Downloadfile 30 PDF

Form
1040 Department of the Treasury—Internal Revenue Service
U.S. Individual Income Tax Return

(99)
2015 OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.
For the year Jan. 1–Dec. 31, 2015, or other tax year beginning , 2015, ending , 20 See separate instructions.
Your first name and initial Last name Your social security number
Casey M Miller 074-74-0348

If a joint return, spouse’s first name and initial Last name Spouse’s social security number
John T Miller 600-62-4188

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above
c
and on line 6c are correct.
4724 W Desert Hills Dr
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
Glendale AZ 85304 Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
Foreign country name Foreign province/state/county Foreign postal code
a box below will not change your tax or
refund. You Spouse
1 Single 4 Head of household (with qualifying person). (See instructions.) If

Filing Status
2 Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter this
Check only one 3 Married filing separately. Enter spouse’s SSN above child’s name here. a
box. and full name here. a 5 Qualifying widow(er) with dependent child
Exemptions 6a
b
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
} Boxes checked
on 6a and 6b
No. of children
2
c Dependents: (2) Dependent’s (3) Dependent’s (4) if child under age 17 on 6c who:
social security number relationship to you qualifying for child tax credit • lived with you 2
(1) First name Last name (see instructions) • did not live with
you due to divorce
john T miller 764-40-3874 Son or separation
If more than four MaezyJane L Miller 765-19-0576 Daughter (see instructions)
dependents, see Dependents on 6c
instructions and not entered above
check here a Add numbers on
d Total number of exemptions claimed . . . . . . . . . . . . . . . . . lines above a 4
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . 7 14,271.
Income
8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a
b Tax-exempt interest. Do not include on line 8a . . . 8b
Attach Form(s)
9a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a
W-2 here. Also
attach Forms b Qualified dividends . . . . . . . . . . . 9b
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10 0.
1099-R if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12 5,100.
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here a 13
If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14
get a W-2,
see instructions. 15a IRA distributions . 15a b Taxable amount . . . 15b
16a Pensions and annuities 16a b Taxable amount . . . 16b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18
19 Unemployment compensation . . . . . . . . . . . . . . . . . 19
20a Social security benefits 20a b Taxable amount . . . 20b
21 Other income. List type and amount 21
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income a 22 19,371.
23 Educator expenses . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24
Income 25 Health savings account deduction. Attach Form 8889 . 25
26 Moving expenses. Attach Form 3903 . . . . . . 26
27 Deductible part of self-employment tax. Attach Schedule SE . 27 361.
28 Self-employed SEP, SIMPLE, and qualified plans . . 28
29 Self-employed health insurance deduction . . . . 29
30 Penalty on early withdrawal of savings . . . . . . 30
31a Alimony paid b Recipient’s SSN a 31a
32 IRA deduction . . . . . . . . . . . . . 32
33 Student loan interest deduction . . . . . . . . 33
34 Tuition and fees. Attach Form 8917 . . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . 36 361.
37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . a 37 19,010.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 07/11/16 Intuit.cg.cfp.sp Form 1040 (2015)
Form 1040 (2015) Page 2
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38 19,010.
Tax and
Credits
39a Check
if:
{ You were born before January 2, 1951,
Spouse was born before January 2, 1951,
Blind.
Blind.
} Total boxes
checked a 39a
b If your spouse itemizes on a separate return or you were a dual-status alien, check here a 39b
Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . . 40 12,600.
Deduction 6,410.
for— 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41
• People who 42 Exemptions. If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see instructions 42 16,000.
check any
box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43 0.
39a or 39b or 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 4972 c 44 0.
who can be
claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45
dependent,
see 46 Excess advance premium tax credit repayment. Attach Form 8962 . . . . . . . . 46
instructions. 47 Add lines 44, 45, and 46 . . . . . . . . . . . . . . . . . . . a 47 0.
• All others:
48 Foreign tax credit. Attach Form 1116 if required . . . . 48
Single or
Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49
separately,
$6,300 50 Education credits from Form 8863, line 19 . . . . . 50
Married filing 51 Retirement savings contributions credit. Attach Form 8880 51
jointly or
Qualifying 52 Child tax credit. Attach Schedule 8812, if required . . . 52 0.
widow(er), 53 Residential energy credits. Attach Form 5695 . . . . 53
$12,600
Head of 54 Other credits from Form: a 3800 b 8801 c 54
household, 55 Add lines 48 through 54. These are your total credits . . . . . . . . . . . . 55 0.
$9,250
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- . . . . . . a 56 0.
57 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 57 721.
Other 58 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 58
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 59
Taxes 60a Household employment taxes from Schedule H . . . . . . . . . . . . . . 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required . . . . . . . . 60b
61 Health care: individual responsibility (see instructions) Full-year coverage . . . . . 61
62 Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 62
63 Add lines 56 through 62. This is your total tax . . . . . . . . . . . . . a 63 721.
Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . 64 1,188.
65 2015 estimated tax payments and amount applied from 2014 return 65
If you have a 5,548.
66a Earned income credit (EIC) . . . . . . . . . . 66a
qualifying
child, attach b Nontaxable combat pay election 66b
Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 . . . . . 67 2,000.
68 American opportunity credit from Form 8863, line 8 . . . 68
69 Net premium tax credit. Attach Form 8962 . . . . . . 69
70 Amount paid with request for extension to file . . . . . 70
71 Excess social security and tier 1 RRTA tax withheld . 71. . .
72 Credit for federal tax on fuels. Attach Form 4136 . 72. . .
73 Credits from Form: a 2439 b Reserved c 8885 d 73
74 Add lines 64, 65, 66a, and 67 through 73. These are your total payments . . . . . a 74 8,736.
Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 8,015.
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here . a 76a 8,015.
a bRouting number 1 2 2 1 0 5 1 5 5 a c Type: Checking Savings
Direct deposit?
See a dAccount number 1 5 1 7 0 5 6 4 0 5 4 9
instructions.
77 Amount of line 75 you want applied to your 2016 estimated tax a 77
Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions a 78
You Owe 79 Estimated tax penalty (see instructions) . . . . . . . 79
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No
Designee’s Phone Personal identification
Designee name a no. a number (PIN) a
Sign 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.
Here Your signature Date Your occupation Daytime phone number
F
Joint return? See

instructions. data entry operator (602)628-9888
Keep a copy for Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent you an Identity Protection
your records. PIN, enter it
engineer here (see inst.)
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
self-employed
Preparer
Use Only Firm’s name a Self-Prepared Firm's EIN a
Firm’s address a Phone no.

www.irs.gov/form1040 REV 07/11/16 Intuit.cg.cfp.sp Form 1040 (2015)
Data Entry 9 9 9 9 9 9
4724 W Desert Hills Dr
Glendale, AZ 85304
5,100.
5,100.
BAA REV 07/11/16 Intuit.cg.cfp.sp

SCHEDULE SE
Self-Employment Tax
OMB No. 1545-0074
2015
(Form 1040)
a Information about Schedule SE and its separate instructions is at www.irs.gov/schedulese.
Department of the Treasury Attachment
Internal Revenue Service (99) a Attach to Form 1040 or Form 1040NR. Sequence No. 17
Name of person with self-employment income (as shown on Form 1040 or Form 1040NR) Social security number of person
Casey M Miller with self-employment income a 074-74-0348
Before you begin: To determine if you must file Schedule SE, see the instructions.
May I Use Short Schedule SE or Must I Use Long Schedule SE?
Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE in the instructions.
Did you receive wages or tips in 2015?
No Yes
d d d
Are you a minister, member of a religious order, or Christian
Yes Was the total of your wages and tips subject to social security Yes
Science practitioner who received IRS approval not to be taxed a or railroad retirement (tier 1) tax plus your net earnings from a
on earnings from these sources, but you owe self-employment
self-employment more than $118,500?
tax on other earnings?
No
No
d d
Are you using one of the optional methods to figure your net Did you receive tips subject to social security or Medicare tax Yes
Yes a
earnings (see instructions)? a that you did not report to your employer?
No
No d
d
No Did you report any wages on Form 8919, Uncollected Social Yes
Did you receive church employee income (see instructions) Yes ` Security and Medicare Tax on Wages? a
reported on Form W-2 of $108.28 or more? a
No
d d
You may use Short Schedule SE below a You must use Long Schedule SE on page 2
Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.
1a Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form
1065), box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . 1a
b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve
Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code Z 1b ( )
2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065),
box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1.
Ministers and members of religious orders, see instructions for types of income to report on
this line. See instructions for other income to report . . . . . . . . . . . . . . 2 5,100.
3 Combine lines 1a, 1b, and 2 . . . . . . . . . . . . . . . . . . . . . 3 5,100.
4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do
not file this schedule unless you have an amount on line 1b . . . . . . . . . . . a 4 4,710.
Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b,
see instructions.
5 Self-employment tax. If the amount on line 4 is:
• $118,500 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 57,
or Form 1040NR, line 55
• More than $118,500, multiply line 4 by 2.9% (.029). Then, add $14,694 to the result.
Enter the total here and on Form 1040, line 57, or Form 1040NR, line 55 . . . . . . . 5 721.
6 Deduction for one-half of self-employment tax.
Multiply line 5 by 50% (.50). Enter the result here and on Form
1040, line 27, or Form 1040NR, line 27 . . . . . . . . 6 361.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 07/11/16 Intuit.cg.cfp.sp Schedule SE (Form 1040) 2015
SCHEDULE EIC Earned Income Credit OMB No. 1545-0074
(Form 1040A or 1040) 1040A `
Qualifying Child Information
2015
..........
a
1040
Complete and attach to Form 1040A or 1040 only if you have a qualifying child.
Department of the Treasury a EIC Attachment
Information about Schedule EIC (Form 1040A or 1040) and its instructions is at www.irs.gov/scheduleeic.
Internal Revenue Service (99) Sequence No. 43
Name(s) shown on return Your social security number
Casey M & John T Miller 074-74-0348
• See the instructions for Form 1040A, lines 42a and 42b, or Form 1040, lines 66a and 66b, to make
Before you begin: sure that (a) you can take the EIC, and (b) you have a qualifying child.
• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card.
Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s
social security card is not correct, call the Social Security Administration at 1-800-772-1213.
F
!
CAUTION
• You can't claim the EIC for a child who didn't live with you for more than half of the year.
• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See the instructions for details.
• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name First name Last name First name Last name First name Last name
If you have more than three qualifying
children, you have to list only three to get
the maximum credit. john T miller MaezyJane L Miller
2 Child’s SSN
The child must have an SSN as defined in
the instructions for Form 1040A, lines 42a
and 42b, or Form 1040, lines 66a and 66b,
unless the child was born and died in
2015. If your child was born and died in
2015 and did not have an SSN, enter
“Died” on this line and attach a copy of
the child’s birth certificate, death
certificate, or hospital medical records.
764-40-3874 765-19-0576
3 Child’s year of birth
Year 2 0 0 4 Year 2 0 1 0 Year
If born after 1996 and the child is If born after 1996 and the child is If born after 1996 and the child is
younger than you (or your spouse, if younger than you (or your spouse, if younger than you (or your spouse, if
filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b; filing jointly), skip lines 4a and 4b;
go to line 5. go to line 5. go to line 5.
4 a Was the child under age 24 at the end of

2015, a student, and younger than you (or Yes. No. Yes. No. Yes. No.
your spouse, if filing jointly)?
Go to Go to line 4b. Go to Go to line 4b. Go to Go to line 4b.
line 5. line 5. line 5.
b Was the child permanently and totally
disabled during any part of 2015?
Yes. No. Yes. No. Yes. No.
Go to The child is not a Go to The child is not a Go to The child is not a
line 5. qualifying child. line 5. qualifying child. line 5. qualifying child.
5 Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, foster child, etc.) Son Daughter
6 Number of months child lived
with you in the United States
during 2015
• If the child lived with you for more than

half of 2015 but less than 7 months,
enter “7.”
• If the child was born or died in 2015 and 12 months 12 months months
your home was the child’s home for more
than half the time he or she was alive Do not enter more than 12 Do not enter more than 12 Do not enter more than 12
during 2015, enter “12.” months. months. months.
For Paperwork Reduction Act Notice, see your tax BAA REV 07/11/16 Intuit.cg.cfp.sp Schedule EIC (Form 1040A or 1040) 2015
return instructions.
SCHEDULE 8812 OMB No. 1545-0074
Child Tax Credit 1040
◀
(Form 1040A or 1040)
▶ Attach to Form 1040, Form 1040A, or Form 1040NR.
1040A
1040NR 2015
Department of the Treasury
▶ Information about Schedule 8812 and its separate instructions is at 8812 Attachment
Internal Revenue Service (99) www.irs.gov/schedule8812. Sequence No. 47
Name(s) shown on return Your social security number
Part I Filers Who Have Certain Child Dependent(s) with an ITIN (Individual Taxpayer Identification Number)
▲
!
CAUTION
Complete this part only for each dependent who has an ITIN and for whom you are claiming the child tax credit.
If your dependent is not a qualifying child for the credit, you cannot include that dependent in the calculation of this credit.
Answer the following questions for each dependent listed on Form 1040, line 6c; Form 1040A, line 6c; or Form 1040NR, line 7c, who has an ITIN
(Individual Taxpayer Identification Number) and that you indicated is a qualifying child for the child tax credit by checking column (4) for that
dependent.
A For the first dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
presence test? See separate instructions.
Yes No
B For the second dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
Yes No
C For the third dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
Yes No
D For the fourth dependent identified with an ITIN and listed as a qualifying child for the child tax credit, did this child meet the substantial
Yes No
Note: If you have more than four dependents identified with an ITIN and listed as a qualifying child for the child tax credit, see separate instructions
and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
}
Part II Additional Child Tax Credit Filers
1 If you file Form 2555 or 2555-EZ stop here, you cannot claim the additional child tax credit.
If you are required to use the worksheet in Pub. 972, enter the amount from line 8 of the Child Tax
Credit Worksheet in the publication. Otherwise:
1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the 1 2,000.
Instructions for Form 1040, line 52).
1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040A, line 35).
1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the
Instructions for Form 1040NR, line 49).
2 Enter the amount from Form 1040, line 52; Form 1040A, line 35; or Form 1040NR, line 49 . . . . . 2 0.
3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit . . . . . . . . . . . . . 3 2,000.
4a Earned income (see separate instructions) . . . . . . . . . . . 4a 19,010.
b Nontaxable combat pay (see separate
instructions) . . . . . . . . . . . 4b
5 Is the amount on line 4a more than $3,000?
No. Leave line 5 blank and enter -0- on line 6.
Yes. Subtract $3,000 from the amount on line 4a. Enter the result . . . 5 16,010.
6 Multiply the amount on line 5 by 15% (.15) and enter the result . . . . . . . . . . . . . . 6 2,402.
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part III and enter the smaller of
line 3 or line 6 on line 13.
Yes. If line 6 is equal to or more than line 3, skip Part III and enter the amount from line 3 on line 13.
Otherwise, go to line 7.
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 07/11/16 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015
Schedule 8812 (Form 1040A or 1040) 2015 Page 2
Part III Certain Filers Who Have Three or More Qualifying Children
7 Withheld social security, Medicare, and Additional Medicare taxes from
Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse’s
amounts with yours. If your employer withheld or you paid Additional
}
Medicare Tax or tier 1 RRTA taxes, see separate instructions . . . . . . 7
8 1040 filers: Enter the total of the amounts from Form 1040, lines
27 and 58, plus any taxes that you identified using code
“UT” and entered on line 62.
1040A filers: Enter -0-. 8
1040NR filers: Enter the total of the amounts from Form 1040NR,
lines 27 and 56, plus any taxes that you identified using
code “UT” and entered on line 60.
}
9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . 9
10 1040 filers: Enter the total of the amounts from Form 1040, lines
66a and 71.
1040A filers: Enter the total of the amount from Form 1040A, line
42a, plus any excess social security and tier 1 RRTA 10
taxes withheld that you entered to the left of line 46
(see separate instructions).
1040NR filers: Enter the amount from Form 1040NR, line 67.
11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 11
12 Enter the larger of line 6 or line 11 . . . . . . . . . . . . . . . . . . . . . . 12
Next, enter the smaller of line 3 or line 12 on line 13.
Part IV Additional Child Tax Credit
13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . . . 13 2,000.
Enter this amount on
1040 Form 1040, line 67,
Form 1040A, line 43, or
1040A Form 1040NR, line 64.
1040NR ◀
REV 07/11/16 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015

Tax History Report 2015
G Keep for your records
Name(s) Shown on Return

Casey M & John T Miller
Five Year Tax History:
2011 2012 2013 2014 2015
Filing status MFJ MFJ MFJ
Total income 23,334. 20,720. 19,371.
Adjustments to income 1,649. 1,464. 361.
Adjusted gross income 21,685. 19,256. 19,010.
Tax expense 25.
Interest expense
Contributions 375.
Miscellaneous
deductions
Other Itemized
Deductions
Total itemized/
standard deduction 12,200. 12,400. 12,600.
Exemption amount 15,600. 15,800. 16,000.
Taxable income 0. 0. 0.
Tax
Alternative min tax
Total credits 0. 0. 0.
Other taxes 3,297. 2,927. 721.
Payments 7,372. 7,460. 8,736.
Form 2210 penalty
Amount owed
Applied to next
year’s estimated tax
Refund 4,075. 4,533. 8,015.
Effective tax rate % -34.00 -38.74 -39.71
**Tax bracket %
**Tax bracket % is based on Taxable income.

IMPORTANT DISCLOSURES
If you are owed a federal tax refund, you have a right to choose how you will receive the
refund. There are several options available to you. Some options cost money and some
options are free. Please read about these options below.
You can file your tax return electronically or by paper and obtain your refund directly from
the IRS for free. If you file your tax return electronically, you can receive a refund check
directly from the IRS through the U.S. Postal Service in 21 to 28 days from the time you
file your tax return or the IRS can deposit your refund directly into your bank account in
less than 21 days from the time you file your tax return unless there are delays by the
IRS. If you file a paper return through the U.S. Postal Service you can receive a refund
check directly from the IRS through the U.S. Postal Service in 6 to 8 weeks from the time
the IRS receives your return or the IRS can deposit your refund directly into your bank
account in 6 to 8 weeks from the time the IRS receives your return.
You can file your tax return electronically, select the Refund Processing Service ("RPS")
for an additional fee of $34.99, and have your federal income tax refund processed through
a bank and processor. The RPS allows your refund to be deposited into a bank account
intended for one-time use at Civista Bank of Sandusky, OH ("BANK") and deducts your
TurboTax fees and other fees you authorize from your refund. The balance is delivered to you
via the disbursement method you select. If you file your tax return electronically and select
the RPS, the IRS will deposit your refund with BANK. Upon receipt of your refund, Santa Barbara
Tax Products Group, LLC ("TPG"), a processor, will deduct and pay from your refund the RPS fee,
any fees charged by TurboTax for the preparation and filing of your tax return and any other amounts
authorized by you and disburse the balance of your refund proceeds to you. Unless there are
delays by the IRS, refunds are received in less than 21 days from the time you file your tax
return electronically.
The RPS is not necessary to obtain your refund. If you have an existing bank account,
you do not need to use the RPS, which requires the payment of a fee, in order to receive a
direct deposit from the IRS. You may consult the IRS website (irs.gov) for information
about tax refund processing.
If you select the RPS, no prior debt you may owe to BANK will be deducted from your
refund.
You can change your income tax withholdings which might result in you receiving
additional funds throughout the year rather than waiting to receive these funds potentially
in a tax refund next year. Please consult your employer or tax advisors for additional
details.
Information regarding low-cost deposit accounts may be available at www.mymoney.gov .
The below chart shows the options for filing your tax return (e-file or paper return), the
RPS product, refund disbursement options, estimated timing for obtaining your tax refund
proceeds, and costs associated with the various options.
WHAT TYPE WHAT ARE YOUR WHAT IS THE WHAT COSTS DO YOU
OF FILING DISBURSEMENT ESTIMATED TIME TO INCUR IN ADDITION
METHOD? OPTIONS? RECEIVE REFUND? TO TAX PREPARATION
FEES?
PAPER RETURN IRS Direct Deposit to Approximately No additional cost.

your personal bank 6 to 8 weeks
No Refund Processing account.
Service
Check mailed by IRS Approximately
to address on tax 6 to 8 weeks
return.
ELECTRONIC IRS Direct Deposit to Usually within 21 days No additional cost.

FILING your personal bank
(E-FILE) account.
No Refund Processing Check mailed by IRS Approximately

Service to address on tax 21 to 28 days
return.
ELECTRONIC (a) Direct Deposit to Usually within $ 34.99

FILING your personal bank 21 days
(E-FILE) account, or
Refund Processing (b) Load to your

Service prepaid card 1.
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your tax refund loaded on a prepaid card.
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Date
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02/24/2016
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sbia1301.SCR 12/17/15
Form 8960 Form 8960 Worksheet 2015
Lines 4b, 5b, 7, 9, 10
Name(s) Shown on Return Your SSN

Line 4b - Adjustment for trade or business income or loss
(a) Activity name (b) Gain or

loss
Enter additional adjustments not included above:
Adjustment for trade or business income not subject to net investment tax
Line 5b - Adjustment for gain or loss on dispositions
(a) Activity name (b) Gain or

loss
Capital loss carryover adjustment from 2014 for net investment tax purposes
Enter additional adjustments not included above and check the box if a capital gain or loss:
Net gain or loss from disposition of property not subject to net investment tax
Capital gain/loss not included in net investment income
(a) Activity name (b) Capital

Gain or Loss
Capital gain or loss from sale of property not subject to net investment income tax
Calculation of line 5b adjustment due to capital loss carryforward
1 Net capital loss not included in net investment income 1 0.

2 Capital loss carryover to next year 2
3 Lesser of line 1 or line 2 (Included as an adjustment on line 5b table above) 3 0.
Line 7 - Other modifications to investment income
1 Casualty and theft losses reported on Schedule A, line 20 1

2 Amounts reported on Form 8814, line 21 2
3 Adjustment for distributions from estates and trusts 3
4 Schedules C and F income/loss included in net investment income 4
5 Substitute interest and dividend payments 5
6 Recovery of a prior year deduction 6 0.
7 7
8 Total other modifications to investment income 8 0.

Casey M & John T Miller 074-74-0348 Page 2
Line 9b - State income tax allocable to net investment income
1 State, local, and foreign income taxes 1

2 Investment income 2
3 Total adjusted gross income 3
4 Divide line 2 by line 3. Enter result as a decimal amount 4
5 State, local and foreign income taxes allocable to investment income 5
Line 10 - Tax preparations fees allocable to net investment income
1 Tax preparations fees 1

2 Investment income 2
3 Total adjusted gross income 3
4 Divide line 2 by line 3. Enter result as a decimal amount 4
5 Tax preparations fees allocable to investment income 5
Lines 9 and 10 - Application of Itemized Deduction Limitations Worksheet
Part I - Application of Section 67 to Deductions Properly Allocable to Investment Income
1 Enter the amount of Miscellaneous Itemized Deductions properly

allocable to investment income before any itemized deductions limitations:
2 Enter the total of all items listed on line 1 2

3 Enter the amount of all Miscellaneous Itemized Deductions after the application
of the section 67 limitation (Schedule A (Form 1040), line 27) 3
4 Enter the lesser of the total reported on line 2 or line 3 4
Part II - Application of Section 67 Limitation to Specific Deductions

(A) (B) (C)
Reenter the amounts and descriptions from Part I, line 1 Fraction Column A
(see Help) times B
x =
x =
x =
x =
Part III - Application of Section 68 to Deductions Properly Allocable to Investment Income
1 Enter the amount of Miscellaneous Itemized Deductions properly

allocable to investment income from Column(C) of Part II:
1
2 Enter the amount of state, local, and foreign income taxes that are properly
allocable to investment income 2
3 Enter the amount of other Itemized Deductions subject to the section 68
limitation and properly allocable to investment income before any itemized
deduction limitation:
3
4 Enter the total deductions properly allocable to investment income subject to
the section 68 limitation. Enter the sum of lines 1 through 3 4
5 Enter the amount of total itemized deductions allowed after the section 68
limitation. Form 1040, line 40 5
6 Enter all other itemized deductions allowed but not subject to the section 68
deduction limitation: 6
7 Subtract line 6 from line 5 7
8 Enter the lesser of line 7 or line 4 8
Part IV - Reconciliation of Schedule A Deductions to Form 8960 plus additional expenses, lines 9 and 10
(A) (B) (C)
Reenter the amounts and descriptions from Part III, lines 1-3 Fraction Column A
(see Help) times B
Miscellaneous Itemized Deductions properly allocable to Investment
Income reportable on Form 8960, line 9c:
1 x =
x =
x =
x =
Total miscellaneous investment expenses to Form 8960, line 9c
2 State, local, and foreign income taxes x =
Itemized Deductions Subject to Section 68 reportable on Form 8960, line 10:

3 x =
x =
x =
x =
Penalty on early withdrawal of savings
Other modifications:
Total additional modifications to Form 8960, line 10
Calculation of Former Passive Activity Suspended Losses Allowed as Deduction Against NII
1) Former Passive Activity Suspended Losses
(a) Activity name (b) Suspended (c) Suspended (d) Used against (e) Used against
12/31/2014 12/31/2015 activity other passive
2) Former Passive Activity Suspended Losses - Schedule D
3) Former Passive Activity Suspended Losses - Form 4797
Form 8960 Deduction Recoveries Worksheet 2015
Line 7
Name(s) Shown on Return Your SSN

Was the recovery taken into account in computing a section 1411 net operating loss? YES NO X
1 Enter total amount of recovery included in gross income 0.

