2 015I9 0 5Apr. 15 , 20L5$0.00

0

C0MPUTER r....$5,087.00YUrvvr.vu$5,087 . 00

......YESiiEMifi oN PER COMPUTER I $5,200 . 00

T0TAL TAX LIABILITY TP FIGURES: . . . .TOTAL TAX LIABILITY TP FIGURES PER COMPUTERPayments

. $0.00

FEDERAL INC0ME TAX WITHHELD:. ..$472.97OTHER PAYMENT CREDIT AM0UNT:....

.$0.00EARNED INC0ME CREDIT:.... ...50.00

EARNED INCOME CREDIT NONTAXABLE COMBAT PAY:....:. ....$().O()

ll-El!_M gl[E,-,I]'prylpyA!^sElrglslP_rlllyi.....::::. ...$0.00::: : : :: : : : : : :: ::.:::: : :.:l:. . $0.00.....0. $0.00SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER:

: : : . : : : : : : : . . : . : : : : : '.'.'.;eir'.6i

Refund or Amount 0wedREFUND AM0UNT:....3AL DUE,/OVER PYMT USINGBAL DUE/OVER PYMT USINGFORM 8888 TOTAL REFUNDThird Party DesigneeTHIRD PARTY DESIGNEE ID

Trackins Number z L00257459264

'ii'iio'iii'iouiutEi; . : : : : : : : : : : : : : : : : . : : : : : :'.'.t:!,17']rl

C0I'IPUTER FIGURES:.... +-472.97PER C0MPUTER:. .$0.00

NUMBER!....AUTH0RIZATI0N INDICAT0R:.... ........0THIRD PARTY DESIGNEE NAHE:This Product Contains Sensitive Taxpayer Data

Fi'.'-#E}E

079625

ffi Internal Revenue Service

ADDRESS: 5888 BOUNTY STsAN DrEGo, CA 92L2O-2919-889

FILING STATUS:FORM NUMBER ICYCLE POSTED:RECEIVED DATE:REMITTANCE:EXEMPTION NUHBER:DEPENDENT I NAME CTRL:DEPENDENT 1 SSN:DEPENDENT 2 NAME CTRL:DEPENDENT 2 SSN:DEPENDENT 3 NAME CTRL:DEPENDENT 3 SSN IDEPENDENT 4 NAME CTRL:DEPENDENT 4 SSN:

Unitcd States l)cpartment of thr TrrnsutgrThis Product Contains Sensitive Taxpayen Data

Request Date: 05-Il-2015Response Date: 05-1I-20L5Tracking Number t 100?5755994L

Tax Return TranscriptSSN Providedr 554-41-5483

Tax Period Ending: Dec. 31, ?0L4The following items reflect the amount as shown on the return (PR), andthe amount as adjusted (PC), if applicable. They do not show subsequentactivity on the account.

