COVER PAGE. Filing Checklist For 2009 Tax Return Filed On Standard Forms. Prepared on: 12/01/ :27:26 pm

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1 COVER PAGE Filing Checklist For 29 Tax Return Filed On Standard Forms Prepared on: 12/1/21 11:27:26 pm Return: C:\Users\Aarons\Documents\HRBlock\MARVIN HALL 1 29 Tax Return.T9 To file your 29 tax return, simply follow these instructions: Step 1 - Sign and date the return Because you're filing a joint return, MARVIN and MOLLY both need to sign the tax return. If your return is signed by a representative for you, you must have a power of attorney attached that specifically authorizes the representative to sign your return. To do this, you can use Form 288, Power of Attorney and Declaration of Representative. Step 2 - Assemble the return These forms should be assembled behind Form 1 --U.S. Individual Income Tax Return - Schedule A - Schedule B - Schedule C - Schedule E - Schedule SE - Form Form Form Page Page 2 (Regular Tax) - - Page (Regular Tax) - Form Schedule M Staple these documents to the front of the first page of the return: Form W-2: Wage and Tax Statement 1st (HOME CARE SERVICES) Step - Mail the return Mail the return to this address: Department of the Treasury Internal Revenue Service Center Fresno, CA We recommend that you use one of these IRS-approved methods to send your return. Retain the proof of mailing to avoid a late filing penalty: - U.S. Postal Service certified mail. - DHL Same Day Service. - FedEx Priority Overnight, Standard Overnight, 2Day, International Priority, or International First. - United Parcel Service Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day Air A.M., Worldwide Express Plus, or Worldwide Express. Step - Keep a copy Print a second copy of the return for your records. We recommend that you also print and retain these supporting forms, which don't need to be sent to the IRS: - - Background Worksheet - - Dependents Worksheet - - Child Tax Credit Worksheet - - Form 199-INT/OID - - Form 199-G - - Home Mortgage Interest Worksheet - - Charitable Worksheet - - n-w2 Wages - - Keogh/SEP/SIMPLE Contributions - - Depreciation Summary - - Depreciation Worksheet - - Vehicle Worksheet - - Rentals & Royalties 29 return information - Keep this for your records Here is some additional information about your 29 return. Keep this information with your records.

2 You will need your 29 AGI to electronically sign your return next year. Quick Summary Total (Gross) Income $86,572 Adjusted Gross Income 7,19 Taxable Income 27,91 Total Federal Tax 8,2 Total Payments 1,2 Penalties Refund Amount,868 Amount You Owe $

3 F or m Department of the Treasury Internal Revenue Service 1 U.S. Individual Income Tax Return 29 Label (See instructions.) Use the IRS label. Otherwise, please print or type. Presidential Election Campaign Filing Status Check only one box. Exemptions If more than four dependents, see instructions and check here Income Attach Form(s) W-2 here. Also attach Forms W-2G and 199-R if tax was withheld. If you did not get a W-2, see instructions. Enclose, but do not attach, any payment. Also, please use Form 1-V. Adjusted Gross Income KIA L A B E L H E R E (99) IRS Use Only Do not write or staple in this space. For the year Jan. 1 Dec. 1, 29, or other tax year beginning, 29, ending, 2 OMB Your first name and initial Last name Your social security number 1 2 MARVIN L HALL If a joint return, spouse's first name and initial Last name Spouse's social security number MOLLY S HALL Home address (number and street). If you have a P.O. box, see instructions. 1 POPLAR AVENUE City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. FORT WAYNE IN 682 6a b c Single Married filing jointly (even if only one had income) Married filing separately. Enter spouse's SSN above and full name here. Head of household (with qualifying person). (See instr.) If the qualifying person is a child but not your dependent, enter this child's name here. 7 Wages, salaries, tips, etc. Attach Form(s) W a Taxable interest. Attach Schedule B if required b Tax-exempt interest. Do not include on line 8a b 9a Ordinary dividends. Attach Schedule B if required b Qualified dividends (see instructions) b 1 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) Alimony received Business income or (loss). Attach Schedule C or C-EZ Capital gain or (loss). Attach Schedule D if required. If not required, check here Other gains or (losses). Attach Form a IRA distributions a b Taxable amount (see inst.) 16a Pensions and annuities a b Taxable amount (see inst.) 16b Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E..... Farm income or (loss). Attach Schedule F Unemployment compensation in excess of $2, per recipient (see instructions) a Social security benefits a b Taxable amount (see inst.) 2b Other income. List type and amount (see instructions) _ Add the amounts in the far right column for lines 7 through 21. This is your total income Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 216 or 216-EZ Health savings account deduction. Attach Form Moving expenses. Attach Form One-half of self-employment tax. Attach Schedule SE Self-employed SEP, SIMPLE, and qualified plans Self-employed health insurance deduction (see instructions) Penalty on early withdrawal of savings a Alimony paid b Recipient's SSN 2 IRA deduction (see instructions) Student loan interest deduction (see instructions) Tuition and fees deduction. Attach Form Qualifying widow(er) with dependent child (see instructions) Yourself. If someone can claim you as a dependent, do not check box 6a Dependents: (1) First name Last name 2 Educator expenses (see instructions) Apt. no. Spouse a Add lines 2 through 1a and 2 through Subtract line 6 from line 22. This is your adjusted gross income (2) Dependent's social security number () Dependent's relationship to you d Total number of exemptions claimed () if qualifying child for child tax credit (see instr.) You must enter your SSN(s) above. Check here if you, or your spouse if filing jointly, want $ to go to this fund (see instructions) You Spouse DALE HALL Son DANA HALL Daughter KIRK HALL Son ZOE HALL Parent 5 Domestic production activities deduction. Attach Form For Disclosure, Privacy Act, and Paperwork Reduction Act tice, see instructions. Checking a box below will not change your tax or refund,55 8, 5, Boxes checked on 6a and 6b. of children on 6c who: lived with you did not live with you due to divorce or separation (see instructions) Dependents on 6c not entered above Add numbers on lines above 7 8a 9a b , 2,5 5,29-5,218 86,572 16,55 7,19 Form 1 (29)

