Form8879 Control Number (DCN) OMS No. 1545·0074 IRS e-fi/e Signature Authorization ~ Do not send to the IRS. This is not a tax return. ~ Keep this form for your records. See instructions. Department of the Treasury Internal Revenue Service 2010 Social security number Declaration 00-871154-18103-1 474-04-3631 Spouse's social security number Taxpayer's name JEREMIAH Spouse's name GRIFFITH KIM SESSIONS lea.•l~i#1Tax Return Information t 1 Adjusted 528-97-6647 - Tax Year Ending December 31, 2010 (Whole Dollars Only) 1 , gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4). .................... 2 Total tax (Form 1040, line 60; Form 1040A, line 37; Form 1040EZ, line 11). ..... ... ... .. ,.,., . ... ,., , , 32,432. 1,060. 4,899. . .. . 2 3 4 11.11Iii1 Taxpayer 3 Federal income tax withheld (Form 1040, line 61; Form 1040A, line 38; Form 1040EZ, line 7). 4 Refund(Form 1040,line 74a; Form 1040A,line 46a; Form 1040EZ,line 12a;Form 1040·SS,Part I, line 12a) ....... . 5 Amount you owe (Form 1040, line 76; Form 1040A, line 48; Form 1040EZ, line 13). ....... . .. . . . . " . .. . ..... .. . Declaration and Signature Authorization 5 (Be sure you get and keep a copy of your return) Underpenaltiesof perjury, I declarethat I haveexamineda copy of my electronic individual incometax return and accompanyingschedulesand statementsfor the tax year ending December31, 2010,and to the best of my knowledgeand belief, it is true, correct, and complete.I further declarethat the amounts in Part I aboveare the amountsfrom my electronic incometax return, I consentto allow my intermediateservice provider, transmitter, or electronic return originator (ERO)to send my return to the IRSand to receivefrom the IRS(a) an acknowledgement f receipt or reasonfor rejection of the transmission, (b) the reasonfor any delay in processingthe return or refund, and (c) the date of any refund. If applicable, o I authorizethe U.S.Treasury and its designatedFinancialAgentto initiate an ACHelectronicfunds withdrawal (direct debit) entry to the financial institution accountindicated in the tax preparationsoftware for paymentof my Federaltaxes owed on this return and/or a paymentof estimatedtax, and the financial institution to debit the entry to this account.I further understandthat this authorizationmay apply to future Federaltax paymentsthat I direct to be debitedthroughthe ElectronicFederalTax PaymentSystem(EFTPS).In order for me to initiate future payments,I requestthat the IRSsend me a personalidentification number(PIN) to accessEFTPS.This authorizationis to remain in full force and effect until I notify the U.S.Treasury FinancialAgentto terminate the authorization.To revokea payment,I must contactthe U.S.Treasury FinancialAgentat 1-888-353-4537 later than 2 no businessdays prior to the payment(settlement) date. I also authorizethe financial institutions involvedin the processingof the electronic paymentof taxesto receiveconfidential information necessaryto answer inquiries and resolve issues related to the payment.I further acknowledgethat the personalidentification number(PIN) below is my signaturefor my electronic incometax return and, if applicable,my ElectronicFundsWithdrawalConsent. Taxpayer's PIN: check one box only [K] I authorize HAYNIE AND COMPANY CPA'S ERO finn name to enter or generate my PIN 78905 Enter five numbers, but do not enter all zeros D I will as my signature on my tax year 2010 electronically filed income tax return. enter my PIN as my signature on my tax year 2010 electronically filed income tax return. Check this box only if you are entering own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below. your Your signature Date ~ Spouse's PIN: check one box only [K] I authorize HAYNIE AND COMPANY CPA'S ERO firm name to enter or generate filed income tax return. my PIN 80240 Enter five numbers, but do not enter all zeros D own PIN and your return issignatureusing the Practitioner2010 electronicallyThefiled income complete Part III below.box only I will enter my PIN as my on my tax year tax return. Check this filed PIN method. ERO must Spouse's signature ~ Date ~ as my signature on my tax year 2010 electronically if you are entering your Practitioner PIN Method Returns Only - Practitioner by your five-digit continue below (pitt. frO Certification ERO's EFIN/PIN. and Authentication EFIN followed PIN Method Only self-selected PIN ... Enter your six-digit 87115412345 do not enter all zeros I certify that the above numeric entry is my PIN, which is my signature for the tax year 2010 electronically filed income tax return for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Publication 1345, Handbook for Authorized IRS e-tite Providers of Individual Income Tax Returns. ERa's signature ~ LARRY R. BERGHOUT, CPA ERO Must Retain This Form - See Instructions . Do Not Submit This Form to the IRS Unless Requested Date ~ To Do So Form 8879 (2010) BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA1701L 11119110 Form 1040A Department of the Treasury - Internal Revenue Service U.S. Individual Income Tax Return Your first name and initial Last name (99) 2010 IRS Use Only - Do not write or staple in this space OMS No. 1545·0074 Your social security number Name, Address, and SSN See separate instructions JEREMIAH GRIFFITH If a joint return, spouse's first name and initial Last name 474-04-3631 Spouse's social security number KIM SESSIONS Home address (number and street). If you have a P.O. box, see instructions. Apartment no. 528-97-6647 •. address, see instructions. 1300 E 6125 S City. town or post office. If you have a foreign Make sure the SSN(s) above and on line 6c are correct. State ZIP code SOUTH OGDEN, UT 84405-7116 Presi denti al Election Campaign ~ 1 2 3 Check here if you, or your spouse if filin ~ jointl Checking a box belowwill not change your tax or refund ~ You Spouse ,want $3 to go to this fund (see instructions)., 4 Filing status Check only one box. X Single Married filingjointly(evenif onlyonehadincome) Married filingseparately. spouse'sSN above Enter S and full name here ~ 5 0 Head household of (withqualifying person). (Seeinstructions.) If thequalifying person a childbutnotyourdependent, is enterthischild'sname here ~ ----------------------Qualifying widow(er) with dependent child (see instructions) " "" } Boxes checked on 6aand6b, , No. of children on 6c who: lived with you. .. Exemptions 6a [R] Yourself. If someone can claim you as a dependent, do not check box 6a. b Spouse . c Dependents: (1) [Xl •••••• 0 ••••• .... ····.0' ..... . ... . ..... . .. 2 ------ . . ... . ....... If more than six dependents, see instructions. First name Last name (2) Dependent's social security number (3) Dependent's relationship to you (4) t/ IT child under age 17 qual for child tax cr (see instrs) • , ZACHARY GRIFFITH 646-90-8270 SON Ix did not live with you due to divorce or separation (see instructions) ... Dependents on 6c not entered above ... • .. -----1 ----------- d Total number of exemptions claimed .... , .......... . ...... ..... ... ... . . . . ..... . ..... ......... . . .... Add numbers .\ on lines above ~ 31 Income AttachForm(s) W-2 here.Also attachForm(s) 1099-R tax if waswithheld. 7 Wages, 'salaries, tips, etc. Attach Form(s) W-2 .. 8a Taxable interest. Attach Schedule B if required. b Tax-exemptnterest. onot include i D online8a ..... , . 9a Ordinary dividends. Attach Schedule B if required ... , .. , .... b Qualified dividends (see instructions), .. , 10 Capital gain distributions (see instructions) ... 11 a IRA distributions. ' 11 a 12a Pensions and annuities If you did not get a W-2, see irrstructiona. 7 __:=.8.::a 9a 32,432. _ 8b 9b 11 b Taxable amount, 12bTaxabie amount. 10 11 b 12b 13 14b 15 12a . , ., . 13 Unemployment compensation and Alaska Permanent Fund dividends (see instructions). . . . . 14a Social security benefits. . . . ... , .... , ... , 14a 14b Taxable amount. 15 Add lines 7 through 14b (far right column). This is your total income, , . 16 Educator expenses (see instructions) ,. 17 IRA deduction (see instructions) .. , ,... 18 Student loan interest deduction (see instructions) .... , .... , 19 Tuition and fees. Attach Form 8917. 