* Do not include recoveries of items that are included in net
investment income in the year of recovery (included on lines 1-6)
* Do not include recoveries of items if the amount relates to a
deduction taken in a tax year beginning before 2013
* Do not include recoveries of items if the amount relates to a
deduction taken in a tax year beginning after 2012, and you were
not subject to the NIIT solely because your MAGI was below the
applicable threshold.
2 Amount of the recovery that would have been included in gross
income but for the application of the tax benefit rule under
section 111 8,944.
3 Total amount of the recovery (add lines 1 and 2) 8,944.
4 Enter as a decimal the percentage of the deduction allocated to
net investment income in the prior year. (If the deduction was not
allocated between investment income and non-investment
income, enter 1.0000)
5 Enter the lesser of (a) line 3 mutiplied by line 4, or (b) the total amount deducted
on the prior year Form 8960 attributable to item recovered (after any deduction
limitations imposed by section 67 or 68)
Calculation of recoveries when the deduction is not taken into account in computing your section 1411 NOL
6 Multiply line 5 by .038

7 Enter the amount of net investment income in the year of the
deduction (previous year’s Form 8960, line 12, unless line 12 is
zero, then previous year’s Form 8960, line 8 minus line 11) 0.
8 Add the amount of line 5 to line 7 0.
9 Using the previous year’s Form 8960, recalculate the NIIT for the
year of the deduction by replacing the amount reported on line 12
with the amount reported on line 8 of this worksheet (do not use
the net investment income reported on that year’s Form 8960,
line 12). Enter your recalculated NIIT here 0.
10 Enter the NIIT reported for the year of the deduction 0.
11 Subtract line 10 from line 9 0.
12 Enter the smaller of line 6 or line 11 0.
13 Divide line 12 by 3.8%. Enter the result here and include on Form 8960, line 7 0.
Calculation of recoveries when the deduction is taken into account in computing your section 1411 NOL
14 Enter the amount of the section 1411 NOL in the year of the
deduction (entered as a positive number)
15 Enter the amount of the section 1411 NOL in the year of the
deduction recomputed without the amount on line 5 (entered as a
positive number, but not less than zero)
16 Subtract line 15 from line 14.Enter the result here and include on Form 8960, line 7
Form 1040 Other Income Statement 2015
Line 21 Statement L21
Name(s) Shown on Return Social Security Number

(a) (b)
Taxpayer Spouse
1 Child’s investment income, from Form 8814

2 Gambling winnings:
a From Form W-2G
b Winnings (prizes, etc.) from Form 1099-MISC, box 3
c Not reported on Form W-2G or Form 1099-MISC
3 Taxable income from Form 1099-MISC:
a Substitute payments in lieu of interest or dividends
b Other income from box 3
c Alaska Permanent Fund
d Tribal Gaming
e Non-Employee Compensation from Form 1099-MISC box 7
f Rent from personal property from Form 1099-MISC box 1
4 Taxable income from Form 1099-Q or 1099-QA:
a Qualified tuition program distributions
b Coverdell ESA distributions
c ABLE account distributions
5 Taxable income from Form 1099-G:
a Grants
b RTAA payments
6 Foreign earned income and housing exclusion, from Form 2555
7 Net operating loss carryover from a prior year
8 Other income, from Schedule(s) K-1
9 Taxable distribution from:
a Form 8853:
1 Taxable Archer MSA distributions MSA
2 Taxable Medicare Advantage distributions Med MSA
3 Taxable long term care distributions LTC
4 Total Form 8853
b Form 8889, Health Savings Accounts
10 Refunds or reimbursements of deductions claimed
in a prior year:
a Reimbursement for deducted medical expenses
b Refunds of deducted taxes (not state or local income taxes)
Type of Tax State or
Local ID
c
Recapture of deducted moving expenses
d
Reimbursement for deducted casualty or theft loss
e
Reimbursement for deducted employee business expenses
f
Other refunds or reimbursements
11 Recoveries of bad debts deducted in a prior year
12 Jury duty pay
13 Bartering income not reported elsewhere
14 Income from the rental of personal property
15 Income from the Cancellation of Debt:
a From Form 1099-C:
1 Amount of debt canceled from box 2
2 Amount of canceled debt excluded from income
3 Taxable amount of canceled debt
b From Schedule(s) K-1
16 Income from "not for profit" activities (hobbies):
17 Other taxable income:
18 Income from Community Property:

a Positive community property adjustment
b Negative community property adjustment (enter as positive)
19 Total. Add lines 1 through 14, 15a(3), 15b, 16, 17 and 18.
Enter here and on Form 1040 or Form 1040NR, line 21
Charitable Organization Worksheet 2015

Charity Name Arroyo Elementary School

Address
City State ZIP code
Combined Amounts Worksheet

Note: Amounts entered in worksheets below will be summarized in this worksheet.
Ref. No. Date Donation Description Donation Type Donation Amount
1 (not needed) Money 375.00
Total: 375.00
Prior Year Total:
ItsDeductible Item Donations Worksheet

Note: Amounts in this worksheet can only be entered using the interview process.
Ref. No. Donat. Date VM* Item Description High Value Qty. Med. Value Qty. Total Value
* VM, Valuation Method. 1 indicates it has been valued by ItsDeductible, 0 indicates you have created
a custom valuation item.
Charitable Organization Worksheet page 2 2015
Other Item Donations Worksheet

Note: Double-click to enter additional information if needed.
Ref. No. Donated Date Donation Description Donation Cost

Acquired Date Donation Type How Valued
How Acquired Donation Value Donation Allowed
Detail of Money Donations Worksheet
Don.
Ref. No. Donat. Date Each Don. Amt Per Yr Once or Recurring 2015 Amount
1 (not needed) 375.00 1 X Once Recur 375.00

Once Recur
Once Recur
Once Recur
Once Recur
Detail of Mileage and Transportation Costs Worksheet
Ref. No. Donation Date Description of Trip

Miles Per Trip Trips Per Yr Once or Recurring Miles Driven
Other Costs Description of Other Costs Value of Miles Total Donation Value
Once Recur
Once Recur
Once Recur
Charitable Organization Worksheet page 3 2015
Detail of Stock Donations Worksheet
Stock
Date of Symbol, Value on Date Stock Donation Value
Ref. No. Donation # shares Donation Date Acquired Original Cost
Charitable Organization Questions
1 Was the entire interest given for all property donated to this charity? X Yes No
2 Were restrictions attached to the charity’s right

to use or dispose of any property donated to this charity? Yes No
3 Did you give to anyone other than this charity the right to income from any
of the donated property or to possession of any of the donated property? Yes No
4 What Type of charitable organization was it? Check one:

X (a) 50% charity (b) Other than 50% charity
Federal Information Worksheet 2015
Part I ' Personal Information
Information in Part I is completely calculated from entries on Personal Information Worksheets.
Taxpayer: Spouse:
First name Casey First name John
Middle initial M Suffix Middle initial T Suffix
Last name Miller Last name Miller
Social security no. 074-74-0348 Social security no. 600-62-4188
Occupation data entry operator Occupation engineer
Date of birth 10/25/1977 (mm/dd/yyyy) Date of birth 11/21/1972 (mm/dd/yyyy)
Age as of 1-1-2016 38 Age as of 1-1-2016 43
Daytime phone (602)628-9888 Ext Daytime phone Ext
Legally blind Legally blind
Date of death Date of death
Dependent of Someone Else: Dependent of Someone Else:

Can taxpayer be claimed as dependent of another Can spouse be claimed as dependent of another
person (such as parent)? Yes X No person (such as parent)? Yes X No
If yes, was taxpayer claimed as dependent on that If yes, was spouse claimed as dependent on that
person’s return? Yes X No person’s return? Yes X No
Credit for the Elderly or Disabled (Schedule R): Credit for the Elderly or Disabled (Schedule R):
Is the taxpayer retired on total Is the spouse retired on total
and permanent disability? Yes No and permanent disability? Yes No
Presidential Election Campaign Fund: Presidential Election Campaign Fund:
Does the taxpayer want $3 to go to the Presidential Does the spouse want $3 to go to the Presidential
Election Campaign Fund? Yes No Election Campaign Fund? Yes No
Part II ' Address and Federal Filing Status (enter information in this section)
Address 4724 W Desert Hills Dr Apt no.
City Glendale State AZ ZIP code 85304
Foreign code Foreign country
Foreign province/county Foreign postal code
APO/FPO/DPO address, check if appropriate APO FPO DPO

Home phone
Check to print phone number on Form 1040 Home X Taxpayer daytime Spouse daytime
Federal filing status:

1 Single
X 2 Married filing jointly
3 Married filing separately
Check this box if you did not live with your spouse at any time during the year
Check this box if you are eligible to claim your spouse’s exemption (see Help)
4 Head of household
If the ’qualifying person’ is your child but not your dependent:
Child’s First name MI Last Name Suff
Child’s social security number
5 Qualifying widow(er)
Check the appropriate box for the year your spouse died 2013
2014
Part III ' Dependent/Earned Income Credit/Child and Dependent Care Credit Information
Information in Part III is completely calculated from entries on Dependent/Nondependent Info Worksheets.
Date of birth Date of death
(mm/dd/yyyy) (mm/dd/yyyy)
Qualified
Not child/dep Lived
C qual care exps with Educ *
Social security o for incurred E taxpyr Tuitn D
First name MI number d child and paid I in and e
Last name Suff Relationship Age e tax cr 2015 C U.S. Fees p
john T 764-40-3874 03/19/2004

miller Son 11 L E 12 Yes
MaezyJane L 765-19-0576 07/26/2010
Miller Daughter 5 L E 12 Yes
* "Yes" - qualifies as dependent, "No" - does not qualify as dependent

Part IV ' Earned Income Credit Information (you must answer these questions to calculate EIC)
Is the taxpayer or spouse a qualifying child for EIC for another person? Yes X No
Was the taxpayer’s (and spouse’s if married filing jointly) home in the United States
for more than half of 2015? X Yes No
If the SSN of the taxpayer, or spouse if married filing jointly, was obtained to
get a federally funded benefit, such as Medicaid, and the Social Security card
contains the legend Not Valid for Employment, check this box (see Help)
Check if you are filing head of household and your spouse is a nonresident alien
and you lived with your spouse during the last six months of 2015
Was EIC disallowed or reduced in a previous year and are you required to file
Form 8862 this year? Yes X No
Check if you were notified by the IRS that EIC cannot be claimed in 2015 or
if you are ineligible to claim the EIC in 2015 for any other reason
Part V ' Direct Deposit or Direct Debit Information (not applicable for Form 9465)
Do you want to elect direct deposit of any federal tax refund? X Yes No
Do you want to elect direct debit of federal balance due (Electronic filing only)? Yes No
If you selected either of the options above, fill out the information below:
Name of Financial Institution (optional) US Bank
Check the appropriate box Checking X Savings
Routing number 122105155 Account number 151705640549
Enter the following information only if you are requesting direct debit of balance due:
Enter the payment date to withdraw from the account above
Balance-due amount from this return
Part VI ' Additional Information for Your Federal Return
Standard Deduction/Itemized Deductions:

Check this box if you are itemizing for state tax or other purposes even though your itemized
deductions are less than your standard deduction
Check this box if you are married filing separately and your spouse itemized deductions
Check this box to take the standard deduction even if less than itemized deductions
Main Form Selection:

Check this box to calculate Form 1040 even if you qualify to use Form 1040A or 1040EZ
Real Estate Professionals:

Do you or your spouse qualify for the special passive activity rules for
taxpayers in real property business? (see Help) Yes No
Credit for Qualified Retirement Savings Contributions (Form 8880):

Is the taxpayer a full-time student? Yes No
Is the spouse a full-time student? Yes No
Foreign Tax Credit (Form 1116):

Check this box to file Form 1116 even if you’re not required to file Form 1116
Resident country USA
Excludable Income from Am. Samoa, Guam, Commonwealth of the N. Mariana Islands, or Puerto Rico:
Excludable income of bona fide residents of American Samoa, Guam, or the
Commonwealth of the Northern Mariana Islands
Excludable income from Puerto Rico
Dual Status Alien Return:

Check this box if you are a dual-status alien
Third Party Designee:

Caution: Review transferred information for accuracy.
Do you want to allow another person to discuss this return with the IRS? Yes No
If Yes, complete the following:
Third party designee name
Third party designee phone number
Personal Identification number (enter any 5 numbers)
If you are entitled to a filing extension or other disaster relief provision as declared by the IRS,
enter the appropriate information (see Help)
Part VI ' Additional Information for Your Federal Return - Continued
Personal Representative for deceased taxpayers:

Name of personal representative required for E-filed
returns when Form 1310 is not filed or it is not the
surviving spouse
Part VII ' State Filing Information
Identity Protection PIN:

If the IRS sent the taxpayer an Identity Protection PIN, enter it here
If the IRS sent the spouse an Identity Protection PIN, enter it here
Taxpayer:
Enter the taxpayer’s state of residence as of December 31, 2015 AZ
Check the appropriate box:
Taxpayer is a resident of the state above for the entire year X
Taxpayer is a resident of the state above for only part of year
Date the taxpayer established residence in state above
In which state (or foreign country) did the taxpayer reside before this change?
Spouse:
Enter the spouse’s state of residence as of December 31, 2015 AZ
Spouse is a resident of the state above for the entire year X
Spouse is a resident of the state above for only part of year
Date the spouse established residence in state above
In which state (or foreign country) did the spouse reside before this change?
Nonresident states:
Nonresident State(s) Taxpayer/Spouse/Joint
Check this box if you are in a Registered Domestic Partnership or a civil union
If you checked the box on the line above, also check the appropriate box below:
Check if this is your individual federal return you are filing with the IRS
Check if this is the joint return created to file joint state tax return (see Help)
Use the IRS web site or call the IRS automated response system to get your Electronic Filing PIN
Electronic Filing PIN assigned to the taxpayer by the IRS
Electronic Filing PIN assigned to the spouse by the IRS
These signature PINs are chosen by the taxpayer and spouse and used for e-filing your tax return
Taxpayer’s PIN used to sign the return 04553
Spouse’s PIN used to sign the return 03233
Taxpayer:
Drivers license or state ID number
Issued by what state
Expiration Date
Issued Date
License or ID license ID
Spouse
Drivers license or state ID number
Issued by what state
Expiration Date
Issued Date
License or ID license ID
Personal Information Worksheet 2015
For the Taxpayer
QuickZoom to another copy of Personal Information Worksheet
QuickZoom to Federal Information Worksheet
Part I ' Taxpayer's Personal Information

First name Casey Middle initial Last name
M Miller
Suffix
Social security no. 074-74-0348 Member of U.S. Armed Forces in 2015? Yes X No
Date of birth 10/25/1977 (mm/dd/yyyy) age as of 1-1-2016 38

Occupation data entry operator Daytime phone (602)628-9888 Ext
Marital status Married

If widowed, check the appropriate box for the year your spouse died:
After 2015 2015 2014 2013 Before 2013
Are you retired on total and permanent disability? (for Schedule R, see Help). Yes No
Check if this person is legally blind Yes X No
If deceased, enter the date of death (mm/dd/yyyy)
Were you under the age of 16 as of 1-1-2016 and this is the first year you
are filing a tax return? Yes No
Do you want $3 to go to Presidential Election Campaign Fund? Yes No
Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer
1 Can someone (such as your parent) claim you as a dependent? Yes X No
2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent
on that person’s tax return? Yes X No
Questions 3 through 5 are only required for individuals who claim the
American Opportunity Credit.
3 Were you a full-time student during any part of five months during 2015? Yes No
4 Did your earned income exceed one-half of your support? Yes No
5 Was at least one of your parents alive on December 31, 2015? Yes No
Part III ' Taxpayer's State Residency Information

Enter this person’s state of residence as of December 31, 2015 AZ
This person is a resident of the state above for the entire year X
This person is a resident of the state above for only part of year
Date this person established residence in state above
In which state (or foreign country) did this person reside before this change?
Part IV ' Dependent Care Expenses

Qualified dependent care expenses incurred and paid for this person in 2015
Unreimbursed medical expenses paid for qualifying person in 2015
Employment taxes paid for dependent care providers in 2015
Full-time student for 5 calendar months during 2015? Yes No
Disabled person who was not physically or mentally capable of self-care? Yes No
This person is a qualifying person for the child and dependent care credit Yes X No
Part VI ' Healthcare Coverage

Does coverage in prior year qualify January and February for eligibility for
short gap exemption? See help for additional details. Yes X No
Prior year covered or exempt other than short gap exemption for November and
December, supports answer to January and February eligible for short gap exemption
above.
Check if covered or exempt (other than short gap) for prior year November
Check if covered or exempt (other than short gap) for prior year December
Check the appropriate box below to indicate the healthcare coverage for this person. Select 12 months
if they were covered all year, select the individual months if they were not covered all year and leave
blank if they did not have minimum essential during any month of the year.
12 months Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
X X X X X X X X X X X X
Enter any Marketplace-granted coverage exemption for this person below:
Exemption Certificate Number Exemption Start Month Exemption End Month
Enter any other insurance coverage exemption requested for this person below:
Exemption Type Check Full Year or Months Exempt for Each Type
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Full Year
Full Year
Full Year
Healthcare coverage information has been completed for this person. X

Personal Information Worksheet 2015
For the Spouse
QuickZoom to another copy of Personal Information Worksheet
Part I ' Spouse's Personal Information

First name John Middle initial Last name
T Miller
Suffix
Social security no. 600-62-4188 Member of U.S. Armed Forces in 2015? Yes X No

Occupation engineer Daytime phone Ext
Marital status Married

If widowed, check the appropriate box for the year your spouse died:
After 2015 2015 2014 2013 Before 2013
Are you retired on total and permanent disability? (for Schedule R, see Help). Yes No
Check if this person is legally blind Yes X No
If deceased, enter the date of death (mm/dd/yyyy)
Were you under the age of 16 as of 1-1-2016 and this is the first year you
are filing a tax return? Yes No
Do you want $3 to go to Presidential Election Campaign Fund? Yes No
Part II ' Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer
1 Can someone (such as your parent) claim you as a dependent? Yes X No
2 If you answered ’Yes’ to question 1, are you actually claimed as a dependent
on that person’s tax return? Yes X No
Questions 3 through 5 are only required for individuals who claim the
American Opportunity Credit.
3 Were you a full-time student during any part of five months during 2015? Yes No
4 Did your earned income exceed one-half of your support? Yes No
5 Was at least one of your parents alive on December 31, 2015? Yes No
Part III ' Spouse's State Residency Information

Enter this person’s state of residence as of December 31, 2015 AZ
This person is a resident of the state above for the entire year X
Part IV ' Dependent Care Expenses

Qualified dependent care expenses incurred and paid for this person in 2015
Full-time student for 5 calendar months during 2015? Yes No
Disabled person who was not physically or mentally capable of self-care? Yes No
This person is a qualifying person for the child and dependent care credit Yes X No

above.
Full Year
Full Year
Full Year

Dependent and Nondependent Information Worksheet 2015
QuickZoom to another copy of Dependent and Nondependent Information Worksheet

First name john Middle initial T Last name miller

Suffix
Social security no. 764-40-3874

Did this person pass away in 2015 (deceased)? Yes No Date of death
Relationship to taxpayer or spouse Son

CAUTION: If claiming a child other than your own, see Relationship in the Tax Help.
NOTE: The ability to set your answers to being the same as last year for the dependent is only
available in Step-by-Step mode and not in Forms mode.
Are the answers to the questions below for this person, to determine
whether they are your dependent, the same as they were last year? Yes No
Dependency code * L Your dependent child who lived with you
*Dependency code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Dependent is disabled
Part II ' Earned Income Credit and Child Tax Credit
Is this person a U.S. citizen, U.S. national, or a U.S. resident? X Yes No

Is this person a resident of Canada or Mexico? Yes X No
This person is adopted and you are a U.S. citizen or U.S. national
The adopted child lived with you all year
*If the child is adopted, you are a U.S. citizen or U.S. national and they lived with you
all year, they are considered to meet the citizen test and the U.S. citizen box will
automatically be checked yes.
Child is a potentially qualifying child for earned income credit X Yes No

Child is a nondependent, but may qualify for earned income credit Yes No
You, and no one else, is claiming this nondependent for the earned income credit Yes No
Months lived with taxpayer in the United States 12
Qualifying for the earned income credit * E Qualifying child
*EIC code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Check if this person is not a qualifying child for the child tax credit
If this dependent has an ITIN issued by the IRS instead of a Dependent has ITIN
social security number issued by the social security administration,
did they meet the substantial presence test? (see Schedule 8812 Instructions) Yes No
Dependent name john T miller Page 2
Part III ' Dependent Care Expenses
Qualified child or dependent care expenses incurred and paid in 2015

Child or dependent is a qualifying person for the child and dependent care credit X Yes No
Child is a nondependent, but may qualify for the child and dependent care credit Yes No
Part V ' Dependent’s State Residency Information
Enter this person’s state of residence as of December 31, 2015

This person is a resident of the state above for the entire year
above.

Full Year
Full Year
Full Year
Part VI ' Identity Protection Pin
If the IRS sent an Identity Protection PIN for this dependent, enter it here
Dependent and Nondependent Information Worksheet 2015
QuickZoom to another copy of Dependent and Nondependent Information Worksheet

First name MaezyJane Middle initial L Last name Miller

Suffix
Social security no. 765-19-0576

Did this person pass away in 2015 (deceased)? Yes No Date of death
Relationship to taxpayer or spouse Daughter

CAUTION: If claiming a child other than your own, see Relationship in the Tax Help.
NOTE: The ability to set your answers to being the same as last year for the dependent is only
available in Step-by-Step mode and not in Forms mode.
Are the answers to the questions below for this person, to determine
whether they are your dependent, the same as they were last year? Yes No
Dependency code * L Your dependent child who lived with you
*Dependency code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Dependent is disabled
Part II ' Earned Income Credit and Child Tax Credit
Is this person a U.S. citizen, U.S. national, or a U.S. resident? X Yes No

Is this person a resident of Canada or Mexico? Yes X No
This person is adopted and you are a U.S. citizen or U.S. national
The adopted child lived with you all year
*If the child is adopted, you are a U.S. citizen or U.S. national and they lived with you
all year, they are considered to meet the citizen test and the U.S. citizen box will
automatically be checked yes.
Child is a potentially qualifying child for earned income credit X Yes No

Child is a nondependent, but may qualify for earned income credit Yes No
You, and no one else, is claiming this nondependent for the earned income credit Yes No
Months lived with taxpayer in the United States 12
Qualifying for the earned income credit * E Qualifying child
*EIC code is set based on your selections in the Dependency Exemption/EIC Smart Worksheet
Check if this person is not a qualifying child for the child tax credit
If this dependent has an ITIN issued by the IRS instead of a Dependent has ITIN
social security number issued by the social security administration,
did they meet the substantial presence test? (see Schedule 8812 Instructions) Yes No
Dependent name MaezyJane L Miller Page 2
Part III ' Dependent Care Expenses
Qualified child or dependent care expenses incurred and paid in 2015

Child or dependent is a qualifying person for the child and dependent care credit X Yes No
Child is a nondependent, but may qualify for the child and dependent care credit Yes No
Part V ' Dependent’s State Residency Information
Enter this person’s state of residence as of December 31, 2015

This person is a resident of the state above for the entire year
above.

