Form 4 Department of the Treasury ' Internal Revenue Service (99) U.S. Individual Income Tax Return For the year Jan. - Dec.,, or other tax year beginning,, ending Your first name and initial OMB No. 545-74 IRS Use Only, See separate instructions. Last name Your social security number Panex 4 Individual If a joint return, spouse's first name and initial Last name Spouse's social security number Panex 4 Individual - Spouse Home address (number and street). If you have a P.O. box, see instructions. Apt. no. 6 Adams St. Ste 4 City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Bowling Green, KY 4 Foreign country name Filing Status Check only one box. Exemptions Foreign province/state/county Single 4 X Married filing jointly (even if only one had income) Married filing separately. Enter spouse's SSN above & full name here.. G 5 Foreign postal code J 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 $ to go to this fund. Checking a box below will not change your tax or refund. You Spouse Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent, enter this child's name here.. G Qualifying widow(er) (see instructions) 6a X Yourself. If someone can claim you as a dependent, do not check box 6a........... b X Spouse......................................................................... c Dependents: () First name If more than four dependents, see instructions and check here... G ' Do not write or staple in this space. Boxes checked on 6a and 6b... No. of children on 6c who: (4) b if child under? lived with you...... age 7 qualifying for child tax credit? did not Last name (see instructions) live with you due to divorce or separation (see instructions).. Dependents on 6c not entered above.. Add numbers on lines claimed........................................................ above...... G () Dependent's social security number () Dependent's relationship to you d Total number of exemptions 7 Wages, salaries, tips, etc. Attach Form(s) W-......................................... 7 Income 8 a Taxable interest. Attach Schedule B if required........................................ 8a b Tax-exempt interest. Do not include on line 8a.............. 8b 9 a Ordinary dividends. Attach Schedule B if required...................................... 9a Attach Form(s) b Qualified dividends........................................ 9b W- here. Also attach Forms Taxable refunds, credits, or offsets of state and local income taxes..................... W-G and 99-R Alimony received.................................................................... if tax was withheld. Business income or (loss). Attach Schedule C or C-EZ................................. If you did not Capital gain or (loss). Attach Schedule D if required. If not required, check here.......... G get a W-, 4 Other gains or (losses). Attach Form 4797............................................. 4 see instructions. 5 a IRA distributions............ 5 a b Taxable amount............. 5 b 6 a Pensions and annuities..... 6 a b Taxable amount............. 6 b 7 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 7 8 Farm income or (loss). Attach Schedule F............................................. 8 9 Unemployment compensation........................................................ 9 a Social security benefits.......... a b Taxable amount............. b Other income. List type and amount Combine the amounts in the far right column for lines 7 through. This is your total income............. G Educator expenses....................................... Adjusted 4 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 6 or 6-EZ.................... 4 Gross 5 Health savings account deduction. Attach Form 8889........ 5 Income 6 Moving expenses. Attach Form 9....................... 6 7 Deductible part of self-employment tax. Attach Schedule SE.............. 7 8 Self-employed SEP, SIMPLE, and qualified plans........... 8 9 Self-employed health insurance deduction.................. 9 Penalty on early withdrawal of savings..................... a Alimony paid b Recipient's SSN.... G a IRA deduction............................................ Student loan interest deduction............................ 4 Tuition and fees. Attach Form 897........................ 4 5 Domestic production activities deduction. Attach Form 89............. 5 6 Add lines through 5................................................................... 6 7 Subtract line 6 from line. This is your adjusted gross income..................... G 7 BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. FDIAL //8 Form 4 ()
