PROSHARES SAMPLE TAX PACKAGE 7501 WISCONSIN AVE SUITE 1000 BETHESDA, MD PROSHARES. K-1 Account Number:

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1 PROSHARES 750 WISCONSIN AVE SUITE 000 BETHESDA, MD 2084 PROSHARES K- Account Number:

2 207 SCHEDULE K- SUPPLEMENTAL INFORMATION % of the amount of interest income included on your Schedule K- is from US Government obligations. FAQS ON TAXATION FOR VOLATILITY, COMMODITY AND CURRENCY PROSHARES ETFS. I understand that Volatility, Commodity and Currency ProShares ETFs ( Fund or Funds ) are treated as partnerships for tax purposes. Can you give specifics on how I can expect my investment to be taxed? Partnerships are "pass-through" entities. The income and expenses of each Fund "flow through" to its shareholders. (This differs from mutual funds and most ETFs registered under the Investment Company Act of 940, which pass through taxable income and capital gains in the form of distributions reported on a Form 099.) Each shareholder of Volatility, Commodity or Currency ProShares ETF is directly responsible for reporting his or her pro rata portion of income, gains, losses, deductions or other taxable events in the ETF for the calendar year. While investors may incur trading profits or losses through buying and selling the Funds, they are also subject to tax on their portion of any income or gains passed through by the Trust. In addition to income and gains, each Fund can also pass through losses, which shareholders may use to reduce their personal taxes. The tax treatment of income, gains or losses depends on the Fund s underlying positions. For example: The Funds will earn income from debt securities and overnight investments. An investor s pro rata portion of that income will be taxed at the investor s ordinary income tax rate. The Funds will invest in a range of derivative instruments, including futures and forward contracts. In general, open futures positions will be marked to market, with their gains and losses reportable as 60% long-term and 40% short- term. The reporting of gains and losses may vary depending on the specifics of a contract. Commodity and Currency ProShares also enter into swap agreements and non-currency forwards that generally produce capital gains/losses that are likely short-term in character. Monthly financial statements in accordance with Generally Accepted Accounting Principles (GAAP) for each Fund will be posted on our website on each Fund s Overview page. Be sure to consult your financial adviser or a tax professional for advice as to your particular tax situation. 2. How do the Funds pass through capital gains or income to the investor? Unlike mutual funds and most ETFs, the Funds are not expected to make distributions with respect to capital gains or income. The Funds are treated as partnerships for tax purposes, so an investor s allocated share of a Fund s income, gains, losses and deductions is reported on a Schedule K-. Investors will not receive a Form 099-DIV, issued by most mutual funds and other ETFs, which itemizes the taxable distributions received by the investor. From a tax perspective, any distributions from the Fund that might occur will be characterized as nontaxable return of capital (lowering the investor s cost basis). Additionally, each investor s allotment of the Fund s taxable income, as reported on the Schedule K-, should increase or decrease the investor s cost basis. Monthly GAAP financial statements for each Fund are posted on our website on each Fund s Overview page. 3. Why do the figures on my Schedule K- differ from the figures on my tax information from my broker? Schedule K-s will reflect your pro rata portion of income, gain, losses, or deductions from fund-driven activities, which are actions the Fund has taken as part of its operation, whereas your 099-B/R will reflect proceeds from sales of ETFs. As a result, your Schedule K- tax package may include a Sales Schedule which provides instructions on how to compute your gain or loss to fully reflect your experience as a shareholder and a partner of the Fund. If you sold shares and did not see a copy of your Sales Schedule with your Schedule K- tax package, please contact Tax Package Support at How does ProShares calculate my pro rata portion of a particular Fund? Your pro rata portion is determined by the number of shares of the Fund you hold or have held and the duration for which you ve held them. If you own shares in a Fund at the beginning of a month and sell them during the month, you may still be responsible for and allocated a pro rata portion of income, gains, losses and deductions that were realized during the full month in which you sold your shares. 