Full Year
Full Year
Full Year
Part VI ' Identity Protection Pin
If the IRS sent an Identity Protection PIN for this dependent, enter it here
Form 1040 Forms W-2 & W-2G Summary 2015

Form W-2 Summary
Box No. Description Taxpayer Spouse Total
1 Total wages, tips and compensation:

Non-statutory & statutory wages not on Sch C 14,271. 14,271.
Statutory wages reported on Schedule C
Foreign wages included in total wages
Unreported tips
2 Total federal tax withheld 1,188. 1,188.
3 & 7 Total social security wages/tips 14,271. 14,271.
4 Total social security tax withheld 885. 885.
5 Total Medicare wages and tips 14,271. 14,271.
6 Total Medicare tax withheld 207. 207.
8 Total allocated tips
9 Not used
10 a Total dependent care benefits
b Offsite dependent care benefits
c Onsite dependent care benefits
11 Total distributions from nonqualified plans
12 a Total from Box 12
b Elective deferrals to qualified plans
c Roth contributions to 401(k) & 403(b) plans
d Deferrals to government 457 plans
e Deferrals to non-government 457 plans
f Deferrals 409A nonqual deferred comp plan
g Income 409A nonqual deferred comp plan
h Uncollected Medicare tax
i Uncollected social security and RRTA tier 1
j Uncollected RRTA tier 2
k Income from nonstatutory stock options
l Non-taxable combat pay
m Total other items from box 12
14 a Total deductible mandatory state tax
b Total deductible charitable contributions
c This line does not apply to TurboTax
d Total RR Compensation
e Total RR Tier 1 tax
f Total RR Tier 2 tax
g Total RR Medicare tax
h Total RR Additional Medicare tax
i Total RRTA tips
j Total other items from box 14
16 Total state wages and tips 14,271. 14,271.
17 Total state tax withheld
19 Total local tax withheld
Form W-2 Wage and Tax Statement 2015
Name Social Security Number

X Spouse’s W-2 Military: Complete Part VI on Page 2 below

Do not transfer this W-2 to next year
a Employee’s social security No 600-62-4188 1 Wages, tips, other 2 Federal income

b Employer’s ID number 52-2010575 compensation tax withheld
c Employer’s name, address, and ZIP code 14,270.50 1,188.29
TEKSYSTEMS INC 3 Social security wages 4 Social security tax withheld
14,270.50 884.77
Street 7437 RACE ROAD 5 Medicare wages and tips 6 Medicare tax withheld
City HANOVER 14,270.50 206.92
State MD ZIP Code 21076 7 Social security tips 8 Allocated tips
Foreign Country
Verification Code 10 Dependent care benefits
d Control number
11 Nonqualified plans Distributions from sect. 457
X Transfer employee information from and nonqualified plans
the Federal Information Worksheet (Important, see Help)
e Employee’s name 12 Enter box 12 below
First John M.I. T
Last Miller Suff. 13 Statutory employee
f Employee’s address and ZIP code Retirement plan
Street 4724 W Desert Hills Dr Third-party sick pay
City Glendale
State AZ ZIP Code 85304 14 Enter box 14 below after entering boxes 18, 19, and 20.
Foreign Country NOTE: Enter box 15 before entering box 14.
Box 12 Box 12 If Box 12 code is:

Code Amount A: Enter amount attributable to RRTA Tier 2 tax
M: Enter amount attributable to RRTA Tier 2 tax
P: Double click to link to Form 3903, line 4
R: Enter MSA contribution for Taxpayer
Spouse
W: Enter HSA contribution for Taxpayer
Spouse
G: Employer is not a state or local government
Box 15 Box 16 Box 17

State Employer’s state I.D. no. State wages, tips, etc. State income tax
AZ 07556933H 14,270.50
Box 20 Box 18 Box 19 Associated

Locality name Local wages, tips, etc. Local income tax State
Box 14 TurboTax Identification of Description or Code

Description or Code (Identify this item by selecting the identification from
on Actual Form W-2 Amount the drop down list. If not on the list, select Other).
Healthcare Entry Sheet 2015
The forms associated with healthcare (8965, 8962, 1095-A, 1095-B, 1095-C, and this Healthcare Entry Sheet) all interact with
information from the information worksheet. Be sure to enter all personal information including dependents listed on the return
before using this sheet to track health insurance coverage.
Yes No/Partial
Everyone on the tax return was covered by health insurance all year.
If everyone on the return was covered and there was no Market Place coverage (Form 1095-A) then check the YES box
above - no other action is required. The 1095-B or 1095-C can be used to verify coverage but you do not need to enter
the information if everyone on the return was covered.
Health Insurance Coverage for Individuals: Use this form to report healthcare coverage for individuals for months:
? not reported on 1095-A, 1095-B or 1095-C
? not covered by employer
? months not covered by an exemption
Note: The 1095-A information must be entered on Form 1095-A in order to correctly calculate any Premium Tax Credit. The 1095-B
or the 1095-C months can be entered directly in the table below.
If applicable enter information on form 1095-A, Health Insurance Marketplace Statement
Note: The IRS is not requiring the 1095-B or 1095-C be filed with the returns. To track the months covered you can either enter
on the 1095-B and/or 1095-C or check the boxes below
If applicable enter information on form 1095-B, Health Coverage
If applicable enter information on form 1095-C, Employer-Provided Health Insurance Offer and Coverage
If applicable enter Market Place exemptions (ECNs) or Request exemptions on form 8965
Note: Do not enter the name, SSN, or date of birth directly on the table below. Instead, enter the information at the bottom of the
Personal Information Worksheet or Dependent and Nondependent Information Worksheet.
Or if you check the box at the top "Yes" that "Everyone on the tax return was covered by health insurance all year." the covered
all 12 months box will be marked for all the individuals below regardless of what is entered on the Personal Information or
Dependent and Nondependent Information Worksheet.
Short Gap
Eligible*
Yes No
a. Name of covered individual(s) Covered all
b. SSN c. DOB 12 months Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Casey Miller Short gap: Yes X No
074-74-0348 10/25/77 X X X X X X X X X X X X T
2 John Miller Short gap: Yes X No
600-62-4188 11/21/72 X X X X X X X X X X X X S
3 john miller Short gap: Yes X No
764-40-3874 03/19/04 X X X X X X X X X X X X 1
4 MaezyJane Miller Short gap: Yes X No
765-19-0576 07/26/10 X X X X X X X X X X X X 2
5 Short gap: Yes No
6 Short gap: Yes No
* See help for explanation of short gap Yes/No box function. It affects the calculation of short gap coverage for January and
February based on answer, which indicates whether coverage at end of prior year qualify months for short gap eligibility.
To review the detail of each person listed on the return (covered, not covered, exempt) and to see any penalty calculation go to the
Health Care Individual Responsibility Smart Worksheet on Form 8965
Completion checkbox:
Check this box once you are finished with all the healthcare related entries.
Form 1099-MISC Summary 2015

Form 1099-MISC Summary
Box Description Taxpayer Spouse Total
1 Total Rents
A Schedule C
A Schedule E
A Form 4835
A Other Income
2 Total Royalties
A Schedule C
A Schedule E
3 Total Other income

A Schedule C
A Schedule F
A Form 4835
For Form 1040:
A Winnings (Prizes, etc.)
A Tribal Gaming
A Alaska Permanent Fund
A Other Income
4 Federal tax withheld

5 Fishing boat proceeds
6 Medical and health care payments
7 Total Nonemployee compensation 5,100. 5,100.

A Schedule C 5,100. 5,100.
A Schedule F
A Wages
A Other Income
8 Substitute payments
10 Total Crop insurance proceeds

A Schedule F
A Form 4835
13 Excess golden parachute payments
14 Gross proceeds paid to an attorney

A Taxable amount
15a Section 409A deferrals

15b Section 409A income
16 State tax withheld - total
Form 1099-MISC Miscellaneous Income 2015
Payer’s Name Garvin Promotion Group, LLC
Payer’s Identification No. EIN 26-2323812 or SSN
Account number (for your records only)
Spouse’s 1099-MISC Do not transfer this 1099-MISC to next year
For each type of 1099-MISC income, select the appropriate form or schedule in your return on which to
report this income. Double-click in the field next to the form’s name and when the window appears,
either "select or create" the copy on which you want to report the 1099-MISC income. See Help.
Box 1 Rents
Required: double-click to select the form on which to report this income:
Schedule C Form 4835
Schedule E Other Income
Box 2 Royalties
Schedule C
Schedule E
Box 3 Other income
Schedule C Form 4835
Schedule F
Winnings (Prizes, etc.)
Tribal Member Gaming Payments
From Alaska Permanent Fund
Other Income
Back Wages from Lawsuit. Amount:
Box 4 Federal income tax withheld
Box 5 Fishing boat proceeds
Required: double-click to select the Schedule C on which to report this income:
Schedule C
Box 6 Medical and health care payments
Schedule C
Box 7 Nonemployee compensation 5,099.50
Data Entry Schedule C
Schedule F
Wages subject to Social Security & Medicare tax
If checked, enter Reason Code for Form 8919 (see Help)
If Reason Code A or C, enter determination date
Other Income
Back Wages from Lawsuit. Amount:
Box 8 Substitute payments in lieu of dividends or interest
Box 10 Crop insurance proceeds
Schedule F
Form 4835
Box 13 Excess golden parachute payments
Report 20% excise tax on Form 1040
Box 14 Gross proceeds paid to an attorney
Taxable amount from box 14 to Schedule C
Schedule C
Boxes Section 409A deferrals
15a & b Section 409A income
Boxes State tax withheld - 1st state
16-18 State name (two letters) - 1st state State ID number - 1st state
State income - 1st state
State tax withheld - 2nd state
State name (two letters) - 2nd state State ID number - 2nd state
State income - 2nd state
FATCA filing requirement
Additional Payer Information
Only required if filing certain states electronically, and state tax was withheld for the state.
Payer’s address and ZIP code Recipient’s address and ZIP code
Transfer address from Federal Information Wks
Street Street
City City
State ZIP Code State ZIP Code
Foreign Country Foreign Country
Wages, Salaries, & Tips Worksheet 2015

The following amounts are included in the total entered on line 7 of Form 1040 (or Form 1040A), on line 1
of Form 1040EZ, on line 8 of Form 1040NR:
Taxpayer Spouse Total
1 Wages, from Form W-2 14,271. 14,271.

2 Miscellaneous income, from Form 8919
3 Items from Form 1099-R:
a Disability before minimum retirement age
b Return of contributions
4 Excess reimbursement, from Form 2106
5a Taxable tips, from Form 4137
b Noncash tips
6 Excess moving expense reimbursement,
from Form 3903
7 Wages earned as a household employee (if
less than $1,900 and without a Form W-2)
8 Items not on Form W-2 or Form 1099-R:
a Sick pay or disability payments
b Total foreign source income
c Check this box if the amount on line 8b is
eligible for the foreign exclusion/deduction
d Ordinary income from employer stock
transactions not reported on Form W-2
9 Other earned income
10 Subtotal.
Add lines 1 through 9 14,271. 14,271.
11 Taxable employer-provided dependent care
benefits, from Form 2441
12 Taxable employer-provided adoption benefits
less any excluded benefits from Form 8839
13 Scholarship/fellowship income not on
Form W-2
14 Other non-earned income
15 Total of lines 10 through 14 14,271. 14,271.

Form 1040 Child Tax Credit Worksheet 2015
Line 52 G Keep for your records
Name as Shown on Return Social Security No.
Note: ? To be a qualifying child for the child tax credit, the child must be under age 17 at the end of 2015
and meet the other requirements listed in the instructions for Form 1040 or 1040A.
? If applicable, first complete Form 2555, Foreign Earned Income and enter any exclusion of
income from U.S. Possessions on the Federal Information Worksheet.
Part 1
1 Number of qualifying children: 2 X $1,000. Enter the result 1 2,000.
2 Enter the amount from Form 1040, line 38, or
Form 1040A, line 22 2 19,010.
3 1040 filers: enter the total of any '
? Exclusion of income from Puerto Rico, and
? Amounts from Form 2555, lines 45 and 50;
Form 2555-EZ, line 18; and Form 4563, 3 0.
line 15.
1040A filers: Enter -0-.
4 Add lines 2 and 3. Enter the total 4 19,010.
5 Enter the amount shown below for your filing status.
? Married filing jointly ' $110,000
? Single, head of household, or
qualifying widow(er) ' $75,000 5 110,000.
? Married filing separately ' $55,000
6 Is the amount on line 4 more than the amount on
line 5?
X No. Leave line 6 blank. Enter -0- on line 7.
Yes. Subtract line 5 from line 4 6
If the result is not a multiple of $1,000,
increase it to the next multiple of $1,000.
For example, increase $425 to $1,000,
increase $1,025 to $2,000, etc.
7 Multiply the amount on line 6 by 5% (.05). Enter the result 7 0.
8 Is the amount on line 1 more than the amount on line 7?
No. Stop.
You cannot take the child tax credit on Form 1040, line 52, or
Form 1040A, line 35. You also cannot take the additional child tax
credit on Form 1040, line 67, or Form 1040A, line 43. Complete the
rest of your Form 1040 or 1040A.
X Yes. Subtract line 7 from line 1. Enter the result. Go to Part 2 8 2,000.
Part 2
9 Enter the amount from Form 1040, line 47, or Form 1040A, line 30 9 0.
10 Add the amounts from '
Form 1040, line 48
Form 1040, line 49, or Form 1040A, line 31 +
Form 5695, line 30 +
Schedule R, line 22 +
Enter the total 10 0.
11 Are you claiming any of the following credits?
? Mortgage interest credit, Form 8396
? Adoption Credit, Form 8839
? Residential energy efficient property credit, Form 5695, Part I
? District of Columbia first-time homebuyer credit, Form 8859
X No. Enter the amount from line 10
Yes. If you are filing Form 2555, enter the amount from 11 0.
line 10. Otherwise, Complete the Line 11 Worksheet below to
figure the amount to enter here.
12 Subtract line 11 from line 9. Enter the result. 12 0.
13 Is the amount on line 8 of this worksheet more than the amount on line 12?
No. Enter the amount from line 8
X Yes. Enter the amount from line 12. This is your child
See the TIP below. tax credit 13 0.
Enter this amount on
Form 1040, line 52, or
Form 1040A, line 35.
TIP: You may be able to take the additional child tax credit on Form 1040, line 67, or Form 1040A,
line 43, only if you answered ’Yes’ on line 13.
? First, complete your Form 1040 through line 66a (also complete line 71), or Form 1040A through
line 42a.
? Then, use Parts II through IV of Schedule 8812 to figure any additional child tax credit.
Schedule D Unrecaptured Section 1250 Gain Worksheet 2015

Regular Alternative
Tax Minimum Tax
If you are not reporting a gain on Form 4797, line 7, skip lines 1
through 9 and go to line 10.
1 If you have a section 1250 property in Part III of Form 4797 for
which you made an entry in Part I of Form 4797 (but not Form
6252), enter the smaller of line 22 or line 24 of Form 4797 for that
property. If you did not have any such property, go to line 4. 1
2 Enter the amount from Form 4797, line 26g, for the property for
which you made an entry on line 1 2
4 Enter the total unrecaptured section 1250 gain included on lines
26 or 37 of Form(s) 6252 from installment sales of trade or
business property held more than one year 4
5 Enter the total of any amounts reported on a Schedule K-1 from a
partnership or an S corporation as "unrecaptured section 1250
gain". 5
6 Add lines 3 through 5 6
7 Enter the smaller of line 6 or the gain from Form
4797, line 7 7
8 Enter the amount, if any, from Form 4797, line 8 8
9 Subtract line 8 from line 7. If zero or less, enter -0- 9
10 Enter the amount of any gain from sale of an interest in a
partnership attributable to unrecaptured section 1250 gain 10
11 Enter the total of any amounts reported to you as "unrecaptured
section 1250 gain" from an estate, trust, real estate investment
trust or mutual fund
Regular AMT
a On Form 1099-DIV
b On Form 2439
c On Schedule(s) K-1
d On Form 1099-R
e From Form 8814
f Other
Total 11
12 Enter the total of any unrecaptured section 1250 gain from sales
(including installment sales) or other dispositions of section 1250
property held more than 1 year for which you did not make
an entry in Part I of Form 4797 for the year of sale 12
13 Add lines 9 through 12 13
14 If you had any section 1202 gain or collectibles gain or (loss),
enter the total of lines 1 thru 4 of the 28% Rate Gain Worksheet.
Otherwise, enter -0- 14 0. 0.
15 Enter the (loss), if any, from Schedule D, line 7. If Schedule D, line
7, is zero or a gain, enter -0- 15 0. 0.
16 Enter your long-term capital loss carryovers from Schedule D, line
14, and Schedule K-1 (Form 1041), line 11, code C 16
a Enter your capital gain excess, if you are filing Form 2555 a 0.
17 Combine lines 14 through 16a. If the result is a (loss), enter it as a
positive amount. If the result is zero or a gain, enter -0- 17 0. 0.
18 Unrecaptured section 1250 gain. Subtract line 17 from line 13. If
zero or less, enter -0-. If more than zero, enter the result here and
on Schedule D, line 19 18
Schedule D 28% Rate Gain Worksheet 2015

Regular Alternative
Tax Minimum Tax
1 Enter the total of all collectibles gain or (loss) from items you
reported on Form 8949, Part II 1
2 Enter as a positive number the amount of any section 1202
exclusion you reported in column (g) of Form 8949, Part II, with
code "Q" in column (f), that is 50% of the gain, plus 2/3 of any
section 1202 exclusion you reported in column (g) of Form
8949, Part II, with code "Q" in column (f), that is 60% of the
gain, plus 1/3 of any section 1202 exclusion you reported in
column (g) of Form 8949, Part II, with code "Q" in column (f),
that is 75% of the gain.
50 % 60 % 75%
Exclusion Exclusion Exclusion
a Schedule D
b Form 8814
c Schedule B
d Form 6252
e Form 2439
f Other
Total 2
3 Enter the total of all collectibles gain or (loss) from:
Regular AMT
a Form 4684, line 4 (but only
if line 15 is more than zero)
b Form 6252
c Form 6781, Part II
d Form 8824
Total 3
4 Enter the total of any collectibles gain reported to you on:
Regular AMT
a Form 1099-DIV, box 2d
b Form 2439, box 1d
c Schedule K-1 from a
partnership, S corporation,
estate, or trust
d Disposition of interest in
partnership or S corporation
e Other
Total 4
5 Enter your long-term capital loss carryovers from Schedule D,
line 14, and Schedule K-1 (Form 1041), line 11, code C 5
6 If Schedule D, line 7, is a (loss), enter that (loss) here.
Otherwise, enter -0-. 6
7 Combine lines 1 through 6. If zero or less, enter -0-. If more
than zero, also enter this amount on Schedule D, line 18 7
8 Enter the amount of any capital gain excess 8 0.
9 Subtract line 8 from line 7. If zero or less, enter -0-.
Enter this amount on Schedule D Tax Worksheet, line 11a 9 0. 0.
Form 1040 Schedule D Tax Worksheet 2015

1 a Enter your taxable income from Form 1040, line 43 1a 0.

b Enter the amount from your (and your spouse’s) Form 2555, line 45 b
c Add lines 1a and 1b 1c 0.
2 a Enter your qualified dividends
from Form 1040, line 9b 2a
b Enter any capital gain excess
attributable to qualified dividends b
c Subtract line 2b from line 2a 2c
3 Amount from Form 4952, line 4g 3
4 a Amount from Form 4952, line 4e 4 a
b Amount from the dotted line
next to Form 4952, line 4e b
c Line 4b, if applicable, 4a, if not c
5 Subtract line 4c from line 3. 5 0.
6 Subtract line 5 from line 2c. If zero or less, enter -0- 6 0.
7 a Enter line 15 of Schedule D 7a
b Enter line 16 of Schedule D b
c Enter the smaller of line 7a or line 7b 7c 0.
8 Enter the smaller of line 3 or line 4c 8
9 a Subtract line 8 from line 7. 9a 0.
b Enter any capital gain excess attributable to
capital gains b
c Subtract line 9b from line 9a 9c 0.
10 Add lines 6 and 9c 10 0.
11 a Enter the amount from Schedule D, line 18 11 a 0.
b Enter the amount from Schedule D, line 19 b
c Add lines 11a and 11b 11 c 0.
12 Enter the smaller of line 9c or line 11c 12 0.
13 Subtract line 12 from line 10 13 0.
14 Subtract line 13 from line 1c. If zero or less, enter -0- 14 0.
15 Enter:
? $37,450 if single or married filing separately;
? $74,900 if married filing jointly or qualifying widow(er); or 15 74,900.
? $50,200 if head of household.
16 Enter the smaller of line 1c or line 15 16 0.
17 Enter the smaller of line 14 or line 16 17 0.
18 Subtr ln 10 from ln 1c. If zero or less, enter -0- 18 0.
19 Enter the larger of line 17 or line 18 19 0.
20 Subtract line 17 from line 16. This amount is taxed at 0% 20 0.
If lines 1c and 16 are the same, skip lines 21 through 41
and go to line 42. Otherwise, go to line 21.
21 Enter the smaller of line 1c or line 13 21
22 Enter the amount from line 20 (if line 20 is blank, enter -0-) 22
24 Enter:
? $413,200 if single,
? $232,425 if married filing separately, 24
? $464,850 if married filing jointly or qualifying widow(er),
? $439,000 if head of household.
25 Enter the smaller of line 1c or line 24 25
26 Add lines 19 and 20 26
28 Enter the smaller of line 23 or line 27 28
29 Multiply line 28 by 15% (.15) 29
If Schedule D, line 19, is zero or blank, skip lines 33 through 38

33 Enter the smaller of line 9c above or Schedule D, line 19 33
35 Enter the amount from line 1c above 35
If Schedule D, line 18, is zero or blank, skip lines 39 through 41
39 Add lines 19, 20, 28, 31, and 37 39
40 Subtract line 39 from line 1c 40
42 Figure the tax on the amount on line 19. If the amount on line 19 is less than $100,000,
use the Tax Table to figure this tax. If the amount on line 19 is $100,000 or more,
use the Tax Computation Worksheet 42
43 Add lines 29, 32, 38, 41, and 42 43 0.
44 Figure the tax on the amount on line 1c. If the amount on line 1c is less than $100,000,
use the Tax Table to figure this tax. If the amount on line 1c is $100,000 or more,
use the Tax Computation Worksheet 44
45 Tax on all taxable income (including capital gains and qualified dividends).
Enter the smaller of line 43 or line 44. Also include this amount on Form 1040, line 44 45
Form 1040 Qualified Dividends and Capital Gain Tax Worksheet 2015

1 Enter the amount from Form 1040, line 43 1

2 Enter the amount from Form
1040, line 9b 2
3 Are you filing Schedule D?
Yes. Enter the smaller of line 15
or 16 of Schedule D. If
either line 15 or 16 is blank
or loss, enter -0- 3
No. Enter the amount from Form
1040, line 13.
5 If filing Form 4952 (used to figure
investment interest expense
deduction), enter any amount from line
4g of that form. Otherwise, enter -0-. 5
8 Enter:
$37,450 if single or married filing separately,
$74,900 if married filing jointly or qualifying widow(er), 8
$50,200 if head of household.
11 Subtract line 10 from line 9 (this amount taxed at 0%) 11
13 Enter the amount from line 11 13
14 Subtract line 13 from line 12. 14
15 Enter:
$413,200 if single,
$232,425 if married filing separately, 15
$464,850 if married filing jointly or qualifying widow(er),
$439,000 if head of household.
24 Figure the tax on the amount on line 7. If the amount on line 7 is less than
$100,000, use the Tax Table to figure the tax. If the amount on line 7 is
$100,000 or more, use the Tax Computation Worksheet 24
25 Add lines 20, 23, and 24 25
26 Figure the tax on the amount on line 1. If the amount on line 1 is less than
$100,000, use the Tax Table to figure this tax. If the amount on line 1 is
$100,000 or more, use the Tax Computation Worksheet 26
27 Tax on all taxable income. Enter the smaller of line 25 or line 26 here and on
Form 1040, line 44. 27
Tax Payments Worksheet 2015

Estimated Tax Payments for 2015 (If more than 4 payments for any state or locality, see Tax Help)
Federal State Local
Date Amount Date Amount ID Date Amount ID
1 04/15/15 04/15/15 04/15/15
2 06/15/15 06/15/15 06/15/15
3 09/15/15 09/15/15 09/15/15
4 01/15/16 01/15/16 01/15/16
Tot Estimated
Payments
Tax Payments Other Than Withholding Federal State ID Local ID

(If multiple states, see Tax Help)
6 Overpayments applied to 2015

7 Credited by estates and trusts
8 Totals Lines 1 through 7
9 2015 extensions
Taxes Withheld From: Federal State Local
10 Forms W-2 1,188.