Form 4 () Tax and Credits Standard Deduction for '? People who check any box on line 9a or 9b or who can be claimed as a dependent, see instructions.? All others: Single or Married filing separately, $6,5 Married filing jointly or Qualifying widow(er), $,7 Head of household, $9,5 Other Taxes Payments If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions. You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Page Panex 4 Individual and Panex 4 Individual - Spouse 8 8 from line 7 (adjusted gross income).......................................... 9 a Check You were born before January, 95, Blind. Total boxes Spouse was born before January, 95, if: Blind. checked G 9 a b If your spouse itemizes on a separate return or you were a dual-status alien, check here......... G 9 b Itemized deductions (from Schedule A) or your standard deduction (see left margin).................... Subtract line 4 from line 8.......................................................... Exemptions. If line 8 is $56,9 or less, multiply $4,5 by the number on line 6d. Otherwise, see instrs...... Taxable income. Subtract line 4 from line 4. If line 4 is more than line 4, enter --....................................................... 44 Tax (see instructions). Check if any from: a c Form(s) 884 b Form 497........................... 45 Alternative minimum tax (see instructions). Attach Form 65.......................... 46 Excess advance premium tax credit repayment. Attach Form 896...................... 47 Add lines 44, 45, and 46........................................................... G 48 Foreign tax credit. Attach Form 6 if required............. 48 49 Credit for child and dependent care expenses. Attach Form 44.......... 49 5 Education credits from Form 886, line 9.................. 5 5 Retirement savings contributions credit. Attach Form 888.. 5 5 Child tax credit. Attach Schedule 88, if required.......... 5 5 Residential energy credits. Attach Form 5695............... 5 4 4 4 4 54 Other crs from Form: a 54 8 b 88 c 55 Add lines 48 through 54. These are your total credits.................................. 56 Subtract line 55 from line 47. If line 55 is more than line 47, enter --.................. G 57 Self-employment tax. Attach Schedule SE...................................................... 58 Unreported social security and Medicare tax from Form: a 899....................... 47 b 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 59 if required................... 6 a Household employment taxes from Schedule H........................................ b First-time homebuyer credit repayment. Attach Form 545 if required................... X... 6 Health care: individual responsibility (see instructions) Full-year coverage 6 Taxes from: a X Form 8959 b X Form 896 c Instrs; enter code(s) 6 Add lines 56 through 6. This is your total tax................................................ G 64 Federal income tax withheld from Forms W- and 99..... 64,6 65 estimated tax payments and amount applied from 6 return........ 65. 66 a Earned income credit (EIC)..............................No 66 a b Nontaxable combat pay election..... G 66 b 67 Additional child tax credit. Attach Schedule 88............ 67 68 American opportunity credit from Form 886, line 8......... 68 69 Net premium tax credit. Attach Form 896.................. 69 7 paid with request for extension to file.............. 7 7 Excess social security and tier RRTA tax withheld......... 7 7 Credit for federal tax on fuels. Attach Form 46............ 7 7 Credits from Form: a 7 49 b Reserved c 8885 d 74 Add lines 64, 65, 66a, and 67 through 7. These are your total payments............................. G 75 If line 74 is more than line 6, subtract line 6 from line 74. This is the amount you overpaid............... 76 a of line 75 you want refunded to you. If Form 8888 is attached, check here.. G G b Routing number........ G c Type: Checking Savings G d Account number........ 77 of line 75 you want applied to your 8 estimated tax........ G 77 78 you owe. Subtract line 74 from line 6. For details on how to pay, see instructions............... G 79 Estimated tax penalty (see instructions).................... 79 Do you want to allow another person to discuss this return with the IRS (see instructions)?........... Designee's name Phone no. G FDIAL //8,7 687, 4 687, 44 45 46 47 7,4 7,4 55 56 57 58 59 6 a 6 b 6 6 6 7,4 6,95 4,5.,6 74 75 76 a,75. 78 X Yes. Complete below. 56-6644 Personal identification number (PIN) No G 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 amounts 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 A Spouse's signature. If a joint return, both must sign. Print/Type preparer's name Paid Preparer Use Only G (4) 4 4 4 Firm's name G Firm's address G Preparer's signature Danny W. Looney, P.C. 745 Dallas Parkway #455 Plano, TX 759 Date If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Spouse's occupation Date 9/4/8 Check PTIN if self-employed 75-7955 (4) 56-6644 Firm's EIN G Phone no. Form 4 ()
SCHEDULE B OMB No. 545-74 Interest and Ordinary Dividends (Form 4A or 4) Department of the Treasury Internal Revenue Service (99) G Attach to Form 4A or 4 G Go to www.irs.gov/scheduleb for instructions and the latest information. Name(s) shown on return Attachment Sequence No. 8 Your social security number Panex 4 Individual and Panex 4 Individual - Spouse List name of payer. If any interest is from a seller-financed mortgage and the buyer used Part I the property as a personal residence, see the instructions and list this interest first. Also, show that buyer's social security number and address G Interest (See instructions and the instructions for Form 4A, or Form 4, line 8a.) Note: If you received a Form 99-INT, Form 99-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. Add the amounts on line............................................................. Excludable interest on series EE and I U.S. savings bonds issued after 989. Attach Form 885............................................................................ 