20 Add lines 16 through 19. These are your total adjustments. --'-16-=----'-17'---.:.18=---'-1.:..9 , . , .. , . -'- Enclose, but do not attach. any payment. Also, please use Form 1040-V. ~ _ _ _ _ 32,432. Adjusted gross income 20 ~ 21 O. 32,432. Form 1040A (2010) 21 Subtract line 20 from line 15. This is your adjusted gross income, BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. FDIA1312L 01108111 Form 1040A (2010) JEREMIAH 22 GRIFFITH AND KIM SESSIONS gross income). Tax, credits, and payments Enter the amount 23a Check If: {D from line 21 (adjusted 0 Spousewas born beforeJanuary2, 1946, 0 Blind itemizes . deduction (see instructions). .. You were born beforeJanuary2,1946, 0 ................. Blind } Total boxes checked. deductions, . . . . . . . . .. ~ •. . . . . . . .. 23a 23 b . D D ~ 474-04-3631 ,....:22==- Page 2 --=3-=2'-',_4.::..3=-=.2-=-. b If you are married filing separately and your spouse see instructions and check here. . 24 25 26 27 28 Enter your standard Subtract 24 25 26 27 28 11,400. 21,032_ 10,950. 10,082. 1,008. line 24 from line 22. If line 24 is more than line 22, enter ·0-.. Multiply $3,650 by the number on line 6d. .. Exemptions. Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income. . . . . . Tax, including any alternative .. minimum tax (see instructions) 29 30 31 32 Creditfor child and dependentcare expenses.Attach Form 2441. . . . Credit for the elderly or the disabled. Education Retirement savings contributions Attach Schedule R. _29 --=-30~ 31 __ 32 _ 192. _ credits from Form 8863, line 23 . . . . . . . credit. Attach . . Form 8880. ----------------------=-33-=-- _ 34 1,008. 33 34 35 36 37 38 39 If you have a qualifying child, attach Schedule EIC. Child tax credit (see instructions). Add lines 29 through Subtract Advance earned 8~1_=6~. 33. These are your total credits from Form(s) line 34 from line 28. If line 34 is more than line 28, enter -0income credit payments W-2, box 9 . --=.38::....... --=-39~ Schedule M. . . . _ --"42=_4_3"-. _4...:.;0=---.:41=-=.a s ................. . ~ 35 -=..:36=-37 0. _ Add lines 35 and 36. This is your total tax Federal income tax withheld tax payments from Forms W-2 and 1099. and amount applied from 0. -=1:..!.,....:0=-6~0-=-. _ -::-.-:8:,-0'-:0'-'--. --=2:::..,<-7-=-=2...:.7-=-. -='1..;:,8-,:4;...:..-. 1_2 8_. __ ~44 . 45 4,899. 4,899. 4::...<,-=8c.::.9-.::..9...:-. 2010 estimated 2009 return . 40 Making work pay credit. Attach income credit (EIC). bNontaxable combat 41 a Earned 42 43 44 pay election._4...:.1'-b"-- Additional American child tax credit. Attach Form 8812... opportunity credit from Form 8863, line 14. Add lines 38, 39, 40, 41a,42, and 43. Theseare your total payments.. If line 44 is more than line 37, subtract This is the amount you overpaid. of line 45 you want refunded 324377613 190001383024 to your 2011 47 to line 37 from line 44. . Refund Direct deposit? See instructions and fill in 46b, 46c, and 46d or Form 8888. 45 46a Amount ~ bRouting number ... ~ dAccount number .. 47 o ~0 _46=.=a Savings Amount of line 45 you want applied estimated tax . Amount you owe. Subtract see instructions. . Estimated tax penalty Amount you owe Third party 48 49 line 44 from line 37. For details on how to pay, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . •. __ 48 .... 49 _ (see instructions} Doyou want to allow anotherpersonto discussthis rsturn with the IRS (soo instructions)? lID Yes. Complete the following. ~ designee ~:~~nee's ~ LARRY R. BERGHOUT, CPA ~~~ne~ 801-972-4800 Personal identification •. 12345 number(PIN) Sign here Joint return? Seeinstructions. Keepa copy for your records. ~ Underpenaltiesof perjury.I declarethat I haveexaminedthis returnand accompanying SChedules andstatements, nd to the bestof my knowledge belief,they a and are true,correct.andaccuratelylist all amountsandsourcesof incomeI received cunnq the tax year. Declaration preparer(otherthanthe taxpayer)IS basedon all of information whichthe preparerhasany knowledge. of Yoursignature Date Youroccupation OPERATOR Spouse's signature.If a joint return.both mustsign. Date Spouse's occupation PrintIType preparer"s name Preparer's signature HOMEMAKER Date BERGHOUT, 2/07/11 Check~ P00439981 Firm'sEIN ~ Phoneno. 