SSN: 554-41-5485SPOUSE SSN: 449-?l-0864

NAME(S) SHOI.,N ON RETURN: ALLEN P & KIMBERLY R READ

Married Filing Joint201512t2

Apr.15 , ?0L5$0.008

READ547 -Lq-3264

READ646-?."-6668

READ545-32-9075

READ546-52-2488

PTIN:PREPARER EIN:fncomettAGES, SALARIES, TIPS, ETC:.... .$126f571.00TAXABLE INTEREST INCOME: SCH B: . . . . $I24. O()TAX-EXEMPT INTEREST:... $0.000RDTNARY DIVIDEND INC0ME: SCH B:. " " '$IL'57(t'00QUALIFIED DIVIDENDS:.... $9,442.00Rrruuns oF srATE/LocAL TAXES:.... ...$411.00ALIM0NY RECEIVED:.... ..$0.00BUSINESS INC0ME 0R L0SS (Schedule C):.. ....$0.00BUSINESS INC0ME 0R LOSS: SCH C PER C0MPUTER:.... ....$0.00CAPITAL GAIN 0R L0SS: (Schedule D)r.. .$4'232.00CAPITAL GAINS 0R L0SS: SCH D PER C0MPUTER:.... .$4,232.00OTi-i5R GAillS SR LCSSES (Form 4797>:.... ..'$0.00TOTAL IRA DISTRIBUTI0NS:.... ...S0.00TAXABLE IRA DISTRIBUTI0NS:.... $0.00T0TAL PENSI0NS AND ANNUITIES: . . . $0.00TAXABLE PENSI0N,/ANNUITY AMOUNT:.... ..$0.00RENT/R0YALTY,/PARTNERSHIP,/ESTATE (Schedu1e E) r.. .$0'00RENT,/R0YALTY,/PARTNERSHIP,/ESTATE (Schedu1e E) PER C0MPUTER:.'.. .$0.00RENT,/R0YALTY INC0ME,/LOSS PER C0MPUTER:. ....$0.00ESTATE,/TRUST INC0ME./L0SS PER C0MPUTER:. ..'.$0.00PARTNERSHIP,/S-C0RP INCOME,/L0SS PER C0MPUTER:.... .....$0'00FARM INC0ME 0R L0SS (Schedule F) : . . . . $0.00FARM INCOME 0R LOSS (Schedule F) PER C0MPUTER:.... ...$0'00UNEMPLOYMENT C0MPENSATI0N:. '.. '..$0.00TOTAL S0CIAL SECURITY BENEFITS:.... ...$0.00TAXABLE SOCIAL SECURITY BENEFITS:.... $0.00

Tracking L0025755994LTAXABLE SOCIAL SECURITY BENEFITS PER C0}'IPUTER: ' 'iI'990THER INC0ME!.... 'tu'uuSCHEDULE EIC SE INC0I'IE PER COHPUTER: ' '$0'00SciiE[[LE Eii rAnfiEn-irlcblrE FEn cor'tFurER:. ' '$0'005cii-Eic-ni50uALiFrEu-ir,rc coNFurrn:.... $0'00a1 a-a nan llibfai'irlE6uE;:::'.:::.:'::.::'.".:::.. " 's143,01?'gsr^TAr rrrrn..E DED nnMprrrtrp. ...