5. If I purchased shares in a Fund, what is my tax reporting responsibility for this investment? Income, gains, losses and expenses are generally reported on the Schedule K- we send you and should be included on your tax return. How many shares you ve held and the duration for which you ve held them determines the portion of any income, gains or losses allocated to you through the K-. Be sure to consult with a tax professional and/or your financial adviser. For tax years beginning after 202, new Internal Revenue Code ( IRC ) Section 4 imposes a 3.8% surtax on certain investment income of individuals and of trusts and estates. Your share of income reported on this Schedule K- and any gain on the sale of Partnership units may be subject to this surtax. The Partnership encourages you to consult your tax advisor concerning the impact of IRC Section 4 to you. 6. If I sell shares in a Fund, what is my tax reporting responsibility for this transaction? Any gains or losses on your sales of shares should usually be reported on your tax return. In addition to any sales of shares reported on your Form 099-B from your broker, the Sales Schedule portion of the Schedule K- we send you will reflect any sales of your investment(s) in the Fund(s). It will also reflect related adjustments to your tax basis. The Sales Schedule includes a worksheet to help you calculate your total gains or losses. Be sure to consult with a tax professional and/or your financial adviser. Note: A Fund s income, gains, losses and deductions are allocated to shareholders on a monthly basis. If you own shares in a Fund at the beginning of a month and sell them during the month, you are generally still considered a shareholder through the end of that month. 7. I didn't receive any cash disbursements from my investment in the Fund(s). Why are there reportable items on my K- that are subject to tax? Each investor in the Fund(s) accounts for his or her pro rata portion of income or losses in the Fund(s) on an annual basis - regardless of whether or not that income, gain or loss is distributed. How many shares you ve held and the duration for which you ve held them determines the portion of any income, gains or losses allocated to you through the K-. 8. Can I receive my K- information any earlier? You can sign up now to receive your future tax information up to one week faster by eliminating the need for a paper K-. Simply locate your investment(s) on register your address and choose the Paperless option. By choosing to eliminate paper K-s, investor tax information will bypass the U.S. Postal Service and be delivered securely through the website. You will even be notified via the instant the K-s are available. You will have the option of saving the electronic version of your tax information to your personal computer or printing a hard copy. 9. Do I have to report a Schedule K- if my shares were held in a non-taxable account? The reporting responsibility of a Schedule K- received for Fund shares held in a non-taxable account may differ than if held in a taxable account. Therefore, please consult with your tax advisor for more information. 0. Will I get a K- if I only bought shares to cover a short position? Covering a short position shouldn't generate a Schedule K-. Some brokers may not distinguish between long and short positions when reporting transactions to our tax accountants. If you received a Schedule K- due to covering a short position, please contact Tax Package Support at for correction. Please note that our Tax Package Support staff is not qualified to give tax advice or answer questions regarding your particular tax situation.. What if the information reported in my tax package is incorrect? The tax calculations found within the tax package you received are based on purchase and sale information obtained from brokers and various reporting sources. If the information provided by these sources is incorrect, the information reported to you, as well as the information reported to the Internal Revenue Service, may also be incorrect. If your ownership records do not agree with the transactions reported on the Ownership Schedule contained in the tax package, please contact Tax Package Support at to obtain a corrected K-. 2. Is any of the allocated income Unrelated Business Taxable Income (UBTI)? We do not expect any UBTI. If there is UBTI, it will be detailed on the Schedule K- in box 20 with the letter V indicated. 3. I have questions about the Schedule K-. Where can I get help? Shareholders with questions about the Schedule K- can visit each Fund s tax package support website ( where you can: Sign up for an alert to notify you when your tax package is available and eliminate paper K-s. View your prior year tax schedules. Print your tax package, including instructions. Download a file of your Schedule K- information that can be imported into select tax software. Request changes to incorrect information. In addition, shareholders will find contact information for our Tax Package Support staff. Please note that our Tax Package Support staff is not qualified to give tax advice or answer questions regarding your particular tax situation. Please refer these questions to your tax advisor. 4. ProShares investors should refer to the applicable ProShares prospectus for important tax information. Where can I obtain a prospectus? The prospectuses for Volatility, Commodity and Currency ProShares (ProShares Trust II) may be obtained on-line at or by contacting ProShares at 866-PRO-525 ( ), or by writing to us at 750 Wisconsin Avenue, Suite 000, East Tower, Bethesda, MD 2084.