87-0325228 8 Paid preparer use only LARRY R. BERGHOUT, AND CPA 2300 LARRY R. CPA 1 Firm'sname •. HAYNIE Firm'saddress~ 1785 COMPANY S WEST SOUTH 84119-2065 SALT LAKE CITY, DT ° 1- 97 2 - 4 8 0 0 Form 1040A (2010) FDIA1312L 01/08/11 SCHEDULE EIC (Form 1040A or 1040) Department of the Treasury Internal Revenue Service Name(s) shown on return Earned Income Credit Qualifying Child Information (99) OMB No. 1545·0074 Complete and attach to Form 7040A or 7040 only if you have a qualifying child. AND KIM SESSIONS Attachment Sequence No. Your social security 201043 number JEREMIAH GRIFFITH 474-04-3631 Before you begin: • See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b, to make 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. CAUTION! • 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. • 1 It will take us longer to process your return and issue your refund if vou do not fill in all lines that apply for each qualifying child . Qualifying Child Information Child's name If you have more than three qualifying children, you only have to list three to get the maximum credit . . . . . ......... ......... , Child 1 First name Child 2 First name Last name First name Child 3 Last name Last name . ZACHARY GRIFFITH BRYSON SESSIONS 2 Child's SSN The child must have an SSN as defined in the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b, unless the child was born and died in 201O. If your child was born and died in 2010 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 ... 646-90-8270 Year 647-36-4901 Year 3 Child's year of birth 2006 1997 Year If born after 7997 AND the child was If born after 7997 AND the child was *~~g%'i~P,:f to Ime5. ~~Yp?Mt!{a Sf~)N6; ~o ~ *~~g~~ntp,:f to Ime 5. ~~!f, sf,fJs,{f;;~o ~?~ls°'l!a *~~g~~'i~p,~~ ~~Ih ?~ls°~~ ~ Sf~Js,{f;;bo i to Ime 5. If born after 7997 AND the child was 4a Was the child under age 24 at the end of 2010, a student, and younger than you (or your spouse, if filing jointly)? .............. DYes. DNo. Go to line 5. Continue. DYes. DNo. Continue. Go to line 5. DYes. DNo. Continue. Go to line 5. bWas the child permanently and totally d;sabl",d dur:na !Ony D""{ 01 ~~1M ... Dv--. Continuo. D ..~· The child is not a qualifying child. n-. Continue. ONQ. The child O'G~' Continue. Orto. The child is not :l qualifying child. is not a qualifying child. S Child's relationship to you (for example, son, daughter, grandchild, niece, nephew, foster child, etc) ..... ........ . SON SON 6 Number of months child lived with you in the United States during 2010 • If the child lived with you for more than half of 2010 but less than 7 months, enter 'T. If the child was born or died in 2010 and your home was the child's home for the entire time he or she was alive during 2010, enter '12:. . . . . . . . . . . . . . . ... .. .... , , • -- 1-2 months -- 12 months -- months Do not enter more than 72 months. BAA For Paperwork Reduction Act Notice, see your tax return instructions. Do not enter more than 72 months. Do not enter more than 72 months. Schedule EIC (Form 1040A or 1040) 2010 FDIA7401L 11/04110 Form 881 2 (99) Complete Additional Child Tax Credit and attach to Form 7040, Form 7040A, or Form 7040NR. OMS No. 1545-0074 2010 ~~g~~~c~n~o. Your social security number Department of the Treasury Internal Revenue Service Name(s) shown on return 47 KIM SESSIONS 1040 filers: 474-04-3631 Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040, line 51). . 1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040A, line 33). 1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040NR, line 48). . If you used Pub 972, enter the amount from line 8 of the worksheet on page 4 of the publication. 1,000. 2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48 . 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit ... 4a Earned income (see instructions) ... b Nontaxable combat pay (see instructions) ..... 5 Is the amount on line 4a more than $3,000? No. Leave line 5 blank and enter -0- on line 6. 4b 2 3 816. 