See separate instructions. Your social security number GREEN BEAN If a joint return, spouse's first name and initial

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1 Form Department of the Treasury - Internal Revenue Service (99) 1040 U.S. Individual Income Tax Return OMB For the year Jan. 1-Dec. 31,, or other tax year beginning,, ending, 0 Your first name and initial Last name 1 Single 4 Head of household (with qualifying person). (See instructions.) Filing If the qualifying person is a child but not your dependent, enter this Married filing jointly (even if only one had income) child's name here. Status 3 Married filing separately. Enter spouse's SSN above Check only one 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.... of children (4) Chk if child under c Dependents: (3) on 6c who: () Dependent's Dependent's age 17 qualifying social security number relationship to you for child tax credit lived with you (1) First name Last name (see instructions) did not live with you due to divorce LIMA BEAN DAUGHTER or separation If more than four (see instructions) NAVY BEAN SON dependents, see Dependents on 6c instructions and not entered above check here d Total number of exemptions claimed... Income 7 Wages, salaries, tips, etc. Attach Form(s) W a Taxable interest. Attach Schedule B if required... 8a b Tax-exempt interest. Do not include on line 8a... 8b Attach Form(s) W- here. Also 9a Ordinary dividends. Attach Schedule B if required... attach Forms b Qualified dividends... 9b 9a W-G and 10 Taxable refunds, credits, or offsets of state and local income taxes R if tax 11 Alimony received was withheld. 1 Business income or (loss). Attach Schedule C or C-EZ Capital gain or (loss). Attach Schedule D if required. If not required, check here 13 If you did not get a W-, 14 Other gains or (losses). Attach Form see instructions. 15a IRA distributions... 15a b Taxable amount... 15b 16a Pensions and annuities.. 16a b Taxable amount... 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (loss). Attach Schedule F Unemployment compensation a Social security benefits.. 0a b Taxable amount... 0b 1 Other income 1 Combine the amounts in the far right column for lines 7 through 1. This is your total income... 3 Educator expenses... 3 Adjusted 4 Certain business expenses of reservists, performing artists, and Gross fee-basis government officials. Attach Form 106 or 106-EZ... 4 Income 5 Health savings account deduction. Attach Form Moving expenses. Attach Form Deductible part of self-employment tax. Attach Schedule SE. 7 8 Self-employed SEP, SIMPLE, and qualified plans Self-employed health insurance deduction Penalty on early withdrawal of savings a Alimony paid b Recipient's SSN 31a 3 IRA deduction Student loan interest deduction Reserved for future use Domestic production activities deduction. Attach Form Add lines 3 through Subtract line 36 from line. This is your adjusted gross income For Disclosure, Privacy Act, and Paperwork Reduction Act tice, see separate instructions. EEA IRS Use Only-Do not write or staple in this space. See separate instructions. Your social security number If a joint return, spouse's first name and initial Last name Spouse's social security number PINTO BEAN Home address (number and street). If you have a P.O. box, see instructions GARBANZO RD City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). DENVER CO 8003 Make sure the SSN(s) above and on line 6c are correct. 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 Add numbers on lines above Apt. no ,000 1,16 117, ,16 Form 1040 ()