4 Form 1 (29) Tax and Credits Standard Deduction for People who check any box on line 9a, 9b, or b or who can be claimed as a dependent, see instructions All others: Single or Married filing separately, $5,7 Married filing jointly or Qualifying widow(er), $11, Head of household, $8,5 Other Taxes Payments If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions and fill in 7b, 7c, and 7d, or Form Amount You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Paid Preparer's Use Only KIA MARVIN L HALL Amount from line 7 (adjusted gross income) a Check You were born before January 2, 195, Blind. Total boxes if: Spouse was born before January 2, 195, Blind. checked 9a b If your spouse itemizes on a separate return, or you were a dual-status alien, see instructions and check here 9b a Itemized deductions (from Schedule A) or your standard deduction (see left margin) b 1 Subtract line a from line Exemptions. If line 8 is $125,1 or less and you did not provide housing to a Midwestern displaced individual, multiply $,65 by the number on line 6d. Otherwise, see instructions Taxable income. Subtract line 2 from line 1. If line 2 is more than line 1, enter Tax (see instructions). Check if any tax is from: a Form(s) 881 b Form Alternative minimum tax (see instructions). Attach Form Add lines and Foreign tax credit. Attach Form 1116 if required Credit for child and dependent care expenses. Attach Form Education credits from Form 886, line Retirement savings contributions credit. Attach Form Child tax credit (see instructions) Credits from Form: a 896 b 889 c Other credits from Form: a Form 8 b Form 881 c 5 5 Add lines 7 through 5. These are your total credits Subtract line 5 from line 6. If line 5 is more than line 6, enter Self-employment tax. Attach Schedule SE Unreported social security and Medicare tax from Form: 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 529 if required Additional taxes: 6 Add lines 55 through 59. This is your total tax Federal income tax withheld from Forms W-2 and estimated tax payments and amount applied from 28 return Making work pay and government retiree credits. Attach Schedule M.. 6 6a Earned income credit (EIC) a b ntaxable combat pay election b 65 Additional child tax credit. Attach Form Refundable education credit from Form 886, line First-time homebuyer credit. Attach Form Amount paid with request for extension to file (see instructions) Excess social security and tier 1 RRTA tax withheld (see instructions) Credits from Form: a 29 b 16 c 881 d Add lines 61, 62, 6, 6a, and 65 through 7. These are your total payments If line 71 is more than line 6, subtract line 6 from line 71. This is the amount you overpaid... 7a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here.... b d 7 Amount of line 72 you want applied to your 21 estimated tax 7 75 Amount you owe. Subtract line 71 from line 6. For details on how to pay, see the instructions 76 Estimated tax penalty (see instructions) Your signature Spouse's signature. If a joint return, both must sign. Preparer's signature If you are increasing your standard deduction by certain real estate taxes, new motor vehicle taxes, or a net disaster loss, attach Schedule L and check here (see instructions) Routing number Account number Firm's name (or yours if self-employed), address, and ZIP code Date Date a 17 b a AEIC payments b Household employment taxes. Attach Schedule H c Type: Checking Savings Do you want to allow another person to discuss this return with the IRS (see instructions)? Designee's Phone Personal indentification name no. number (PIN) Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your occupation Spouse's occupation Date Check if self-employed b 2, 12, 8 EIN 8 a a 75. Complete the following Daytime phone number CLAIMS ADJUSTER REGISTERED NURSE Preparer's SSN or PTIN Phone no. Page 2 7,19 21,28 8,991 21,9 27,91,226,226 2, 1,226 7,16 8,2 1,2,868,868 Form 1 (29)