3 Schedule K- (Form 065) 207 Internal Revenue Service For calendar year 207, or tax year X Part III Final K- Amended K- 657 OMB No Partner s Share of Current Year Income, Deductions, Credits, and Other Items Ordinary business income (loss) 5 Credits beginning / / 207 ending / / Partner s Share of Income, Deductions, Credits, etc. See back of form and separate instructions. A B Part I Information About the Partnership Partnership s name, address, city, state, and ZIP code PROSHARES 750 WISCONSIN AVE SUITE 000 BETHESDA, MD Net rental real estate income (loss) 3 Other net rental income (loss) 4 Guaranteed payments 5 Interest income 6a Ordinary dividends 6b Qualified dividends Foreign transactions C D E F G IRS Center where partnership filed return e-file X Check if this is a publicly traded partnership (PTP) Part II Information About the Partner Partner s identifying number Partner s name, address, city, state, and ZIP code 750 WISCONSIN AVE SUITE 000 BETHESDA, MD 2084 General partner or LLC member-manager Limited partner or other LLC member H X Domestic partner Foreign partner X 7 Royalties 8 Net short-term capital gain (loss) - 9a Net long-term capital gain (loss) 9b Collectibles (28%) gain (loss) 9c Unrecaptured section 250 gain 0 Net section 23 gain (loss) Other income (loss) C -3,756 7 Alternative minimum tax (AMT) items 8 Tax-exempt income and nondeductible expenses I I2 J What type of entity is this partner? Individual If this partner is a retirement plan (IRA/SEP/Keogh/etc.), check here Partner s share of profit, loss, and capital (see instructions): Beginning Ending Profit % % Loss % % Capital % % 2 Section 79 deduction Other deductions K Distributions 20 Other information K Partner s share of liabilities at year end: Nonrecourse $ Qualified nonrecourse financing. $ Recourse $ 4 Self-employment earnings (loss) L M Partner s capital account analysis: Beginning capital account... $ 0 Capital contributed during the year $ 43,980 Current year increase (decrease). $ -3,843 Withdrawals & distributions.. $ ( ) Ending capital account.... $ X Tax basis GAAP Section 704(b) book Other (explain) Did the partner contribute property with a built-in gain or loss? Yes X No If Yes, attach statement (see instructions) 40,37 0 *See attached statement for additional information. For IRS Use Only For Paperwork Reduction Act Notice, see Instructions for Form Cat. No. 394R Schedule K- (Form 065) 207

4 Schedule K- (Form 065) 207 Page 2 This list identifies the codes used on Schedule K- for all partners and provides summarized reporting information for partners who file Form 040. For detailed reporting and filing information, see the separate Partner s Instructions for Schedule K- and the instructions for your income tax return.. Ordinary business income (loss). Determine whether the income (loss) is Code Report on passive or nonpassive and enter on your return as follows. L Empowerment zone Report on employment credit Passive loss M Credit for increasing research Passive income Schedule E, line 28, column (g) activities Nonpassive loss See the Partner's Instructions N Credit for employer social Nonpassive income Schedule E, line 28, column (j) security and Medicare taxes 2. Net rental real estate income (loss) O Backup withholding 3. Other net rental income (loss) P Other credits Net income Schedule E, line 28, column (g) Net loss 4. Guaranteed payments Schedule E, line 28, column (j) 5. Interest income Form 040, line 8a 6a. Ordinary dividends Form 040, line 9a 6b. Qualified dividends Form 040, line 9b 7. Royalties Schedule E, line 4 8. Net short-term capital gain (loss) Schedule D, line 5 9a. Net long-term capital gain (loss) Schedule D, line 2 9b. Collectibles (28%) gain (loss) 28% Rate Gain Worksheet, line 4 (Schedule D instructions) 9c. Unrecaptured section 250 gain 0. Net section 23 gain (loss). Other income (loss) Code A Other portfolio income (loss) B Involuntary conversions C Sec. 256 contracts & straddles Form 678, line D Mining exploration costs recapture See Pub. 535 E Cancellation of debt Form 040, line 2 or Form 982 F Other income (loss) 2. Section 79 deduction 3. Other deductions A Cash contributions (50%) B Cash contributions (30%) C Noncash contributions (50%) D Noncash contributions (30%) See the Partner s E Capital gain property to a 50% Instructions organization (30%) F Capital gain property (20%) G Contributions (00%) H