4 Subtract line from line. Enter the result here and on Form 4A, or Form 4, line 8a.................. G Note: If line 4 is over $,5, you must complete Part III. Part II 5 4 List name of payer G Ordinary Dividends (See instructions and the instructions for Form 4A, or Form 4, line 9a.) Note: If you received a Form 99-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. 5 6 Add the amounts on line 5. Enter the total here and on Form 4A, or Form 4, line 9a................... G Note: If line 6 is over $,5, you must complete Part III. Part III 6 You must complete this part if you (a) had over $,5 of taxable interest or ordinary dividends; (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Foreign Accounts and Trusts 7a At any time during, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country? See instructions........................................................................................ If 'Yes,' are you required to file FinCEN Form 4, Report of Foreign Bank and Financial Accounts (FBAR), to report that financial interest or signature authority? See FinCEN Form 4 and its instructions for filing (See instructions.) requirements and exceptions to those requirements...................................................... b If you are required to file FinCEN Form 4, enter the name of the foreign country where the financial Yes No X account is located G 8 During, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If 'Yes,' you may have to file Form 5 See instructions.................................................. X BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA4L /5/7 Schedule B (Form 4A or 4)
Form 8959 Department of the Treasury Internal Revenue Service OMB No. 545-74 Additional Medicare Tax G If any line does not apply to you, leave it blank. See separate instructions. G Attach to Form 4, 4NR, 4-PR, or 4-SS. G Go to www.irs.gov/form8959 for instructions and the latest information. Attachment Sequence No. 7 Name(s) shown on return Your social security number Panex 4 Individual and Panex 4 Individual - Spouse Part I Additional Medicare Tax on Medicare Wages Medicare wages and tips from Form W-, box 5. If you have more than one Form W-, enter the total of the amounts from box 5... Unreported tips from Form 47, line 6......................... 4 5 Wages from Form 899, line 6................................. Add lines through.......................................... Enter the following amount for your filing status: 6 Married filing jointly................................. $5, Married filing separately............................. $5, 5 Single, Head of household, or Qualifying widow(er).... $, Subtract line 5 from line 4. If zero or less, enter --.............................................. 6 Additional Medicare Tax on Medicare wages. Multiply line 6 by 9% (9). Enter here and go to Part II....................................................................................... 7,5 7 Part II 4 Additional Medicare Tax on Self-Employment Income 8 Self-employment income from Schedule SE (Form 4), Section A, line 4, or Section B, line 6. If you had a loss, enter -- (Form 4-PR and Form 4-SS filers, see instructions.)............. 9 Enter the following amount for your filing status: Married filing jointly................................. Married filing separately............................. Single, Head of household, or Qualifying widow(er).... 8 $5, $5, $, 9 Enter the amount from line 4................................... Subtract line from line 9. If zero or less, enter --............ Subtract line from line 8. If zero or less, enter --............................................. Additional Medicare Tax on self-employment income. Multiply line by 9% (9). Enter here and go to Part III................................................................................... Part III Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation 4 Railroad retirement (RRTA) compensation and tips from Form(s) W-, box 4 (see instructions).................................. 5 Enter the following amount for your filing status: 6 Married filing separately............................. $5, 5 Single, Head of household, or Qualifying widow(er).... $, Subtract line 5 from line 4. If zero or less, enter --............................................ Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 6 by 9% (9). Enter here and go to Part IV............................................................ Married filing jointly................................. 7 Part IV 8 4 $5, 7 Total Additional Medicare Tax Add lines 7,, and 7. Also include this amount on Form 4, line 6, (Form 4NR, 4-PR, and 4-SS filers, see instructions) and go to Part V............................................ Part V 6 8,5,6 Withholding Reconciliation 9 Medicare tax withheld from Form W-, box 6. If you have more than one Form W-, enter the total of the amounts from box 6.................................................... 9 Enter the amount from line..................................., Multiply line by.45% (45). This is your regular Medicare tax withholding on Medicare wages............................. 8,7 Subtract line from line 9. If zero or less, enter --. This is your Additional Medicare Tax withholding on Medicare wages................................................................. Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-, box 4 (see instructions)........................................................................ Total Additional Medicare Tax withholding. Add lines and. Also include this amount with federal income tax withholding on Form 4, line 64 (Form 4NR, 4-PR, and 4-SS filers, see instructions)............................................................................... 4 4 BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA6 7//7,6 Form 8959 ()