$1431012.00+[ili ilifiilE'iiiliouiiiiR:::::::... "$]43,012'00Adjustments to IncomeEDUCAT0R EXPENSES:.... '$0'00EDUCATOR EXPENSES'PER COHPUTER:.... . "$(]'O()nE5Eiivisr-nuD ornrir-iiuiingss ExPENSE:.... "$0'00iiEartu-Savluos AC-i DaD0dirou:.... " "$0'00iiEarrii Savir.reS accr nEbucriolt PER coMPTR: ... " "$0'00M0VING EXPENSES: F5903!.... $0'00sElF"ruFto?r,tgNr rhi- uEnucrr0N: ' ' $0 ' 00SELF EMPL0YIIENT iAx DEb[eiiou rrn coMPurER:.... '$0'00[EobHTSeF-conrnriiifrolr-nen[cirou:.... '$0'00SEIF--EMF HEALTH i[s-nEnuctrolt, " ' $0 ' 00Ean'rv-i,iirnunAnAl-iiF Sa[ine5 prrualrv:.... " '$0'00ALIH0NY PAID SSN:....ALIM0NY PAID: $0 ' 00?nn"il'roub?i-on;::... " '$o'ooih';i DEDUarroH prn coMPUTER 2.... '$0 '00StijnEnl-ioAr'r rnfEnE5t nrnucrroN:.... " '$0'00SilnEiir ronr'r iHrEiiESi DEDucrioN PER coMPUTER:. '$0'00iuitirir.r aHn rrrs DEDUCTT0N:.... 's0'00i[Iitoi'i ar'rD rrrs pEbucrior'r PER coMPUTER:. "$0'00JURY DUTY PAY DEDUCTI0N: " " $0 ' 00poi'irsric pnouucf rol AcirvrrrEs DEDUcrr0N: ' ' $0 ' 00a^ 6doTHER ADJUSTMENTS:.. "'IX'X:ARCHER MSA DEDUCTI0N: ' ' tu ' uuARCHER MSA DEDuitioii'pin coNpurER: . " $0 ' 00a6 n6T0TAL ADJUSTMENTS:.. .''tu'uuT0TAL ADJUSTMENTS PER C0MPUTER:.... " '$0'00A[iij5rrD-enoSS rNcoME:.... '$145,012'09a[Ju5rEb enoss ii.icoME'rrn coMPUTER:.... "'$143,012'00Tax and Credits55-0R-0VER:... """'N0 ltnBLIND:.... " "1;XSP0USE 55-0R-0VER:... ""I;XSP0USE BLIND:.. '. " 'r'Ie5raftnAnn-nrnucrion'iiR coMPurER:.... "$0'00ADDITIONAL STANDAiiU.DEPUCTIOII FTN CO}IPUTER..... .$().OOT[X-iABtE-rNC0ME"i;En-col,rFuTER,. ..$87 '?1e.90-rxEr.rFtiop aMour'ri i'rri ioururER:. "$51,508'gq?iixiibiE-iucot'tr:.... " '$ss '64e 's0ilixABLE iucoMr pER coupurER: . . . "s55,6!e'99tiitirr-Fo5iirvr lr,rdollr-'prn-CoNpurER:. '$143'012'00iEHtArlvr-TAX: " '$5'38e'qgiElirnrivr rAX pER coupurER3.... .. '$5,3q9'ggioHM daia auorriiiruAt rAx-Ar'roUNr: . $0'00ini"ox-rlrcoNr r-ESS"Soc"5rC rtldollE PER coHPurER:.... ' '$0'00riiiiu-CzEi ALrenflir[n-uiuipr[M raxi. ".. ...': " "$0'00F0RM5251ALTERNATIVEMINIMUMTAx.PERc0MPUTER:'roii'ereN-inx-cneprr:....

