FORMS REQUIRED: FORM 1040, SCH A, FORM 2106EZ, FORM 2441, FORM 8283, FORM 8888, LA IT540, SCH E, SCH G, 2007 NONREFUNDABLE CHILDCARE CREDIT WORKSHEET
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1 FORMS REQUIRED: FORM 1040, SCH A, FORM 2106EZ, FORM 2441, FORM 8283, FORM 8888, LA IT540, SCH E, SCH G, 2007 NONREFUNDABLE CHILDCARE CREDIT WORKSHEET INFORMATION RETURNS ATTACHED: W-2 (1), 1099R (1) STATEMENTS: 1 PREPARED BY: TAXPAYER TAXPAYER : RONALD F. BLACKBURN SSN: OCCUPATION: CHEF DOB: 05/10/1959 DISABLED: NO (RONALD) YES (MARY) PRES ELECTION FUND: BOTH YES BLIND: NO BLIND: YES DOB: 05/19/1961 DAYTIME PHONE: SPOUSE : MARY J. BLACKBURN SSN: CHECK DIGITS FROM IRS LABEL: QQ ADDRESS: 74 BUILDER DR BATON ROUGE LA FILING STATUS: MARRIED FILING JOINTLY LINE 6D: 8 DEPENDENT INFORMATION: DOB AGE SSN #MO CHILDCARE CREDIT BILL BLACKBURN SON 12 BOB BLACKBURN SON 12 X KIM BLACKBURN DAUGHTER 12 X KATIE BLACKBURN DAUGHTER 12 X LEAH BLACKBURN DAUGHTER 12 X LANCE BLACKBURN SON 12 X
2 SCHEDULE A LINE 5: 1204 LINE 6: 2500 LINE 9: 3704 LINE 10: 7000 LINE 15: 7000 LINE 16: 2750 LINE 19: 2750 LINE 29: FORM 2441: PART I: LINE 1: (a) (b) (c) KINDERCARE 12 FUN ST BATON ROUGE LA PART II LINE 2: (a) (b) (c) LANCE BLACKBURN LINE 3: 3000 LINE 4: LINE 5: 3000 NOTE: MAY WAS FULLY DISABLED FOR 12 MONTHS LINE 6: 3000 LINE 7: LINE 9: 600 LINE 10: 2119 LINE 11: 0
3 LATEST # 3 FORM 8888 (PLEASE INPUT A RTN AND ACCOUNT NUMBER THAT WILL WORK FOR YOU) LINE 1A: 6829 LINE 1B: LINE 1C: CHECKING LINE 1D: LINE 2A: 912 LINE 2B: LINE 2C: SAVINGS LINE 2D: LINE 4: 7741 LA TOTAL LA PROPERTY INSURANCE PREMIUM 1234 LOUISIANA CITIZENS INSURANCE CREDIT 108 INSURANCE : POLICY NO: EVERYSTATE 321C246A MILITARY FAMILY ASSISTANCE FUND 33 START PROGRAM DONATION 125 RECAPTURE OF START 325 FEDERAL RETIREMENT BENEFITS RETIREMENT DATE 10/07 CHILD CARE STAR RATING 3
4 FORMS INCLUDED: FORM 1040, FORM W 2, FORM 1099R FORM 1040: TAXPAYER S FIRST, INITIAL, LAST RONALD F BLACKBURN TAXPAYER S SOCIAL SECURITY NUMBER SPOUSE S FIRST, INITIAL, LAST MARY J BLACKBURN SPOUSE S SOCIAL SECURITY NUMBER HOME ADDRESS 74 BUILDER DR CITY STATE ZIP BATON ROUGE LA TAXPAYER S PRESIDENTIAL ELECTION CAMPAIGN FUND SPOUSE S PRESIDENTIAL ELECTION CAMPAIGN FUND FILING STATUS LINE 6A: YOURSELF (EXEMPTION) LINE LB: SPOUSE (EXEMPTION) YES YES MARRIED FILING JOINTLY X X NUMBER OF BOXES CHECKED ON 6A AND 6B 2