5 SCHEDULE A (Form 1) Department of the Treasury Internal Revenue Service (99) Name(s) shown on Form 1 Medical and Dental Expenses Taxes You Paid (See instructions.) Interest You Paid (See instructions.) te: Personal interest is not deductible. Gifts to Charity If you made a gift and got a benefit for it, see instructions. Casualty and Attach to Form 1. Itemized Deductions See Instructions for Schedule A (Form 1). Caution. Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses (see instructions) , 2 Enter amount from Form 1, line ,19 Multiply line 2 by 7.5% (.75) ,251 Subtract line from line 1. If line is more than line 1, enter State and local (check only one box): a Income taxes, or 5 2,91 b General sales taxes Real estate taxes (see instructions) ,98 7 New motor vehicle taxes from line 11 of the worksheet in the instructions (skip this line if you checked box 5b) 7 8 Other taxes. List type and amount 8 9 Add lines 5 through Home mortgage interest and points reported to you on Form , 11 Home mortgage interest not reported to you on Form 198. If paid to the person from whom you bought the home, see instructions and show that person's name, identifying no., and address _ Points not reported to you on Form 198. See instructions for special rules Qualified mortgage insurance premiums (See instructions) Investment interest. Attach Form 952 if required. (See instr.) Add lines 1 through Gifts by cash or check. If you made any gift of $25 or more, see instructions , 17 Other than by cash or check. If any gift of $25 or more, see 17 instructions. You must attach Form 828 if over $ Carryover from prior year Add lines 16 through Theft Losses 2 Casualty or theft loss(es). Attach Form 68. (See instructions.) Job Expenses 21 Unreimbursed employee expenses job travel, union dues, job and Certain education, etc. Attach Form 216 or 216-EZ if required. (See Miscellaneous instructions.) Form 216 Deductions _ (See instructions.) Other Miscellaneous Deductions Total Itemized Deductions _ 21,18 22 Tax preparation fees Other expenses investment, safe deposit box, etc. List type and amount _ 2 2 Add lines 21 through , 25 Enter amount from Form 1, line ,19 26 Multiply line 25 by 2% (.2) , 27 Subtract line 26 from line 2. If line 26 is more than line 2, enter Other from list in the instructions. List type and amount 29 Is Form 1, line 8, over $166,8 (over $8, if married filing separately)?. Your deduction is not limited. Add the amounts in the far right column for lines through 28. Also, enter this amount on Form 1, line a.. Your deduction may be limited. See instructions for the amount to enter. If you elect to itemize deductions even though they are less than your standard deduction, check here OMB Attachment Sequence. 7 Your social security number MARVIN L HALL KIA For Paperwork Reduction Act tice, see Form 1 instructions. Schedule A (Form 1) ,79 8,9 5,, 1,9 21,28

6 Schedule A (Form 1) 29 Before you begin: Worksheet for Line 7 New motor vehicle tax deduction 1 Enter the state or local sales or excise taxes you paid in 29 for the purchase of a new motor vehicle(s) after February 16, 29 (see instructions) You cannot take this deduction if the amount on Form 1, line 8, is equal to or greater than $15, ($26, if married filing jointly). See the instructions for line 7. 1 Page 2 Use this worksheet to figure the amount to enter on line 7. (Keep a copy for your records.) 2 Enter the purchase price (before taxes) of the new motor vehicle(s) Is the amount on line 2 more than $9,5?. Enter the amount from line 1.. Enter the portion of the tax from line 1 that is attributable to the first $9,5 of the purchase price of each new motor vehicle and enter it here (see instructions). Enter the amount from Form 1, line Enter the total of any Amounts from Form 2555, lines 5 and 5; Form 2555-EZ, line 18; and Form 56, line 15, and Exclusion of income from Puerto Rico Add lines and Enter $125, ($25, if married filing jointly) Is the amount on line 6 more than the amount on line 7?. Enter the amount from line above on Schedule A, line 7. Do not complete the rest of this worksheet.. Subtract line 7 from line Divide the amount on line 8 by $1,. Enter the result as a decimal (rounded to at least three places). If the result is 1. or more, enter Multiply line by line KIA 11 Deduction for new motor vehicle taxes. Subtract line 1 from line. Enter the result here and on Schedule A, line Schedule A (Form 1) 29