" '$154'00FoiiErGi.i iAX aREDii'iliR'c0MPUTER:.... $134'00FoRETGN TNCoME Excrirsiot'r-prn coMpurrR:.... $0'00FoiiEicli iHcoMr EXaL[sioN rAx prn c0MPUTER:.... "$0'00EXCESS ADVANCE FI{EMIIM-TAX CNENTT_RTPAVMTNT AMOUNT'.... ...$O.OOExcESS auvAncr i,iiEMrui, rAx cnrnir REPAYHENT vERTFTED AMouNr:.... ....1q'qqciiirD-a"DrerHDgHr cARE cREDrr:.. ""'$0'00aiiilD a brpEnDri.it cAHE cnrnir PER coMPUTER:. ' " '$0'00ciiEurr-rbn ELnriiiv-iil'iD nf SAstrp ' " ' $0 ' 00aiiEDii ron e[nriili Ai'ib uiSastro PER coMPUTER: "$0'00EDucArlolr cRrnrr:.... '$1,500'ggEnucariolr cnEuri'PiR coMPUTER:.... $1,500'00cR05S'EnucAtiolr'cirEbli-pen corqrurER:. "$1,s00'00

019625

Trackins Numben r L00257559941RETIREMENT SAVINGS CNTRB CREDIT:.... .$0.00RETIREMENT SAVINGS CNTRB CREDIT PER C0MPUTER: . . . $0.00PRIM RET SAV CNTRB: F8880 LN6A: ..$0.00SEC RET SAV CNTRB: F8880 LN5B: . . . $0.00T0TAL RETIREMENT SAVINGS CONTRIBUTI0N: F8880 CMPTR:.... ...$0.00RESIDENTIAL ENERGY CREDIT:.... .$220.00RESIDENTIAL ENERGY CREDIT PER C0MPUTER: . . $220.0t)CHILD TAX CREDIT:... ...$1,300.00CHILD TAX CREDIT PER C0MPUTER:.... $I,500.00ADOPTI0N CREDIT: F8839:.... .....$0.00AD0PTI0N CREDIT PER COMPUTER, . . . $0.00DC lST TIME HOMEBUYERS CREDIT:.... ...$0.00DC 1ST TIME H0MEBUYERS CREDIT PER COMPUTER: . . . . $0.00F0RM 8595 M0RTGAGE CERTIFICATE CREDIT:.... .$0.00F0RM 8395 M0RTGAGE CERTIFICATE CREDIT PER COMPUTER:. $0.00F3800, F8801 AND 0THER CREDIT AM0UNT:.... ..$0.00F0RM 3800 GENERAL BUSINESS CREDITS!.... ...$0.00F0RM 5800 GENERAL BUSINESS CREDITS PER C0MPUTER: . . . . $0.00PRI0R YR MIN TAX CREDIT: F880I:.... ..$0.00PRI0R YR MIN TAX CREDIT: F8801 PER COMPUTER:. ..$0.00F8854 ELECTRIC VEHICLE CREDIT AM0UNT:.... ..$0.00F8955 ELECTRIC M0T0R VEHICLE CREDIT AM0UNT:.... .....$0.00F8910 ALTERNATIVE M0T0R VEHICLE CREDIT AM0UNT!.... ..$0.00OTHER CREDITS:..... ....$0.00T0TA[ CREDITS:.... .$3,154.00T0TAL CREDITS PER C0MPUTER: . . $5,154.00INC0ME TAX AFTER CREDITS PER C0MPUTER:. S2'235.00Other TaxesSE TAX:..... ....$0.00SE TAX PER C0MPUTER:. .....50.00SOCIAL SECURITY AND MEDICARE TAX 0N UNREP0RTED TIPS: . . . . . . $0.00SOCIAL SECURITY AND MEDICARE TAX 0N UNREP0RTED TIPS PER C0MPUTER:. .$0.00TAX 0N QUALIFIED PLANS F5329 (PR): ..$0.00TAX 0N QUALIFIED PLANS F5329 PER C0MPUTER: . . . . . . $0.00IRAF TAX PER C0MPUTER:. ....$0.00TP TAX FIGURES (REDUCED BY IRAF) PER C0MPUTER:. ..$2,255.00IMF TOTAL TAX (REDUCED BY IRAF) PER C0MPUTER:. ...$2,235.00OTHER TAXES PER COMPUTER: . . . $0.00UNPAID FICA 0N REP0RTED TIPS: . . $0.00OTHER TAXES:..... $0.00RECAPTURE TAX: F85Il:.... ...$0.00H0USEHOLD EMPL0YMENT TAXES:.... ..$0.00H0USEH0LD EMPL0YMENT TAXES PER COMPUTER: . . . $0.00RECAPTURE TAXES:.... . . . . $0.00T0TAL ASSESSMENT PER C0MPUTER:.... $2,235.00T0TAL TAX LIABILITY TP FIGURES!.... ....$2,255.00T0TAL TAX LIABILITY TP FIGURES PER COMPUTER:. ....$2,235.00PaymentsFEDERAL INC0ME TAX WITHHELD:. ..... $8,225.00HEALTH CARE: INDIVIDUAL RESPONSIBILITY:. $0.00

....1HEALTH CARE FULL-YEAR C0VERAGE INDICATOR ! . . . .COBRA PREMIUM SUBSIDY:.... .....$0.00ESTIMATED TAX PAYMENTS: . $0.00OTHER PAYfiENI' CRED]T:REFUNDABLE EDUCATIONREFUNDABLE EDUCAT]ONREFUNDABLE EDUCATION

