00000000: 00 06 20 20 20 20 20 20 20 20 20 20 20 20 20 20 |.. |
00000010: 20 20 20 20 20 20 20 20 20 20 0D 0A 6D 45 44 49 | ..mEDI|
00000020: 43 41 4C 20 41 4E 44 20 64 45 4E 54 41 4C 20 65 |CAL AND dENTAL e|
00000030: 58 50 45 4E 53 45 53 20 0D 0A 0D 0A 20 31 41 20 |XPENSES .... 1A |
00000040: 70 52 45 53 43 2E 20 4D 45 44 49 43 49 4E 45 53 |pRESC. MEDICINES|
00000050: 20 26 20 44 52 55 47 53 0D 0A 20 20 20 20 69 4E | & DRUGS.. iN|
00000060: 53 55 4C 49 4E 20 44 4F 43 54 4F 52 53 20 45 54 |SULIN DOCTORS ET|
00000070: 43 2E 0D 0A 20 20 42 20 74 52 41 4E 53 50 4F 52 |C... B tRANSPOR|
00000080: 54 41 54 49 4F 4E 20 26 20 4C 4F 44 47 49 4E 47 |TATION & LODGING|
00000090: 0D 0A 20 20 43 20 6F 54 48 45 52 2D 45 4E 54 45 |.. C oTHER-ENTE|
000000A0: 52 20 48 45 41 52 49 4E 47 20 41 49 44 53 20 0D |R HEARING AIDS .|
000000B0: 0A 20 20 20 20 44 45 4E 54 55 52 45 53 20 45 54 |. DENTURES ET|
000000C0: 43 2E 20 28 66 35 29 0D 0A 20 32 20 20 74 4F 54 |C. (f5).. 2 tOT|
000000D0: 41 4C 0D 0A 20 33 20 20 6D 55 4C 54 49 50 4C 59 |AL.. 3 mULTIPLY|
000000E0: 20 41 4D 4F 55 4E 54 20 4C 49 4E 45 20 33 31 0D | AMOUNT LINE 31.|
000000F0: 0A 20 20 20 20 46 4F 52 4D 20 31 30 34 30 20 42 |. FORM 1040 B|
00000100: 59 20 37 2E 35 25 20 28 2E 30 37 35 29 0D 0A 20 |Y 7.5% (.075).. |
00000110: 34 20 20 74 4F 54 41 4C 20 6D 45 44 49 43 41 4C |4 tOTAL mEDICAL|
00000120: 20 26 20 64 45 4E 54 41 4C 0D 0A 0D 0A 74 41 58 | & dENTAL....tAX|
00000130: 45 53 20 79 4F 55 20 70 41 49 44 20 0D 0A 20 20 |ES yOU pAID .. |
00000140: 20 64 4F 20 4E 4F 54 20 64 45 44 55 43 54 20 73 | dO NOT dEDUCT s|
00000150: 41 4C 45 53 20 74 41 58 45 53 0D 0A 20 20 0D 0A |ALES tAXES.. ..|
00000160: 20 35 20 20 73 54 41 54 45 20 26 20 6C 4F 43 41 | 5 sTATE & lOCA|
00000170: 4C 20 69 4E 43 2E 20 74 41 58 45 53 20 20 0D 0A |L iNC. tAXES ..|
00000180: 20 36 20 20 72 45 41 4C 20 65 53 54 41 54 45 20 | 6 rEAL eSTATE |
00000190: 54 41 58 45 53 0D 0A 20 37 20 20 6F 54 48 45 52 |TAXES.. 7 oTHER|
000001A0: 20 74 41 58 45 53 20 28 66 35 29 0D 0A 20 38 20 | tAXES (f5).. 8 |
000001B0: 20 74 4F 54 41 4C 20 74 41 58 45 53 0D 0A 0D 0A | tOTAL tAXES....|
000001C0: 69 4E 54 45 52 45 53 54 20 79 4F 55 20 70 41 49 |iNTEREST yOU pAI|
000001D0: 44 0D 0A 0D 0A 20 69 46 20 59 4F 55 20 49 4E 43 |D.... iF YOU INC|
000001E0: 4C 55 44 45 20 49 4E 54 45 52 45 53 54 20 4F 4E |LUDE INTEREST ON|
000001F0: 20 41 20 0D 0A 20 4C 4F 41 4E 20 54 41 4B 45 4E | A .. LOAN TAKEN|
00000200: 20 4F 55 54 20 41 46 54 45 52 20 38 2F 31 35 2F | OUT AFTER 8/15/|
00000210: 38 36 20 0D 0A 20 26 20 49 46 20 54 48 45 20 4C |86 .. & IF THE L|