Investment interest expense Form 4952, line I Deductions royalty income Schedule E, line 9 J Section 59(e)(2) expenditures K Deductions portfolio (2% floor) Schedule A, line 23 L Deductions portfolio (other) Schedule A, line 28 M Amounts paid for medical insurance Schedule A, line or Form 040, line 29 N Educational assistance benefits O Dependent care benefits Form 244, line 2 P Preproductive period expenses Q Commercial revitalization deduction from rental real estate activities See Form 8582 instructions R Pensions and IRAs S Reforestation expense deduction T Domestic production activities information See Form 8903 instructions U Qualified production activities income Form 8903, line 7b V Employer s Form W-2 wages Form 8903, line 7 W Other deductions 4. Self-employment earnings (loss) Note: If you have a section 79 deduction or any partner-level deductions, see the Partner s Instructions before completing Schedule SE. A Net earnings (loss) from self-employment Schedule SE, Section A or B B Gross farming or fishing income C Gross non-farm income 5. Credits A Low-income housing credit (section 42(j)(5)) from pre-2008 buildings B Low-income housing credit (other) from pre-2008 buildings C Low-income housing credit (section 42(j)(5)) from post-2007 buildings D Low-income housing credit (other) from post-2007 buildings E Qualified rehabilitation expenditures (rental real estate) F Other rental real estate credits G Other rental credits H Undistributed capital gains credit Form 040, line 73; check box a I Biofuel producer credit J Work opportunity credit See the Partner's Instructions K Disabled access credit 6. Foreign transactions A Name of country or U.S. possession B Gross income from all sources Form 6, Part I C Gross income sourced at partner level Foreign gross income sourced at partnership level D Passive category E General category Form 6, Part I F Other Deductions allocated and apportioned at partner level G Interest expense Form 6, Part I H Other Form 6, Part I Deductions allocated and apportioned at partnership level to foreign source income I Passive category J General category Form 6, Part I K Other Other information L Total foreign taxes paid Form 6, Part II M Total foreign taxes accrued Form 6, Part II N Reduction in taxes available for credit Form 6, line 2 O Foreign trading gross receipts Form 8873 P Extraterritorial income exclusion Form 8873 Q Other foreign transactions 7. Alternative minimum tax (AMT) items A Post-986 depreciation adjustment B Adjusted gain or loss See the Partner s C Depletion (other than oil & gas) Instructions and D Oil, gas, & geothermal gross income the Instructions for E Oil, gas, & geothermal deductions Form 625 F Other AMT items 8. Tax-exempt income and nondeductible expenses A Tax-exempt interest income Form 040, line 8b B Other tax-exempt income C Nondeductible expenses 9. Distributions A Cash and marketable securities B Distribution subject to section 737 C Other property 20. Other information A Investment income Form 4952, line 4a B Investment expenses Form 4952, line 5 C Fuel tax credit information Form 436 D Qualified rehabilitation expenditures (other than rental real estate) E Basis of energy property F Recapture of low-income housing credit (section 42(j)(5)) Form 86, line 8 G Recapture of low-income housing credit (other) Form 86, line 8 H Recapture of investment credit See Form 4255 I Recapture of other credits J Look-back interest completed long-term contracts See Form 8697 K Look-back interest income forecast method See Form 8866 L Dispositions of property with section 79 deductions M Recapture of section 79 deduction N Interest expense for corporate partners O Section 453(l)(3) information P Section 453A(c) information Q Section 260(b) information R Interest allocable to production expenditures S CCF nonqualified withdrawals T Depletion information oil and gas U Reserved V Unrelated business taxable income W Precontribution gain (loss) X Section 08(i) information Y Net investment income Z Other information See the Partner s Instructions

5 PROSHARES Individual AC DA BUY SELL //207 2/3/207 BROKER - MAN BROKER - MAN, , END OF YEAR SHARES

6 PROSHARES Individual () (2) (3) (4) (5) (6) (7) (8) (9) (0) UNITS DISPOSED ACQUISITION DATE DISPOSITION DATE SALES PROCEEDS ORIGINAL PURCHASE AMOUNT CUMULATIVE ADJUSTMENT TO TAX BASIS, //207 2/3/207-3,843 TOTAL BASIS TOTAL GAIN/LOSS (-) SHORT-TERM CAPITAL GAIN/LOSS (-) LONG-TERM CAPITAL GAIN/LOSS (-) 8949, COL (b) 8949, COL (c) 8949, COL (d) 8949, COL (e) SCH D, LINE 3, COL (h) SCH D, LINE 0, COL (h)