Form 896 Department of the Treasury Internal Revenue Service (99) Net Investment Income Tax ' Individuals, Estates, and Trusts D Attach to your tax return. OMB No. 545-7 Attachment Sequence No. D Go to www.irs.gov/form896 for instructions and the latest information. Name(s) shown on your tax return Your social security number or EIN Panex 4 Individual and Panex 4 Individual - Spouse Part I Investment Income Section 6(g) election (see instructions) 7 Section 6(h) election (see instructions) Regulations section.4-(g) election (see instructions) Taxable interest (see instructions).................................................................... Ordinary dividends (see instructions)................................................................. Annuities (see instructions).......................................................................... 4 a Rental real estate, royalties, partnerships, S corporations, trusts, etc. (see instructions)................................................... 5 a Net gain or loss from disposition of property (see instructions)............. 5a b Net gain or loss from disposition of property that is not subject to net investment income tax (see instructions).............................. 5b c Adjustment from disposition of partnership interest or S corporation stock (see instructions).................................................. 5c d Combine lines 5a through 5c......................................................................... 6 Adjustments to investment income for certain CFCs and PFICs (see instructions)........................ 7 Other modifications to investment income (see instructions)............................................ 8 Total investment income. Combine lines,,, 4c, 5d, 6, and 7....................................... 4c 5d 6 7 8, 9a 9b 9c d Add lines 9a, 9b, and 9c............................................................................. Additional modifications (see instructions)............................................................ Total deductions and modifications. Add lines 9d and.............................................. Investment Expenses Allocable to Investment Income and Modifications 9 a Investment interest expenses (see instructions)........................... b State, local, and foreign income tax (see instructions)..................... c Miscellaneous investment expenses (see instructions)..................... Part III 4a b Adjustment for net income or loss derived in the ordinary course of a non-section 4 trade or business (see instructions).................... 4b c Combine lines 4a and 4b............................................................................ Part II 9d Tax Computation Net investment income. Subtract Part II, line from Part I, line 8. Individuals complete lines -7. Estates and trusts complete lines 8a-. If zero or less, enter --....................................., Individuals: 4 4 5 Modified adjusted gross income (see instructions)......................... Threshold based on filing status (see instructions)......................... Subtract line 4 from line. If zero or less, enter --..................... 6 Enter the smaller of line or line 5... 6, 7 Net investment income tax for individuals. Multiply line 6 by.8% (.8). Enter here and include on your tax return (see instructions)......................................................... 7,8 4 5 Estates and Trusts: 8 a Net investment income (line above)................................... 8 a b Deductions for distributions of net investment income and deductions under section 64(c) (see instructions)......................... 8b c Undistributed net investment income. Subtract line 8b from 8a (see instructions). If zero or less, enter --............................... 9 a Adjusted gross income (see instructions)................................. 8c 9a b Highest tax bracket for estates and trusts for the year (see instructions)........................................................ 9b c Subtract line 9b from line 9a. If zero or less, enter --................... 9c Enter the smaller of line 8c or line 9c............................................................... Net investment income tax for estates and trusts. Multiply line by.8% (.8). Enter here and include on your tax return (see instructions)..................................................... BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIA68L 7/8/7 Form 896 ()
Federal Statements Client PANEX Page Panex 4 Individual and Panex 4 Individual - Spouse 9/4/8 :PM Statement Form 4 Wage Schedule Taxpayer - Employer W Grand Total Wages Federal W/H FICA Medicare 7,886., 7,886., State W/H Local W/H