.s0.00CREDIT:.... ..$I,000.00CREDIT PER COMPUTER:. ..$1,000.00CREDIT VERIFIED:.... ..$0.00

EARNED INC0HE CREDIT:.... $0.00EARNED INC0ME CREDIT PER C0MPUTER: . . . . $0.00EARNED INC0ME CREDIT NONTAXABLE C0HBAT PAY: . . . . . $0.00SCHEDULE 8812 N0NTAXABLE COMBAT PAY:. .$0.00EXCESS S0CIAL SECURITY & RRTA TAX IIITHHELD:. ....$0.00SCHEDULE 8812 T0T SS,/MEDICARE WITHHELD: . . . . $0.00SCHEDULE 8812 ADDITI0NAL CHILD TAX CREDIT:... ...$0.00SCHEDULE 8812 ADDITIONAL CHILD TAX CREDIT PER C0MPUTER:.... ....S0.00SCHEDULE 8812 ADDITI0NAL CHILD TAX CREDIT VERIFIED:... ....$0.00AM0UNT PAID WITH F0RM 48583.... ..$0.00F0RM 2439 REGULATED INVESTHENT C0MPANY CREDIT:.... ...$0.00

Tnacking Number t L00?57559941FORM 4155 CREDIT FOR FEDERAL TAX 0N FUELS3..... ....$0.00FORM 4135 CREDIT FOR FEDERAL TAX 0N FUELS PER C0MPUTER:. ..$0.00HEALTH C0VERAGE TX CR: F8885:.... ...$0.00FORM 8801 REFUNDABLE CREDIT FOR PRI0R YEAR MIN. TAX: . . . . . $0.00PREHIUH TAX CREDIT AMOUNT:.... .....$0.00PREMIUH TAX CREDIT VERIFIED AM0UNTI.... ..$0.00PRIMARY NAP FIRST TIME H0ME BUYER INSTALLMENT AMT: . . . . . . $0.00SEC0NDARY NAP FIRST TIME HOME BUYER INSTALLMENT AMT3.... $0.00FIRST TIME HOMEBUYER CREDIT REPAYMENT AM0UNT:.... ...$0.00FORM 5405 TOTAL HOMEBUYERS CREDIT REPAYMENT PER COHPUTER:. ....$O.OOSMALL EMPLOYER HEALTH INSURANCE PER C0MPUTER: . . . . $0.00SMALL EMPLOYER HEALTH INSURANCE PER COMPUTER (2).... .,...$O.O()FORM 2459 AND OTHER CREDITS:.... ....SO.OOT0TAL PAYMENTS:.... ..$9,226.09TOTAL PAYMENTS PER C0MPUTER: . .$9 ,225.00Refund or Amount 0wedREFUND AH0UNT:.... ..$-5,99\.00APPLIED T0 NEXT YEARTS ESTIMATED TAX:..... ...$0.00ESTIHATED TAX PENALTY:.. ..$0.00TAX 0N INC0ME LESS STATE REFUND PER C0HPUTER:. ...$0.00BAL DUE,/OVER PYMT USING TP FIG PER C0MPUTER:. .....$-5,991.00BAL DUE,/0VER PYMT USING C0MPUTER FIGURES:..... ....$-5,991.00FORH 8888 TOIAL REFUND PER CUHPUTER:. $0.00Third Party DesigneeTHIRD PARTY DESIGNEE ID NUMBER: . . . . .AUTH0RIZATI0N INDICAT0R:..... .......0THIRD PARTY DESIGNEE NAME:Schedule A--Itemized Deductions

MEDICAt,/DENTAL

HEDICAL AND DENTAL EXPENSES: . . . . $0.00ADJUSTED GROSS INCOME PERCENTAGE: . . .ADJUSTED GROSS INCOME PERCENTAGE PER COMPUTER 1ADJUSTED GROSS INCOME PERCENTAGE PER COMPUTER 7

. s0.0u

NET HEDICAL DEDUCTI0N: . . .NET MEDICAL DEDUCTION PER

0 PERCENT3.... ..$14,301.00.5 PERCENT:... ..$10,725.09

ioMiiiii; : : : : : : : . : : : : . . : : : : : . : . : : : : . : : : . . . : . : . :33:33TAXES PAIDSTATE AND L0CAL INC0ME TAXES:.... $7,933.00INC0HE TAX 0R GENERAL SALES TAX:. Income TaxesREAL ESTATE TAXES:.... $7,675.00PERS0NAL PR0PERTY TAXES:.... .$855.000THER TAXES AM0UNT:.... .$0.00

INTEREST PAIDM0RTGAGE INTEREST (FINANCIAL):.. .$13,050.00

. . . . . . i . . . ; -. . . . . . . . $0.00DEDUCTIBLE P0INTS:.... $0.00QUALIFIED M0RTGAGE INSURANCE PREHIUMS:.... .....$0.00DEDUCTIBLE INVESTHENT INTEREST: . . . . $0.00TOTAL INTEREST DEDUCTION: . . . $15,050.00$15, 050 . ooCHARITABLE CONTRIBUTIONSCASH C0NTRIBUTI0NS3.......