7 SCHEDULE B (Form 1A or 1) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Part I Interest (See the instructions for Form 1A, or Form 1, line 8a.) te: If you received a Form 199-INT, Form 199-OID, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total interest shown on that form. Part II Ordinary Dividends (See the instructions for Form 1A, or Form 1, line 9a.) te: If you received a Form 199-DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. Part III Foreign Accounts and Trusts (See instructions.) Interest and Ordinary Dividends Attach to Form 1A or 1. See Instructions. 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see instructions and list this interest first. Also, show that buyer's social security number and address Amount CITY OF SOUTH BEND BANK 1,7 WELLS FARGO BANK 8 2 Add the amounts on line Excludable interest on series EE and I U.S. savings bonds issued after Attach Form Subtract line from line 2. Enter the result here and on Form 1A, or Form 1, line 8a te: If line is over $1,5, you must complete Part III. 5 List name of payer 6 Add the amounts on line 5. Enter the total here and on Form 1A, or Form 1, line 9a te. If line 6 is over $1,5, you must complete Part III. foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. 7a At any time during 29, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See instructions for exceptions and filing requirements for Form TD F ,5 Amount You must complete this part if you (a) had over $1,5 of taxable interest or ordinary dividends; or (b) had a b If "," enter the name of the foreign country _ 8 During 29, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If "," you may have to file Form 52. See instructions KIA For Paperwork Reduction Act tice, see Form 1A or 1 instructions. Schedule B (Form 1A or 1) 29 6 OMB Attachment Sequence. 8 Your social security number MARVIN L HALL ,5

8 SCHEDULE C (Form 1) Department of the Treasury Internal Revenue Service Name of proprietor A C F Accounting method: OMB (Sole Proprietorship) Partnerships, joint ventures, etc., generally must file Form 165 or 165-B. 29 Attachment Attach to Form 1, 1NR, or 11. See Instructions for Schedule C (Form 1). Sequence. 9 Social security number (SSN) Principal business or profession, including product or service (see the instructions) Business name. If no separate business name, leave blank. E Business address (including suite or room no.) City, town or post office, state, and ZIP code FORT WAYNE IN 682 H If you started or acquired this business during 29, check here Income Expenses. Enter expenses for business use of your home only on line. 1 Commissions and fees a 16b 17 b Deductible meals and entertainment (see instructions)... B Enter code from instructions G Did you "materially participate" in the operation of this business during 29? If "," see instructions for limit on losses... Part I 1 Gross receipts or sales. Caution. See instructions and check the box if: This income was reported to you on Form W-2 and the Statutory employee box on that form was checked, or... You are a member of a qualified joint venture reporting only rental real estate income not subject to self-employment tax. Also, see instructions for limit on losses. 2 Returns and allowances Subtract line 2 from line Cost of goods sold (from line 2 on page 2) Gross profit. Subtract line from line Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) Gross income. Add lines 5 and Part II 8 Advertising Car and truck expenses (see instructions) Depreciation and section 179 expense deduction (not included in Part III) (see instructions) Employee benefit programs (other than on line 19) Insurance (other than health). 16 Interest: KIA (99) Profit or Loss From Business MARVIN L HALL CLAIMS ADJUSTER 5229 MARVIN'S CLAIM ADJUSTER 11 Contract labor (see instructions) 12 Depletion a Mortgage (paid to banks, etc.) b Other Legal and professional services Wages (less employment credits).. 27 Other expenses (from line 8 on page 2) Total expenses before expenses for business use of home. Add lines 8 through Tentative profit or (loss). Subtract line 28 from line Expenses for business use of your home. Attach Form Net profit or (loss). Subtract line from line 29. (1) Cash (2) Accrual () 2 If you have a loss, check the box that describes your investment in this activity (see instructions). D Employer ID number (EIN), if any Other (specify) _ 18 Office expense Pension and profit-sharing plans... 2 Rent or lease (see instructions): a Vehicles, machinery, & equipment.. b Other business property Repairs and maintenance Supplies (not included in Part III)... 2 Taxes and licenses Travel, meals, and entertainment: a Travel Utilities If a profit, enter on both Form 1, line 12, and Schedule SE, line 2, or on Form 1NR, line 1 (if you checked the box on line 1, see instructions). Estates and trusts, enter on Form 11, line. If a loss, you must go to line 2. For Paperwork Reduction Act tice, see the instructions. 2 PEONY STREET SUITE 1 2,7 2,2 1,5 1,7 If you checked 2a, enter the loss on both Form 1, line 12, and Schedule SE, line 2, or on Form 1NR, line 1 (if you checked the box on line 1, see the line 1 instructions). Estates and trusts, enter on Form 11, line. If you checked 2b, you m ust attach Form Your loss may be limited a 2b a 2b a 2b 72, 72, 72, 72, 8,1 1,1 9 7, 21,71 5,29 5,29 All investment is at risk. Some investment is not at risk. Schedule C (Form 1) 29