11 Forms W-2G
12 Forms 1099-R
13 Forms 1099-MISC and 1099-G
14 Schedules K-1
15 Forms 1099-INT, DIV and OID
16 Social Security and Railroad Benefits
17 Form 1099-B St Loc
18 a Other withholding St Loc
b Other withholding St Loc
c Other withholding St Loc
d Positive Adjustment St Loc
e Negative Adjustment St Loc
f Additional Medicare Tax
19 Total Withholding Lines 10 through 18f
1,188.
20 Total Tax Payments for 2015 1,188.
Prior Year Taxes Paid In 2015 State ID Local ID

(If multiple states or localities, see Tax Help)
21 Tax paid with 2014 extensions

22 2014 estimated tax paid after 12/31/2014
23 Balance due paid with 2014 return
24 Other (amended returns, installment payments, etc)
Schedule A Tax and Interest Deduction Worksheet 2015
Lines 5 - 12 G Keep for your records

Tax Deductions
1 State and local taxes:

Optional Sales Tax Tables
a Available Income:
(1) Income from Form 1040, line 38 19,010.
(2) Nontaxable income entered elsewhere on return
(3) Available income: 2014 refundable credits in excess of tax 0.
(4) Enter any additional nontaxable income
(5) Total available income 19,010.
b Sales Tax Per State of Residence:
Enter state in column (1), then enter total (combined) state and local sales tax rate in column (4).
Colorado, Illinois, Louisiana, New Jersey, New York or South Carolina only:
Double-click in column (4) to select your locality for each state entered.
(1) (2) (3) (4) (5) (6) (7) (8) (9)

S Date Date Enter State Local State Local Prorated
t Lived in Lived in Total Sales Sales Sales Sales or Total
a State State State & Tax Tax Tax Tax Amount
t From To Local Rate Rate (%) Table Amount
e Rate (%) (%) (4) - (5) Amount
c Total general sales tax using tables

d Sales Tax Paid on Specific Items (see help):
(1) (2) (3) (4) (5) (6) (7) (8)

ST Total Description Type Cost Rate if Actual Specific
State & Different Sales Tax Item
Local Amount Deduction
Rate Paid
e Total sales tax deduction on specific items

f Total general sales tax per tables plus sales tax on specific items
g Actual State and Local General Sales Tax:
Actual sales taxes (enter the total sales taxes paid during the year on all items)
h State and Local Income Taxes:
State and Local Income taxes 0.00
i State and Local Tax Deduction to Schedule A, line 5:
Greater of line 1f, line 1g, or line 1h (to Schedule A, line 5) 0.00
j Check a box to choose to use income taxes paid, sales taxes paid, or whichever
provides the greater deduction:
Income Taxes Sales Taxes Greater amount X
2 Real estate taxes:

a Real estate taxes paid on principal residence not entered on Form 1098
b Real estate taxes paid on principal residence entered on Form 1098
c Real estate taxes paid on additional homes or land
Personal portion of real estate taxes from Schedule E Worksheet for:
d Principal residence
e Vacation home
f Less real estate taxes deducted on Form 8829
g Add lines 2a through 2f (to Schedule A, line 6)
3 Personal property taxes:
a Auto registration fees based on the value of the vehicle.
2014 Amount Enter 2015 description:
Honda Civic 25.00
b Non-business portion of personal property taxes from Car & Truck Exp Wks
c Other personal property taxes
d Add lines 3a through 3c (to Schedule A, line 7) 25.00
4 Other taxes:
a Other taxes from Schedule(s) K-1
b Foreign taxes from interest and dividends
c Foreign taxes from Schedule(s) K-1
d Other foreign taxes (not used to claim a foreign tax credit)
e Other taxes.
2014 Amount Enter 2015 description:
f Add lines 4a through 4e (to Schedule A, line 8)
Interest Deductions
5 Home mortgage interest and points reported on Form 1098:

a Mortgage interest and points from the Home Mortgage Interest Worksheet
b Qualified mortgage interest from Schedule E Worksheet
c Less home mortgage interest/points deducted on Form 8829
d Less home mortgage interest from Form 8396, line 3
e Add lines 5a through 5d (to Sch A, line 10) or line A2 from above
6 Home mortgage interest not reported on Form 1098:
a Mortgage interest from the Home Mortgage Interest Worksheet
b Less home mortgage interest deducted on Form 8829
c Add lines 6a and 6b (to Sch A, line 11) or line B2 from above
7 Points not reported on Form 1098:
a Amortizable points from the Home Mortgage Interest Worksheet
b Other points not on Form 1098 from the Home Mortgage Interest Worksheet
c Less points deducted on Form 8829
d Add lines 7a through 7c (to Schedule A, line 12) or line C2 from above
Schedule A State and Local Tax Deduction Worksheet 2015

State and Local Income Taxes
State income taxes:

1 State income tax withheld 1
2 2015 state estimated taxes paid in 2015 2
3 2014 state estimated taxes paid in 2015 3
4 Amount paid with 2014 state application for extension 4
5 Amount paid with 2014 state income tax return 5
6 Overpayment on 2014 state income tax return applied to 2015 tax 6
7 Other amounts paid in 2015 (amended returns, installment payments, etc.) 7
8 State estimated tax from Schedule(s) K-1 (Form 1041) 8
Local income taxes:
9 Local income tax withheld 9
10 2015 local estimated taxes paid in 2015 10
11 2014 local estimated taxes paid in 2015 11
12 Amount paid with 2014 local application for extension 12
13 Amount paid with 2014 local income tax return 13
14 Overpayment on 2014 local income tax return applied to 2015 tax 14
15 Other amounts paid in 2015 (amended returns, installment payments, etc.) 15
16 Local estimated tax from Schedule(s) K-1 (Form 1041) 16
Other:
17 17
18 Total Add lines 1 through 17 18
19 State and local refund allocated to 2015 19 0.
20 Nondeductible state income tax from line 28 20
21 Total reductions Add lines 19 and 20. 21 0.
22 Total state and local income tax deduction Line 18 less line 21 22 0.
Nondeductible State Income Tax (Hawaii Only)
23 Nontaxable federal employee cost of living allowance 23

24 Adjusted gross income 24
26 Nondeductible percent. Line 23 divided by line 25 26 %
27 Hawaii state income tax included in line 18 27
28 Nondeductible Hawaii state income tax. Multiply line 26 by line 27. 28
Schedule A Cash Contributions Worksheet 2015

Cash Contributions
Name of Charitable Organization Type 2015 Amount

Note: Summarized from the Charitable Organization Worksheet.
Enter amounts on the Charitable Organization Worksheet.
1a Arroyo Elementary School A 375.00
2 From Schedule K-1 ' Partnerships and S Corporations 2

3 From Form(s) W-2, Box 14 3
4 Miles driven:
a To perform charitable service 4a
b From Detail of Mileage and
Transportation Costs Worksheet
above 4b
c Add lines 4a and 4b 4c
d Multiply line 4c by 14 cents per mile 4d
5 Parking fees, tolls, and local transportation
a To perform charitable service 5a
b From Charitable Org. Wks 5b
c Add lines 5a and 5b. 5c
6 Add lines 1 thru 5 and enter here (to Schedule A, line 16) 6 375.00
Charitable Deduction Limits Worksheet 2015
For Current Year Contributions

Step 1. List your qualified charitable contributions made during the year.
1 RESERVED for future use
Step 2. List your other charitable contributions made during the year.
2 Enter your contributions to 50% limit organizations. Do not include contributions of capital
gain property deducted at fair market value. Do not include contributions entered on line 1. 375.
3 Enter your contributions to 50% limit organizations of capital gain property deducted at fair
market value
4 Enter your contributions (other than of capital gain property) to organizations that are not
50% limit organizations
5 Enter your contributions "for the use" of any qualified organization
6 Add lines 4 and 5
7 Enter your contributions of capital gain property to or for the use of any qualified
organization. (But do not enter here any amount entered on line 1 or 2)
Step 3. Figure your deduction for the year and your carryover to the next year.
8 Enter your adjusted gross income 19,010.
9 Multiply line 8 by 0.5. This is your 50% limit. 9,505.
Limits Deduct Carryover

this year to next
Cash and Other Capital gain year
50% Other 50% Other

Org Org
Contributions to 50% limit

organizations
12 Subtract line 10 from line 9 9,130.
Contributions not to 50% limit

organizations
13 Add lines 2 and 3 375.
14 Multiply line 8 by 0.3. This is your 30%
limit. 5,703. 5,703.
16 Enter the smallest of line 6, 14, or 15 0.
Capital gain property to 50% limit

organizations
Capital gain property not to 50% limit

organizations
limit. 3,802.
24 Enter the smaller of line 7, 18, 21, 22,
or 23 0.
26 Add lines 10, 16, 19, and 24.

Amount for Schedule A, Line 19 375.
27 Reserved for future use
30 Add lines 11, 17, 20, and 25. Carry
to next year. 0.
Charitable Deduction Limits Worksheet 2015
For Carryover Contributions

Step 1. List your qualified charitable contributions made during the year.
1 RESERVED for future use
Step 2. List your other charitable contributions made during the year.
2 Enter your contributions to 50% limit organizations. Do not include contributions of capital
gain property deducted at fair market value. Do not include contributions entered on line 1.
3 Enter your contributions to 50% limit organizations of capital gain property deducted at fair
market value
4 Enter your contributions (other than of capital gain property) to organizations that are not
50% limit organizations
5 Enter your contributions "for the use" of any qualified organization
6 Add lines 4 and 5
7 Enter your contributions of capital gain property to or for the use of any qualified
organization. (But do not enter here any amount entered on line 1 or 2)
Step 3. Figure your deduction for the year and your carryover to the next year.
8 Enter your adjusted gross income 19,010.
9 Multiply line 8 by 0.5. This is your 50% limit. 9,505. less 375. 9,130.
Limits Deduct Carryover

this year to next
Cash and Other Capital gain year
50% Other 50% Other

Org Org
Contributions to 50% limit

organizations
Contributions not to 50% limit

organizations
13 Add lines 2 and 3 375.
limit. 5,703. 5,703.
Capital gain property to 50% limit

organizations
Capital gain property not to 50% limit

organizations
limit. 3,802.
24 Enter the smaller of line 7, 18, 21, 22,
or 23 0.
26 Add lines 10, 16, 19, and 24.

Amount for Schedule A, Line 19 0.
30 Add lines 11, 17, 20, and 25. Carry
to next year. 0.
Charitable Contributions Summary 2015
Part I Cash Contributions Summary
(a) (b) (c) (d)
Name of Charitable Organization Total 50% 30% RESERVED
Limit Limit for future
use
Arroyo Elementary School 375. 375.
Totals: 375. 375.

Part II Non-Cash Contributions Summary
Total Other Property Capital Gain Property
(a) (b) (c) (d) (e)

Name of Charitable Organization Total 50% 30% 30% 20%
Limit Limit Limit Limit
Totals:
Part III Contribution Carryovers to 2016
Total Cash and Other Capital Gain
Non-Capital Gain Property Property
(a) (b) (c) (d) (e) (f)
Total RESERVED 50% 30% 30% 20%
Limit Limit Limit Limit
1 2015 contributions 375. 375.
2 2015 contributions
allowed 375. 375. 0. 0. 0.
3 Carryovers from:
a 2014 tax year
b 2013 tax year
c 2012 tax year
d 2011 tax year
e 2010 tax year
4 Carryovers
allowed in 2015 0. 0. 0. 0. 0.
5 Carryovers
disallowed in 2015 0. 0. 0. 0. 0.
6 Carryovers to 2016:
a From 2015 0. 0. 0. 0. 0.
b From 2014
c From 2013
d From 2012
e From 2011
f From 2010
Part IV Special Situations in Your Return for Current Year Donations

1 Was the entire interest given for all property donated to all charities? X Yes No
2 Were restrictions attached to any charities’s right
to use or dispose of any property donated to any charity? Yes X No
3 Did you give to anyone other than the charity the right to income from any
of the donated property or to possession of any of the donated property? Yes X No
4 Was any charity other than a 50% charity? Yes X No
Schedule A Itemized Deductions Worksheet 2015

1 Add the amounts on Schedule A, lines 4, 9, 15, 19, 20, 27 and 28 1 400.
2 Add the amounts on Schedule A, lines 4, 14 and 20, plus any gambling
and casualty or theft losses included on line 28 2
CAUTION: Be sure your total gambling and casualty or theft losses are clearly
identified on the Miscellaneous Itemized Deductions Statement.
3 Is the amount on line 2 less than the amount on line 1?
No. STOP. Your deduction is not limited. Enter the amount from
line 1 above on Schedule A, line 29.
X Yes. Subtract line 2 from line 1 3 400.
4 Multiply line 3 by 80% (.80) 4 320.
5 Enter the amount from Form 1040, line 38 5 19,010.
6 Enter $258,250 if single; $309,900 if married filing
jointly or qualifying widow(er); $284,050 if head of
household, $154,950 if married filing separately 6 309,900.
7 Is the amount on line 6 less than the amount on
line 5?
X No. STOP. Your deduction is not limited.
Enter the amount from line 1 above on
Schedule A, line 29.
Yes. Subtract line 6 from line 5 7
10 Total itemized deductions. Subtract line 9 from line 1.
(to Schedule A, line 29) 10
Form 1040 Standard Deduction Worksheet for Dependents 2015

Use this worksheet only if someone can claim you, or your spouse if filing jointly, as a dependent.
1 Is your earned income* more than $700?
Yes. Add $350 to your earned income. Enter the total 1
No. Enter $1,050
2 Enter the amount shown below for your filing status.
? Single or married filing separately ' $6,300
? Married filing jointly or Qualifying widow(er) ' $12,600 2 12,600.
? Head of household ' $9,250
3 Standard deduction.
3 a Enter the smaller of line 1 or line 2. If born after January 1, 1951, and not
blind, stop here and enter this amount on Form 1040, line 40. Otherwise go
to line 3b 3a
3 b If born before January 2, 1951, or blind, multiply the number on Form 1040,
line 39a, by $1,250 ($1,550 if single or head of household) 3b
3 c Add lines 3a and 3b. Enter the total here and on Form 1040, line 40 3c
*Earned income includes wages, salaries, tips, professional fees, and other compensation received for
personal services you performed. It also includes any amount received as a scholarship that you must
include in your income. Generally, your earned income is the total of the amount(s) you reported on Form
1040, lines 7, 12, and 18, minus the amount, if any, on line 27; or on Form 1040A, line 7.
Form 1040 Deduction for Exemptions Worksheet 2015

1 Multiply $4,000 by the total number of exemptions claimed on Form

1040, line 6d 1 16,000.
2 Enter the amount from Form 1040, line 38 2 19,010.
3 Enter the amount shown below for your filing status:
? Single, enter $258,250
? Married filing jointly or qualifying widow(er), enter $309,900
? Married filing separately, enter $154,950
? Head of household, enter $284,050 3 309,900.
4 Subtract line 3 from line 2. If zero or less, stop; enter the amount from
line 1 above on Form 1040, line 42 4 -290,890.
5 Is line 4 more than $122,500 ($61,250 if married filing separately)?
Yes. You cannot take a deduction for exemptions.
Enter zero here and on Form 1040, line 42.
Do not complete the rest of this worksheet.
No. Divide line 4 by $2,500 ($1,250 if married filing separately). If the
result is not a whole number, increase it to the next whole number
(for example, increase .0004 to 1) 5
6 Multiply line 5 by 2% (.02) and enter the result as a decimal 6
7 Multiply line 1 by line 6 7
8 Deduction for exemptions. Subtract line 7 from line 1. Enter the result here
and on Form 1040, line 42 8
Earned Income Worksheet 2015

Part I ' Earned Income Credit Wks Computation Taxpayer Spouse Total
1 If filing Schedule SE:

a
Net self-employment income 5,100. 5,100.
b
Optional Method and Church Employee income
c
Add lines 1a and 1b 5,100. 5,100.
d
One-half of self-employment tax 361. 361.
e
Subtract line 1d from line 1c 4,739. 4,739.
2 If not required to file Schedule SE:
a Net farm profit or (loss)
b Net nonfarm profit or (loss)
c Add lines 2a and 2b
3 If filing Schedule C or C-EZ as a statutory
employee, enter the amount from line 1
of that Schedule C or C-EZ
4 Add lines 1e, 2c and 3. To EIC Wks, line 5 4,739. 4,739.
Part II ' Form 2441 and Standard Deduction Worksheet Computations
5 Net self-employment earnings (line 4 above) 4,739. 4,739.

6 Wages, salaries, and tips less distributions
from nonqualified or section 457 plans, etc 14,271. 14,271.
7a Taxable employer-provided adoption benefits
b Foreign earned income exclusion
8 Add lines 5 through 7b. To Form 2441, lines 19
and 20 4,739. 14,271. 19,010.
9a Taxable dependent care benefits
b Nontaxable combat pay
10 Add lines 8, 9a & 9b . To Form 2441, lines
4 and 5 4,739. 14,271. 19,010.
11 Scholarship or fellowship income not on W-2
12 SE exempt earnings less nontaxable income
13 Distributions from nonqualified/Sec. 457 plans
14 Add lines 5, 6, 7a, 9a and 11 through 13.
To Standard Deduction Worksheet 4,739. 14,271. 19,010.
Part III ' IRA Deduction Worksheet Computation
15 Net self-employment income or (loss) 4,739. 4,739.

16 Wages, salaries, tips, etc 14,271. 14,271.
17 Net self-employment loss
18 Alimony received
19 Nontaxable combat pay
20 Foreign earned income exclusion
21 Keogh, SEP or SIMPLE deduction
22 Combine lines 15 through 21. To IRA Wks, ln 2 4,739. 14,271. 19,010.
Part IV ' Schedule 8812 and Child Tax Credit Line 11 Worksheet Computations
23 Self-employed, church and statutory employees 4,739. 4,739.

24 Wages, salaries, tips, etc 14,271. 14,271.
25 Nontaxable combat pay
26 Combine lines 23 through 25. To Schedule
8812, line 4a & Line 11 Wks, line 2 4,739. 14,271. 19,010.
Form 4952 Investment Interest Expense Worksheet 2015

Investment Interest Expense ( Form 4952, line 1)

1 Investment interest expense, from Schedule K-1 1
2 Investment interest expense from royalties 2
3 Other investment interest expense:
a 3a
b b
c c
d d
4 Total investment interest expense. Add lines 1 through 3. 4
Gross Income from Property Held for Investment (Form 4952, line 4a)
5 Taxable investment income:
a From Schedule B, Interest and Dividend Income 5a
b From Schedules K-1, Partnerships, S Corporations, Estates and Trusts b
c From Form 8814, Parents’ Election to Report Child’s Interest and Dividends c
d Total d
6 Royalty income, from Schedule E 6
7 Net passive income from publicly traded partnerships 7
8 Income from nonpassive trade or business without material participation 8
9 Other investment income:
a 9a
b b
c c
d d
10 Total investment income. Add lines 5d through 9. 10
Net Capital Gain Income (Form 4952, lines 4d and 4e)

Regular Tax Alt Min Tax
11 a Net gains from Schedule D, line 16 11 a

b Less net gains from property not held for investment b
c Net gains from property held for investment. c
12 a Net capital gains from Schedule D, lesser of ln 15 or ln 16 12 a

b Less net capital gains from property not held for investment b
c Net capital gains from property held for investment. c
Investment Expenses (Form 4952, line 5)

13 Royalty expenses 13
14 Investment expenses included as itemized deductions (after the 2% limitation) 14
15 Investment expenses included as itemized deductions (no 2% limitation) 15
16 Expenses from nonpassive trade or business without material participation 16
17 Other investment expenses:
a 17 a
b b
c c
d d
18 Total investment expenses. Add lines 13 through 17. 18
Allocation of Investment Interest Expense (Schedule A, line 14)

Regular Tax Alt Min Tax
19 Allowed investment interest expense, Form 4952, line 8 19

20 Less amount deducted on other forms and schedules: 20
a Deducted on Schedule E, page 2 for passthru entities a
b Deducted on Schedule E, page 1 for royalties b
c Other amounts deducted on other forms and schedules c
d Total amount deducted on other forms and schedules d
21 Investment interest expense. 21
Form 1040 Earned Income Credit Worksheet 2015

QuickZoom to Schedule EIC

QuickZoom to Dependent Information Worksheet to enter qualifying children information
QuickZoom to Wages, Salaries, & Tips Worksheet to enter earned and non-earned income
QuickZoom to page 2 of this worksheet, if credit is not calculated on line 7
1 Enter the amount from Form 1040 or 1040A, line 7, or Form 1040EZ, line 1,
less amounts considered not earned for EIC purposes 1 14,271.
2 Adjustments to line 1 amount:
a Income reported as wages and as self-employment income 2a
b Other income entered as wages that is not considered earned income b
c Distributions from section 457 and other nonqualified plans reported on W-2 c
3 Subtract lines 2a, 2b and 2c from line 1 3 14,271.
4a Taxpayer’s nontaxable combat pay election for EIC 4a
b Spouse’s nontaxable combat pay election for EIC b
c Total nontaxable combat pay election 4c
5 If you were self-employed or used Schedule C or Schedule C-EZ
as a statutory employee, enter the amount from the
Earned Income Worksheet, line 4 5 4,739.
6 Earned income. Add lines 3, 4c, and 5 6 19,010.
7 Enter the credit, from the EIC Table, for the amount on line 6. Be sure to use
the correct column for filing status and number of children 7 5,548.
If line 7 is zero, stop. You cannot take the credit.

Enter "No" on the dotted line next to Form 1040, line 66a.
8 Enter your AGI from Form 1040, line 38 8 19,010.

9 If you have:
? No qualifying children, is the amount on line 8 less than $8,250
($13,750 if married filing jointly)?
? 1 or more qualifying children, is the amount on line 8 less than $18,150
($23,650 if married filing jointly)?
X Yes. Go to line 10 now.

No. Enter the credit, from the EIC Table, for the amount on line 8. Be
sure to use the correct column for filing status and number of children 9
10 Earned income credit.
? If ’Yes’ on line 9, enter the amount from line 7
? If ’No’ on line 9, enter the smaller of line 7 or line 9 10 5,548.
Enter line 10 amount on Form 1040, line 66a, Form 1040A, line 42a, or Form 1040EZ, line 8a.
Compliance and Due Diligence Information
1 Is this how long your dependents lived with you in the U.S in 2015?
Yes, all of the above is correct.

No, I’ll go back and review my dependent information.
The IRS may ask you for documents to prove you lived with anyone you’re claiming for the Earned
Income Credit.
Is this where you lived with your dependents the longest in 2015?
2 Yes, my dependents lived with me at this address.