7 207 Graphic Guide Form 678 Internal Revenue Service Name(s) shown on tax return Gains and Losses From Section 256 Contracts and Straddles Go to for the latest information. Attach to your tax return. OMB No Attachment Sequence No. 82 Identifying number Form 040 Internal Revenue Service (99) U.S. Individual Income Tax Return 207 OMB No IRS Use Only Do not write or staple in this space. For the year Jan. Dec. 3, 207, or other tax year beginning, 207, ending, 20 See separate instructions. Your first name and initial Last name Your social security number If a joint return, spouse s first name and initial Last name Spouse s social security number C Check all applicable boxes (see instructions). A Mixed straddle election Mixed straddle account election B D Straddle-by-straddle identification election Net section 256 contracts loss election Part I Section 256 Contracts Marked to Market (a) Identification of account (b) (Loss) (c) Gain SCHEDULE D (Form 040) Internal Revenue Service (99) Name(s) shown on return Part I 2 Add the amounts on line in columns (b) and (c) ( ) 3 Net gain or (loss). Combine line 2, columns (b) and (c) Form 099-B adjustments. See instructions and attach statement Combine lines 3 and Note: If line 5 shows a net gain, skip line 6 and enter the gain on line 7. Partnerships and S corporations, see instructions. 6 If you have a net section 256 contracts loss and checked box D above, enter the amount of loss to be carried back. Enter the loss as a positive number. If you didn't check box D, enter Combine lines 5 and Short-term capital gain or (loss). Multiply line 7 by 40% (0.40). Enter here and include on line 4 of Schedule D or on Form 8949 (see instructions) Long-term capital gain or (loss). Multiply line 7 by 60% (0.60). Enter here and include on line of Schedule D or on Form 8949 (see instructions) Part II Gains and Losses From Straddles. Attach a separate statement listing each straddle and its components. Section A Losses From Straddles (f) Loss. (e) Cost or If column (e) (g) (h) Recognized loss. (b) Date (c) Date other basis is more than Unrecognized If column (f) is more entered (d) Gross (a) Description of property closed out plus (d), enter gain on than (g), enter into or sales price or sold expense of difference. offsetting difference. acquired s Otherwise, posi Otherwise, enter -0- enter -0- Capital Gains and Losses Attach to Form 040 or Form 040NR. Go to for instructions and the latest information. Use Form 8949 to list your transactions for lines b, 2, 3, 8b, 9, and 0. Short-Term Capital Gains and Losses Assets Held One Year or Less See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. a Totals for all short-term transactions reported on Form 099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line b. b Totals for all transactions reported on Form(s) 8949 with Box A checked Totals for all transactions reported on Form(s) 8949 with Box B checked Totals for all transactions reported on Form(s) 8949 with Box C checked (d) Proceeds (sales price) (e) Cost (or other basis) OMB No Attachment Sequence No. 2 Your social security number (g) Adjustments to gain or loss from Form(s) 8949, Part I, line 2, column (g) (h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 678, and Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover Worksheet in the instructions ( ) 7 Net short-term capital gain or (loss). Combine lines a through 6 in column (h). If you have any longterm capital gains or losses, go to Part II below. Otherwise, go to Part III on the back Part II Long-Term Capital Gains and Losses Assets Held More Than One Year See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. (d) Proceeds (sales price) 3 3 (e) Cost (or other basis) 8a Totals for all long-term transactions reported on Form 099-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 8b. 8b Totals for all transactions reported on Form(s) 8949 with Box D checked Totals for all transactions reported on Form(s) 8949 with Box E checked Totals for all transactions reported on Form(s) 8949 with Box F checked Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from Forms 4684, 678, and Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K- 2 (g) (h) Gain or (loss) Adjustments