2 Form 1040 () Page 38 Amount from line 37 (adjusted gross income) ,16 Tax and 39a Check You were born before January, 1953, Blind. Total boxes Credits { } if: Spouse was born before January, 1953, Blind. checked 39a b If your spouse itemizes on a separate return or you were a dual-status alien, check here... 39b Standard 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) Deduction for - 41 Subtract line 40 from line , ,516 People who 4 Exemptions. If line 38 is $156,900 or less, multiply $4,050 by the number on line 6d. Otherwise, see instructions.. 4 check any box on line 43 Taxable income. Subtract line 4 from line 41. If line 4 is more than line 41, enter ,00 88,316 39a or 39b or who can be 44 Tax (see instructions). Check if any from: a Form(s) 8814 b Form 497 c 44 13,559 claimed as a 45 Alternative minimum tax (see instructions). Attach Form dependent, see 46 Excess advance premium tax credit repayment. Attach Form instructions. 47 Add lines 44, 45, and ,559 All others: 48 Foreign tax credit. Attach Form 1116 if required Single or Married filing 49 Credit for child and dependent care expenses. Attach Form separately, 50 Education credits from Form 8863, line $6,350 Married filing 51 Retirement savings contributions credit. Attach Form jointly or 5 Child tax credit. Attach Schedule 881, if required... 5 Qualifying widow(er), 53 Residential energy credit. Attach Form $1, Other credits from Form: a 3800 b 8801 c 54 Head of household, 55 Add lines 48 through 54. These are your total credits $9, Subtract line 55 from line 47. If line 55 is more than line 47, enter , Self-employment tax. Attach Schedule SE... F Other 58 Unreported social security and Medicare tax from Form: a 4137 b Taxes 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 539 if required a Household employment taxes from Schedule H... 60a b First-time homebuyer credit repayment. Attach Form 5405 if required... 60b 61 Health care: individual responsibility (see instructions) Full-year coverage Taxes from: a Form 8959 b Form 8960 c Instructions; enter code(s) 6 63 Add lines 56 through 6. This is your total tax ,959 Payments 64 Federal income tax withheld from Forms W- and , estimated tax payments and amount applied from 016 return If you have a 66a Earned income credit (EIC)... 66a qualifying child, attach b ntaxable combat pay election... 66b CLERGY Schedule EIC. 67 Additional child tax credit. Attach Schedule American opportunity credit from Form 8863, line Net premium tax credit. Attach Form Amount paid with request for extension to file Excess social security and tier 1 RRTA tax withheld Credit for federal tax on fuels. Attach Form Credits from Form: a 439 b Reserved c 8885 d Add lines 64, 65, 66a, and 67 through 73. These are your total payments ,315 Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here. 76a Direct deposit? b Routing number c Type: Checking Savings See d Account number instructions. 77 Amount of line 75 you want applied to your 018 estimated tax Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions You Owe 79 Estimated tax penalty (see instructions) Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)?. Complete below. Designee Designee's name Phone no. Personal identification number (PIN) Sign Here Joint return? See instructions. Keep a copy for your records. Paid Preparer Use Only EEA GREEN & PINTO BEAN 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 accurately list all amount and sources of income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation Daytime phone number MINISTER Spouse's signature. If a joint return, both must sign. Date Spouse's occupation NURSE Identity Protection PIN (see inst.) Preparer's signature Date Check if PTIN John Doe self-employed P Print/Type preparer's name Firm's name Firm's address John Doe The Tax Firm 134 Tax Lane Anytown, US 8734 Firm's EIN Phone no. Form 1040 ()

3 SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) Go to for instructions and the latest information. Department of the Treasury Attachment Internal Revenue Service (99) Attach to Form 1040, 1040NR, or 1041; partnerships generally must file Form Sequence. 09 Name of proprietor Social security number (SSN) A Principal business or profession, including product or service (see instructions) B Enter code from instructions MINISTER C Business name. If no separate business name, leave blank. D Employer ID number (EIN), (see instr.) GREEN BEAN E Business address (including suite or room no.) 1345 GARBANZO RD City, town or post office, state, and ZIP code DENVER, CO 8003 F Accounting method: (1) Cash () Accrual (3) Other (specify) G Did you "materially participate" in the operation of this business during? If "," see instructions for limit on losses... H If you started or acquired this business during, check here... I Did you make any payments in that would require you to file Form(s) 1099? (see instructions)... J If "," did you or will you file required Forms 1099?... Part I Income 1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on Form W- and the "Statutory employee" box on that form was checked... 