No, I’d like to add an additional address where I lived with my dependents. Use the Interview to
add an additional address where you lived with your dependents the longest in 2015.
Compliance and Due Diligence Indicator X

Disqualified from Earned Income Credit Yes X No
Potential qualifying child count 2

Non dependent potential qualifying child count 0
Qualifying child count (max 3) 2
Schedule SE Adjustments Worksheet 2015

(a) Taxpayer (b) Spouse
QuickZoom to the Short Schedule SE (Schedule SE, page 1) X

QuickZoom to the Long Schedule SE (Schedule SE, page 2)
A Use Long Schedule SE, even if qualified to use Short Schedule SE

B Approved Form 4029. Exempt from SE tax on all income
C Chapter 11 bankruptcy net profit or loss for Schedule SE, line 3
D QuickZoom to the Explanation statement for any adjustment to
SE income/loss shown on a partnership K-1. (See Help)
Part I Farm Profit or (Loss) Schedule SE, line 1

1 Total Schedules F
2 Farm partnerships, Schedules K-1
3 Other SE farm profit or (loss) (See Help)
4 Less SE exempt farm profit or (loss) (See Help)
5 Total for Schedule SE, line 1
6 Conservation Reserve Program payments not subject to self-
employment tax reported on:
a Schedule F, line 4b
b Schedule K-1 (Form 1065), box 20, code Z
c Total CRP payments not subject to SE tax
Part II Nonfarm Profit or (Loss) Schedule SE, line 2

1a Total Schedules C 5,100.
b Less SE exempt Schedules C (approved Form 4361)
2 Nonfarm partnerships, Schedules K-1
3 Forms 6781
4 Other SE income reported as income on Form 1040, line 7
5a Clergy Form W-2 wages
b Clergy housing allowance
c Less clergy business deductions
d QuickZoom to the Explanation statement for entry on line 5c
6 Other SE nonfarm profit or (loss) (See Help)
7 Less other SE exempt nonfarm profit or (loss) (See Help)
8 Total for Schedule SE, line 2 5,100.
9 Exempt Notary Public income for Schedule SE, line 3 (See Help)
Part III Farm Optional Method Schedule SE, page 2, Part II

1 Use Farm Optional Method
2 Gross farm income from Schedules F
3 Gross farming or fishing income from partnership Schedules K-1
4 Other gross farming or fishing self-employment income
5 Total gross income for Farm Optional Method
Part IV Nonfarm Optional Method Schedule SE, page 2, Part II

1 Use Nonfarm Optional Method (Must have had net SE earnings
of $400 or more in 2 of prior 3 years and used the
Nonfarm Optional Method less than 5 times)
2 Gross nonfarm income from Schedules C
3 Gross nonfarm income from partnership Schedules K-1
4 Other gross nonfarm self-employment income
5 Total gross income for Nonfarm Optional Method
Form 6251 Schedule D Tax Worksheet 2015
Line 37 as refigured for the
Alternative Minimum Tax

(a) (b) (c)

Before Allocation of After
Allocation of Capital Gain Allocation of
Capital Gain Excess * Capital Gain
Excess * Excess
1 Not applicable
2 Enter your total qualified dividends as refigured for
the Alternative Minimum Tax (AMT):
a Total qualified dividends
b Adjustment from Schedules K-1
c Other adjustments to qualified dividends
d Total. Combine lines 2a, 2b, and 2c 0. 0.
3 Enter the amount from Form 4952 for AMT, line 4g
4 Enter the amount from Form 4952 for AMT, line 4e
5 Subtract line 4 from line 3. If zero or less, enter -0- 0. 0.
6 Subtract line 5 from line 2. If zero or less, enter -0- 0. 0.
7 Net long-term capital gain:
a Enter the gain from line 15 of Schedule D
as refigured for the AMT 0.
b Enter the gain from line 16 of Schedule D
c Enter the smaller of line 7a or line 7b 0. 0.
8 Enter the smaller of line 3 or line 4
9 Subtract line 8 from line 7c. If zero or less, enter -0- 0. 0. 0.
10 Add lines 6 and 9 0. 0.
A Enter the amount from Form 6251, line 30. 0.
B Capital gain excess. Subtract line A from line 10. * 0.
11 Total 28% rate and unrecaptured section 1250 gain:
a Enter the gain from line 18 of Schedule D
b Enter the gain from line 19 of Schedule D
as refigured for the AMT
c Add lines 11a and 11b 0.
12 Enter the smaller of line 9 or line 11c 0.
13 Subtract line 12 from line 10. Also enter this amount
on Form 6251, line 37. 0.
* Capital gain excess applies only if filing Form 2555, Foreign Earned Income.
Form 6251 Alternative Minimum Tax Worksheet 2015
Taxable Income ' Line 1

1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41.
Otherwise, enter the amount from Form 1040, line 38. (If less than zero,
enter as a negative amount.) 1 19,010.
2 Additions to income 2
3 Add lines 1 and 2 3 19,010.
4 Subtractions from income 4
5 Subtract line 4 from line 3. Enter on Form 6251, line 1 5 19,010.
Taxes ' Line 3

1 Generation skipping transfer taxes included on Schedule A, line 8 1
Home Mortgage Interest Adjustment ' Line 4

(a) (b) (c)
NOT Total
Deductible Deductible Home
for AMT for AMT Mortgage
Purposes Purposes Interest
1 Attributable to mortgage used to purchase, build, or

improve:
a Main home or second home that is house, apartment,
condominium or non-transient mobile home
b Second home that is transient mobile home or boat
c Total
2 Attributable to mortgage used to refinance:
a To pay off mortgage
b For other purposes
c Total
3 Attributable to other mortgage deductible for AMT:
a Pre-July 1, 1982 mortgage
4 Total column (a)

5 Total column (b). Enter result on Form 6251, line 4.
6 Total mortgage interest from Schedule A
Refund of Taxes ' Line 7

1 Taxable refund of state and local income tax 1 0.
2 Amount and description of any refund of state and local personal property
taxes, foreign income or real property taxes deducted after 1986 2
3 Total tax refund adjustment. Enter on Form 6251, line 7 3 0.
Alternative Tax Net Operating Loss Deduction (ATNOLD) ' Line 11
1 Alternative minimum taxable income (AMTI) without ATNOLD 1 19,010.

2 Enter adjustments 2
3 Adjustment for domestic production activities deduction 3
4 Adjusted AMTI without ATNOLD. Add lines 1-3 4 19,010.
5 ATNOLD limitation. Multiply line 4 by 90% 5 17,109.
6 Enter ATNOL carried to 2014 from other year(s) 6
7 Enter ATNOL included above attributable to qualified disaster losses 7
8 ATNOL above not attributable to qualified disaster losses. Line 6 minus 7 8
9 ATNOL deduction other than qualified disaster losses. Lesser of line 5 or 8 9
10 ATNOL Disaster Deduction. Lesser of line 7 or (line 4 minus line 9) 10
11 ATNOLD. Add lines 9 and 10. Enter on Form 6251, line 11, as neg 11
Incentive Stock Options ' Line 14
1 Incentive stock options adjustment from Schedule K-1 worksheets 1

2 Incentive stock options from Employer Stock Transaction Worksheets 2
3 Incentive stock options from Exercise of Stock Options Worksheets 3
4 Other incentive stock options 4
5 Total incentive stock options. Enter on Form 6251, line 14 5
Alternative Minimum Taxable Income ' Line 28
If married filing separately and Form 6251, line 28, is more than $246,250:
1 Alternative minimum taxable income, Form 6251 1
2 Threshold amount 2
5 Smaller of line 4 or $41,700 5
6 Add line 1 and line 5. Enter on Form 6251, line 28 6
Exemption ' Line 29
1 Enter $53,600 if single or head of household, $83,400 if married filing jointly

or qualifying widow(er), $41,700 if married filing separately 1 83,400.
2 Enter your alternative minimum taxable income from Form 6251, line 28 2 19,010.
3 Enter $119,200 if single or head of household, $158,900 if married filing
jointly or qualifying widow(er), $79,450 if married filing separately 3 158,900.
4 Subtract line 3 from line 2. If zero or less, enter -0- 4 0.
5 Multiply line 4 by 25% (.25) 5 0.
6 Subtract line 5 from line 1. If zero or less, enter -0- 6 83,400.
If any of the three conditions under Certain Children Under Age 24 apply, go
to line 7. Otherwise, enter this amount on Form 6251, line 29.
7 Minimum exemption amount for certain children under age 24 7
8 a Enter the child’s earned income, if any 8a
b Enter any adjustments b
9 Add lines 7, 8a and 8b. If zero or less, enter -0- 9
10 Enter the smaller of line 6 or line 9 here and on Form 6251, line 29. 10
Form 6251 Foreign Earned Income 2015
Line 31 Alternative Minimum Tax Worksheet

1 Enter amount from Form 6251, line 30 1

2 a Enter amount from Form(s) 2555, lines 45 and 50 2a
b Enter the total amount of any itemized deductions or exclusions you could not
claim because they are related to excluded income 2b
c Subtract line 2b from line 2a. If zero or less, enter 0 2c
3 Add line 1 and line 2c. Enter the result here and on Form 6251 line 36 3
4 Tax on amount on line 3
? If you reported capital gain distributions directly on Form 1040, line 13; or
you reported qualified dividends on Form 1040, line 9b; or you had a gain
on both line 15 and 16 of Schedule D (Form 1040), enter the amount from
line 3 of this worksheet on Form 6251, line 36. Complete the rest of Part III
of Form 6251. However, before completing Part III, see Form 2555 to see
if you must complete Part III with certain modifications. Then enter the
amount from Form 6251, line 64 here.
? All Others: If line 3 is $185,400 or less ($92,700 or less if married filing
separately), multiply line 3 by 26% (.26). Otherwise, multiply line 3 by 28%
(.28) and subtract $3,708 ($1,854 if married filing separately) from
the result. 4
5 Tax on amount on line 2c. If line 2c is $185,400 or less ($92,700 or less if
married filing separately), multiply line 2c by 26% (.26). Otherwise, multiply
line 2c by 28% (.28) and subtract $3,708 ($1,854 if married filing separately)
from the result 5
6 Subtract line 5 from line 4. Enter here and on Form 6251, line 31. If zero or
less, enter 0 6
Federal Carryover Worksheet 2015

2014 State and Local Income Tax Information (See Tax Help)
(a) (b) (c) (d) (e) (f) (g)

State or Paid With Estimates Pd Total With- Paid With Total Over- Applied
Local ID Extension After 12/31 held/Pmts Return payment Amount
AZ 100.
Totals 100.
Other Tax and Income Information 2014 2015
1 Filing status 1 2 MFJ 2 MFJ

2 Number of exemptions for blind or over 65 (0 - 4) 2
3 Itemized deductions 3 0. 400.
4 Check box if required to itemize deductions 4
5 Adjusted gross income 5 19,256. 19,010.
6 Tax liability for Form 2210 or Form 2210-F 6 0. 0.
7 Alternative minimum tax 7
8 Federal overpayment applied to next year estimated tax 8
QuickZoom to the IRA Information Worksheet for IRA information
Excess Contributions 2014 2015
9a Taxpayer’s excess Archer MSA contributions as of 12/31 9a

b Spouse’s excess Archer MSA contributions as of 12/31 b
10 a Taxpayer’s excess Coverdell ESA contributions as of 12/31 10 a
b Spouse’s excess Coverdell ESA contributions as of 12/31 b
11 a Taxpayer’s excess HSA contributions as of 12/31 11 a
b Spouse’s excess HSA contributions as of 12/31 b
Loss and Expense Carryovers 2014 2015

Note: Enter all entries as a positive amount
12 a Short-term capital loss 12 a

b AMT Short-term capital loss b
13 a Long-term capital loss 13 a
b AMT Long-term capital loss b
14 a Net operating loss available to carry forward 14 a
b AMT Net operating loss available to carry forward b
15 a Investment interest expense disallowed 15 a
b AMT Investment interest expense disallowed b
16 Nonrecaptured net Section 1231 losses from: a 2015 16 a
b 2014 b
c 2013 c
d 2012 d
e 2011 e
f 2010 f
Federal Carryover Worksheet page 2 2015
Loss and Expense Carryovers (cont’d) 2014 2015
17 AMT Nonrecap’d net Sec 1231 losses from: a 2015 17 a

b 2014 b
c 2013 c
d 2012 d
e 2011 e
f 2010 f
Credit Carryovers 2014 2015
18 General business credit 18

19 Adoption credit from: a 2015 19 a
b 2014 b
c 2013 c
d 2012 d
20 Mortgage interest credit from: a 2015 20 a
b 2014 b
c 2013 c
d 2012 d
21 Credit for prior year minimum tax 21
22 District of Columbia first-time homebuyer credit 22
23 Residential energy efficient property credit 23
Other Carryovers 2014 2015
24 Section 179 expense deduction disallowed 24

25 Excess a Taxpayer (Form 2555, line 46) 25 a
foreign b Taxpayer (Form 2555, line 48) b
housing c Spouse (Form 2555, line 46) c
deduction: d Spouse (Form 2555, line 48) d
Charitable Contribution Carryovers
26 2014 Carryover of Other Property Capital Gain

charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%
a 2014
b 2013
c 2012
d 2011
e 2010
27 2015 Carryover of Other Property Capital Gain

charitable contributions
from: (a) 50% (b) 30% (c) 30% (d) 20%
a 2015
b 2014
c 2013
d 2012
e 2011
28 Amount overpaid less earned income credit 0.
2014 State Capital Loss Carryovers (For users not transferring from the prior year)
State Short-term AMT Short-term Long-term AMT Long-term Capital Loss AMT Capital Loss
ID Capital Loss Capital Loss Capital Loss Capital Loss (combined) (combined)
for State for State for State for State for State for State
Form 8582 Modified Adjusted Gross Income Worksheet 2015

Description Amount
Income
Wages 14,271.
Interest income before Series EE bond exclusion
Dividend income
Tax refund 0.
Alimony received
Nonpassive business income or loss 5,100.
Royalty and nonpassive rental activities income or loss
Nonpassive partnership income or loss
Nonpassive S corporation income or loss
Nonpassive farm rental income or loss
Nonpassive farm income or loss
Nonpassive estate and trust income or loss
Real estate mortgage investment conduits
Business gains and losses from nonpassive activities
Capital gains and losses
Taxable IRA distributions
Taxable pension distributions
Unemployment compensation
Other income
Total income 19,371.
Adjustments
Educator expenses
Certain business expenses of reservists, performing artists, and government officials
Health savings account deduction
Moving expenses
Self-employed SEP, SIMPLE, and qualified plans
Self-employed health insurance deduction
Penalty on early withdrawals of savings
Alimony paid
Other adjustments
Total adjustments
Modified adjusted gross income 19,371.

Two-Year Comparison 2015

Income 2014 2015 Difference %
Wages, salaries, tips, etc 14,271. 14,271.

Interest and dividend income
State tax refund 0. 0. 0.
Business income (loss) 20,720. 5,100. -15,620. -75.39
Capital and other gains (losses)
IRA distributions
Pensions and annuities
Rents and royalties
Partnerships, S Corps, etc
Farm income (loss)
Social security benefits
Income other than the above
Total Income 20,720. 19,371. -1,349. -6.51
Adjustments to Income 1,464. 361. -1,103. -75.34
Adjusted Gross Income 19,256. 19,010. -246. -1.28
Itemized Deductions
Medical and dental
Income or sales tax
Real estate taxes
Personal property and other taxes 25. 25.
Interest paid
Gifts to charity 375. 375.
Casualty and theft losses
Miscellaneous
Phaseout of itemized deductions
Total Itemized Deductions 400. 400.
Standard or Itemized Deduction 12,400. 12,600. 200. 1.61
Exemption Amount 15,800. 16,000. 200. 1.27
Taxable Income 0. 0. 0.
Income tax 0. 0. 0.
Additional income taxes
Alternative minimum tax
Total Income Taxes 0. 0. 0.
Nonbusiness credits 0. 0. 0.
Business credits
Total Credits 0. 0. 0.
Self-employment tax 2,927. 721. -2,206. -75.37
Other taxes
Total Tax After Credits 2,927. 721. -2,206. -75.37
Withholding 1,188. 1,188.
Estimated and extension payments
Earned income credit 5,460. 5,548. 88. 1.61
Additional child tax credit 2,000. 2,000. 0. 0.00
Other payments
Total Payments 7,460. 8,736. 1,276. 17.10
Form 2210 penalty
Applied to next year’s estimated tax
Refund 4,533. 8,015. 3,482. 76.81
Balance Due
Current year effective tax rate -39.71 %

Tax Summary 2015
Name (s)
Total income 19,371.

Adjustments to income 361.
Adjusted gross income 19,010.
Itemized/standard deduction 12,600.
Exemption amount 16,000.
Taxable income 0.
Tentative tax 0.
Additional taxes
Alternative minimum tax
Total credits 0.
Other taxes 721.
Total tax 721.
Total payments 8,736.
Estimated tax penalty
Amount Overpaid 8,015.
Refund 8,015.
Amount Applied to Estimate
Balance due 0.
Which Form 1040 to file?

You must use Form 1040 because
you have Net Profit From Business (Schedule C-EZ).
Compare to U. S. Averages 2015
Name(s) Shown on Return Social Security No

Your 2015 adjusted gross income (AGI) 19,010.

National adjusted gross income range used below from 15,000. to 29,999.
Note: National average amounts have been adjusted for inflation. See Help for details.
Actual National
Selected Income, Deductions, and Credits Per Return Average
Salaries and wages 14,271. 21,346.

Taxable interest 856.
Tax-exempt interest 5,521.
Dividends 2,352.
Business net income 5,100. 12,897.
Business net loss 8,590.
Net capital gain 3,660.
Net capital loss 2,285.
Taxable IRA 7,646.
Taxable pensions and annuities 12,709.
Rent and royalty net income 6,397.
Rent and royalty net loss 7,248.
Partnership and S corporation net income 10,658.
Partnership and S corporation net loss 12,366.
Taxable social security benefits 2,431.
Medical and dental expenses deduction 8,505.

Taxes paid deduction 25. 3,346.
Interest paid deduction 6,868.
Charitable contributions deduction 375. 2,302.
Total itemized deductions 400. 15,632.
Child care credit 426.

Education tax credits 750.
Child tax credit 0. 458.
Retirement savings contributions credit 173.
Earned income credit 5,548. 3,645.
Other Information Actual National

Per Return Average
Adjusted gross income 19,010. 22,459.

Taxable income 0. 9,438.
Income tax 0. 1,191.
Alternative minimum tax 1,975.
Total tax liability 721. 1,325.
CUSTOMER SERVICE: 877-908-7228
Green Dot Bank
Refund Processing Agreement ("Agreement")
Name
Social Security No.
This Agreement contains important terms, conditions and disclosures about the processing of your refund by
Green Dot Bank, Member FDIC (’BANK’). Read this Agreement carefully before accepting its terms and
conditions, and print a copy and/or retain this information electronically for future reference. As used in this
Agreement, the words ’you’ and ’your’ refer to the applicant or both the applicant and joint applicant if the
2015 federal income tax return is a joint return (individually and collectively, ’Applicant’). The words ’we,’ ’us’
and ’our’ refer to BANK and Processor. The term ’Servicer’ or ’Processor’ refer to the third party processor,
Santa Barbara Tax Products Group, LLC.
1. NOTICE: No Requirement To Have BANK Process Your Refund In Order To File Electronically.
YOU UNDERSTAND THAT A REFUND PROCESSING FEE OF $ IS CHARGED TO ESTABLISH A
TEMPORARY ACCOUNT TO RECEIVE YOUR FEDERAL TAX REFUND, TO PROCESS IT, TO DEDUCT YOUR
TURBOTAX FEES FROM THAT ACCOUNT, AND TO FORWARD FUNDS TO YOU. THE REFUND PROCESSING
FEE IS NOT A LOAN; IT IS DUE TO BANK WHETHER OR NOT THE REFUND PROCESSING SERVICE
OCCURS. THIS FEE IS COLLECTED AT THE TIME THE REFUND OCCURS. YOU CAN AVOID THIS FEE AND
NOT USE THE REFUND PROCESSING SERVICE BY INSTEAD PAYING THE APPLICABLE TURBOTAX FEES
TO INTUIT BY CREDIT OR DEBIT CARD AT THE TIME YOU FILE YOUR 2015 FEDERAL INCOME TAX
RETURN AND ELECTING TO HAVE YOUR REFUND DIRECTLY DEPOSITED IN YOUR OWN BANK ACCOUNT
OR MAILED TO YOU. IF YOU DO USE THE REFUND PROCESSING SERVICE, YOU CAN EXPECT TO
RECEIVE THE PROCEEDS FROM YOUR FEDERAL TAX REFUND WITHIN 21 DAYS FROM WHEN THE IRS
ACCEPTS YOUR RETURN UNLESS THERE ARE PROCESSING DELAYS BY THE IRS. THE REFUND
PROCESSING SERVICE WILL NEITHER SPEED UP NOR DELAY YOUR FEDERAL TAX REFUND. THE COST
OF PREPARING YOUR TAX RETURN IS NOT ANY MORE OR LESS IF YOU PURCHASE THE REFUND
PROCESSING SERVICE.
2. Authorization to Release Personal Information. You authorize the Internal Revenue Service (’IRS’) to
disclose any information to BANK and Processor related to the funding of your 2015 federal tax refund.
You also authorize Intuit, as the transmitter of your electronically filed tax return, to disclose your tax return
and contact information to BANK and Processor for use in connection with the refund processing services
being provided pursuant to this Agreement and BANK and Processor to share your information with Intuit.
None of Intuit, BANK or Processor will disclose or use your tax return information for any other purpose,
except as permitted by law. BANK and Processor will not use your tax information or contact information
for any marketing purpose. For more information concerning our privacy policy please see the disclosures
at the end of this Agreement describing how BANK may use or share your personal information.
3. Summary of Terms
Expected Federal Refund $
Less Bank Refund Processing Fee $
Less TurboTax Fees $
Less Additional Products and Services Purchased $
Expected Proceeds* $
*These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a returned item and other processing fees paid to Processor as set forth in paragraphs 4 and 7 below.
4. Temporary Deposit Account Authorization. You hereby authorize BANK to establish a temporary deposit
account (’Deposit Account’) for the purpose of receiving your tax year 2015 federal tax refund from the IRS.
BANK or Servicer must receive an acknowledgement from the IRS that your return has been electronically
filed and accepted for processing before the Deposit Account can be opened. You authorize BANK
or Servicer to deduct from your Deposit Account the following amounts: (i) the refund processing fee;
(ii) the fees and charges related to the preparation, processing and transmission of your tax return (TurboTax
Fees); and (iii) amounts to pay for additional products and services purchased plus applicable taxes. You
also authorize BANK to deduct twenty dollars ($20) as a returned item processing fee from your Deposit
Account in the event that your deposit is returned or you provide incorrect bank account or routing
Page 2
information, as set forth in the Note in paragraph 7 below. This fee shall be paid by BANK to Processor.
You authorize BANK and Processor to disburse the balance of the Deposit Account to you after making all
authorized deductions or payments. If the Deposit Account does not have sufficient funds to pay the
TurboTax fees and the fees for Additional Products and Services Purchased as set forth in Section 3, (a)
you authorize BANK and/or Processor to automatically deduct such fees (or any portion thereof) via ACH,
electronic check, or wire transfer directly from the account or card in which you authorized BANK to deposit
your Expected Proceeds as set forth in Section 7, and (b) if you made alternative arrangements with
TurboTax for payment of such fees, those arrangements will be attempted prior to any automatic deduction.
5. Acknowledgements. (a) You understand that: (i) neither BANK nor Processor can guarantee the amount
of your tax year 2015 federal tax refund or the date it will be issued, and (ii) neither BANK nor Processor is
affiliated with the transmitter of the tax return (Intuit) and neither warrants the accuracy of the software
used to prepare the tax return. (b) You agree that Intuit is not acting as your agent and is not under any
fiduciary duty with respect to the processing of your refund by BANK and Processor. (c) Your refund may
be held or returned to the IRS if it is suspected of fraud or identity theft.
6. Truth in Savings Disclosure. The Deposit Account is being opened for the purpose of receiving your
(both spouses if this is a jointly filed return) tax year 2015 federal tax refund. Processor and BANK will
deduct the fees set forth in Section 3 including $ for opening and maintaining the Deposit Account
and processing your refund. No other deposits may be made to the Deposit Account. No withdrawals will be
allowed from the Deposit Account except as provided in Section 4. No interest is payable on the deposit;
thus, the annual percentage yield and interest rate are 0%. The Deposit Account will be closed after all
authorized deductions have been made and any remaining balance has been disbursed to you. We will also
charge a Return Item Fee of $20 if the refund cannot be delivered as directed in Section 4 of this
application. An Account Research and Legal Processing fee of $25 may be charged if we are required to
provide additional processing to return the funds to the IRS. These fees will be paid by Bank to the
Processor. Questions or concerns about the Deposit Account should be directed to: Green Dot Bank,
c/o Santa Barbara Tax Products, Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, CA 92037
or via the Internet at http://sbtpg.com.
7. Disbursement Method: You agree that the disbursement method selected below will be used by
BANK to disburse funds to you.
a) Direct Deposit to Prepaid Debit Card: If you choose this option, you authorize BANK to transfer
the balance of your Deposit Account to the financial institution that supports your prepaid debit card,
so that the financial institution may deposit the balance of your refund, as directed by you, on the
respective prepaid debit card you have selected. Additional fees may be charged for the use of the
card. Please review the cardholder agreement associated with the use of your prepaid debit card
provided by the participating financial institution to learn of other fees, charges, terms and conditions
that will apply. Neither BANK nor Processor will be responsible for your funds once they have been
deposited with the respective financial institution.
b) Direct Deposit to Checking or Savings Account: If you choose this option, the balance of your
Deposit Account will be disbursed to you electronically by ACH Direct Deposit to your personal bank
account designated below. If a joint return is filed, the bank account may be a joint account or the
individual account of either spouse.
DIRECT DEPOSIT ACCOUNT TYPE:

Checking
Savings
RTN #
Account #
Note: To ensure that there are no delays in receiving your refund, please contact your financial
institution to confirm that you are using the correct RTN (routing) and account number. If you or your
representative enter your account information incorrectly and your deposit is returned to BANK, the
Deposit Account balance minus a $20 returned item processing fee will be disbursed to you via a
cashier’s check mailed to your physical address of record. The BANK, the Processor and Intuit are not
responsible for the misapplication of a direct deposit that results from error, negligence or malfeasance
on the part of you or your representative. In cases where the BANK has received your federal tax
refund but is unable to deliver the funds directly to you, funds may be held at the BANK until claimed,
or returned to the IRS or State of residency. Additional return item and processing fees may be
deducted from the Deposit Account for federal tax refunds that continue to be undeliverable and
unclaimed and must be returned to the IRS or State. The amount of additional processing fees will be
determined by the efforts required and the complexity of the transaction but will not exceed $25.
Processing fees will be paid by BANK to Processor.
Page 3
You must notify BANK in writing 3 business days prior to the account being debited to revoke the
authorization for applicable fees agreed to in Section 4, and to afford BANK a reasonable opportunity
to act on your request. You may notify us in writing at: Green Dot Bank, c/o Santa Barbara Tax
Products Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037.
8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES: In case of errors or questions about
electronic transfers into the Deposit Account, write Green Dot Bank, c/o Santa Barbara Tax Products
Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037 or telephone
(877) 908-7228 and provide your name, a description or explanation of the error, and the dollar amount of
the suspected error. We will determine whether an error occurred within 10 business days after we hear
from you and will correct any error promptly. If we need more time, however, we may take up to 45 days
to investigate your complaint or question. If we decide to do this, we will credit your Deposit Account
within 10 business days for the amount you think is in error, so that you will have the use of the money
during the time it takes us to complete our investigation. If we ask you to put your complaint or question
in writing and we do not receive it within 10 business days, we may not credit your Deposit Account.
For errors involving new accounts, we may take up to 90 days to investigate your complaint or question.
For new accounts, we may take up to 20 business days to credit your Deposit Account for the amount
you think is in error. We will tell you the results within three business days after completing our
investigation. If we decide that there was no error, we will send you a written explanation. You may ask
for copies of the documents that we used in our investigation.
Business Days: Our business days are Monday through Friday, excluding federal holidays. Saturday,
Sunday, and federal holidays are not considered business days, even if we are open.
Confidentiality: We will disclose information to third parties about your account or the transfers you make:
? To complete transfers as necessary;

? To verify the existence and condition of your account upon the request of a third party, such as a credit
bureau or merchant;
? To comply with government agency or court orders;
? If you give us your written permission; or
? As explained in the Privacy section of this disclosure
Our Liability: If we do not complete a transfer to your account on time or in the correct amount according
to this Agreement, BANK or Processor may be liable for your losses or damages. In addition to all other
limitations of liability set forth in this Agreement, we will not be liable to you if, among other things:
? Circumstances beyond our control (natural disasters, such as fire or flood) prevent the transfer, despite
reasonable precautions that have been taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.
9. Compensation. In addition to any fees paid directly by you to Intuit, BANK or Processor will deliver a
portion of the refund processing fee to Intuit in consideration of Intuit’s provision of various
programming, testing, data processing, transmission, systems maintenance, status reporting and other
software, technical and communications services. Processor will pay compensation to BANK for its
banking services and will retain a portion of the refund processing fee for its services.
10. Governing Law. The enforcement and interpretation of this Agreement and the transactions
contemplated herein shall be governed by the laws of the United States, including the Electronic Signatures
in Global and National Commerce Act, and, to the extent state law applies, the substantive law of Ohio.
Page 4
11. Arbitration Provision. This arbitration provision is made pursuant to a transaction involving interstate
commerce and shall be governed by the Federal Arbitration Act. You agree that any and all disputes which
in any way arise out of or relate to this Agreement, shall be resolved solely by binding arbitration before the
American Arbitration Association (’AAA’) before a single arbitrator in arbitration commenced as close as
possible to where you reside. Any and all disputes must be brought in the parties’ individual capacity, and
not as a plaintiff or class member in any purported class or representative proceeding. Judgment on the
award rendered by the arbitrator may be entered in any court having jurisdiction thereof. Each party to any
such arbitration shall bear its own separate costs and expenses of the arbitration and shall share equally in
the charges of the AAA, including the fee of the arbitrator. However, if you are unable to pay any fee of the
AAA or the arbitrator, BANK or Processor agrees to pay those fees for you. By agreeing to arbitration, you,
BANK, and Processor are waiving each of their respective rights to file a lawsuit and proceed in court and
to have a jury trial to resolve disputes. The word ’disputes’ is given its broadest possible meaning,
and includes all claims; disputes or controversies, including without limitation any claim or attempt to set
aside this arbitration provision.
12. USA Patriot Act Disclosure. To help the government fight the funding of terrorism and money laundering
activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies
each person who opens an account. What this means for you: When we open a Deposit Account for you for
the purpose of receiving your IRS federal tax refund or if you apply for one of our products, we will ask for
your name, address, date of birth, and other information that will allow us to identify you. We may also ask
for your driver’s license information or information from other identifying documents of yours.
YOUR AGREEMENT
BANK and Processor agree to all of the terms of this Agreement. By selecting the 'I Agree' button in
TurboTax: (i) You authorize BANK and Processor to receive your 2015 federal tax refund from the IRS
and to make the deductions from your refund described in the Agreement, (ii) You agree to receive all
communications electronically in accordance with the ’Communications’ section of the Tax Year 2015
TurboTax(R) User Agreement, (iii) You consent to the release of your 2015 federal tax refund
deposit information and application information as described in Section 2 of this Agreement;
and (iv) You acknowledge that you have reviewed, and agree to be bound by, the Agreement’s terms
and conditions. If this is a joint return, selecting 'I Agree' indicates that both spouses agree to be
bound by the terms and conditions of the Agreement.
Green Dot Bank’s Privacy Policy
FACTS What does Green Dot Bank do with your personal information?
Why? Financial Companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.
What? The types of personal information that we collect and share depend on the product or service
you have with us. This can include:
? Social Security number and account balances

? Account transactions and payment history
? Transaction history and overdraft history
When you are no longer our customer, we continue to share your information as described in
this notice.
How? All Financial Companies need to share customers’ personal information to run their everyday
business. In the section below we list the reasons financial companies can share their
customers’ personal information; the reasons Green Dot Bank chooses to share
and whether you can limit the sharing.
Reasons we can share your Does Green Dot Bank Can you limit this sharing?
personal information Share?
For our everyday business purposes

such as to process your transaction,
maintain your account(s), respond to court Yes No
orders and legal investigations, or report to
credit bureaus.
For our marketing purposes ' No We don’t share

to offer our products and services to you.
For joint marketing with other No We don’t share

financial companies.
For our affiliates’ everyday

business purposes ' Yes No
information about your transactions
and experiences.

business purposes ' No We don’t share
information about your creditworthiness.
For our affiliates to market to you. No We don’t share
For non affiliates to market to you. No We don’t share
Questions? Toll Free: 1-866-795-7597 or go to www.greendot.com

Page 2
Who we are
Who is providing this notice? Green Dot Bank
What we do
How does Green Dot Bank To protect your personal information from unauthorized access
protect my and use, we use security measures that comply with federal law.
personal information? These measures include computer safeguards and secured files
and buildings.
How does Green Dot We collect personal information about you when you apply for a tax
collect my related product. This includes information in your application, such
personal information? as your name, address, social security number, income,
deductions, refund and the like. We also collect information about
your transactions with us., tax preparers and similar providers, such
as payment histories, balances due, and tax information. We may
also collect information concerning your credit history from a
consumer reporting agency.
Why can’t I limit all sharing? Federal law gives you the right to limit only:
? Sharing for affiliates everyday business purposes ' information

about your creditworthiness,
? Affiliates from using your information to market to you,
? Sharing for non affiliates to market to you.
State laws and individual companies may give you additional rights
to limit sharing.
See below for more on your rights under state law.
Definitions
Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies.
? Our affiliates include financial companies, such as

our parent bank holding company.
Non affiliates Companies not related by common ownership or control. They can
be financial or nonfinancial companies.
? Green Dot Bank does not share with non

affiliates so they can market to you.
Joint Marketing A formal joint marketing agreement between non affiliated financial
companies that together market financial products or services
to you.
? Green Dot Bank does not jointly market
Other Important Information
Depending on where you live, you may have additional privacy protections under state law.
We will comply with applicable state laws before sharing nonpublic personal information about you.
We may do this by sending a separate notice of those rights to you.
For example, if you are a resident of California or Vermont, we will not share with nonaffiliates except
for our everyday business purposes or with your consent.
sbia0912.SCR 12/01/2015
CUSTOMER SERVICE: 877-908-7228
Civista Bank
Refund Processing Agreement ("Agreement")
Name Casey M & John T Miller

Social Security No. 074-74-0348
This Agreement contains important terms, conditions and disclosures about the processing of your refund by
Civista Bank of Sandusky, OH (’BANK’). Read this Agreement carefully before accepting its terms and
conditions, and print a copy and/or retain this information electronically for future reference. As used in this
Agreement, the words ’you’ and ’your’ refer to the applicant or both the applicant and joint applicant if
2015 federal income tax return is a joint return (individually and collectively, ’Applicant’). The words ’we,’ ’us’
and ’our’ refer to BANK and Processor. The term ’Servicer’ or ’Processor’ refer to the third party processor
Santa Barbara Tax Products Group, LLC.
1. NOTICE: No Requirement To Have BANK Process Your Refund In Order To File Electronically.
YOU UNDERSTAND THAT A REFUND PROCESSING FEE OF $34.99 IS CHARGED TO ESTABLISH A
TEMPORARY ACCOUNT TO RECEIVE YOUR FEDERAL TAX REFUND, TO PROCESS IT, TO DEDUCT YOUR
TURBOTAX FEES FROM THAT ACCOUNT, AND TO FORWARD FUNDS TO YOU. THE REFUND PROCESSING
FEE IS NOT A LOAN; IT IS DUE TO BANK WHETHER OR NOT THE REFUND PROCESSING SERVICE
OCCURS. THIS FEE IS COLLECTED AT THE TIME THE REFUND OCCURS. YOU CAN AVOID THIS FEE AND
NOT USE THE REFUND PROCESSING SERVICE BY INSTEAD PAYING THE APPLICABLE TURBOTAX FEES
TO INTUIT BY CREDIT OR DEBIT CARD AT THE TIME YOU FILE YOUR 2015 FEDERAL INCOME TAX
RETURN AND ELECTING TO HAVE YOUR REFUND DIRECTLY DEPOSITED IN YOUR OWN BANK ACCOUNT
OR MAILED TO YOU. IF YOU DO USE THE REFUND PROCESSING SERVICE, YOU CAN EXPECT TO
RECEIVE THE PROCEEDS FROM YOUR FEDERAL TAX REFUND WITHIN 21 DAYS FROM WHEN THE IRS
ACCEPTS YOUR RETURN UNLESS THERE ARE PROCESSING DELAYS BY THE IRS. THE REFUND
PROCESSING SERVICE WILL NEITHER SPEED UP NOR DELAY YOUR FEDERAL TAX REFUND. THE COST
OF PREPARING YOUR TAX RETURN IS NOT ANY MORE OR LESS IF YOU PURCHASE THE REFUND
PROCESSING SERVICE.
2. Authorization to Release Personal Information. You authorize the Internal Revenue Service (’IRS’) to
disclose any information to BANK and Processor related to the funding of your 2015 federal tax refund.
You also authorize Intuit, as the transmitter of your electronically filed tax return, to disclose your tax return
and contact information to BANK and Processor for use in connection with the refund processing services
being provided pursuant to this Agreement and BANK and Processor to share your information with Intuit.
None of Intuit, BANK or Processor will disclose or use your tax return information for any other purpose,
except as permitted by law. BANK and Processor will not use your tax information or contact information
for any marketing purpose. For more information concerning our privacy policy please see the disclosures
at the end of this Agreement describing how BANK may use or share your personal information.
3. Summary of Terms
Expected Federal Refund $ 8,015.00
Less Bank Refund Processing Fee $ 34.99
Less TurboTax Fees $ 116.98
Less Additional Products and Services Purchased $
Expected Proceeds* $ 7,863.03
*These charges are itemized. This is only an estimate. The amount will be reduced by any applicable sales taxes, and if
applicable, a returned item and other processing fees paid to Processor as set forth in paragraphs 4 and 7 below.
4. Temporary Deposit Account Authorization. You hereby authorize BANK to establish a temporary deposit
account (’Deposit Account’) for the purpose of receiving your tax year 2015 federal tax refund from the IRS.
BANK or Servicer must receive an acknowledgement from the IRS that your return has been electronically
filed and accepted for processing before the Deposit Account can be opened. You authorize BANK
or Servicer to deduct from your Deposit Account the following amounts: (i) the refund processing fee;
(ii) the fees and charges related to the preparation, processing and transmission of your tax return (TurboTax
Fees); and (iii) amounts to pay for additional products and services purchased plus applicable taxes. You
also authorize BANK to deduct twenty dollars ($20) as a returned item processing fee from your Deposit
Account in the event that your deposit is returned or you provide incorrect bank account or routing
information, as set forth in the Note in paragraph 7 below. This fee shall be paid by BANK to Processor.
You authorize BANK and Processor to disburse the balance of the Deposit Account to you after making all
authorized deductions or payments. If the Deposit Account does not have sufficient funds to pay the
TurboTax fees and the fees for Additional Products and Services Purchased as set forth in Section 3, (a)
you authorize BANK and/or Processor to automatically deduct such fees (or any portion thereof) via ACH,
electronic check, or wire transfer directly from the account or card in which you authorized BANK to deposit
your Expected Proceeds as set forth in Section 7, and (b) if you made alternative arrangements with
TurboTax for payment of such fees, those arrangements will be attempted prior to any automatic deduction.
5. Acknowledgements. (a) You understand that: (i) neither BANK nor Processor can guarantee the amount
of your tax year 2015 federal tax refund or the date it will be issued, and (ii) neither BANK nor Processor is
affiliated with the transmitter of the tax return (Intuit) and neither warrants the accuracy of the software
used to prepare the tax return. (b) You agree that Intuit is not acting as your agent and is not under any
fiduciary duty with respect to the processing of your refund by BANK and Processor. (c) Your refund may
be held or returned to the IRS if it is suspected of fraud or identity theft.
6. Truth in Savings Disclosure. The Deposit Account is being opened for the purpose of receiving your
(both spouses if this is a jointly filed return) tax year 2015 federal tax refund. Processor and BANK will
deduct the fees set forth in Section 3 including $ 34.99 for opening and maintaining the Deposit Account
and processing your refund. No other deposits may be made to the Deposit Account. No withdrawals will be
allowed from the Deposit Account except as provided in Section 4. No interest is payable on the deposit;
thus, the annual percentage yield and interest rate are 0%. The Deposit Account will be closed after all
authorized deductions have been made and any remaining balance has been disbursed to you. We will also
charge a Return Item Fee of $20 if the refund cannot be delivered as directed in Section 4 of this
application. An Account Research and Legal Processing fee of $25 may be charged if we are required to
provide additional processing to return the funds to the IRS. These fees will be paid by Bank to the
Processor. Questions or concerns about the Deposit Account should be directed to: Civista Bank, c/o Santa
Barbara Tax Products, Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, CA 92037 or via
the Internet at http://sbtpg.com.
7. Disbursement Method: You agree that the disbursement method selected below will be used by
BANK to disburse funds to you.
a Direct Deposit to Prepaid Debit Card: If you choose this option, you authorize BANK to transfer
the balance of your Deposit Account to the financial institution that supports your prepaid debit card,
so that the financial institution may deposit the balance of your refund, as directed by you, on the
respective prepaid debit card you have selected. Additional fees may be charged for the use of the
card. Please review the cardholder agreement associated with the use of your prepaid debit card
provided by the participating financial institution to learn of other fees, charges, terms and conditions
that will apply. Neither BANK nor Processor will be responsible for your funds once they have been
deposited with the respective financial institution.
b X Direct Deposit to Checking or Savings Account: If you choose this option, the balance of your
Deposit Account will be disbursed to you electronically by ACH Direct Deposit to your personal bank
account designated below. If a joint return is filed, the bank account may be a joint account or the
individual account of either spouse.
DIRECT DEPOSIT ACCOUNT TYPE:

X Checking
Savings
RTN # 122105155
Account # 151705640549
Note: To ensure that there are no delays in receiving your refund, please contact your financial
institution to confirm that you are using the correct RTN (routing) and account number. If you or your
representative enter your account information incorrectly and your deposit is returned to BANK, the
Deposit Account balance minus a $20 returned item processing fee will be disbursed to you via a
cashier’s check mailed to your physical address of record. The BANK, the Processor and Intuit are not
responsible for the misapplication of a direct deposit that results from error, negligence or malfeasance
on the part of you or your representative. In cases where the BANK has received your federal tax
refund but is unable to deliver the funds directly to you, funds may be held at the BANK until claimed,
or returned to the IRS or State of residency. Additional return item and processing fees may be
deducted from the Deposit Account for federal tax refunds that continue to be undeliverable and
unclaimed and must be returned to the IRS or State. The amount of additional processing fees will be
determined by the efforts required and the complexity of the transaction but will not exceed $25.
Processing fees will be paid by BANK to Processor.
You must notify BANK in writing 3 business days prior to the account being debited to revoke the
authorization for applicable fees agreed to in Section 4, and to afford BANK a reasonable opportunity
to act on your request. You may notify us in writing at: Civista Bank, c/o Santa Barbara Tax
Products Group, LLC, 11085 North Torrey Pines Road Suite 210, La Jolla, CA 92037.
8. FEDERAL ELECTRONIC FUND TRANSFER ACT DISCLOSURES: In case of errors or questions about
electronic transfers into the Deposit Account, write Civista Bank, c/o Santa Barbara Tax Products
Group, LLC, 11085 North Torrey Pines Road, Suite 210, La Jolla, California 92037 or telephone
(877) 908-7228 and provide your name, a description or explanation of the error, and the dollar amount of
the suspected error. We will determine whether an error occurred within 10 business days after we hear
from you and will correct any error promptly. If we need more time, however, we may take up to 45 days
to investigate your complaint or question. If we decide to do this, we will credit your Deposit Account
within 10 business days for the amount you think is in error, so that you will have the use of the money
during the time it takes us to complete our investigation. If we ask you to put your complaint or question
in writing and we do not receive it within 10 business days, we may not credit your Deposit Account.
For errors involving new accounts, we may take up to 90 days to investigate your complaint or question.
For new accounts, we may take up to 20 business days to credit your Deposit Account for the amount
you think is in error. We will tell you the results within three business days after completing our
investigation. If we decide that there was no error, we will send you a written explanation. You may ask
for copies of the documents that we used in our investigation.
Business Days: Our business days are Monday through Friday, excluding federal holidays. Saturday,
Sunday, and federal holidays are not considered business days, even if we are open.
Confidentiality: We will disclose information to third parties about your account or the transfers you make:
? To complete transfers as necessary;

? To verify the existence and condition of your account upon the request of a third party, such as a credit
bureau or merchant;
? To comply with government agency or court orders;
? If you give us your written permission; or
? As explained in the Privacy section of this disclosure
Our Liability: If we do not complete a transfer to your account on time or in the correct amount according
to this Agreement, BANK or Processor may be liable for your losses or damages. In addition to all other
limitations of liability set forth in this Agreement, we will not be liable to you if, among other things:
? Circumstances beyond our control (natural disasters, such as fire or flood) prevent the transfer, despite
reasonable precautions that have been taken.
? The funds in your account are subject to legal process or other claim restricting such transfer.
9. Compensation. In addition to any fees paid directly by you to Intuit, BANK or Processor will deliver a
portion of the refund processing fee to Intuit in consideration of Intuit’s provision of various
programming, testing, data processing, transmission, systems maintenance, status reporting and other
software, technical and communications services. Processor will pay compensation to BANK for its
banking services and will retain a portion of the refund processing fee for its services.
10. Governing Law. The enforcement and interpretation of this Agreement and the transactions
contemplated herein shall be governed by the laws of the United States, including the Electronic Signatures
in Global and National Commerce Act, and, to the extent state law applies, the substantive law of Ohio.
Page 4
11. Arbitration Provision. This arbitration provision is made pursuant to a transaction involving interstate
commerce and shall be governed by the Federal Arbitration Act. You agree that any and all disputes which
in any way arise out of or relate to this Agreement, shall be resolved solely by binding arbitration before the
American Arbitration Association (’AAA’) before a single arbitrator in arbitration commenced as close as
possible to where you reside. Any and all disputes must be brought in the parties’ individual capacity, and
not as a plaintiff or class member in any purported class or representative proceeding. Judgment on the
award rendered by the arbitrator may be entered in any court having jurisdiction thereof. Each party to any
such arbitration shall bear its own separate costs and expenses of the arbitration and shall share equally in
the charges of the AAA, including the fee of the arbitrator. However, if you are unable to pay any fee of the
AAA or the arbitrator, Bank or Processor agrees to pay those fees for you. By agreeing to arbitration, you,
BANK, and Processor are waiving each of their respective rights to file a lawsuit and proceed in court and
to have a jury trial to resolve disputes. The word ’disputes’ is given its broadest possible meaning,
and includes all claims; disputes or controversies, including without limitation any claim or attempt to set
aside this arbitration provision.
12. USA Patriot Act Disclosure. To help the government fight the funding of terrorism and money laundering
activities. Federal law requires all financial institutions to obtain, verify, and record information that identifies
each person who opens an account. What this means for you: When we open a Deposit Account for you for
the purpose of receiving your IRS federal tax refund or if you apply for one of our products, we will ask for
your name, address, date of birth, and other information that will allow us to identify you. We may also ask
for your driver’s license information or information from other identifying documents of yours.
YOUR AGREEMENT
BANK and Processor agree to all of the terms of this Agreement. By selecting the 'I Agree' button in
TurboTax: (i) You authorize BANK and Processor to receive your 2015 federal tax refund from the IRS
and to make the deductions from your refund described in the Agreement, (ii) You agree to receive all
communications electronically in accordance with the ’Communications’ section of the Tax Year 2015
TurboTax(R) User Agreement, (iii) You consent to the release of your 2015 federal tax refund
deposit information and application information as described in Section 2 of this Agreement;
and (iv) You acknowledge that you have reviewed, and agree to be bound by, the Agreement’s terms
and conditions. If this is a joint return, selecting 'I Agree' indicates that both spouses agree to be
bound by the terms and conditions of the Agreement.
Civista Bank’s Privacy Policy
FACTS What does Civista Bank do with your personal information?
Why? Financial Companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.
What? The types of personal information that we collect and share depend on the product or service
you have with us. This can include:
? Social Security number and account balances

? payment history and transaction history
? overdraft history and account transactions
When you are no longer our customer, we continue to share your information as described in
this notice.
How? All Financial Companies need to share customers’ personal information to run their everyday
business. In the section below we list the reasons financial companies can share their
customers’ personal information; the reasons Civista Bank chooses to share
and whether you can limit the sharing.
Reasons we can share your Does Civista Bank Can you limit this sharing?
personal information Share?
For our everyday business purposes

such as to process your transaction,
maintain your account(s), respond to court Yes No
orders and legal investigations, or report to
credit bureaus.
For our marketing purposes ' No We don’t share

to offer our products and services to you.
For joint marketing with other No We don’t share

financial companies.

information about your transactions
and experiences.

information about your creditworthiness.
For our affiliates to market to you. No We don’t share
For non affiliates to market to you. No We don’t share
Questions? Toll Free: 800-604-9368 or go to www.civistabank.com

Who we are
Who is providing this notice? Civista Bank
What we do
How does Civista Bank To protect your personal information from unauthorized access
protect my and use, we use security measures that comply with federal law.
personal information? These measures include computer safeguards and secured files
and buildings.
How does Civista We collect personal information about you when you apply for a tax
collect my related product. This includes information in your application, such
personal information? as your name, address, social security number, income,
deductions, refund and the like. We also collect information about
your transactions with us., tax preparers and similar providers, such
as payment histories, balances due, and tax information. We may
also collect information concerning your credit history from a
consumer reporting agency.
Why can’t I limit all sharing? Federal law gives you the right to limit only:
? Sharing for affiliates everyday business purposes ' information

about your creditworthiness,
? Affiliates from using your information to market to you,
? Sharing for non affiliates to market to you.
State laws and individual companies may give you additional rights
to limit sharing.
Definitions
Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies.
? Civista Bank does not share with our affiliates.
Non affiliates Companies not related by common ownership or control. They can
be financial or nonfinancial companies.
? Civista Bank does not share with non

affiliates so they can market to you.
Joint Marketing A formal joint marketing agreement between non affiliated financial
companies that together market financial products or services
to you.
? Civista Bank does not jointly market.
Other Important Information
This Notice is adopted in recognition of our obligations under Title V of Gramm-Leach Bliley Act of 1999.
This Notice applies only to individuals who have applied for a tax-related bank product.
sbia1514.SCR 11/30/2015
ELECTRONIC POSTMARK - CERTIFICATION OF ELECTRONIC FILING
Taxpayer: Casey M & John T Miller

Primary SSN: 074-74-0348
Federal Return Submitted: February 24, 2016 03:35 PM PST

Federal Return Acceptance Date:
Your return was electronically transmitted on 02/24/2016
The Intuit Electronic Postmark shows the date and time Intuit received your federal tax return. The Intuit
Electronic Postmark documents the filing date of your income tax return, and the electronic postmark
information should be kept on file with your tax return and other tax-related documentation.
There are two important aspects of the Intuit Electronic Postmark:
1. THE INTUIT ELECTRONIC POSTMARK.