5 LINE 6C: LITERAL STATEMENT #1 DEPENDENT #1: BILL BLACKBURN SOCIAL SECURITY NUMBER SON DEPENDENT #2: BOB BLACKBURN SOCIAL SECURITY NUMBER SON DEPENDENT #3: KIM BLACKBURN SOCIAL SECURITY NUMBER DAUGHTER DEPENDENT #4: KATIE BLACKBURN SOCIAL SECURITY NUMBER DAUGHTER DEPENDENT #5: LEAH BLACKBURN SOCIAL SECURITY NUMBER DAUGHTER DEPENDENT #6: LANCE BLACKBURN SOCIAL SECURITY NUMBER SON NUMBER OF CHILDREN WHO LIVED WITH YOU 6 LINE 6D: TOTAL NUMBER OF EXEMPTIONS CLAIMED 8
6 LINE 7: WAGES SALARIES TIPS ETC LINE 16B TAXABLE AMOUNT LINE 22: TOTAL INCOME LINE 37: ADJUSTED GROSS INCOME LINE 38: AMOUNT FROM LINE LINE 39A: SPOUSE BLIND X TOTAL BOXES CHECKED 1 LINE 40: ITEMIZED DEDUCTIONS LINE 41: SUBTRACT 40 FROM LINE 42: MULTIPLY 3500 BY # OF EXEMPTIONS LINE 43: TAXABLE INCOME LINE 44: TAX 2119 LINE 46: ADD LINES 44 AND LINE 48: CREDIT FOR CHILD AND DEPENDENT CARE 600 LINE 52: CHILD TAX CREDIT 1519 LINE 55: TOTAL CREDITS 2119 LINE 56: SUBTRACT 55 FROM 46 0 LINE 61: TOTAL TAX 0 LINE 62: FEDERAL INCOME TAX WITHHELD 4260 LINE 66: ADDITIONAL CHILD TAX CREDIT 3481 LINE 71: TOTAL PAYMENTS 7741 LINE 72: OVERPAYMENT 7741 LINE 73A: REFUND 7741
7 W-2: BOX B: EMPLOYER IDENTIFICATION NUMBER BOX C: EMPLOYER S ADDRESS AND ZIP CODE JOHNS WASHINGTON STEAKHOUSE 424 N WASHINGTON ST BATON ROUGE LA BOX D: EMPLOYEE S SOCIAL SECURITY NUMBER BOX E: EMPLOYEE S FIRST INITIAL AND LAST RONALD F BLACKBURN BOX F: EMPLOYEE S ADDRESS AND ZIP CODE 74 BUILDERS DR BATON ROUGE LA BOX 1: WAGES TIPS OTHER COMPENSATION BOX 2: FEDERAL INCOME TAX WITHHELD 4260 BOX 3: SOCIAL SECURITY WAGES BOX 4: SOCIAL SECURITY TAX WITHHELD 2381 BOX 5: MEDICARE WAGES AND TIPS BOX 6: MEDICARE TAX WITHHELD 557 BOX 15: STATE LA EMPLOYER S STATE ID NUMBER BOX 16: STATE WAGES TIPS ETC BOX 17: STATE INCOME TAX 1204
8 FORM 1099R RETIREMENT DATE 10/07 PAYER S STREET ADDRESS CITY STATE AND ZIP USDA 3000 N DAKOTA ST WASHINGTON DC PAYER S FEDERAL IDENTIFICATION NUMBER RECIPIENT S IDENTIFICATION NUMBER RECIPIENT S RECIPIENT S STREET ADDRESS RONALD BLACKBURN 74 BUILDER DR RECIPIENT S CITY STATE AND ZIP BATON ROUGE LA BOX 1A: GROSS DISTRIBUTION BOX 2A: TAXABLE AMOUNT BOX 2B: TOTAL DISTRIBUTION 0 BOX 6: NET UNREALIZED 7 BOX 7: DISTRIBUTION CODE