1 Returns and allowances..., Subtract line from line ,500 4 Cost of goods sold (from line 4) Gross profit. Subtract line 4 from line ,500 6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) Gross income. Add lines 5 and ,500 Part II Expenses. Enter expenses for business use of your home only on line Advertising Office expense (see instructions) Car and truck expenses (see 19 Pension and profit-sharing plans 19 instructions) Rent or lease (see instructions): 10 Commissions and fees a Vehicles, machinery, and equipment. 0a 11 Contract labor (see instructions) 11 b Other business property... 0b 1 Depletion Repairs and maintenance Depreciation and section 179 Supplies (not included in Part III) 350 expense deduction (not 3 Taxes and licenses... 3 included in Part III) (see instructions) Travel, meals, and entertainment: 14 Employee benefit programs a Travel... 4a 850 (other than on line 19) b Deductible meals and 15 Insurance (other than health). 15 entertainment (see instructions) 4b 16 Interest: 5 Utilities... 5 a Mortgage (paid to banks, etc.). 16a 6 Wages (less employment credits) 6 b Other... 16b 7a Other expenses (from line 48). 7a 17 Legal and professional services 17 b Reserved for future use... 7b 8 Total expenses before expenses for business use of home. Add lines 8 through 7a ,84 9 Tentative profit or (loss). Subtract line 8 from line 7... SEE CLERGY ATTACHMENT 9 1,16 30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form unless using the simplified method (see instructions). Simplified method filers only: enter the total square footage of: (a) your home: and (b) the part of your home used for business: Method Worksheet in the instructions to figure the amount to enter on line 30 Net profit or (loss). Subtract line 30 from line 9.. Use the Simplified... If a profit, enter on both Form 1040, line 1 (or Form 1040NR, line 13) and on Schedule SE, line. (If you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3. If a loss, you must go to line 3. If you have a loss, check the box that describes your investment in this activity (see instructions). If you checked 3a, enter the loss on both Form 1040, line 1, (or Form 1040NR, line 13) and on Schedule SE, line. (If you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter on Form 1041, line 3. If you checked 3b, you must attach Form Your loss may be limited. For Paperwork Reduction Act tice, see the separate instructions. Schedule C (Form 1040) EEA a 3b All investment is at risk. Some investment is not at risk. OMB ,16

4 8867 OMB Form Earned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC), and Additional Child Tax Credit (ACTC) Department of the Treasury To be completed by preparer and filed with Form 1040, 1040A, 1040EZ, 1040NR, 1040SS, or 1040PR. Attachment Internal Revenue Service Go to for instructions and the latest information. Sequence. 70 Taxpayer name(s) shown on return Taxpayer identification number Enter preparer's name and PTIN Part I a b Due Diligence Requirements Paid Preparer's Due Diligence Checklist GREEN & PINTO BEAN John Doe Please check the appropriate box for the credit(s) claimed on this return and complete the related Parts I IV for the credit(s) claimed (check all that apply). Did you complete the return based on information for tax year provided by the taxpayer or reasonably obtained by you?... Did you complete the applicable EIC and/or CTC/ACTC worksheets found in the Form 1040, 1040A, 1040EZ, 1040SS, 1040PR, or 1040NR instructions, and/or the AOTC worksheet found in the Form 8863 instructions, or your own worksheet(s) that provides the same information, and all related forms and schedules for each credit claimed?... Did you satisfy the knowledge requirement? To meet the knowledge requirement, you must do both of the following: Interview the taxpayer, ask questions, and document the taxpayer's responses to determine that the taxpayer is eligible to claim the credit(s) Review information to determine that the taxpayer is eligible to claim the credit(s) and for what amount... Did any information provided by the taxpayer, a third party, or reasonably known to you, in connection with preparing the return, appear to be incorrect, incomplete, or inconsistent? (If "," answer questions 4a and 4b. If "," go to question 5.)