184. 32,432. o [R] 6 29,432. ~ Yes. Subtract $3,000 from the amount on line 4a. Enter the result. Multiply the amount on line 5 by 15% (.15) and enter the result. . Next. Do you have three or more qualifying children? No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13. o Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line Otherwise, go to line 7. 3 on line 13. Certain Filers Who Have Three or More Qualif in Children 7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse's amounts with yours. If you worked for a railroad, see the instructions. . .......... .............. 8 1040 filers: Enter the total of the amounts from Form 1040, lines 27 and 57, plus any taxes that you Identified usinq code 'UT' and entered on the dotted line next to line 60. 1040A filers: Enter -0-. 1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27 and 55, plus any taxes that you Identified usmq code 'UT' and entered on the dotted line next to line 59. Add lines 7 and 8. . 1040 filers: 1040A filers: S 1--7_1-- _ 8 9 10 9 Enter the total of the amounts from Form 1040, lines 64a and 69. Enter the total of the amount from Form 1040A, line 41a, plus any excess social security and tier 1 RRTA taxes withheld that you entered to the left of line 44 (see instructions). l040NR filers: Enter the amount from Form 1040NR, line 64. Subtract line 10 from line 9. If zero or less, enter -0-. L....:..10-'--'-- _ 11 11 12 Enter the larger of line 6 or line 11 ..... Next, enter the smaller of line 3 or line 12 on line 13. 12 13 This is your additional child tax credit. . 13 Enter this amount on Form 7040, line 65, 184. Form 1040A, line 42, or Form 7040NR, line 62. BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA300lL 07/08/10 Form 8812 (2010) Form 8863 (99) Education Credits (American Opportunity and Lifetime Learning Credits) ~ See separate instructions to find out if you are eligible to take the credits. ~ Attach to Form 1040 or Form 1040A. . Your social security OMB No. 1545-0074 Department of the Treasury Internal Revenue Service Name(s) shown on return 2010 Attachment Sequence No. number 50 JEREMIAH GRIFFITH AND KIM SESSIONS CAUTION! same year. 474-04-3631 You cannot take both an education credit and the tuition and fees deduction (see Form 8977) for the same student for the W.lII.'. American Caution' Opportunity Credit (t) If column (d) is You cannot take the American opportunity credit for more than 4 tax years for the same student (e) Multiply the 1 (a) Student's name (b) Student's (c) Qualified (d) Subtract $2,000 (as shown on page 1 social security expenses (see from the amount in amount in column (d) by 25% (.25) of your tax return) number (as shown instructions). Do column (c). If zero on page 1 of not enter more or less, enter -0your tax return) than $4,000 for First name each student. --------------Last name --------------- zero, enter the amount from column (c). Otherwise, add $2,000 to the amount in column (e). JEREMIAH GRIFFITH 474-04-3631 320. 320. --------------- --------------- 2 Tentative American opportunity credit. Add the amounts on line 1, column (t). .If .you.are t~klng t.helifetime learning credit for a different student, go to Part II; otherwise, go to Part III .... ~I 2 320. ~arari:l.lLifetime Caution: Learning Credit. You cannot take the Amencan opportunity credit and the lifetime learning credit for the same student In the same year. (c) Qualified (b) Student's social (a) Student's name (as shown on page 1 of your tax return) expenses security number (as (see instructions) shown on page 1 of your tax return) Last name 3 First name 4 Add the amounts on line 3, column (c), and enter the total ........... .... . .. . ....... 5 Enter the smaller of line 4 or $10,000. .......... 6 Tentative _.... , .. " , ... .... ' . . . . . . . . . .. .... ... , , ..... 4 . . . ....... ..... .. . .. " ..... ... 5 6 Form 8863 (2010) otherwise go to Part IV . lifetime learning credit. Multiply line 5 by 20% (.20). If you have an entry on line 2, go to Part III; . .. , .. , ........ .......... . . . ... . .. . ... . .. . .. . ........ . . . ..... , . . ............. ' BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA3601L 12131110 474-04-3631 Page 2 320. 8 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er). . . . . . . . . 9 Enter the amount from Form 1040, line 38,* or Form 1040A, line 22 Subtract line 9 from line 8. If zero or less, stop; you cannot take any education credit. . . . . . . . . . . . Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er). If line 10 is: • Equal to or more than line 11, enter 1.000 on line 12. . . . . •.. Less than line 11, divide line 10 by line 11. Enter the result as a decimal (rounded to at least three places). . . . . . . . . . . .. 13 } .. .. 8 9 10 180,000. 32,432. 147,568. 20,000. 10 11 12 11 1. 000 . ... • Df-'-13=--1-14 15 Multiply line 7 by line 12. Caution: If you were under age 24 at the end of the year and meet the conditions in the instructions, you cannot take the refundable American opportunity credit. Skip line 14, enter the amount from line 13 on line 15, and check this box.. 3.:....:;.2...:.0--'-. 128. 192. 14 Refundable American opportunity credit. Multiply line 13 by 40% (.40). Enter the amount here and on Form 1040, line 66, or Form 1040A, line 43. Then go to line 15 below tRait .l~ 15 Nonrefundable Education Credits Subtract line 14 from line 13. Enter the amount from line 6, if any. If you have no entry on line 6, skip lines 17 through 22, and enter the amount from line 15 on line 6 of the Credit Limit Worksheet (see instructions). Enter: $120,000 if married filing jointly; $60,000 if single, head of household, or qualifying widow(er). Enter the amount from Form 1040, line 38,* or Form 1040A, line 22. Subtract line 18 from line 17. If zero or less, skip lines 20 and 21, and enter zero on line 22. Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er). . . . . . . . . . . . . . .............. f-'-'7=-----1-_ 16 17 18 19 20 21 16 f-=-18::......f- _ 19 r--~------<-=-20=--'-_ 22 If line 19 is: • Equal to or more than line 20, enter 1.000 on line 21 and go to line 22 • Less than line 20, divide line 19 by line 20. Enter the result as a decimal (rounded to at least three places). . . . .......... ......... Multiply line 16 by line 21. Enter here and on line 1 of the Credit limit Worksheet (see instructions). Nonrefundable education credits. Enter the amount from line 11 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 49, or Form 1040A, line 31 . . . • If you are filing Form 2555, 2555-EZ, or 4563. or you are excluding income from Puerto Rico, see Pub 970 for the amount to-enter. r=2'=--f-------·f--=22=-t-------- 23 23 192. Form 8863 (2010) FDIA3601L 12131110 SCHEDULE M (Form 1040A or 1040) Department of the Treasury Internal Revenue Service Name(s) shown on return OM8 No. 1545-0074 Making Work Pay Credit (99) • Attach to Form 1040A or 1040. • See separate instructions. Your social security 2010 Attachment Sequence No. number 166 JEREMIAH GRIFFITH AND KIM SESSIONS Caution: 474-04-3631 To take the making work pay credit, you must include your social security number (if filing a joint return, the number of either you or your spouse) on your tax return. A social security number does not include an identification number issued by the IRS. Only the Social Security Administration issues social security numbers. You cannot take the making work pay credit if you can be claimed as someone else's dependent or if you are a nonresident alien. Caution: Important: Check the 'No' box on line 1a and see the instructions if: (a) You have a net loss from a business, (b) You received a taxable scholarship or fellowship grant not reported on a Form W-2, (c) Your wages include pay for work performed while an inmate in a penal institution, (d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental section 457 plan, or (e) You are filing Form 2555 or 2555-EZ. 1 a Doyou(andyourspouse filing jointly) have if 2010 wages more of than$6,451 ($12,903 if married filingjointly)? !Kl Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) o on line 4 and go to line 5. No. Enter your earned Income (see Instructions). . . . . . . . . . . . . . . . . . . . . . . . . . 