Subtract column (e) to gain or loss from from column (d) and Form(s) 8949, Part II, combine the result with line 2, column (g) column (g) 3 Capital gain distributions. See the instructions Long-term capital loss carryover. Enter the amount, if any, from line 3 of your Capital Loss Carryover Worksheet in the instructions ( ) 5 Net long-term capital gain or (loss). Combine lines 8a through 4 in column (h). Then go to Part III on the back For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 338H Schedule D (Form 040) 207 Schedule K- (Form 065) 207 Internal Revenue Service For calendar year 207, or tax year beginning / / 207 ending / / Partner s Share of Income, Deductions, Credits, etc. See back of form and separate instructions. Part I Information About the Partnership A Partnership s employer identification number B C D Partnership s name, address, city, state, and ZIP code ProShare Capital Management LLC 750 Wisconsin Ave. Suite 000 Bethesda MD 2084 IRS Center where partnership filed return Check if this is a publicly traded partnership (PTP) Part II Information About the Partner E Partner s identifying number F Partner s name, address, city, state, and ZIP code G General partner or LLC Limited partner or other LLC member-manager member H Domestic partner Foreign partner I I2 J K L M What type of entity is this partner? If this partner is a retirement plan (IRA/SEP/Keogh/etc.), check here Partner s share of profit, loss, and capital (see instructions): Beginning Ending Profit % % Loss % % Capital % % Partner s share of liabilities at year end: Nonrecourse $ Qualified nonrecourse financing. $ Recourse $ Partner s capital account analysis: Beginning capital account... $ Capital contributed during the year $ Current year increase (decrease). $ Withdrawals & distributions.. $ ( ) Ending capital account.... $ Tax basis GAAP Section 704(b) book Other (explain) Did the partner contribute property with a built-in gain or loss? Yes No If Yes, attach statement (see instructions) 657 Final K- Amended K- OMB No Part III Partner s Share of Current Year Income, Deductions, Credits, and Other Items Ordinary business income (loss) 5 Credits 2 Net rental real estate income (loss) 3 Other net rental income (loss) 4 Guaranteed payments 5 Interest income 6a 6b Ordinary dividends Qualified dividends 7 Royalties 8 Net short-term capital gain (loss) 9a 9b 9c Net long-term capital gain (loss) Collectibles (28%) gain (loss) Unrecaptured section 250 gain 0 Net section 23 gain (loss) Other income (loss) 2 Section 79 deduction 3 Other deductions 4 Self-employment earnings (loss) 6 Foreign transactions 7 Alternative minimum tax (AMT) items 8 Tax-exempt income and nondeductible expenses 9 Distributions 20 Other information *See attached statement for additional information. For Paperwork Reduction Act Notice, see Instructions for Form Cat. No. 394R Schedule K- (Form 065) 207 The tax information provided in this package and reflected on the schedules provided to you is based on existing federal and state laws and regulations as interpreted by the Trustee. Before undertaking any tax filing, you should both refer to the appropriate federal and state income tax laws and consult with your general tax advisor. Not all items may apply to the included K- For IRS Use Only 2 C 3 K 4 Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above and on line 6c are correct. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund. Checking Foreign country name Foreign province/state/county Foreign postal code a box below will not change your tax or refund. You Spouse Single 4 Head of household (with qualifying person). (See instructions.) Filing Status 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, enter this Check only one 3 Married filing separately. Enter spouse s SSN above child s name here. box. and full name here. 5 Qualifying widow(er) (see instructions) 6a Yourself. If someone can claim you as a dependent, do not check box 6a..... Boxes checked Exemptions on 6a and 6b b Spouse No. of children c Dependents: (2) Dependent s (3) Dependent s (4) if child under age 7 on 6c who: () First name Last name social security number relationship to you qualifying for child tax credit lived with you (see instructions) did not live with you due to divorce or separation If more than four (see instructions) dependents, see Dependents on 6c instructions and not entered above check here Add numbers on d Total number of exemptions claimed lines above 7 Wages, salaries, tips, etc. Attach Form(s) W Income 8a Taxable interest. Attach Schedule B if required a b Tax-exempt interest. Do not include on line 8a... 8b Attach Form(s) 9a Ordinary dividends. Attach Schedule B if required a W-2 here. Also attach Forms b Qualified dividends b W-2G and 0 Taxable refunds, credits, or offsets of state and local income taxes R if tax Alimony received was withheld. 