... Did you make reasonable inquiries to determine the correct, complete, and consistent information?... Did you document your inquiries? (Documentation should include the questions you asked, whom you asked, when you asked, the information that was provided, and the impact the information had on your preparation of the return.)... Did you satisfy the record retention requirement? To meet the record retention requirement, you must keep a copy of your documentation referenced in 4b, a copy of this Form 8867, a copy of applicable worksheets, a record of how, when, and from whom the information used to prepare Form 8867 and worksheet(s) was obtained, and a copy of any document(s) P provided by the taxpayer that you relied on to determine eligibility or to compute the amount for the credit(s)... List those documents, if any, that you relied on. Healthcare Statement, Doctor Statement EIC CTC/ACTC AOTC Did you ask the taxpayer whether he/she could provide documentation to substantiate eligibility for and the amount of the credit(s) claimed on the return if his/her return is selected for audit?... Did you ask the taxpayer if any of these credits were disallowed or reduced in a previous year?... (If credits were disallowed or reduced, go to question 7a; if not, go to question 8.) a Did you complete the required recertification Form 886?... N/A 8 If the taxpayer is reporting self-employment income, did you ask questions to prepare a complete and correct Form 1040, Schedule C?... N/A For Paperwork Reduction Act tice, see separate instructions. Form 8867 () EEA

5 GREEN & PINTO BEAN Form 8867 () Page Part II Due Diligence Questions for Returns Claiming EIC (If the return does not claim EIC, go to Part III.) EIC CTC/ACTC AOTC 9a Have you determined that this taxpayer is, in fact, eligible to claim the EIC for the number of children for whom the EIC is claimed, or to claim EIC if the taxpayer has no qualifying child? (Skip 9b and 9c if the taxpayer is claiming EIC and does not have a qualifying child.)... b Did you explain to the taxpayer that he/she may not claim the EIC if the taxpayer has not lived with the child for over half the year, even if the taxpayer has supported the child?... c Did you explain to the taxpayer the rules about claiming the EIC when a child is the qualifying child of more than one person (tie-breaker rules)?... N/A Part III 10a b Part IV Due Diligence Questions for Returns Claiming CTC and/or ACTC (If the return does not claim CTC or ACTC, go to Part IV.) Did all children for whom the taxpayer is claiming the CTC/ACTC reside with the taxpayer? (If "," go to question 10c; if "," go to question 10b.)... Did you ask if there is an active Form 833, Release/Revocation of Claim to Exemption for Child by Custodial Parent, or a similar statement in place and, if applicable, did you attach it to the return?... N/A c Have you determined that the taxpayer has not released the claim to another person?... N/A Due Diligence Questions for Returns Claiming AOTC (If the return does not claim AOTC, go to Part V.) 11 Did the taxpayer provide substantiation such as a Form 1098-T and /or receipts for the qualified tuition and related expenses for the claimed AOTC?... Part V Credit Eligibility Certification You have complied with all due diligence requirements with respect to the credits claimed on the return of the taxpayer identified above if you: A. Interview the taxpayer, ask adequate questions, document the taxpayer s responses on the return or in your notes, review adequate information to determine if the taxpayer is eligible to claim the credit(s) and in what amount(s); B. Complete this Form 8867 truthfully and accurately and complete the actions described in this checklist for all credits claimed; C. Submit Form 8867 in the manner required; and D. Keep all five of the following records for 3 years from the latest of the dates specified in the Form 8867 instructions under Document Retention. 