00000220: 4F 41 4E 20 50 52 4F 43 45 45 44 53 20 57 45 52 |OAN PROCEEDS WER|
00000230: 45 20 0D 0A 20 4E 4F 54 20 55 53 45 44 20 54 4F |E .. NOT USED TO|
00000240: 20 42 55 59 20 59 4F 55 52 20 48 4F 4D 45 20 0D | BUY YOUR HOME .|
00000250: 0A 20 41 54 54 41 43 48 20 38 35 39 38 3F 20 28 |. ATTACH 8598? (|
00000260: 79 45 53 2F 6E 4F 29 0D 0A 20 39 41 20 64 45 44 |yES/nO).. 9A dED|
00000270: 55 43 54 20 48 4F 4D 45 20 4D 4F 52 54 47 41 47 |UCT HOME MORTGAG|
00000280: 45 20 49 4E 54 20 0D 0A 20 20 20 20 50 41 49 44 |E INT .. PAID|
00000290: 20 54 4F 20 46 49 4E 41 4E 43 49 41 4C 20 49 4E | TO FINANCIAL IN|
000002A0: 53 54 2E 0D 0A 20 39 42 20 64 45 44 20 48 4F 4D |ST... 9B dED HOM|
000002B0: 45 20 4D 4F 52 54 20 49 4E 54 20 50 41 49 44 20 |E MORT INT PAID |
000002C0: 54 4F 0D 0A 20 20 20 20 49 4E 44 49 56 49 44 55 |TO.. INDIVIDU|
000002D0: 41 4C 53 0D 0A 0D 0A 20 20 20 20 69 4E 44 49 56 |ALS.... iNDIV|
000002E0: 49 44 55 41 4C 27 53 20 4E 41 4D 45 20 20 0D 0A |IDUAL'S NAME ..|
000002F0: 20 20 20 20 69 4E 44 49 56 49 44 55 41 4C 27 53 | iNDIVIDUAL'S|
00000300: 20 41 44 44 52 0D 0A 31 30 20 20 64 45 44 55 43 | ADDR..10 dEDUC|
00000310: 54 49 42 4C 45 20 70 4F 49 4E 54 53 0D 0A 31 31 |TIBLE pOINTS..11|
00000320: 20 20 64 45 44 55 43 54 49 42 4C 45 20 69 4E 56 | dEDUCTIBLE iNV|
00000330: 20 69 4E 54 45 52 45 53 54 0D 0A 31 32 41 20 70 | iNTEREST..12A p|
00000340: 45 52 53 4F 4E 41 4C 20 69 4E 54 2E 20 79 4F 55 |ERSONAL iNT. yOU|
00000350: 20 70 41 49 44 20 0D 0A 31 32 42 20 6C 49 4E 45 | pAID ..12B lINE|
00000360: 20 31 32 41 20 54 49 4D 45 53 20 36 35 25 20 28 | 12A TIMES 65% (|
00000370: 2E 36 35 29 0D 0A 31 33 20 20 74 4F 54 41 4C 20 |.65)..13 tOTAL |
00000380: 69 4E 54 45 52 45 53 54 0D 0A 0D 0A 63 4F 4E 54 |iNTEREST....cONT|
00000390: 52 49 42 55 54 49 4F 4E 53 20 79 4F 55 20 6D 41 |RIBUTIONS yOU mA|
000003A0: 44 45 0D 0A 0D 0A 31 34 41 20 63 41 53 48 20 63 |DE....14A cASH c|
000003B0: 4F 4E 54 52 49 42 55 54 49 4F 4E 53 2D 69 46 20 |ONTRIBUTIONS-iF |
000003C0: 59 4F 55 20 0D 0A 20 20 20 20 47 41 56 45 20 24 |YOU .. GAVE $|
000003D0: 33 30 30 30 20 4F 52 20 4D 4F 52 45 20 54 4F 20 |3000 OR MORE TO |
000003E0: 41 4E 59 20 0D 0A 20 20 20 20 4F 4E 45 20 4F 52 |ANY .. ONE OR|
000003F0: 47 41 4E 49 5A 41 54 49 4F 4E 20 52 45 50 4F 52 |GANIZATION REPOR|
00000400: 54 20 20 0D 0A 20 20 20 20 43 4F 4E 54 52 49 42 |T .. CONTRIB|
00000410: 55 54 49 4F 4E 53 20 4F 4E 20 31 34 42 0D 0A 31 |UTIONS ON 14B..1|
00000420: 34 42 20 63 41 53 48 20 63 4F 4E 54 52 20 4F 56 |4B cASH cONTR OV|
00000430: 45 52 20 24 33 30 30 30 20 54 4F 20 0D 0A 20 20 |ER $3000 TO .. |