Federal Worksheets Client PANEX Page Panex 4 Individual and Panex 4 Individual - Spouse 9/4/8 :PM Deduction for Exemptions Worksheet (Form 4, Line 4)... 4. 5. $4,5 per exemption on Form 4, line 6d Enter amount from Form 4, line 8 Threshold for your filing status Subtract line from line Is line 4 more than $,5 ($6,5 if MFS)?,8 86, 8, Yes. Enter -- on Form 4, line 4. Do not complete the rest of this worksheet. No. Divide line 4 by $,5 ($,5 if MFS) 6. Multiply line 5 by % (.) 7. Multiply line by line 6 8. Deduction for Exemptions (Subtract line 7 from line ) Tax Computation Worksheet (Form 4, Line 44) Taxable Income (a) (b) (c) (d) Tax If Line 4 is - Enter the from Line 4 Multiplication Multiply (a) by (b) Subtraction Subtract (d) from (c) (rounded) Over $47,7 687, 9.6% 7,78 54,769. 7,4 Federal Income Tax Withheld Additional Medicare Tax Withholding (Form 8959) Total,6,6
Federal Worksheets Client PANEX Page Panex 4 Individual and Panex 4 Individual - Spouse 9/4/8 :PM State and Local Taxes (Schedule A, Line 5) State and Local Sales Taxes Using the Optional Sales Tax Tables Available Income: Adjusted gross income per Form 4 Tax-exempt interest Nontaxable combat pay Nontaxable social security benefits Nontaxable pensions Nontaxable IRAs Prior year refundable credits (refundable portion only) Additional nontaxable amounts Total Available Income (not less than zero) Number of Exemptions.. State general sales taxes per Tables. Local general sales taxes per Tables for certain residents of AK, AZ, AR, CO, GA, IL, LA, MO, MS, NC, NY, SC, TN, UT, and VA (based on a rate of %). Local general sales tax rate 4. If line is zero, enter your state general sales tax rate. Otherwise, skip line 4 and 5, and go to line 6 5. Divide line by line 4 6. Local general sales taxes. If line is zero, multiply line by line 5. Otherwise, multiply line by line. 7. State and local general sales taxes (add lines and 6) 8. Sales taxes paid on vehicles, boats, etc. 9. Sales tax deduction when using Tables (add lines 7 and 8),58. 6.,58.,58. State and Local Sales Tax Deduction (Greater of Taxes Paid or Table )... 4. 5. General sales taxes paid Use taxes paid Total actual taxes paid (add lines and ) Sales taxes using Tables Greater of sales taxes paid or Table amount,58.,58. Itemized Deductions Worksheet (Schedule A, Line 9). Add amounts on Schedule A, lines 4, 9, 5, 9,, 7, and 8. Add amounts on Schedule A, lines 4, 4, &, plus any gambling losses and casualty or theft losses included on line 8, and any qualified contributions included on line 6. Subtract line from line 4. Multiply line above by 8% (.8) 5. Enter amount from Form 4, line 8 6. Threshold based on filing status ($,8 if MFJ/QW, $87,65 if HH, $6,5 if S, $56,9 if MFS) 7. Subtract line 6 from line 5 8. Multiply line 7 above by % (.),58.,646.,8 86,,586.,58.
Client PANEX Federal Worksheets Page Panex 4 Individual and Panex 4 Individual - Spouse 9/4/8 :PM Itemized Deductions Worksheet (Schedule A, Line 9) (continued) 9. Enter the smaller of line 4 or line 8 Total Itemized Deductions (Subtract line 9 from line ),646. 4. Form 896, Line Modified Adjusted Gross Income Worksheet. Enter your Adjusted Gross Income a. Foreign Earned Income Exclusion (Form 555, line 4) b. Deductions reported on Form 555, line 44 allocable to your Foreign Earned Income Exclusion. Adjustments for certain CFCs and certain PFICs a. Adjustment from Form 4, K-, Code H (if positive amount) 4. Sum of lines, a, b,, and a $ $
Client PANEX Tax Reform Impact Summary Page Panex 4 Individual and Panex 4 Individual - Spouse 9/4/8 The Tax Reform it had been in tax return, or the tax law to :5PM Impact Summary shows the impact of the Tax Cuts and Jobs Act as if effect this tax year. It does not attempt to forecast next year's account for expiring provisions. Specific limitations in applying this return, if any, are noted on continuing pages. Tax Law 8 Tax Law INCOME Total income............................................................ 7, 7, ADJUSTMENTS TO INCOME Total adjustments..................................................... Adjusted gross income............................................... 7, 7, ITEMIZED DEDUCTIONS Taxes...................................................................... Overall itemized deductions limitation...................... Total itemized deductions.........................................,58 -,646 4,58,58 TAX COMPUTATIONS Standard deduction................................................... Larger of itemized or standard deduction................... Income prior to exemption deduction.......................... Exemption deduction.................................................. Taxable income......................................................... Tax before credits...................................................,7,7 687, 687, 7,4 4, 4, 676, 676, 89,499 NONREFUNDABLE CREDITS Total nonrefundable credits...................................... Tax after credits..................................................... 7,4 89,499 OTHER TAXES Other taxes.............................................................. Total tax................................................................. 6,95 4,5 6,95 96,449 REFUNDABLE CREDITS Total refundable credits........................................... Total tax after refundable credits............................ 4,5 96,449