9 Schedule C (Form 1) 29 MARVIN L HALL Page 2 Part III Cost of Goods Sold (see instructions) Method(s) used to value closing inventory: a Cost b Lower of cost or market c Other (attach explanation) Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If "," attach explanation Inventory at beginning of year. If different from last year's closing inventory, attach explanation Purchases less cost of items withdrawn for personal use Cost of labor. Do not include any amounts paid to yourself Materials and supplies Other costs Add lines 5 through Inventory at end of year Cost of goods sold. Subtract line 1 from line. Enter the result here and on page 1, line Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 562 for this business. See the instructions for line 1 to find out if you must file Form 562. When did you place your vehicle in service for business purposes? (month, day, year) Of the total number of miles you drove your vehicle during 29, enter the number of miles you used your vehicle for: a Business _ b Commuting (see instructions) c Other 5 Was your vehicle available for personal use during off-duty hours? Do you (or your spouse) have another vehicle available for personal use? a Do you have evidence to support your deduction? b If "," is the evidence written? Part V Other Expenses. List below business expenses not included on lines 8 26 or line. DUES UTILITIES, 8 Total other expenses. Enter here and on page 1, line KIA, Schedule C (Form 1) 29

10 SCHEDULE E (Form 1) Department of the Treasury Internal Revenue Service Name(s) shown on return (99) 19 Add lines 5 through Depreciation expense or depletion (see instructions) Total expenses. Add lines 19 and 2 Supplemental Income and Loss (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.) OMB Attach to Form 1, 1NR, or Form 11. See Instructions for Schedule E (Form 1). Attachment Sequence. 1 Your social security number MARVIN L HALL Part I Income or Loss From Rental Real Estate and Royalties te. If you are in the business of renting personal property, use Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 85 on page 2, line. 1 List the type and location of each rental real estate property: 2 For each rental real estate property A B RENTAL 1.% listed on line 1, did you or your family 22 CARDINAL RD ELKHART IN 6515 use it during the tax year for personal purposes for more than the greater of: A 1 days or 1% of the total days rented at B C fair rental value? (See instructions.) C Income: Properties Totals A B C (Add columns A, B, and C.) Rents received Royalties received ,5 1,5 Expenses: 5 Advertising Auto and travel (see instructions). 6 7 Cleaning and maintenance Commissions Insurance ,225 1 Legal and other professional fees Management fees Mortgage interest paid to banks, etc. (see instructions) ,5 12 1,5 1 Other interest Repairs Supplies Taxes ,62 17 Utilities Other (list) STREET PAVING ASSESSMENT 1, , , , Income or (loss) from rental real estate or royalty properties. Subtract line 21 from line (rents) or line (royalties). If the result is a (loss), see instructions to find out if you must file Form ,218 2 Deductible rental real estate loss. Caution. Your rental real estate loss on line 22 may be limited. See instructions to find out if you must file Form Real estate professionals must complete line on page ( 5,218 ) ( ) ( ) 2 Income. Add positive amounts shown on line 22. Do not include any losses Losses. 25 ( 5,218 Add royalty losses from line 22 and rental real estate losses from line 2. Enter total losses here.... ) 26 Total rental real estate and royalty income or (loss). Combine lines 2 and 25. Enter the result here. If Parts II, III, IV, and line on page 2 do not apply to you, also enter this amount on Form 1, line 17, or Form 1NR, line 18. Otherwise, include this amount in the total on line 1 on page ,218 KIA For Paperwork Reduction Act tice, see instructions. Schedule E (Form 1) 29