00000440: 20 20 41 4E 59 20 4F 4E 45 20 4F 52 47 41 4E 49 | ANY ONE ORGANI|
00000450: 5A 41 54 49 4F 4E 20 28 66 35 29 20 0D 0A 31 35 |ZATION (f5) ..15|
00000460: 20 20 6F 54 48 45 52 20 54 48 41 4E 20 63 41 53 | oTHER THAN cAS|
00000470: 48 0D 0A 31 36 20 20 63 41 52 52 59 4F 56 45 52 |H..16 cARRYOVER|
00000480: 20 46 52 4F 4D 20 50 52 49 4F 52 20 59 45 41 52 | FROM PRIOR YEAR|
00000490: 20 0D 0A 31 37 20 20 74 4F 54 41 4C 20 63 4F 4E | ..17 tOTAL cON|
000004A0: 54 52 49 42 55 54 49 4F 4E 53 0D 0A 0D 0A 63 41 |TRIBUTIONS....cA|
000004B0: 53 55 41 4C 54 59 20 41 4E 44 20 74 48 45 46 54 |SUALTY AND tHEFT|
000004C0: 20 6C 4F 53 53 45 53 0D 0A 0D 0A 31 38 20 74 4F | lOSSES....18 tO|
000004D0: 54 2E 20 63 41 53 55 41 4C 54 59 20 26 20 74 48 |T. cASUALTY & tH|
000004E0: 45 46 54 20 6C 4F 53 53 0D 0A 0D 0A 6D 4F 56 49 |EFT lOSS....mOVI|
000004F0: 4E 47 20 65 58 50 45 4E 53 45 53 20 28 66 4F 52 |NG eXPENSES (fOR|
00000500: 4D 20 33 39 30 33 29 0D 0A 0D 0A 31 39 20 20 6D |M 3903)....19 m|
00000510: 4F 56 49 4E 47 20 65 58 50 45 4E 53 45 53 0D 0A |OVING eXPENSES..|
00000520: 0D 0A 6D 49 53 43 20 64 45 44 55 43 54 49 4F 4E |..mISC dEDUCTION|
00000530: 53 2D 32 25 20 61 67 69 20 4C 49 4D 49 54 0D 0A |S-2% agi LIMIT..|
00000540: 0D 0A 32 30 20 20 75 4E 52 45 49 4D 42 55 52 53 |..20 uNREIMBURS|
00000550: 45 44 20 62 55 53 2E 20 65 58 50 2E 0D 0A 32 31 |ED bUS. eXP...21|
00000560: 20 20 6F 54 48 45 52 20 65 58 50 45 4E 53 45 53 | oTHER eXPENSES|
00000570: 20 28 66 35 29 0D 0A 32 32 20 20 74 4F 54 41 4C | (f5)..22 tOTAL|
00000580: 20 0D 0A 32 33 20 20 6D 55 4C 54 49 50 4C 59 20 | ..23 mULTIPLY |
00000590: 4C 49 4E 45 20 33 31 20 4F 4E 20 0D 0A 20 20 20 |LINE 31 ON .. |
000005A0: 20 46 4F 52 4D 20 31 30 34 30 20 42 59 20 32 25 | FORM 1040 BY 2%|
000005B0: 20 28 2E 30 32 29 0D 0A 32 34 20 20 6C 49 4E 45 | (.02)..24 lINE|
000005C0: 20 32 33 20 46 52 4F 4D 20 32 32 0D 0A 32 35 20 | 23 FROM 22..25 |
000005D0: 20 6D 49 53 43 20 64 45 44 55 43 54 49 4F 4E 53 | mISC dEDUCTIONS|
000005E0: 20 4E 4F 54 20 0D 0A 20 20 20 20 53 55 42 4A 45 | NOT .. SUBJE|
000005F0: 43 54 20 54 4F 20 32 25 20 61 67 69 20 4C 49 4D |CT TO 2% agi LIM|
00000600: 49 54 0D 0A 0D 0A 74 4F 54 41 4C 20 69 54 45 4D |IT....tOTAL iTEM|
00000610: 49 5A 45 44 20 64 45 44 55 43 54 49 4F 4E 53 0D |IZED dEDUCTIONS.|
00000620: 0A 0D 0A 32 36 20 20 74 4F 54 41 4C 2D 66 4F 52 |...26 tOTAL-fOR|
00000630: 4D 20 31 30 34 30 20 4C 49 4E 45 20 33 33 61 0D |M 1040 LINE 33a.|
00000640: 0A 6F 54 48 45 52 20 6D 45 44 49 43 41 4C 20 65 |.oTHER mEDICAL e|
00000650: 58 50 45 4E 53 45 53 0D 0A 6E 41 4D 45 0D 0A 61 |XPENSES..nAME..a|
