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COVER PAGE
Filing Checklist for 2016 Tax Return Filed On Standard Forms
Prepared on: 05/13/2017 04:17:37 pm
Return: C:\Users\Irene\Documents\ACTG067\2017 CA Material\2016 CA mock returns\Jack Jones 2016 Tax Return.T16
To file your 2016 tax return, simply follow these instructions:
Step 1. Sign and date the return
Because you're filing a joint return, Jack and Norma both need to sign the tax 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 D
- - Form 8949
Staple these documents to the front of the first page of the return:
Form W-2: Wage and Tax Statement
1st (ABC Technology)
2nd (Al's Supermarket)
Step 3. Mail the return
Mail the return to this address:
Department of the Treasury
Internal Revenue Service
Fresno, CA 93888-0002
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 Express, Express 9:00, Express 10:30, Express 12:00, Express Worldwide, Express Envelope, Import Express 10:30, Import Express
12:00, and Import Express Worldwide.
- FedEx First Overnight, Priority Overnight, Standard Overnight, 2 Day, International Next Flight Out, International Priority, International First, or
International Economy.
- United Parcel Service Next Day Air Early AM, Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day Air A.M., Worldwide Express Plus, or
Worldwide Express.
Step 4. 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
- - Form 1099-INT/OID
- - Form 1099-DIV
- - Form 1099-G
- - Home Mortgage Interest Worksheet
- - Charitable Worksheet
- - State and Local Income Tax
- - Capital Gains and Losses Worksheet
- - Health Care Coverage
- - Health Care Summary
2016 return information - Keep this for your records
Here is some additional information about your 2016 return. Keep this information with your records.
You will need your 2016 AGI to electronically sign your return next year.
Quick Summary
Income
Adjustments
-
$228,556
$0
Deductions
Exemption(s)
Taxable income
Tax withheld or paid already
Actual tax due
Refund applied to next year
Refund
* 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.
-
-
$36,030
$8,100
$184,426
$45,000
$37,013
$0
$7,987
(99)
F
Department of the Treasury—Internal Revenue Service
o
r
m
For the year Jan. 1–Dec. 31, 2016, or other tax year beginning
1040 U.S. Individual Income Tax Return 2016
Your first name and initial
OMB No. 1545-0074
, 2016, ending
IRS Use Only—Do not write or staple in this space.
See separate instructions.
Your social security number
, 20
Last name
Jack
Jones
If a joint return, spouse's first name and initial
Norma
614-80-2222
Last name
Spouse's social security number
Jones
618-70-3333
Home address (number and street). If you have a P.O. box, see instructions.
Apt. no.
Make sure the SSN(s) above
and on line 6c are correct.
15 Maple Street
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
San Jose
CA
Foreign country name
Filing Status
Foreign province/state/county
Single
1
2
Check only one
box.
3
Exemptions
6a
X
b
c
Foreign postal code
Married filing separately. Enter spouse's SSN above
and full name here.
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
You
Spouse
4
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.
5
Qualifying widow(er) with dependent child
Married filing jointly (even if only one had income)
X
X
Presidential Election Campaign
95134
Yourself. If someone can claim you as a dependent, do not check box 6a
Boxes checked
on 6a and 6b
. . . . . . .
Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(4) X if child under age 17
Dependents:
(2) Dependent's
(3) Dependent's
qualifying for child tax credit
(1) First name
Last name
social security number
relationship to you
•
•
lived with you
did not live with
you due to divorce
or separation
(see instructions)
(see instructions)
If more than four
dependents, see
instructions and
check here
Dependents on 6c
not entered above
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see instructions.
Adjusted
Gross
Income
2
8a
205,000
156
9a
400
0
.
.
.
.
.
.
.
10
11
12
13
14
15b
16b
17
18
19
20b
21
Other income. List type and amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
21
22
23
24
Combine the amounts in the far right column for lines 7 through 21. This is your total income
Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ . . . . . . . 24
Health savings account deduction. Attach Form 8889 . . . . . . . . . . . 25
Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . . . 26
Deductible part of self-employment tax. Attach Schedule SE . . . . . . . 27
Self-employed SEP, SIMPLE, and qualified plans . . . . . . . . . . . . . 28
Self-employed health insurance deduction . . . . . . . . . . . . . . . . . 29
Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . 30
31a
Alimony paid b Recipient's SSN
IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . 33
34
Tuition and fees. Attach Form 8917 . . . . . . . . . . . . . . . . . . . .