11 SCHEDULE SE (Form 1) Department of the Treasury Internal Revenue Service (99) Attach to Form 1. Name of person with self-employment income (as shown on Form 1) Who Must File Schedule SE Self-Employment Tax See Instructions for Schedule SE (Form 1). Social security number of person with self-employment income OMB Attachment Sequence. 17 MARVIN L HALL You must file Schedule SE if: You had net earnings from self-employment from other than church employee income (line of Short Schedule SE or line c of Long Schedule SE) of $ or more, or You had church employee income of $18.28 or more. Income from services you performed as a minister or a member of a religious order is not church employee income (see instructions). te. Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use either "optional method" in Part II of Long Schedule SE (see instructions). Exception. If your only self-employment income was from earnings as a minister, member of a religious order, or Christian Science practitioner and you filed Form 61 and received IRS approval not to be taxed on those earnings, do not file Schedule SE. Instead, write "Exempt-Form 61" on Form 1, line 56. May I Use Short Schedule SE or Must I Use Long Schedule SE? te. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE, above. Did you receive wages or tips in 29? Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? Was the total of your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from self-employment more than $16,8? Are you using one of the optional methods to figure your net earnings (see instructions)? Did you receive tips subject to social security or Medicare tax that you did not report to your employer? Did you receive church employee income reported on Form W-2 of $18.28 or more? Did you report any wages on Form 8919, Uncollected Social Security and Medicare Tax on Wages? You may use Short Schedule SE below 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 6, and farm partnerships, Schedule K-1 (Form 165), box 1, code A Net profit or (loss) from Schedule C, line 1; Schedule C-EZ, line ; and Schedule K-1 (Form 165), box 1, code A (other than farming); and Schedule K-1 (Form 165-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 Combine lines 1a, 1b, and Net earnings from self-employment. Multiply line by 92.5% (.925). If less than $, do not file this schedule; you do not owe self-employment tax Self-employment tax. If the amount on line is: $16,8 or less, multiply line by 15.% (.15). Enter the result here and on Form 1, line 56. More than $16,8, multiply line by 2.9% (.29). Then, add $1,2.2 to the result. Enter the total here and on Form 1, line Deduction for one-half of self-employment tax. Multiply line 5 by 5% (.5). Enter the result here and on Form 1, line KIA b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 6b, or listed on Schedule K-1 (Form 165), box 2, code.. 1b ( ) For Paperwork Reduction Act tice, see Form 1 instructions. 6,55 1a 2 5 5,29 5,29 6, 7,16 Schedule SE (Form 1) 29

12 Form OMB Depreciation and Amortization 562 (Including Information on Listed Property) 29 Department of the Treasury Internal Revenue Service (99) Name(s) shown on return (b) Month and year placed in service Business or activity to which this form relates 25 yrs yrs. MM 27.5 yrs. MM 9 yrs. MM MM Attachment Sequence. 67 Identifying number MARVIN L HALL SCH C Part I Election To Expense Certain Property Under Section 179 te: If you have any listed property, complete Part V before you complete Part I. 1 Maximum amount. See the instructions for a higher limit for certain businesses , 2 Total cost of section 179 property placed in service (see instructions) Threshold cost of section 179 property before reduction in limitation (see instructions) $8, Reduction in limitation. Subtract line from line 2. If zero or less, enter Dollar limitation for tax year. Subtract line from line 1. If zero or less, enter --. If married filing separately, see instructions , 6 (a) Description of property (b) Cost (business use only) (c) Elected cost REC FURN 2,2 2,2 7 Listed property. Enter the amount from line Total elected cost of section 179 property. Add amounts in column (c), lines 6 and ,2 9 Tentative deduction. Enter the smaller of line 5 or line ,2 1 Carryover of disallowed deduction from line 1 of your 28 Form Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11 25, 12 Section 179 expense deduction. Add lines 9 and 1, but do not enter more than line ,2 1 Carryover of disallowed deduction to 21. Add lines 9 and 1, less line te: Do not use Part II or Part III below for listed property. Instead, use Part V. Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.) 1 Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions) Property subject to section 168(f)(1) election Other depreciation (including ACRS) Part III MACRS Depreciation (Do not include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here Section B Assets Placed in Service During 29 Tax Year Using the General Depreciation System (a) Classification of property 19a -year property b 5-year property c 7-year property d 1-year property e 15-year property f 2-year property g 25-year property h Residential rental property i nresidential real property See separate instructions. (c) Basis for depreciation (business/investment use only see instructions) Attach to your tax return. (d) Recovery period (e) Convention (f) Method (g) Depreciation deduction 7. HY 2DB Section C Assets Placed in Service During 29 Tax Year Using the Alternative Depreciation System 2a Class life S/L b 12-year 12 yrs. S/L c -year yrs. MM S/L Part IV Summary (See instructions.) 21 Listed property. Enter amount from line Total. Add amounts from line 12, lines 1 through 17, line 19 and 2 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations see instructions. 22 2,2 2 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 26A costs KIA For Paperwork Reduction Act tice, see separate instructions. Form 562 (29) S/L S/L S/L S/L S/L