. $1,250. 000THER THAN CASH: Form 8283: . .$24,998. ooCARRY0VER FROM PRI0R YEAR:.... .$0.00SCH A T0TAL C0NTRIBUTIONS: .$25,?48.00SCH A T0TAL CONTRIBUTI0NS PER C0MPUTER:..... $26,2q8.00

079625

Trackins Number z L00?57559941CASUALTY AND THEFT LOSS

CASUALTY 0R THEFT L0SS: . . $0.00JOBS AND MISCELLANEOUSUNREIMBURSED EMPL0YEE EXPENSE AM0UNT:.... .....$0.00TOTAL LIMITED MISC EXPENSES: . . $1,655.00NET LIMITED MISC DEDUCTI0N:.... ...$0.00NET LIMITED HISC DEDUCTION PER COMPUTER: . . . . . $0.00OTHER MISCELLANEOUS

OTHER THAN GAHBLING AMOUNT:.. ....50.000THER MISC DEDUCTI0NS:.... ...$0.00TOTAL ITEMIZED DEDUCTIONSTOTAL ITEMIZED DEDUCTI0NS:... $55,755.00TOTAL ITEMIZED DEDUCTI0NS PER C0MPUTER:.... ....S55,763.00ELECT ITEMIZED DEDUCTI0N INDICATORi.....SCH A ITEMIZED PERCENTAGE PER COMPUTER:.... ....$0.00fntenest and DividendsGR0SS SCHEDULE B INTEREST:... 5L24.00TAXABLE INTEREST INC0ME:.... .$124.00EXCLUDABLE SAVINGS FR0M B0ND INT; . . $0.00GR0SS SCHEDULE B DIVIDENDS:.. ..$ll

'674.00DIVIDEND INC0ME:.... ..$11,674.00F0REIGN ACCOUNTS IND:. .....NoREQUIRED T0 FILE FINCEN F0RM tl4:.. ..NoneSchedule D--Capital Gains and Losses

SHORT TERM CAPITAL GAINS AND LOSSESSH0RT TERM BASIS N0 ADJUSTMENTS SALE AHOUNT:.. $0.00SHORT TERM BASIS N0 ADJUSTMENTS C0ST AMOUNT:.. $0.00SH0RT TERM BASIS SALE AMOUNT!.... .5205.00SHORT TERM BASIS C0ST AH0UNT3.... ..$195.00SH0RT TERM BASIS ADJUSTMENTS: . . $0.00SH0RT TERH N0 BASIS SALE AM0UNT: . . . $0.00SHORT TERH N0 BASIS C0ST AM0UNT: . . . $0.00SHORT TERM N0 BASIS ADJUSTMENTS: . . . . $0.00SHORT TERM N0 10998 SALE AM0UNT: . . . . $0.00SH0RT TERM N0 10998 COST AM0UNT: . . . . $0.00SHORT TERM N0 10998 ADJUSTMENTS: . . . 50.00SHORT TERH SCHEDULE K-I AMOUNT:.... .50.00NET SHORT-TERM GAIN,/L0SS!.... .....$10.00LONG TERI'I CAPITAL GAINS AND LOSSESL0NG TERM BASIS N0 ADJUSTMENTS SALE AM0UNT: . . . . . . $0.00L0NG TERH BASIS N0 ADJUSTMENTS COST AMOUNT:.. ....$0.00L0NG TERM BASIS SALE AMOUNT:.. .....$103.00LONG TERM BASIS COST AMOUNT: . . $96.00