1a 1b 2 3 . _ b Nontaxable combat pay included on line 1a (see instructions) . 2 Multiply line 1a by 6.2% (,062). . 3 Enter $400 ($800 if married filing jointly). 4 5 6 7 Enter the smaller of line 2 or line 3 (unless you checked 'Yes' on line 1a) Enter the amount from Form 1040, line 38*, or Form 1040A, line 22 . Enter $75,000 ($150,000 if married filing jointly) Is the amount on line 5 more than the amount on line 6? . 800. 5 6 32,432. 150,000. !Kl o No. Skip line 8. Enter the amount from line 4 on line 9 below. Yes. Subtract line 6 from line 5 . . . I-~+--------- 8 9 10 Multiply line 7 by 2% (,02). Subtract line 8 from line 4. If zero or less, enter -0-..... Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You may have received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received social security benefits, supplemental security income, railroad retirement benefits, or veterans disability compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions). 800. !Kl No. Ent~r -0- on line 10 and go to line 11. o Yes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010. Do not enter more than $250 ($500 if married filing jointly) f---'-10"--f'---'-11-'---'-- ...:..O-'-, 11 Making work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on Form 1040, line 63; or Form 1040A, line 40.... . 8-'--'-0...:..0-' *If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions. BAA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule M (Form 1040A or 1040) 2010 FDIA8501 L 09/2011 0 r 40001 Utah Individual Income Tax Return All State Income Tax Dollars Fund Education 2010 TC-40 Intuit 1032 Your Social Security No. Fiscal year end month/year (mm/yy) Amended Return - enter code Form 8886 filed X if deceased 474043631 Spouse's SSN JEREMIAH KIM 1300 E 6125 S GRIFFITH 528976647 SESSIONS SOUTH OGDEN Filing Status - enter code - 2 Exemptions - enter number a b 1 = Single 2= Married filing jointly 3= Married filingseparately 4= Head of Household 5= Qualifying widow(er) 4 5 6 7 8 9 UT 1 1 1 Yourself } Spouse Dependents 844057116 UTIA0112L 11/10110 3 Election Campaign Fund - enter code C = Constitution Yourself Spouse - 2 fromfederal eturn r o = c d Democratic L = Libertarian R = Republican N = No contribution - N - N 3 Total exemptions (add a through c) Does not increase tax or reduce refund. Federal adjusted gross income from federal return Additions to income from TC-40A, Part 1 (attach TC-40A, page 1) Total income (add lines 4 and 5) State tax refund included on federal Form 1040, line 10 Subtractions from income from TC-40A, Part 2 (attach TC-40A, page 1) Utah taxable income (subtract the total of lines 7 and 8 from line 6 (not less than zero» - 4 - 5 6 32432 32432 -7 -8 - 9 -10 - 11 32432 1622 10 Utah tax calculation - multiply line 9 by 5% (.05) 11 Exemption amount - multiply $2,738 by line 2d above 12 Enter your federal standard or itemized deductions 8214 11400 Filing electronically is quick, easy and free, and will speed up your refund. 13 Add lines 11 and 12 14 State income tax deducted on federal Schedule A, line 5 (see instructions) 15 Subtract line 14 from line 13 16 17 18 19 Multiply line 15 by 6% (.06) Enter amount based on filing status: if line 1 equals 1 or 3, enter $12,535; if line 1 equals 4, enter $18,802; if line 1 equals 2 or 5, enter $25,070 Subtract line 17 from line 9 (not less than zero) Multiply line 18 by 1.3% (.013) 13 19614 15 19614 f---------To learn more, go to 1177 25070 18 taxexpress. utah.gov 7362 96 - 20 20 Taxpayer tax credit (subtract line 19 from line 16 (not less than zero» 21 If you are a qualified exempt taxpayer, enter 'X' (see worksheet in instructions) 22 Utah income tax (subtract line 20 from line 10 (not less than zero» 1081 541 23 Apportionable nonrefundable credits from TC-40A, Part 3 (attach TC-40A, page 1) L 24 Subtract line 23 from line 22 (not less than zero) Non or Part-Year Residents, complete TC-408 before continuing on page 2 24 541 --.J r 25 26 27 40002 Utah Individual Income Tax Return - 2010 _L_as_t _na_m_e----'G_R_I_F_F_I_T_H-'-- TC-40 Intuit Page 