13 Form 562 (29) MARVIN L HALL Page 2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment, recreation, or amusement.) te: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 2a, 2b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) 2a Do you have evidence to support the business/investment use claimed? 2b If "," is the evidence written? (a) Type of property (list vehicles first) (a) Description of costs (b) Date placed in service (c) Business/ investment use percentage (b) Date amortization begins (d) Cost or other basis (a) Vehicle 1 (e) Basis for depreciation (business/investment use only) (c) Amortizable amount (f) Recovery period (d) Code section (g) Method/ Convention 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 5% in a qualified business use (see instructions) Property used more than 5% in a qualified business use: % % % (e) Amortization period or percentage (h) Depreciation deduction 27 Property used 5% or less in a qualified business use: FORD EPLO 6/1/7 2 % S/L % S/L % S/L 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page Add amounts in column (i), line 26. Enter here and on line 7, page Section B Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. Total business/investment miles driven during the year (do not include commuting miles) Total commuting miles driven during the year 2 Total other personal (noncommuting) miles driven Total miles driven during the year. Add lines through ,2 6,8 (b) Vehicle 2 29 (i) Elected section 179 cost Was the vehicle available for personal use during off-duty hours? Was the vehicle used primarily by a more than 5% owner or related person? 6 Is another vehicle available for personal use? Section C Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). 7 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners Do you treat all use of vehicles by employees as personal use? Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? Do you meet the requirements concerning qualified automobile demonstration use? (See instructions)..... te: If your answer to 7, 8, 9,, or 1 is "," do not complete Section B for the covered vehicles. Part VI Amortization 2 Amortization of costs that begins during your 29 tax year (see instructions): (c) Vehicle (d) Vehicle (e) Vehicle 5 (f) Vehicle 6 1, (f) Amortization for this year Amortization of costs that began before your 29 tax year Total. Add amounts in column (f). See the instructions for where to report KIA Form 562 (29)

14 Form OMB Depreciation and Amortization 562 (Including Information on Listed Property) 29 Department of the Treasury Internal Revenue Service (99) Name(s) shown on return See separate instructions. Attach to your tax return. Business or activity to which this form relates Attachment Sequence. 67 Identifying number MARVIN L HALL Form Part I Election To Expense Certain Property Under Section 179 te: If you have any listed property, complete Part V before you complete Part I. 1 Maximum amount. See the instructions for a higher limit for certain businesses , 2 Total cost of section 179 property placed in service (see instructions) Threshold cost of section 179 property before reduction in limitation (see instructions) $8, Reduction in limitation. Subtract line from line 2. If zero or less, enter Dollar limitation for tax year. Subtract line from line 1. If zero or less, enter --. If married filing separately, see instructions , 6 (a) Description of property (b) Cost (business use only) (c) Elected cost 7 Listed property. Enter the amount from line Total elected cost of section 179 property. Add amounts in column (c), lines 6 and Tentative deduction. Enter the smaller of line 5 or line Carryover of disallowed deduction from line 1 of your 28 Form Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11 25, 12 Section 179 expense deduction. Add lines 9 and 1, but do not enter more than line Carryover of disallowed deduction to 21. Add lines 9 and 1, less line te: Do not use Part II or Part III below for listed property. Instead, use Part V. Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.) 1 Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions) Property subject to section 168(f)(1) election Other depreciation (including ACRS) Part III MACRS Depreciation (Do not include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here Section B Assets Placed in Service During 29 Tax Year Using the General Depreciation System (a) Classification of property 19a -year property b 5-year property c 7-year property d 1-year property e 15-year property f 2-year property g 25-year property h Residential rental property i nresidential real property (b) Month and year placed in service (c) Basis for depreciation (business/investment use only see instructions) (d) Recovery period 25 yrs yrs. MM 27.5 yrs. MM 9 yrs. MM MM (e) Convention (f) Method (g) Depreciation deduction Section C Assets Placed in Service During 29 Tax Year Using the Alternative Depreciation System 2a Class life S/L b 12-year 12 yrs. S/L c -year yrs. MM S/L Part IV Summary (See instructions.) 21 Listed property. Enter amount from line Total. Add amounts from line 12, lines 1 through 17, line 19 and 2 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations see instructions For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 26A costs KIA For Paperwork Reduction Act tice, see separate instructions. Form 562 (29) S/L S/L S/L S/L S/L