[uilffililiiiii;iliiiluilll i i : i : : : : : : : : : : : : : : : : : . : : : : : : : : :, . .. . ::iH HTAX COMPUTATION USING MAXIMUM CAPITAL GAINS RATES282 RATE GAIN: ...$0.00

Trackins Number z 14025755994LUNRECAPTURED SECT: 1250 GAIN: ....$0.00SCH D 152 TAX CMPTR:.... ....$0.00CAPITAL GAINS LESS INVEST INC0ME PER C0HPUTER:. ..$4,222.09CAP GAINS TENTATIVE AMT PER C0MPUTER (1):. .$15,554.00CAP GAINS TAX AMT PER C0HPUTER (1) r.. ..$5,589.00CAP GAINS TENTATIVE AMT PER C0MPUTER (2):. .$13,664.00CAP GAINS TAX AMT PER C0HPUTER (5):.. .$0.00CAP GAINS TAX AMT PER C0MPUTER (5):.. .$0.00SCHEDULE D TAX PER COMPUTER:. $5,389.00Form 8853 - Education Cnedits (Hope and Lifetime Leanning Credits)Part I - EDUCATION CREDITSSTUDENT I NAHE CNTRL!.... . . READSTUDENT I SSN:......STUDENT 2 NAME CNTRL 545-22-6668STUDENT 2 SSN:....STUDENT 3 NAME CNTRL:....STUDENT 5 SSN!....TENTATIVE CREDIT AHOUNT:PART II - LIFETIME LEARNING CREDITSTOTL LIFETIM LRNING CR QLFD EXP:.EDUCATIONAL INSTITUTION FEDERAL ID NUMBERSECOND EDUCATIONAL INSTITUTION FEDERAL IDEDUCATIONAL INSTITUTION FEDERAL ID NUMBERSECOND EDUCATIONAL INSTITUTION FEDERAL IDEDUCATIONAL INSTITUTION FEDERAL ID NUMBERSECOND EDUCATIONAL INSTITUTION FEDERAL IDPRIOR YEAR HOPE SCHOLARSHIP OR AOT CREDIT

'iiuDiNiNUMBER,STUDENTNUMBERSTUDENTNUMBERCLAIMEI)

1:.,...STUDENT2;.....

STUDENT3:.....STUDENT

STUDENT

....$0.00000000000i : . . . . . . . . .0000000000000000002:... ..000000000

. .0000000003:... ..0000000001:... N0ACADEHIC ELIGIBILITY, STUDENT 1:... .....YESP0ST-SEC0NDARY COMPLETE STUDENT 1: . . . N0FELONY C0NVICTION STUDENT 1: . . . N0PRIOR YEAR H0PE SCH0LARSHIP 0R A0T CREDIT CLAIMED STUDENT ?2... .N0NEACADEMIC ELIGIBILITV STUDENT 2!.... ...N0NEPOST-SECONDARY COHPLETE STUDENT 22... ..N0NEFEL0NY C0NVICTI0N STUDENT 2:... .NONEPRIOR YEAR H0PE SCH0LARSHIP 0R A0T CREDIT CLAIMED STUDENT 5,... ......N0NEACADEMIC ELIGIBILITY STUDENT 3I. .NONEP0ST-SEC0NDARY COMPLETE STUDENT 3:... ......NONEFELONY C0NVICTI0N STUDENT 3: .VERIFIED NUMBER OF EDUCATIONTOTL LIFETIM LRNING CR QLFD E

....NoNESTUDENTS:.... . .00CREDi

XP PEi'EiiciBii'R COMPUTER:

PART III - ALLOWABLE EDUCATION CREDITSGR0SS EDUCATI0N CR PER C0MPUTER:.... ...$I,500.00T0TAL EDUCATI0N CREDIT AM0UNT:.... ....$1,500.00T0TAL EDUCATI0N CREDIT AMOUNT PER C0MPUTER:. ....$1,500.00This Product Contains Sensitive Taxpayer Data