9 IT540 FIRST INITIAL LAST RONALD F BLACKBURN SOCIAL SECURITY NUMBER SPOUSE INITIAL LAST MARY J BLACKBURN SOCIAL SECURITY NUMBER FILING STATUS MARRIED FILING JOINTLY EXEMPTIONS 6A: YOURSELF X 6B: SPOUSE X BLIND X TOTAL 6A & 6B 3 DEPENDENTS 6 BILL BLACKBURN SON 02/04/1988 BOB BLACKBURN SON 03/17/1995 KIM BLACKBURN DAUGHTER 08/10/1997 KATIE BLACKBURN DAUGHTER 12/20/1998 LEAH BLACKBURN DAUGHTER 09/11/2001 LANCE BLACKBURN SON 04/02/2004 6D: TOTAL EXEMPTIONS 9 LINE 7: FEDERAL AGI SCHEDULE E X LINE8A: FEDERAL ITEMIZED DEDUCTIONS LINE 8B: FEDERAL STANDARD DEDUCTION LINE 8C: EXCESS FEDERAL ITEMIZED DEDUCTION 2554 LINE 8D: 65% EXCESS FEDERAL ITEMIZED DED 1660 LINE 10: LA TAX TABLE INCOME LINE 11: YOUR LA INCOME TAX 645 LINE 12A: FEDERAL CHILD CARE CREDIT 600 LINE 12B: 2008 LA NONREFUND CHILD CARE 25 LINE 12D: 2008 LA NONREFUND SCHOOL READINESS 1(STAR RATING)
10 LINE 13: EDUCATION CREDIT 100 LINE 14: OTHER NONREFUND CREDIT 100 LINE 15: TOTAL NONREFUNDABLE TAX CREDITS 250 LINE 16: ADJUSTED LA INCOME TAX 395 LINE 18: TOTAL INCOME TAX 395 LINE 22: LA CITIZENS INSURANCE CREDIT 108 LINE 23: LA PROPERTY INSURANCE CREDIT 79 LINE 25: LA TAX WITHHELD 1204 LINE 30: TOTAL REFUND CREDIT 1391 LINE 31: OVERPPAYMENT 996 LINE 33: ADJUSTED OVERPAYMENT 996 LINE 34: MILITARY FAMILY ASSISTANCE FUND 33 LINE 35: START 125 LINE 40: TOTAL DONATIONS 158 LINE 41: SUBTOTAL 838 LINE 43: REFUND 838 SCHEDULE E LINE 1: FEDRAL ADJUSTED GROSS INCOME LINE 2A: RECAPTURE START 325 LINE 3: TOTAL LINE 4A: FEDERAL RETIREMENT BENEFITS 04E LINE 4I: EXEMPT INCOME LINE 4K: EXEMPT INCOME LINE 5A: LA ADJUSTED GROSS INCOME LINE 5C: LA ADJUSTED GROSS INCOME FEDERAL RETIREMENT BENEFITS TAXPAYER DATE RETIRED 10/07
11 SCHEDULE G LINE 2B: SPOUSE BLIND LINE 2D: TOTAL 1 LINE 2E: 100 LINE 11: TOTAL 100
FORMS REQUIRED: FORM 1040, SCH C, SCH SE, FORM 3800, IT540, SCH E, SCH F, SCH G, SCH H NAME: LATEST L JONES SSN: DOB: 02/01/1943 DISABLED:
FORMS REQUIRED: FORM 1040, SCH C, SCH SE, FORM 3800, IT540, SCH E, SCH F, SCH G, SCH H INFORMATION RETURNS ATTACHED: ENTRIES NOT REQUIRING FORMS: 1040, LINE 20A: 13456, LINE 63: 6000 (4X 1500 PAYMENT)
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