1. A copy of Form 8867,. The applicable worksheet(s) or your own worksheet(s) for any credits claimed, 3. Copies of any taxpayer documents you may have relied upon to determine eligibility for and the amount of the credit(s), 4. A record of how, when, and from whom the information used to prepare this form and worksheet(s) was obtained, and 5. A record of any additional questions you may have asked to determine eligibility for and amount of the credits, and the taxpayer s answers. If you have not complied with all due diligence requirements for all credits claimed, you may have to pay a $510 penalty for each credit for which you have failed to comply. 1 Do you certify that all of the answers on this Form 8867 are, to the best of your knowledge, true, correct, and complete?... EEA Form 8867 ()

6 Form Part I 8965 Health Coverage Exemptions Department of the Treasury Internal Revenue Service Name as shown on return Attach to Form 1040, Form 1040A, or Form 1040EZ. OMB Attachment Sequence. 75 Complete this form if you have a Marketplace-granted coverage exemption or you are claiming a coverage exemption on your return Marketplace-Granted Coverage Exemptions for Individuals. If you and/or a member of your tax household have an exemption granted by the Marketplace, complete Part I. (a) (b) (c) Name of Individual SSN Exemption Certificate Number 6 Part II Coverage Exemptions Claimed on Your Return for Your Household 7 If you are claiming a coverage exemption because your household income or gross income is below the filing threshold, check here... Coverage Exemptions Claimed on Your Return for Individuals. If you and/or a member of your tax Part III household are claiming an exemption on your return, complete Part III Go to for instructions and the latest information. Your social security number PINTO BEAN PENDING LIMA BEAN PENDING NAVY BEAN PENDING PENDING (c) (d) (a) (b) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) Exemption Full Name of Individual SSN Jan Feb Mar Apr May June July Aug Sept Oct v Dec Type Year 13 For Privacy Act and Paperwork Reduction Act tice, see your tax return instructions. EEA Form 8965 ()

7 Name(s) as shown on return GREEN & PINTO BEAN Federal Supporting Statements (Keep for your records) All Source Gross Income Tax ID Number WK_TTLGI PG01 Description Amount Wages and tips 116,000 Schedule C, line 7,500 Total 118,500 WK_TTLGI.LD

8 Forms 1040, 1040A, 1040NR Name(s) as shown on return TIP Child Tax Credit Worksheet GREEN & PINTO BEAN Before you begin: Figure the amount of any credits you are claiming on Form 5695, Part II, line 30; Form 8910; Form 8936; or Schedule R. CAUTION! To be a qualifying child for the child tax credit, the child must be under age 17 at the end of and meet the other requirements listed earlier under Qualifying Child.Also see Taxpayer identification number needed by due date of return, earlier. If you do not have a qualifying child, you cannot claim the child tax credit. Part 1 1. Number of qualifying children: 1 $1,000. Enter the result. 1. 1,000. Enter the amount from Form 1040, line 38; Form 1040A, line ; or Form 1040NR, line , Filers. Enter the total of any - 4. Add lines and 3. Enter the total Leave line 6 blank. Enter -0- on line 7.. Subtract line 5 from line ,000 If the result is not a multiple of $1,000, increase it to the next multiple of $1, Multiply the amount on line 6 by 5% (.05). Enter the result STOP Complete the rest of your Form 1040, Form 1040A, or Form 1040NR.. Subtract line 7 from line 1. Enter the result. Go to Part below Part 9. Enter the amount from Form 1040, line 47; Form 1040A, line 30; or Form 1040NR, line , Add the following amounts from: 11. Form 1040 or Form 1040A or Form 1040NR 1. Subtract line 11 from line 9. Enter the result Exclusion