Domestic production activities deduction. Attach Form 8903 . . . . . . . 35
Taxable interest. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . .
Tax-exempt interest. Do not include on line 8a . . . . . . . . . . . . . .
8b
Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . .
Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9b
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 . . . . . . . . . . . . . . . . . . .
13
Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . . . . . . . . . . . . . .
14
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . .
15a IRA distributions . . . . . . . . . . . . . . 15a
b Taxable amount
16a Pensions and annuities . . . . . . . . . . . 16a
b Taxable amount
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
b Taxable amount . . . . .
20a
8a
b
9a
b
25
26
27
28
29
30
31a
32
33
KIA
Add numbers on
lines above
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . .
Income
2
No. of children
on 6c who:
7
. . .
600
. . .
400
. . .
. . .
. . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
22
0
12,000
0
0
0
11,000
0
228,556
0
0
0
0
0
0
0
0
34
0
35
36
Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
Subtract line 36 from line 22. This is your adjusted gross income . . . . . . . . . . . . . . . .
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
36
37
0
228,556
Form 1040 (2016)
Jack
Form 1040 (2016)
Tax and
Credits
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,
$9,300
Other
Taxes
Payments
If you have a
qualifying
child, attach
Schedule EIC.
Direct deposit?
See
instructions.
614-80-2222
Page 2
228,556
38
. . . . . .
40
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41
36,030
192,526
8,100
184,426
37,013
0
40
Itemized deductions (from Schedule A) or your standard deduction (see left margin)
41
Subtract line 40 from line 38
42
Exemptions. If line 38 is $155,650 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions
43
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-
44
Tax (see instructions). Check if any from:
45
46
Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . . . . . . . . . . . . . . . . . .
45
Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . . . . . . . . . .
46
47
Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
37,013
48
Foreign tax credit. Attach Form 1116 if required . . . . . . . . . . . . .
48
49
Credit for child and dependent care expenses. Attach Form 2441 . . . .
49
50
Education credits from Form 8863, line 19
. . . . . . . . . . . . . . .
50
51
Retirement savings contributions credit. Attach Form 8880 . . . . . . .
51
52
53
Child tax credit. Attach Schedule 8812, if required . . . . . . . . . . .
Residential energy credits. Attach Form 5695 . . . . . . . . . . . . . .
52
54
Other credits from Form: a
54
55
56
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- . . . . . . . . . . . . . .
55
57
Self-employment tax. Attach Schedule SE
57
0
37,013
0
0
0
0
0
Form(s) 8814
a
3800 b
b
Form 4972
.
42
. . . . . . . . . . . . . . .
43
44
c
0
0
53
8801 c
0
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
8919 . . . . . . . .
58
59
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . . . .
60 a Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . .
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . . . . . . . . .
60a
58
Unreported social security and Medicare tax from Form:
61
Health care: individual responsibility (see instructions)
62
Taxes from: a
63
Add lines 56 through 62. This is your total tax
64
65
Form 8959 b
Form 8960 c
a
4137
b
Full-year coverage X
. . . . . . . . . .
59
60b
61
0
37,013
62
Instructions; enter code(s)
. . . . . . . . . . . . . . . . . . . . . . . . .
45,000
64
Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . .
0
2016 estimated tax payments and amount applied from 2015 return . .
65
63
66a
66a Earned income credit (EIC) . . . . . . . . . . . . . . . . . . . . . .
66b
b Nontaxable combat pay election . . . . .
67
Additional child tax credit. Attach Schedule 8812 . . . . . . . . . . . .
68
American opportunity credit from Form 8863, line 8 . . . . . . . . . . .
67
69
Net premium tax credit. Attach Form 8962 . . . . . . . . . . . . . . . .
68
69
70
Amount paid with request for extension to file . . . . . . . . . . . . . .
70
71
Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . .
71
72
73
Credit for federal tax on fuels. Attach Form 4136 . . . . . . . . . . . .
72
Credits from Form:
Reserved c
8885 d
a
2439 b
73
Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . . . . . . .
74
Refund
Jones
Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Blind.
You were born before January 2, 1952,
39a Check
Total boxes
0
checked
39a
if:
Spouse was born before January 2, 1952,
Blind.
39b
b If your spouse itemizes on a separate return or you were a dual-status alien, check here
38
0
0
45,000
7,987
7,987
74
75
If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid . . .
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . . . .
b Routing number XXXXXXXXX
c Type: X Checking
Savings
d Account number XXXXXXXXXXXXXXXXX
75
76a
0
77
78
Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions . .
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
77
Amount of line 75 you want applied to your 2017 estimated tax
Amount
You Owe
X No
Third Party
Designee's
Phone
Personal identification
Designee
name
no.
number (PIN)
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
Sign
accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Date
Your occupation
Daytime phone number
Here
Joint return? See
engineer
instructions.
Keep a copy for
your records.
Paid
Preparer
Use Only
KIA
Spouse's signature. If a joint return, both must sign.
Date
Spouse's occupation
If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
bookkeeper
Print/Type preparer's name
Preparer's signature
Date
Firm's name
Firm's EIN
Firm's address
Phone no.
www.irs.gov/form1040
Check
if
self-employed
PTIN
Form 1040 (2016)
SCHEDULE A
(Form 1040)
Itemized Deductions
OMB No. 1545-0074
2016
Information about Schedule A and its separate instructions is at www.irs.gov/schedulea.
Department of the Treasury
(99)
Internal Revenue Service
Attachment
Sequence No.
Attach to Form 1040.
Jack
Medical
and
Dental
Expenses
Taxes You
Paid
Jones
614-80-2222
Caution. Do not include expenses reimbursed or paid by others.
1 Medical and dental expenses (see instructions) . . . . . . . . . .
1
228,556
2 Enter amount from Form 1040, line 38 . . . 2
3 Multiply line 2 by 10% (10.10). But if either you or your spouse was
born before January 2, 1952, multiply line 2 by 7.5% (0.075) instead 3
4
5
0
22,856
4
0
9
22,630
15
9,800
19
3,600
Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . . . . . . 20
Unreimbursed employee expenses—job travel, union dues,
job education, etc. Attach Form 2106 or 2106-EZ if required.
(See instructions.) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
___________________________________
0
21
___________________________________
Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . 22
Other expenses—investment, safe deposit box, etc. List type
and amount
_________________________
0
23
___________________________________
0
24
Add lines 21 through 23 . . . . . . . . . . . . . . . . . . . . . .
228,556
Enter amount from Form 1040, line 38 . . . 25
4,571
Multiply line 25 by 2% (0.02) . . . . . . . . . . . . . . . . . . . . 26
Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . . . . . . 27
Other—from list in instructions. List type and amount
________________
________________________________________________
28
0
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
18,500
5
. . . . . . . . . . . . . . . . . . .
b.
General sales taxes
4,000
Real estate taxes (see instructions) . . . . . . . . . . . . . . . . 6
6
7 Personal property taxes . . . . . . . . . . . . . . . . . . . . . .
8 Other taxes. List type and amount
_______________
___________________________________
7
130
0
8
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest
You Paid
Note.
Your mortgage
interest
deduction may
be limited (see
instructions).
Gifts to
Charity
If you made a
gift and got a
benefit for it,
see instructions.
9 Add lines 5 through 8
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Mortgage insurance premiums (see instructions) . . . . . . . . .
14 Investment interest. Attach Form 4952 if required. (See instructions.)
15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . . .
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 . . . . . . . . . . . . . . . . . . . . . . .
Casualty and
Theft Losses 20
Job Expenses 21
and Certain
Miscellaneous
Deductions
22
23
24
25
26
27
28
Other
Miscellaneous
Deductions
29
Total
Itemized
Deductions
KIA
07
Your social security number
Name(s) shown on Form 1040
10
9,800
11
0
12
13
0
0
14
. . . . . . . . . . .