15 Form 562 (29) MARVIN L HALL Page 2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment, recreation, or amusement.) te: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 2a, 2b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) 2a Do you have evidence to support the business/investment use claimed? 2b If "," is the evidence written? (a) Type of property (list vehicles first) (a) Description of costs (b) Date placed in service (c) Business/ investment use percentage (b) Date amortization begins (d) Cost or other basis (a) Vehicle 1 (e) Basis for depreciation (business/investment use only) (c) Amortizable amount (f) Recovery period (d) Code section (g) Method/ Convention 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 5% in a qualified business use (see instructions) Property used more than 5% in a qualified business use: % % % (e) Amortization period or percentage (h) Depreciation deduction 27 Property used 5% or less in a qualified business use: BUICK LESA 7/1/5 % S/L % S/L % S/L 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page Add amounts in column (i), line 26. Enter here and on line 7, page Section B Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. Total business/investment miles driven during the year (do not include commuting miles) Total commuting miles driven during the year 2 Total other personal (noncommuting) miles driven Total miles driven during the year. Add lines through , 7, (b) Vehicle 2 29 (i) Elected section 179 cost Was the vehicle available for personal use during off-duty hours? Was the vehicle used primarily by a more than 5% owner or related person? 6 Is another vehicle available for personal use? Section C Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). 7 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners Do you treat all use of vehicles by employees as personal use? Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? Do you meet the requirements concerning qualified automobile demonstration use? (See instructions)..... te: If your answer to 7, 8, 9,, or 1 is "," do not complete Section B for the covered vehicles. Part VI Amortization 2 Amortization of costs that begins during your 29 tax year (see instructions): (c) Vehicle (d) Vehicle (e) Vehicle 5 (f) Vehicle 6 1, (f) Amortization for this year Amortization of costs that began before your 29 tax year Total. Add amounts in column (f). See the instructions for where to report KIA Form 562 (29)

16 Form 6252 Department of the Treasury Internal Revenue Service Name(s) shown on return Installment Sale Income Attach to your tax return. Use a separate form for each sale or other disposition of property on the installment method. OMB Attachment Sequence. Identifying number MARVIN L HALL Description of property MARSHALL COUNTY LAND a Date acquired (mm/dd/yyyy) 5/9/2 b Date sold (mm/dd/yyyy) 5/1/9 Was the property sold to a related party (see instructions) after May 1, 198? If "," skip line Was the property you sold to a related party a marketable security? If "," complete Part III. If "," complete Part III for the year of sale and the 2 years after the year of sale Part I Gross Profit and Contract Price. Complete this part for the year of sale only. 5 Selling price including mortgages and other debts. Do not include interest whether stated or unstated 5 1, 6 Mortgages, debts, and other liabilities the buyer assumed or took the property subject to (see instructions) , 7 Subtract line 6 from line Cost or other basis of property sold Depreciation allowed or allowable Adjusted basis. Subtract line 9 from line Commissions and other expenses of sale Income recapture from Form 797, Part III (see instructions) Add lines 1, 11, and Subtract line 1 from line 5. If zero or less, do not complete the rest of this form (see instructions).. 1 1, 15 If the property described on line 1 above was your main home, enter the amount of your excluded gain (see instructions). Otherwise, enter Gross profit. Subtract line 15 from line , 17 Subtract line 1 from line 6. If zero or less, enter Contract price. Add line 7 and line , Part II Installment Sale Income. Complete this part for the year of sale and any year you receive a payment or have certain debts you must treat as a payment on installment obligations. 19 Gross profit percentage (expressed as a decimal amount). Divide line 16 by line 18. For years after the year of sale, see instructions If this is the year of sale, enter the amount from line 17. Otherwise, enter Payments received during year (see instructions). Do not include interest, whether stated or unstated Add lines 2 and Payments received in prior years (see instructions). Do not include interest, whether stated or unstated Installment sale income. Multiply line 22 by line Enter the part of line 2 that is ordinary income under the recapture rules (see instructions) Subtract line 25 from line 2. Enter here and on Schedule D or Form 797 (see instructions) Part III Related Party Installment Sale Income. Do not complete if you received the final payment this tax year. 27 Name, address, and taxpayer identifying number of related party Did the related party resell or dispose of the property ("second disposition") during this tax year? If the answer to question 28 is "," complete lines through 7 below unless one of the following conditions is met. Check the box that applies. a The second disposition was more than 2 years after the first disposition (other than dispositions of marketable securities). If this box is checked, enter the date of disposition (mm/dd/yyyy) b The first disposition was a sale or exchange of stock to the issuing corporation. c The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition. d The second disposition occurred after the death of the original seller or buyer. e It can be established to the satisfaction of the Internal Revenue Service that tax avoidance was not a principal purpose for either of the dispositions. If this box is checked, attach an explanation (see instructions). Selling price of property sold by related party (see instructions) Enter contract price from line 18 for year of first sale Enter the smaller of line or line Total payments received by the end of your 29 tax year (see instructions) Subtract line from line 2. If zero or less, enter Multiply line by the gross profit percentage on line 19 for year of first sale Enter the part of line 5 that is ordinary income under the recapture rules (see instructions) Subtract line 6 from line 5. Enter here and on Schedule D or Form 797 (see instructions) KIA For Paperwork Reduction Act tice, see instructions. Form 6252 (29) 79 1.