00000660: 4D 4F 55 4E 54 0D 0A 6F 54 48 45 52 20 74 41 58 |MOUNT..oTHER tAX|
00000670: 45 53 0D 0A 6E 41 4D 45 0D 0A 61 4D 4F 55 4E 54 |ES..nAME..aMOUNT|
00000680: 0D 0A 63 41 53 48 20 63 4F 4E 54 52 49 42 55 54 |..cASH cONTRIBUT|
00000690: 49 4F 4E 53 20 6F 56 45 52 20 24 33 30 30 30 0D |IONS oVER $3000.|
000006A0: 0A 6E 41 4D 45 20 0D 0A 61 4D 4F 55 4E 54 0D 0A |.nAME ..aMOUNT..|
000006B0: 6F 54 48 45 52 20 4E 4F 4E 2D 32 25 20 64 45 44 |oTHER NON-2% dED|
000006C0: 55 43 54 49 4F 4E 53 0D 0A 6E 41 4D 45 0D 0A 61 |UCTIONS..nAME..a|
000006D0: 4D 4F 55 4E 54 0D 0A 6F 54 48 45 52 20 6D 49 53 |MOUNT..oTHER mIS|
000006E0: 43 45 4C 4C 41 4E 45 4F 55 53 20 64 45 44 55 43 |CELLANEOUS dEDUC|
000006F0: 54 49 4F 4E 53 0D 0A 6E 41 4D 45 0D 0A 61 4D 4F |TIONS..nAME..aMO|
00000700: 55 4E 54 0D 0A 1A |UNT... |
.. ..MEDICAL AND
DENTAL EXPENSES .... 1A PRESC. MEDICINES
& DRUGS.. INSULIN DOCTORS ETC... B
TRANSPORTATION & LODGING.. C OTHER-ENTE
R HEARING AIDS .. DENTURES ETC. (F5).
. 2 TOTAL.. 3 MULTIPLY AMOUNT LINE 31.
. FORM 1040 BY 7.5% (.075).. 4 TOTAL
MEDICAL & DENTAL....TAXES YOU PAID ..
DO NOT DEDUCT SALES TAXES.. .. 5 STAT
E & LOCAL INC. TAXES .. 6 REAL ESTATE
TAXES.. 7 OTHER TAXES (F5).. 8 TOTAL T
AXES....INTEREST YOU PAID.... IF YOU INC
LUDE INTEREST ON A .. LOAN TAKEN OUT AFT
ER 8/15/86 .. & IF THE LOAN PROCEEDS WER
E .. NOT USED TO BUY YOUR HOME .. ATTACH
8598? (YES/NO).. 9A DEDUCT HOME MORTGAG
E INT .. PAID TO FINANCIAL INST... 9B
DED HOME MORT INT PAID TO.. INDIVIDU
ALS.... INDIVIDUAL'S NAME .. INDI
VIDUAL'S ADDR..10 DEDUCTIBLE POINTS..11
DEDUCTIBLE INV INTEREST..12A PERSONAL
INT. YOU PAID ..12B LINE 12A TIMES 65% (
.65)..13 TOTAL INTEREST....CONTRIBUTION
S YOU MADE....14A CASH CONTRIBUTIONS-IF
YOU .. GAVE $3000 OR MORE TO ANY ..
ONE ORGANIZATION REPORT .. CONTRIB
UTIONS ON 14B..14B CASH CONTR OVER $3000
TO .. ANY ONE ORGANIZATION (F5) ..15
OTHER THAN CASH..16 CARRYOVER FROM PR
IOR YEAR ..17 TOTAL CONTRIBUTIONS....CA
SUALTY AND THEFT LOSSES....18 TOT. CASUA
LTY & THEFT LOSS....MOVING EXPENSES (FOR
M 3903)....19 MOVING EXPENSES....MISC D
EDUCTIONS-2% AGI LIMIT....20 UNREIMBURS
ED BUS. EXP...21 OTHER EXPENSES (F5)..2
2 TOTAL ..23 MULTIPLY LINE 31 ON ..
FORM 1040 BY 2% (.02)..24 LINE 23 FROM
22..25 MISC DEDUCTIONS NOT .. SUBJE
CT TO 2% AGI LIMIT....TOTAL ITEMIZED DED
UCTIONS....26 TOTAL-FORM 1040 LINE 33A.
.OTHER MEDICAL EXPENSES..NAME..AMOUNT..O
THER TAXES..NAME..AMOUNT..CASH CONTRIBUT
IONS OVER $3000..NAME ..AMOUNT..OTHER NO
N-2% DEDUCTIONS..NAME..AMOUNT..OTHER MIS
CELLANEOUS DEDUCTIONS..NAME..AMOUNT...
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