of income from Puerto Rico, and (Keep for your records) Amounts from Form 555, lines 45 and 50; Form 555-EZ, line 18; and Form 4563, line A and 1040NR Filers. Enter -0-. Enter the amount shown below for your filing status. Married filing jointly - $110,000 Single, head of household, or qualifying widow(er) - $75,000 Married filing separately - $55,000 Is the amount on line 4 more than the amount on line 5? For example, increase $45 to $1,000, increase $1,05 to $,000, etc. Is the amount on line 1 more than the amount on line 7? You cannot take the child tax credit on Form 1040, line 5; Form 1040A, line 35; or Form 1040NR, line 49. You also cannot take the additional child tax credit on Form 1040, line 67; Form 1040A, line 43; or Form 1040NR, line 64. Line 48 Line 46 + Line 49 Line 31 Line 47 + Line 50 Line 33 + Line 51 Line 34 Line 48 + Form 5695, line Form 8910, line Form 8936, line Schedule R, line... + Enter the total. 10. Are you claiming any of the following credits? WK_881.LD Mortgage interest credit, Form Adoption credit, Form Residential energy efficient property credit, Form 5695, Part I. District of Columbia first-time homebuyer credit, Form Enter the amount from line 10.. If you are filing Form 555 or 555-EZ, enter the amount from line 10. Otherwise, complete the Line 11 Worksheet, later, to figure the amount to enter here. Is the amount on line 8 of this worksheet more than the amount on line 1?. Enter the amount from line This is your child tax credit Enter the amount from line 1. See the TIP below. You may be able to take the additional child tax credit on Form 1040, line 67; Form 1040A, line 43; or Form 1040NR, line 64, only if you answered "" on line 13. First, complete your Form 1040 through line 66a (also complete line 71), Form 1040A through line 4a, or Form 1040NR through line 63 (also, complete line 67). Then, use Parts II - IV of Schedule 881 to figure any additional child tax credit. 117,16 110,000 Tax ID Number , Enter this amount on Form 1040, line 5; Form 1040A, line 35; or Form 1040NR, line 49.

9 Name(s) as shown on return Household Income Worksheets for Form 8965 and Flat Dollar Amount Worksheet (Keep for your records) Household Income Worksheet 1. Enter your adjusted gross income (AGI) from Form 1040, line 38; Form 1040A, line ; or Form 1040NR, line Enter any tax-exempt interest from Form 1040, line 8b; Form 1040A, line 8b; or Form 1040NR, line 9b Enter any amounts from Form 555, lines 45 and 50, and Form 555-EZ, line Modified AGI. Add lines through Amount from Dependents' Combined Modified AGI Worksheet, line Household income. Add lines 1, 5, and 6. Enter here and on the Shared Responsibility Payment Worksheet, line Premiums paid through a salary reduction arrangement Household income for computing Coverage Exemption "A". Add lines 7 and n-taxable social security received by taxpayers and dependents who were required to file a return Household income for computing Coverage Exemption "G" for residents of a state that did not expand Medicaid. Add lines 7 and Dependents' Combined Modified AGI Worksheet - Line b 1. Enter the AGI for your dependents from Form 1040, line 38; Form 1040A, line ; Form 1040EZ, line 3; and Form 1040NR, line Enter any tax-exempt interest for your dependents from Form 1040, line 8b; Form 1040A, line 8b; Form 1040EZ, the amount written to the left of the line entry space; and Form 1040NR, line 9b Enter any amounts for your dependents from Form 555, lines 45 and 50, and Form 555-EZ, line Add lines and Add lines 1 and 4. Enter here and on Household Income Worksheet, line The Filing Threshold for this return is... The Federal Poverty Line for this household is... Household income (Household Income Worksheet, line 11) as a percentage of Federal Poverty Line... Flat Dollar Amount Worksheet CAUTION! Do not complete this worksheet unless the amount on line 10 of the Shared Responsibility Payment Worksheet is less than $,085. For each month, is the amount on line 5 of the Shared Responsibility Payment Worksheet Enter the amount Enter the amount less than the amount on line 10 of the Shared Responsibility Payment Worksheet?* from line 10 from line 5 1. January.... February March April May June July August September October vember December Add the amounts in each column Add the amounts on line 13 of both columns. Enter the result on line 11 of the Shared Responsibility Payment Worksheet... *If the amount on line 1 of the Shared Responsibility Payment Worksheet is -0- for any month, leave both columns of this worksheet blank for that month. WK_8965.LD Tax ID Number 117, ,16 117,16 117,16 0,800 4,