2 Business income or (loss). Attach Schedule C or C-EZ Capital gain or (loss). Attach Schedule D if required. If not required, check here 3 If you did not 4 Other gains or (losses). Attach Form get a W-2, see instructions. 5a IRA distributions. 5a b Taxable amount... 5b 6a Pensions and annuities 6a b Taxable amount... 6b 7 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 7 8 Farm income or (loss). Attach Schedule F Unemployment compensation a Social security benefits 20a b Taxable amount... 20b 2 Other income. List type and amount 2 22 Combine the amounts in the far right column for lines 7 through 2. This is your total income Educator expenses Adjusted 24 Certain business expenses of reservists, performing artists, and Gross fee-basis government officials. Attach Form 206 or 206-EZ 24 Income 25 Health savings account deduction. Attach Form Moving expenses. Attach Form Dedu part of self-employment tax. Att h Schedule SE Self EP, SIMPLE, and plans Sel nsuran. 30 SCHEDULE A Itemized Deductions OMB No (Form 040) Go to for instructions and the latest information. Attach to Form Attachment Internal Revenue Service (99) Caution: If you are claiming a net qualified disaster loss on Form 4684, see the instructions for line 28. Sequence No. 07 Name(s) shown on Form 040 Your social security number Caution: Do not include expenses reimbursed or paid by others. Medical Medical and dental expenses (see instructions)..... and 2 Enter amount from Form 040, line 38 2 Dental Expenses 3 Multiply line 2 by 7.5% (0.075) Subtract line 3 from line. If line 3 is more than line, enter Taxes You 5 State and local (check only one box): Paid a Income taxes, or b General sales taxes Real estate taxes (see instructions) Personal property taxes Other taxes. List type and amount 8 9 Add lines 5 through Interest 0 Home mortgage interest and points reported to you on Form You Paid Home mortgage interest not reported to you on Form 098. If paid to the person from whom you bought the home, see instructions Note: and show that person s name, identifying no., and address Your mortgage interest deduction may be limited (see 2 Points not reported to you on Form 098. See instructions for instructions). special rules Reserved for future use Investment interest. Attach Form 4952 if required. See instructions 4 5 Add lines 0 through Gifts to 6 Gifts by cash or check. If you made any gift of $250 or more, Charity see instructions If you made a 7 Other than by cash or check. If any gift of $250 or more, see gift and got a instructions. You must attach Form 8283 if over $ benefit for it, 8 Carryover from prior year see instructions. 9 Add lines 6 through Casualty and 20 Casualty or theft loss(es) other than net qualified disaster losses. Attach Form 4684 and Theft Losses enter the amount from line 8 of that form. See instructions Job Expenses 2 Unreimbursed employee expenses job travel, union dues, and Certain job education, etc. Attach Form 206 or 206-EZ if required. Miscellaneous See instructions. 2 Deductions 22 Tax preparation fees Other expenses investment, safe deposit box, etc. List type and amount Add lines 2 through Enter amount from Form 040, line Multiply line 25 by 2% (0.02) Subtract line 26 from line 24. If line 26 is more than line 24, enter Other 28 Other from list in instructions. List type and amount Miscellaneous Deductions 28 Total 29 Is Form 040, line 38, over $56,900? Itemized No. Your deduction is not limited. Add the amounts in the far right column Deductions for lines 4 through 28. Also, enter this amount on Form 040, line Yes. Your deduction may be limited. See the Itemized Deductions Worksheet in the instructions to figure the amount to enter. 30 If you elect to itemize deductions even though they are less than your standard deduction, check here For Paperwork Reduction Act Notice, see the Instructions for Form 040. Cat. No. 745C Schedule A (Form 040) 207