The electronic postmark shows the date and time Intuit received the federal return, and is deemed the
filing date if the date of the electronic postmark is on or before the date prescribed for filing of the
federal individual income tax return.
TIMELY FILING:
For your federal return to be considered filed on time, your return must be postmarked on or before
midnight April 18, 2016. Intuit’s electronic postmark is issued in the Pacific Time (PT) zone. If you are
not filing in the PT zone, you will need to add or subtract hours from the Intuit Electronic Postmark time
to determine your local postmark time. For example, if you are filing in the Eastern Time (ET) zone and
you electronically file your return at 9 AM on April 18, 2016, your Intuit electronic postmark will indicate
April 18, 2016, 6 AM. If your federal tax return is rejected, the IRS still considers it filed on time if the
electronic postmark is on or before April 18, 2016, and a corrected return is submitted and accepted
before April 23, 2016. If your return is submitted after April 23, 2016, a new time stamp is issued to
reflect that your return was submitted after the IRS deadline and, consequently, is no longer considered
to have been filed on time.
If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 17, 2016 If your federal tax return is rejected, the IRS will still consider it filed on time
if the electronic postmark is on or before October 17, 2016, and the corrected return is submitted and
accepted by October 22, 2016.
2. THE ACCEPTANCE DATE.

Once the IRS accepts the electronically filed return, the acceptance date will be provided by the Intuit
Electronic Filing Center. This date is proof that the IRS accepted the electronically filed return.
We need your consent - Early Access
"Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use
your tax return information for purposes other than the preparation and filing of your tax return without
your consent.
consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not
specify the duration of your consent, your consent is valid for one year from the date of signature."
bottom of the page.
Date
F7216U01 SBIA5001
bottom of the page.
Date
sbia5101 F7216D
To, enable the Tax Identity restoration protection service that you purchased as part of the MAX
bundle, we need your consent to send some of your personal information to our partner, ID Notify.
Entering your name and date below allows us to disclose the data below to ID Notify's parent
company, CSIdentity Corporation. With your consent, we will send the following:
First Name, Middle Initial, Last Name, Date of Birth, Phone Number, Street Address, City, State,
Zip, Social Security Number, Email Address, Username, and a randomly generated Subscriber Number.
bottom of the page.
I authorize Intuit to send my information listed above to CSIdentity Corporation.
Date
sbia5102 F7216D02
IMPORTANT DISCLOSURES
If you are owed a federal tax refund, you have a right to choose how you will receive the
refund. There are several options available to you. Please read about these options below.
You can file your tax return electronically or by paper and obtain your refund directly from
the IRS for free. If you file your tax return electronically, you can receive a refund check
directly from the IRS through the U.S. Postal Service in 21 to 28 days from the time you
file your tax return or the IRS can deposit your refund directly into your bank account in
less than 21 days from the time you file your tax return unless there are delays by the
IRS. If you file a paper return through the U.S. Postal Service you can receive a refund
check directly from the IRS through the U.S. Postal Service in 6 to 8 weeks from the time
the IRS receives your return or the IRS can deposit your refund directly into your bank
account in 6 to 8 weeks from the time the IRS receives your return.
You can file your tax return electronically, select the Refund Processing Service ("RPS"),
and have your federal income tax refund processed through a bank and processor. The RPS
allows your refund to be deposited into a bank account intended for one-time use at
Civista Bank of Sandusky, OH ("BANK") and deducts your TurboTax fees and other fees you
authorize from your refund. The balance is delivered to you via the disbursement method you
select. If you file your tax return electronically and select the RPS, the IRS will deposit your
refund with BANK. Upon receipt of your refund, Santa Barbara Tax Products Group, LLC ("TPG"),
a processor, will deduct and pay from your refund any fees charged by TurboTax for the
preparation and filing of your tax return and any other amounts authorized by you and
disburse the balance of your refund proceeds to you. Unless there are delays by the IRS,
refunds are received in less than 21 days from the time you file your tax return electronically.
The RPS is not necessary to obtain your refund. If you have an existing bank account,
you do not need to use the RPS in order to receive a direct deposit from the IRS. You
may consult the IRS website (irs.gov) for information about tax refund processing.
If you select the RPS, no prior debt you may owe to BANK will be deducted from your
refund.
You can change your income tax withholdings which might result in you receiving
additional funds throughout the year rather than waiting to receive these funds potentially
in a tax refund next year. Please consult your employer or tax advisors for additional
details.
Information regarding low-cost deposit accounts may be available at www.mymoney.gov .
The below chart shows the options for filing your tax return (e-file or paper return), the
RPS product, refund disbursement options, estimated timing for obtaining your tax refund
proceeds, and costs associated with the various options.
WHAT TYPE WHAT ARE YOUR WHAT IS THE WHAT COSTS DO YOU
OF FILING DISBURSEMENT ESTIMATED TIME TO INCUR IN ADDITION
METHOD? OPTIONS? RECEIVE REFUND? TO TAX PREPARATION
FEES?
PAPER RETURN IRS Direct Deposit to Approximately Free

your personal bank 6 to 8 weeks
No Refund Processing account.
Service
Check mailed by IRS Approximately
to address on tax 6 to 8 weeks
return.
ELECTRONIC IRS Direct Deposit to Usually within 21 days Free

FILING your personal bank
(E-FILE) account.
No Refund Processing Check mailed by IRS Approximately

Service to address on tax 21 to 28 days
return.
ELECTRONIC (a) Direct Deposit to Usually within Free option with your
FILING your personal bank 21 days purchase of
(E-FILE) account, or TurboTax Premium or
TurboTax MAX 2
Refund Processing (b) Load to your
Service prepaid card 1.
1You may incur additional charges from the issuer of the prepaid card if you select to have
your tax refund loaded on a prepaid card.
2The cost of TurboTax Premium and TurboTax MAX ranges depending on the edition of TurboTax
purchased. See Section 3 of the Refund Processing Agreement on the next page for the cost of the
service you have chosen.
Questions? Call 1-877-908-7228

Casey M & John T Miller 074-74-0348 1
Smart Worksheets from your 2015 Federal Tax Return
SMART WORKSHEET FOR: Form 1040: Individual Tax Return
Tax Smart Worksheet
A Tax 0.
Check if from:
1 Tax table X
2 Tax Computation Worksheet (see instructions)
3 Schedule D Tax Worksheet
4 Qualified Dividends and Capital Gain Tax Worksheet
5 Schedule J
6 Form 8615
7 Foreign Earned Income Tax Worksheet
B Additional tax from Form 8814
C Additional tax from Form 4972
D Tax from additional Form(s) 4972
E Recapture tax from Form 8863
F IRC Section 197(f)(9)(B)(ii) election for an additional tax
G Tax. Add lines A through F. Enter the result here and on line 44 0.
SMART WORKSHEET FOR: Form 8960 Deduction Recoveries Worksheet
Line 9 - Recalculated Prior Year Net Investment Income Tax Smart Worksheet
A Prior year Form 8960, line 13, modified adjusted gross income 19,256.
B Prior year Form 8960, line 14, threshold based on filing status 250,000.
C Prior year Form 8960, line 15, Subtract line B from A, not less than zero 0.
D Smaller of line 8 or line C 0.
E Recomputed net investment income tax. Multiply line D by 3.8% (.038) 0.
SMART WORKSHEET FOR: Dependent Information Worksheet (john)
Dependency Exemption/EIC Smart Worksheet

NOTE: It is recommended that you answer the questions below using the Step-by-Step mode.
That will help insure that answers to the questions are not inconsistent.
A How many months did this person live with you?

Note: if born or died in current year and lived with you entire
time or qualified missing child select "The whole year". If
more than one-half the year select 7 or more The whole year
B Who are the parents of this person?
To determine if additional questions are necessary for
children of divorced parents.
Both Taxpayer and spouse X
Taxpayer
Spouse
C Did this person provide more than 1/2 their own support? Yes X No
D Was this person married on December 31, 2015 and
filing a joint return for the year (You may answer no if the
only reason the joint return is filed is to get a refund of tax
withheld or estimated tax payments and neither spouse
would have a tax liability on their return if they filed
separate returns)? Yes No
E Is this person a Full time student? Yes No
F Is this person’s gross income less than $4,000? Yes No
1 Did you provide over 1/2 the support for this person?
or
Did you provide over 10% of the support for the person
and with other individuals who would be able to claim
the person except for the support test over 1/2 the
support and all of you have agreed that you alone will
claim the person and you have filled out the Multiple
Support Declaration, Form 2120, to attach to your return? Yes No
G Is there an agreement with this person’s other parent
about who can claim this person as a dependent? Yes No
Note: The noncustodial parent claiming the exemption for
the child must attach to their return Form 8332 from the
custodial parent releasing the claim to the exemption
for the child
H Who will be claiming this person as a dependent as a result
of
an agreement between the parents
or
as a result of the rules controlling who can claim a qualifying
child when the child meets the conditions to be a
qualifying child of more than one person?
Taxpayer (includes spouse if married filing
joint) in this return? X
Other parent in different return?
Someone else in different return?
SMART WORKSHEET FOR: Dependent Information Worksheet (MaezyJane)
Dependency Exemption/EIC Smart Worksheet

NOTE: It is recommended that you answer the questions below using the Step-by-Step mode.
That will help insure that answers to the questions are not inconsistent.
A How many months did this person live with you?

Note: if born or died in current year and lived with you entire
time or qualified missing child select "The whole year". If
more than one-half the year select 7 or more The whole year
B Who are the parents of this person?
To determine if additional questions are necessary for
children of divorced parents.
Both Taxpayer and spouse X
Taxpayer
Spouse
C Did this person provide more than 1/2 their own support? Yes X No
D Was this person married on December 31, 2015 and
filing a joint return for the year (You may answer no if the
only reason the joint return is filed is to get a refund of tax
withheld or estimated tax payments and neither spouse
would have a tax liability on their return if they filed
separate returns)? Yes No
E Is this person a Full time student? Yes No
F Is this person’s gross income less than $4,000? Yes No
1 Did you provide over 1/2 the support for this person?
or
Did you provide over 10% of the support for the person
and with other individuals who would be able to claim
the person except for the support test over 1/2 the
support and all of you have agreed that you alone will
claim the person and you have filled out the Multiple
Support Declaration, Form 2120, to attach to your return? Yes No
G Is there an agreement with this person’s other parent
about who can claim this person as a dependent? Yes No
Note: The noncustodial parent claiming the exemption for
the child must attach to their return Form 8332 from the
custodial parent releasing the claim to the exemption
for the child
H Who will be claiming this person as a dependent as a result
of
an agreement between the parents
or
as a result of the rules controlling who can claim a qualifying
child when the child meets the conditions to be a
qualifying child of more than one person?
Taxpayer (includes spouse if married filing
joint) in this return? X
Other parent in different return?
Someone else in different return?
SMART WORKSHEET FOR: Earned Income Credit Worksheet
Nontaxable Combat Pay Election Smart Worksheet
QuickZoom to enter nontaxable combat pay on Form W-2

A Taxpayer:
1 Taxpayer, nontaxable combat pay
2 Election for earned income credit (EIC):
Elect taxpayer’s nontaxable combat pay as earned income for EIC? Yes No
3 Election for dependent care benefits (DCB):
Elect taxpayer’s nontaxable combat pay as earned income for DCB? Yes No
4 Election for child and dependent care credit:
Elect taxpayer’s nontaxable combat pay as earned income
for child and dependent care credit? Yes No
B Spouse:
1 Spouse, nontaxable combat pay
2 Election for earned income credit (EIC):
Elect spouse’s nontaxable combat pay as earned income for EIC? Yes No
3 Election for dependent care benefits (DCB):
Elect spouse’s nontaxable combat pay as earned income for DCB? Yes No
4 Election for child and dependent care credit:
Elect spouse’s nontaxable combat pay as earned income
for child and dependent care credit? Yes No
C You may compare the tax benefit of electing or not electing by checking a box on line A or
line B and reviewing the overpayment or amount due below:
Overpayment 8,015. Amount due
Investment Income Smart Worksheet
A Taxable and tax exempt interest

B Dividend income
C Capital gain net income
D Royalty and rental of personal property net income
E Passive activity net income:
1 Rental real estate net income or loss
2 Farm rental net income or loss
3 Partnerships and S corporations net income or loss
4 Estates and trusts net income or loss
5 Total of lines 1 through 4
6 Total passive activity net income, line 5 if greater than zero
F Interest and dividends from Forms 8814
G Adjustments
H Total investment income, add lines A through G 0.
Is line H, total investment income over $3,400?

X No. You may take the credit.
Yes. Stop. You cannot take the credit.
Qualifying Children Smart Worksheet
Year of birth
Was the child under

age 24 at the end of Was the child Lived
2015, a student, and permanently and with
Social security younger than you totally disabled taxpayer
First name MI number (or your spouse, if during any part of in the
Last name Suff Relationship filing jointly)? 2015? U.S.
john T 764-40-3874 2004

miller Son Yes No Yes No 12
MaezyJane L 765-19-0576 2010
Miller Daughter 12
Arizona Form
AZ-8879 E-file Signature Authorization 2015

Your First Name and Initial Last Name Your Social Security Number
Enter
your
Your Spouse’s First Name and Initial (if filed joint) Last Name Spouse’s Social Security No.
SSN(s).
PART 1 – PURPOSE
• To certify the truthfulness, correctness, and completeness of the taxpayer’s electronic income tax return.
• To authorize the Electronic Return Originator (ERO) to affirm that the taxpayer wishes to use the taxpayer’s electronic signature to the taxpayer’s
federal individual income tax return as the taxpayer’s signature to the taxpayer’s electronic Arizona individual income tax return.
PART 2 – TAX RETURN INFORMATION PART 3 – FINANCIAL INSTITUTION INFORMATION

Must be present when requesting direct debit or deposit.
1 Arizona Adjusted Gross Income 14,410 00  Foreign Account Deposit/Debit: See instructions below.
2 Balance Of Tax.......................... 0 00 TYPE OF ACCOUNT ROUTING NUMBER
3 Arizona Income Tax Withheld.... 00  Checking  Savings 1 2 2 1 0 5 1 5 5

Check box 4 or box 5: ACCOUNT NUMBER
4 REFUND: Enter the amount of refund...................... 100 00 1 5 1 7 0 5 6 4 0 5 4 9

5 AMOUNT YOU OWE: Enter the amount owed......... 00 DIRECT DEBIT REQUEST DATE DIRECT DEBIT PAYMENT AMOUNT
$ .00
Box 4 Checkbox – Refund: You are due a refund based on the information Foreign Account Deposit/Debit Checkbox: Check the “Foreign Account
provided on your tax return. Your refund amount will be deposited in the Deposit/Debit” box if your deposit will be ultimately placed in or come
account listed in the Financial Institution Information Section (Part 2). from a foreign account. If you check this box, do not enter your account
Box 5 Checkbox – Amount You Owe: You owe taxes based on the numbers. If this box is checked, we will not direct deposit or debit your
information provided on your tax return. You have elected to direct debit account. If you are due a refund, we will send you a check instead. If you
for payment. The payment will be withdrawn from the account and on the owe tax, you must mail a check to the Arizona Department of Revenue,
date listed in the Financial Institution Information Section (Part 2). PO Box 52016, Phoenix, AZ 85072-2016.
PART 4 – DECLARATION AND SIGNATURE AUTHORIZATION (Sign only after completing Part 2)
Under penalties of perjury, I declare that I have examined a paper copy of my I consent to my Electronic Return Originator (ERO) or On-Line Service
electronic Arizona individual income tax return and accompanying schedules Provider (OLSP) sending my electronic Arizona individual income tax
and statements for the year ending December 31, 2015, and to the best of return and accompanying schedules and statements to DOR, and I
my knowledge and belief, it is true, correct, and complete. I further declare consent to my ERO or OLSP sending such information to DOR through a
that the amounts of Arizona adjusted gross income, total tax, Arizona income transmitter. I consent to DOR sending my ERO, OLSP and/or transmitter
tax withheld, and refund (or amount owed) listed above are the amounts an acknowledgement of receipt of transmission and an indication of
shown on the paper copy of my electronic Arizona income tax return. whether or not the transmission of my return is accepted and, if the return
is rejected, the reason(s) for the rejection. If the processing of my return
6a 
I consent that my refund be directly deposited as designated in the
or refund is delayed, I authorize DOR to disclose to my ERO, OLSP and/or
electronic portion of my 2015 Arizona individual income tax return.
If I have filed a joint return, this is an irrevocable appointment of transmitter the reason(s) for the delay, or when the refund was sent. If
the other spouse as an agent to receive the refund. DOR contacts my ERO for a copy of my return, any documents or schedules
to my return, and/or this authorization form, I authorize my ERO to release

6b I do not want direct deposit of my refund or I am not receiving a copies of the requested documents to DOR.
refund.
6c 
I authorize the Arizona Department of Revenue (DOR) and its
designated Financial Agent to initiate an ACH electronic funds I authorize Self-Prepared
withdrawal (direct debit) entry to the financial institution account (ELECTRONIC RETURN ORIGINATOR)
indicated in the tax preparation software for payment of my Arizona
taxes owed on this return. I also authorize the financial institutions to make the election that I want my electronic signature to my electronic
involved in the processing of the electronic payment of taxes to federal individual income tax return to serve as my signature to my
receive confidential information necessary to answer inquiries and electronic Arizona individual income tax return for the year ending
resolve issues related to the payment. December 31, 2015. I understand that when my ERO makes the election
that my electronic signature to my federal individual income tax return will
If I have filed a balance due return, I understand that if the DOR does not
serve as my signature to my Arizona individual income tax return, I will
receive full and timely payment of my tax liability by April 15, 2016, I will
have signed my Arizona individual income tax return and declared under
remain liable for the tax liability and all applicable interest and penalties.
penalties of perjury that to the best of my knowledge and belief the return
When electronically filing my federal and state tax returns, I understand
is true, correct and complete.
that if there is an error on my federal return, the electronic portion of my
state return will also be rejected.

PLEASE SIGN HERE

YOUR PEN AND INK SIGNATURE DATE

SPOUSE’S PEN AND INK SIGNATURE DATE
Do not mail this form to the Arizona Department of Revenue. The ERO must retain this document a minimum of four years.
ADOR 10549 (15) REV 12/02/15 Intuit.cg.cfp.sp
1555
DO NOT STAPLE ANY ITEMS TO THE RETURN. Arizona Form FOR CALENDAR YEAR
Resident Personal Income Tax Return 2015
Check box 82F
140
82F if filing under extension OR FISCAL YEAR BEGINNING AND ENDING . 66F
Your First Name and Middle Initial Last Name Your Social Security Number
Enter
1 Casey M Miller 074-74-0348
your
Spouse’s First Name and Middle Initial (if box 4 or 6 checked) Last Name Spouse’s Social Security No.
SSN(s).
1 John T Miller 600-62-4188
Current Home Address - number and street, rural route Apt. No. Daytime Phone (with area code)
2 4724 W Desert Hills Dr 94
City, Town or Post Office State ZIP Code Last Names Used in Last Four Prior Year(s) (if different)
3 Glendale AZ 85304 97
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

EXEMPTIONS FILING STATUS
4 Married filing joint return

88
5  Head of household: Enter name of qualifying child or dependent on next line:
6  Married filing separate return: Enter spouse’s name and Social Security Number above.
7  Single
 Enter the number claimed. Do not put a check mark.
8 Age 65 or over (you and/or spouse) If completing lines 8
9 Blind (you and/or spouse) 81 PM 80 RCVD
through 11, also complete
10 2 Dependents: Do not include self or spouse.
lines 38 through 41.
11 Qualifying parents and grandparents
(Box 10): Dependent Information: Children and other dependents. For more space, (check)  and complete page 3.
(a) (b) (c) (d) (e) (f)
FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS
LIVED IN YOUR
 if this person  if you did not claim
(Do not list yourself or spouse.) did not qualify as a this person on your
HOME IN 2015 dependent on your federal return due to
federal return educational credits
10a john T miller 764-40-3874 Son 12  

Dependents
10b MaezyJane L Miller 765-19-0576 Daughter 12  

10c  
(Box 11): Qualifying parents and grandparents. See instructions. For more space, (check)  and complete page 3.
Place any required federal and AZ schedules or other documents after Form 140.
(a) (b) (c) (d) (e) (f)

FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS
(Do not list yourself or spouse.) LIVED IN YOUR  if  if
age 65 or over died in 2015
HOME IN 2015
11a  
11b  
12 Federal adjusted gross income (from your federal return).................................................................................... 12 19,010 00
13 Non-Arizona municipal interest.................................................................................................................................... 13 00
00
Additions
14 Partnership Income: See instructions............................................................................................................................. 14

15 Total federal depreciation............................................................................................................................................. 15 00
16 Other additions to income: See instructions and include your own schedule....................................................................... 16 00
17 Subtotal: Add lines 12 through 16 and enter the total........................................................................................................ 17 19,010 00
18 Total net capital gain or (loss): See instructions...................................................................... 18 00
19 Total net short-term capital gain or (loss): See instructions..................................................... 19 00
20 Total net long-term capital gain or (loss): Enter the amount from your worksheet, line 14, col. (a) 20 00
21 Net long-term capital gain from assets acquired after December 31, 2011. Enter the
amount from your worksheet, line 14, col. (c)................................................................................ 21 00
22 Multiply line 21 by 25% (.25) and enter the result........................................................................................................ 22 00
23 Net capital gain derived from investment in qualified small business.......................................................................... 23 00
24 Recalculated Arizona depreciation............................................................................................................................... 24 00
This box may be blank or may contain a printed barcode of data from your return.
00
Subtractions
25 Partnership Income: See instructions.......... 25

26 Adjustment for I.R.C. §179 expense not allowed.. 26 00
27 Interest on U.S. obligations........................ 27 00
28 Exclusion for fed., AZ state or local govt. pensions. 28 00
29 Arizona state lottery winnings on federal return.. 29 00
30 U.S. Social Security or Railroad Retirement Act 30 00
31 Certain wages of American Indians............ 31 00
32 Pay received for being an active service member. 32 00
33 Net operating loss adjustment.................... 33 00
34 Contributions to 529 College Savings Plans....... 34 00
35 Other Subtractions: See instructions............ 35 00
36 Subtract lines 22 through 35 from line 17.. 36 19,010 00
ADOR 10413 (15) 1555 AZ Form 140 (2015) REV 12/07/15 Intuit.cg.cfp.sp Page 1 of 3
Your Name (as shown on page 1) Your Social Security Number
37 Enter the amount from page 1, line 36............................................................................................................................ 37 19,010 00
38 Age 65 or over: Multiply the number in box 8 by $2,100........................................................................................................ 38 00
Exemptions
39 Blind: Multiply the number in box 9 by $1,500....................................................................................................................... 39 00