16
3,600
17
0
0
18
. . . . . . . . . . .
0
0
Is Form 1040, line 38, over $155,650?
No. Your deduction is not limited. Add the amounts in the far right column
36,030
for lines 4 through 28. Also, enter this amount on Form 1040, line 40.
. . . . . . . 29
Yes.
Your
deduction
may
be
limited.
See
the
Itemized
Deductions
X
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see Form 1040 instructions.
Schedule A (Form 1040) 2016
SCHEDULE D
(Form 1040)
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0074
Capital Gains and Losses
(99)
Attachment
Sequence No. 12
Your social security number
Name(s) shown on return
Jack
Part I
2016
Attach to Form 1040 or Form 1040NR.
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.
Jones
614-80-2222
Short-Term Capital Gains and Losses—Assets 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.
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)
(g)
Adjustments
to gain or loss from
Form(s) 8949, Part I,
line 2, column (g)
(e)
Cost
(or other basis)
(h) Gain or (loss)
Subtract column (e)
from column (d) and
combine the result with
column (g)
0
0
1b Totals for all transactions reported on Form(s) 8949 with
Box A checked . . . . . . . . . . . . . . . . . . . .
0
0
0
0
Totals for all transactions reported on Form(s) 8949 with
Box B checked . . . . . . . . . . . . . . . . . . . .
0
0
0
0
Totals for all transactions reported on Form(s) 8949 with
Box C checked . . . . . . . . . . . . . . . . . . . .
0
0
0
0
4
0
2
3
4
5
6
7
0
Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . .
Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss
Carryover Worksheet in the instructions.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 page 2 . . . . . . . .
Part II
5
6
0)
(
7
0
(g)
Adjustments
to gain or loss from
Form(s) 8949, Part II,
line 2, column (g)
(h) Gain or (loss)
Subtract column (e)
from column (d) and
combine the result with
column (g)
Long-Term Capital Gains and Losses—Assets 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)
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
0
0
8b Totals for all transactions reported on Form(s) 8949 with
Box D checked . . . . . . . . . . . . . . . . . . . .
0
0
0
0
Totals for all transactions reported on Form(s) 8949 with
Box E checked . . . . . . . . . . . . . . . . . . . .
62,000
50,000
0
12,000
Totals for all transactions reported on Form(s) 8949 with
Box F checked . . . . . . . . . . . . . . . . . . . .
0
0
0
0
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
0
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
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
14
Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss
Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
9
10
11
15
KIA
Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on
page 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions.
0
15
0
(
0)
12,000
Schedule D (Form 1040) 2016
Schedule D (Form 1040) 2016
Part III
16
Jack
Jones
614-80-2222
Page
2
Summary
Combine lines 7 and 15 and enter the result
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
12,000
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 . . . . . .
18
0
19
Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the
instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
0
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). Don't complete
lines 21 and 22 below.
No. Complete the Schedule D Tax Worksheet in the instructions. Don't 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 and Form 1040NR.
KIA
Schedule D (Form 1040) 2016
Form 8949 (2016)
Attachment Sequence No.
Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on Page 1
Jack
12A
Page 2
Social security number or taxpayer identification number
Jones
614-80-2222
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.
(D) Long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above)
X (E) Long-term transactions reported on Form(s) 1099-B showing basis wasn't reported to the IRS
(F) Long-term transactions not reported to you on Form 1099-B
1
(a)
Description of property
(Example: 100 sh. XYZ Co.)
150 shares of Apple
(b)
Date acquired
(Mo., day, yr.)
01/01/05
(c)
Date sold or
disposed of
(Mo., day, yr.)
05/11/16
(d)
Proceeds
(sales price)
(see instructions)
62,000
(e)
Cost or other basis
See the Note below
and see Column (e)
in the separate
instructions
50,000
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.
(f)
(g)
Code(s) from
instructions
Amount of
adjustment
(h)
Gain or (loss).
Subtract column (e)
from column (d) and
combine the result
with column (g)
0
12,000
0
0
0
0
0
0
0
0
0
0
0
0
0
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)
62,000
50,000
0
12,000
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.
KIA
Form 8949 (2016)