2 I SSN 474043631 541 Entertax (full-year resident,entertax from line 24; non or part-yearresident,entertax from TC-40B,line 37) Nonapportionable nonrefundable credits from form TC-40A, Part 4 (attach TC-40A, page 1) Subtract line 26 from line 25 (not less than zero) - add lines 28a through Wildlife 28d and enter total contributions on line 28 Code Account Account Account Amount Sch Dist Code 27 541 28 Contributions Code Description Utah Nongame Pamela Atkinson 01 .28a 02 03 05 09 10 Homeless Kurt Oscarson School Children's Organ Transplant .28b .28c .28d Fund District & Nonprofit Housing School District Foundation Reconstruction refund 28 Cat & Dog Community Methamphetamine Spay and Neuter Program & Rehabilitation 29 AMENDED RETURN ONLY - previous 30 31 Recapture of low-income housing credit Utah use tax 32 Total tax, use tax and additions to tax (add lines 27 through 31) 32 page 1) to 2010 541 888 33 34 Utah income tax withheld shown on TC-40W, Part 1 (attach TC-40W, Credit for Utah income taxes prepaid from TC-546 and 2009 refund applied 35 36 37 38 39 40 Pass-through Mineral entity withholding withholding tax from TC-40W, tax from TC-40W, payments Part 3 (attach TC-40W, Part 2 (attach TC-40W, page 2) page 2) production AMENDED Refundable RETURN ONLY - previous credits from TC-40A, Part 5 (attach TC-40A, page 2) Total withholding and refundable credits (add lines 33 through 38) 39 888 TAX DUE - Subtrad Penalty and interest line 39 from line 32 (not less than zero) 41 42 43 44 45 41 (add lines 40 and 41) line 32 from line 39 (not less than zero) to your 2011 taxes account information number .44 checking savings PAY THIS AMOUNT REFUND - Subtract 347 190001383024 (see instructions) • Account type: • Enter the amount • Routing number of refund you want applied - provide DIRECT DEPOSIT YOUR REFUND 324377613 • Account X • Check box if refund will go to an account outside the United States 46 To deposit total refund to your Utah Educational Savings Plan account(s), enter 'X' (see instructions) Under penalties of perjury, I declare to the best of my knowledge and belief, this return and accompanying schedules reflect my true tax status, SIGN Your signature Date I Spouse's signature Desiqnee's telephone number Designee. PIN Date Preparer's telephone number Preparer's • PTIN Preparer's • EIN Date HERE Third Party Name of designee (if any) you authorize to discuss this return Designee Paid Preparer's Section PREPARER Preparer's signature 2/07/11 LARRY R_ BERGHOUT, CPA Firm's name and address HAYNIE AND COMPANY CPA'S 1785 WEST 2300 SOUTH SALT LAKE CITY UTIAOl12L 11110110 801-972-4800 UT 841192065 P0043998 1 87032522 8 L r 40008 Part 1 - Utah Withholding Tax Schedule =La=s~tn=a~m=e __ Intuit TC-40W Page 1 G=R~I=F~F~IT==H I~s=sN~~4~7~4~-~0~4~-~3 Line Explanations: IMPORTANT Do not send your W-2s or 1099s with your return. Instead, enter W-2 or 1099 information below, but only if there is Utah withholding on the form. 1 2 3 4 5 6 7 Employer/payer 10 number from W-2 box 'b' or 1099 Utah withholding 10 number from W-2 box '15' or 1099 Employer/payer name and address from W-2 box 'c' or 1099 Enter 'X' if reporting Utah withholding from form 1099 Employee's Social Security number from W-2 box 'a' or 1099 Utah wages/income fromW-2 box '16' or 1099 Utah withholding tax from W-2 box '17' or 1099 Use additional forms TC·40W if you have more than four W-2s and/or 1099s with Utah withholding tax. Enter mineral production withholding from TC-675R in Part 2 of TC-40W; enter pass-through entity withholding in Part 3 of TC-40W. 1 2 3 410215170 Z88464 TARGET CORPORATION MAILSTOP NCD-0280, PO BOX 9401 MINNEAPOLIS, MN 55440-9401 4 510391628 2 3 12251777-003-W URS FEDERAL TECHNICAL SERVICES 20501 SENECA MEADOWS PKW GERMANTOWN, MD 20876 4 5 474043631 9957 123 5 6 7 474043631 22475 765 6 7 1 2 3 2 3 4 5 6 7 4 5 6 7 Enter total Utah withholding lax from all lines 7 here and on TC-40, page 2, line 33 888 Submit this page ONLY if data entered. UTIA0212L 11/1 1/10 L Attach this form to your 2010 Utah Income Tax Return. Do not attach W-2s or 1099s to your Utah return.