10 Figuring the Percentage of Tax-Free Income te. For each line, enter the appropriate amount in all boxes that are not shaded. Worksheet 1 (Keep for your records) Name(s) as shown on return Tax ID Number 1 W- salary as a minister (from box 1 of Form W-) 1 3 a FRV* of parsonage provided by church 3a b c d e Excess utility allowance (subtract line 3d from line 3b) 4 a Parsonage or rental allowance 4a 5 b c d e f g h i Gross income from weddings, baptisms, writing, lecturing, etc. (from line 1 of Schedule C or C-EZ) te. Complete either lines 3a through 3e or lines 4a through 4i. 6 Percentage of tax-free income: * FRV (Fair Rental Value): As determined objectively and between unrelated parties, what it would cost to rent a comparable home (including furnishings) in a similar location. (a) (b) (c) Source of Income Taxable Tax-free Total If your church provides you with a parsonage, complete lines 3a through 3e. If, instead of providing a parsonage, your church provides you with a rental or parsonage allowance, complete lines 4a through 4i. Utility allowance, if any Actual expenses for utilities Enter the smaller of line 3b or 3c Utility allowance, if separate Total allowance (add lines 4a and 4b) Actual expenses for parsonage Actual expenses for utilities Total actual expenses for parsonage and utilities (add lines 4d and 4e) FRV* of home, plus the cost of utilities Enter the smaller of line 4c, 4f, or 4g Excess allowance (subtract line 4h from line 4c) Ministerial income (for columns (a), (b), and (c), add lines 1 through 4i) 3b 3c 3d 3e 4b 4c 4d 4e 4f 4g 4h 4i 5 Total tax-free income (line 5(b)) $ Total income (line 5(c)) $ 4,000 4,000,500,500 44,500 58,900 = % ** 58,900 ** This percentage of your ministerial expenses won't be deductible. Use Worksheets and 3 to figure your allowable deductions. WK_CLGY1.LD

11 Worksheet Figuring the Allowable Deduction for Schedule C or C-EZ Expenses (Keep for your records) Name(s) as shown on return Tax ID Number 1 Business use of car for entire year: miles x 53.5 cents ($0.535) 3 Meals and entertainment: $ x 50% (0.50) 3 4 Other expenses (list item and amount) a OFFICE EPENSE 4a 500 b SUPPLIES 4b 350 c TRAVEL 4c 850 d 4d e f 5 Total Schedule C or C-EZ expenses (add lines, 3, and 4f) Percentage of expenses that are nondeductible (from Worksheet 1, line 6): % Total other expenses (add lines 4a through 4e) ndeductible part of Schedule C or C-EZ expenses (multiply line 5 by the percent in line 1) Deduction allowed.* Subtract line 6 from line 5. Enter the result here and on Schedule C, line 7a, or Schedule C-EZ, line. * ne of the other deductions claimed in this return are allocable to tax-free income e 4f 6 7 1,700 1, ,84 WK_CLGY.LD

12 Worksheet 4 Figuring Net Self-Employment Income for Schedule SE (Form 1040) (Keep for your records) Name(s) as shown on return Tax ID Number 1 W- salary as a minister (from box 1 of Form W-) 1 Net profit from Schedule C, line 31, or Schedule C-EZ, line 3 3 a Parsonage or rental allowance (from Worksheet 1, line 3a or 4a) 3a b c 4 Add lines 1,, and 3c 4 5 Schedule C or C-EZ expenses allocable to tax-free income (from Worksheet, line 6) Total business expenses not deducted in lines 1 and above (add lines 5 and 6) 7 8 Utility allowance (from Worksheet 1, line 3b or 4b) Total allowance (add lines 3a and 3b) Total unreimbursed employee business expenses after the 50% reduction for meals and entertainment (from Worksheet 3, line 9) Net self-employment income. Subtract line 7 from line 4. Enter here and on Schedule SE, Section A, line ; or Section B, line. *** IRS-approved Form 4361, Exemption from SE Tax *** 3b 3c ,000 1,16 57, ,00 WK_CLGY4.LD