40 Dependents: Multiply the number in box 10 by $2,300.......................................................................................................... 40 4,600 00
41 Qualifying parents and grandparents: Multiply box 11 by $10,000...................................................................................... 41 00
42 Arizona adjusted gross income: Subtract lines 38 through 41 from line 37....................................................................... 42 14,410 00
43 Deductions: Check box and enter amount. See instructions......................... 43I ITEMIZED 43S STANDARD 43 10,173 00
44 Personal exemptions: See instructions............................................................................................................................. 44 6,300 00
45 Arizona taxable income: Subtract lines 43 and 44 from line 42............................................................................................. 45 -2,063 00
Balance of Tax
46 Compute the tax using amount on line 45 and Tax Table X, Y or Optional Tax Tables.................................................... 46 0 00
47 Tax from recapture of credits from Arizona Form 301, Part 2, line 40............................................................................. 47 00
48 Subtotal of tax: Add lines 46 and 47 and enter the total........................................................................................................ 48 0 00
49 Family income tax credit (from the worksheet - see instructions)........................................................................................... 49 160 00
50 Credits from Arizona Form 301, Part 2, line 76............................................................................................................... 50 00
51 Balance of tax: Subtract lines 49 and 50 from line 48. If the sum of lines 49 and 50 is more than line 48, enter zero................... 51 0 00
52 Arizona income tax withheld during 2015........................................................................................................................ 52 00
00
Total Payments and
Refundable Credits
53 Arizona estimated tax payments for 2015....................................................................................................................... 53

54 2015 Arizona extension payment (Form 204)................................................................................................................. 54 00
55 Increased Excise Tax Credit (from the worksheet - see instructions)..................................................................................... 55 100 00
56 Property Tax Credit from Form 140PTC.......................................................................................................................... 56 00
57 Other refundable credits: Check the box(es) and enter the total amount........................ 571308-I 572342 573349 57 00
58 Total payments and refundable credits: Add lines 52 through 57 and enter the total........................................................ 58 100 00
59 TAX DUE: If line 51 is larger than line 58, subtract line 58 from line 51 and enter amount of tax due. Skip lines 60, 61 and 62......... 59 00
Overpayment
Tax Due or
60 OVERPAYMENT: If line 58 is larger than line 51, subtract line 51 from line 58 and enter amount of overpayment......................... 60 100 00
61 Amount of line 60 to be applied to 2016 estimated tax................................................................................................... 61 0 00
62 Balance of overpayment: Subtract line 61 from line 60 and enter the difference..................................................................... 62 100 00
Solutions Teams
63 - 72 Voluntary Gifts to: Assigned to Schools............ 63 00 Arizona Wildlife................ 64 00
Voluntary Gifts
Child Abuse Prevention............ 65 00 Domestic Violence Shelter.. 66 00 Political Gift..................... 67 00

Neighbors Helping Neighbors.. 68 00 Special Olympics................. 69 00 Veterans’ Donations Fund.70 00
Sustainable State Parks
I Didn’t Pay Enough Fund........ 71 00 and Road Fund.................... 72 00
73 Political Party (if amount is entered on line 67 - check only one): 731Americans Elect 732AZ Green Party 733Democratic 734Libertarian 735 Republican
74 Estimated payment penalty and Arizona Long-Term Health Care Savings Account (AZLTHSA) penalty....................... 74 00
Penalty
75 751Annualized/Other 752Farmer or Fisherman 753Form 221 included 754AZLTHSA Penalty
76 Add lines 63 through 72 and 74; enter the total.............................................................................................................. 76 00

77 REFUND: Subtract line 76 from line 62. If less than zero, enter amount owed on line 78........................................................... 77 100 00
Amount Owed
Direct Deposit of Refund: Check box 77A if your deposit will be ultimately placed in a foreign account; see instructions. 77A
Refund or
ROUTING NUMBER ACCOUNT NUMBER

C  Checking or
98 1 2 2 1 0 5 1 5 5 1 5 1 7 0 5 6 4 0 5 4 9 S  Savings
78 AMOUNT OWED: Add lines 59 and 76. Make check payable to Arizona Department of Revenue; write your SSN on payment,
and include with your return.................................................................................................................................................. 78 00
Under penalties of perjury, I declare that I have read this return and any documents with it, 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.
PLEASE SIGN HERE
 data
entry operator
YOUR SIGNATURE DATE OCCUPATION
 engineer

SPOUSE’S SIGNATURE DATE SPOUSE’S OCCUPATION
Self
Prepared
PAID PREPARER’S SIGNATURE DATE FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

PAID PREPARER’S STREET ADDRESS PAID PREPARER’S TIN

PAID PREPARER’S CITY STATE ZIP CODE PAID PREPARER’S PHONE NUMBER
If you are also sending a payment, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ 85072-2016 (PO Box 29204, Phoenix, AZ 85038-9204 if your return has a barcode).
If you are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ 85072-2138 (PO Box 29205, Phoenix, AZ 85038-9205 if your return has a barcode).
ADOR 10413 (15) 1555 AZ Form 140 (2015) REV 12/07/15 Intuit.cg.cfp.sp
Page 2 of 3
Arizona Form
Credit for Contributions Made or
322 Fees Paid to Public Schools 2015
Include with your return.
 Do not use this form for contributions to private school tuition organizations.
 See Form 323 for contributions to private school tuition organizations.
For the calendar year 2015 or fiscal year beginning 2 0 1 5 and ending 2 0 .
Your Name as shown on Form 140, 140NR, 140PY or 140X Your Social Security Number
Casey M Miller
074-74-0348
Spouse’s Name as shown on Form 140, 140NR, 140PY or 140X (if joint return) Spouse’s Social Security Number
John T Miller
600-62-4188
Part 1 Current Year’s Credit

Donations made during 2015; if you made cash contributions or paid fees to more than three public schools, include a
separate schedule.
(a) (b) (c) (d)
Name of Public School School District Name Location of Public School Contribution
to which you made contributions or paid fees: and Number (City, State) Made or Fees Paid
1 Arroyo Elementary School Washington Elementary School District 4535 W Cholla St Glendale AZ 85304 375 00
2 00
3 00
4 Total cash contributions made or fees paid to public schools in Arizona during 2015: Add the
amounts in column (d) of lines 1, 2, and 3. Also, add any amount included on a separate schedule. 4 375 00
Donations made from January 1, 2016 through April 18, 2016 for which you are claiming a credit on your 2015 return; if you
made cash contributions or paid fees to more than three public schools, include a separate schedule.
(a) (b) (c) (d)
Name of Public School School District Name Location of Public School Contribution
to which you made contributions or paid fees: and Number (City, State) Made or Fees Paid
5 00
6 00
7 00
8 Total cash contributions made or fees paid to public schools in Arizona from January 1, 2016
through April 18, 2016: Add the amounts in column (d) of lines 5, 6, and 7. Also, add any amount
included on a separate schedule........................................................................................................... 8 0 00
9 Add lines 4 and 8. Enter the total......................................................................................................... 9 375 00
10 Single taxpayers or heads of household, enter $200. Married taxpayers, enter $400......................... 10 400 00
11 Current year’s credit: Enter the smaller of line 9 or line 10. In most cases, if you are married filing a
separate return, enter one-half of the smaller of line 9 or line 10. See instructions............................. 11 375 00
Continued on page 2 
ADOR 10941 (15) REV 12/08/15 Intuit.cg.cfp.sp

1555
Your Name (as shown on page 1) Your Social Security Number
074-74-0348 600-62-4188
Part 2 Available Credit Carryover

(a) (b) (c) (d)
Taxable Year Original Credit Amount Amount Previously Used Available Carryover:
from which you are Subtract column (c)
carrying the credit from column (b).
12 2010 00 00 00
13 2011 00 00 00
14 2012 00 00 00
15 2013 00 00 00
16 2014 00 00 00
17 TOTAL AVAILABLE CARRYOVER: Add lines 12 through 16, column (d)..... 00
Part 3 Total Available Credit

18 Current year’s credit: Enter the amount from Part 1, line 11.
Also, enter this amount on Arizona Form 301, Part 1, line 13, column (a)............................................ 18 375 00
19 Available credit carryover from Part 2, line 17, column (d).
Also, enter this amount on Arizona Form 301, Part 1, line 13, column (b)............................................ 19 00
20 Total Available Credit: Add line 18 and line 19.
Also, enter this amount on Arizona Form 301, Part 1, line 13 column (c)............................................. 20 375 00
REV 12/08/15 Intuit.cg.cfp.sp

1555
ADOR 10941 (15) AZ Form 322 (2015) Page 2 of 2
Form 140 Additional Dependents Worksheet 2015
Keep for your records

Type Date Social No.

of First Name Last Name of security Relationship mos
Dep birth number in
(mm/dd/yyyy) home
Stillborn Certificate Number Deceased
D john T miller 03/19/2004 764-40-3874 Son 12
D MaezyJane L Miller 07/26/2010 765-19-0576 Daughter 12
Enter additional dependents below
Type Date Social No.

of First Name Last Name of security Relationship mos
Dep birth number in
(mm/dd/yyyy) home
Stillborn Certificate Number Deceased
Dependent Information:
In the 'Type of Dep' column above, select the appropriate code for each dependent listed:
D ' Dependent (Default)
A ' Parent/Ancestor (65 or over, lived 12 months in taxpayer home)
O ' Dependent on AZ only (65 or older, not claimed on federal return)
E ' Dependent on AZ only (student not claimed on federal return to allow federal education credits)
S ' Dependent on AZ only (Stillborn)
N ' N/A (Not a qualified dependent), exclude dependent from tax return
See the government instructions on a main form, dependent section, for more information.
othdep.SCR 10/08/14
1555
Form 140 Family Income Tax Credit Worksheet 2015
Name as Shown on Return Social Security Number

Family Income Tax Credit Worksheet
A Number of dependents listed as type "D" 2

B Number of personal exemptions based upon filing status (MFJ = 2, otherwise = 1) 2
C Add lines A and B 4
D Multiply line C by $40 160.
E Enter $240 if MFJ or HOH; enter $120 if Single or MFS 240.
F Lesser of line D or line E. Enter here and on Form 140, line 49 160.
Arizona
Section 179 Carryover Worksheet 2015
Name as Shown on Return Social Security Number

Arizona Prior Year Carryover of Excess Section 179 Subtraction Adjustment
Federal Section Arizona Section Federal Section Allowance of

179 Expense 179 Limit 179 Over Limit one fifth of
excess
(A) (B) (C = A - B) (D = C / 5)
1 2012 carryover 25,000.

2 2011 carryover 25,000.
3 Arizona Subtractions from Income Adjustment, Sum of Lines 1 and 2 Col. D
AZIW2001.SCR 04/30/15
Arizona Information Worksheet 2015
Part I - Personal Information
Taxpayer: Spouse:
First Name Casey First Name John
Middle Initial M Suffix Middle Initial T Suffix
Last Name Miller Last Name Miller
Social Security No 074-74-0348 Social Security No 600-62-4188
Date of Birth 10/25/1977 Date of Birth 11/21/1972
Date of Death Date of Death
Daytime Phone (602)628-9888 Daytime Phone
Extension Extension
Home Phone
Print this daytime phone on forms Taxpayer daytime Spouse daytime Home
Street Address 4724 W Desert Hills Dr Apt No.
City Glendale State AZ ZIP Code 85304
Last name(s) in prior years if different from name(s) used in current year
Part II - Main Form
X Form 140: Resident Tax Return (Long form)

Form 140A: Resident Tax Return (Short form)
Form 140NR: Nonresident Tax Return
Enter Nonresident income allocations on Form 140NR
Form 140PY: Part-Year Resident Tax Return
Dates of Residency: From: To:
Other states of residency:
Enter Part-Year Resident income allocations on Form 140PY
Form 140PTC: Full-Year Resident Property Tax Refund (Credit Claim) Only
Military personnel and composite return filers:

You were active duty in Arizona and are filing part-year or nonresident return (Form 140NR or 140PY)
You are filing a composite return on Form 140NR
Part III - Filing Status
X Married filing joint return

Head of household
Child’s First name MI Last Name Suff
Head of household and married in 2015
Married filing separate return
Spouse itemized deductions
Married filing separate with one spouse claiming at least one dependent
Single
Part IV - Other Information
Your Arizona gross income for 2014 was in excess of $75,000 ($150,000 if MFJ)
Someone (such as taxpayer’s parent) can claim taxpayer as a dependent
You qualify as a farmer or fisherman for federal tax purposes
Itemize even if itemized deductions are less than standard deduction
Take the standard deduction even if less than itemized deductions
Increased Excise Tax Credit: You were sentenced to 60 days or more in a county, state
or federal prison during tax year 2015
Check this box if you are a first time Arizona income tax filer
Voluntary Gifts
1 Solutions Teams Assigned to Schools Fund 1
2 Arizona Wildlife Fund 2
3 Child Abuse Prevention Fund 3
4 Domestic Violence Shelter Fund 4
5 I Didn’t Pay Enough Fund 5
6 Neighbors Helping Neighbors Fund 6
7 Special Olympics Fund 7
8 Veterans’ Donations Fund 8
9 Sustainable State Parks and Road Fund 9
10 Political Gift - select party below 10
Americans Elect
Democratic
Green
Libertarian
Republican
Part V - Electronic Filing Information
Yes No
X Federal PIN(s) will be used (See help)
Part VI - Direct Deposit Information or Direct Debit Information
Yes No
X Do you want to elect direct deposit of state tax refund?
Do you want direct debit of state tax payment (Electronic Filing Only)?
Name of Financial Institution (optional) US Bank

Account type Checking X Savings
Routing number 122105155
Account number 151705640549
Enter the payment date to withdraw from the account above
State balance-due amount from this return
International ACH Transactions

Yes No
X Will the funds for this refund (or payment) go to (or come from) an account outside the U.S.?
Part VII ' Extension Status
Yes No
XHas the tax return due date been extended for a six month extension?
Extended due date
QuickZoom to Form 204: Application for Filing Extension
Part VIII ' Amended Return
You are filing an Arizona amended return for 2015 (See Tax Help)
Current tax year you are amending
Payment with original return
Overpayment from original return
QuickZoom to Form 140X: Individual Amended Income Tax Return
AZIW0112.SCR 04/30/15
Form AZ-140ES Estimated Tax Worksheet 2016
Name(s) Shown on Return Your Social Security Number

Part I 2016 Estimated Tax Amount Options to be paid before January 15, 2014
1 Select One of Five Ways to Calculate the Required Annual Payment for 2016 Estimates:
a 100% of 2015 taxes (default, see Tax Help) X 0.
b 100% of tax on 2016 estimated taxable income 0.
c 90% of tax on 2016 estimated taxable income 0.
d Equal to 100% of overpayment (no vouchers) 100.
e Enter total amount you want to use for estimates and check box
Voluntary Payments:
Method 1: If federal Form 1040ES was filed, Arizona estimated payments can be calculated based
on a percentage (10, 15 or 20%) of the federal estimated tax paid. To choose this option, enter
the percentage to be used and the total amount of federal estimate tax on lines a and b below.
Then check the box on line 1e.
a Enter percentage to calculate the estimated vouchers %
b Enter total federal estimates due
Method 2: Installments may be filed on or before the due dates (April 15, June 15, September 15,
and January 15). To choose this option, check the box and enter the total amount to be paid with
estimates on line 1e. Then, on Part IV, line 2, check the box indicating the number of installments
to be used.
Method 3: Estimated tax payments can be made as a single, lump-sum payment before January 15.
To choose this option, check the box and enter the total to be paid with estimates on line 1e. Then
check the box on Part IV, line 2, column 4 indicating the January payment is due next.
2 Selected estimated tax amount:
a 2016 Required Annual Payment based on your choice above 0.
b Estimated amount of 2016 state income tax withholding
c Total of estimated tax payments required for 2016 (line 2a less line 2b) 0.
3 Select Estimated Tax Payment option:
a Calculate estimates if Arizona gross income in 2015 and expected 2016
gross income exceeds $75,000 ($150,000 if MFJ) (default) X
b Calculate estimates if (specify amount) or more
c Calculate estimates regardless of amount
d Do not calculate estimates
Part II Overpayment Application Options
1 Amount of overpayment available (Arizona Form 140, 140NR, or 140PY) 100.

2 Select Overpayment Application Amount Option:
a Apply none (refund entire overpayment) X
b Apply all (increase estimate if required)
c Apply to extent of total estimated tax and refund excess
d Apply to extent of first quarter amount and refund excess
e Enter amount you want to apply
f Amount applied to 2016 estimated tax 0.
g Overpayment to be refunded (line 1 less line 2f) 100.
3 Select Overpayment Application Sequence:
a X H Consecutively b H Evenly
Part III Rounding and Printing Options
1 Select Rounding Option:

aX H Round up to b H Round up to c H Round up to d H Round to
next $1 next $10 next $100 nearest $1
2 Select Voucher Printing Option:
a H Print (per Part I, lines 3a - c) b H Print only name, etc. c X H Do not print vouchers
Part IV Estimated Tax Payment Summary
1 2 3 4 Total
Apr 18, 2016 Jun 15, 2016 Sep 15, 2016 Jan 17, 2017
1 If you have already

made payments,
enter amounts
2 Indicate which payment is
due next. (e.g. if it is now
April 25, check col. 2) X
3 Required Payment
4 Overpayment applied
5 Net payment due
6 Voucher amounts
Part V Changes to Income, Deductions and Withholding for 2016
2015 income and deductions are shown in the ’2015 Actual’ column below.
*Caution: For each line in the ’2016 Estimated’ column, enter the estimated 2016 amount if different from
2015. Otherwise, the ’2015 Actual’ amount will be used for that line. If zero, you must enter zero.
2015 Actual *2016 Estimated

1 Use the estimated tax worksheet attached to IRS Form 1040ES
and enter here the amount shown as income on your
federal worksheet 19,010.
Additions
2 Non-Arizona municipal interest
3 Partnership Income
4 Total federal depreciation
5 Other additions to income
Subtractions
6 Amounts received as annuities from certain federal, Arizona
state or local government retirement and disability funds
(up to $2,500) that are subject to federal tax
7 Interest income on obligations of the United States (e.g. U.S.
savings bonds, treasury bills, etc)
8 Arizona state lottery winnings (up to $5,000) included as
income on federal return
9 U.S. Social Security benefits or railroad retirement act benefits
included as income on federal return
10 Other exempt income
Deductions
11 If you plan to itemize deductions, enter the estimated total of
your deductions. If you do not plan to itemize deductions, see
the instructions for the allowable 2015 standard deduction 10,173.
12 Arizona tax withholding
Part VI Filing Status and Personal Exemptions for 2016
1 Choose 2016 filing status:

X Married filing jointly
Head of household
Check the box if head of household and married in 2016
Married filing separately
Check box if married filing separate with one spouse claiming at least one dependent
Single
2 a Number of exemptions for age 65 and over to be claimed in 2016 (taxpayer or spouse only) 0
b Number of blind exemptions to be claimed in 2016 0
c Number of dependents to be claimed in 2016 (do not include taxpayer or spouse) 2
d Number of Arizona ONLY dependents to be claimed in 2016, included on line 2c above
e Number of qualifying parents and ancestors of parents to be claimed in 2016
3 Part-year and Nonresident Filers only: Arizona percentage from Form 140NR, line B17 or
Form 140PY, line B20 %
Part VII 2016 Estimated Taxable Income and Tax
1 Amount shown as income on your federal estimated tax worksheet 19,010.

2 Adjustments to income:
a Total additions
b Total subtractions
c Net adjustments
3 Deductions 10,173.
4 Personal and dependent exemptions 10,900.
5 Total deductions and exemptions 21,073.
6 Estimated Arizona taxable income (line 1 plus line 2c minus line 5) -2,063.
7 Tax on amount from line 6. This is your 2016 tax based on your estimate
of 2016 income 0.
aziw1312.SCR 04/30/15
Arizona
Carryover Worksheet 2015
Keep for your records
Name(s) Shown on Return Your Social Security No.
Form 310 - Credit for Solar Energy Devices
(a) (b) (c) (d)
Taxable year Credit still Amount Carryover to
of original available for used in next year
credit current year current year (b) - (c)
2010
2011
2012
2013
2014
2015
Total Amount Used in Current Year
Form 321 - Credit for Contributions to Charities that provide Assistance to the Working Poor
(a) (b) (c) (d)
2010
2011
2012
2013
2014
2015 0.
Form 322 - Credit for Contributions Made or Fees Paid to Public Schools
(a) (b) (c) (d)
2010 0.
2011 0.
2012 0.
2013 0.
2014 0.
2015 375. 0. 375.
Total Amount Used in Current Year 0.
Form 323 - Credit for Contributions to Private School Tuition Organizations
(a) (b) (c) (d)
2010
2011
2012
2013
2014
2015
Form 348 - Credit for Contributions to Certified School Tuition Organizations
(a) (b) (c) (d)
2010
2011
2012
2013
2014
2015
Tax Payments Worksheet 2015

Tax Payments for the Current Year
State
Date Payment
1 First Payment
2 Second Payment
3 Third Payment
4 Fourth Payment
Additional Payments
5 Payment
Payment
Payment
Payment
Payment
6 Overpayment from previous year applied to current year 6

7 Amount paid with current year extension 7
8 Total tax payments 8
Income Taxes Withheld for the Current Year
9 State withholding on Forms W-2 9

10 State withholding on Forms W-2G 10
11 State withholding on Forms 1099-R 11
12 a State withholding on Forms 1099-MISC 12 a
b State withholding on Forms 1099-G b
13 Other state tax withholding 13
14 Total income tax withheld 14
15 Date return will be filed and balance paid 15
OTHV0301.SCR 01/05/16
Tax Summary 2015
Name(s)
Federal adjusted gross income 19,010.

Arizona adjusted gross income 14,410.
Itemized or standard deduction 10,173.
Personal exemptions 6,300.
Arizona taxable income -2,063.
Non-refundable Credits 160.
Balance of Tax 0.
Total payments and refundable credits 100.
Tax due
Overpayment 100.
Amount applied to estimates 0.
Voluntary contributions
Penalties
Refund 100.
Amount owed
Smart Worksheets from your 2015 Arizona Tax Return
SMART WORKSHEET FOR: Form 140: Resident Personal Return
Income Tax Smart Worksheet
Use Optional Tax Rate Table only (for less than $50,000 taxable income)
Use Tax Rate Table X or Y only
a Tax from Optional Tax Rate Table (if taxable income is less than $50,000) 0.
b Tax from Tax Rate Table X or Y 0.
c Smaller of line a and line b 0.

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Form

1040 Department of the Treasury—Internal Revenue Service

U.S. Individual Income Tax Return

Casey M Miller 074-74-0348

John T Miller 600-62-4188

1 Single 4 Head of household (with qualifying person). (See instructions.) If

Joint return? See

Firm’s address a Phone no.

4724 W Desert Hills Dr

BAA REV 07/11/16 Intuit.cg.cfp.sp

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Did you receive wages or tips in 2015?

Qualifying Child Information Child 1 Child 2 Child 3

4 a Was the child under age 24 at the end of

• If the child lived with you for more than

REV 07/11/16 Intuit.cg.cfp.sp Schedule 8812 (Form 1040A or 1040) 2015

Name(s) Shown on Return

Five Year Tax History:

2011 2012 2013 2014 2015

Filing status MFJ MFJ MFJ

Total income 23,334. 20,720. 19,371.

Adjustments to income 1,649. 1,464. 361.

Adjusted gross income 21,685. 19,256. 19,010.

Tax expense 25.

Exemption amount 15,600. 15,800. 16,000.

Alternative min tax

Other taxes 3,297. 2,927. 721.

Payments 7,372. 7,460. 8,736.

Form 2210 penalty

Refund 4,075. 4,533. 8,015.

Effective tax rate % -34.00 -38.74 -39.71

**Tax bracket % is based on Taxable income.

Information regarding low-cost deposit accounts may be available at www.mymoney.gov .

PAPER RETURN IRS Direct Deposit to Approximately No additional cost.

ELECTRONIC IRS Direct Deposit to Usually within 21 days No additional cost.

No Refund Processing Check mailed by IRS Approximately

ELECTRONIC (a) Direct Deposit to Usually within $ 34.99

Refund Processing (b) Load to your

Questions? Call 1-877-908-7228

The following statements apply:

First Name Last Name

IRS regulations require the following statements:

Please type the date below:

IRS regulations require the following statements:

Sign this agreement by entering your name:

Please type the date below:

IRS regulations require the following statements:

Sign this agreement by entering your name:

Please type the date below:

Name(s) Shown on Return Your SSN

Line 4b - Adjustment for trade or business income or loss

(a) Activity name (b) Gain or

Enter additional adjustments not included above:

Line 5b - Adjustment for gain or loss on dispositions

(a) Activity name (b) Gain or

Capital gain/loss not included in net investment income

(a) Activity name (b) Capital

Calculation of line 5b adjustment due to capital loss carryforward